Tatsuta Arai

A 30-year follow-up after ventricular septation: the first and the present patient

Two patients with double inlet left ventricles were successfully treated by ventricular septation. Patient 1, a 38-year-old woman, underwent operation in 1971. This patient has been a full-time worker. Patient 2, a 2-year-old boy, had a relatively small left ventricle with an estimated volume of 134% of normal value. This patient underwent ventricular septation in 1995. He is now in New York Heart Association class II and enjoying school life.

Use of the 21-mm Björk-Shiley Monostrut valve in patients with a narrow aortic root.

Technical considerations regarding the insertion of 21-mm Björk-Shiley Monostrut valves, particularly regarding decalcification of a calcified annulus with an ultrasonic surgical dissector, in patients with aortic stenosis and a narrow aortic root are described. Short-term follow-up (mean(s.d.) 37(10) months) is also presented. Ten adults whose body surface area ranged from 1.26 to 1.47 m2 underwent implantation of a 21-mm valve without outflow patch or annuloplasty. One operative death occurred; there were no other complications. The New York Heart Association functional class decreased from a mean of 3.2 before surgery to 1 in all cases. The mean(s.d.) end-diastolic volume decreased from 129(44) ml to 80(21) ml, and the end-systolic volume from 41 (21) ml to 27(10) ml (P< 0.01). The mean(s.d.) maximum velocity, as measured by Doppler echocardiography in the aortic position, decreased from 4.35(0.55) m/s to 2.42(0.59) m/s (P< 0.01). This degree of improvement was not meaningfully different from that of the 23-mm valve. However, there was a negative correlation between the reduction in left ventricular mass and body surface area (r = −0.72, P< 0.03). It is concluded that the 21-mm Björk-Shiley Monostrut valve can be inserted using a modified technique in most patients with a narrow aortic root. This size valve is satisfactory when the patients body surface area is < 1.45 m2.

Technical Considerations and Intermediate-Term Results with Modified Devega Tricuspid Annuloplasty

Because of unsatisfactory long-term results with current DeVega tricuspid annuloplasty, 43 patients with secondary tricuspid regurgitation associated with mitral disease were treated with a modified DeVega operation. This procedure continues the suture line to the tendon of Todaro, resulting in almost circumferential traction of the tricuspid annulus. The suture is tied securely around a 29-mm or 31-mm (for women and men, respectively) ball-shaped obturator. Atrioventricular block was not observed. One patient died during the early postoperative period. During a mean(s.d.) follow-up of 5.0(2.0) years, one patient died from causes unrelated to tricuspid regurgitation 2 years after surgery. The mean(s.d.) functional class (New York Heart Association) was 3.1(0.5) on admission and improved to 1.2(0.4) at the end of follow-up The mean(s.d.) cardiothoracic ratio improved from 67(6) to 60(5)% at 1 month after operation and was 59(5)% at the final examination. Preoperative Doppler echocardiography revealed a mean(s.d.) regurgitation grade of 2.7(0.7). (Grades 1–4 are equivalent to mild, moderate, severe and massive regurgitation, respectively.) At 1 month, regurgitation was corrected almost completely in all patients (grade 0.2(0.4)) and remained significantly improved at follow-up (grade 0.5(0.6)). The actuarial freedom rate at 5 years for moderate or severe reguritiation (> grade 2) was 93%. This modification of the DeVega technique substantially improved early and late tricuspid valve competence.

Shift of Atrial Reentrant Tachycardia with Transient Entrainment to an Uncommon and a Common Type of Atrial Flutter

Atrial reentrant tachycardia (ART) which demonstrated transient entrainment shifted to an uncommon type of atrial flutter (AF) with premature atrial stimulation, and then returned to ART spontaneously, Subsequently, this ART shifted to a common type of AF by rapid atrial pacing, which was further transformed into an uncommon type of AF and finally terminated by rapid atrial pacing. The mechanism of AF in clinical cases is still controversial, but in this case, AF, both uncommon and common types, is considered due to macro‐reentry within the atria. To explain (he shift of ART to AF and mutual transformation between common and uncommon type of AF, we made a schematic figure of reentry loop within (he atria of ART and AF.

Successful repair of a rare type of total anomalous pulmonary venous drainage

This report describes a 2-month-old female infant with a rare supracardiac type of total anomalous pulmonary venous drainage. The intrapulmonary drainage of the pulmonary veins was into the right lung from the left lung. The anomaly was successfully repaired by atriocavoplasty.

Ventricular Septation for Double Inlet Left Ventricle

Ventricular septation is a biventricular repair for certain types of functionally univentricular hearts. Double inlet left ventricle (DILV) is one type of functionally univentricular heart which in certain instances is amenable to ventricular septation. Thirty-four patients underwent ventricular septation for DILV from 1971 to 2000. Hospital death occurred in seven and late death in two. Mean follow-up period was 15 years. Actuarial survival rate was 73.3% (24 patients) at 15 years, 73.3% (15 patients) at 20 years, 73.3% (five patients) at 25 years, and 73.3% (one patient) at 30 to 40 years. Ventricular septation is an alternative to Fontan operation for selected patients with single ventricle, DILV.