Operation For Ventricular Septal Defect Research Articles

VSD 根治術後に GVHD と思われる経過を示した1例

VSD 根治術後に GVHD と思われる経過を示した1例

A new operation for ventricular septal defect with aortic incompetence

Two boys, 10 years of age, with ventricular septal defect and severe aortic insufficiency were treated using a new method. An autograft of anterior pulmonary artery wall and the adjacent leaflet and subpulmonary muscle was excised. The excised pulmonary artery segment was used to replace the prolapsed right coronary cusp, and the autograft muscle was used to close the ventricular septal defect. The right ventricular outflow tract and pulmonary valve were repaired using an autologous pericardial patch with an autologous single cusp. The results in both cases were satisfactory.

Surgical management of the infant with coarctation of the aorta and ventricular septal defect

Clinical and cardiac catheterization data were collected from 39 infants with coarctation of the aorta and ventricular septal defect, 31 of whom were initially managed only by surgical repair of coarctation. Data were analyzed to determine mortality, morbidity, outcome and factors that might predict survival or the need for septal defect closure.Of the eight patients who did not require surgical treatment before 3 months of age, seven underwent coarctation repair alone at a mean age of 2.3 years. Of the 23 infants managed with coarctation repair alone, before age 3 months, 9 needed no additional surgical treatment and 6 required early and 8 required late repair of the ventricular septal defect. Seven infants underwent coarctation repair and simultaneous pulmonary artery bandnig and one eventually required debanding after spontaneous closure of the septal defect. The overall mortality rate in this series was 10.3% (mean follow-up time 5.7 years). Of 39 infants, 16 (41%) never required a second operation for ventricular septal defect closure.For patients who had only coarclation or coarctation repair with pulmonary artery banding at <3 months of age, ventricular septal defect size was categorized as small (<0.5 cm/m2), moderate (<1 cm/m2) or large (>1 cm/m2) on the basis of defect size at operative repair or echocardiographic or angiographic assessment. Defect size did not necessarily correlate with the need for operative repair. Stepwise multiple regression analysis revealed that increased right to left ventricular peak systolic pressure (p = 0.004) and decreased systemic venous oxygen content (p = 0.028) were significantly predictive of the eventual need for ventricular septal defect repair.Thus, most infants with coarctation of the aorta and ventricular septal defect do not require pulmonary artery banding or open heart closure of the ventricular septal defect at the time of coarctation repair. A significant number of infants will not require a second operation.

開心術後の刺激伝導障害に関する研究

The cardiac surgery has made a remarkable progress in recent years. On the other hand, various types of arrhythmias following open heart surgery have become serious clinical problems. In the present study a series of the cases of complete right bundle branch block with left anterior hemiblock (CRBBB c LAH) following a radical operation for an ventricular septal defect (VSD) and tetralogy of Fallot (TF) was analyzed in terms of the function of the coducting system.CRBBB coupled with LAH occured in 5 of 43 total cases (11.6%) following operation for VSD and TF. The percentage agrees with that reported by other authors. Measurement of the intervals of the cardiac cycle in electrocardiograms of the bundle of His (HBE) showed normal values except in 2 cases of VSD in which the H-V interval was prolonged to 55 msec. After right atrial pacing all conductions were found to retain 1 to 1 correspondence even at a maximum pacing rate of 240 per minute. The sinus node recovery time (SNRT) (460-1080 msec) corrective sinus node recovery time (CSRT) (-40 -355 msec), measured by the overdrive and suppression test, were both within the normal range. Measurements of the A-V node effective refractory period (AVN-ERP) and A-V node functional refractory period (AVN-FRP) showed normal values in all 4 cases.During an observation period of twelve to thirty-four months, all patients convalesced without any evidence of complete heart block and Adams-Stocks attack, showing normal sinus rhythm. These results are in agreement with other data recently published.