遠位弓部大動脈瘤肺動脈穿破

We report an extremely rare case of rupture of an aortic arch aneurysm into the pulmonary artery. An 85-year-old man was visited to our hospital for surgical repair of aortic arch aneurysm. After arrived at hospital, we noticed he suffer from severe congestive heart failure. Chest auscultation indicated Levine III/IV continuous heart murmur. Computed tomography revealed aortic arch aneurysm and aortic dissection of ascending aorta. Echocardiography demonstrated an abnormal shunt flow from aortic arch aneurysm into the pulmonary artery. At surgery, total arch replacement and pulmonary artery reconstruction were performed

遠位弓部大動脈瘤肺動脈穿破

We report an extremely rare case of rupture of an aortic arch aneurysm into the pulmonary artery. An 85-year-old man was visited to our hospital for surgical repair of aortic arch aneurysm. After arrived at hospital, we noticed he suffer from severe congestive heart failure. Chest auscultation indicated Levine III/IV continuous heart murmur. Computed tomography revealed aortic arch aneurysm and aortic dissection of ascending aorta. Echocardiography demonstrated an abnormal shunt flow from aortic arch aneurysm into the pulmonary artery. At surgery, total arch replacement and pulmonary artery reconstruction were performed

チアノーゼ性心疾患に対する肺動脈絞扼術

The early and late results of pulmonary artery banding (PAB) for cyanotic heart defects in early infancy were reviewed. Nine patients were divided into two groups : Group F (five patiens) in which Fontan type repairs were expected as definitive repair in the near future ; Group A (four patients) in which anatomical repairs were programmed in the near future. Six patients had a good early postoperative course, and then consisted of three patients of Group A and three patients of Group F. The band circumference, intraoperative pulmonary-to-systemic systolic pressure ratio and arterial oxygen tension after PAB in the good cases of Group A were 20.0±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.52±0.07 and 46.4±11.3 mmHg respectively. These indices in the good cases of Group F were 21.1±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.55±0.02 and 38.8±1.0 mmHg respectively. The standard deviations of every index for PAB in Group F were small. Three patients of Group A have undergone successful total correction. Intraoperative pulmonary-to-systemic systolic pressure ratio of 0.5 as the index of PAB is preferable to Group A. However, only two patient of Group F were waiting for Fontan type definitive repair. For the patient especially in Group F, careful observation and well-timed staged repair with regard to subaortic stenosis and restrictive atrial septal defect and ventricular septal defect are necessary after accurate PAB as mentioned above

Surgical management of infants with mitral valve stenosis or atresia without diminutive ascending aorta

The surgical strategy in infants with mitral valve stenosis or atresia without diminutive ascending aorta remains to be established, including the potential for biventricular repair as a definitive operation. Our surgical experience of six infants with mitral valve stenosis (4patients) or atresia (2patients) without diminutive ascending aorta was evaluated based on three important factors:left ventricular volume;the nature of the systemic outflow obstruction; and the type of mitral valve anomaly. Two patients with systemic outflow tract diameter less than 65% of normal underwent systemic outflow tract reconstruction, and the other patients with outflow tract diameter more than 68%of normal were able to maintain systemic circulation without repair. Only one patient with mitral valve stenosis without left ventricular outflow tract obstruction underwent a successful open mitral valvotomy as a biventricular repair after first-stage palliation. The left ventricle of the other patients did not grow after first-stage palliation. Due to progressive subaortic narrowing, pulmonary artery banding should be avoided in patients with mitral atresia due to absent atrioventricular connection who are future Fontan candidates. Most patients with this lesion can be expected to become candidates for safe Fontan-type repair