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KMID : 0364019740070020209
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Korean Journal of Thoracic and Cardiovascular Surgery
1974 Volume.7 No. 2 p.209 ~ p.216
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Left ventricular-right atrial shunt
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趙範九/Cho, Bumkoo
盧炳宣/李鍾明/洪承祿/車弘道/Rho, Byungsun/Lee, Jongmyung/Cha, Hongdo/Hong, Seungnok
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Abstract
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Left ventricular-right atrial shunt is a rare lesion. Aberg et al, collected about 150 cases in the literatures in 1970. Laurichesse et al. estimated the incidence to be about 0.08% of all congenital lesions. The etiology is almostly exclusively congenital, although fetal endocarditis, trauma and endocarditis are possible factors. The Pathology of the lesion can be classified into 3 types: supravalvular, infravalvular and combined, acding depends upon the level of the defect above or below the tricuspid valve.
The diagnosis of left ventricular-right atrial shunt have stressed the importance of the following findings: 1. Harsh holosystolic murmur and thrill along the left sternal border 2. Radiation of the murmur to the right sternal border 3. Expiratory splitting of the second sound in the pulmonic area 4. Holosystolic murmur heard since the newborn period 5. Congestive heart failure within one month after birth G. Immediate opacification of a right atrium on left ventricular angiocardiography.
In 17 years old girl, preoperative tentative diagnosis was left ventricular-right atrial shunt, according to O_(2) step-up at right atrium, dye opacification of right atrium on seletive left ventricular angiocardiography and loud pansystolic murmur along left sternal border which was not compatible with ASD. Under the cardio-pulmonary bypass, the right atrium was opened with close state of left vent, there was a jet-blood stream just above the atrio-ventricular portion adjacent to the septal leaflet of the tricuspid valve. The jet-blood stream was coordinated with left ventricular systole and not with the aortic pressure. There was no tricuspid valve anomalies or VSD. The defect measuring 3×5mm was closed with direct interrupted sutures and this was enforced with Teflon pledget. The recovery was uneventful except wound infection. Follow-up findings after 5 months, revealed increased tolerance of exercise, decreased pulmonary vascular marking and abscence of murmur.
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