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KMID : 0364019960290101081
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Korean Journal of Thoracic and Cardiovascular Surgery
1996 Volume.29 No. 10 p.1081 ~ p.1089
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Surgical Treatment of Pulmonary Artesia with Intact Ventricular Septum -Effect of the size of tricuspid valve annulus on the surgical outcome-
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이정렬
김용진/윤태진/노준량/오삼세/이석재/서경필/김헤순/노정일
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Abstract
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Pulmonary atresia with mtact ventricular septum has continued to have a high surgical mortality and morbidity. This may attribute to the non-uniformity of the anomaly. We reviewed a total of 34 infants with pulmonary atresia and intact
ventricular
septum managed in this hospital between 1987 and 1995. Mean age and body weight were 57.2(range, 3-208) days and 4.1 (range, 2.3~6.8) kg. The preoperative Z-value of the diameter of the tricuspid valve was less than -2 in 85.2% of patients and
less
than
-4 in 33.3%. It is well correlated with right ventricular cavity size(n=27, r=0.68, p<0.05). Coronary artery-right ventricular fistulas were identified in 3 patients, and right ventricular dependency was suspected in l. Overall hospital mortality
was
23.5%(8/34), although it decreased to 16.6%(4/24) in 1990s. Subsequent procedures were performed in 6 patients between 3 days and 58 months after initial palliation ; one bidirectional cavopulmonary shunt and l Fontan operation after
systemic-pulmonary
shunt, 3 transannular patch + atrial septal defect closure and l additional systemic-pulmonary shunt after pulmonary valvectomy of valvotomy. Changes of Z-values of the diameter of tricuspid valve have4 been followed up in ll patients between 1
and
66
months postoperatively. Z-values were increased in 5 out of 8 transannular right ventricular outflow tract enlargement group and in l out of 3 pulmonary valvectomy or valvotomy group. Our data suggest that tailoring a treatment to right
ventricular
cavity size and coronary anomalies may improve the surgical outcome. A Z-value of the tricuspid valve diameter could be used as a.
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