小児先天性僧帽弁膜症の外科治療

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  • Surgical Repair of Congenital Mitral Valve Disease in Infancy and Childhood

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Between 1959 and June, 1984, 63 patients with congenital mitral valve disease 43 parsistent common atrioventricular canal (CAVC) and mital incompetence with/without other cardiac anomalies) surgical repair. Mitral valve replacement was performed in 7 (11%) out of these 63 patients. The hospital mortality of 30 cases of incomplete CAVC was 33% (10/30), 38.5% (5/13) in the complete CAVC and 15% (3/20) in patients with mitral incompetence. Seven out of 10 hospital deaths in incomplete CAVC belonged to the early period of this series and there has been no death since 1981. Three out of 5 hospital deaths in complete CAVC was due to increased pulmonary vascular resistance during infancy. There was no late death. Six patients (9.5%) underwent reoperation mainly for residual mitral incompetenc (3), degenerative change of bioprosthesis (2) and as a second stage operation (1). Reconstructive surgery such as annuloplasty, chordoplasty and simple cleft suture for mitral lesions is most advisable procedure for infants and children, because prosthetic valve replace-ment in children is a palliative procedure at best. Mitral valve replacement with ventricular septum extension using mitral anterior leaflet in cases of persistent CAVC proposed by Asano is advisable procedure to protect His bundle and to release the obstruction of the left ventricular outflow tract by the implanted prosthesis. Preservation of posterior leaflet with its chordae and papillary muscles at MVR maintains left ventricular contraction and performance immediately after surgery and promises markedly improved recovery course.

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