Surgical treatment for adult congenital heart disease.

A total of 1,408 adult congenital heart disease patients (age over 13 years) underwent surgery between 1979 and 1995 at Siriraj Hospital, contributing 33.75 percent to the overall number of congenital heart disease cases (4,172) who underwent surgery in that period. This finding is similar to statistics in the West. The ages ranged from 13.3 years to 72 years, with a mean of 24.06 years. The oldest patient was a 72 year-old man with coronary cardiac chamber fistula. The most common diagnoses in descending order were: atrial septal defect (41.05 per cent), patent ductus arteriosus (16.19 per cent), tetralogy of Fallot (14.06 per cent) and ventricular septal defect (10.87 per cent). These four categories covered 82 percent of the cases. The overall surgical mortality was 1.78 per cent, compared with 3 per cent in patients who had undergone surgery during childhood. Only patients with double outlet of the right ventricle and congenital aortic stenosis, or left ventricular outflow tract obstruction, showed increased risk of death (20 per cent), compared with 5.77 per cent in those cases who had undergone surgery during childhood. The conclusions drawn from the study are that surgical treatment for adult congenital heart diseases showed a low average of surgical mortality of less than 2 per cent in almost every category except double outlet of the fight ventricle and congenital aortic stenosis, for which early surgery is recommend.

Surgical treatment for pulmonary stenosis with intact interventricular septum.

Pulmonary stenosis with intact interventricular septum (PS, IVS) is one of the five most common congenital heart diseases to have required surgery at Siriraj Hospital during the past 17 years. It represents 4.5% of all congenital heart diseases operated upon. We reviewed 166 patients who received open-heart surgical treatment for PS, IVS at Siriraj Hospital from 1979 to 1995. Female predominated in neonates. Overall operative mortality was 2.4% with a failure rate of 0.6%. Infundibular plus valvar stenosis was the most common morphology founded at surgery (46%). There was no difference in operative mortality relevance to the level of obstruction. Operative mortality was higher (22%) in infant age group than in the neonate and childhood groups. Since 1992, there has been no operative mortality in any of the age groups. It can be concluded that, the result of surgical treatment for PS, IVS in Siriraj Hospital is excellent with a very low failure rate.

Subpleural lipoma: A case report.

Our first experience with a solitary subpleural lipoma was reported with emphasis on the reliability of computed tomography as a non-invasive means for establishing diagnosis of parietal intrathoracic lipomas.

Cardiac surgery at Siriraj Hospital, B.E. 2522-2532.

An eleven year retrospective analysis of patients being treated for heart disease at Siriraj Hospital, during 1979-1989, was carried out in order to find out the epidemiological characteristics of disease and the results of surgical treatment. There were 4289 patients encountered during the period of study. Of these patients, 2565 (60 percent) had congenital heart disease while the rest had the acquired ones. 40 percent of these patients were 13 years and below. Among patients with congenital heart disease, PDA, ASD, Tetralogy of Fallot, and VSD were encounted in 25, 22, 20 and 15 percent respectively. Valvular heart disease, coronary artery disease and pericardial disease were encountered in 56, 15 and 12 percent respectively. The opened heart surgery was carried out in 2753 patients (64 percent) while only 1536 patients (36 percent) had the closed one. The overall mortality following surgery was 3.1 percent. The mortalities among patients with the congenital and the acquired heart disease were 2.03 and 5.22 percent and for those underwent opened and closed surgery were 3.92 and 2.21 percent respectively.