Surgical Repair of the Tetralogy of Fallot with Unusual Coronary Artery Distribution / 日本心臓血管外科学会雑誌

Extracardiac Conduit Repair (ECCR) is conventionally selected for the Tetralogy of Fallot (TOF) with unusual coronary artery distribution. However, in recent years conduit obstruction has been an important factor. Recently, we select the Right Ventricle Outflow Tract Reconstruction (RVOTR) using direct anastomosis between PA and RV as much as possible. In this paper, RVTOR was compared with ECCR. RVOT stenosis was relieved sufficiently and the ventricular function was well maintained after both surgical methods. We concluded that RVOTR should be selected instead of the ECCR because of the conduit obstruction.

Experiences of Absorbable Suture Material in Pediatric Cardiovascular Surgery / 日本心臓血管外科学会雑誌

We have used absorbable suture material for the repair of pediatric cardiovascular anomalies where subsequent growth of the suture line was requied since 1986. We reviewed long-term results of three groups of patients using absorbable suture (1. cardiovascular surgery in the high-pressure areas, 2. semicircular annuloplasty for mitral regurgitation, 3. cardiovascular surgery in the low pressure areas). In group 1, six patients after Jatene procedure using PDS^® were examined. Subsequent growth of the neo-aortic anastomotis were well preserved without formation of pseudoaneurysm 6-56 (average 18.6) months after the operation. In group 2, seven patients with mitral regurgitation (mitral valve regurgitation 4, endocardial cushion defect 3) were examined. The semicircular annuloplasty was applied using Vicryl^® and Dexon^® and mitral regurgitation was improved and in two patients normal growth of the mitral annulus was recognized 4 and half years after the operation. In group 3, sixteen patients in the repair of total anomalous pulmonary venous drainage (Darling type I, III) using PDS^® were examined. Pulmonary venous obstruction were encountered 1 and 5 months after the anastomotis between common pulmonary vein and left atrium in two patients and anastomotic stenosis was thought to be induced by tissue overgrowth. On the basis of our clinical experiences, we believe that application of absorbable suture in pediatric cardiovascular surgery in the high-pressure areas could be recommended as an alternative treatment, but that should be avoided in the neonatal small low-pressure areas on the assumption that anastomotic stenosis might be induced by tissue overgrowth.