| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2006;132:693-694
© 2006 The American Association for Thoracic Surgery
Brief Communication |
Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Received for publication April 25, 2006; accepted for publication May 3, 2006. * Address for reprints: Shin Takabayashi, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan (Email: shin1111{at}clin.medic.mie-u.ac.jp).
Patients with congenital heart defects characterized by a hypoplastic right ventricle (RV) are at high risk for the development of postoperative RV failure. Although the usefulness of a 1-way valved patch1
for biventricular repair of a hypoplastic RV2 has been reported in pediatric patients, little is known about the effects of a 1-way valved patch in adult patients. Here we report biventricular repair in an adult patient by using a 1-way valved patch to reduce the risk of postoperative RV failure.
Clinical Summary
A 60-year-old man weighing 79 kg was given a diagnosis of a secundum atrial septal defect (ASD), severe pulmonary stenosis, and a hypoplastic RV. On admission, his oxygen saturation as measured by means of pulse oximetry was 80% at room air, and erythrocytosis (hematocrit level, 63%) was detected. Transesophageal echocardiography showed a secundum ASD of 15 mm with a right-to-left shunt and a tricuspid valve diameter of 33 mm (80% of the normal value). Angiocardiography revealed that the RV end-diastolic volume (index) was 91 mL (48.1 mL/m2), and that the RV ejection fraction was 44%. The pulmonary valve diameter was 19 mm (87% of the normal value), with doming and calcification. The left ventricular end-diastolic volume (index) was 107 mL (57.2 mL/m2), and the left ventricular ejection fraction was 65%. The cardiac index was 2.2 L · min–1 · m–2, and the Qp/Qs was 0.54. The left ventricular pressure was 171/9 mm Hg, and the RV pressure was 108/14 mm Hg. Mean pulmonary artery pressure was 13 mm Hg, and right atrial pressure (14 mm Hg) was higher than left atrial pressure (11 mm Hg).
Surgical intervention was performed with cardiopulmonary bypass during moderate hypothermia. After cardioplegic arrest, a right atriotomy was performed. The ASD was closed with the hand-fashioned 1-way valved patch (a hole of 10 mm in diameter on a 0.4-mm expanded polytetrafluoroethylene patch and a monocusp of ellipse form of 15 mm in width using a 0.1-mm expanded polytetrafluoroethylene sheet). Next, an RV overhaul2 was performed to increase the RV volume. An RV outflow tract reconstruction was performed by means of pulmonary valve replacement (27-mm stented porcine valve) and Dacron patch enlargement. A pressure study after cardiopulmonary bypass showed an ascending aortic pressure of 95/28 mm Hg and an RV pressure of 38/13 mm Hg. Intraoperative transesophageal echocardiography showed that the 1-way valve was open, and the right-to-left shunt remained (Figure 1, A).
|
|
In pediatric patients requiring biventricular repair for congenital heart defects associated with a hypoplastic RV correlated with pulmonary obstruction, the use of a 1-way valved patch permits a postoperative intra-atrial1-3 or intraventricular4 right-to-left shunt, decompresses the failing RV, and maintains the systemic cardiac output. Regarding adult patients, although severe RV failure after acute postperfusion RV failure5 has been successfully treated through creation of an ASD, there have been no reports of 1-way valved patch repair in an adult heart.
The adult heart is characterized by reduced ventricular compliance compared with that in children because of fibrous changes. In addition, our patient had erythrocytosis, such that his heart would have been exposed to hypoxia, and pulmonary valvular calcification associated with aging would have progressed this hypoxia. His age and history indicated the causes of the intraoperative finding that the muscle of the RV free wall was thick and fragile. However, by using a 1-way valved patch closure of the ASD and concomitant performance of an RV overhaul,2 RV adaptation for an increased volume load was obtained in this adult hypoplastic RV heart exposed to hypoxia for a long period.
In conclusion, we performed a biventricular repair using a 1-way valved patch for an adult patient with an ASD, severe pulmonary stenosis, and a hypoplastic RV. One-way valved patch closure for an ASD represents a useful option for treating a hypoplastic RV in the mature heart to reduce the risk of postoperative RV failure.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
