J.Jpn. Surg. Soc.. 60(10): 1683-1709, 1959
STUDIES ON THE INFLUENCE OF CUTTING THE TRICUSPIDAL CHORDAE TENDINAE IN CARDIAC SURGERY
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Surgical department, Tokyo Women's Medical College (Director: Prof. S. Sakakibara) Yung TAIK KIM |
The effects and characteristics of each procedure were clearified.
1) Degree of back flow was analyzed by using atrial pressure wave in the cardiac catheterization. Among the group in which the chordae tendinae of single valve were cut, the least regurgitation was seen when the chordae tendina of septal cusp were cut. And also in deviding valular cusp, the least back flow was found when the septal cusp was incised.
Among the group in which chordae tendinae of two valves were cut, the least back flow was observed in cutting simultaneously chordae tendina of septal cusp and conus side of anterior cusp. The greatest effect was seen when the chordae tendinae of anterior and posterior cusps were cut simultaneously.
2) The findings of Angiocardiography were in accordance with those of cardiac catheterization. In septal cusp group, abnormal regurgitation was not seen.
The picture of back flow was definitely seen in other experimental groups, though there were some differences in degree. The signs in the vcnae cavae which could not judged by cardiac catherization, was easily seen by angiocardiography. The degree of regurgitation due to insufficiency was evaluated by making the prolongation of flow time of the contrast media in synchronized pulsatory phase angiocardiography as standard.
3) Histopathologically, in experimental group of septal cusp, no change was found in fifty four percent and forty six percent showed some changes, In other experimental group, definite changes were seen in seventy five to ninety percent and the more marked was the regurgitation, the more changes were seen histopathologicatly.
4) The relation between the regurgitation and cardiac output revealed that the larger was the regurgitation, the lesser was the output.
In experimental group of septal cusp, although the cardiac output decreased somewhat, it remained almost within normal range.
5) As to the relation between the degree of regurgitation and cardiopulmonary index, the larger was the regurgitation the tendency towards the more increase of the index was shown. It remained within normal range in experimental group of septal cusp.
6) There was no definite relation between the degree of regurgitation and liver function. The histopathologic hepatic stasis and liver function test with Bromsulphalein showed no relation. No definite relation was seen between liver function and venous pressure.
7) In Electrocardiogram, the change like expected to appear hemodynamically in the right side of the heart was not seen among all the experimental groups.
The slight elevation of S-T segment and flattening of T waves, which seemed to be due to the influence of operation itself, was observed from V3 to V6 in precordial lead.
8) Without any relation to the location and degree of insufficiency, there was no apparent variation in hemoglobin, blood corpuscles and electrolytes. The plasma total protein seemed to show tendency towards slight decrease.
On the basis of experimental results described above, those procedures of deviding or cutting cusp, chordae tendinae or papillay muscles were applied clinically with great success in the closure of ventricular septal defect with eIective cardiac arres and artificial heart lung machine.
Needless to say, immediately after the closure of the defect, the cut papillary muscle was sutured back to normal position and devided cusp was repaired.
Those experimental data contribut much in the diagnosis of tricuspid insufficiency as a heart disease also.
(Author's abstract)
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