[
Abstract]
[
Full Text PDF] （in Japanese / 3379KB）
[Members Only And Two Factor Auth.] J.Jpn. Surg. Soc.. 89(8): 1279-1285, 1988
Original article
OPERATIVE RESULTS FOR ACQUIRED VALVULAR DISEASE WITH BLOOD CARDIOPLEGIA FOLLOWED BY TERMINAL CARDIOPLEGIA
Cold blood cardioplegia followed by terminal cardioplegia was employed as a method of myocardial protectin for acquired valvular disease. Postoperative clinical results of both cardiac iso-enzyme and cardiac function were discussed from the effect of the myocardial protection. In operative procedures of 62 cases, 30 cases underwent mitral valve replacement and other mitral repair, 17 cases aortic valve replacement, 10 cases double valve replacement and 5 cases modified Bentall operation. Iso-enzymes of Creatine-Kinase (CK) and Lactate-Dehydrogenase (LDH) were measured by the constant time-interval. Cardiac function was estimated in acute postoperative phase and late phase. Hospital mortality was 1.5%. The cause of death was thought to be postoperative Graft Versus Host Disease with skin rash and pancytopenia. Cardiac function during acute phase well recovered in 62 cases of which two cases were controlled with intra-aortic balloon pumping. The values of CK-MB were measured during aortic cross-clamp, 30 min, 3 hours, 6 hours and 24 hours after cross-clamp release. Peak CK-MB value was detected 3 hours or 6 hours in almost cases. In contrast, peak LDH-1 value was detected 24 hours after cross-clamp release. Perioperative myocardial infarction was occurred in one case with modified Bentall operation whose CK-MB value was elevated over 150 IU/L at 3rd hour and 24th hour. However, the cardiac radio-isotope data of this case revealed good cardiac function with left ventricular ejection fraction (LVEF) 76% by cardiac pool imaging in spite of small postero-lateral perfusin defect by Thallium 201 scintigram. In 61 survival cases, LVEF was improved or not worsened including one case with end-stage aortic regurgitatin. In functional NYHA classification, 11 cases with NYHA IV degree were improved to NYHA II degree in 2 cases and NYHA I degree in 9 cases. Blood cardioplegia followed by terminal cardioplegia has offered good cardiac protection and also excellent cardiac function in late phase.
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