左室より右房への直接短絡を示した房室中隔部欠損の手術成功例

Successful Surgical Repair of Defect of Atrioventricular Portion of The Septum With Left Ventricular-right Atrial Shunt Associated With Partial Defect of The Tricuspid Valve.

　広島市民病院では不銃鋼製気泡型人工心肺装置を使用して、過去1年間に56例の開心術を行い，特に最近では25例に死亡率なしという好成績をあげ、完全体外循環時間も50分以上の症例が高率をしめるようになつたと同時に，診断学的，発生学的，根治手術的に極めて興味ある症例を経験し，しばしば報告して来た。今回は最近経験し，根治手術に成功した左室より三尖弁中隔葉の根部を直接右房に穿通する欠損症例に就いて報告する。

　本症については本邦では全く報告例はなく，欧米の文献に数例の報告が散見するにすぎず，Sta—hlman①の2例は死亡しているので，われわれの例が成功第1例と考えられる。ここにわれわれは本症を房室中隔部欠損と命名する事を提案すると同時に，発生学的，診断学的，外科的解剖及び根治手術手技について記述するものである。

An Unusual case of congenital communication between the left ventricle and the right atrium resul-ting from the defect of atrioventricular portion of the septum associated with Partial defect of the septal leaflet of the tricspid valve is reported. The patient, a girl of 4 years of age, has been de-veloped severe frequent upper respiratory tract infections with 4 attacks of severe bronchopneumonia, since her birth.

Utilizing a stemless steel bubble type pump-oxygenator, this unusual defect was successfully repair-ed with right ventriculotomy. This required the total bypass of 36 minutes. The postoperative cour-se was very uneventful and she is doing very well now.

The key-points of diagnosis of this special anomaly of the heart were the unusual enlargment of right atrium in fluoroscopy, increased pressure and the appearlance of insufficient "c" waves in the right atrial and vena caval manometory.

Embriologically, this defect should be called "Defect of atrioventricular portion of the septum wi-th of without defective leaflet of tricuspid valve". Because of the meticulous prognosis and marked restriction of the living, the early diagnosis and the surgical repair would be essential in this special anomaly of the heart.