Fallot氏四徴症—ことに外科的治療の立場から

Tetralogy of Fallot. Surgical correction and its related clinical manifestations.

I．緒論

　心臓疾患の最近の進歩は先天性，後天性のほとんどあらゆる心臓疾患の根治手術を可能ならしめる段階に至つている。しかし，これら心臓疾患のうち，頻度の高いものは幾種類かに限られており，ここにその論述を依頼されたFallot氏四徴症はかかる疾患のうち，もつとも古くから外科的療法に成功したものの一つでありながら，いぜんとして充分解決されていない重要な臨床的問題を有する疾患である。過去9年に及ぶ本症の外科的治療の経験から，これら諸問題のごく一部について概括的に報告を試みんとするものであるが，著者の最近1年間の短絡手術死亡率56例中7.2％，根治手術41例中7.7％という成績よりみて，すくなくとも臨床的方法論としては妥当性の高いものと信ずる。

The author described various clinical manifestations of tetralogy of Fallot and its key points of corrective surgery in the open hearts from the broad experiences of over 200 cases during the past 9 years. In the recent series of 41 cases of corrective surgery and 59 cases of shunt operation during the past one year, the mortality was only 7.7% and 7.2%, res-pectively.

1. Surgical anatomy of tetralogy of Fallot. In this item, the author demonstrated a new classification of tetralogy of Fallot, in which type A—G were subdivided.

2. Clinical methods for surgical indications. Hemodynamical methods to evaluate the surgical indications have no valuable suggestion. On the contrary, the selective cardioan-giography, wedge pulmonary arteriography and selective aortography were methods of ch-oice to select the patients for the candidates of corrective surgery in the open hearts.

3. Key points of corrective surgery. A newly developed procedure for corrective surgery, application of controlled hypothermic selective cardiac cooling and special techniques of extracorporeal circulation in this special lesions were demonstrated.

4. Prolonged postoperative treatments in avoidance of chronic postoperative right ventri-cular failure was also essential.