[Warm heart surgery facilitates atrioventricular valve repair].
The valve structure varies with cases in children's atrioventricular valvular regurgitation. Filling the left ventricle simply with cold saline solution and testing the valve competency in the cold cardioplegic arrest do not clarify true valve function, although it was the widely used method. Three dimensional evaluation of the lesion in the dynamic and more nearly normal state and the very fine operative procedure in the static state are required for the successful repair. For this purpose we employed the warm heart surgery on 12 children for valve repair (age 1.3-10.1 years, body weight 6.6-28.2 kg). Because no topical cooling was used, preparation of the heart from the adhesion caused by previous operation was not necessary. The aorta was cross clamped at the temperature of 34 degrees of centigrade with continuous coronary perfusion and the lesion in the valve structure and the regurgitation stream were inspected in the beating state, then the repair was performed in the arrest state obtained by infusing the potassium into the coronary perfusion line. Beating and arrest was repeated 2-5 times by on-off potassium infusion until the repair seems satisfactory. In two cases, the repair was not feasible and mitral valve replacement was performed, but in other 10 cases, the postoperative regurgitation decreased down to the grade 2. Despite prolonged aortic cross clamping (65-216 min), post-operative course was quite satisfactory without low-output syndrome in any cases. Postoperatively administered maximum dose of Dopamine was 4.0 +/- 2.2 micrograms/kg/min. CK-MB at 1 POD was also within normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
Takayama
T
T
Department of Thoracic Surgery Kanagawa Children's Medical Center, Japan.
Miyairi
T
T
Nagata
N
N
Koseni
K
K
Yoshimura
Y
Y
Ito
K
K
D001831:Body Temperature; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006324:Heart Arrest, Induced; D006801:Humans; D007223:Infant; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*