THE KURUME MEDICAL JOURNAL V01.13, No.1, 1966 FOLLOW-UP OF SURGERY FOR CONGENITAL HEART DISEASES MICHIHIRO KOGA, HIDETO MASAKI, KIROKU OISHI, HIROAKI ITO, NORIYUKI NISHIMURA, MASAKI KASUGA AND AZUMA YANAGI The Second Department of Surgery, Kurume University School, of Medicine Kurume-shi, Japan (Received for Publication May 5, 1966) During the last ten years, our Department has treated 731 patients by means of cardiac surgery, of these patients 344 were with congenital heart disease and 387 with acquired one. At the present time, the long-term results of the cases which could be observed for a period greater than six months following the operation and were not accompanied with other cardiac malformation, among patients with congenital heart disease, are reported. The total of 167 follow-up cases include 58 with interatrial septal defect (ASD), 27 with interventricular septal defect (VSD), 37 with patent ductus arteriosus (PDA) and 45 with tetralogy of Fallot for which shunt operation was performed. The changes in roentgenologic cardiothoracic ratio in tetralogy of Fallot were as follows : The ratio began to increase at about sixth month following operation. A increase was observed in 83% of the cases after a year, but the value tended to lower in successive years as 68% after two years, 56% after three years and 43% after five years. A marked decrease in the ratio after the operation began to appear at about the fifth month in PDA, most rapidly at about the third month in ASD and at about the sixth month in VSD, but these decrease approximated to a normal value after a year. The more severe the preoperative pathological findings, the more remarkable was the change described above (Fig. 1, 2). As the changes in EKG, QRS vector in frontal section, the waves R and S in V1, and the waves R and S in V6 were especially investigated. In tetralogy of Fallot, the increase in the load to the left ventricle, due to the increase in pulmonary blood flow, appeared six months after operation, which the tendency of this increase retarded two years after. In ASD, the load to the right heart was palliated remarkably after three months, and it recovered to a normal value after six months. The change varied markedly in proportion to the severity of the load to the right ventricle before the operation. In PDA, the improvement of the load to the left and right ventricles appeared four months after the operation. The higher the pulmonary artery pressure before the operation, the more remarkable was the palliation of the load to the right ventricle. Similar results could be observed at about the sixth month, even in VSD (Fig. 3, 4). Haematological findings, in the case of tetralogy of Fallot which was treated with shunt operation, were that both Hb-value and red cell count started to decrease 44
FOLLOW-UP OF SURGERY 45 Fig. 1 Fig. 2 conspicuously after three months, but, in some cases, they were almost normal after six months. The slope of the decrease slowed down thereafter. Three years later, about 23% of the cases revealed values higher than that preceeding the operation. Then, the number of the case showing a higher value tended to increase. This fact is suggestive of the time adequate to radical operation (Fig.5). When the peripheral circulation in tetralogy of Fallot was investigated by capill-
46 MICHIHIRO KOGA, ET AL. Fig. 3 Fig. 4 ary microscopy of the nail-bed of the finger, the marked teleangiectatic figure disappeared in parallel with the decrease of cyanosis after the operation. In the observation of the change in hae modynamics after the operation, in majority of the cases with radical opeartion demonstrated the disappearance of a shunt and the normalization of the intracardiac pressure. However in some cases which heart murmur was heard after the operation, it presented a preserved shunt in
FOLLOW-UP OF SURGERY 47 Fig. 5 Fig. 6
48 MICHIHIRO KOGA, ET AL. spite of an improvement of subjective symptoms. The latter group included 2 cases of PDA, 2 of ASD, and 1 of VSD. The re-operation in two cases with aneurysm formation caused by reopening of the ductus arteriosus was successfully accomplished by protection of aneurysm by the wrapping method in one case and by excision with bypass-graft method in the other (Fig. 6). The long-term results of subjective symptoms of the cases which elapsed over six months after the operation were examined by Ellis-Harken's classification, more than 90% of the cases with ASD and VSD lived under normal conditions, and in the cases with PDA also revealed almost the same results. In tetralogy of Fallot, 20% of them showed an improvement over the grade 2 in severity and 60% demonstrated an improvement in their locomotor activity. Nevertheless, the shorter the lapse after the operation, the better was the improvement in locomotor activity after shunt operation. It should be noticed that the improvment begins to reduce gradually after three years. Three cases of PDA, one of ASD and one of tetralogy of Fallot had given birth following a cardiac operation, and both mother and baby were well. SUMMARY The long-term results of surgical treatment of congenital cardiac diseases which was carried out in our Department have been summarily reported especially with regard to an improvement of physical conditions after the operation. REFERENCES 1) ELLIS, L. B. ET AL : New England J. Medicine, 270, 643, 1964.