@phdthesis{oai:nagoya.repo.nii.ac.jp:00014758,
 author = {Yasuda, Isao},
 month = {Jun},
 note = {If not all of the right ventricular outflow tract obstruction (RVOTO) is removed in the operation for pulmonary stenosis, high right ventricular pressure can sometimes occur afterward. However, it is not easy to assess the amount of RVOTO that is to be removed, and there is no quantifiable method for selecting operative procedures. The aim of this report is to discuss the formulation of a numerical indicator, based on the parameters peak systolic right-ventricular pressure (RVP), systolic systemic arterial pressure (AP), pulmonary valvular orifice size (VS), and body surface area (BSA), from the results obtained in sixty-four open heart surgeries for pulmonary stenosis with intact ventricular septum. (1) A group, in which an outflow tract patch was not used and which had a higher pre-operative RVP/AP ratio, had a tendency to have a correspondingly higher RVP/AP ratio one month after the operation. Most patients with a high RVP/AP ratio one month after the operation showed a significant decrease in this ratio a long time after the operation. But, there were exceptions to this rule where the ratio remained high. (2) Reconstruction of the right ventricular outflow was considered for some patients whose RVP/AP ratios remained high. Reconstruction of the RVOT by using an outflow tract patch worked well for patients with an associated infundibular stenosis. A subannular patch was used for patients with infundibular stenosis, and a transannular patch was used for patients with annular stenosis. The optimal annulus size was such that VS/BSA was not less than 2 cm2/m2. A transannular monocusp patch was applied to an area which was more than 10 mm wide. (3) The correlation between the pre-operative RVP/AP and the pre-operative VS/BSA ratio was good. However, no correlation between the post-operative RVP/AP ratio and the post-operative VS/BSA ratio was observed. Therefore, it seems impossible to predict the post-operative RVP only from the size of pulmonary valvular orifice. (4) The pressure measurement during the operation gives an indication for determining the prognosis. That is, the RVP/AP ratio just after the operation and the RVP/AP ratio one month after the operation showed a good correlation. The RVP/AP just after the operation should be 0.7 or less. If this ratio is more than 0.7, reconstruction of the RVOT needs to be done even with repeated cardiopulmonary bypass (CPB). Assessment of the operative application to pulmonary stenosis needs careful study in every case, not only before but also during the operation., 名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成3年9月14日 安田公氏の博士論文として提出された},
 school = {名古屋大学, NAGOYA University},
 title = {Pulmonary Stenosis with Intact Ventricular Septum: Assessment and Indication of Reconstructive Surgery for Residual Right-Ventricular Outflow Tract Obstruction},
 year = {1991}
}