Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Aortic Valvuloplasty Using Triangular Resection lechniolue

설상절제술(triangular resection)을 사용한 대동맥판막 성형술의 단기 성적

  • 김욱성 (인제대학교 일산 백병원 흉부외과학 교실) ;
  • 정철현 (인제대학교 상계 백병원 흉부외과학 교실) ;
  • 허재학 (인제대학교 상계 백병원 흉부외과학 교실) ;
  • 백만종 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 이석기 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 박영관 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김종환 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 장우익 (서울대학교 흉부외과) ;
  • 장지민 (부천세종병원 흉부외과, 세종심장연구소)
  • Published : 2002.02.01
Download PDF
⟨ Previous Next ⟩

Abstract

With an increasing awareness of the limitations of both mechanical prostheses and bioprostheses, aortic valvuloplasty has gained attention as an alternative procedure for aortic valve disease. Material and Method: Eight consecutive patients underwent aortic valvuloplasty caused by leaflet prolapse between June 1799 to June 2000. Mean age of the patients was 18.4$\pm$12.6 year. Four paitents(50%) were male. Six patients had tricuspid valves and ventricular septal defect and two patients had bicuspid valves. The extent of aortic insufficiency was 3.5$\pm$0.5 by preoperative Doppler echocardiography. The technique involved triangular resection of the free edge of the prolapsed leaflet, annular plication at the commissure, and resection of a raphe when present in bicuspid valves. Result: There was no in-hospital mortality or morbidity. Mean follow-up was complete at 11.973.6months. There was no late mortality or morbidity. The amount of the severity of aortic insufficiency, as assessed by echocardiography preoperatively, postoperatively and at late follow-up was 3.5$\pm$0.5, 0.6$\pm$0.5 and 0.8$\pm$0.6, respectively(p value : 0.01). There was one patient with grade 2/4 aortic insufficiency and in the other patients, grade 1/2 or trivial aortic insufficiency were detected with late echocardiograms. Conclusion: Triangular resection in the patients with aortic leaflet prolapse offers a good early clinical result, but long-term follow-up is necessary.

기계판막이나 조직판막을 이용한 인공판막 치환술의 한계가 인식되면서부터 대동맥판막 성형술은 판막치환술의 대안으로 관심을 끌어왔다. 대상 및 방법: 1999년 7월부터 2000년 7월까지 대동맥판막 폐쇄부전으로 설상절제술(triangular resection)을 시행 받은 8명의 환자를 대상으로 수술합병증 및 수술 전후의 심초음파 소견을 비교하였다. 8례 중 남자와 여자는 각자 4명이었으며, 평균 연령은 18.4$\pm$12.6세였다. 술전 시행한 심초음파검사에서 대동맥판막 폐쇄부전의 정도는 평균 3.570.5였다. 6례에서는 심실중격결손증을 동반한 삼첨판인 대동맥판막이었고, 2례에서는 이첨판이었다. 수술방법은 탈출된 판엽을 nodule of Arantius를 중심으로 다른 엽보다 길어진 만큼 설상절제하고 교련술을 시행하였다. 이첨판인 경우는 raphe를 제거하였다. 결과: 기사망이나 합병증은 발생하지 않았다. 평균 추적기간은 11.9$\pm$3.6개월이었으며, 술후 항응고제는 사용되지 않았다. 수술전, 퇴원전 그리고 마지막 추적 검사시 시행한 심초음파검사에 의한 대동맥판막 폐쇄부전의 정도는 각각 grade 3.5$\pm$0.6, grade 0.6$\pm$0.5 그리고 grade 0.8$\pm$0.6으로 통계적으로 유의하게 감소하였다(p value=0.01). 마지막 추적검사에서의 대동맥판막 폐쇄부전의 정도는 grade 2가 1명이였고, 나머지 환자들에서는 grade 1이거나 경도 미만한 정도였다. 결론: 설상절제술은 만족할만한 조기결과를 보여주지만,오랜 기간의 추적검사가 필요하리라 본다.

Keywords

References

  1. J Thorac Cardiovasc Surg v.66 Repair of ventricular septal defect with aortic insuffciency Trusler GA;Moes CAF;Kidd BSL
  2. Operative Techniques in Cardiac & Thoracic Surgery v.1 Aortic valuve repair and reconstruction. Duran CG.
  3. J Thorac Cardiovasc Surg v.103 Late results after repair of aortic insufficiency associated with ventricular septal defect Trusler GA;Williams WG;Smallhorn JF;Freedom RM
  4. J Thorac Cardiovasc Surg v.86 Cardiac vaive surgery-the "French correction" Carpentier A.
  5. Ventricular septal defect associated with aoAnn Thorac Surg v.49 rtic valve incompetence:Results of two surgical managements. Chauvaud S;Serraf A;Mihaileanu S;et al.
  6. J. Thorac Cardiovasc Surg v.102 Valvuloplasty for aortic insufficiency. Cosgrove DM;Rosenkranz ER;Hendran WG;Bartlett JC;Stewart WJ.
  7. Ann Thorac Surg v.58 Repair of insufficient bicuspid aortic valves Fraser CD;Wang N;Mee RB;et al
  8. Operative Techniques in Cardiac & Thoracic Surgery v.1 Aortic valve repair Cosgrove DM;Fraser CD
  9. Ann Thorac Surg v.41 Reoperation after aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect Ohkita Y;Miki S;Kusuhara K;et al
  10. 대?외지 v.26 대동맥판막성형술 이신영;김창호
  11. Ann Thorac Surg v.53 Infundibular septai defect with severe aortic regurgitation:A new surgical approach Bonhoeffer P;Fabbrocini M;Lecompte Y;et al
  12. J Thorac Cardiovasc Surg v.113 Anatomic correction of the syndrome of prolapsing right corornary cusp, dilatation of the valsalva, and ventricular septal defect Yacoub MH;Khan H;Stavri G;Shinebourne E;Radley-Smith R.
  13. J Thorac Cardiovasc Surg v.114 Aortic valvuloplasty for aortic insufficiency associated with ventricular septal defect Mariani MA;Waterbolk TW;Strengers L;Ebels T