Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Mitral Valve Reconstruction in Patients with Moderate to Severe Left Ventricular Dysfunction

중등도 이상의 좌심기능부전 환자에서 승모판성형술

  • Baek, Man-Jong (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Na, Chan-Young (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Oh, Sam-Sae (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Kim, Woong-Han (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Whang, Sung-Wook (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Kim, Soo-Cheol (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Kyunghee University) ;
  • Lim, Cheong (Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University) ;
  • Kim, Wook-Sung (Dept. of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University) ;
  • Lee, Young-Tak (Dept. of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Chong-Whan (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon)
  • 백만종 (부천세종병원 흉부외과, 심장연구소) ;
  • 나찬영 (부천세종병원 흉부외과, 심장연구소) ;
  • 오삼세 (부천세종병원 흉부외과, 심장연구소) ;
  • 김웅한 (부천세종병원 흉부외과, 심장연구소) ;
  • 황성욱 (부천세종병원 흉부외과, 심장연구소) ;
  • 김수철 (경희대학교 의과대학 흉부외과) ;
  • 임청 (서울대학교 의과대학 흉부외과) ;
  • 김욱성 (인제대학교 의과대학 일산백병원 흉부외과) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김종환 (부천세종병원 흉부외과, 심장연구소)
  • Published : 2003.11.01
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Abstract

Background: Left ventricular dysfunction is one of the important prognostic factors of early mortality and long-term survival after valve operation. We studied the intermediate term results of mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction. Material and Method: Forty four patients who underwent mitral valve reconstruction with a left ventricular ejection fraction (EF) of <45% or less (20∼45%) from April 1995 through July 2001 were reviewed retrospectively. Ages ranged from 10 to 67 years (46∼14 years) and 32 patients were in NYHA class III-IV. The mitral valve diseases were regurgitation (MR) in 28 patients, stenosis(MS) in 10, and mixed lesion in 5. The etiologies of mitral valve disease were rheumatic in 20 patients, degenerative in 14, ischemic in 5, annular dilatation in 2, congenital in 2, and endocarditis in 1. Operatively, all patients had annuloplasty and/or various valvuloplasty techniques, and a total of 52 procedures were concomitantly performed. Total cardiopulmonary bypass and aortic crossclamp time were 160$\pm$57 minutes and 112$\pm$45 minutes respectively. Result: Two operative deaths occurred as a result of left ventricular failure (4.5%). After the mean follow-up of 39 months (range, 10∼83 months), there was no late death. Transthoracic echocardiography revealed no or grade I of MR in 29 patients (72.5%) and no or mild MS in 35 patients (87.5%). The actuarial survival at 5 years was 100%. Four patients required mitral valve replacement due to progressive mitral valvular disease. The actuarial freedom from valve-related reoperation at 5 years was 84$\pm$9%. Conclusion: This study suggests that mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction offers good early and intermediate survival and acceptable freedom from valve-related reoperation, and it is the strategy for effective management for these patients.

배경: 좌심실 기능부전은 판막수술 후 조기사망 및 장기 생존에 영향을 미치는 중요한 요인의 하나이다. 중등도 이상의 심기능부전 환자에서의 승모판막성형술의 중기 결과에 대해 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2001년 7월까지 좌심실 구혈률이 45% 이하의 심기능부전 환자에서 승모판막성형술을 받은 44명의 환자를 후향적으로 조사하였다. 환자 연령은 46∼14세였고 32명이 NYHA III-IV였다. 승모판막 질환은 페쇄부전 28명, 협착 10명, 혼합형이 5명이었으며 원인은 류머치스성 20명, 퇴행성 14명, 허혈성 5명, 판륜확장 및 선천성이 각 2명, 그리고 심내막염이 1명이었다. 수술시 판륜성형술은 35명(79.6%)에서 시행되었으며 또한 다양한 판첨성형술이 사용되었고 총 52건의 동반수술이 시행되었다. 총체외순환 및 대동맥차단시간은 각각 160$\pm$57분과 112$\pm$45분이었다. 결과: 조기사망은 2명(4.5%)으로 좌심실 기능부전으로 사망하였다. 평균 39개월을 추적한 후 만기사망은 없었다. 심장초음파 검사에서 승모판폐쇄부전은 29명에서 없거나 I도 이하였으며(72.5%) 승모판협착은 35명에서 경도 이하 상태였다(87.5%). 4명이 승모판막 관련질환으로 치환술을 받았다(9.5%). 5년 후 actuarial survival은 100%였으며 승모판막 관련 질환으로 인한 재수술로부터의 자유도는 84$\pm$9%였다. 결론: 중등도 이상의 심한 좌심기능부전 환자들의 승모판막 질환에서 판막성형술 결과 조기 및 중기 생존율과 판막질환으로부터의 재수술률도 양호한 결과를 보임으로써 좌심기능부전 환자들에서 효과적인 치료의 한 방침으로 적용할 수 있다

Keywords

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