심실대혈관 연결 이상에 대한 변형된 Lecompte 술식의 장기 성적

Long-term Results of Modified Lecompte Procedure for the Anomalies of Ventriculoarterial Connection

  • 임홍국 (서울대학교 병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 한국남 (서울대학교 병원 흉부외과, 서울대학교 의과대학 흉부외과학교) ;
  • 김웅한 (서울대학교 병원 흉부외과, 서울대학교 의과대학 흉부외과학교) ;
  • 이정렬 (서울대학교 병원 흉부외과, 서울대학교 의과대학 흉부외과학교) ;
  • 노준량 (서울대학교 병원 흉부외과, 서울대학교 의과대학 흉부외과학교) ;
  • 김용진 (서울대학교 병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • 발행 : 2004.09.01

초록

심실대혈관 연결 이상을 교정하기 위한 Lecompte 술식은 폐동맥 협착의 재건을 위해 심장외 도관이 필요없는 장점이 있다. 저자들은 Lecompte 술식의 장기 성적을 분석하여 그 효과와 적용 가능성을 평가하였다. 대상 및 방법: 1988년 7월부터 2004년 4월까지 서울대학교 어린이병원 흉부외과에서는 총 46명의 환아에서 상기 술식을 시행하였다. 평균 연령은 29.2$\pm$20.3 (범위: 3∼83)개월이었다. 술전 진단은 심실중격결손과 폐동맥 협착(또는 폐쇄)을 동반한 완전대혈관 전위가 30명이었고(65.2%), 페동맥 협착(또는 폐쇄)을 동반한 양대혈관 우심실 기시가 14명(30.4%), 방실중격 결손과 페동맥 협착을 동반한 완전대혈관 전위가 1명(2.2%), 폐동맥 협착을 동반한 양대혈관 좌심실 기시가 1명(2.2%)에서 있었다. 결과: 대상 환자 중 2명(4.4%)의 조기 사망이 있었으며, 3명(6.8%)의 만기 사망이 있었다. 평균 추적 관찰 기간은 11.2$\pm$6.9년이었다. 18명(43.9%)에서 30 mmHg 이상의 우심실 유출로 협착이 있었으며, 그 주된 원인은 15명(83.3%)에서 석회화된 단엽 판막 때문이었다. 17명(37.0%)에서 재수술을 시행하였으며, 재수술을 시행한 원인은 우심실유출로 협착이 15명(32.6%), 잔존 심실 중격 결손이 5명, 좌심실 유출로 협착이 4명, 폐동맥판막 폐쇄부전이 3명, 기타 4명이었다. 누적 생존율은 10년에 91.3$\pm$4.2%였으며, 15년에 87.0$\pm$5.8%였다. 잔존 우심실 유출로 협착에 대한 재수술 없이 생존할 확률은 5년에 90.6$\pm$4.5%였으며, 10년에 73.9$\pm$7.3%였으며, 15년에 54.0$\pm$10.4%였다. 결론: Lecompte 술식은 페동맥 협착을 갖는 많은 선천성 심기형에 대한 효과적인 치료 방법이다. 좋은 장기 성적을 보이며, 어린 연령에서도 시행할 수 있으나, 단엽 판막의 퇴행성 변화에 의한 우심실 유출로 협착의 재발이 해결되어야 할 문제이다.

The Lecompte procedure for transposition of the great arteries has an advantage because it obviates the need for an extracardiac conduit for the reconstruction of the pulmonary outflow tract. We evaluated the effectiveness and the application of the Lecompte procedure. Material and Method: A retrospective review was conducted of the records of 46 patients who underwent the Lecompte procedure during the past 15 years. Mean age at operation was 29.2$\pm$20.3 (range: 3∼83) months. The diagnoses involved anomalies of the ventriculoarterial connection with ventricular septal defect and pulmonary outflow tract obstruction, such as transposition of the great arteries, double-outlet right ventricle, and double-outlet left ventricle. Result: Early mortality was 4.4% (2 of 46 patients) and late mortality was 6.8% (3 of 44). The mean follow-up was 11.2$\pm$6.9 years. Eighteen patients (43.9% of survivors, n=41) had pulmonary stenosis (pressure gradient above 30 mmHg), the main reason for which was a calcified monocusp valve (n=15, 83.3%). Seventeen of 46 patients (37.0%) underwent reoperation: 15 for pulmonary stenosis, 5 for residual ventricular septal defect, 4 for left ventricular outflow tract obstruction, 3 for pulmonary insufficiency, and 4 for other causes. The cumulative survival rates were 91.3$\pm$4.2%, and 87.0$\pm$5.8% at 10 and 15 years, respectively. The actuarial probabilities of freedom from reoperation for pulmonary stenosis were 90.6$\pm$4.5%, 73.9$\pm$7.3%, and 54.0$\pm$10.4% at 5, 10, and 15 years, respectively. Conclusion: The Lecompte procedure is an effective treatment modality. Repair in early age is possible with acceptable morbidity and mortality, but recurrent right ventricular outflow tract obstruction caused by degeneration of the monocusp valve is a problem that needs resolution.

키워드

참고문헌

  1. Circulation v.39 Complete repair of transposition of the great arteries with pulmonary stenosis: a review and report of a case corrected by using a new surgical technique Rastelli GC.;Wallace RB.;Ongley PA.
  2. J Thorac Cardiovasc Surg Anatomic correction of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis Rastelli GC.;McGoon DC.;Wallace RB.
  3. J Thorac Cardiovasc Surg v.84 Reconstruction of the pulmonary outflow tract without prosthetic conduit. Lecompte Y;Neveux JY;Leca F(et al.)
  4. J Thorac Cardiovasc Surg v.103 Transposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obsrtuction. Rastelli or Lecompte procedure? Vouhe PR;Tamisier D;Leca F;Ouaknine R;Vernant F;Neveux JY
  5. Cardiol Young v.1 Reparation a l`etage ventriculaire - The REV procedure : Technique and clinical result Lecompte Y.
  6. Korean J Thorac Cardiovasc Surg v.31 Lecompte procedure in complex congenital heart diseases Kim YJ;Kim KH;Lee SJ(et al.)
  7. Eur J Cardiothorac Surg v.25 Repair of transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction Lee JR;Lim HG;Kim YJ(et al.)
  8. J Thorac Cardiovasc Surg v.114 Extending the concept of the autograft for complete repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: a report of ten cases of a modified procedure Metras D;Kreitmann B;Riberi A(et al.)
  9. Circulation v.75 Anatomic correction of simple transposition of the great arteries in 50 neonates Sidi D;Planche C;Kachaner J(et al.)
  10. Am J Cardiol v.63 Two-dimensional and Doppler echocardiographic evaluation after arterial switch repair in infancy for complete transposition of the great arteries Martin MM;Snider AR;Bove EL
  11. J Thorac Cardiovasc Surg v.114 Ourflow obstruction after the arterial switch operation: a multiinstitutional study Williams WG;Quaegebeur JM;Kirklin JW;Blackstone EH
  12. Ann Thorac Surg v.72 Modified Lecompte procedure for the anomalies of ventriculoarterial connection Kim YJ;Park JJ;Lee JR(et al.)
  13. J Thorac Cardiovasc Surg v.95 Anatomic repair of anomalies of ventriculoarterial connection associated with ventricular septal defect. Ⅱ. Clinical results in 50 patients with pulmonary outflow tract obstruction Borromee L;Lecompte Y;Batisse A(et al.)
  14. J Thorac Cardiovasc Surg v.112 Shortterm effect of monocuspid valves on pulmonary insufficiency and clinical outcome after surgical repair of tetralogy of Fallot Bigras JL;Boutin C;McCrindle BW;Rebeyka IM
  15. Ann Thorac Surg v.56 Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve Yamagishi M;Kurosawa H
  16. ASAIO J v.44 Monocusp valve and transannular patch reconstruction of the right ventricular outflow tract: an experimental study Scavo VA Jr;Turrentine MW;Aufiero TX(et al.)
  17. J Thorac Cardiovasc Surg v.115 Conotruncal repair for tetralogy of Fallot: midterm results Kurosawa H;Morita K;Yamagishi M;Shimizu S;Becker AE;Anderson RH
  18. J Card Surg v.14 The pericardial membrane pulmonary monocusp: surgical technique and early results Roughneen PT;DeLeon SY;Parvathaneni S;Cetta F;Eidem B;Vitullo DA
  19. Eur J Cardiothorac Surg v.10 Lecompte operation with preservation of the pulmonary valve for anomalies of ventriculoarterial connection with ventricular septal defect and subpulmonary stenosis Van Son JAM;Sim EKW
  20. Ann Thorac Surg v.57 Locompte procedure for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis Kim YJ;Song H;Lee JR;Rho JR;Suh KP
  21. Circulation v.90 no.5 Early changes in ventricular geometry and ventricular septal defect size following Rastelli operation of intro-ventricular baffle repair for conotruncal anomaly: a cause for development of sub-aortic stenosis Rychik J;Jacobs ML;Norwood WI
  22. J Thorac Cardiovasc Surg v.120 Twenty-five-year experience with Rastelli repair for transposition of the great arteries Kreutzer C;De Vive J;Oppido G(et al.)
  23. J Thorac Cardiovasc Surg v.93 Left ventricular wall stress and contractile function in transposition of the great arteries after the Rastelli operation Graham TP;Franklin RC;Wyse RK;Gooch V;Deanfield JE
  24. Am Heart J v.112 Ventricular pump performance in patients with obstructed right ventricular-pulmonary artery conduits Palik I;Graham TP;Burger J