Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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외상성 심실중격결손 수술 후 잔존하는 심실중격결손에 대한 중재적 심도자술을 이용한 폐쇄

Transcatheter Closure of a Residual Shunt after Surgical Repair of Traumatic Ventricular Septal Defect

  • 정희정 (충남대학교 의과대학 소아과학교실) ;
  • 임한혁 (충남대학교 의과대학 소아과학교실) ;
  • 유재현 (충남대학교 의과대학 흉부외과학교실) ;
  • 이재환 (충남대학교 의과대학 내과학교실) ;
  • 길홍량 (충남대학교 의과대학 소아과학교실)
  • Jeong, Hee Jeong (Department of Pediatrics College of Medicine, Chungnam National University) ;
  • Lim, Han Hyuk (Department of Pediatrics College of Medicine, Chungnam National University) ;
  • Yu, Jae Hyun (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University) ;
  • Lee, Jae Hwan (Department of, Internal Medicine, College of Medicine, Chungnam National University) ;
  • Kil, Hong Ryang (Department of Pediatrics College of Medicine, Chungnam National University)
  • 투고 : 2005.06.27
  • 심사 : 2005.08.09
  • 발행 : 2005.10.15
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초록

흉부 관통상에 의해 심실중격결손이 동반된 대부분의 환자들은 내원 시 활력징후가 불안정하여 심폐소생술 및 응급 개흉술을 시행받게 되는데, 이러한 경우 심장과 흉부 손상의 위치 및 정도에 대한 자세한 검사가 이루어지지 않은 상태이므로 발견되지 않았거나 잔존하는 이상 소견들이 수술 후 검사에서 발견될 수 있고 이에 대한 재수술을 필요로 하는 경우도 있다. 심실중격결손의 심도자술을 통한 폐쇄는 수술을 대처할 수 있는 방법으로서, 특히 수술 후 잔존하는 단락의 경우 이차 수술의 위험을 피할 수 있다. 저자들은 흉부 자상에 의한 심실벽의 열창 및 심실중격결손을 수술적 방법으로 봉합한 후 잔존하는 심실중격결손을 기구($Amplatzer^{(R)}$ VSD occluder)를 이용한 중재적 심도자술로 치료한 증례를 문헌 고찰과 함께 보고한다. 심도자술 6개월 후 시행한 심초음파검사에서 잔존하는 심실 좌우 단락은 없었고, 심실 크기와 기능도 정상이었고, 현재 상태는 양호하여 정상적으로 학교생활을 하고 있다.

The traumatic ventricular septal defect (VSD) is a rare but potentially life threatening complication of chest wall injury. The traumatic VSD occurs in up to 4.5% of penetrating cardiac trauma. Most of the patients are usually operated on because of heart failure and/or significant left-to-right shunt. The feasibility of surgical repair under cardiopulmonary bypass may be affected by coexisting pulmonary, cerebral or other vascular injuries. Transcatheter closure of VSD is being considered as an alternative therapeutic modality to surgery in order to avoid the potential risk of cardiopulmonary bypass. We report a patient who underwent a successful transcatheter closure of VSD with an $Amplatzer^{(R)}$ VSD occluder. The patient had a residual VSD with significant left-to-right shunt after surgical repair of post-traumatic VSD using cardiopulmonary bypass.

키워드

참고문헌

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