Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Use of Rapid Ventricular Pacing to Facilitate Stent Graft Deployment in the Distal Aortic Arch

빠른 심실유도를 이용한 흉부대동맥류의 혈관 내 스텐트 그라프트 치료

  • Kong, Joon-Hyuk (Department of Thoracic and Cardiovascular Surgery, Kangpuk Samsung Hospital, Sungkyunkwan University College of Medicine) ;
  • Koo, Yang-Hee (Department of Anesthesiology and Pain Medicine, Daegu Veterans Hospital) ;
  • Lee, Yoon-Ji (Department of Anesthesiology and Pain Medicine, Daegu Veterans Hospital) ;
  • Hur, Jin (Department of Thoracic and Cardiovascular Surgery, Andong General Hospital) ;
  • Kim, Duk-Sil (Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, CHA University) ;
  • Kim, Sung-Wan (Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, CHA University)
  • 공준혁 (성균관대학교 의과대학 강북삼성병원 흉부외과학교실) ;
  • 구양희 (대구보훈병원 마취통증의학과) ;
  • 이윤지 (대구보훈병원 마취통증의학과) ;
  • 허진 (안동병원 흉부외과) ;
  • 김덕실 (차의과대학교 구미차병원 흉부외과학교실) ;
  • 김성완 (차의과대학교 구미차병원 흉부외과학교실)
  • Received : 2010.05.25
  • Accepted : 2010.07.30
  • Published : 2010.12.05
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Abstract

Systemic hypotension has been traditionally used to facilitate deployment of thoracic stent grafts. Decreasing blood pressure with vasodilating agents further increases cardiac output and, consequently, the cardiac output-mediated windsock effect during deployment. Use of rapid ventricular pacing reduces the windsock effect during stent graft deployment and allows the graft to appose to the aortic wall under zero cardiac output, thus minimizing aortic wall shear stress. In this case we report the use of transvenous rapid ventricular pacing, a safe and reproducible technique to allow precise deployment of a Valiant Captivia stent graft in the distal thoracic arch for a saccular thoracic aneurysm.

전신저혈압은 흉부대동맥질환의 스텐트 그라프트 치료에 전통적으로 많이 이용되어 왔으나, 혈관확장제를 이용한 혈압강하는 심박출량을 증가시킬 수 있으며 이로 인해 스텐트 그라프트의 전개 시 바람자루효과가 발생할 수 있다. 빠른 심실유도는 자동제어방식으로 일시적인 심박출량의 정지를 유도하여 심정지 지속시간이 제어 가능하고, 스텐트 그라프트 전개 시 대동맥 손상을 최소한으로 줄일 수 있다는 장점이 있다. 본원에서는 흉부대동맥궁 하방에 발생한 주머니동백자루 환자에게 빠른 심실유도하에 Valiant Captivia 스텐트 그라프트를 이용하여 효과적으로 혈관내 스텐트 그라프트 시술을 하였기에 문헌 고찰과 함께 보고하는 바이다.

Keywords

References

  1. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stentgrafts for the treatment of descending thoracic aortic aneurysm. N Engl J Med 1994;331:1729-34. https://doi.org/10.1056/NEJM199412293312601
  2. Leurs LJ, Bell R, Degrieck Y, et al, EUROSTAR; UK Thoracic Endograft Registry Collaborators. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg 2004;40:670-9. https://doi.org/10.1016/j.jvs.2004.07.008
  3. Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 2008;85(Suppl):S1-41. https://doi.org/10.1016/j.athoracsur.2007.10.099
  4. Nienaber CA, Kische S, Ince H. Thoracic aortic stent-graft devices: problems, Failure modes, and applicability. Semin Vasc Surg 2007;20:81-9. https://doi.org/10.1053/j.semvascsurg.2007.04.005
  5. Nienaber CA, Kische S, Rehders TC, et al. Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta. J Endovasc Ther 2007;14:506-12. https://doi.org/10.1583/1545-1550(2007)14[506:RPFBPC]2.0.CO;2
  6. Pornratanarangsi S, Webster MW, Alison P, et al. Rapid ventricular pacing to lower blood pressure during endograft deployment in the thoracic aorta. Ann Thorac Surg 2006;81:e21-3. https://doi.org/10.1016/j.athoracsur.2006.01.081
  7. Moon MC, Dowdall JF, Roselli EE. The use of right ventricular pacing to facilitate stent graft deployment in the distal aortic arch: a case report. J Vasc Surg 2008;47:629-31. https://doi.org/10.1016/j.jvs.2007.08.055
  8. Parker JD, Golledge J. Outcome of endovascular treatment of acute type B aortic dissection. Ann Thorac Surg 2008;86: 1707-12. https://doi.org/10.1016/j.athoracsur.2008.06.074
  9. Dagenais F, Dumont E, Voisine P. Thoracic stent-grafting for complicated type B dissection: use and safety of rapid ventricular pacing for stent-graft implantation. The 45th Annual Meeting of the Society of Thoracic Surgeons.