Journal of Chest Surgery

  • 제27권11호
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  • Pages.893-901
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  • 1994
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

좌심실유출로 협착증의 외과적 요법 - 대동맥판막하 협착증의 임상고찰 -

Surgical Mnayement of Left Ventricular Outflow Tract Obstuction -A Clinical Study on Subaortic Stenosis-

  • 발행 : 1994.11.01
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초록

Forty nine patients [M: 31, F: 18], age from 2 months to 17 years [mean= 4.9 years], underwent operations, from April 1986 to December 1992, for the relief of subvalvular aortic stenosis in normal atrioventricular and ventriculoarterial connections.There were 4 anatomic types of subaortic stenosis : membranous in 29 cases [59.2%], fibromuscular in 11 [22.4%], diffuse tunnel type in 7 [14.3%], and miscellaneous in 2 cases. Thirty four patients [69.4%] had associated cardiac anomalies, of which ventricular septal defect was the most common [27 cases]. Other anomalies were patent ductus arteriosus, coarctation of the aorta, valvular aortic stenosis, double chambered right ventricle [DCRV], infundibular pulmonic stenosis, persistent left superior vena cava, and rigt aortic arch. Mean systolic pressure gradient between the left ventricle and ascending aorta was 26.4$\pm$17.6 mmHg : 13.1$\pm$17.6mmHg in the membranous type, 22.0$\pm$18.4mmHg in the fibromucular type, and 56.1$\pm$38.4mmHg in the diffuse tunnel type. Operative procedures were determined according to the type of subvalvular aortic stenosis : simple excision of subaortic membrane in the membranous type [29 cases], left ventricular myectomy with or without myotomy or fibrous tissue excision in the fibromuscular type [11 cases]. Among the 7 of diffuse tunnel type cases, ventricular myectomy was performed in 2 and a modified Konno operation was performed in 5 . Postoperative follow up was made with periodic echocardiography. The Mean postoperative follow up period was 33.8 months. There were 2 hospital mortalities [4.1%] and 2 late deaths. Residual stenosis remained in 3 cases and recurrence developed in 2 cases during the follow up period. 5 years actuarial survival rate was 91.8$\pm$3.9% and 5 year complication free rate was 72.3$\pm$10.4%. Conclusions : 1. Subvalvular aortic stenosis should be relieved completely as soon as possible when diagnosed, regardless of left ventricular outflow tract pressure gradient. 2. Good results were obtained using only simple excision of subaortic membrane in the membranous type of subaortic stenosis. However, aortoventriculoplasty [modified Konno prodedure] was necessary for good results in the diffuse tunnel type. 3. Periodic postoperative echocardiography was helpful in detecting the progression of residual stenosis and development of new stenosis.

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참고문헌

  1. Am J Cardiol v.42 Congenital heart disease in a cohort of 19,502 births with long-term follow up Hoffman,J.E.;Christianson,R.
  2. Circulation v.27 Congenital aortic stenosis Braunwald,E.;Goldblatt,A.;Aygen,M.M.(et al.)
  3. Am J Cardiol v.38 Discrete subvalvular aortic stenosis in childhood. Study of 51 patients Newfeld,E.A.;Muster,A.J.;Paul,M.H.;Idriss,F.S.;Ricker,W.L.
  4. J Thorac Cardiovasc Surg v.87 The late prognosis after localized resection for fixed (discrete and tunnel) left ventricular outflow tract obstruction Moses,R.D.;Barnhart,G.R.;Jones,M.
  5. J Thorac Cardiovasc Surg v.87 Operation for discrete subvalvular aortic stenosis Cain,T.;Campbell,D.;Paton,B.;Clarke,D.
  6. Am J Cardiol v.52 Fixed subaortic stenosis in the young: medical and surgical course in 83 patients Wright,G.B.;Keane,J.F.;Nadas,A.S.;Bernhard,W.F.;Castaneda,A.R.
  7. Br Heart J v.43 Fate of patients with fixed subaortic stenosis after surgical removal Somerville,J.;Stone,S.;Ross,D.
  8. Pediatric cardaic surgery(2nd ed.) Left ventricular outflow tract obstruction Lupinetti,F.M.;Bove,E.L.;Mavrouis,C.;Backer,E.L.
  9. Chest v.72 Membranous subaortic stenosis and patient ductus arteriosus Steinherz,L.;Ehiers,K.H.;Kevin,A.R.;Engle,M.A.
  10. Radiology v.101 Subaortic stenosis (discrete form). Classification and angiography features Deutch,V.;Shem-Lov,A.;Yahini,H.;Newfeld,H.N.
  11. Guys Hosp Resp Observations on the disease of the orifice and valves of the aorta Chevers,N.N.
  12. Br J Child Dis v.10 Subaortic stenosis Thursfield,H.;Scott,H.W.
  13. 대흉외지 v.19 대동맥판막하 막상 협착증의 수술요법 노준량;이재원
  14. 대흉외지 v.21 대동맥판막 막상협착증 치험 3례 문경훈;허용;김병열;이정호;유희성
  15. 대흉외지 v.23 선천성 대동맥판막하 막상협착증 치험 2례 송인기;임태근;윤재도;양태봉;최순호
  16. Lancet v.2 Schorstein Lecture on the fate of the bulbus cordis in the human heart Keith,A.
  17. J Pediatr v.75 Spontaneous closure of ventricular septal defects by aneurysmal formation of the membranous septum Varghese,P.J.;Rowe,R.D.
  18. Am J Cardiol v.53 Combined discrete subaortic stenosis and ventricular septal defect in infants and children Chung,K.J.;Fulton,D.R.;Kreidberg,M.B.;Payne,D.D.;Cleveland,R.J.
  19. Circulation v.47 no.SUP.III Development of subaortic stenosis after pulmonary artery banding Freed,M.D.;Rosenthal,A.;Plauth,W.H.;Nadas,A.S.
  20. Circulation v.17 Coexistence of patent ductus arteriosus and congenital aortic valvular stenosis Mark,H.;Jacobson,B.;Young,D.
  21. Am J Cardiol v.48 Signs of membranous subaortic stenosis appearing after correction of persistent common atrioventricular canal Ben-Shacher,G.;Mooler,G.H.;Casteneda-Zuniga,W.;Edwards,J.E.
  22. Am J Cardiol v.26 Tetralogy of Fallot with severe left ventricular outflow tract obstruction due to anomalous attatchement of the mitral valve to the ventricular septum Van Praagh,R.;Corwin,R.D.;Dahiquist,E.H.;Freedom,R.M.;Mattioll,L.;Nebesar,R.A.
  23. Circulation v.31 Pathology of left ventricular outflow tract obstruction Edwards,J.E.
  24. Circulation v.43 no.SUP.Ⅰ Congenital fixed subvalvular aortic stenosis. An anatomical classification and correlations with operative results Reis,R.L.;Peterson,L.M.;Mason,D.T.;Simon,A.L.;Morrow,A.G.
  25. Br Heart J v.48 Left ventricular outflow tract obstruction coexisting with ventricular septal defect Shore,D.F.;Smallhorn,J.;Stark,J.;Lincoln,C.;De Leval,M.R.
  26. J Thorac Cardiovasc Surg v.80 Accessory flaplike tissue causing ventricular outflow obstruction Gomes,A.S.;Nath,P.H.;Singth,A.;Lucas,R.V.Jr;Amplatz,K.;Nicoloff,D.M.;Edwards,J.E.
  27. Am J Cardiol v.43 Echocardiographic assessment in discrete subaortic stenosis in childhood Berry,T.E.;Aziz,K.U.;Paul,M.H.
  28. Circulation v.66 Clinial presentation and natural hisotry of mild dicrete subaortic stenosis. Follow up of 17 years Shem-Tov,A.;Schneeweis,A.;Motro,M.;Newfeld,H.N.
  29. Circulation v.54 Tunnel subaortic stenossis. Left ventricular outflow tract obstruction produced by fibroumuscular tubular narrowing Maron,B.J.;Redwood,D.R.;Roberts,W.C.;Henry,W.L.;Morrow,A.G.;Epstein,S.E.
  30. J Thorac Cardiovasc Surg v.70 A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring Konno,S.;Yasuharu,I.;Yoshinao,I.;Masamichi,N.;Katuhiko,T.
  31. J Thorac Cardiovasc Surg v.71 Aortoventriculoplsty. A new technique for the treatment of left ventricular outflow tract obstructions Rastan,H.;Konez,J.
  32. J Thorac Cardiovasc Surg v.90 Long term results after excision of fixed subaortic stenosis Ashraf,H.;Cotronseo,J.;Dahr,N.(et al.)