Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Surgical Analysis of the Postinfarction Ventricular Septal Defect

심근 경색에 합병된 심실중격결손의 외과적 고찰

  • 조유원 (울산대학교 의과대학 서울중앙병원 흉부외과) ;
  • 이현우 (울산대학교 의과대학 서울중앙병원 흉부외과)
  • Published : 1996.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Between May 1991 and September 1995, 7 patients underwent surgical repair of ventricular septal defect (VSD) complicated with myocardial infarction in Asan Medical Center. The patients included two male and five female. The ages of patients were ranged from 54 years to 76 years with a mean of 65 years. The sites of postinfarction ventricular septal defect were consist of anterior septal defect in 6 patients and anteroposterior septal defect in 1 patient. Preoperative 2D-echocardiography & angiography were performed in all patients in order to measure ventricular function and evaluate the extent of coronary artery disease. The operations were delayed till mean 24 $\pm$ 12days after myocardial infarction. All patients underwent infarctectomy and Teflon patch closures through the area of the left ventricle infarction or aneurysm in the anterior or apical aspect of postinfarction ventricular septal defect. The ventricular septal defect repaired simultaneously with coronary artery b pass graft in 3 patients, with ventricular aneurysmectomy in 5 patients, and with left ventricular thrombectomy in 1 patient. Patch fixation in the left side of interventricular septum by tracts-septal interrupted pledget suture reduced the recurrence rate of VSD. There were 2 postoperative complications : One with pneumonia, 1 patient with the skin necrosis of left thigh. There was ilo early death. The 6 patients except for one emigrant were followed up postoperatively between 3 and 63 months(mean .28 months), without any sequelae and late death. They are in New York Heart Association functional class I-II.

본 서울중앙병원에서는 1991년 5월에서 1995년 9월까지 심근경색후 합병된 심실중격결손증 7례 환자의 수술을 시행 하였다. 남자환자가 2명, 여자환자가 5명 이었으며, 평균연령은 65세 (범위 : 54~76)였다. 심실중격결손의 위치는 전중격 결손이 6명이 었으며, 전후중격 경계부 심실중격결손이 1명 있었다. 모든 환자에서 술전 심초음파와 심혈관조영술을 시행하여 심실기능과 관상동맥 병변의 위치를 파악하였다. 수술은 심근괴사후 평균 24 $\pm$ 12일 후에 시행하였다. 좌심실 심근괴사 조직을 통하여 Teflon patch로 봉합하였고, 추가적인 수술로 3명 환자에서는 관상동맥 우회 술을 시행하였고, 5명 환자에서 심실류 제거술을 시행하였으며, 1명 환자에서 좌심실혈전 제거술을 시행하였다. 심실중격결손의 봉합시 중격근육전층을 통하여 interuptted pledget 봉합함으로써 심실중격 결손 재발을 막으려고 노력하였으며, 수술후 합병증으로는 폐렴 1명, 좌측대퇴부 피부괴사 1명이 있었다. 조기 사망률은 없었고 외국으로 이민간 1명을 제외하고 6명 모두 수술후 3개월에서 63개월 사이(평균28개월)에 추적 조사상 합병증이나 사망 없이 NYHA I-II상태로 생활하고 있다.

Keywords

References

  1. J Thorac Cardiovasc Surg v.37 Postinfarction ventricular septal degect-Surgical stratagies and results Segeser,L.K.;Sibenmann,R.;Schneider,K.;Jnni,R.;Trina,M.
  2. Adult cardiac surgery Robert,M.B.
  3. J Thorac Cardiovasc Surg v.93 Surgical repair of acquired ventricular septal defect, Determinants early and late outcome Jones,M.T.;Scholfild,P.M.;Dark,J.F.;Mousalli,H.;Deiraniya,A.K.;Lawson,R.A.M.
  4. Lecture on subjects connected with clinical medicine comprising deseases of the heart v.2 Latham,P.M.
  5. Surgry v.41 Surgical repair of ruptured intrventricular septum following acute myocardial-infarction Cooley,D.A.;Belmonte,B.A.;Zeis,L.B.;Schnur,S.
  6. Ann Thorac Surg v.41 Surgical management of postinfarction ventricular rupture Heitmiller,R.;Jacobs,M.L.;Daggett,W.M.
  7. 대흉외지 v.27 심근경색후 발생한 심실중격결손의 외과적 치료후 장기 결과 유경종;장병철;홍유선;강면식;조범구;홍승록
  8. N Engl J Medi v.297 Rapid bed side differentiation of ruptured interventricular septum from acute mitral insufficiency Meister,S.G.;Heifant,R.H.
  9. Ann Thorac Surg v.54 Postinfarct ventricular septal defect repair : Effect of coronary artery bypass grafting Derk,D.;Muehrcke,M.D.;Willard,M.(et al.)
  10. J Thorac Cardiovasc Surg v.99 Surgical treatment for infarct-related ventricular septal defects : improved early results combined with analysis of late functional status Skillington,P.D.;Davies,R.H.;Luff,A.J.(et al.)
  11. Circulation v.82 no.Pt2 Surgical repair of postinfarction ventricular septal defect Komeda,M.;Fremes,S.E.;David,T.E.
  12. Am Heart J v.18 The speed of healing of myocardial infarction: A study of the pathologic anatomy in seventy-two cases Mallory,G.K.;White,P.D.;Salcedo-Salgar J.
  13. Circulation v.49 Postinfarction ventricular septal rupture: Srgical considerations and results Giuliani,E.R.;Damielson,G.K.;Pluth,J.R.;Odyniec,N.A.;Wallace,R.B.
  14. Circulation v.64 Ventricular suptal rupture; a review of clinical and physiologic features and an analysis of survival Radford,M.J.;Johnson,R.A.;DAggett,W.M.(et al.)
  15. J Cardiovasc Surg v.22 Postinfarction rupture of the interventricular septum Killen,D.A.;Reed,W.A.;Wathanacharoen,S.;McAllister,B.D.;Bell,H.H.
  16. J Thorac cardiovasc Surg v.104 Results of early repair of ventricular septal defect after an acute myocardial infarction Blanche,C.;Khan,S.S.;Matoff,J.M.(et al.)
  17. Surgery v.98 Postinfarction ventricular septal defect : an argument for early operation Gaudiani,V.A.;Miller,D.C.;Stinson,E.B.(et al.)