Journal of Chest Surgery

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

Evaluation of the Surgical Treatment for Mitral Stenosis

승모판협착증의 외과적 치료에 대한 평가

  • Sin, Dong-Geun (Dept.of Thoracic and Cardiovascular Surgery, Chonbuk University Medical School) ;
  • Kim, Min-Ho (Dept.of Thoracic and Cardiovascular Surgery, Chonbuk University Medical School) ;
  • Jo, Jung-Gu (Dept.of Thoracic and Cardiovascular Surgery, Chonbuk University Medical School) ;
  • Kim, Gong-Su (Dept.of Thoracic and Cardiovascular Surgery, Chonbuk University Medical School)
  • 신동근 (전북대학교 의과대학 흉부외과학교실) ;
  • 김민호 (전북대학교 의과대학 흉부외과학교실) ;
  • 조중구 (전북대학교 의과대학 흉부외과학교실) ;
  • 김공수 (전북대학교 의과대학 흉부외과학교실)
  • Published : 1996.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

From July 1983 to June 1995, 95 consecutive patients with mitral stenosis were treated surgically in the Department of Thoracic and Cardiovascular Surgery, Chonbuk national University Hospital, mitral valve replacement(MVR) in 62 patients and open mitral commissurotomy(OMC) in 33 patients. Mitral stenosis combined with coronary artery disease, with aortic valve disease, or wish mitral valvular Insufficiency, were excluded from this study. Surgical procedures for mitral stenosis were evaluated, according to complication, reoperation, mor- tality, nd functional change at mid- and long-term postoperative period. Cardiothoracic ratio in the MVR group was greater than the OMC group(0.59 $\pm$0.07 in MVR, 0.53 $\pm$0. 07 in OMC, p<0.05), but other variables(age, sex, MYHA functional classification, EKG finding, echocardiographic finding) did not show significant difference between two groups in the preoperative periods. Even though pathologic valvular lesion(Sellor's pathologic type m: 35 in MVR, 13 in OMC) and valvular calcification(35 in MVR, 11 in OMC) were severe in the MVR group(p=0.001) at intraoperative observation, OMC was possible in 11 patients(23.9%) among 46 patients with valvular calcification and in 13 patients(27.1 %) among 61 patients with Sellor's pathologic type IH . There was no significant difference in early and late mortality, actuarial survival(75% in MVR, 87.6% in OMC at 12 year), but early and late hemorrhagic, thromboembolic complications in the MVR group were greater than in the OMC. Functional changes in NYHA functional classification, EKG lEnding, cardiothoraclc ratio, and echocardiographic finding(EF, LVIDS, LWDd, LAD) did not differ between two groups in mid- and long-term postoperative periods. We conclude that our efforts for preservation of the native valve would be continued, because hemorrhagic and thromboembolic complications in the MVR were greater than in the OMC, and OMC was possible even in patients with severely stenotic and calcified mitral valve, although there was no sis-nificant difference in the functional change, mortality, and survival between the M VR and OMC.

1983년 7월부터 1995년 6월까지 전북대학교병원 흉부외과학 교실에서 승모판협착증으로 수술을 시행한 판막치환술 62예와 교련절개술 33예를 패상으로 하였다. 대동맥 판막이나 관상동맥 질환을 동반하거나 중등도 이상의 승모판 폐쇄부전증이 동반된 경우는 본 연구에서 제외하였으며 승모판 협착증에 대한 술식들을 합병증과 재수술, 사망율, 수술후 기능적인 변화에 따라 비교 분석 하였다. 수술전 대상환자의 특성 중 승모판 치환술군에서 심흉곽비가높았던 점 이외에 나이나 성별, NYHA 기능분류, 심전도상 심방세동의 유무, 심초음파 소견에서 두군 간에 의의 있는 차이는 없었다. 수술시 판막 병변의 병리학적 소견은 치환술군에서 더 심하였고(Sellors type IR, 35 in MVR, 1) in OMC 3 판엽의 석회화를 보이는 경우도 많았으나(35 in MVR, 11 in OMC), 판엽의 석 회화가 있었던 46 예 중 11예(23.9%)와 Sellor의 제3형 협착 61예 중 13예(27.1 %)에서 교련절개 술이 가능하였다. 수술후 조기 및 만기사망과 생존율에서 두군 간에 차이는 없었고, 출혈 및 혈전색전증과관련된 조기 및 만기 합병증이 치환술군에서 더 많았으며, 수술후 중장기 추적관찰시 N HA기능분류, EKG, 심흉 곽비, 심초음파 소견(EF, LAD, LWDs, LWDd) 등의 기능상의 변화에서는 두군간에 의의있는 차이를 발견할 수 없었다. 승모판 헙착증의 상호 보완적인 주요술식인 치환술과 교련절개술은 술식에 따른 기능상의 변화와 사망 및 생존율에 의의있는 차이는 없으나 출혈 및 혈전색전증과 관련된 합병증이 치환술군에서 많았고 고도의 협착 및 판막석회화가 존재하는 상황에서도 교련절개술이 가능하였으므로 자연판막의 보전을 위한 노력은 지속되어야 한다.

Keywords

References

  1. J Thorac Cardiovasc Surg v.105 Long-term reults of mitral commissurotomy Scalia,D.;Rizzoli,G.;Campanile,F.(et al.)
  2. J Thorac Cardiovasc Surg v.106 Early open mitral commissurotomy : Long -term results Eguaras,M.G.;Garcia Jmenez M.A.;Calleia,F.(et al.)
  3. Ann Thorac Cardiovasc Surg v.31 Open mitral commissurotomy Vega,J.L.;Fleitas,M.;Martinez,R.(et al.)
  4. Ann Thorac Surg v.45 Results in closed mitral valvotomy Spencer,F.C.
  5. J Thorac Cardiovasc Surg v.94 Roconstruction of indication for open miral commissurotomy based on pathologic featires of the stenosed mitral valve Nakano,S.;Kawashima,Y.;Hirose,H.(et al.)
  6. Ann Thorac Surg v.47 A comparison of mitral valve reconstruction with mitral valve replacement : Intermediate-term results Galloway,A.C.;Colvin,S.B.;Baumann,F.G.(et al.)
  7. Circulation v.89 Mitral valve replacement versus mitral valve repair : A doppler and quantitative stress echocardiographic study Tischler,M.D.;Cooper,K.A.;Rowen,M.;LeWinter,M.M.
  8. Circulation v.91 Valve repair improves the outcome of surgery for mitral regurgitation : A multivariate analysis Enriquez-Sarano M.;Schaff,H.V.;Orszulak,T.A.;Tajik,A.J.;Bailey,K.R.;Frye,R.L.
  9. Ann Thorac Surg v.55 Open mitral commissurotomy : Fourteen-to eighteen-year follow-up clinical study Herrera,J.M.;Vega,J.L.;Bernal,J.M.;Rabasa,J.M.;Revuelta,J.M.
  10. Ann Thorac Surg v.56 Comparison of balloon valvuloplasty with operative treatment for mitral stenosis Cohen,J.M.;Glower,D.D.;Harrison,J.K.(et al.)
  11. J Thorac Cardiovasc Surg v.108 Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis Okita,Y.;Miki,S.;Ueda,Y.(et al.)
  12. 대흉외지 v.28 승모판막 교련절개술의 임상적 연구 박경신;여승동;김응중;임승평;이영
  13. 대흉외지 v.28 승모판 치환술의 임상성적 나국주;김상형;김광휴
  14. J Thorac Cardiovasc Surg v.108 The St.Jude Medical prosthesis : A thirteen-year experience Ibrahim,M.;O'Kane,H.;Cleand,J.;Gladstone,D.;Sarsam,M.;Patterson,C.