Tissue Failure of the Standard-Profile lonescu-Shiley Pericardial Valve in Mitral Position

승모판에서의 표준형 이오네스류 판막의 조직실패

  • 김종환 (서울대학교 의과대학 흉부외과학교실)
  • Published : 1996.10.01

Abstract

Structural deterioration of the bioprosthetic xenograft valves due to primary tissue failure occurs in two modes: from fatigue lesions with tear and wear with or without calcification and from calcification with obstruction. Two groups of consecutive 56 patients with the Hancock porcine ortic valve(HM) and of 1 13 patients with the standard-profile onescu-Shiley bovine pericardial valve(ISM) explanted from mitral position at the time of re-replacement surgery for primary tissue failure at Seoul national University Hospital until 1994, were studied for clinical and pathological features. Their ages at primary implant were 31.9 $\pm$9.2 years In HM and 30.4$\pm$ 12.5 years in ISM. Hemodrnamic dysfunction of the failed mitral bloprostheses were predominantly insufficiency in HM(64.3%) and stenosis in ISM(51.3%)(p<0.001). Pathologic findings of the explanted mitral valves reflected these hemodynamic changes, revealing failure more often from tissue damage(tears and wears) in HM and more often from calcification in ISM(p< 0.001). Explant period(from primary implant to explant) was relatively short in ISM(8.7$\pm$2.6years), compared with the one in HM(10.4 $\pm$2.6 years)(p<0.001). In conclusion, both the Hancock and the lonescu-shiley valves would fail from calcification as well as issue damage. However, while the Hancock porcine valves in mitral position failed more frequently from tissue failure and insufficiency, the standard-profile lonescu-Shiley pericardial valves did from calcification and stenosis, especially in young pAtients . Although the possibility of less occurrence of valve failure from mechanical reasons may be expected with newer generation bloprostheses, it does not seem to Improve durability significantly unless further refinement in antimineralization is achieved. Therefore, clinical use of the glutaraldehyde-treated bioprosthetic valves is, at present, limited to the patients of advanced age groups.

표준형 이오네스큐우심낭판막의 일차성 조직실패상의 특징의 일부를 알아보고져 승모판위치에서 각 각 행콕판막을 적출하였던 56례와 표준형 이오네스큐판막을 적출하였던 연속적 전례인 일차성 조직실 패환자 113례를 대상으로 임상 및 병리학적으로 분석 검토하였다. 양 환자군의 수술당시의 연령은 각각 31.9$\pm$9.2세와 30.4$\pm$ 12.5세였다. 행콕판막은 조직손상으로 인 한 판막폐쇄부전이 빈발한 반면 이오네스큐판막은 석회화변성의 빈도가 높고 협착병변인 경향이 우세 하였다. 판막적출기간은 행콕판막에서보다 이오네스큐판막에서 단축되 었다. 이러한 판막실패의 특징은 판막구조설계의 개선으로 기계적 요소로 인한 판막실패를 감소할 수 있을 것으로 보이나 항광물화상의 개선 없이는 조직판막의 내구성의 개선은 곤난할 것임을 시사하였다.

Keywords

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