Surgical Role of the Treatment of the Patients with Infective Endocarditis in Childhood

아동기 전염성 심내막염 환자치료의 외과적 역할

  • 김경환 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 서경필 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Published : 1997.12.01

Abstract

Background. Infective endocarditis s an uncommon but serious disease in children. Optimal treatment strategy, especially surgical indications, continues to evolve. Method. In this report, we retrospectively reviewed 19 patients who underwent operations in Seoul National University Children's Hospital for infective endocarditis between September 1986 and February 1996. There were 8 male and 11 female patients(mean age 70.6 months) and their main symptoms were fever and dyspnea. Preoperative echocardiography detected vegetation in 14 cases out of 19. Congenital anomalies were in 15 cases and acquired forms were in 4 cases. Causative organisms were identified in 12 cases and Gram-positive cocci were in 7 cases. Adequate preoperative antibiotic management was done. Result. With cardiopulmonary bypass in all cases, surgical corrections including vegetation removal were performed. 4 patients died after operations(21.1%). All the mortality cases were having underlying complex cardiac anomalies. There were no late deaths. Act arial survival rate was 79.0% at 1 year and 79.0% at 5 year and reoperationfree survival rate was 73.7% at 1 year and 73.7% at 5 year. Collclusion. Despite advances in antibiotic therapy, early surgical treatment is imperative in a significant subset, and concurrent intracardiac repair should be appropriate.

연구배경. 아동기의 전염성 심 내막염은 비록 드물게 발생하지만 심각한 임상경과를 밟을수 있는 질환이다. 수술적 요법을 포함하는 적절한 치료 방침 내지는 전략의 수립이 필수적이다. 방법. 1986년 9월부터 1996년 2월까지 총 19례의 전염성 심 내막염으로 수술 시행한 환자를 후향적으로 조사하였다. 남녀비는 8:11이고 평균연령은 70.6개월이었으며 주 중상은 발열,호흡 곤란이었다. 술전 시행한 심 에코상 14례에서 우종을 발견할 수 있었다. 선천성 기형이 15례, 후천성이 4례였고 원인균은 12례에서 동정되었으며 7례가 그람 양성 구균이었다. 적절한 술전 항균제 처치를 시행하였다. 결과. 전 례에서 심폐기 가동 하에 우종 제거를 포함한 수술적 치료를 시행하였다. 4례의 사망으로 21.1%의 사망률을 나타내었으며, 4례 모두가 선천성 복잡 심기형을 가진 환아였다. 누적생존율은 1년,5 년에 모두 79.0%였고, 재수술 없는 누적 생존율은 1년,5년에 모두 73.7%였다. 결론. 항생제의 획기적인 발전에도 불구하고 조기적 수술이 반드시 필요한 환아가 있으며 이 경우 동반된 심기형의 적절한 치료가 함께 요망된다.

Keywords

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