Postoperative Evaluation for Ventricular Septal Defect Associated with Aortic Valvular Prolapse

대동맥판 탈출이 동반된 심실 중격 결손증의 술후 평가

  • Published : 1999.02.01

Abstract

Background: From January 1989 to December 1996, we analyzed 22 cases of ventricular septal defect associated(VSD) with aortic valvular prolapse. Material and Method: The mean age of the patients was 7 years with a range of 6 months to 22 years . Thirteen patients were male and 9 were female. The types of VSD were Kirklin type I in 13 , Kirklin type II in 8 and Kirklin type I+II in one. Result: The preoperative echocardiographic findings were aortic valvular prolapse in 10 patients, aortic valvular prolapse associated with aortic regurgitation in 6, and only aortic regurgitation in 2. Aortic valvular prolapse were found in operation field in 4 that was not be in preoperative echcardiography. Preoperative mean Qp/Qs, systolic PAP, systolic RVP were 1.48${\pm}$0.42, 27.9${\pm}$9.87, 32.9${\pm}$10.87 mmHg, respectively. Twenty patients underwent patch closure of VSD, and two patients with moderate aortic regurgitation and prolapsed of the aortic valve underwent patch closure of VSD and aortic valvuloplasty. Short and long term echocardiographic follow-up in 8 patients who had preoperative aortic regurgitation were found to have improved or not aggravated by performing VSD patch closure only and patch closure with valvuloplasty in 2. Twelve patients who had only preoperative aortic valvular prolapse had no change in prolapsed valve in postoperative echocardiography. Conclusion: Early closure of VSD with patch is necessary in VSD with aortic valvular prolapse even in associated with mild regurgitation. But in moderate regurgitation, VSD closure with valvuloplasty is recommended.

배경: 전북대학교병원 흉부외과에서는 1989년에서 1996년 까지 심실 중격 결손증 164명중 대동맥판 탈출이 동반된 22명의 환자를 경험하였다. 대상 및 방법: 연령은 6개월에서 22세 까지고 평균연령은 7세였다. 22명중 13명은 남자, 9명은여자였다. Kirklin type I이 13명, Kirklin type II가 8명, Kirklin type I+II가 1명 이었다. 결과: 술전 심초음파 소견상 대동맥 판막 탈출이 10명, 대동맥 판막 탈출 및 폐쇄부전이 동반된 경우가 6명, 대동맥판 폐쇄부전의 소견만 보였던 경우도 2명에서 있었다. 나머지 4명에서는 술전 심초음파에서는 판막 탈출을 관찰하지 못하였으나 수술시야에서 발견되었다. 술전 평균 Qp/Qs, 수축기 폐동맥압, 수축기 우심실압은 1.48$\pm$0.42, 27.9$\pm$9.87, 32.9$\pm$10.87 mmHg였다. 수술 소견상 가장 많이 탈출된 판엽은 우관동맥판이었다. 수술방법은 모든 환자에서 patch 봉합술을 시행했고, 폐쇄부전과 판막의 하향 전위가 있던 2명에서는 판막 성형술을 시행하였다. 술후 시행한 장,단기 심초음파상 술전 대동맥판 폐쇄부전이 있던 8명의 환자에서 폐쇄부전이 개선되거나 더 이상 악화되지 않았다. 술전 판막탈출만 있었던 12명의 환자에서는 판막이상등 다른 이상 소견은 보이지 않았다. 결론: 대동맥판 탈출이 동반된 심실 중격 결손증에서는 조기에 포편봉합을 함으로 대동맥판 탈출이나 폐쇄부전의 진행을 개선할 수 있으며, 중등도의 대동맥판 폐쇄부전이 동반된 경우에는 판막 성형술이 고려되어야 할것으로 생각된다.

Keywords

References

  1. Les souffles de(a maladie de Roger). Rev Med Paris v.50 Traite des maladies Carpentales du Cocur Laubry C;Pezzi C;Laubry C;Rourier D;Soulie P
  2. Am J Cardiol v.5 ventricular septal defect with aortic insufficiency, Successful surgical correction of both defects by the transaortic approach Garamella JJ;Cruz AB;Heupel WH;Dahl JC;Jensen NK;Berman R
  3. Ann Thorac Surg v.17 Ventricular septal defect and aortic insufficiendy Sanfelippo PM;DuShane JW;McGoon DC;Danielson GK
  4. Circulation v.56 clinical course in ventricular septal defect Weidman WH;Blout SG;DuShane JW;Gersony WM;Hayes CJ;Nadas AS
  5. 대흉외지 v.16 대동맥판폐쇄부전이 동반된 심실중격결손증 수술지침 24례 보고 정경영;이두연;조범구;홍승록
  6. Jpn Circul J v.47 Echocardiographic evaluation of aortic cusp prolapse in children with ventricular septal defect Ueda T;Nishioka K;Mikawa H(et al)
  7. Ann Thorac Surg v.12 ventricular septal defect with aortic insuffiency Trasure RL;Hopeman AR;Jahnke EJ;Green DC;Czarneck SW
  8. J Thorac Cardiovasc Surg v.43 The treatment of aortic regurgitation associated with a ventricular septal defect Spencer FC;Bahnson HT;Neill CA
  9. J Thorac Surg v.43 ventricular septal defect and aortic insufficiency Moreno-Cabral RJ;Mamiya RT;Nakamura FF;Brainard SC;McNamaa JJ
  10. Heart disease in infancy and chidhood Ventricular septal defect Keith JD;Keith JD;Rowe RD;Viad P
  11. Surg. Gynecol Obstst v.111 Surgical collection of aortic insufficiency associated with ventricular septal defect Starr A;Menache V;Dotter C
  12. J Thorac Cardiovasc Surg v.86 Cardiac valve surgery. French correction Carpentier A
  13. J Thorc Cardiovasc Surg v.66 Repair of ventricular septal defect with aortic insufficiency Trusler GA;Moes CAF;Kidd BSL
  14. Jpn J Thorac Surg v.30 valvuloplastic surgery for aortic insufficiency with ventricular septal degect with special reference to long-term follow up study Tatsuta N;Yokota M;Noguchi K;Hikasa Y;Miki S;Minami K
  15. Ann Thorac Surg v.41 Reoperation after aortic valvuloplasty for aortic regurgitation associate with ventricular septal defect Shkita Y;Miki S;Kudsuhara K(et al)