Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Echocardiographic Follow-up after Arterial Switch Operation for Transposition of the Great Arteries

동맥전환술을 시행한 대혈관전위 환자에서 심초음파를 이용한 술후 추적

  • 한승세 (영남대학교 의과대학 흉부외과학교실) ;
  • 정태은 (영남대학교 의과대학 흉부외과학교실) ;
  • 이동협 (영남대학교 의과대학 흉부외과학교실) ;
  • 오정훈 (영남대학교 의과대학 흉부외과학교실) ;
  • 이정철 (영남대학교 의과대학 흉부외과학교실)
  • Published : 2001.10.01
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Abstract

Background: To evaluate the efficacy of arterial switch operation for transposition of great arteries, serial echocardiographic studies were performed in 8 patients who underwent the surgery between 1989 and 1998 at Dept. of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital in Daegu City, Korea. Material and Method: Follow-up period ranged from 6 months to 11 years(average of 4.1 years). Body weight ranged from 2.6kg to 4.8kg, with average of 3.6kg. 5 of 8 patients were preoperatively diagnosed as TGA+VSD, and 3 as TGA+IVS. LV function was evaluated by the measurement of LV shortening fraction, LVSTI, and LVEF. RVSTI was also measured. Postoperative function of valve and growth of great vessels were analyzed by the measurement of PSPGV, valvular regurgitation, LA/AO ratio, root dimension of aorta and pulmonary artery, comparing with the age matched controls, respectively. Result: LVEF had an average of 65.0+9.03% which is tended to increase serially. LVAOPG had an average of 15.9mmHg. RVPAPG, 27.5mmHg. From the measurement of aortic root dimension of 6 patients at end-systole, aortic root growth was assumed to increase more than the mean value of normal growth. PA root dimension at end-systole showed a similar growth progress when compared with age matched normal controls. Postoperative pulmonic valve regurgitation was noted in 5 of total 8 patients, in which 1 patient who showed grade 2 and 4 showed below grade 1. AR, in 6 patients and all grade 1 Except 1 patient, all the valvular regurgitations were below grade 1, which was presumed to be clinically insignificant.

배경: 영낡치대 흥부외과학교실에서 1989년부터 1998년 사이에 대혈관전위로 동맥전환술을 받고 6개월 이상 추적관찰한 환자 8례를 대상으로, 동맥 전환술의 효용도를 평가하기 위해 반복적인 심초음파 검사를 시행한 후 그 자료를 후향적으로 분석하였다. 대상 및 방법: 추적관찰기간은 평균 4.1년이었고 최단 6개월에서 최장 11년이었다. 대성환자의 연령은 평균 29일(범위 3∼56일)이었고 체중은 평균 3.6kg(범위 2.6∼4.8kg)이었다. 술 전 진단은 TGA+VSD가 5례, TGA+IVS가 3례이었다. 좌심실 shortening fraction, 좌심실 수축기 시간간격(left ventricle systolic time interval, LVSTI), 우심실 수축기 시간간격(right ventricle systolic time interval, RVSTI), 그리고 좌심실구축률(EF)을 측정하여 좌심실의 기능을 평가하였다. 대동맥과 폐동맥의 최고 수축기압차 속도 (peak systolic pressure gradient velocity, PSPGV), 판막의 폐쇄부전상태, 좌심방/대동맥비(LA/Ao ratio), 대동맥과 폐동맥 근부의 크기, 등을 정상치와 비교하여 판막의 기능과 대혈관의 성장을 평가하였다. 결과: 좌심실구축률은 평균 65.0+9.03%이었으며 추적관찰 동안 시간이 경가함에 따라 대체로 증가하는 경향을 보였다. 좌심실상행대동맥압차는 평균 15.9mmHg이었고 우심실폐동맥압차는 평균 27.5mmHg이었다. 수축기말 대동맥근부 크기(aortic root dimension at end-systole)는 8례 중 6례에서 동일 연령군의 정상발육 평균치보다 발육이 증가하는 양상이었고 발육과정에 따라 증가하는 양상을 보였다. 수축기말 폐동맥 근부 크기(PA root dimension at end-systole)는 동일연령군의 정상발육 평균치와 비교할 때 비슷한 성장경과를 보였다. 술후 판막 폐쇄부전의 변동을 보면 폐동맥판막폐쇄부전은 8례 중 5례에서 있었고 1례에서 2도이었고 그 외는 1도 이하이었다. 대동맥판막폐쇄부전은 8례 중 술전 0도에서 술후 1도로 변동한 경우가 6례였다. 이상과 간이 폐쇄부전이 있더라도 대부분 1도 이하이었기 때문에 인상적인 의의는 없었다

Keywords

References

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