Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Treatment of Pulmonary Hypertensive Crisis Using ECMO - A Case Report -

성인의 선천성 심질환 수술 후 발생한 폐동맥 고혈압 위기증에서 체외막 산소화 장치를 이용한 치험 - 1례 보고 -

  • 최재성 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김기봉 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Published : 2002.09.01
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Abstract

Extracorporeal membrane oxygenation(ECMO) provides stable oxygenation to prevent elevation of pulmonary vascular resistance and bypasses a significant part of cardiac output to the pulmonary vascular bed to reduce pulmonary perfusion pressure. In addition, ECMO prevents right heart failure and low cardiac output by means of ventricular assist and reduction in volume load to right ventricle. As a result, ECMO can be used for the treatment of pulmonary hypertensive crisis after surgery for congenital heart disease, especially when it is refractory to conventional measures. We report a case of postoperative pulmonary hypertensive crisis, developed in a 37-year-old male with patent ductus arteriosus with secondary pulmonary hypertension, which was successfully managed including ECMO.

선천성 심질환에 대한 개심술후 발생한 폐동맥 고혈압 위기증이 혈관확장제 등의 내과적 치료에 반응하지 않는 경우에 체외막 산소화 장치를 사용함으로써, 안정적인 산소공급의 확보를 통한 폐혈관 저항의 상승 방지, 심박출량의 상당 부분의 바이패스를 통한 폐관류압의 감소, 우심실의 용적 부하 감소 및 심실보조 기능을 통한 우심부전 및 저심박출의 예방 등의 치료 효과를 기대할 수 있다. 본 증례의 경우, 동맥관 개존증과 이차성 폐동맥 고혈압이 합병되어 있었던 37세 남자에서 수술후 발생한 폐동맥 고혈압 위기증에 대한 치료시 체외막 산소화 장치를 함께 사용하여 좋은 결과를 얻었기에 보고하는 바이다.

Keywords

References

  1. Eur J Cardiothorac Surg v.7 Salvage of postoperative pulmonary hypertensive crisis wsng ECMO via cervical cannulation in a case of truncus arteriosus Pearson GA;Sosnowski A;Chan KC;Firmin RK https://doi.org/10.1016/1010-7940(93)90073-K
  2. Eur J Cardiothorac Surg v.9 Extracorporeal membrane oxygenation and the treatment of critical pulmonary hypertension in congenital heart disease disease Dhillon R;Pearson GA;Firmin RK;Chan KC;Leanage R https://doi.org/10.1016/S1010-7940(05)80004-1
  3. Ann Thorac Surg v.71 When to discontinue extracorporeal membrane oxygenation for postcardiotomy support Fiser SM;Tribble CG;Kaza AK(et al.) https://doi.org/10.1016/S0003-4975(00)02340-7
  4. Eur J Cardiothorac Surg v.21 Bilateral lung transplantation with intra- and postoperatively prolonged ECMO support in patients with pulmonary hypertension Pereszlenyi A;Lang G;Steltzer H(et al.) https://doi.org/10.1016/S1010-7940(02)00058-1
  5. Ann Thorac Surg v.68 Extracorporeal membrane oxygenation for adult cardiac support : The Allegheny experience Magovern GJ;Simpson KA https://doi.org/10.1016/S0003-4975(99)00581-0
  6. HURST's The Heart.(9th ed.) Pulmonary hypertention Fisherman AP;Alexander RW(ed.);Schlant RC(ed.);Fuster V(ed.)
  7. Circulation v.80 Primary Pulmonary Hypertension : Vascular Structure, Morphometry, and Responsiveness to Vasodilator Agents Palevsky HI;Schloo BL;Pietra GG(et al.) https://doi.org/10.1161/01.CIR.80.5.1207
  8. Circulation v.70 Primary pulmonary hypertension : Natural history and the importance of thrombosis Fuster V;Steele PM;Edwards WD;Gersh BJ;McGoon MD;Frye RL https://doi.org/10.1161/01.CIR.70.4.580