Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Repair of Distal Aortic Arch and Descending Aorta Dissection under Right Atrium-Retrograde Cerebral Perfusion

우심방-역행성 뇌관류 하에 원위 대동맥궁 및 하행대동맥 박리증의 수술

  • 최종범 (원광대학교 의과대학 흉부외과학 교실) ;
  • 양현웅 (원광대학교 의과대학 흉부외과학 교실) ;
  • 박권재 (원광대학교 의과대학 흉부외과학 교실) ;
  • 임영혁 (조선대학교 의과대학 흉부외과학 교실)
  • Published : 2002.10.01
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Abstract

Retrograde cerebral perfusion under hypothermic circulatory arrest is a simple and useful adjunct to avoid cerebral ischemic injury in the treatment of aortic arch pathology. In the surgery of distal aortic arch and proximal descending aortic lesions through the left thoracotomy incision, right atrium-retrograde cerebral perfusion (RA-RCP) through a venous cannula positioned into the right atrium is simpler than retrograde cerebral perfusion through superior vena cava. The time limits for RA-RCP during aortic arch reconstruction have yet to be clarified. We, herein, present a case with uneventful recovery after RA-RCP of 94 minutes during reconstruction of aortic arch and descending aorta. These data suggest that RA-RCP, as an adjunct to hypothermic circulatory arrest, may prolong the circulatory arrest time and thus prevent ischemic injury of the brain, even when RA-RCP exceeds 90 minutes.

초저체온 하에 체외순환정지와 역행성 뇌관류는 대동맥궁 병변의 수술에서 뇌손상을 피하기 위해서 흔히 이용되는 수술과정이다. 좌측 개흉으로 원위 대동맥궁과 하행대동맥 병변을 수술할 때 역행성 뇌관류를 상대정맥으로 시행하기 어려울 경우 대퇴정맥에서 우심방으로 넣은 정맥 캐뉼라를 통해 전신정맥 관류를 시행하여 역행성 뇌관류(우심방-역행성 뇌관류)를 시행하는 것이 더 쉬운 방법일 수 있다 이러한 역행성 뇌관류 방법의 안전한 시간은 명확하지 않다. 저자들은 94분의 우심방-역행성 뇌관류 하에 대동맥궁 하행대동맥 병변을 수술하여 신경학적 이상 없이 환자를 회복시킬 수 있었다. 이 결과에서 초저체온의 순환정지 상태에서 90분 이상의 우심방-역행성 뇌관류로 뇌의 허혈을 극복할 수 있다고 생각된다.

Keywords

References

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