Changes of Microembolic Signals after Heart Valve Surgery

심장 판막 수술 후 미세색전의 변화

  • 조수진 (한림대학교 의과대학 한강성심병원 신경과) ;
  • 이은일 (고려대학교 의과대학 예방의학과) ;
  • 백만종 (부천세종병원 흉부외과) ;
  • 오삼세 (부천세종병원 흉부외과) ;
  • 나찬영 (부천세종병원 흉부외과)
  • Published : 2003.05.01

Abstract

Background: The detection of circulating microemboli by transcranial Doppler ultrasonography (TCD) has the potential to select the patients with high risk for future symptomatic brain embolism. We prospectively evaluated the positive rate and the frequency of microembolic signals (MES) before and after the heart valve surgery (HVS). Material and Method: Fifty in-patients with heart valve disease were enrolled in this study. Patients with history of previous stroke or heart valve surgery were excluded. Two unilateral TCD monitoring sessions were peformed from middle cerebral artery for 1-hour, before and after HVS. Result: Mechanical Heart valves were implanted in 28 patients, tissue valves were implanted in 10 patients, and remaining 12 patients received mitral valve repair. Positive rate of MES was significantly increased after HVS (50%), compared to that of before HVS (8%, p=0.00). There was no relation between MES after HVS and intensity of anticoagulation, cardiac rhythm, patients' age, and history of hypertension. The positive rate of MES after implantation of mechanical heart valve (71.4%) was significantly higher than those after implantation of tissue valve or mitral valve plasty (p=0.002). Conclusion: Positive rate of MES was increased significantly after the implantation of HVS. The changes of MES in those with mechanical prosthesis may be related to the increased risk or embolism after Hvs.

배경: 경두개 초음파 검사에 의한 미세색전의 진단은 향후 뇌색전증의 위험이 높은 환자의 선별에 큰 도움이 되리라 기대된다. 우리는 전향적으로 심장 판막 수술 전과 후의 미세색전의 양성률과 빈도를 검사하였다. 대상 및 방법: 심장 판막 질환이 있는 50명의 환자를 대상으로 본 연구는 진행되었다. 뇌경색의 병력이 있거나, 과거에 인공 기계 심장 판막 수술을 받은 환자는 본 연구에서 제외하였다. 경두개 초음파 검사는 중대뇌동맥에서 1시간 동안 미세색전을 감시하였고, 수술 전과 수술 후 2차례 검사하였다. 결과: 기계 심장 판막 수술은 28명, 조직 판막 수술은 10명, 승모판막 성형술은 12명에서 시행되었다. 미세색전의 양성률은 수술 전(8%)에 비하여 수술 후(50%)에 의미 있게 증가하였으며 (p=0.00), 미세색전은 항응고제 강도, 심장 부정맥, 환자의 연령, 고혈압의 병력과 관련성이 없었다. 기계 심장 판막 이식수술 후 미세색전의 양성률(71.4%)은 조직 판막 이식수술(10%)이나 승모판막 성형술(33.3%)에 비하여 의미 있게 높았다(p=0.002). 결론: 미세색전은 심장 판막 수술 후 의미 있게 증가하며 이러한 변화는 인공 기계 심장 판막 수술 후 색전증의 위험과 관련되어 있다고 추정된다.

Keywords

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