Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Mitral Valve Repair for Active and Healed Endocarditis

급성 혹은 치유된 심내막염 환자에서의 승모판막성형술

  • Baek, Man-Jong (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Na, Chan-Young (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Oh, Sam-Sae (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Kim, Woong-Han (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Whang, Sung-Wook (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Lee, Cheol (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Kang, Chang-Hyun (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Chang, Yun-Hee (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Jo, Won-Min (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Kim, Jae-Hyun (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Seo, Hong-Ju (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon) ;
  • Kim, Wook-Sung (Dept. of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University) ;
  • Lee, Young-Tak (Dept. of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Chong-Whan (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon)
  • 백만종 (부천세종병원 흉부외과, 심장연구소) ;
  • 나찬영 (부천세종병원 흉부외과, 심장연구소) ;
  • 오삼세 (부천세종병원 흉부외과, 심장연구소) ;
  • 김웅한 (부천세종병원 흉부외과, 심장연구소) ;
  • 황성욱 (부천세종병원 흉부외과, 심장연구소) ;
  • 이철 (부천세종병원 흉부외과, 심장연구소) ;
  • 강창현 (부천세종병원 흉부외과, 심장연구소) ;
  • 장윤희 (부천세종병원 흉부외과, 심장연구소) ;
  • 조원민 (부천세종병원 흉부외과, 심장연구소) ;
  • 김재현 (부천세종병원 흉부외과, 심장연구소) ;
  • 서홍주 (부천세종병원 흉부외과, 심장연구소) ;
  • 김욱성 (인제대학교 의과대학 일산백벽원 흉부외과) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김종환 (부천세종병원 흉부외과, 심장연구소)
  • Published : 2003.11.01
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Abstract

Background: Mitral valve repair rather than replacement for mitral regurgitation (MR) offers a number of well-accepted benefits. However, the surgical results of repair for mitral valve endocarditis remain largely unknown. Material and Method: Fourteen patients who underwent mitral valve repair for MR caused by mitral valve endocarditis from April 1995 through October 2001 were reviewed retrospectively. There were 9 male patients and mean age was 32$\pm$10 years. Four patients had previous embolism and 2 had active infections. The grade of MR were III in 6 patients and IV in 8. Operatively, mitral annuloplasty was performed in 12 patients and various valvuloplasty techniques were applied in all patients. One patient had immediate valve replacement due to residual MR after weaning of cardiopulmonary bypass. Result: There was no early operative death. Early postoperative transthoracic echocardiography revealed no or grade I of MR and no or mild mitral stenosis in 13 patients. After the mean follow-up of 36 months, there was no late death, and no or grade I of MR in 11 patients (84.6%) and no or mild mitral stenosis in 12 patients (92.3%). Reoperation required in one patient (7.1%). The cumulative freedom from recurrent MR and valve-related reoperation at 5 years were 91$\pm$9% and 75$\pm$22%, respectively. Conclusion: This study suggests that mitral valve repair for mitral regurgitation caused by endocarditis offers good early and intermediate survival and functional improvement without reinfection, and it is an attractive alternative to valve replacement in selective patients with bacterial endocariditis.

승모판막폐쇄부전에 대한 판막성형술은 치환술에 비해 많은 장점들이 있다 하지만 심내막염으로 인한 승모판막폐쇄부전에 대한 성형술 결과에 대한 연구보고는 잘 알려져 있지 않다. 대상 및 방법: 1995년 4월부터 2001년 10월까지 급성 혹은 치유된 심내막염으로 발생한 승모판막폐쇄부전으로 판막성형술을 받은 14명의 환자를 대상으로 후향적으로 조사하였다. 남녀비는 9 : 5이었고 평균 연령은 32$\pm$10세였다. 과거에 색전증은 4명에서 있었으며 2명은 급성심내막염 상태에서 수술을 하였다. 승모판막폐쇄부전은 III도가 6명, IV도가 8명 이었다. 시행된 승모판성형술로는 판륜성형술이 12명에서 판첨성형술은 14명에서 시행되었다 한 명은 술후 경식도초음파 검사에서 승모판폐쇄부전이 II도 이상으로 관찰되어 판막치환술을 시행하였다. 결과: 조기사망은 없었으며 승모판막폐쇄부전은 13명 모두 0-I도를 승모판협착은 13명에서 경도 이하 상태였다. 35$\pm$22개월을 추적조사한 결과 만기사망은 없었다. 승모판막폐쇄부전은 11명(84.6%)에서 0-I도를, 승모판협착은 12명(92.3%)에서 경도 이하 상태였다. 재수술은 한 명(7.1%)에서 수술 47개월 후 승모판 및 대동맥판폐쇄부전으로 이중판막치환술이 필요하였다. 5년 후 승모판막폐쇄부전 재발 및 재수술로부터의 자유도는 각각 91$\pm$9%와 75$\pm$22%였다. 결론: 심내막염으로 인한 심한 승모판막폐쇄부전에서 판막성형술은 양호한 조기 및 중기 생존율과 감염의 재발 없이 현저한 증상 호전을 보이며, 일부 선택된 심내막염성 승모판막폐쇄부전 환자들에서 성형술은 좋은 치료방법의 하나라고 생각한다.

Keywords

References

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