Journal of Chest Surgery

  • 제37권1호
  • /
  • Pages.50-55
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  • 2004
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

인공 기계 심장 판막 이식 환자에서 산소 흡입 중 미세색전 신호의 중요성

Significance of Microembolic Signals during Oxygen Inhalation in Patients with Prosthetic Mechanical Heart Valve

  • 조수진 (한림대학교 의과대학 신경과) ;
  • 나찬영 (부천세종병원 흉부외과) ;
  • 이은일 (고려대학교 의과대학 예방의학과) ;
  • 민양기 (한림대학교 의과대학 신경과) ;
  • 권기한 (한림대학교 의과대학 신경과) ;
  • 이정주 (부천세종병원 신경과) ;
  • 백만종 (부천세종병원 흉부외과) ;
  • 오삼세 (부천세종병원 흉부외과) ;
  • 홍석근 (부천세종병원 심장내과)
  • 발행 : 2004.01.01
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초록

배경: 경두개 초음파 검사는 색전의 위험이 있는 환자에서 미세색전 신호를 진단할 수 있다. 미세색전 신호의 임상적 중요성은 인공 기계 심장 판막 환자에서는 아직 증명되지 않았다. 우리는 인공 기계 심장 판막 수술 후의 뇌 혈전색전증과 산소 흡입 중 측정되는 미세색전 신호의 관련성을 연구하였다. 대상 및 방법: 인공 기계 심장 판막 수술 후 뇌 혈전색전증의 병력이 있는 20명의 환자군과 성별, 연령별로 일치시킨 30명의 대조군을 대상으로 연구하였다. 경두개 초음파 검사로 일측 중대뇌동맥을 감시하였다. 20분간의 기초 검사 후 40분 동안 100% 산소를 흡입하면서 검사하였다. 결과: 인공 기계 심장 판막의 수술 부위와 수술 후 기간은 환자군과 대조군의 차이가 없었다. 기초 검사 동안 측정된 미세색전 신호의 양성률과 빈도는 양 군 간의 차이가 없었다. 산소 흡입 중 환자군은 대조군에 비하여 미세색전 신호의 양성률이 높았고(55%, 27.6%, p=0.045), 미세색전 신호수도 흔하였다(p=0.027). 결론: 산소 흡입을 이용한 경두개 초음파 검사는 인공 기계 심장 판막 이식 환자에서 임상적으로 의미가 있는 미세색전의 감별에 도움이 된다.

Background: Transcranial Doppler ultrasonography (TCD) can detect microembolic signals (MES) in the patients with a potential embolic source. Clinical significance of MES has not been demonstrated in patients with prosthetic mechanical heart valves. We studied the correlation between cerebral thromboemoblic events after the mechanical heart valve surgery (MHVS) and residual MES during TCD monitoring with 100% oxygen inhalation in patients with mechanical heart valves. Material and Method: Twenty patients with previous cerebral thromboemoblic events after MHVS and a sex- and age-matched control group (n=30) were studied. TCD monitoring was performed from unilateral middle cerebral artery. After baseline monitoring for 20 minutes, 61 of oxygen was inspired for 40 minutes. Result: The site of valve and the duration after MHVS of the patients did not differ from those of controls. During baseline monitoring, there was no significant difference in MES prevalence or counts compared to controls. During oxygen inhalation, patients showed a higher MES prevalence (55%, 27.6%, p=0.045) and a more frequent MES counts (p=0.027) compared to controls. Conclusion: TCD monitoring with oxygen inhalation may be useful to differentiate clinically significant MES in patients with mechanical heart valve.

키워드

참고문헌

  1. J Neurol Sci v.122 Detection of circulating cerebral embolism using Doppler ultrasound in a sheep model Markus,H.;Loh,A.;Brown,M.M. https://doi.org/10.1016/0022-510X(94)90061-2
  2. J Neurol Sci v.136 Cardiac microembolism: prevalence and clinical outcome Eicke,B.M.;Barth,V.;Kukowski,B.;Werner,G.;Paulus W. https://doi.org/10.1016/0022-510X(95)00299-H
  3. Korean J Thorac Caidiovasc Surg v.36 Changes of microembolic signals after heart valve surgery Cho,S.J.;Lee,E.;Back,M.J.;OH,S.S.;Na,C.Y.
  4. Eur J Cardiothorac Surg v.22 Clinical relevance of microembolic signals in patients with prosthetic heart valves Georgiadis,D.;Studer,A.;Baumgartner,R.W.;Zerkowski,H.R. https://doi.org/10.1016/S1010-7940(02)00333-0
  5. Eur J Cardiothorac Surg v.21 Clinical relevance of intracranial high intensity transient signals in patients following prosthetic aortic valve replacement Kofidis,T.;Fischer,S.;Leyh,R.(et al.) https://doi.org/10.1016/S1010-7940(01)01064-8
  6. J Neuroimgaing v.12 Is cerebral microembolism in mechanical prosthetic heart valves clinically relevant? Nadareishvili,Z.G.;Beletsky,V.;Black,S.E.(et al.) https://doi.org/10.1111/j.1552-6569.2002.tb00138.x
  7. Stroke v.28 Oxygen inhalation differentiate gaseous from nongaseous microemboli detected by transcranial Doppler ultrasound Droste,D.W.;Hansberg,T.;Kemedy,V.(et al.) https://doi.org/10.1161/01.STR.28.12.2453
  8. Stroke v.28 Influence of oxygen ventilation on Doppler microemboli signals in patients with artificial heart valves Georgiadis,D.;Wenzel,A.;Lehman,D.(et al.) https://doi.org/10.1161/01.STR.28.11.2189
  9. Stroke v.26 Consensus committee of the ninth international cerebral hemodynamics symposium. Basic identification of Doppler microembolic signals https://doi.org/10.1161/01.STR.26.6.1123
  10. Stroke v.29 International Consensus Group on Microembolus Detection. Consensus on microembolic detection by TCD https://doi.org/10.1161/01.STR.29.3.725
  11. Stroke v.27 How good is interdot agreement in the identification of embolic signals in carotid artery disease? Markus,H.;Bland,J.M.;Rose,G.;Sitzer,M.;Siebler,M. https://doi.org/10.1161/01.STR.27.7.1249
  12. Stroke v.30 Asymptomatic embolization predicts stroke and TIA risk in patients 11. with corotid stenosis Molloy,J.;Markus,H.S. https://doi.org/10.1161/01.STR.30.7.1440
  13. Cerebrovasc Dis v.10 Microembolic signal monitoring in hemispheric acute ischaemic stroke: a prospective study Serena,J.;Segura,T.;Castellanos,M.;Davalos,A. https://doi.org/10.1159/000016070
  14. Stroke v.29 Clinical correlations of Doppler microembolic signals in patients with prosthetic cardiac valves Sliwka,U.;Geogiadis,D. https://doi.org/10.1161/01.STR.29.1.140
  15. J Heart Valve Dis v.6 Time course of high-intensity transient signals in patients undergoing elective heart valve replacement: a prospective study Linder,A.;Georgiadis,D.;Luhmann,A.(et al.)
  16. Stroke v.26 Incidence and frequency of cerebral embolic signals in patients with a similar bileaflet mechanical heart valve Braekken,S.K.;Russell,D.;Brucher,R.;Svennevig,J.
  17. J Am Soc Echocardiogr v.11 Effect of blood and microbubble oxygen and nitrogen on perfluorocarbon-filled dextrose albumin microbubble and efficacy: in vitro and in vivo studies Porter,T,;Kricsfeld,D.;Cheatham,S.;Li,S. https://doi.org/10.1016/S0894-7317(98)70020-3
  18. J Thorac Cardiovasc Surg v.122 Microembolic signals counts increase during hyperbaric expose in patients with prosthetic heart valve Baumgartner,R.W.;Frick,A.;Kremer,C.(et al.) https://doi.org/10.1067/mtc.2001.117282
  19. J Cardiovasc Surg v.39 Intracranial high-intensity transient signals after homograft or mechanical aortic valve replacement Lievense,A.M.;Bakker,S.L.M.;Dippel,D.W.J.;Taams,M.A.;Koudstaal,P.J.;Bogers,A.J.J.C.