Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Experience of Reoperation after Valve Replacement Using Mechanical Heart Valve -8 cases -

기계판막을 이용한 판막치환술 후 재수술에 대한 경험 -8예 보고-

  • Kim Hyuck (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Lee Hyung Chang (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Wee Jang Seop (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Kang Jung Ho (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Chung Won Sang (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Chon Sun Ho (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Lee Chul Bum (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Kim Young Hak (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University)
  • 김혁 (한양대학교 의과대학 흉부외과학교실) ;
  • 이형창 (한양대학교 의과대학 흉부외과학교실) ;
  • 위장섭 (한양대학교 의과대학 흉부외과학교실) ;
  • 강정호 (한양대학교 의과대학 흉부외과학교실) ;
  • 정원상 (한양대학교 의과대학 흉부외과학교실) ;
  • 전순호 (한양대학교 의과대학 흉부외과학교실) ;
  • 이철범 (한양대학교 의과대학 흉부외과학교실) ;
  • 김영학 (한양대학교 의과대학 흉부외과학교실)
  • Published : 2005.11.01
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Abstract

Eight patients underwvnt reoperation after valve replacement surgery with a mechanical valve from January, 1992 to December, 2003. Among the various indications for reoperation, there were 4 patients with paravalvular leakage; 3 patients underwent resuturing of the area of leakage and one patient underwent redo valve replacement. Among the three patients with stenosis due to thrombosis of the valve, 2 patients underwent redo valve replacement and one patient underwent thrombectomy. In one patient, the valve functioned normally, but stenosis was caused by overgrowth of the patient and redo valve replacement was done 123 months later. There was no postoperative mortality or morbidity. After an average of 51 months ($2\~134$ months) of postoperative follow up, the patients were in good condition and were able to maintain a NYHA functional class of I or II. The operative method used, whether it be a redo valve replacement or valve sparing method, depends upon the type of lesion and the anatomic structure.

1992년 1월부터 2003년 12월까지 8명의 환자에서 기계판막을 사용한 판막치환술 후 재수술이 시행되었다. 판막주위누출이 원인인 4예에서는 누출부 재봉합술 3예, 판막재치환술 1예가 시행되었다 판막의 혈전에 의한 폐쇄가 원인인 3예에서는 판막재치환술 2예, 혈전제거술 1예가 시행되었다. 1명의 환자는 판막기능은 정상이었으나 환자의 성장에 따른 협착소견으로 123개월 후 재치환술을 시행하였다. 수술과 관련된 사망이나 합병증은 발생하지 않았으며 평균 51.0 $(2\~134)$개월의 추적관찰에서 NYHA 기능성분류 I 또는 II로 양호한 경과를 나타내었다 수술방법으로써 판막의 재치환 또는 기존판막을 보존하는 방법을 시행할지의 여부는 병변의 종류와 해부학적 구조에 따라 선택적으로 시행할 수 있을 것으로 생각한다.

Keywords

References

  1. Schoen FC, Hobson CE. Anatomic analysis of removed prosthetic heart valves 1980 to 1983. Hum Pathol 1985; 16:549-59 https://doi.org/10.1016/S0046-8177(85)80103-9
  2. Okita Y, Miki S, Kushura K, et al. Intractable hemolysis caused by perivalvular leakage following mitral valve replacement with St.Jude medical prosthesis. Ann Thorac Surg 1988:46:88-92
  3. Genoni M, Franzen D, Vogt P, et al. Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery? Eur J Cardiothorac Surg 2000;17: 14-9 https://doi.org/10.1016/S1010-7940(99)00358-9
  4. Martinell J, Frail J, Artiz V, Cortina J, Frasneda P, Rabago G. Reoperations for left-sided low-profile mechanical prosthetic obstructions. Ann Thorac Surg 1987;43:172-5 https://doi.org/10.1016/S0003-4975(10)60390-6
  5. Renzulli A, De Luca L, Caruso A, Verde R, Galzerano D, Cortufo M. Acute thrombosis of prosthetic valve; a multivariate analysis of the risk factors for a lifethreatening event. Eur J Cardiothorac Surg 1992;6:412-21 https://doi.org/10.1016/1010-7940(92)90065-6
  6. Formolo JM, Reyes P. Refractory hemolytic anemia secondary to perivalvular leak diagnosed by transesophageal echocardiography. J Clin Ultrasound 1995;23:185-8 https://doi.org/10.1002/jcu.1870230307
  7. Montero CG, Mula N, Burgos R, Padras R, Figuera D. Throm-bectomy of the Bjork-Shiley prosthetic valve revisited: long- term result. Ann Thorac Surg 1989;48:824-8 https://doi.org/10.1016/0003-4975(89)90678-4
  8. Tasi KT, Lin PJ, Chang CH, et al. Surgical management of thrombotic disc valve. Ann thorac Surg 1993;55:98-101 https://doi.org/10.1016/0003-4975(93)90481-V