Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Analysis of Recurred Mitral Regurgitation after Mitral Repair according to Procedure or Valve Related Causes

승모판막 성형술 후 재발의 원인에 대해 술기와 판막 요인에 대한 분석

  • Shin Hong Ju (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Yoo Dong Gon (Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Lee Yong Jik (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Park Soon Ik (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Choo Suk Jung (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Song Hyun (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Chung Cheol Hyun (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Song Meong Gun (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine) ;
  • Lee Jae Won (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine)
  • 신홍주 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 유동곤 (강릉아산병원 흉부외과, 울산대학교 의과대학) ;
  • 이용직 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 박순익 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 주석중 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 송현 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 정철현 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 송명근 (서울아산병원 흉부외과, 울산대학교 의과대학) ;
  • 이재원 (서울아산병원 흉부외과, 울산대학교 의과대학)
  • Published : 2005.12.01
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Abstract

Background: Mitral valve repair (MVP) is the optimal procedure for mitral regurgitation (MR), however, failure and subsequent reoperations are the limitations. The current study assessed the procedure in relation to the primary valve related causes of recurrent MR. Material and Method: MR was treated in 493 patients undergoing MVP from January of 1994 to January of 2002. The causes of MR were degenerative $(n=252,\;51.5\%),$ rheumatic $(n=156,\; 31.6\%),$ and others $(n=85,\; 16.9\%).$ Surgery comprised 446 ring annuloplasties $(90.5\%),$ 227 new chordae formations $(46\%),$ 125 quadriangular resections $(25.3\%),$ 28 chordae transfers $(5.7\%),$ and 8 Alfieri's stitches $(1.6\%).$ The mean follow up was $29.04\pm22.81$ months. Result: There were 5 early $(1.01\%)$, and 5 late deaths $(1.01\%).$ The reoperation rate was $1.42\%$. There were 45 $(9.1\%)$ recurrent MR (grade III or IV). Of these, 24 were procedure related including incomplete repair (n=14), discordant new chordae length (n=8) and others (n=2). In 21 patients, the cause was valve related including rheumatic disease progression (n=10), recurrent chordae elongation or prolapse (n=5) and others (n=6). Severe MR was higher after incomplete repair (p < 0.001), and valve related failure strongly correlated with rheumatic progression (p < 0.05). Conclusion: Since completeness of operation is the prime risk factor that determine the repair durability, intra-operative assessment of the initial repair with trans-esophageal echocardiography is essential.

배경: 승모판막 성형술은 승모판막 폐쇄부전증에서 적절한 치료이지만 승모판막 폐쇄부전의 재발과 그에 따른 재수술이 제한점이다. 본 연구는 승모판막 성형술 후 재발의 원인에 대해 술기와 판막 요인에 대하여 분석하였다 대상 및 방법: 1994년 1월부터 2002년 1월까지 승모판막 폐쇄부전증으로 승모판막 성형술을 받은 493명을 대상으로 하였다. 승모판막 폐쇄부전의 원인으로는 퇴행성이 252예$(51.5\%)$, 류마티스성이 156예$(31.6\%)$, 다른 원인이 85예$(16.9\%)$였다. 성형술은 링을 사용한 판막륜성형술이 446예$(90.5\%)$, 신건삭 재건술이 227예$(46\%)$, 사각 절제술이 125예$(25.3\%)$, 건삭 전이술이 28예 $(5.7\%)$, Alfieri 방법이 8예$(1.6\%)$였다. 평균 추적 관찰 기간은 $29.04\pm22.81$개월이었다. 결과: 5예의 조기 사망$(1.01\%)$과 5예의 만기 사망$(1.01\%)$이 있었다. 재수술율은 $1.42\%$였다. 승모판막 폐쇄부전의 재발은 45예$(9.1\%)$에서 있었다. 24예에서 술기와 동반된 재발이 발생하였는데, 불완전한 성형술로 인한 재발이 14예, 신건삭 길이의 부적합으로 인한 재발이 8예, 기타 원인으로 인한 재발이 2예 있었다. 21예에서 판막 요인에 의한 재발이 발생하였는데, 류마티스성 질병 진행으로 인한 재발이 10예, 건삭의 연장이나 탈출로 인한 재발이 5예, 기타 원인으로 인한 재발이 6예 있었다. 심한 승모판막 폐쇄 부전은 불완전한 성형술 후 많이 나타났으며(p<0.001),판막 요인에 의한 재발은 류마티스성 진행과 강한 상관관계를 보였다(p<0.05). 결론: 승모판막 성형술의 내구성을 결정하는 위험 인자로 수술의 완전성이 가장 중요하므로, 초기 성형술 후 수슬장에서 경식도 초음파로 검사하는 것이 필수적이다.

Keywords

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