Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Effects of Pulmonary Thromboendarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

만성 혈전색전성 폐고혈압 환자에서 폐동맥 혈전내막제거술의 효과

  • Kim, Hyun Kuk (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Suck Chan (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Sang-Bum (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Oh, Yeon-Mok (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lim, Chae-Man (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Koh, Younsuck (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Woo Sung (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Dong Soon (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Won Dong (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sang-Do (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 김현국 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 홍석찬 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 이재원 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 내과학교실)
  • Received : 2005.08.22
  • Accepted : 2005.09.29
  • Published : 2005.12.30
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Abstract

Background : Bilateral pulmonary thromboendarterectomy(PTE) is recognized as the definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We investigated the symptomatic, hemodynamic and prognostic effects of PTE in comparison with medical treatment. Methods : Twenty-four patients diagnosed with CTEPH from 1995 to 2003 at the Asan Medical Center were divided into two groups: patients treated with PTE(PTE group, n=12) and those not treated with PTE(Med group, n=12). The serial changes in dyspnea, the tricuspid regurgitation maximal velocity (TRVmax) and survival of the PTE and Med groups were compared retrospectively. Results : In PTE group, during a follow-up period of 1 year, the New York Heart Association(NYHA) functional class significantly improved, while there was no significant improvement in the Med group. PTE significantly lowered the TRVmax from $4.23{\pm}0.54m/sec$ to $3.22{\pm}0.70m/sec$ over a follow up period of 2 years. (p=0.028) However, the TRVmax in the medically treated group did not show any significant improvement, changing from $3.98{\pm}0.68m/sec$ to $4.27{\pm}0.95m/sec$ during 1 year. The 5-year survival of the PTE group was 77.9% compared with 64.3% in the medically treated group. Conclusion : PTE provides substantial long-term improvement in dyspnea and the echocardiographic changes compared with medically treated patients.

배 경 : 만성 혈전색전성 폐고혈압(chronic thromboembolic pulmonary hypertension, CTEPH)의 치료에 약물치료를 포함한 고식적인 방법으로는 예후를 호전시킬 수 없고 폐동맥 혈전내막제거술(pulmonary thromboendarterectomy, PTE)을 통해서 증상과 혈역학적 호전 및 생존율의 향상을 기대할 수 있다. 이에 저자들은 PTE에 의한 효과를 고식적인 치료를 받은 환자들과 비교 분석하고자 하였다. 방 법 : 1995년부터 2003년까지 서울아산병원에서 CTEPH으로 진단 받은 24명의 환자를 대상으로 후향적으로 연구를 진행하였다. PTE를 시행 받았던 12명과 수술을 시행 받지 않았던 12명의 환자의 시간경과에 따른 호흡곤란 및 심초음파상 삼첨판역류 최고속도의 변화와 생존율을 비교분석 하였다. 결 과 : 호흡곤란은 수술군에서 1년후에는 통계적으로 유의하게 호전되었지만 비수술군에서는 유의한 호전은 없었다. 삼천판역류최고속도는 수술군에서 수술전 $4.23{\pm}0.54m/sec$에서 수술 1년후 및 2년후에는 각각 $3.23{\pm}0.77m/sec$와 $3.22{\pm}0.70m/sec$로 감소하였으나 비수술군에서는 진단시에는 $3.98{\pm}0.68m/sec$에서 진단 1년후에는 $4.27{\pm}0.95m/sec$로 변화가 없었다. 5년 생존율은 수술군과 비수술군이 각각 77.9%와 64.3%였으나 통계적으로 유의하지는 않았다. 결 론 : CTEPH은 비수술군에 비해 수술군에서 의미있는 증상 및 혈역학적 호전을 장기적으로 가져오므로 수술환자의 선택에 있어서 절대적 금기가 없다면 가능한 한 수술을 시행하는 것이 본 질환의 치료에 중요할 것으로 사료된다.

Keywords

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