Journal of Chest Surgery

  • 제38권3호
  • /
  • Pages.221-228
  • /
  • 2005
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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

대동맥판막 질환과 동반된 상행대동맥 확장에 대한 봉합봉축법에 의한 대동맥 축소성형술

Reduction Aortoplasty with Suture Plication Technique for Dilatation of the Ascending Aorta associated with Aortic Valve Disease

  • 나찬영 (부천세종병원 흉부외과) ;
  • 오삼세 (부천세종병원 흉부외과) ;
  • 이창하 (부천세종병원 흉부외과) ;
  • 황성욱 (부천세종병원 흉부외과) ;
  • 이철 (부천세종병원 흉부외과) ;
  • 임홍국 (부천세종병원 흉부외과) ;
  • 김재현 (부천세종병원 흉부외과) ;
  • 서홍주 (부천세종병원 흉부외과) ;
  • 김근직 (부천세종병원 흉부외과) ;
  • 백만종 (부천세종병원 흉부외과)
  • Na Chan-Young (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Oh Sam-Sae (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Lee Chang-Ha (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Whang Seong Wook (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Lee Cheol (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Lim Hong Gook (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim Jae Hyun (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Seo Hong Ju (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim Gun Gyk (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Baek Man-Jong (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute)
  • 발행 : 2005.03.01
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초록

대동맥 축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 수술치료의 한 방법이라고 주장되어 왔다. 저자들은 대동맥판막치환술과 동반 시행한 상행대동맥의 변형 축소성형술에 대한 결과에 대해 알아보았다. 대상 및 방법: 2001년 7월부터 2002년 12월까지 상행대동맥벽의 절제 없이 봉합봉축법에 의한 변형 대동맥 축소성형술을 받은 14명의환자들을 대상으로 하였다. 평균 연령은 63.7$\pm$6.7세(50$\~$75세)였다. 10명의 환자에서 이엽성 대동맥판막이 동반되었다. 10명에서 심한 대동맥판막 협착을 보였으며 6명에서는 III-lV도의 대동맥판막폐쇄부전이 동반되었다. 상행대동맥의 직경은 수술 전과 후 그리고 6개월과 12개월 후에 심장초음파 및 컴퓨터 단층촬영으로 측정하였다. 술 후 평균 추적기간은 14.7$\pm$5.4개월(7$\~$24개월)이었으며 모든 7환자에서 추적이 가능하였다. 결과: 술 후 조기 사망이나 출혈과 같은 합병증은 없었다. 봉합봉축법에 의한 대동맥 축소성형술 후 상행대동맥의 직경은 술 전 49.4$\pm$3.5 mm에서 술 후 33.2$\pm$3.4 mm (P<0.001)로 감소하였다. 추적기간동안 만기 사망이나 상행대동맥의 재확장은 없었다. 결론: 대동맥벽의 절제없이 봉합봉축법에 의한 변형 대동맥축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 양호한 조기 및 중기성적을 보였다. 하지만 본 방법들 사용한 환자들에 대한 장기 추적결과에 추가적인 연구가 필요하리라 생각한다.

Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. Material and Method: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7$\pm$6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve, Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III$\~$IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7$\~$5.4 (7 to 24) months. Result: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4$\pm$3.5 mm preoperatively to 33.2$\pm$3.4 mm postoperatively (p <0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. Conclusion: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.

키워드

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