Journal of Chest Surgery

  • 제39권6호
  • /
  • Pages.434-439
  • /
  • 2006
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

대동맥궁 이상이 동반된 선천성 심장병에서 국소 순환을 이용한 일차 완전 교정

One Stage Total Repair of the Aortic Arch Anomaly using the Regional Perfusion

  • 장우성 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 임청 (서울대학교 분당병원 흉부외과) ;
  • 임홍국 (부천세종병원 흉부외과) ;
  • 민선경 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 곽재건 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 정의석 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김동진 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김웅한 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Jang Woo-Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Lim Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lim Hong-Kook (Department of Thoracici and Cardiovascular Surgery, Sejong General Hospital) ;
  • Min Sun-Kyung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Kwak Jae-Kun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Chung Eui-Seuk (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Kim Dong-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Kim Woong-Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
  • 발행 : 2006.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

배경: 대동맥궁 이상 수술 시 완전 순환정지 방법은 신경학적 문제나 심근의 손상을 줄 수 있다. 이를 피하기 위해서 저자들은 대동맥궁 이상이 동반된 선천성 심장병 수술 시 뇌 및 심장의 국소 관류법을 사용하고 있으며 이번 조사를 통하여 그 결과를 알아보고자 한다. 대상 및 방법: 2000년 3월부터 2004년 12월까지 대동맥궁 이상이 동반된 선천성 심장병으로 양심실 일차 완전 교정을 시행한 62명의 신생아 및 영아를 대상으로 하였다. 대동맥궁 이상은 축착이 46명, 대동맥 단절이 12명, 좌심실 저형성 증후군 2명, 총동맥관 2명이었으며 동반된 심기형은 심실중격 결손 51명, 총정맥 환류 이상 1명, 부분 정맥 환류 이상 1명, 방실 중격 결손 2명 있었다. 수술시 대동맥궁 기형 교정하는 동안 모든 환자에서 무명동맥과 관상 동맥 혈류를 유지하였다 결과: 국소 관류 시간은 평균 $28{\pm}10$분이었다. 수술 사망은 없었고, 평균 11개월의 관찰 기간동안 1명의 만기 사망(1.6%)이 있었다. 술 후 신경계 합병증은 1명에서 일시적인 무도증이 발생한 것 외에는 없었다. 대동맥궁 기형 교정과 관계된 재수술은 없었다. 1명에서 대동맥궁 기형 교정과 관계되어 기관지 합병증이 발생하였으며 대동맥고정(aortopexy)으로 교정되었다. 결론: 국소 순환법을 이용한 대동맥궁 기형 교정 방법은 완전 순환 정지사용 시 야기될 수 있는 신경 및 심근의 손상을 최소화 할 수 있는 방법이다.

Background: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. So we surveyed if the regional cerebral and myocardial perfusion might eliminate those potential side effects. Material and Method: From March 2000 to December 2004, 62 neonates or infants with aortic arch anomaly underwent one stage biventricular repair using the regional perfusion technique by single surgeon. Preoperative diagnosis of the arch anomaly consisted of coarctation (n=46), interruption of the aorta (n=12), hypoplastic left heart syndrome (n=2) and truncus areteriosus (n=2). Combined anomalies were ventricular septal defect (n=51), TAPVR (n=1), PAPVR (n=1) and atrioventricular septal defect (n=2). Arterial cannula was inserted at the innominate artery. Result: The mean regional perfusion time of brain was $28{\pm}10min$. Operative mortality rates was 0 (0/62). Late death was 1 (1/62) during $11{\pm}7$ months of follow-up. Neurologic complications consisted of transient chorea in 1 case. There was no reoperation associated with arch anolamy. Pulmonary complication associated with arch repair occurred in f case which was managed by aortopexy. Conclusion: One-tage rch repair using the regional profusion is safe and effective in minimizing the neurologic and myocardial complications.

키워드

참고문헌

  1. Greeley WJ, Kern FH, Ungerleider RM, et al. The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children. J Thorac Cardiovasc Surg 1991;101:783-94
  2. Newburger JW, Jonas RA, Wemovsky G, et al. A comparison of the perioperative neurobgic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 1993;329:1057-64 https://doi.org/10.1056/NEJM199310073291501
  3. Oates RK, Simpson JM, Turnbull JAB, Cartmill TB. The relationship between intelligence and duration of circulatory arrest with deep hypothermia. J Thorac Cardiovasc Surg 1995;110:786-92 https://doi.org/10.1016/S0022-5223(95)70112-5
  4. Asou T, Kado H, Imoto Y, et al. Selective cerebral perfusion technique during aortic arch repair in neonates. Ann Thorac Surg 1996;61:1546-8 https://doi.org/10.1016/0003-4975(96)80002-S
  5. Bellinger DC, Jonas RA, Rappaport LA, et al. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 1995;332:549-55 https://doi.org/10.1056/NEJM199503023320901
  6. Glauser TA, Rorke LB, Weinberg PM, Clancy RR.Acquired neuropathologic lesions associated with the hypoplastic left heart syndrome. Pediatrics 1990;85 :991-1000
  7. Newberger JW, Jonas RA, Wemovsky G, et al. A comparison of the perioperative effects of hypothermic circulatoryarrest versus low flow cardiopulmonary bypass. N Engl J Med 1993;329:1057-64 https://doi.org/10.1056/NEJM199310073291501
  8. Hickey PR. Neurologic sequelae associated with deep hypothermic circulatory arrest. Ann Thorac Surg 1998;65:S65-70 https://doi.org/10.1016/S0003-4975(97)01185-5
  9. Kern FH, Ungerleider RM, Reves JG, et al. The effect of altering pump flow rate on cerebral blood flow and metabolism in infants and children. Ann Thorac Surg 1993;56: 1366-72 https://doi.org/10.1016/0003-4975(93)90683-9
  10. Pigula FA, Gandhi SK, Siewers RD, Davis PJ, Webber SA, Nemoto EM. Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery. Ann Thorac Surg 2001;72:401-6 https://doi.org/10.1016/S0003-4975(01)02727-8
  11. Jonas RA, Wernovsky G, Ware J, et al. The Boston circulatory arrest study: perioperative neurologic and developmental outcome after the arterial switch operation. Circulation 1992;86(Suppl):1360
  12. Hickey PR. Neurologic sequelae associated with deep hypothermia circulatory arrest. Ann Thorac Surg 1998;65:S65-70 https://doi.org/10.1016/S0003-4975(97)01185-5
  13. Pigula FA, Siewers RD, Nemoto EM. Regional perfusion of the brain during neonatal aatic arch reconstruction. J Thorac Cardiovasc Surg 1999;117:1023-4 https://doi.org/10.1016/S0022-5223(99)70387-9
  14. Ishino K, Kawada M, Irie H, Kino K, Sano S. Single-stage repair of aortic coarctation with ventricular septal defect using isolated cerebral and myocardial perfusion. Eur J Cardiothorac Surg 2000;17:538-42 https://doi.org/10.1016/S1010-7940(00)00409-7
  15. McElhinney DB, Reddy VM, Silverman NH, Hanley FL. Modified Damus-Kaye-Stansel procedure for single ventricle, subaortic stenosis, and arch obstruction in neonates and infants: midterm results and techniques for avoiding circulatory arrest. J Thorac Cardiovasc Surg 1997;114:718-25 https://doi.org/10.1016/S0022-5223(97)70075-8
  16. Asou T, Kado H, Imoto Y, et al. Selective perfusion technique during aortic arch repair in neonates. Ann Thorac Surg 1996;61:1546-8 https://doi.org/10.1016/0003-4975(96)80002-S
  17. Pigula FA. Arch reconstruction without circulatory arrest: scientific basis for continued use and application to patients with arch anomalies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002;5:104-15 https://doi.org/10.1053/pcsu.2002.31480
  18. Sano S, Mee RBB. Isolated myocardial perfusion during arch repair. Ann Thorac Surg 1990;49:970-2 https://doi.org/10.1016/0003-4975(90)90878-A