Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Mid to Long Term Outcomes of Surgical Treatment for Isolated Coarctation of Aorta

단순 대동맥 축착의 외과적 치료 후 중.장기 결과

  • Lee, Seung-Cheol (Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Yoon, Tae-Jin (Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Park, Jeong-Jun (Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Song, Meong-Gun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Kim, Young-Hwee (Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Ko, Jae-Kon (Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Park, In-Sook (Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, College of Medicine University of Ulsan) ;
  • Seo, Dong-Man (Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan)
  • 이승철 (울산대학교 의과대학 서울아산병원 흉부외과, 소아심장외과분과) ;
  • 윤태진 (울산대학교 의과대학 서울아산병원 흉부외과, 소아심장외과분과) ;
  • 박정준 (울산대학교 의과대학 서울아산병원 흉부외과, 소아심장외과분과) ;
  • 송명근 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 김영휘 (울산대학교 의과대학 서울아산병원 소아과, 소아심장분과) ;
  • 고재곤 (울산대학교 의과대학 서울아산병원 소아과, 소아심장분과) ;
  • 박인숙 (울산대학교 의과대학 서울아산병원 소아과, 소아심장분과) ;
  • 서동만 (울산대학교 의과대학 서울아산병원 흉부외과, 소아심장외과분과)
  • Published : 2007.02.05
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Abstract

Background: The surgical repair of an isolated coarctation of the aorta, without complex cardiac anomalies, has improved, with very good results. However, despite the success of surgical repair, many long-term complications, such as hypertension, re-coarctation and an aortic aneurysm, still exist. Material and Method: Between 1991 and 2006, 50 patients diagnosed with an isolated coarctation of the aorta were reviewed retrospectively. The incidence of re-coarctation and hypertension were compared with respect to age and surgical methods. Result: There were no early & late mortality, or post operative aortic aneurysms. Hypertension developed in 11 patients (22%). A greater number of patients in the child/adult group had hypertension (52.4%) than in the neonate/infant group (0%). With respect to the surgical methods, the patients in the graft interposition group suffered more hypertension (88.9%) than those in the EEEA (extended end to end anastomosis) group (5.3%). Post operative re-coarctation developed in 2 out of the 29 patients (6.9%) in the neonate/infant group and 2 out of the 21 patients (9.5%) in the child/adult group, but without any statistical difference. There were no statistical differences between the operative type-related groups. Conclusion: Even though the surgical outcomes have greatly improved, an isolated coarctation of the aorta still has many long-term problems, such as hypertension and re-coarctation. An isolated coarctation is accepted as a systemic vascular dysfunction, and often progresses to other cardiovascular diseases. Therefore, patients with a coarctation of the aorta have to be carefully followed-up, and aggressive management must be given when required.

배경: 심장 내 기형을 동반하지 않는 단순 대동맥 축착은 이미 수술적 치료가 안정화되었으나 수술의 성공 여부와 관계없이 고혈압, 재축착 등의 부작용이 적지 않은 질환이다. 본 연구에서는 본원에서 단순 대동맥 축착의 교정술을 시행 받은 환자들을 대상으로 부작용의 발생 정도 및 교정 방법에 따른 차이에 대해 알아보고, 이에 영향을 미치는 인자들을 분석해 보고자 한다. 대상 및 방법: 1991년 2월부터 2006년 2월까지 본원에서 단순 대동맥 축착으로 수술을 시행 받은 총 50명(남 33명, 여 17명)을 대상으로 하였다. 환자들의 연령은 생후 5일부터 53세까지 다양하였고, 수술 시기 및 집도의에 따라 확장 단단문합술, 인공혈관 치환술 및 패치 대동맥 성형술 등으로 수술하였다. 이들을 연령별, 수술방법 등에 따라 나누어 수술결과 및 부작용 발생 등을 비교하였다. 결과: 수술 후 수술과 관련된 사망 환자는 없었고, 현재까지 수술 문합 부위에 대동맥류가 발생한 환자도 없다. 고혈압은 전체의 22% 인 11명에서 관찰되었는데, 연령별로는 소아/성인군(52.4%)이 신생아/영아군(0%)보다 높은 유병률을 보였고, 수술 방법별로는 인공혈관 치환술(Graft interposition)군 (88.9%)에서 확장 단단문합술(Extended end to end anastomosis)군(5.3%)보다 유의하게 많이 관찰되었다. 재협착의 경우 신생아/영아군(6.9%)과 소아/성인군(9.5%)에서 발생률의 차이가 없었고(p=0.5), 수술 방법에 따라서도 유의한 차이를 보이지 않았다. 결론: 단순 대동맥 축착의 경우 근래에는 수술 후 사망률이나 이환율은 매우 적지만, 술 후 장기 추적 관찰에 의하면 고혈압이나 재협착 등이 적지 않게 발생하고 그로 인한 심혈관계 질환이 문제가 되므로 지속적인 관찰과 적극적인 치료가 필요할 것으로 생각된다.

Keywords

References

  1. Margarida M, Vera DA, Miguel BM, Munir E. Coarctation of the aorta corrected during childhood. Clinical aspects during follow-up. Arq Bras Cardiol 2000;74:174-80
  2. Andrew CF, Laurice KF, Theresa S, et al. Comparison of angioplasty and surgery for neonatal aortic coarctation. Thorac Surg 2005;80:1659-65 https://doi.org/10.1016/j.athoracsur.2005.03.143
  3. Conte S, Lacour-Gayet F, Serraf A, et al. Surgical management of neonatal coarctation. J Thorac Cardiovasc Surg 1995;109:663-75 https://doi.org/10.1016/S0022-5223(95)70347-0
  4. Ziemer G, Jonas RA, Perry SB, Freed MD, Castaneda AR. Surgery for coarctation of the aorta in the neonate. Circulation 1986;74(suppl):125-31
  5. Kappetein AP, Zwinderman AH, Bogers AJ, Rohmer J, Huysmans HA. More than thirty-five years of coarctation repair. An unexpected high relapse rate. J Thorac Cardiovasc Surg 1994;107:87-95
  6. Kron IL, Flanagan TL, Rheuban KS, et al. Incidence and risk of reintervention after coarctation repair. Ann Thorac Surg 1990;49:920-5 https://doi.org/10.1016/0003-4975(90)90867-6
  7. Brouwer RM, Erasmus ME, Ebels T, Eijgelaar A. Influence of age on survival, late hypertension and recoarctation in elective aortic coarctation repair. Including long-term results after elective aortic coarctation repair with a follow-up from 25 to 44 years. J Thorac Cardiovasc Surg 1994;108:525-31
  8. Gail EW, Cheryl AN, Caren SG, et al. Extended resection and end-to-end anastomosis for aortic coarctation in infants: results of a tailored surgical approach. Ann Thorac Surg 2005;80:1453-9 https://doi.org/10.1016/j.athoracsur.2005.04.002
  9. Marcello D, Carlo P, Mia K, et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001;1004:I165-70
  10. Gardiner HM, Celermajer DS, Soensen KE. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 1994;89:1745-50 https://doi.org/10.1161/01.CIR.89.4.1745
  11. Vogt M, Kuhn A, Baumgartner D, et al. Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries? Circulation 2005;111:3269-73 https://doi.org/10.1161/CIRCULATIONAHA.104.529792
  12. Xu J, Shiota T, Omoto R, et al. Intravascular ultrasound assessment of regional aortic wall stiffness, distensibility, and compliance in patients with coarctation of the aorta. Am Heart J 1997;134:93-8 https://doi.org/10.1016/S0002-8703(97)70111-X
  13. Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM. Excessive anaerobic metabolism during exercise after repair of aortic coarctation. J Pediatr 1997; 131:210-4 https://doi.org/10.1016/S0022-3476(97)70155-0
  14. Wells WJ, Prendergast TW, Berdjis F, et al. Repair of coarctation of the aorta in adults. Ann Thorac Surg 1996; 61:1168-71 https://doi.org/10.1016/0003-4975(96)00008-2
  15. Bhat MA, Neelakandhan KS, Unnikrishnan M, Rathore RS, Mohan Singh MP, Lone GN. Fate of hypertension after repair of coarctation of the aorta in adults. Br J Surg 2001;88:536-8 https://doi.org/10.1046/j.1365-2168.2001.01745.x
  16. Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J 2004;25:1853-9 https://doi.org/10.1016/j.ehj.2004.07.021
  17. Knyshov GV, Sitarr LL, Glagola MD, Atamanyuk MY. Aortic aneurysm at the site of repair of coarctation of the aorta: a review of 48 patients. Ann Thorac Surg 1996;61:935-9 https://doi.org/10.1016/0003-4975(95)01189-7
  18. Rao PS, Galal O, Smith PA, Wilson AAD. Five to nine year follow-up results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol 1996;27:462-70 https://doi.org/10.1016/0735-1097(95)00479-3