Journal of Chest Surgery

  • 제40권2호
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  • Pages.83-89
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  • 2007
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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

단순 대동맥 축착의 외과적 치료 후 중.장기 결과

Mid to Long Term Outcomes of Surgical Treatment for Isolated Coarctation of Aorta

  • 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)
  • 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)
  • 발행 : 2007.02.05
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초록

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.

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.

키워드

참고문헌

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