Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Mitral Valve Repair for Mitral Regurgitation in Pediatric Patients

승모판폐쇄부전증를 가진 소아 환자에서 승모판성형술의 임상적 고찰

  • Sim, Hyung-Tae (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yun, Tae-Jin (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jeong-Jun (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Uhm, Ju-Yeon (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jhang, Won-Kyoung (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Hwue (Division of Pediatric Cardiology, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Jae-Kon (Division of Pediatric Cardiology, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, In-Sook (Division of Pediatric Cardiology, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Dong-Man (Division of Pediatric Cardiac Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 심형태 (울산대학교 의과대학 서울아산병원 소아심장외과) ;
  • 윤태진 (울산대학교 의과대학 서울아산병원 소아심장외과) ;
  • 박정준 (울산대학교 의과대학 서울아산병원 소아심장외과) ;
  • 정성호 (울산대학교 의과대학 서울아산병원 소아심장외과) ;
  • 엄주연 (울산대학교 의과대학 서울아산병원 소아심장외과) ;
  • 장원경 (울산대학교 의과대학 서울아산병원 소아심장외과) ;
  • 김영휘 (울산대학교 의과대학 서울아산병원 소아심장과) ;
  • 고재곤 (울산대학교 의과대학 서울아산병원 소아심장과) ;
  • 박인숙 (울산대학교 의과대학 서울아산병원 소아심장과) ;
  • 서동만 (울산대학교 의과대학 서울아산병원 소아심장외과)
  • Published : 2007.08.05
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Abstract

Background: Compared to adult patients, mitral regurgitation in pediatric patients is uncommon and it shows a wide spectrum of morphologic abnormalities. We retrospectively evaluated the midterm results of mitral valve repair in pediatric patients. Material and Method: Between December 1993 and August 2006, mitral valve repair was performed in 35 patients who were aged less than 18 years, The mean age was $5.3{\pm}5.3$ years and the mean body weight was $20,0{\pm}16.3\;kg$. 18 patients had associated cardiac anomalies. The most common pathologic finding was leaflet prolapse (n=17). The most common method of repair was the double orifice technique (n=15). Result: There was no early mortality. Eight patients underwent reoperation (24.2%), and five of them required mitral valve replacement. Among the four ring annuloplasty cases, two have developed mitral stenosis. Four out of the 14 double orifice cases required reoperation. One case of early mortality and one case of late mortality occurred in the reoperation cases. The 5-year survival rate and the freedom from reoperation rate were $93.3{\pm}4.6%$ and $76.1{\pm}8.2%$, respectively. The 5-year freedom from mitral valve replacement rate was $83.6{\pm}6.7%$. There was no significant risk factor for reoperation. Conclusion: The midterm results of mitral valve repair are very acceptable in pediatric patients compared to the adult cases, although the reoperation rate is slightly higher.

배경: 소아 환자에서의 승모판폐쇄부전은 성인에 비해 상대적으로 드물고 다양한 형태의 병변을 보인다. 또한 수술 기법도 덜 정형화되어 있으며 그 결과에 대한보고는 드물다. 본 연구는 이러한 다양한 원인에 의한 승모판페쇄부전이 있었던 소아 환자에 대해 시행된 승모판성형술의 결과를 후향적으로 분석하고자 하였다. 대상 및 방법: 1993년 12월부터 2006년 8월까지 승모판폐쇄부전으로 수술 받은 18세 이하의 환자 35명을 대상으로 하였다. 수술 당시 평균 연령은 $5.3{\pm}5.3$세였고 평균 체중은 $20.0{\pm}16.3kg$이었다. 술 전 승모판폐쇄부전의 정도는 Grade II가 9예, III, IV가 각각 16예, 10예였다. 18예에서 심장 기형을 동반하고 있었으며 심실중격결손이 9예로 가장 많았고, 주관상동맥-폐동맥 이상 연결증, 좌측 주관상동맥기시부 폐쇄 등도 각각 2예, 1예 있었다. 승모판의 병리적 소견은 판막엽의 탈출증이 17예로 가장 많았고, 판막에 열이 있는 경우가 7예, 짧은 건삭을 보인 경우가 6예, 판막륜의 확장을 보인 경우가 5예, 허혈성유두상근을 보인 경우가 2예, 유두상근형성부전이 1예 있었고, 심내막염에 의한 건삭파열이 1예 있었다. 승모판성형술은 이중입구성형술이 15예로 가장 많이 시행되었고, 봉합판막륜성형술 14예, 판막열 봉합술 7예, 유두상근 분리술 5예, 링을 이용한 판막륜 성형술 4예, 판막엽 절제술 4예, 신건삭 형성술 2예 각각 시행되었다. 술 후 평균 추적 관찰 기간은 $47.5{\pm}39.0$개월($2{\sim}138$개월)이었다. 결과: 수술 후 조기 사망은 없었다. 술 후 승모판폐쇄부전의 정도는 1명의 환자를 제외하고 모두 의미 있는 감소를 보였다. 8명(24.2%)이 재수술을 시행 받았고 이 중 5명은 승모판치환술을 받았다. 재수술의 원인으로는 승모판 협착이 3예, 잔류 승모판폐쇄부전이 5예였다. 승모판협착은 링을 이용하여 수술한 4명의 환자 중에서 2명이 발생하였고, 폐쇄부전은 이중입구성형술을 시행 받은 환자 14명중에서 4명에서 발생하였다. 재수술 후 조기 사망 1명, 만기 사망 1 명이 있었다. 환자들의 5년 생존율은 $93.3{\pm}4.6%$, 5년 재수술의 회피율은 $76.1{\pm}8.2%$, 5년 승모판치환술의 회피율은 $83.6{\pm}6.7%$였다. 통계학적으로 의미 있는 재수술의 위험인자는 발견할 수 없었다. 결론: 승모판폐쇄부전이 있는 소아 환자에서 시행된 승모판 성형술은 양호한 중단기 성적을 보였으나 비교적 높은 재수술의 가능성은 남아 있어 향후 재수술의 원인과 대책에 대한 좀더 깊이 있는 연구가 필요하다고 생각한다.

Keywords

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