Twelve Years of Experience with Vascular Ring Surgery

혈관륜 수술의 12년 경험 보고

  • Kim, Yun-Seok (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Goo, Hyun-Woo (Department of Radiology, Asan Medical Center, University of Ulan College of Medicine) ;
  • Jhang, Won-Kyoung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yun, Tae-Jin (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Dong-Man (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jeong-Jun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 김윤석 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 구현우 (울산대학교 의과대학 서울아산병원 영상의학교실) ;
  • 장원경 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 윤태진 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 서동만 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 박정준 (울산대학교 의과대학 서울아산병원 흉부외과학교실)
  • Published : 2009.12.05

Abstract

Background: Vascular ring is a rare anomaly of the aortic arch. We did surgical repair procedures on 16 cases of vascular ring over the past 12 years. This article reviews our results. Material and Method: Between 1995 and 2007, 16 patients (5 with double aortic arch, 7 with right aortic arch-left ligamentum, 4 with pulmonary artery sling) underwent surgical repair. Mean age at the time of the operation were as follows: double aortic arch, $5.7{\pm}5.5$ years; right aortic arch-left ligamentum, $6.1{\pm}13.4$ years; pulmonary artery sling, $2.9{\pm}2.6$ years. Five patients (71%) with right aortic arch-left ligamentum had an associated Kommerell's diverticulum. Two patients (40%) with double aortic arch, 2 patients (28.6%) with right aortic arch-left ligament and 4 patients (100%) with pulmonary artery sling had associated airway stenosis. Cardiac anomalies were present in 8 of 16 patients. Result: There was no peri-operative or post-operative mortality. The mean hospital stay was $27.1{\pm}38.2$ days. None of our patients underwent reoperation. Conclusion: Vascular ring is rare, but, it needs surgical correction. It is important to suspect the diagnosis and to validate with echocardiography. Preoperative and postoperative computed tomography and bronchoscopy are useful to evaluate the airway and surrounding structures.

배경: 혈관륜은 대동맥궁의 드문 기형으로 저자들이 12년 간 경험한 16예의 수술 결과를 정리하여 그 경험을 공유하고자 한다. 대상 및 방법: 1995년 11월부터 2007년 9월까지 혈관륜으로 수술을 받은 16명을 대상으로 하여 이중 대동맥궁(n=5), 우측 대동맥궁-동맥관 인대(n=7), 폐동맥 슬링(n=4)의 세 가지 그룹으로 분류하였다. 각 그룹의 수술 당시 평균 연령은 이중 대동맥궁 그룹에서 $5.7{\pm}5.5$세, 우측 대동맥궁-동맥관 인대 그룹에서 $6.1{\pm}13.4$세, 폐동맥 슬링 그룹에서 $2.9{\pm}2.6$세였다. 우측 대동맥궁-동맥관 인대 그룹의 71% (n=5)에서 Kommerell 게실이 동반되어 있었다. 기관 협착은 이중 대동맥궁 그룹 중 2예(40%), 우측 대동맥궁-동맥관 인대 그룹 중 2예(28.6%), 폐동맥 슬링 그룹 중 4예 (100%)에서 동반되어 있었다. 함께 진단된 심장 기형은 전체의 50% (n=8)였다. 결과: 사망한 예는 없었고, 증상 재발 및 문합부 협착 등으로 재수술을 시행한 예도 없었다. 평균 재원 기간은 $27.1{\pm}38.2$일이었다. 결론: 혈관륜은 드문 질환이지만 수술적 교정이 필요하므로, 원인이 명확하지 않은 호흡기 증상이 반복될 경우에는 심초음파 등으로 반드시 확인해 보아야 하며, 수술 전후의 전산화 단층촬영 및 기관지 내시경은 기도 협착 및 주변 해부학적 구조와의 관계 평가에 유용하게 이용할 수 있다.

Keywords

References

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