Coronary Blood Flow Disturbance of a Single Coronary Artery in a Patient Undergoing Aortic Valve Replacement - A case report -

단일관상동맥환자에시 대동맥판막 치환술 시행 중 발생한 관상동맥혈류장애의 치험 - 1예 보고 -

  • Jung, Hee-Suk (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 정희석 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 이재원 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 정성호 (울산대학교 의과대학 서울아산병원 흉부외과학교실)
  • Published : 2009.12.05

Abstract

A 57-year-old man with dyspnea was transferred to our institution. Echocardiography demonstrated grade III aortic valve regurgitation with a bicuspid aortic valve. The preoperative coronary angiography showed a left single nary artery. Replacement of the aortic valve was performed. Ventricular fibrillation developed during weaning patient of cardiopulmonary bypass after aortotomy repair. An anomalous origin of the coronary arteries is an incidental finding. However, in patients who are undergoing aortic valve replacement, a can significantly complicate the procedure. If this is present, then it is imperative that the clearly identified and the required procedure should be modified to avoid injury to these.

57세 남자가, NYHA class III의 호흡곤란을 주소로 내원하여 시행한 심장초음파 검사상 Grade III에 해당하는 대동맥판막 역류증을 진단받았다. 그는 수술 전 시행한 심혈관조영술 검사상 단일관상동맥 기형을 가지고 있었으며, 기계판막을 이용한 대동맥판막 치환술을 시행받았다. 수술장 소견상 단일관상동맥이었으며 대동맥절개시술부위의 좌측절개부위와 우관상동맥의 주행이 인접한 해부학적 구조를 보였다. 판막치환술을 시행하고 절개된 대동맥을 봉합한 후 인공심폐기로부터 탈출하던 도중 좌측대동맥절개부위와 인접한 우관상동맥이 당겨지면서 심실세동이 발생하여 대동맥을 다시 절개하였으며, 우관상동맥을 박리하고 대동맥을 재봉합하여 문제 없이 수술이 종료되었다. 수술 직후 방실리듬이 관찰되어 심방조율하여 정상동방결절리듬으로 전환되었고, 술 후 8일 째 특이 문제없이 퇴원하였다.

Keywords

References

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