Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Treatment of Complete Atrioventricular Septal Defect: The Early and Mid-Term Results

완전방실중격결손증의 외과적 교정술: 조기 및 중기 결과

  • Kim, Hyung-Tae (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun, Tae-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang, Ji-Hyuk (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Pyo-Won (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Wook-Sung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Young-Taek (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung, Ki-Ick (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김형태 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 전태국 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 양지혁 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 박표원 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 김욱성 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 성기익 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실)
  • Published : 2009.06.05
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Abstract

Background: Although the results of the surgical management for complete atrioventricular septal defect (c-AVSD) have improved, the optimal surgical strategy is still controversial. The aims of this study are to evaluate the outcome of c-AVSD repair and to define the risk factors related to reoperation. Material and Method: We retrospectively reviewed the medical records of 35 patients (8 males and 27 females) who underwent the total correction of c-AVSD from August 1996 to March 2008. The median age at repair was 5.2 months (range: 3 days$\sim$82 months). Sixteen patients (45.7%) were associated with Down syndrome. Prior palliative operations were performed in 4 patients. The one-patch techniques were performed in 3 patients, and the two-patch techniques were done in 32 patients. Result: There was 1 early death (2.9%). The median follow-up period was 68 months (range: $2\sim134$ months) for 34 survivors. There was no late death. Reoperations were performed in 5 patients (14.3%) for severe left atrioventricular valvular regurgitation (AVVR). Nine patients (25.7%) showed left an AVVR of more than grade III. Associated major cardiac anomalies and the use of Gore-Tex patch for ventricular septal closure were the risk factors for postoperative left atrioventricular valve failure and reoperation. Conclusion: In this study, we found that surgical repair of c-AVSD was safe and effective. However, the high reoperation rate after repair remains a problem to be solved.

배경: 완전방실중격결손증의 수술적 치료의 결과는 지난 20여 년간 많은 발전을 하였다. 그러나 이러한 환자들에 대한 효과적인 수술적 치료는 여전히 몇 가지 논란이 있다. 저자들은 완전방실중격결손 증의 수술적 치료 결과를 평가하고, 재수술과 연관된 위험인자들을 알아보고자 한다. 대상 및 방법: 1996년 9월부터 2008년 3월까지 완전방실중격결손증으로 수술받은 환아중 양심실 완전교정술이 가능했던 35명의 환아(남자 8명, 여자 27명)에 대해 후향적으로 조사하였다. 수술당시 환아연령의 중앙 값은 5.2개월(3일$\sim$82개월)이었다. 다운증후군이 동반된 환아는 16명으로 전체의 45.7%를 차지했다. 4명의 환아에서 이전에 폐동맥밴딩이나 체폐단락술과 같은 고식적인 수술을 시행하였다. 수술은 방실중격결손을 폐쇄하기 위한 방법으로 단일점포법과 이중첩포법을 각각 3예와 32예에서 시행하였다. 결과: 조기사망은 1예(2.9%) 있었다. 나머지 생존환아에 대한 평균 추적기간의 중앙값은 68개월(2$\sim$134개월)이었다. 만기 사망은 없었다. 전체환아중 5명(14.3%)의 환아에서 술 후 심한 승모판막 폐쇄부전으로 재수술을 시행하였다. 9명(25.7%)의 환아에서 수술후 중등도 이상의 좌측방실판막폐쇄부전 소견을 보였다. 동반된 심기형과 Gore-Tex 점포를 이용한 심실중격폐쇄가 좌측방실판막부전이나 재수술의 위험인자로 나타났다. 결론: 본 연구에서 완전방실중격결손증의 수술적 교정술은 비교적 안전하고 효과적인 치료방법으로 나타났다. 하지만 수술후 보이는 높은 재수술률은 여전히 해결해야 할 과제로 남아있다.

Keywords

References

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