• 제목/요약/키워드: Right ventricular outflow obstruction

검색결과 58건 처리시간 0.031초

Right ventricular failure in congenital heart disease

  • Cho, Young Kuk;Ma, Jae Sook
    • Clinical and Experimental Pediatrics
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    • 제56권3호
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    • pp.101-106
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    • 2013
  • Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD.

심실중격결손이 동반된 좌심실유출로협착 환아에서의 Norwood-Rastelli Procedure -3예 보고 - (The Norwood-Rastelli Procedure for Left Ventricular Outflow Tarct Obstruction with a Ventricular Septal Defect - Three case report -)

  • 김동중;곽재건;오세진;장우성;김동진;이창하;김웅한
    • Journal of Chest Surgery
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    • 제40권9호
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    • pp.624-628
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    • 2007
  • 2001년부터 2006년까지 심실중격결손이 동반된 여러 부위의 좌심실유출로 협착 진단을 받은 3명의 신생아를 대상으로 하여 Norwood-Rastelli 술식을 시행하였다. 대상 신생아들의 체중은 $2.9{\sim}3.1 kg$ 이었으며 승모판막과 좌심실의 크기 및 형태는 정상이었다. 수술은 완전순환정지 없이 국소 관류하에서 자가 조직만을 이용하여 광범위하게 좌심실 유출로를 재건하는 수정된 Norwood 술식, 판막이 없는 우심막 도관을 이용하여 우심실과 폐동맥을 연결하는 Rastelli 형태의 술식 및 좌심실에서 폐동맥 판막으로 혈류가 가도록 연결하는 심실중격결손 폐쇄술을 시행하였다. 모두 수술 후 특별한 문제는 없었다. 추적 관찰 중 1명에서 수술 7개월 뒤 우심실유출로 도관의 협착으로 심도자술 도중 발생한 심정지와 이로 인한 합병증으로 사망하였다. 생존한 2명 중 1명은 우심실유출로 도관 협착으로 재수술을 받았으며 5년째 건강한 상태이며 나머지 환아도 1년째 건강한 상태로 외래 추적 중이다.

부분방실중격결손증에 대한 외과적 교정의 장기 결과 (Long-term Results of Surgical Correction for Partial Atrioventricular Septal Defects -Seventeen-year Experience -)

  • 이정렬;박천수;임홍국;김용진;노준량;배은정;노정일;윤용수
    • Journal of Chest Surgery
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    • 제36권12호
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    • pp.911-920
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    • 2003
  • 본 연구에서 지난 17년간 경험한 부분방실중격결손증의 외과적 교정술의 장기결과를 후향적으로 분석하였다. 대상 및 방법: 1986년 4월부터 2002년 12월까지 부분방실중격결손증으로 외과적 교정술을 시행 받은 93명의 환자를 대상으로 사망률, 생존율 및 그 위험인자를 분석하고, 추적관찰 기간중 재수술과 관련되는 위험인자를 분석하였다. 남자 환자가 32명 여자 환자가 61명이었으며, 수술 당시 연령의 중앙값은 68개월(3∼818개월)이었고 평균추적관찰기간은 108$\pm$59.4개월(1∼200개월)이었다. 결과: 조기사망은 4예로 수술 사망률은 4.3%였다. 사망원인은 발작성 폐동맥고혈압증 1예, 저심박출증 1예, 심부전에 의한 심폐기이탈실패 1예, 심실세동 1예였고, 사망과 관련하여 통계적으로 의미 있는 인자는 없었다. 조기사망한 환자 4명을 제외한 89명의 환자를 추적 관찰하였고, 1예에서 만기사망을 확인하였다. 3년, 5년, 10년, 15년 생존율은 각각 95.7%, 94.3%, 94.3%, 94.3%였다. 수술 직후 63명(67.7%)의 환자에서 좌측 방실판막폐쇄부전이 개선되었고, 14명(15.1%)의 환자에서는 술 전과 같았고, 12명(12.9%)에서는 악화되었다. 추적관찰 기간 중 8명(9.0%)의 환자에서 재수술을 시행하였으며, 완전 교정술 후 평균 38.6개월(3∼136개월) 후 시행되었다. 3년, 5년, 10년, 15년 무재수술 생존율은 각각 94.0%, 91.4%, 91.4%, 88.2%였다. 재수술의 원인으로는 좌측 방실판막페쇄부전이 7예, 좌심실유출로협착이 2예, 잔존심방중격결손 1예, 좌측 방실판막협착 1예, 우심부전 1예였고, 재수술과 관련하여 좌심실 유출로 협착이 통계적으로 의미있는 위험인자였다(p=0.002). 10명의 환자에서 술 후 부정맥이 발생하였는데, 3명의 환자에서 상심실성 부정맥, 7명의 환자에서는 완전 방실전도차단이 발생하였고, 이 중 6명의 환자에서 영구 인공심박조율기의 삽입이 필요하였다. 걸론: 부분방실중격결손증은 낮은 사망률로 수술을 시행할 수 있었다. 재수술의 원인은 좌측 방실판막페쇄부전이 가장 많았다. 방실판막구조물의 기형이 동반된 경우 재수술의 가능성이 높아지는 경향을 보였으나 통계적 의미는 없었다. 또한, 술후 좌심실유출로협착여부가 재수술의 위험인자였으므로 좌측 방실판막 및 좌심실 유출로의 해부학적인 구조에 대한 정확한 이해가 요구된다. 좌심실유출로협착은 발생시 대동맥하부의 조직에 대한 절제술을 시행할 수 있으나 재발 가능성이 크고, 필요시 수정 Konno수술로 만족할만한 결과를 얻을 수 있었다. 또한, 방실전도차단은 초기시행단계에서 많이 발생하였으며, 심장 전도계에 대한 정확한 해부학적 이해와 경험축적으로 극복할 수 있었다.

우심방 및 폐동맥 절개를 통한 활로 4증 교정술 (Transatrial-Transpulmonary Repair of Tetralogy of Fallot)

  • 백완기;노준량
    • Journal of Chest Surgery
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    • 제24권2호
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    • pp.153-160
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    • 1991
  • Tetralogy of Fallot was repaired by a transatrial-transpulmonary approach in 91 of 250 patients treated surgically [including redo operations] between April 1986 and December 1989. Their age ranged from 6 months to 14 years [mean 39.7 months]. Associated cardiovascular anomalies were right aortic arch [n=22], ASD [n=12], PDA [n=5], persistent left SVC [n=5], and others [n=6]. PA index was measured pre-operatively since 1987 to estimate pulmonary artery size and safe total correction[mean 289$\pm$110mm2/BSA]. Eight patients received previous shunt take down procedure concomitantly. Pulmonary arteriotomy was extended through small pulmonary annulus to a minimal distance upon the right ventricular infundibulum and transannular patch was applied in 38 patients [41.3%], in 31 of them monocuspid patch was utilized. pRV/LV was measured at operation room in 77 patients [mean 0.58$\pm$0.36]. Operative mortality was 6.6% [6/91]. The causes of death were low cardiac output [n=5], arrhythmia[n=1] and respiratory failure [n=1]. At follow-up between 12 months and 57 months [mean 30.8 months] most patients were in New York Heart Association class I without cardiac medication. There was no late death, but reoperations were required in 3 patients to relieve residual right ventricular outflow obstruction. Thus successful repair of tetralogy of Fallot can be accomplished in most patients including infants by transatrial-transpulmonary approach and the better result can be anticipated with respect to postoperative right ventricular function and arrhythmia than the conventional transventricular approach.

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성인 활로씨 4징증 수술치험 101예 보고 (Surgical Correction of Tetralogy of Fallot in Adults - 101 Cases Report -)

  • 조범구
    • Journal of Chest Surgery
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    • 제21권4호
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    • pp.649-655
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    • 1988
  • One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.

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Pulmonic stenosis with atrial septal defect in a Siamese cat

  • Kim, Ji-Youn;Lee, Sung-Wook;Lee, Seung-Gon;Suh, Sang-Il;Hyun, Changbaig
    • 대한수의학회지
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    • 제57권1호
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    • pp.63-66
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    • 2017
  • A 6-month-old mature intact female Siamese cat presented with exertional dyspnea. Diagnostic studies revealed pleural effusion, grade 4/6 left basal systolic murmur, deep S-wave in electrocardiograph leads I, II, and III, cardiomegaly with pleural effusion on radiography, pulmonic systolic (~5.8 m/sec) and tricuspid (3.6 m/sec) regurgitant jets, atrial septal defect, and a hypoplastic right outflow tract. Based on these results, the case was diagnosed as pulmonic stenosis with atrial septal defect. To the best of our knowledge, this is the first case report describing pulmonic stenosis with atrial septal defect in a cat in Korea.

삼첨판막 폐쇄부전을 동반한 선천성 교정형 대혈관전위증치험 1례 보 (Corrected transposition of the great arteries associated with severe tricuspid insufficiency: one case report)

  • 김치경;나범환;이홍균
    • Journal of Chest Surgery
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    • 제17권3호
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    • pp.362-370
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    • 1984
  • The term corrected transposition of great arteries [hereafter referred to as corrected TGA] of the heart in which there is both a discordant atrio-ventricular relationship and transposition of the great vessels. Usually situs solitus is present, while the ventricles are inverted showing an l -loop. The great vessels are transposed and in the l-position so that the pulmonary artery arises from the right-sided morphological left ventricle and the anteriorly l- transposed aorta arises from the left-sided morphological right ventricle yielding an SLL pattern. In the majority of cases, associated lesions are common. The most frequent are ventricular septal defect, obstruction to the pulmonary outflow tract, tricuspid valve incompetence and atrio-ventricular conduction abnormalities. In the rare cases, no associated conditions are present and hemodynamic pathways are normal. In the report, we present one case of a 20 year-old male having corrected TGA associated with severe tricuspid valve incompetence, was corrected by tricuspid valve replacement, directly developed a supra-ventricular tachycardia but was controlled by calcium-entry blocker, verapamil, successfully.

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우심실 양분증 이환견에 대한 풍선확장술 시술 증례 (Balloon dilation of double chambered right ventricle in a dog)

  • 김진욱;윤병국;박준석;김정국;이기호;박형진;허찬;서경원;송근호
    • 한국동물위생학회지
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    • 제40권1호
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    • pp.67-70
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    • 2017
  • A 4 months old, intact male Shih-tzu was referred to the Veterinary Medical Teaching Hospital of Chungnam National University for evaluation of the cause of cardiac murmur and syncope. Thoracic radiography revealed right-sided cardiomegaly. Echocardiography showed marked hypertrophy of right ventricular free wall and obstruction of right ventricular outflow tract, indicating double chambered right ventricle (DCRV). The dog was medicated with atenolol and sildenafil for DCRV, however, clinical signs did not control by medication. Balloon dilation for DCRV was performed to ameliorate patient's clinical signs. The peak systolic pressure gradient across the obstruction region was decreased and clinical signs was improved by balloon dilation procedure. This is the first case report of balloon dilation for the treatment of canine DCRV in South Korea.

폐혈류유출로협착을 동반한 양대혈관 우심기시증의 수술치험 (Surgical Experience of Double Outlet Right Ventricle with Right Ventricular Outflow Obstruction)

  • 김삼현
    • Journal of Chest Surgery
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    • 제21권2호
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    • pp.326-333
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    • 1988
  • The results of surgical experience of double outlet right ventricle with pulmonic stenosis in 14 patients are reported. Among the 14 patients, 8 underwent the intraventricular tunnel repair with the result of 3 hospital deaths, 5 had Fontan type operations due to the various anatomic reasons and resulted in one hospital death, and the remaining one patient had palliative pulmonary valvotomy. Besides the problems related to the effective relief of the pulmonic stenosis, double outlet right ventricle with pulmonic stenosis may present a surgical challenge because severe associated anomalies which definitely complicate their repair are not uncommon. We describe the anatomic details of our 14 cases of DORV with PS and the surgical results. The results having been unsatisfactory, more meticulous diagnostic studies for the detailed intracardiac morphologies and the strict indication for their repair with the refinement of surgical technique seem necessary for the better surgical results.

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활로 4 징증에서 술전 폐동맥 크기에 대한 연구 (A study on surgical significance of angiographic pulmonary arterial size in tetralogy)

  • 조재일;김종환
    • Journal of Chest Surgery
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    • 제16권1호
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    • pp.40-48
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    • 1983
  • Tetralogy of Fallot is characterized by the interventricular septal defect associated with obstruction of the right ventricular outflow. The importance of the latter anatomic malformation was clinically evaluated according to the angiographic measurements of the pulmonary arteries along with the pulmonary valve annulus. Seventy of a total 76 patients operated on during a whole year of 1981 were the patients for clinical evaluation. Fifteen patients died within 1 month after operation with the operative mortality of 21.4%. The young age and the severity of pulmonary arterial hypoplasia were ones among the surgical risk factors at a total corrective surgery of tetralogy. Preoperative angiographic measurements of the pulmonary arteries to speculate the expected postoperative ratio between the left ventricular and the right ventricular pressures were retrospectively calculated according to the formula. The predicted values of P RV/LV greater than 0.5 carried apparenliy higher complication and mortality rates than the group of P RV/LV less then 0.5. The selection of the candidates for either a total correction or the staged operation In tetralogy of Fallot can be evaluated on the preoperative angiographic measurements and the expected Improvements of the clinical results were discussed.

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