초록접수 현황
| 14F-232 | 구연 발표 |
Atrial Septal Defect with Secondary Pulmonary Arterial Hypertension: Outcomes of Surgical Closure and Predictors of Persistent Pulmonary Hypertension
신홍주, 김효현, 김도정, 신유림, 박영환, 박한기
연세대학교 의과대학 심장혈관병원 심장혈관외과학교실
Background : We investigated the outcome of surgical closure of atrial septal defect (ASD) and predictors persistent pulmonary arterial hypertension in adult patients with atrial septal defect with secondary pulmonary hypertension in current era.
Methods : The medical records of 36 patients (>20 years, mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg) who underwent surgical closure of ASD between March 2004 and January 2014 were reviewed, retrospectively. The median age of patients was 46.6 years (range, 24.6 to 65.9 years). The mean mPAP was 38.0 ± 13.7mmHg and mean Rp was 3.9 ± 4.2 Wood unit. ASD was surgically closed and fenestration was left in 12 (33.3%) patients. Pulmonary hypertensive medication was taken only one patient before the operation. Median follow up period was 3.6 years (range 0.2 to 10.1 years).
Results : There were two hospital deaths and one late death. At last follow-up pulmonary hypertension existed in seven patients (19.4%), and ten patients (27.8%) took pulmonary hypertensive medications. Univariate analysis for postoperative pulmonary hypertension revealed that mPAP, Qp/Qs, Rp, saturation, and fenestration were identified as significant risk factors. From these variables, only saturation remained significant risk factors in multivariate analysis (p=0.041). Preoperative saturation (p-0.049) and fenestration (p=0.011) were predictive factor for postoperative using of pulmonary hypertension in multivariate analysis. We could not find any risk factor for mortality.
Conclusion : Surgical closure of ASD in patients with pulmonary hypertension still has relatively higher risk. After closure of ASD, pulmonary hypertension improves in most patients. Low preoperative arterial oxygen saturation is a predictor of persistent pulmonary hypertension.
Methods : The medical records of 36 patients (>20 years, mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg) who underwent surgical closure of ASD between March 2004 and January 2014 were reviewed, retrospectively. The median age of patients was 46.6 years (range, 24.6 to 65.9 years). The mean mPAP was 38.0 ± 13.7mmHg and mean Rp was 3.9 ± 4.2 Wood unit. ASD was surgically closed and fenestration was left in 12 (33.3%) patients. Pulmonary hypertensive medication was taken only one patient before the operation. Median follow up period was 3.6 years (range 0.2 to 10.1 years).
Results : There were two hospital deaths and one late death. At last follow-up pulmonary hypertension existed in seven patients (19.4%), and ten patients (27.8%) took pulmonary hypertensive medications. Univariate analysis for postoperative pulmonary hypertension revealed that mPAP, Qp/Qs, Rp, saturation, and fenestration were identified as significant risk factors. From these variables, only saturation remained significant risk factors in multivariate analysis (p=0.041). Preoperative saturation (p-0.049) and fenestration (p=0.011) were predictive factor for postoperative using of pulmonary hypertension in multivariate analysis. We could not find any risk factor for mortality.
Conclusion : Surgical closure of ASD in patients with pulmonary hypertension still has relatively higher risk. After closure of ASD, pulmonary hypertension improves in most patients. Low preoperative arterial oxygen saturation is a predictor of persistent pulmonary hypertension.
책임저자: 박한기
연세대학교 의과대학 심장혈관병원 심장혈관외과학교실
연락처 : 박한기, Tel: 02-2228-8497 , E-mail : hank@yuhs.ac
