초록접수 현황
| 15F-050 | 구연 발표 |
The Growth of Neopulmonic Valve After The Arterial Switch Operation In Patients With Aortic Arch Obstruction.
박지영¹, 김웅한¹, 현관용¹, 조성규¹, 이정렬¹, 김용진²
서울대학교 의과대학 서울대학교병원 흉부외과학교실¹, 서울대학교 분당서울대학교병원 흉부외과학교실²
Background : One-stage repair of transposition of great arteries(TGA) or Taussig-Bing anomaly(TBA) with aortic arch obstruction (AAO) is currently advocated, but small neopulmonary valve can cause the right ventricular outflow tract obstruction(RVOTO) often. We evaluate the growth of neopulmonic valve and significance of right-sided obstruction according to the different surgical strategies.
Methods : Between January 2001 and January 2015, 23 patients with TGA/AAO or TBA/AAO (11, 47.8 %) underwent surgical repair. Aortic arch obstruction included : coarctation of aorta (n=17), interrupted aortic arch (n=6). One-stage repair was performed in 10 paitents (Group 1), two-staged repair was performed in 13 patients (Group 2). The arterial switch operation (ASO) was performed 6.4 ± 2.9 months after the repair of aortic arch obstruction and pulmonary artery banding. In Group 2, we checked the growth of aortic valve (i.e., neopulmonary) during the interstage period by echocardiography
Results : The initial Z-score of aortic annulus was comparable in the two groups (-1.74±0.62, -1.46±1.15, p=0.51). In Group 2, during the interstage period, the Z-score of aortic annulus increased from -1.46±1.15 (range -3.57 to 0.29) to 0.59±0.76 (range, -0.22 to 2.05) (p<0.001). The Z-score of neopulmonic valve of Group 2 at 1-year follow-up and at the latest follow-up were significantly larger than those of Group 1(1-year:-1.1±1.6, 0.2±0.39, p=0.04, the latest follow-up:-1.6±1.5, -0.7±0.56, p=0.003). Four patients had a significant pressure gradient (> 30 mmHg) across the right ventricular outflow tract in Group 1, whereas no patient in Group 2. There was one hospital death and one late death, they were all in Group 1. There was one hospital death and one late death, they were all in Group 1. There have been 3 reoperations for RVOTO (2 in Group 1;20 %, 1 in Group 2 ; 7.6 %).
Conclusion : The growth of neopulmonic valve through short interstage period in two-staged repair was significant, this could lead the improvement for right sided obstruction and reduce the reoperation rate associated with RVOTO. The two-staged repair would be a reasonable option, especially patients who have small aortic valve.
The growth of neopulmonic valve through short interstage period in two-staged repair was significant, this could lead the improvement for right sided obstruction and reduce the reoperation rate associated with RVOTO. The two-staged repair would be a reasonable option, especially patients who have small aortic valve.
Methods : Between January 2001 and January 2015, 23 patients with TGA/AAO or TBA/AAO (11, 47.8 %) underwent surgical repair. Aortic arch obstruction included : coarctation of aorta (n=17), interrupted aortic arch (n=6). One-stage repair was performed in 10 paitents (Group 1), two-staged repair was performed in 13 patients (Group 2). The arterial switch operation (ASO) was performed 6.4 ± 2.9 months after the repair of aortic arch obstruction and pulmonary artery banding. In Group 2, we checked the growth of aortic valve (i.e., neopulmonary) during the interstage period by echocardiography
Results : The initial Z-score of aortic annulus was comparable in the two groups (-1.74±0.62, -1.46±1.15, p=0.51). In Group 2, during the interstage period, the Z-score of aortic annulus increased from -1.46±1.15 (range -3.57 to 0.29) to 0.59±0.76 (range, -0.22 to 2.05) (p<0.001). The Z-score of neopulmonic valve of Group 2 at 1-year follow-up and at the latest follow-up were significantly larger than those of Group 1(1-year:-1.1±1.6, 0.2±0.39, p=0.04, the latest follow-up:-1.6±1.5, -0.7±0.56, p=0.003). Four patients had a significant pressure gradient (> 30 mmHg) across the right ventricular outflow tract in Group 1, whereas no patient in Group 2. There was one hospital death and one late death, they were all in Group 1. There was one hospital death and one late death, they were all in Group 1. There have been 3 reoperations for RVOTO (2 in Group 1;20 %, 1 in Group 2 ; 7.6 %).
Conclusion : The growth of neopulmonic valve through short interstage period in two-staged repair was significant, this could lead the improvement for right sided obstruction and reduce the reoperation rate associated with RVOTO. The two-staged repair would be a reasonable option, especially patients who have small aortic valve.
The growth of neopulmonic valve through short interstage period in two-staged repair was significant, this could lead the improvement for right sided obstruction and reduce the reoperation rate associated with RVOTO. The two-staged repair would be a reasonable option, especially patients who have small aortic valve.
책임저자: 김웅한
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 박지영, Tel: 010-7765-8731 , E-mail : chunhaa@naver.com
