초록접수 현황
| 15F-053 | 구연 발표 |
Long-term Outcome of Surgical Management for Coronary Artery Fistula in Children.
박지영¹, 김웅한¹, 조성규¹, 현관용¹, 이정렬¹, 김용진²
서울대학교 의과대학 서울대학교병원 흉부외과학교실¹, 서울대학교 분당서울대학교병원 흉부외과학교실²
목적 : Some controversy still exists concerning the surgical management of coronary artery fistulas. Long-term outcome after closure of coronary artery fistula is poorly documented. In this study, we assessed our surgical results on this disease.
방법 : Between April 1986 and January 2015, 26 patients with coronary fistulas underwent surgical correction. Four patients (15.3 %) presented with congestive heart failure, 14 patients (53.8 %) with no symptom. Repair was undertaken with cardiopulmonary bypass in 23 patients (88.4 %), and 14 patients (53.8 %) had concomitant repair of associated cardiac lesions. 17 patients (65.3 %) underwent epicardial closure, in 6 patients (23.0 %) endocardial closure was used and 3 patients required both approaches.
결과 : Median age at the operation was 1.05 years (range 7 days ~ 14.4 years). There were no early or late deaths, during a mean of 9.0 ± 6.9 years of follow-up. Transient myocardial ischemia occurred in 2 patients (7.6 %), it was improved on discharge. There was no late ischemic event. Anatomically, none of them had two or more coronary fistulas. The site of origin were left coronary system in 13 patients (50 %). The drainage site were right ventricle in 16, right atrium in 5, left ventricle in 2, main pulmonary artery in 2 and superior vena cava in 1. One patient (3.8 %) underwent reoperation for sinus of valsalva aneurysm which developed after epicardial closure for right coronary fistula, 8.2 years after initial surgery. There were 7 patients (26.9 %) with arrhythmia; sinus arrhythmia (5), second degree atrioventricular block (1), ventricular tachycardia (1). The freedom from arrhythmia after the repair were 92.3 %, 87.4% and 71.1 % 1, 5 and 10 years. At last follow-up, all patients were in New York Heart Association class I.
결론 : Long-term outcome of surgical repair for coronary fistula in children is excellent, with neither death nor late ischemic event. Late follow-up is of paramount importance, as one-third of patients developed arrhythmias after the operation.
방법 : Between April 1986 and January 2015, 26 patients with coronary fistulas underwent surgical correction. Four patients (15.3 %) presented with congestive heart failure, 14 patients (53.8 %) with no symptom. Repair was undertaken with cardiopulmonary bypass in 23 patients (88.4 %), and 14 patients (53.8 %) had concomitant repair of associated cardiac lesions. 17 patients (65.3 %) underwent epicardial closure, in 6 patients (23.0 %) endocardial closure was used and 3 patients required both approaches.
결과 : Median age at the operation was 1.05 years (range 7 days ~ 14.4 years). There were no early or late deaths, during a mean of 9.0 ± 6.9 years of follow-up. Transient myocardial ischemia occurred in 2 patients (7.6 %), it was improved on discharge. There was no late ischemic event. Anatomically, none of them had two or more coronary fistulas. The site of origin were left coronary system in 13 patients (50 %). The drainage site were right ventricle in 16, right atrium in 5, left ventricle in 2, main pulmonary artery in 2 and superior vena cava in 1. One patient (3.8 %) underwent reoperation for sinus of valsalva aneurysm which developed after epicardial closure for right coronary fistula, 8.2 years after initial surgery. There were 7 patients (26.9 %) with arrhythmia; sinus arrhythmia (5), second degree atrioventricular block (1), ventricular tachycardia (1). The freedom from arrhythmia after the repair were 92.3 %, 87.4% and 71.1 % 1, 5 and 10 years. At last follow-up, all patients were in New York Heart Association class I.
결론 : Long-term outcome of surgical repair for coronary fistula in children is excellent, with neither death nor late ischemic event. Late follow-up is of paramount importance, as one-third of patients developed arrhythmias after the operation.
책임저자: 김웅한
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 박지영, Tel: 010-7765-8731 , E-mail : chunhaa@naver.com
