초록접수 현황
| 15F-168 | 구연 발표 |
Detachment of the Tricuspid Valve for Ventricular Septal Defect Closure in Young Infant under 3months of Age
방지현, 박정준, 윤태진, 박천수
울산대학교 의과대학 서울아산병원 흉부외과학교실 소아심장외과
Background : Although several reports demonstrated that the ventricular septal defect (VSD) can be closed safely through detached tricuspid valve (TV) without impairing TV function, there is lack of studies investigating the influence of detaching TV for VSD closure in young infants under 3 months of age.
Methods : From January 2004 to December 2013, a total of 1455 patients underwent corrective surgery for isolated VSD in our center. Among them, 296 infants under 3 months of age who underwent VSD closure through the right atrial approach were included in the present study. TV was detached to better expose the defect in 49 patients (16.6%, study group) and it was not detached in 247 patients (83.4%, control group).
Results : The median age was 63.5 days (range, 14-90 days) and the median weight was 4.4kg (range, 2.1-6.7kg). Abnormal chordal attachment or aneurysmal sac formation of the TV in preoperative echocardiogram was associated with detaching TV during surgery (24/49 vs. 52/247, p=0.002). The Cardiopulmonary bypass times (90.8±33.3 vs. 73.4±21.6 minutes; P=0.001) and aortic cross-clamp times (60.0±22.1 vs. 46.1±15.2 minutes; P<0.001) were significantly longer in the study group. Postoperative junctional ectopic tachycardia was developed in 5 patients (1/49 vs. 4/247, p>0.99), and 2 patients required permanent pacemaker due to heart block in control group. One hospital death occurred in a premature baby due to capillary leak syndrome after neonatal repair. Follow-up echocardiography was available in 282 patients (282/295, 95.6%) at a median of 21 months (range, 1-108 months), without intergroup difference (P=0.26). In the latest echocardiogram, significant TR (more than grade 2) was observed in only one patient in study group, and VSD leak existed in 4 patients (1 in study group and 3 in control group) without clinical significance. Reoperation for residual VSD or significant tricuspid valve regurgitation (TR) was required in 3 patients (1 in study group vs. 2 in control group).
Conclusion : Detachment of the TV can be safely used to better expose the VSD without increasing the risk of tricuspid regurgitation in young infants. Preoperative echocardiogram might be useful to predict the possibility of detaching TV for enhancing exposure of the VSD.
Methods : From January 2004 to December 2013, a total of 1455 patients underwent corrective surgery for isolated VSD in our center. Among them, 296 infants under 3 months of age who underwent VSD closure through the right atrial approach were included in the present study. TV was detached to better expose the defect in 49 patients (16.6%, study group) and it was not detached in 247 patients (83.4%, control group).
Results : The median age was 63.5 days (range, 14-90 days) and the median weight was 4.4kg (range, 2.1-6.7kg). Abnormal chordal attachment or aneurysmal sac formation of the TV in preoperative echocardiogram was associated with detaching TV during surgery (24/49 vs. 52/247, p=0.002). The Cardiopulmonary bypass times (90.8±33.3 vs. 73.4±21.6 minutes; P=0.001) and aortic cross-clamp times (60.0±22.1 vs. 46.1±15.2 minutes; P<0.001) were significantly longer in the study group. Postoperative junctional ectopic tachycardia was developed in 5 patients (1/49 vs. 4/247, p>0.99), and 2 patients required permanent pacemaker due to heart block in control group. One hospital death occurred in a premature baby due to capillary leak syndrome after neonatal repair. Follow-up echocardiography was available in 282 patients (282/295, 95.6%) at a median of 21 months (range, 1-108 months), without intergroup difference (P=0.26). In the latest echocardiogram, significant TR (more than grade 2) was observed in only one patient in study group, and VSD leak existed in 4 patients (1 in study group and 3 in control group) without clinical significance. Reoperation for residual VSD or significant tricuspid valve regurgitation (TR) was required in 3 patients (1 in study group vs. 2 in control group).
Conclusion : Detachment of the TV can be safely used to better expose the VSD without increasing the risk of tricuspid regurgitation in young infants. Preoperative echocardiogram might be useful to predict the possibility of detaching TV for enhancing exposure of the VSD.
책임저자: 박천수
울산대학교 의과대학 서울아산병원 흉부외과학교실 소아심장외과
연락처 : 방지현, Tel: 010-2643-5777 , E-mail : mibbi@naver.com
