초록접수 현황
| 15F-192 | 구연 발표 |
Right Vnertricular "Overhaul" - as a Surgical Option in the Pulmonary Atresia with Intact Ventricular Septum.
조성규, 김웅한, 현관용, 박지영, 이정렬, 김용진
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : Management of pulmonary atresia with intact ventricular septum (PAIVS) remains controversial. Sometimes right ventricular (RV) overhaul procedure were required, consisting of resection of intraventricular obstructive muscle bundles to enlarge the right ventricular cavity.
Methods : From September 1999 to July 2015, 11 patients aged 10 days to 4.81 years (median age: 1.04 year) with PAIVS underwent RV overhaul procedure, 7 patients with biventricular repair and 4 patients with one and half repair. Mean body weight was 8.21 ± 3.03kg. The primary intervention in 6 patients was a cardiac catheterization and balloon pulmonary vavuloplasty. The systemic to pulmonary shunt and RV outflow tract procedure were in 4 patients, and shunt only was in 1 patient. Median age at primary intervention for PAIVS was 8days.
Results : One patient, who underwent one and half repair, died postoperatively due to progressive heart failure. Mean length of follow up was 9.6±11.6 year. Mean tricuspid valve(TV) Z-score was -2.1 ±1.7 (n = 11 ). There was no significantly difference of TV Z-score between biventricular repair group (n=7, TV Z-score : -1.6± 2.0 ) and One & a half repair group(n=4,TV Z-score : -2.9 ±0.9)( p=0.13). Follow up echocardiography showed that TV Z-score increased significantly after RV overhaul procedure (Pre: -2.2 ± 1.9 vs. Post: -0.54 ± 1.0, p=0.048). Two patients exhibited right pulmonary artery stenosis and moderate tricuspid regurgitation. They underwent tricuspid vavuloplasty and pulmonary angioplasty
Conclusion : In the patients with only moderately reduced ventricular size, RV overhaul procedure allowed us to consider between a biventricular repair or univentricular repair. RV overhaul could be helpful to enlarge the RV cavity
Methods : From September 1999 to July 2015, 11 patients aged 10 days to 4.81 years (median age: 1.04 year) with PAIVS underwent RV overhaul procedure, 7 patients with biventricular repair and 4 patients with one and half repair. Mean body weight was 8.21 ± 3.03kg. The primary intervention in 6 patients was a cardiac catheterization and balloon pulmonary vavuloplasty. The systemic to pulmonary shunt and RV outflow tract procedure were in 4 patients, and shunt only was in 1 patient. Median age at primary intervention for PAIVS was 8days.
Results : One patient, who underwent one and half repair, died postoperatively due to progressive heart failure. Mean length of follow up was 9.6±11.6 year. Mean tricuspid valve(TV) Z-score was -2.1 ±1.7 (n = 11 ). There was no significantly difference of TV Z-score between biventricular repair group (n=7, TV Z-score : -1.6± 2.0 ) and One & a half repair group(n=4,TV Z-score : -2.9 ±0.9)( p=0.13). Follow up echocardiography showed that TV Z-score increased significantly after RV overhaul procedure (Pre: -2.2 ± 1.9 vs. Post: -0.54 ± 1.0, p=0.048). Two patients exhibited right pulmonary artery stenosis and moderate tricuspid regurgitation. They underwent tricuspid vavuloplasty and pulmonary angioplasty
Conclusion : In the patients with only moderately reduced ventricular size, RV overhaul procedure allowed us to consider between a biventricular repair or univentricular repair. RV overhaul could be helpful to enlarge the RV cavity
책임저자: 김웅한
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 조성규, Tel: 02-2072-2348 , E-mail : csk1022@hanmail.net
