초록접수 현황
| 16F-117 | 포스터 발표 |
Redo-Rastelli Operation with Nuss Operation for Relieving the
Compression of an Extracardiac Conduit and Coronary Arteries.
Pill Jo Choi, Sung Sil Yoon, Jae Wha Chung, Yong Seok Lee, Siho Kim
Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
Background : An 18-year-old female patient presenting significant dyspnea on exertion referred to our department of thoracic and cardiovascular surgery for a redo-Rastelli (an exchange of a extracardiac conduit) operation. The patient underwent the Rastelli operation with a Polystan® conduit 15 years ago for DORV(double outlet of right ventricle) with PS (pulmonary stenosis) and single coronary orifice.
Methods : The previous conduit, however was located antero-right position to the aorta due to nearly transposed great vessels, traveling crossed the sternum. In follow-up of echocardiography, cardiac computed tomography(CT) and cardiac catheterization, the patient’s extra-cardiac conduit showed very severe stenosis and calcification. The pressure of right ventricle (RV) was high; 120/40 (mmHg) when systemic pressure was 120/80 (mmHg). Mild pectus excavatum (PE, haller index: 3.3) was also found. As results, the patient’s extra-cardiac conduit was already compressed against the sternum and the space for a new conduit was not roomy at the time. So it was sure that the a lager new conduit definitely be squeezed by the sternum and compresses the single coronary orifice underneath the new conduit.
Therefore we did combined operation; the handmade valved-conduit replacement and RVOT enlargement under the beating heart and the Nuss operation. The choice of a tissue valve was an issue as well. Because space problem under the sternum had to change with a smaller valve than those of her ages but needs as large as true internal diameter and enough effective orifice Valve-In-Valve(VIV) procedure of transcatheter pulmonic valve replacement(PVR) in the future. We decided a Perimount 21® for these concerns as mentioned earlier.
Results : The result of combined operation was satisfactory with a decrease of RV pressure (120mmHg to 60mmHg), preventing from relieving luminal compressions of conduit ,coronary artery and severe postoperative complications or instability of chest wall.
Conclusion : In conclusion, the Nuss operation can be a good option for not only solving chest
deformities but also decreasing compression of an extra-cardiac conduit in redo Rastelli
operation. The suitable and effective valve choice is also an important consideration for the next VIV transcatheter PVR procedures.
Methods : The previous conduit, however was located antero-right position to the aorta due to nearly transposed great vessels, traveling crossed the sternum. In follow-up of echocardiography, cardiac computed tomography(CT) and cardiac catheterization, the patient’s extra-cardiac conduit showed very severe stenosis and calcification. The pressure of right ventricle (RV) was high; 120/40 (mmHg) when systemic pressure was 120/80 (mmHg). Mild pectus excavatum (PE, haller index: 3.3) was also found. As results, the patient’s extra-cardiac conduit was already compressed against the sternum and the space for a new conduit was not roomy at the time. So it was sure that the a lager new conduit definitely be squeezed by the sternum and compresses the single coronary orifice underneath the new conduit.
Therefore we did combined operation; the handmade valved-conduit replacement and RVOT enlargement under the beating heart and the Nuss operation. The choice of a tissue valve was an issue as well. Because space problem under the sternum had to change with a smaller valve than those of her ages but needs as large as true internal diameter and enough effective orifice Valve-In-Valve(VIV) procedure of transcatheter pulmonic valve replacement(PVR) in the future. We decided a Perimount 21® for these concerns as mentioned earlier.
Results : The result of combined operation was satisfactory with a decrease of RV pressure (120mmHg to 60mmHg), preventing from relieving luminal compressions of conduit ,coronary artery and severe postoperative complications or instability of chest wall.
Conclusion : In conclusion, the Nuss operation can be a good option for not only solving chest
deformities but also decreasing compression of an extra-cardiac conduit in redo Rastelli
operation. The suitable and effective valve choice is also an important consideration for the next VIV transcatheter PVR procedures.
책임저자: Siho Kim
Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
발표자: Sung Sil Yoon, E-mail : chestkim@gmail.com