Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Changes of Hemodynamic and Central Pulmonary Artery Dimension After Bidirectional Cavopulmonarv Shunt

양방향성 체정맥-폐동맥 단락술후 혈역학 및 중심 폐동맥 크기의 변화

  • 이정렬 (서울대학교병원 흉부외과, 서울대학교의과대학 흉부외과학교실, 서울대학교 심장연구소) ;
  • 이해원 (서울대학교병원 흉부외과, 서울대학교의과대학 흉부외과학교실, 서울대학교 심장연구소, 서울대학교병원 소아과, 서울대학교 의과대학 소아과학교실)
  • Published : 1996.12.01
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Abstract

This study reviewed the changes of hemodynamlcs and centrAl pulmonary artery dimension in 54 patients who underwent bidirectional cavopulmonary shunt(BCPS) between February 1992 and December 1995 at Seoul National University Childrell's Hospital. Ag and body weight of patients averaged 36.8 $\pm$ 37.7 months and 8.0$\pm$3.0 kg, respectively Eightynine percent of patients had more than 2 violations of the risk factors for Fontan operation, resulting overall hospital mortality of 16.6%(9154). Serial hemodynamic and anglographic examinations before and mean 16.3 $\pm$ 14.3 months iirter BCPS were compared. The arterial oxygen saturation improved from a preoperative value of 71 9: 10.1 % to 79.H $\pm$ 8. 5% (n:4), p<0.05). The values of arterial oxygen saturation were lower as the age of the patients with BCPS in place was older(n=22, R'=0.341, p=0.004). A mean pulmonary artery pressure and pulmonary vascular resistance reduced from 31 $\pm$17 to 1).5$\pm$3.SmmHg(n=22, p<0.05) and from ).2$\pm$2.1 to 2.3$\pm$2.7 unit (n=7. p>0.05), respectively. Follow-up study showed a significant Increase of absolute values of ipsilateral pulmoanry artery (n: 14, p<0.05), but no change of contralateral pulmonary artreries (n: 14. p=not significant(HSI). However, there w re significant decreases in diameters of both ipsilateral and contralateral pulmonary arteries standardized by patients' body surface areas(16.8% decrease, n: 14, p< 0. 05 for ipsilatreal, 25.1%, n=14, p<0.05 for contralateral). Pulmonary artery indices for cross sectional areas of both pulmonary arterises decreased 9.3 $\pm$ 13.8% with showing a trend of more decrease as the follow-up duration was longer, We conclude that the bidirectional cavopulmonary shunt provide an excellent.

본연구는 서울대학교병원 어린이병원 흉부외과에서 1992년 2월부터 1995년 12월까지 양방향성 체정맥-폐동맥단락술을 시행받은 환자 54례를 대상으로 하였다. 환아의 평균연령 및 체중은 각각 36.8+37.7개월, 8.0+3.0kg이 었다. 환아의 89%는 폰탄(Fontan)수술의 위험 인자를 2개이상 동반하고 있었으며 병원 사망율은 16.6%(9154)였다. 생존 환아를 대상으로 양방향성 체정맥-폐동맥 단락술전과 평균 16.3+14.3개월후의 혈역학 및 심혈관 조영술 검사 소견을 비교하였다. 동맥혈의 평균 산소포화도는 술전 71.9+10.1 %에서 79.8+8.5%로 향상되었으나(n:4), p< 0.05). 양방향성 체정 맥-폐동맥단락의 혈역학으 로 생존하는 환아들은 나이가 많을수록 동맥혈의 산소포화도가 낮은 경향을 보였다(n=22, R2=0.34, p=0.004). 환아들의 평균 폐동맥압은 31+17mrnHg에서 13.5+3.5mmHg로 유의한 감소를 보였으며 (n=22, p<0.05), 폐혈관저항 역시 감소하는 경향을 보였으나 자료의 개수가 적어 통계적으로 유의한 차이는 발견할 수 없었다. 폐동맥의 술전후 크기 변화에 관해서는 폐동맥의 절대 크기는 동측의 경우 유의한 증가가 있었으나(n: 14, p<0.05) 반대측의 경우 차 隔\ulcorner없었다(n=14 p<0.05). 그러나 환아의 체표면적을 고려한 폐동맥크기 변화는 동측이건 반대측이건 모두 현저한 감소를 보여 통계적으로 유의하였다(동측의 경우 16.8, 감소, n=14, p<0.05, 반대측의 경우 25.1% 감소, n= 14, p<0.05). 좌,우 폐동맥 단면적에 대한 폐동맥지수는 동기간 평균 9.3+13.8%의 감소를 보였으며 술후 추적 기간이 길면 길수록 폐동맥 진수의 % 감소가 커지는 경향을 보였다(n=24, R2=0.34, p=0.002). 저자등은 본 연구를 통하여 양방향성 체정맥-폐동맥 단락술이 단계적 폰탄 수술의 중단기 고식술로서 우수함을 입증하였다. 그러나 환아가 성장함에 따라 상대적으로 폐동맥 크기가 감소하며 추적 기간이 길면 길수록 그런 현상이 더욱 심화된다는 사실은 양방향성 체정맥-폐동맥 단락술후 가능하면 빠른시기에 완전 폰탄을 시행하는 것이 바람직하다는 가설을 뒷받침한다.

Keywords

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