Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Subannular Procedures in Mitral Valve Reconstruction

승모판 재건술의 승모판막하술식

  • 이재원 (서울중앙병원 흉부외과학 교실) ;
  • 정종필 (서울중앙병원 흉부외과학 교실)
  • Published : 1997.02.01
Download PDF
⟨ Previous Next ⟩

Abstract

Between December 1993 and March 1996, 75 patients had undergone ubannular procedures in mitral valve reconstruction. Their mean age was 45 years and they consisted of 28 males and 47 females. The cause of mitral disease in 75 patients were classified as follow : 29 cases were degenerative, 40 cases were rheumatic, 3 cases were congenital, 2 cases were infectious and 1 case was ischemic. Average number of mitral anatomical lesion per patient was 3.1 and we used average 1.5 procedures on subannular structure in mitral valve per patient. Subannular procedures were chordae shortening 21, chordae transfer 22, new chordae formation 20, papillary muscle splitting 33, shortening of papillary muscle 2. Intraoperative transesophageal echocardiography was carried out for providing an immediate and accurate assessment of the adequacy of the reconstruction. There was no operative death. Patients have been followed up from 2 to 29months, mean 12.5. There were two failures that necessitated reoperation. The mean functional class (NYHA) was 3.19 preoperative and improved to 1.12 postoperatively. After mitral valve repair, the patients were improved hemodynamic, echocardiographic data. In conclusion, subannular procedure in mitral valve repair when feasible is stable and safe with a low prevalence of reoperation.

1993년 11월부터 1996년 3월까지 75명의 환자에서 승모판 재건술중에 승모판막하술식을 시행하였다. 평균 연령은 45, 5세로 남자가 28명, 여자가 47명이었다. 질환 발생 원인은 퇴 행성 29례, 류마치스성 40 례, 선천성 3례, 감염성 2례 및 허혈성 1례였다. 승모판막 병변은 환자당 평균3. 1개의 병변이 있었는데, 승모판막하술식은 환자당 평균 1, 5례 시행하였다. 건삭단축술 21례(28%), 건삭전이술 22례(30%), 건삭 절제술 17례(23%), 새로운 건삭의 형성 20례(27%), 유두근분할 33례(43%), 유두근단축술 2례(2. 6%)를 시행하였다 경식도심초음파를 수술중에 시행하여 승모판막의 기능을 정확하게 확인하였다. 환자들의 평균 외래 추적관찰기간은 12개월(2-29개월)이었다. 수술후 사망은 없었다. 수술전후의 NYHA 기능적 분류의 변화는 술전에 평균 3. 19등급에서 수술후 1. 12등급으로 개선되었다. 승모판 재건수술후 환자들 은 심초음파 자료상에서 혈역차적으로 개선됨을 보였다. 결론적으로, 승모판 재건술중 실행가능한 승모 판막하술식은 안전하며, 재수술률이 매우 낮은 술식이다.

Keywords

References

  1. Circulation v.78 no.SUP. Long-term result of mitral reconstruction with Carpentier techniques in 148 patients with mitral insufficiency Galloway AC;Colvin SB;Baumann FG(et al.)
  2. 대흉외지 v.26 승모판 재건술 이재원;도한구;장택회;조상록;나명훈
  3. 대흉외지 v.29 승모판 폐쇄부전증에서 승모판막 재건술 및 중기성적 윤양구;장병철;유경종;김시호
  4. 대흉외지 v.28 승모판 재건술 이현우;송현;이재원;김동관;서동만;송명근
  5. Circulation v.89 Mitral valve replacement versus mitral valve reapir Tischler MC;Cooper KA;Rowen M(et al.)
  6. J Thorac Cardiovasc Surg v.39 Repair of mitral insufficiency due to retpured chordae tendinae McGoon
  7. J Thorac Cardiovasc Surg v.86 Cardiac valve surgery - the French correction Carpentier A
  8. J Thorac Cardiovasc Surg v.99 Valve repair with Carpentier techniques : The second decade Carpentier A
  9. Ann Thorac Surg v.56 Late result of mitral valve repair for mitral regurgitation due to degenerative disease David TE;Amstrong S;Sun Z(et al.)
  10. J Thorac Cardiovasc Surg v.90 Experiences with the Carpentier techniques of mitral valve reconstruction in 103patient(1980-1985) Spencer FC;Colvin SB;Culliford AT;Isom OW
  11. Circulation v.91 no.2 Intraoperative Doppler color flow mapping for decision-making in valve repair for mitral regurgitation Stewart WJ;Currie PJ;Lytle BW(et al.)
  12. Curr Probl Cardiol v.14 no.7 Mitral valvuloplasty Cosgrove DM;Stewart WJ
  13. J Thorac Cardiovasc Surg v.104 Correction of anterior mitral prolapse : result of chordal transposition Salati M;Scofani R;Fundaro P(et al.)
  14. Ann Thorac Surg v.45 Treament of ruptured or elongated anterior mitral valve chordae by partial transposition of the posterior leaflet : experience with 29 patient Lessana A;Romano M;Lutfalla G(et al.)
  15. Circulation no.Ⅱ Transposition of chordae in mitral valve repair -mid-term result- Uva MS;Grare P;Jebara V(et al.)
  16. J Thorac Cardiovasc Surg v.101 Mitral valve repair by replacement of chordae tendinae with polyfluorethylene sutures David TE;Bos J;Rakowski H
  17. 대흉외지 v.29 새로운 건삭형성술 이현우;이재원;서동만;송현
  18. J Thorac Cardiovasc Surg v.111 Repair of chordae tendineae for rheumatic mitral valve disease Bernal JM;Rabasa JM;Olalla JJ(et al.)