Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Pulmonary Thromboendarterectomy for Pulmonary Hypertension Caused by Chronic Pulmonary Thromboembolism

만성폐색전중으로 인한 폐동맥고혈압 환자에서 시행한 폐동맥내막절제술

  • Song Seung-Hwan (Department of Thoracic and Cardiovascular surgery, Pusan National University School of Medicine) ;
  • Jun Tae-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee Young-Tak (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung Ki-Ick (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang Ji-Hyuk (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi Jin-Ho (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim Jin-Sun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim Ho-Joong (Department of Pulmonology, Samsung Medical Center, Sungkyunkwan Uniersity School of Medicine) ;
  • Park Pyo-Won (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 송승환 (부산대학교 의과대학 부속병원 흉부외과) ;
  • 전태국 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 성기익 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 양지혁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 최진호 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김진선 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김호중 (성균관대학교 의과대학 삼성서울병원 호흡기내과) ;
  • 박표원 (성균관대학교 의과대학 삼성서울병원 흉부외과)
  • Published : 2006.08.01
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Abstract

Background: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvement of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. Material and Method: Between January 2001 and December 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. Result: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from $91{\pm}21$ mmHg to $40{\pm}17$ mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. Conclusion: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.

배경 : 만성폐색전증으로 인한 폐동맥고혈압은 국내에 잘 알려져 있지 않으나 매우 나쁜 예후를 보이는 질환이다, 내과적인 치료는 그 효과가 적으며 고식적인 치료방법으로 사용된다. 폐동맥 내막절제술은 수술 술기 및 술 후 관리의 발달에 따라 이 질환의 가장 좋은 근본적인 치료방법으로 알려져 있다. 대상 및 방법: 2001년 l월에서 2005년 12월 사이에 11명의 환자에서 폐동맥 내막절제술을 시행하였다. 모든 환자는 만성적인 호흡곤란과 운동불내성(exercise intolerance)을 나타냈다. 진단은 심장초음파, 폐관류스캔, 컴퓨터 단층촬영을 통해 이루어졌다. 수술 전 한 명의 환자를 제외한 모든 환자에서 하대정맥필터를 삽입하였다. 수술은 극저체온상태에서 전신순환정지를 통해 폐동맥의 최대한 원위부까지 내막절제술을 시행하였다. 중등도 이상의 삼첨판 역류증은 수술 중에 판막성형술로 교정하였다. 결과: 수술사망 및 만기사망은 없었다. 우심실수축기압은 수술 전 $91{\pm}21$ mmHg 에서 수술 후 $40{\pm}17$ mmHg로 의미 있게 감소하였다(p=0.001). NYHA class 및 삼첨판역류증도 수술 후 호전을 보였다. 경도의 재관류 손상이 3예, 수술 후 섬망이 1예 있었으나 후유증 없이 회복하였다. 결론: 폐동맥 내막절제술은 낮은 사망률과 유병률 그리고 좋은 임상결과를 보임으로써 폐동맥색전증으로 인한 폐동맥고혈압 환자에서 안전하고도 효과적인 치료로 생각된다.

Keywords

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