Homograft Aortic Root Replacement for Aortic Regurgitation with Behcet's Disease

Behcet씨 병과 동반된 대동맥판막 폐쇄부전에서 동종이식편을 이용한 대동맥근부 치환술

  • Baek, Man-Jong (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Na, Chan-Young (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim, Woong-Han (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Oh, Sam-Se (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim, Soo-Cheol (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Lim, Cheong (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Ryu, Jae-Wook (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kong, Joon-Hyuk (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Lee, Young-Tak (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center School of Medicine, SungKyunkwan University) ;
  • Moon, Hyun-Soo (Department of Anesthesiology, Hallym Medical Center, School of Medicine, Hallym University) ;
  • Park, Young-Kwan (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim, Chong-Whan (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute)
  • 백만종 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 나찬영 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김웅한 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 오삼세 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김수철 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 임청 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 류재욱 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 공준혁 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 이영탁 (성균관대학교 삼성서울병원 흉부외과) ;
  • 문현수 (한림대학교 의과대학 마취과) ;
  • 박영관 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김종환 (부천세종병원 흉부외과, 세종심장연구소)
  • Published : 2002.04.01

Abstract

Background: Paravalvular leakage or false aneurysm developed after isolated aortic valve replacement(AVR) for aortic regurgitation(AR) associated with Behcet's disease is one of the most serious complications, and requires subsequent reoperations. We describe the surgical result of homograft aortic root replacement(ARR) for AR associated with Behcet's disease. Material and Method: From January 1992 to December 2001, 6 patients with AR associated with Behcet's disease underwent 7 ARR with homograft and 1 Ross operation. Five patients were male and one was female. The grafts used for ARR were 5 aortic and 2 pulmonic homografts. Ages at operation ranged from 27 to 51 years(mean, 37$\pm$9 years). Two patients underwent ARR with aortic homograft at the first operation. In the remaining 4 patients, ARR using a homograft was performed for paravalvular leakage that developed after AVR, and the mean interval from AVR to ARR was 21 $\pm$29 months(range, 5 to 73.3 moths, median, 7.6 months). Result: There was no early death. All patients were followed up for an average of 18.9$\pm$24.0 months(range, 1.9 to 68.9 months, median, 8.4 months). Two of 4patients who had undergone ARR after AVR required subsequent reoperations for false aneurysm of the ascending aorta and failure of pulmonary homograft. One patient underwent re-replacement of the aortic root, ascending aorta and partial aortic arch with an aortic homograft, the other underwent Ross operation. Conclusion: This study suggests that aortic root replacement using a homograft in aortic regurgitation with Behcet's disease may provide good clinical results and decrease the incidence of paravalvular leakage or false aneurysm after aortic valve replacement. However, the adequate perioperative management and complete removal of the inflarrunatory tissue at operation were also important for the good long-term results.

배경: Behcet씨 병과 동반된 대동맥판막 폐쇄부전에서 인공 대동맥판막 치환술 후 발생하는 인공판륜 주위 누출이나 가성동맥류는 가장 심각한 합병증의 하나로써, 재수술을 필요로 한다. 저자들은 Behcet씨 병과 동반된 대동맥판막 폐쇄부전 환자에서 동종이식편을 이용한 대동맥근부 치환술 결과를 알아보고자 하였다. 방법 및 대상: 1992년 1월부터 2001년 12월까지 저자들은 6명의 Behcet씨 병 환자에서 동종이식편을 이용한 근부치환술 7례와 1례의 Ross 술식을 시행하였다. 남자 5명, 여자가 1명이었으며 수술 당시 평균 연령은 37$\pm$9세(27~51세)였다. 2명은 1차 수술에서 동종이식편을 이용한 근부치환술을 시행하였고 다른 4명은 대동맥판막 치환술 후 발생한 인공판륜 주위 누출로 동종이식편을 이용하여 근부치환술을 시행하였다. 인공판막치환술 후 재수술까지 평균 기간은 21 $\pm$29개월(5 ~73.3개월, 중앙값, 7.6 개월)이였다. 결과: 동종이식편을 이용한 근부치환술 후 조기 사망은 없었다. 6명에서 평균 18.9$\pm$24.0개월(1.9~68.9개월, 중앙값, 8.4개월)을 추적 관찰하였다. 판막치 환술 후 동종이식편을 이용한 근부치환술 환자 4명중 2명에서 상행대동맥에 발생한 가성동맥류와 폐동맥 동종이식편의 기능 부전으로 재수술이 필요하였다. 1명은 대동맥 동종이식편을 이용하여 대동맥근부, 상행대동맥 및 부분 대동맥궁을 재치환하였으며 다른 1명은 Ross수술을 시행하였다. 결론: 본 연구 결과 Behcet씨 병과 동반된 대동맥판막 폐쇄부전에서 동종이식편이나 폐동맥 자가이식편을 이용한 대동맥근부.치환술은 양호한 조기 수술 결과를 보이며, 인공판막 치환술 후 발생할 수 있는 인공판륜 주위 누출이나 가성동맥류의 발생을 줄일 수 있다. 그렇지만 Behcet씨 병의 정확한 진단과 수술 전후 적절한 내과적인 치료 및 수술시 염증 조직의 완전한 제거가 장기 결과의 향상을 위해 매우 중요할 것으로 사료된다.

Keywords

References

  1. Lancet v.335 Criteria for diagnosis of Behcet's disease. International Study Group for Behcet's disease.
  2. Postgrad Med J v.56 Aortic regurgitation and false aortic aneurysm formation in Bencet's disease. Rae SA;Vandenbrug M;Scholtz CL. https://doi.org/10.1136/pgmj.56.656.438
  3. Ann Thorac Surg v.64 Surgical management of Behcet's aortitis: a report of eight patients. Okada K;Eishi K;Takamoto S(et al) https://doi.org/10.1016/S0003-4975(97)00365-2
  4. Chest v.86 Conduction disturbance in Behcet's disease. Association with ruptured aneurysm of the sinus of Valsalva into the left ventricular cavity. Nojiri C;Endo M;Koyanagi H. https://doi.org/10.1378/chest.86.4.636
  5. 대흉외지 v.33 베체트씨병에 의한 대동맥판 폐쇄부전의 수술적 치료 김경환;김기봉;김원곤;김주현;안혁.
  6. 대한순환기학회지 v.31 혈관염에 의한 대동맥판 폐쇄부전 환자의 임상상. 정영훈;박재형;장진석;송종민;강덕현;송재관
  7. 대흉외지 v.30 베체씨 병에서의 동종 이식편을 이용한 대동맥 근위부 치환술 -1례 보고. 문현종;안혁
  8. Am Heart J v.103 Recongnition of the diverse cardiovascular manifestations in Behcet's disease. Geriant James D;Thompson A. https://doi.org/10.1016/0002-8703(82)90298-8
  9. J Cardiovasc Surg(Torino) v.29 Vasculo-Behcet's disease. Immunological study of the formation of aneurysm. Yamana K;Kosuga K;Kinoshita H(et al)
  10. Circulation v.80 Surgical consideration of aortitis involving the aortic root Suzuki A;Amano J;Tanaka H;Sakamoto T;Sunamori M.
  11. Ann Int Med v.99 Acute, severe, aortic regurgitation in Behcet's syndrome. Comess KA;Zibelli LR;Gordon D;Fredrickson SR. https://doi.org/10.7326/0003-4819-99-5-639
  12. Cardiology v.79 Diffuse aortitis complicating Behcet's disease leading to severe aortic regurgitation. Tai YT;Fong PC;Ng WF(et al) https://doi.org/10.1159/000174874
  13. Eur Heart J v.11 Aortic regurgitation secondary to Behcet's disease: a case report and review of the literature. Chikamori T;Doi YL;Yonezawa Y;Takata J;Kawamura M;Ozawa T https://doi.org/10.1093/oxfordjournals.eurheartj.a059752
  14. Cardiovasce Surg v.7 Surgical treatment of aortic regurgitation secondary to aortitis. Ando M;Kosakai Y;Okita Y;Matsukawa R;Takamoto S. https://doi.org/10.1016/S0967-2109(98)00095-7
  15. Ann Thorac Surg v.45 The surgical treatment of aortic regurgitation secondary to aortitis. Isomura T;Hisatomi I;Yanagi I. https://doi.org/10.1016/S0003-4975(10)62433-2
  16. Ann Thorac Surg v.67 Intravalvular implantation technique for aortic valve replacement in aortitis syndrome. Kotsuka Y;Tanaka O;Takamoto S. https://doi.org/10.1016/S0003-4975(98)01062-5
  17. Nippon Kyogu Geka Gakkai Zasshi v.41 Application of cryopreserved allograft to aortic root replacement for detachment case due to aortitis. Motomura N;Kawazoe K;Kito H;Eishi K;Kawashima Y;Oka T.
  18. J Jpn Assn Thorac Surg v.46 Aortic root replacement by cryopreserved homograft for prosthetic valve detachment case due to aortitis. Yamamoto T;Makuuchi H;Naruse Y.
  19. Nippon Kyobu Geka Gakkai Zasshi v.38 Surgical treatment of valvular heart disease associated with Behcet's disease. Sugimoto T;Miyashita M;Ota T;Yamashita C;Okada M;Nakamura K
  20. J Jpn Assn Thorac Surg v.42 Relationship between postoperative prognosis and preoperative immunological factors in aortitis syndrome. Noji S;Kitamura N;Yamaguchi A.