Journal of Chest Surgery

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

Intermediate-term Result of Tricuspid Annuloplasty for Tricuspid Regurgitation Associated with Congenital Heart Disease in Adult

성인 선천성 심기형에 동반된 삼첨판막 폐쇄부전의 판막륜 성형술 후 중기성적

  • Yun, Tae-Jin (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Kim, Sang-Hwa (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Lee, Jun-Wan (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Park, Jeong-Jun (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Song, Hyun (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Lee, Jae-Won (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Seo, Dong-Man (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Song, Meong-Gun (Dept. of Thoracic and Cardiovascular Surgery, College Medicine, University of Ulsan) ;
  • Song, Jong-Min (Dept. of Internal Medicine, College Medicine, University of Ulsan) ;
  • Kang, Duck-Hyun (Dept. of Internal Medicine, College Medicine, University of Ulsan) ;
  • Song, Jae-Kwan (Dept. of Internal Medicine, College Medicine, University of Ulsan) ;
  • Jang, Wan-Sook (Dept. of Pediatrics, College of Medicine, University of UIsan) ;
  • Kim, Young-Hwue (Dept. of Pediatrics, College of Medicine, University of UIsan) ;
  • Ko, Jae-Kon (Dept. of Pediatrics, College of Medicine, University of UIsan) ;
  • Park, In-Sook (Dept. of Pediatrics, College of Medicine, University of UIsan)
  • 윤태진 (울산대학교 의과대학 흉부외과학교실) ;
  • 김상화 (울산대학교 의과대학 흉부외과학교실) ;
  • 이준완 (울산대학교 의과대학 흉부외과학교실) ;
  • 박정준 (울산대학교 의과대학 흉부외과학교실) ;
  • 송현 (울산대학교 의과대학 흉부외과학교실) ;
  • 이재원 (울산대학교 의과대학 흉부외과학교실) ;
  • 서동만 (울산대학교 의과대학 흉부외과학교실) ;
  • 송명근 (울산대학교 의과대학 흉부외과학교실) ;
  • 송종민 (울산대학교 의과대학 내과학교실) ;
  • 강덕현 (울산대학교 의과대학 내과학교실) ;
  • 송재관 (울산대학교 의과대학 내과학교실) ;
  • 장완숙 (울산대학교 의과대학 소아과학교실) ;
  • 김영휘 (울산대학교 의과대학 소아과학교실) ;
  • 고재곤 (울산대학교 의과대학 소아과학교실) ;
  • 박인숙 (울산대학교 의과대학 소아과학교실)
  • Published : 2003.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

We assessed the intermediate-term result of tricuspid annuloplasty (TAP) for tricuspid valve regurgitation (TR) associated with congenital heart disease in adults. Risk factors for residual TR were also analysed. Material and Method: From August 1989 to June 2001, seventy three adult patients, 51 females and 22 males, underwent TAP for TR associated with various congenital heart disease. Their age ranged from 46 years to 73 years (mean:43). Associated heart anomalies were atrial septal defect (55), ventricular septal defect (6), partial anomalous pulmonary venous return (4) and others (8). Preoperative and post-operative TR velocities were 3.25 m/sec and 2.56 m/sec respectively, and the types of TAP were De Vega in 43, Kay in 18 and Ring annuloplasty in 12. Postoperative follow-up duration was 2,347 patient-month (mean: 32.6 months), and 134 two-dimensional echocardiographic examinations were done during this period. Residual TR greater than III/IV was considered as TAP failure. Result: TAP failure was observed in 7 patients (9.6%), and one patient among them underwent tricuspid valve replacement. Risk factors for TAP failure were diagnosis other than atrial septal defect (p=0.001), preoperative (p=0.038) and postoperative (p=0.028) high TR velocity. There was no statistical significance in terms of TAP methods. Conclusion: Careful evaluation of valve morphology and aggressive surgical intervention are mandatory for the repair of TR with preoperative or residual RV pressure overload.

성인 선천성 심기형에 동반된 삼첨판막 폐쇄부전에 대한 판막륜 성형술의 중기 성적 및 잔존폐쇄부전의 위험인자를 분석하였다. 대상 및 방법： 1989년 8월부터 2001년 6월까지 총 73명의 성인환자가 선천성 심기형에 동반된 삼첨판막 폐쇄부전으로 판막륜 성형술을 받았다. 환자의 성비는 51：22로 여자가 많았고 연령은 16∼73세(평균 43세)였다. 진단은 심방중격결손(55), 심실중격결손(6), 부분 폐정맥 환류이상(4), 기타(8)의 순 이였다. 수술 전, 후 판막 폐쇄부전의 평균 혈류 속도는 각각 3.25 m/sec, 2.56 m/sec이었고, 판막 성형술의 방법은 De Vega 형(43), Kay 형(18), Ring Annuloplasty 형(12)의 순 이었다. 외래 추적기간은 2,347 patient-month (평균: 32.6개월)이었고, 이 기간 중 총 134예의 심초음파가 시행되었다. 초음파상 III/IV 이상의 잔존 판막 폐쇄 부전이 있는 경우 판막 성명술 실패로 간주하였다. 결과: 7명의 환자(9.6%)에서 판막 성명술 실패의 소견을 보였고, 이중 1명에서 삼천판막 치환술이 시행되었다. 잔존 폐쇄부전의 위험인자로는 심방 중격 결손 이외의 진단, 폐쇄부전이 우심실 압력 과부하에 의한 경우, 수술 후 높은 판막 폐쇄부전 혈류 속도 등으로 해석되었고. 판막 성형술의 방법은 잔존 폐쇄부전과 무관하였다. 결론: 선천성 심기형에 동반된 삼첨판막의 폐쇄부전이 우심실 압력 과부하에 의한 경우 판막 성형술 시 주의를 요하며, 수술 후 우심실 압부하가 소실되지 않는 경우 잔존 폐쇄부전의 위험이 높다.

Keywords

References

  1. Eur J Cardiothorac Surg v.20 Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease Kuwaki K;Morishita K;Tsukamoto M;Abe T https://doi.org/10.1016/S1010-7940(01)00786-2
  2. Ann Thorac Surg v.72 Tricuspid valve repair with the Cosgrove-Edwards Annuloplasty system: Early clinical and echocardiographic results Gatti G;Maffei G;Lusa AM;Pugliese P. https://doi.org/10.1016/S0003-4975(01)02830-2
  3. J Heart Valve Dis v.8 Tricuspid regurgitation late after mitral valve replacement: Clinical and echocardiographic evaluation Porter A;Shapira Y;Wurzel M(et al.)
  4. J Thorac Cardiovasc Surg v.117 Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume:Characterisic difference based on primary cardiac lesion Sugimoto T;Okada M;Ozaki N;Hatakeyama T;Kawahira T https://doi.org/10.1016/S0022-5223(99)70325-9
  5. Ann Thorac Surg v.72 De Vega Tricuspid annuloplasty for tricuspid regurgitation in children Kanter KR;Doelling NR;Fyfe DA;Sharma S;Tam VKH. https://doi.org/10.1016/S0003-4975(01)02976-9
  6. Thorac Cardiovasc Surg v.41 Surgery for tricuspid insufficiency: Long term follow-up after De Vega annulopasty Holper K;Haehnel JC;Augustin N;Shening F. https://doi.org/10.1055/s-2007-1013812
  7. J Cardiovasc Surg v.31 The De Vega tricuspid annuloplasty. Perioperative mortality and long term follow-up De Paulis R;Bobbio M;Ottino G(et al.)
  8. Chest v.88 Trends and results in tricuspid valve surgery Kratz JM;Crawford FA;Stroud MR;Appleby DC;Hauger KH. https://doi.org/10.1378/chest.88.6.837
  9. Thorac Cardiovasc Surg v.33 Functional tricuspid insufficiency: Conservative or operative management Klepetko W;Klicpera M;Kronik G(et al.)
  10. J Thorac Cardiovasc Surg v.99 Tricuspid operations in 530 patients Mcgrath LB;Gonalez-Lavin L;Bailey BM(et al.)
  11. Ann Thorac Surg v.66 Influence of functional tricuspid regurgitation on right ven-tricular function Sugimoto T;Okada M;Ozaki N;Kawahira T;Fukuoka M. https://doi.org/10.1016/S0003-4975(98)01041-8
  12. J Am Coll Cardiol v.32 Tricuspid valve surgery and intraoperative echocardiography factors affecting survival, clinical outcome and echocardiographic success Bajzer CT;Stewart WJ;Cosgrove DM;Azzam SJ;Arheart KL. https://doi.org/10.1016/S0735-1097(98)00355-6
  13. Eur J Cardiothorac Surg v.6 Evaluation and treatment of secondary tricuspid insufficiency Pellegrini A;Colombo T;Donatelli F(et al.) https://doi.org/10.1016/1010-7940(92)90144-M
  14. J Thorac Cardiovasc Surg v.106 Vanishing De Vega annuloplasty for functional tricuspid regurgitation Duran CM;Kumar N;Prabhakar G;Ge Z;Bianchi S;Gometza B.
  15. Ann Thorac Surg v.62 De vega annuloplasty for acquired tricuspid disease: Early and late results in 110 patients Abe T;Tsukamoto M;Morishita K;Tanaka T;Kuwaki K. https://doi.org/10.1016/S0003-4975(96)00957-5
  16. J Thorac Cardiovasc Surg v.95 Evaluation of long-term results of bicuspidalization annuloplasty for functional tricusipid regurgitation Nakano S;Kawashima Y;Hirose H(et al.)
  17. J Heart Valve Dis v.6 Treatment of functional tricuspid regurgitation by bicuspidalization annuloplasty during mitral valve surgery Katircioglu SF;Yamak B;Ulus AT(et al.)
  18. Ann Thorac Surg v.64 Tricuspid valve repair with the cosgrove-Edwards annuloplasty system MaCarthy JF;Cosgrove DM. https://doi.org/10.1016/S0003-4975(97)00348-2
  19. J Heart Valve Dis v.10 De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation Matsuyam K;Matsumoto M;Sugita T(et al.)