Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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One Stage Total Repair of the Aortic Arch Anomaly using the Regional Perfusion

대동맥궁 이상이 동반된 선천성 심장병에서 국소 순환을 이용한 일차 완전 교정

  • Jang Woo-Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Lim Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lim Hong-Kook (Department of Thoracici and Cardiovascular Surgery, Sejong General Hospital) ;
  • Min Sun-Kyung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Kwak Jae-Kun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Chung Eui-Seuk (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Kim Dong-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine) ;
  • Kim Woong-Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
  • 장우성 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 임청 (서울대학교 분당병원 흉부외과) ;
  • 임홍국 (부천세종병원 흉부외과) ;
  • 민선경 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 곽재건 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 정의석 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김동진 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김웅한 (서울대학교 어린이병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Published : 2006.06.01
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Abstract

Background: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. So we surveyed if the regional cerebral and myocardial perfusion might eliminate those potential side effects. Material and Method: From March 2000 to December 2004, 62 neonates or infants with aortic arch anomaly underwent one stage biventricular repair using the regional perfusion technique by single surgeon. Preoperative diagnosis of the arch anomaly consisted of coarctation (n=46), interruption of the aorta (n=12), hypoplastic left heart syndrome (n=2) and truncus areteriosus (n=2). Combined anomalies were ventricular septal defect (n=51), TAPVR (n=1), PAPVR (n=1) and atrioventricular septal defect (n=2). Arterial cannula was inserted at the innominate artery. Result: The mean regional perfusion time of brain was $28{\pm}10min$. Operative mortality rates was 0 (0/62). Late death was 1 (1/62) during $11{\pm}7$ months of follow-up. Neurologic complications consisted of transient chorea in 1 case. There was no reoperation associated with arch anolamy. Pulmonary complication associated with arch repair occurred in f case which was managed by aortopexy. Conclusion: One-tage rch repair using the regional profusion is safe and effective in minimizing the neurologic and myocardial complications.

배경: 대동맥궁 이상 수술 시 완전 순환정지 방법은 신경학적 문제나 심근의 손상을 줄 수 있다. 이를 피하기 위해서 저자들은 대동맥궁 이상이 동반된 선천성 심장병 수술 시 뇌 및 심장의 국소 관류법을 사용하고 있으며 이번 조사를 통하여 그 결과를 알아보고자 한다. 대상 및 방법: 2000년 3월부터 2004년 12월까지 대동맥궁 이상이 동반된 선천성 심장병으로 양심실 일차 완전 교정을 시행한 62명의 신생아 및 영아를 대상으로 하였다. 대동맥궁 이상은 축착이 46명, 대동맥 단절이 12명, 좌심실 저형성 증후군 2명, 총동맥관 2명이었으며 동반된 심기형은 심실중격 결손 51명, 총정맥 환류 이상 1명, 부분 정맥 환류 이상 1명, 방실 중격 결손 2명 있었다. 수술시 대동맥궁 기형 교정하는 동안 모든 환자에서 무명동맥과 관상 동맥 혈류를 유지하였다 결과: 국소 관류 시간은 평균 $28{\pm}10$분이었다. 수술 사망은 없었고, 평균 11개월의 관찰 기간동안 1명의 만기 사망(1.6%)이 있었다. 술 후 신경계 합병증은 1명에서 일시적인 무도증이 발생한 것 외에는 없었다. 대동맥궁 기형 교정과 관계된 재수술은 없었다. 1명에서 대동맥궁 기형 교정과 관계되어 기관지 합병증이 발생하였으며 대동맥고정(aortopexy)으로 교정되었다. 결론: 국소 순환법을 이용한 대동맥궁 기형 교정 방법은 완전 순환 정지사용 시 야기될 수 있는 신경 및 심근의 손상을 최소화 할 수 있는 방법이다.

Keywords

References

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