Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Magnetic Resonance Angiographic Evaluation as a Screening Test for Patients who are Scheduled for Cardiac Surgery

심장수술 대상자에서 선별 검사로서 두경부 MRA

  • Suh, Jong-Hui (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Choi, Si-Young (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Yong-Hwan (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 서종희 (가톨릭대학교 의과대학 의정부성모병원 흉부외과학교실) ;
  • 최시영 (가톨릭대학교 의과대학 의정부성모병원 흉부외과학교실) ;
  • 김용환 (가톨릭대학교 의과대학 의정부성모병원 흉부외과학교실)
  • Published : 2008.12.05
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Abstract

Background: The advances in surgical techniques, anesthesia management, perfusion methodology and postoperative intensive care have markedly decreased the mortality and cardiac morbidity of patients who undergo heart surgery over the past 2 decades. Nevertheless, it is well recognized that cardiac surgery carries a substantial risk for central nervous system complications. This study was conducted to evaluate the prevalence of subclinical cerebrovascular lesions in the head and neck by performing magnetic resonance angiography (MRA), and we investigated the clinical course of patients who had abnormal lesion seen on head and neck MRA. Material and Method: The subjects were 107 patients (71 men and 36 women ranging in age from 21 to 83 years) who were scheduled for cardiac surgery under nonemergency conditions between October 2005 and June 2008. Informed consent was obtained before the MRA. The carotid arteries, intracranial arteries and brain parenchyme were examined for subclinical cerebrovascular lesions by performing MRA. We reviewed the patients' medical records and MR findings to evaluate the prevalence of neurologically high risk patients and their clinical course. Result: The overall prevalence of neurologically high risk patients was 15.7% (17 patients). Among these patients, 11 patients had ischemic heart disease and 6 patients had valvular heart disease. Only 2 patients had a history of cerebrovascular disease. The clinical courses of 14 patients (13.1%) were changed according to their MRI findings. Conclusion: The prevalence of subclinical cerebrovascular disease in patients who were scheduled for cardiac surgery was higher than was expected. MR angiography was of value to identify these patients.

배경: 최근 20년간 수술적인 기법, 마취 기술, 심폐기 운용, 중환자실 관리의 발전으로 심장수술의 사망률과 합병증은 상당히 감소하였지만 심장수술이 중추신경계에 상당한 위험 요소가 되는 것은 널리 알려진 바이다. 이 연구는 두경부 MRA를 통해 심장 수술 대상자에서 불현성 뇌혈관계 질환의 유병률과 두경부 MRA 상에서 비정상적인 소견을 보인 환자의 치료 방침의 변화를 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2008년 6월까지 두경부 MRA 촬영에 동의한 107명의 심장수술 예정자(21세에서 83세까지의 연령분포를 보인 남자 71명과 여자 36명)를 대상으로 하였다. 이 환자들 중에서 신경학적인 고위험군의 비율과 그 환자들의 치료 방침의 변화를 관찰하였다. 결과: 신경학적으로 고위험군 환자의 비율은 15.7% (17예)였으며, 이중 11예는 허혈성 심질환, 6예는 판막 질환이였으며, 이 중 2예의 환자만이 이전에 신경학적인 병력이 있었다. 14명(13.1%)의 환자에서 치료 방침에 변화가 있었다. 결론: 심장수술 대상자에 있어 불현성 뇌혈관계 질환은 비교적 높은 것으로 생각되며, 이를 밝히는 데 있어 두경부 MRA가 의미 있는 것으로 생각된다.

Keywords

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