소아 심실중격 결손증의 임상적 고찰

Abstract

[한글]

심실중격 결손증은 소아의 선천성 심장 질환중 가장 흔한 것으로서, Roger(1879)가 임상적으로 청진 소견을 보고한 이래 여러 연구자에의해서 많은 보고가 있었다.

저자는 1964년 1월부터 1979년 8월까지 약 15년 8개월간 연세대학교 부속 세브란스 병원에 입원하여 심도자 술에 의해 심실중격 결손증이 확진된 만 15세이하의 환아 225예을 임상적 소견, 심저도 검사, 혈역학적 변화 및 치료결과를 분석 관찰하여 다음과 같은 결과를 얻었다.

1. 남아가 130예, 여아가 95예로 남녀의 비는 1.4:1였다.

2. 입원시 임상증상은 빈번한 상기도 감염이 81예 (72.9퍼센트), 그리고 운동성 호흡곤란 72예 (63.2퍼센트)의 순이었다.

3. 입원시 이학적 소견은 청진상 수축기 잡음이 전에에서 들렸고, 간장비대 39예 (35.1퍼센트), 전흉벽 돌출 27예 (24.3퍼센트) 등이었다.

4. 심전도상 심실 비대가 없었던 경우가 14예 (12.6퍼센트), 좌심실 비대가 41예 (36.9퍼센트), 양심실 비대가 38예 (34.3퍼센트), 그리고 우심실 비대가 18예 (16.2퍼센트)였다.

5. 심도자 검사 소견은 우심방과 우심실 간의 산소함량의 차이는 평균 2.5Vol퍼센트였으며 Pp / Ps가 45퍼센트이하인 경우는 72예 (64.9퍼센트) 45퍼센트∼75퍼센트 19예(17.1퍼센트), 그리고 75퍼센트이상은 20예 (18퍼센트)였다.

6. 심실중격 결손증과 다른 심장질환이 동반되었던 경우는 65예 (36.9퍼센트)였으며 이중 폐동맥판막 협착증이 30예, 대동맥판막 부전증이 9예, 심방중격 결손증이 6예, 대혈관 전위가 3예, 그리고 좌측 상공정맥 유존이 2예 등이었다.

7. 심실중격 결손증을 수술로 교정한 63예를 Kirklin 방식으로 분류하면 Ⅱ형이 33예 (52.4퍼센트), Ⅰ형이 19예 (30.2퍼센트)의 순으로 많았다.

8. 수술 사망률은 전체적으로 6.3퍼센트였으며 폐동맥 협축술을 시행하였던 경우는 9예중 3예 (33.3퍼센트)에서 사망하였다.

[영문]

Two hundred and twenty five cases of ventricular septal defect, which was confirmed by cardiac catheterization at Severance Hospital, were observed on clinical, hemodynamic, electrocardiographic findings and their correlation, during

the period from January, 1964 to August, 1979. The six hundred and forty one cases of congenital heart disease under fifteen years old received cardiac catheterization during this period. The incidence of ventricular septal defect was 35.1% in our hospital. Sixty three cases had corrective surgery at the Department of Chest Surgery, Yonsei University.

The results were as follows;

1) Two hundred and twenty five cases of ventricular septal defect included and hundred and thirty male patients and ninetyfive female patients.

2) The age distribution of the two hundred and twenty five cases of ventricular septal defect were 78 cases (34.7%) between 7 and 12 years of age, 70 cases (31.1%) between 3 and 6, 50 cases (22.2%) under 2 years, and 27 cases (12%) over 13 years of age.

3) The commoln symptoms of Ⅲ cases of isolated ventricular septal defect showed frequent upper respiratory tract illness 81 cases (72.9%), exertional dyspnea 72 cases (63.2%), growth retardation 23 cases (20.7%), and palpitation 12 cases (10.8%).

4) The common physical findings included systolic murmur in all cases on the third and forth intercostal space on anscultation, systolic thrill in 62 cases (55.9%), hepatomegaly in 39 cases (35.1%), protrusion of anterior chest wall in 27 cases (24.3%) and cyanosis in 6 cases (5.4%).

5) The electrocardiographic findings showed LVH 41 cases (36.9%), BVH 38 cases (34.2%), RVH 18 cases (16.2%) and no ventricular hypertrophy 14 cases (12.6%). The correlation to electrocardiographic findings and right ventricular systolic

pressure showed mean pressure of 28.2 mmHg in normal EKG patterns, 45.9 mmHg in LVH, 59.6 mmHg in BVH, and 77.6 mmHg in RVH.

6) On cardiac catheterization of Ⅲ cases of isolated ventricular septal defect, the ratio of systolic pressure of main pulmonary artery to systemic artery (Pp/Ps) was in 72 cases (64.9%) below 45%, 19 cases (17.1%) between 45 and 20 cases (18.0%) over 75%. Pulmonary artery systolic pressure was under 30 mmHg in many cases in older children; 15 cases between 3 and 6 years of age, 20 cases betweeb 7 and 12, and 8 cases over 13 years old.

7) The cardiac disease associated with ventricular septal defect were 65 cases in all; 30 cases of pulmonary stenosis, 9 cases of aortic insufficiency, 6 cases of atrial septal defect and 2 cases of persistent left superior vena cava.

8) In the type of ventricular septal defect of 63 cases, which had corrective surgery, by Kirklin classification, 33 cases (52.4%) were type 2, 19 cases (30.2%) in type 1, 5 cases (7.9%) in type 3, and type 2 and type 3 was one case (1.6%).

9) Overall operative mortality was 6.3%, and the causes of death were in one case asphyxia, in one case congestive heart failure with persistent pulmonary hypertension, in one case respiratory insufficiency and in one case complete heart block. The mortality rate in the pulmonary artery banding was 33.3% and the causes of death were in one case congestive heart failure, in one case asphyxia and in one case respiratory insufficiency.