폐동맥 고혈압과 우심실 부전이 동반된 만성 승모판막 질환 환자에서 승모판막 대치술이 수술 직후 우심실 기능에 미치는 영향
The Effect of Preoperative Pulmonary Arterial Pressure and Right Ventricular Function on the Changes in Right Ventricular Function after Mitral Valve Replacement
강상화 ; 곽영란 ; 홍용우 ; 박준희 ; 남상범 ; 오영준 ; 심연희
Korean Journal of Anesthesiology (대한마취과학회지), Vol.40(1) : 16~21, 2001
Korean Journal of Anesthesiology (대한마취과학회지)
Background: In patients with mitral valvular disease with pulmonary hypertension (PHT) accompanying right ventricular (RV) dysfunction, mitral valve replacement (MVR) improves RV function and other hemodynamic variables in long term follow-up. However, there are controversies in improvement of RV function in the immediate postoperative period. We compared the RV function immediately after a MVR with a pulmonary artery catheter (PAC) between patients with normal and decreased RV function with PHT preoperatively.
Methods: Twenty nine patients undergoing a MVR were included in the study. The patients (n = 14) with mean pulmonary arterial pressure (PAP) ≤ 25 mmHg were assigned to group I and the patients (n = 15) with mean PAP 25 mmHg were assigned to group II. A PAC with rapid response-thermistors which enables us to determine right ventricular ejection fraction (RVEF) was inserted in all patients and hemodynamic variables were measured before and after cardiopulmonary bypass (CPB).
Results: After CPB, PAP, pulmonary vascular resistance index (PVRI), and RV end-diastolc volume (RVEDV) were significantly decreased and RVEF was significantly increased in group II compared with group I in which no hemodynamic variables were changed.
Conclusions: A MVR decreased RV afterload and increased RV function more significantly in patients with preoperative PHT accompanying RV dysfunction than in patients with normal PAP preoperatively.