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동맥전환술 후의 신생대동맥근부 확장과 대동맥판막폐쇄부전의 관계

Other Titles
 Relation of Neoaortic Root Dilation and Aortic Insufficiency after Arterial Switch Operation 
 박한기  ;  김도균  ;  박영환  ;  조범구  ;  최재영  ;  이종균  ;  홍유선 
 Korean Journal of Thoracic and Cardiovascular Surgery (대한흉부외과학회지), Vol.36(12) : 921-927, 2003 
Journal Title
 Korean Journal of Thoracic and Cardiovascular Surgery (대한흉부외과학회지) 
Issue Date
Arterial switch operation ; Aortic valve ; Aorta
Arterial switch operation ; Aortic valve ; Aorta
Arterial switch operation (ASO) has been the most effective surgical option for transposition of the great arteries. But, the inappropriate dilation of the neoaortic root has been reported and its effect on neoaortic valve function and growth of aorta has not been well documented. Material and Method: Forty-eight patients who underwent cardiac catheterization during follow up after arterial switch operation were included in this study. Arterial switch operation was performed at a median age of 18 days (range 1∼211 days). Preoperative cardiac catheterization was performed in 26 patients and postoperative catheterization was performed in all patients at 15.8±9.6 months after ASO. Postoperative ratios of the diameters of neoaortic annulus, root and aortic anastomosis against the descending aorta were compared to the size of preoperative pulmonary annular, root and sinotubular junction. Preoperative and operative parameters were analyzed for the risk factors of neoaortic insufficiency. Result: There were two clinically significant neoaortic insufficiencies (grade≥II/IV) during follow up, one of which required aortic valve replacement. Another patient required reoperation due to aortic stenosis on the anastomosis site. Post-operatively, neoaortic annulus/DA ratio increased from 1.33±0.28 to 1.52±.033 (p=0.01) and neoaortic root/DA ratio increased form 2.02±0.40 to 2.56±0.38 (p<0.0001). However, the aortic anastomosis/DA ratio showed no statistically significant difference (p=0.06). There was no statistically significant correlation between the occurrence of neoaortic insufficiency and neoaortic annulus/DA ratio and neoaortic root/DA ratio. Non-neonatal repair (age>30days) (p=0.02), preopeative native pulmonaic valve stenosis (p=0.01), and bisuspid pulmonic valve (p=0.03) were the risk factors for neoaortic insufficiency in univariate risk factor analysis. Conclusion: After ASO, aortic anastomosis site showed normal growth pattern proportional to the descending aorta, but neoaortic valve annulus and root were disproportionally dilated. Significant neoaortic valve insufficiency rarely developed after ASO and neoaortic annulus and root size do not correlate with the presence of postoperative neoarotic insufficiency. ASO after neonatal period, preoperative native pulmonary valve stenosis, and bicuspid native pulmonic valve are risk factors for the development of neoaortic insufficiency.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
7. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
Yonsei Authors
Kim, Do Kyun(김도균)
Park, Young Hwan(박영환)
Park, Han Ki(박한기) ORCID logo https://orcid.org/0000-0002-7472-7822
Lee, Jong Kyun(이종균)
Cho, Bum Koo(조범구)
Choi, Jae Young(최재영) ORCID logo https://orcid.org/0000-0002-1247-6669
Hong, You Sun(홍유선)
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