한국인의 심방중격결손증에 대한 임상적 고찰

Abstract

[한글]

1962년 12월부터 1977년 3월까지 13년 3개월간 연세대학교 부속 세브란스 흉부외과에서 심방중격결손증으로 수술받았던 61예중 기록을 찾을 수 있었던 58예를 대상으로 아래와 같은 결론을 얻었다.

남자가 27예, 여자가 31예로 1:1.14로 여자에 많았다. 58예의 심방중격결손증에선 2차형 심방중격결손이 51예(87.9%), 1차형 심방중격결손이 7예(12.1%)였다. 심방중격결손증 58예중 40예(68.9%)에서 폐동맥 수축기압이 체동맥 수축기압의 40mmHgdlgkduTdmsk 12예에선 40∼50mmHg의 중증도의 폐동맥압 상승을 보였고 평균년령은 30세였다. 폐혈류와 체혈류의 비교가 가능하였던 58예중 52예중 Q^^p/Q^^s가 1.5∼2.5인 예는 22예(42.3%)로 가장

많았다. 가장 적은 폐혈류량은 체혈류량의 1.39배였고 가장 많은 폐혈류량을 보인 예는 9.6배이었다.

51예의 2차형 심방중격결손증에서 단순봉합으로 교정이 가능하였던 44예(86.2%)가 있었고, 나머지 7예는 patch 봉합폐쇄 하였다(13.8%).

결손의 크기는6.0∼10.0㎠(가로X세로)의 가장 많아 19예(32.7%)나 되었다.

수술후 사망예는 2예(3.4%)였었는데 모두 1차형 심방중격결손증이었고 사인은 1예에선 심근부전과 승모판 부전으로 수술중 사망하였고, 또 1예에선 수술후 패혈증으로 사망하였다. 2차형 심방중격결손증의 수술후 사망예는 없었다. 수술후 원격조사가 가능하였던 2차형 심방중격결손증 36예와 1차형 심방중격결손증 2예 도합 38예중 37예(97.3%)에서 functional class Ⅰ (NYHA)로 회복하였고 1차형 심방중격결손증 1예에서 8년후 승모판 폐쇄부전으로 울혈성 심부전증이 발생하였다.

[영문]

Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cadiac patients received cardiac catheterization in the cardiac department of Yonsei University medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congenital atrial septal defect. This amounted to 16.04% of all those with congenital heart disease.

58 cases of congenital atrial septal defect, operated on in the chestsyrgery department, were presented.

Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female.

Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure ; in 6 cases, the range of the main pulmonary artery was 40-50mmHg. Average age of these was 30.1 years. This study tends to show that Korean patients wit atrial septal defect even though younger, have a slight higher systolic pressure of the main pulmonary artery than Western patients have.

In only one of the 58 cases of atrial septal defect was, the Rp was found to be as high as 45% of Rs.

All other cases were below this level.

51 cases had ostium secoundum defect, 4 of these cases had ostium secundum defect combined with mitral incompotence and 6 of them had double ostium secundum defect.

The remaining 7 cases had ostium primum defect. Their atrial septal defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia.

44 cases(2nd atrial septal defect) were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches(1 pericardium and 13 Teflon).

In 4 cases there were single defects while 7 cases showed two defects. However the associated septal defect was so small that it could be closed by direct sutures.

The size of the defect ranfged between 6.0㎠ and 10.0㎠ in 19 cases; (32.7%) the smallest being 0.5㎠ and the largest 24㎠. the surgocal mortality was 2 cases(3.4%).

These one case with ostium primum defect, could not be resuscitated on operation table.

The cause of death in thia case was myocardial failure & MI. The other, a case of ostium primum defect had a second operation on the first post operative day due to massive bleeding from RV vent0line insertion site. The patient died on 26th post-operative day due to sepsis.