심실 중격 결손증에 대한 임상적 고찰

Abstract

[한글]

1963년 12월부터 1977년 6월말까지 약 13년 6개월 간 연세대하교 부속병원 흉부 외과에서 심실 중격 결손증으로 수술 받았던 70예를 대상으로 아래와 같은 결과를 얻었다.

① 남자가 56예, 여자가 16예로 3.5:1로 남자에 많았다.

② 이중 대다수가 15세 이전에 수술을 받았고 ③ 심실 중격 결손 중 단독으로 있는 50예중 Pp/Pp<0.45인 예가 29예(56.5%)로 가장 많았다.

③ Pp/Pp>0.75인 예는 19예(25.0%)가 있었는데 이 환자들의 평균연령은 15세 이전에 발생되었던 예였다. ④ Pp/Pp가 0.75이상인 유아에서는 응급조치로서 폐동맥 협축술(banding)을 시행하였고 ⑤ Kirklin분류에 의한 결손의 형은 Ⅱ형이 36예(56.2%), Ⅰ형이 21예(3

2.8%)순으로 많았다. ⑥ 수술 사망률은 전체적으로 8.3%였는데 폐동맥 협축술을 시행했던 8예에서 사망률은 37.5%였고, 폐동맥 고혈압이 동반되지 않았던 심실 중격 결손 37예에서는 교정 후 사망 예가 없었으며 폐동맥 고혈압이 동반되었던 14예에서는 교정수술 사망률이 7.1%였고 다른 심장기형과 같이 동반되었던 13예에서 15.4%의 사망률을 나타내었다.

⑦ 원격 조사가 가능하였던 환자는 42명(62.6%)이 있었는데 뉴욕 심장협회(NYHA)분류에 의한 Ⅰ형이 24예(27.0%), Ⅱ형이 7예(16.6%), Ⅲ형이 5예(11.9%), Ⅳ형이 6예(14.2%)였다

[영문]

Venticular septal defect was the most common congenital disease admitted to the Severance Hospital from December, 1963 to June 30, 1977.

A total of 1,811 cardiac patients received cardiac catheterization in the Caridac Center of Yonsei University Medical College. Out of the 1,811 cardiac patients, 791 cases had congenital heart disease and of these 172 cases had ventricular septal defect. This amounted to 21.7% of all those with congenital heart disease.

Seventy-two cases of ventricular septal defect operated o in the chest surgery department are presented. Of these 72 cases of ventricular septal defect, 56 cases were male and 16 cases were female. Their ages ranged from 4/12 months to 32 years. The ratio of systolic pressure of the main pulmonary to systemic artery (Pp/Ps) for 28 of the 58 isolated ventricular septal defects was below 45 percent. Pp/Ps ratio for 19 of the 59 isolated ventricular septal defects was 75 percent. The patients were mostly below fifteen years of age. Out of 64 cases, there were 36 case of type Ⅱdefects, 21 cases of type Ⅰ, 4 cases of type Ⅲ, 2 cases of type Ⅳ and one case of both type Ⅱ and Ⅲ.

The amomalies associated with ventricular spetal defect were 14 in all; 4 cases of aortic insufficiency, 3 cases of ruptured aneurysm of the aortic sinus of valsalva, 2 cases of ruptured aneurysm of the aortic sinus of valsalve with aortic insufficiency, 2 cases of pat ent ductus arteriosus, one case of ruptured aneurysm of the aortic sinus of valsalva with atrial septal defect (secundum type), one case of atrial septal defect(secundum type) and one case of left ventricular right

atrial communication.

Overall mortality was 8.3 percent. The mortality in pulmonary artery banding was 37.5 percent. The causes of mortality were in one case congestive heart failure, in one case asphyxia and in one case respiratory insufficiency. The mortality in ventricular septal defect associated with pulmonary hypertension was 7.1 percent.

The cause of mortality was in one case low cardiac output syndrome. there was no mortality in the ventricular septal defects without pulmonary hypertension and the mortality in the ventricular septal defect associated with cardiac anomaly was 14.3 percent. The cause of mortality were in one case respiratory insufficiency and in one case congestive heart failure.