완전방실중격결손의 수술적 교정에 대한 장기성적

Abstract

Background :The purpose of this study was to evaluate the long-term surgical result and to analysis the risk factors associated postoperative death and residual left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect. Material and Method : Case histories of the patients with atrioventricular septal defect presenting to our institution between July 1989 and June 2000 were reviewed. Seventy consecutive patients(M:36, F:34, age range, 1 month to 19 years, mean body weight 8.9 ±6.6 kg) underwent primary intracardiac repair of complete atrioventricular septal defect. Down syndrome was present in 39(55.7%). The 42 valves were postoperatively classified as Rastelli type A(60.0%), 6 type B(8.6%), and 20 type C(28.6%) and 2 valves were not clearly classified. Median follow-up time was 45.3 months. Result : Operative mortality was 12.9%(9 patients). Operative mortality, however, decreased over the period of the study from 20.0% before 1996 to 7.7% during the recent 5 years. Residual left atrioventricular valve regurgitation(over grade III/IV) was present in 10 patients(14.3%). Five-year and ten-year survival rate was 79.4% and five-year and ten-year freedom from reoperation was 91.4%. Multivariate logistic regression analysis identified only residual left atrioventricular valve regurgitation(over grade III/IV) as risk factor (odds ratio=38.5, p=0.001) for postoperative death and the commissure repair of left atrioventricular valve after cleft repair(odds ratio=6.72, p=0.02) as risk factor for residual left atrioventricular valve regurgitation(over grade III/IV). Conclusion : Repair of complete atrioventricular septal defect during the infancy and the early childhood has acceptable early mortality, long-term survival rate and a low incidence of reoperation. For postoperative good function of left trioventricular valve and improved survival rate, surgical method should be focused on the leakless repair of AV valve.