활로4징의 완전 교정술 후 우심실 유출로 및 폐동맥의 형태학적 이상 - 폐동맥지 협착의 유발인자 분석-

Abstract

Background and Objectives: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. Methods: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.1±19.8 months, follow-up duration after operation 13.9±5.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. Results: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=0.776, p<0.01) and post-operative RVEDP(r=0.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade Ⅱ of residual PI than grade Ⅲ∼Ⅳ. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(pressure gradient, ㎜Hg)=5.43+16.24×[false aneurysmal change of RVOT]+14.13×[RVOT patch enlargement to LPA] + 16.89×PDA. Conclusion: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.