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심방-폐동맥 문합술 후 총 체정맥-폐동맥 문합술로의 전환 : 수술 적응증 및 혈역학적 특징의 검토

Other Titles
 Conversion of Total Atrio-pulmonary Connection to Total Cavo-pulmonary Connection -Review of Indications and Hemodynamic Characteristics- 
 서정호  ;  이종균  ;  최재영  ;  설준희  ;  이승규  ;  박영환  ;  조범구 
 Journal of the Korean Pediatric Association (소아과), Vol.45(2) : 199-207, 2002 
Journal Title
Journal of the Korean Pediatric Association(소아과)
Issue Date
Total atrio-pulmonary connection ; Total cavo-pulmonary connection ; Protein losing enteropathy ; Single ventricle
Purpose : Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. Methods : Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization 11? months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. Results : There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range : 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was 18.0?.6 mmHg, but baffle pressure, corresponding to right atrial pressure decreased to 14.8?.6 mmHg after TCPC. The size of the pulmonary arteries did not regress after TCPC. Conclusion : The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.
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Appears in Collections:
6. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Young Hwan(박영환) ORCID logo https://orcid.org/0000-0001-9802-8017
Sul, Jun Hui(설준희)
Lee, Sung Kyu(이승규)
Lee, Jong Kyun(이종균)
Cho, Bum Koo(조범구)
Choi, Jae Young(최재영) ORCID logo https://orcid.org/0000-0002-1247-6669
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