Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Pulmonary Thromboendarterectomy Under Total Circulatory Arrest

완전순환정지를 이용한 폐동맥색전증의 수술 치험 1례

  • Kim, Chang-Young (Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Chang-Hyeun (Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ahn, Hyuk (Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • 김창영 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 강창현 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 안혁 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Published : 2002.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Besides lung transplantation, pulmonary thromboembolectomy is the only effective therapeutic option for chronic thromboembolic pulmonary hypertension. It is however associated with a considerably high hospital mortality between 6.6 to 23%. Proper patient selection is critical when considering a patient for pulmonary thromboembolectomy. And It cannot be overemphasised that the key to the success of the operation is complete endarterectomy of the entire pulmonary arterial tree. We report that pulmonary thromboendarterectomy under total circulatory arrest was an effective and safe method in the surgical correction of the chronic thrornboernbolic pulmonary hypertension and enabled complete removal of superimposed peripheral organized thrombi in a good operative field.

만성 색전성 폐동맥 고혈압의 치료는 폐이식을 제외하면 폐동맥 색전제거술이 유일하지만, 수술 사망률이 6.6∼23%로 높게 보고되고 있다. 수술을 시행하기 전에 수술의 적응이 되는 환자인지를 판단하고, 수술을 시행할 때 전체 폐동맥 분지에 대해 충분히 색전을 제거하는 것이 수술의 성공적인 시행을 결정하는 가장 중요한 요인이다. 본원에서는 만성 폐동맥 색전증의 수술적 치료시 완전순환정지를 적용하여 좋은 수술 시야를 확보함으로써 각 구역 폐동맥수준까지 혈전을 제거하는 것이 유용한 방법임을 확인할 수 있었고, 술 후 합병증이 없이 안전하게 시행할 수 있었음을 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. 대흉외지 v.34 만성 폐색전증의 내막절제술 1례 보고 반동규;김혁;김영학 (등.)
  2. Chest v.103 Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension Moser KM;Bloor CM https://doi.org/10.1378/chest.103.3.685
  3. Chest v.81 Long-term follow-up of patients with pulmonary thromboembolism: Late prognosis and evoluin of hemodynamics and respiratory data Riedel M;Stanek V;Widimsky J;Prerovsky I https://doi.org/10.1378/chest.81.2.151
  4. J Thorac Cardiovasc Surg v.99 Risk factors for pulmonary thromboendarterectomy Daily PO;Dembitsky WP;Iversen S;Moser KM;Auger W
  5. J Thorac Cardiovasc Surg v.106 Experience and results of 150 pulmonary thromboendarterectomy operations over a 29 month period Jamieson S;Auger WR;Fedullo PF(et al.)
  6. Ann Thorac Surg v.62 Predictors of mortality in pulmonary thromboendarterectomy Hartz RS;Byrne JG;Levitsky S;Park J;Rich S https://doi.org/10.1016/0003-4975(96)00460-2
  7. Eur J Cardiothorac Surg v.18 Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension: hemodynamic characteristics and changes D'Armini AM;Cattadori B;Monterosso C (et al.) https://doi.org/10.1016/S1010-7940(00)00584-4
  8. Eur J Cardiothorac Surg v.19 Pulmonary thromboendarterectomy - risk factors for early survival and hemodynamic improvement Tscholl D;Langer F;Wendler O;Wilkens H;Georg T;Schafers HJ https://doi.org/10.1016/S1010-7940(01)00686-8
  9. Heart v.79 Pulmonary thromboendarterectomy Jamieson SW https://doi.org/10.1136/hrt.79.2.118
  10. Am J Respir v.174 Predictors of patient response to pulmonary thromboendarterectomy Bergin CJ;Sirlin C;Deutsch R (et al.)
  11. Ann Thorac Surg v.61 Inhaled Nitric Oxide as an Adjunct to Pulmonary Thromboendarterectomy Pinelli G;Mertes PM;Carteaux JP (et al.) https://doi.org/10.1016/0003-4975(95)00775-X