소아 환자에서 Ross 수술 성적 보고: 아산병원 10년 경험 = The Ross Procedure in Pediatric Patients: 10 Years Experience at the Asan Medical Center

다국어 초록 (Multilingual Abstract)

Background: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. Material and Method: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: 0.5∼14.0). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8∼138.2 months). We reviewed the echocardiographic data with focusing on the autograft dysfunction and reoperation. Result: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from 1.6±1.7/0.9±1.7 at preoperation to 1.8±1.6 (p=0.64)/2.2± 0.9 (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency. Conclusion: Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Yet reoperation due to allograft dysfunction was a major concern.

국문 초록 (Abstract)

배경: Ross 수술은 대동맥 질환을 가진 소아 환자에서 좋은 치료 방법으로 알려져 있으나, 국내에서는 이에 대한 보고가 드물다. 이 연구는 소아에서의 Ross 수술에 관하여 아산병원의 10년 동안의 중기 성적을 조사하였다. 대상 및 방법: 1997년 3월부터 2008년 10월까지 16세 이하인 18명의 환자가 Ross 수술을 시행 받았다. 남자 환자는 11명, 여자 환자는 7명이었다. 환자의 중위수 나이는 8.5세(0.5∼14세)였다. 대동맥 판막 병태생리는 대동맥 부전증이 6예, 대동맥 협착증이 4예, 대동맥 협착부전증이 7례 그리고 감염성 심내막염이 1예였다. 판막 형태는 이첨판이 11예, 삼첨판이 7예였다. 모든 환자의 수술은 근부 치환술로 시행하였다. 폐동맥 판막은 심막으로 만든 단엽판막 팻취를 사용한 1예를 제외하고, 모두 동종이식 판막으로 대치되었다. 추적 관찰의 평균 기간은 52.8개월이었다(5.8∼138.2개월). 심장 초음파 자료를 검토하여 자가이식 판막 부전, 동종 이식 판막 부전, 그리고 재수술 여부를 조사하였다. 결과: 추적 관찰 기간중 병원 내 사망과 후기 사망은 없었다. 2예에서 자가이식 판막 부전이 2등급이었고, 4예에서 자가이식 판막 부전이 1등급이었으며 나머지 경우는 역류가 없거나 근소하였다. 폐동맥 위치 도관에 의한 재수술이 3명에서 4회 있었다. 5년 재수술이 없는 생존률은 72.2%였다. 연속적인 경과 관찰에서, 대동맥륜(aortic annulaus)과 대동맥굴(aortic sinus)의 z-value는 수술 전 1.6±1.7/0.9±1.7에서 마지막 검사에서 1.8±1.6 (p=0.64)/2.2±0.9 (p=0.01)로 변화되었다. 신대동맥 근부의 성장과 신대동맥 부전의 의미 있는 연관성은 없었다. 결론: 소아 환자에서 Ross 수술의 중기 결과는 좋은 자가이식판막의 기능과 성장 잠재력을 보여줬다. 그러나, 동종 이식 판막의 기능 부전으로 인한 재수술은 주요 문제로 관찰되었다.

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