CAJ | 학술논문

目的：总结不同心脏手术中选择性应用自体心包及其复合补片的经验。方法159例心脏手术中，对于继发孔房间隔缺损、心内膜垫缺损的原发孔房间隔缺损和黏液瘤切除术后房间隔缺失部位，用自体心包片进行修补。自体心包外衬涤纶片作为复合补片主要用于法洛三联症、法洛四联症的肺动脉、右心室流出道的狭窄、主动脉瓣上狭窄和主动脉瓣环细小等需要加宽成形的手术。结果术后无栓塞、感染性心内膜炎等并发症发生，心房间隔缺损术后无残余漏、也无补片钙化和瘤样改变。术后中远期随访，直接应用自体心包片加宽主动脉瓣环2例，超声心动图和CT显示心包补片部位呈主动脉瘤样扩张，而自体心包外衬涤纶片者主动脉均无瘤样扩张。结论自体心包片可直接用于心房间隔部位缺损的心脏修补手术，对于主动脉、肺动脉、右室流出道狭窄部位的心脏手术，因承受压力较大，建议使用自体心包时外衬涤纶片，以防瘤样变形。
목적：총결불동심장수술중선택성응용자체심포급기복합보편적경험。방법159례심장수술중，대우계발공방간격결손、심내막점결손적원발공방간격결손화점액류절제술후방간격결실부위，용자체심포편진행수보。자체심포외츤조륜편작위복합보편주요용우법락삼련증、법락사련증적폐동맥、우심실류출도적협착、주동맥판상협착화주동맥판배세소등수요가관성형적수술。결과술후무전새、감염성심내막염등병발증발생，심방간격결손술후무잔여루、야무보편개화화류양개변。술후중원기수방，직접응용자체심포편가관주동맥판배2례，초성심동도화CT현시심포보편부위정주동맥류양확장，이자체심포외츤조륜편자주동맥균무류양확장。결론자체심포편가직접용우심방간격부위결손적심장수보수술，대우주동맥、폐동맥、우실류출도협착부위적심장수술，인승수압력교대，건의사용자체심포시외츤조륜편，이방류양변형。
Objective We intended to investigate the experience of applying the autologous pericardium and its composite patch selectively to cardiac surgery.Methods Autologous pericardium was used directly to repair atrial septal defect or to reconstruct atrial septum after left atrial myxoma resection.Autologous pericardium with dacron composite patch was mainly used for the reconstruction of right outflow tract such as tetralogy of Fallot ,pulmonary stenosis and for enlargement of small aortic root in rheumatic heart disease.Results No embolism, infectious endocarditis,residual shunt,patch calciflcation and aneurysm deformity occurred after atrial septal defect repair.Aneurysm enlargement happened in 2 cases after only autologous pericardium was used for repairing small aortic root in rheumatic heart disease during mid-term followed-up.Conclusion The autologous pericardium was suitable for repairing atrial septal defect and we suggest that autologous pericardium and its composite patch should be applied to the reconstruction of aorta,pulmonary and right outflow tract stenosis to prevent aneurysm deformity.