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Korean J Crit Care Med > Volume 17(2); 2002 > Article
Korean Journal of Critical Care Medicine 2002;17(2): 100-106.
원저 : 허혈성 심근병증(Ischemic Cardiomyopathy) 환자에서 Endoventricular Circular Patch Plasty 수술 중 및 술 후 환자관리
김진희, 함병문, 김용락, 전윤석, 한성희, 성재상, 김기봉, 김형렬
서울대학교 의과대학 마취통증의학교실, *흉부외과학교실
Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy
Jin Hee Kim, Byung Moon Ham, Yong Lak Kim, Yoon Seok Jeon, Sung Hee Han, Jae Sang Sung, Ki Bong Kim, Hyeong Ryul Kim
1Department of Anesthesiology, Seoul National University, College of Medicine, Seoul, Korea. hambm@anu.ac.kr
2Department of Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul, Korea.
BACKGROUND: Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy. METHODS: EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit. RESULTS: Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively. CONCLUSIONS: EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.
Key Words: Ejection fraction; Endoventricular circulatr patch plasty; Milrinone; beta-adrenergics
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