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憎帽瓣狹窄症의 外科的 治療法에 關한 硏究

Surgical Treatment of Mitral Stenosis

최신의학 1959년 2권 2호 p.11 ~ 25
홍필훈,
소속 상세정보
홍필훈 (  ) - 연세의대 외과

Abstract


The treatment of mitral stenosis has become more and more surgical with corresponding good results, as reported by leading medical institutions throughout the world. Among many congenital and acquired heart diseases amenable to surgery, mitral stenosis representsa subject in which the surgical technic is relatively simple and standardized, and the results fairly predictable. Much of the credit for developing this operation goes to Bailey of Philadelphia and Harken of Boston (3,9) who developed the modern concept of direct surgery on stenotic mitral valves.
The author has experienced 21 mitral commissurotomies. The preoperative management, the anesthesia and operative technic were, more or less, similar to the one described by Bailey in detail. The only difference was that, in this series, the innominate and left carotid artery were not dissected out but, instead, the anesthetist was asked to compress both carotid arteries during the intra-cardiac maneuver. These cases ranged 16 to 45 years in age and more than 50 ´% were in their twenties. There were 1 1 males and 10 females. The presenting complaints were progressive limitation in exercise tolerance in all, evidence of congestive failure in 6 and hemoptysis in 6. The duration of the symptoms was from 2 to 12 years. All the cases showed apical diastolic rumbling murmur ranging from grade II to IV and, in 5,there were also systolic murmurs. The X-ray findings showed increased lung markings in 20, evidence of right ventricular enlargement in 18. The E.C.G. showed rig-ht ventricular hypertrophy pattern in 17 and neutral axis in 3. In 10 cases, finger alone was used in opening the valve. The pulmonary venous pressure decreased in all after the commissurotomy ranging between 12 to 78%. Excellent results were obtained in 11(52%), and good results in 8(38?,). One case did not benefit from the surgery and 1 case became worse after surgery. There was no post-operative motality.
A review of the cases seems to indicate that slight to moderate degree of regurgitation following the commissurotomy does not seem to influence the final outcome, provided the valve orifice was made large enough. There was apparent parallelism between the decrease in the pulmonary venous pressure following the opening of the valve and the results obtained. It seems apparent from the review of these cases that the size of the valve orifice following the procedure is of paramount importance in the functional recovery of thepatient.
Mitral stenosis is as organic disease which presents a mechanical problem affecting hemodynamics. Unless this obstruction is released by operation, the chances of giving a lasting relief to these patients are remote. This is evidenced by figures given by Bigelow (15) who stated that 50% of the patients who have had at least one episode of severe pulmonary
congestion died within 5 years and 8090/ in 15 years. Conseguently, this disease should be considered to be a potentially malignant disease and should be treated as such. Unless there are definite contraindications such as acute rheumatic disease, subacute bacterial endocarditis, severe mitral insufficiency or disease of the aortic valve, these patien is should have the benefit of operation.

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