소아 심장질환에서 삼첨판역류의 빈도

Abstract

Background : Although tricuspid valve regurgitation can be due to organic disease of the tricuspid valve, it is generally a functional disorder, and frequently occurs after valvular disease of the left heart or in association with congenital heart disease. Real time, 2-dimensionaL color-codccl Dopplcr flow imaging system has proved useful for detecting tricuspid regurgitation. The aim of this study is to compare the incidence of tricuspid regurgitation between children with congenital heart disease and normal children. Method : Real time, 2-dimensionaL color-coded Doppler Echocardiography was performed to evaluate the tricuspid regurgitation in 231 cases(l 13 with congenital heart disease. 30 with Kawasaki disease. 88 with normal subjects). The duration of systolic turbulence of tricuspid regurgitation in the right atrium was evaluated by continuous wave Doppler method. The distance of systolic turbulence within the right atrium from the tricuspid plane was evaluated by pulsed and color Doppler method. Results : The following results were obtained. Incidcncc of tricuspid regurgitation in congenital heart disease was 40.7究. Kawasaki diseases 20.2%. and normal subjects 26.1 Incidence of tricuspid regurgitation in each disease was as follows. 100% in Ebstein anomaly. 83.3% in atrioventricular septal defects. 73.3% in patent ductus arteriosus. 66.7 % in pulmonary stenosis. 50.0% in atrial septal defects. 21.2% in ventricular septal defects. Incidence of severe tricuspid regurgitation based on the distance reached more than half by the abnormal signals from the tricuspid orificc toward the posterior wall was as follows. 100% in atrioventricular septal defects. 100% in Ebstein anomaly. 66.7% in atrial septal defects. 63.6% in patent ductus arteriosus. 50.0% in pulmonary stenosis & Tetralogy of Fallot. 4.3% in normal subjects. Conclusion ‘ The incidence and severity of tricuspid regurgitation were significantly higher in patients with congenital heart disease than in normal children. Further and follow up examination of normal children's tricuspid regurgitation is needed.

연구배경 ： 2-D color Doppler 심에코검사를 이용하여 소아 심장질환아에 있어서의 삼첨판역류의 빈도와 정도 에 대해 조사하여 정상아의 빈도 및 정도와 비교 하고자 이 연구를 시행하였다. 방 법 : 1992년 6월부터 12월까지 계명대학교 동산병원 소아과에서 진료한 환아중 선천성 심장질환아 113명，Kawasaki 병 30명과 정상아 88명을 대상으로 Acuson 128 XP/10 color Doppler로 삼첨판 역류 유무 및 정도에 관하여 관찰하였다. 결 과 : 선천성 심장질환아중 40.7%에서 삼첨판역류고 관찰되었고 29.2%에서 전수축기에 걸친 역류를 h 수 있었다. 전수축기에 걸친 삼첨판 역류의 출현빈도는 Ebs tein 기형 환아의 100%, 방실중격 결손 환아의 83.3 복합심기형 환아의 75.0%, 동맥관개존의 53.3 %의 순으로 나타났으며 수축기 초기나 중기에 역류가 관찰된 예를 포함하면 Ebstein 기형 100%. 방실중격결손 83.3% , 동맥관개존 73.3% , 폐동맥 협착 66.7%. 심방중격결손 50.0%이었으며 심실중 격결손 21.2%, Fallot 4징 18.27%에서 관찰되었다.