완전 방실 차단을 보인 미숙아에서 생후 초기 영구적 심박동기 수술 1례
A Case of Pacemaker Implantation in Premature Newborn with Congenital Complete Atrioventricular Block
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초록
신생아 홍반성 낭창의 가장 심각한 부작용인 선천성 방실 차단은비교적 드문 질환 이다. 선천성 방실 차단을 가진 환아는 심박출량감소로 울혈성 심부전으로 진행할 수 있다. 1도, 2도 방실 차단의 경우 조기에 발견하여 출생 전 경 태반으로 시행하는 스테로이드나 베타-아드레너직 자극제 치료를 해볼 수 있으며, 이런 치료에 회복되는 경우도 많다. 하지만 완전 방실 차단의 경우는 거의 반응이 없는경우가 대부분이다. 만약 완전 방실 차단이 동반되었을 경우에는 특별한 금기 사항이 없는 한 분만하여, 조기에 영구적 심박동기를 삽입하는 것이 환자의 생존율을 향상 시킬 수 있다. 저자들은 재태 주령 21주에 완전 방실 차단으로 진단받고 35주 0일 2,577 g으로 태어난 미숙아에게 국내 최초로 생후 5일째 영구적심박동기 수술을 시행하였다. 이 수술로 호전된 1례를 경험하였기에문헌고찰과 함께 보고한다.
Abstract
The congenital complete atrioventricular block(CCAVB) is a rare disease, which is the most serious complication of neonatal lupus erythematosus. Newborn with CCAVB are at risk of diminished cardiac output and the subsequent development of congestive heart failure. Transplacental steroid and β-adrenergic agonist therapies are useful for the first and second degree atrioventricular block. But those therapies are usually not effective for complete atrioventricular block. If the fetus has a complete atrioventricular block, delivery should be considered unless other delivery contraindications. In this situation, early pacemaker implantation surgery can improve the survival rate of patients. We report one case of premature newborn with congenital complete atrioventricular block who is successfully recovered by pacemaker implantation.
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