기능성 삼첨판막 역류-임상적 의의와 적절한 수술 시기
Clinical Implications of Functional Tricuspid Regurgitation and Optimal Surgical Timing
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중증 삼첨판막 역류증은, 그 잠재적인 삶의 질과 기능적운동 능력, 또한 생존에 대한 영향력을 고려하였을 때, 결코간과되어서는 안될 것이다. 좌심실 판막 질환의 성공적인 수술로 기능적 삼첨판막 역류증이 항상 호전되는 것이 아니므로, 삼첨판막 역류증 교정술을 함께 하거나(비록 삼첨판막역류증이 경증일지라도) maze 수술(심방세동이 있을 경우) 을 함께 시행하는 것이 반드시 고려되어야 할 것이다. 비록최적의 수술 시기를 결정하는 것은 가장 중요한 일이지만, 원발성 삼첨판막 역류증(isolated TR)의 시기 적절한 수술적교정은 우심실의 용적 및 기능, 심장 지수(cardiac index) 그리고 운동 능력을 향상시킬 것이다. 우심실은 그 복잡한 기하학적 구조로, 이차원적 접근은 태생적으로 제한적이다. 따라서, 향후 삼차원 심장 초음파와 심장 자기공명영상을 통한진단과 예후적 가치에 대한 새로운 접근이 고려되어야 한다. 중증 삼첨판막 역류증 교정 수술을 성공적으로 받은 많은 환자들이 동반 이환 질환들로 힘들어하는 만큼, 향후 이런 환자들을 위한 최적의 약물 치료와 치료방침을 결정할 수 있는연구들도 필요할 것이다.
Abstract
Optimal surgical timing is of crucial importance for the treatment of valvular heart diseases. Clinical implications of functional tricuspid regurgitation (TR) are increasingly being recognized. In contrast to the well-established treatment strategies for left-sided valve disease, optimal surgical timing of functional TR has not yet been established. Several lines of evidence have accumulated over the past 10 years, and now is the perfect time to review the data. The present article reviews the clinical implications and treatment strategies of functional TR, particularly in relation to optimal surgical timing. (Korean J Med 2016;91:139-149)
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