This experiment was carried out under the postulation that activation of an intracellular calcium-calmodulin complex may play an important role in myocardial injury induced by ischemia and reperfusion. Trifluoperazine[TFP], a calmodulin antagonist, was added to the potassium cardioplegic solution and used just before ischemia, and its protective effect from ischemic injury was investigated, using Langendorff rat heart model. TFP group had better post-ischemic functional recovery and lower post-ischemic contracture after 30 minutes of normothermic ischemia. Creatine kinase leakage was also decreased in TFP group but there was no statistical difference between control group and TFP group. We concluded that TFP has some protective effect from myocardial ischemic injury and its effect might be due to prevention of activation of intracellular calcium-calmodulin complex.

This study was designed to investigate the protective effect of chlorpromazine against the reperfusion injury of myocardium after high potassium cardioplegic arrest. Langendorff`s preparations of rat heart were infused with high potassium cardioplegic solution[St. Thomas Hospital Solution] at 25oC. Chlorpromazine [10-7Ｍ] increased the recovery of myocardial contractility[dp/dt], left ventricular pressure[LVP], and coronary flow rate of the reperfused heart. Both in control and experimental groups, the restoration of myocardial activity could not reach to the level of preplegic control. These results suggest that the etiologic factors of the reperfusion injury include the influence of high potassium cardioplegic solution and/or reperfusion itself, and that chlorpromazine protects myocardium from the reperfusion injury.

From November 1978 through June 1989, 33 patients aged 3 months to 27 years [mean 9.7 years] underwent repair of intracardiac defects associated with corrected transposition. Five patients had had previous palliative surgery. Operation were performed in 31 for ventricular septal defect, 22 for pulmonary outflow tract obstruction, 16 for atrial septal defect, and 5 for anatomical tricuspid valve regurgitation. Pulmonary outflow tract obstruction was relieved by pulmonary valvotomy in 9, Rastelli procedure in 5, modified Fontan procedure in 3, and by REV procedure in 5 patients recently. Early mortality was 21.2%[7/33] and no late mortality during follow up period. Two had residual pulmonary outflow tract obstruction and one residual VSD. In eight patients, transient arrhythmia was found but soon returned to sinus rhythm. Five patients developed complete heart block and 2 were given permanent pacemaker insertion. There were 8 RBBB, 1 LBBB and one second degree atrioventricular block patients, but all showed no clinical significance. This report suggests that surgical repair of intracardiac defects associated with corrected transposition can be achieved with acceptable low risk. Though the mortality is still high, we can improved the result by advancing surgical technique, knowledge of the special conduction system, and by improving postoperative care.

Postoperative cardiac performance of cyanotic congenital heart disease is somewhat different from that of other cardiac diseases. For the evaluation of postoperative cardiac performance in the cyanotic congenital heart disease we measured cardiac output by thermodilution technique at 1, 4, 8, 12, 16, 20, 24, 36, 48 postoperative hours in 14 patients operated from Feb. 1989 to Nov. 1989 in The Department of Thoracic and Cardiovascular Surgery, Seoul National University Children`s Hospital. At the same time, we checked left atrial pressure [LAP], central venous pressure [CUP], and mixed venous oxygen saturation [SvO2] to detect correlation between them. Immediate postoperative cardiac index was 3.585 $\pm$ 0.945 L/min/m2, and it decreased maximally to 3.322$\pm$1.007 L/min/m2 at postoperative 16 hours. After then it increased and stabilized from 36 hours after operation, and its value was 4.426$\pm$1.358 L/min/m2. There were no correlations between cardiac index and left atrial pressure or central venous pressure. Between mixed venous oxygen saturation and cardiac index, there was no correlation in the early postoperative period but after postoperative 16 hours, there was significant correlation between them and correlation coefficients were 0.573 [16hrs], 0.743 [20hrs], 0.436 [24hrs], 0.560 [36hrs], 0.636 [48hrs], respectively. From these results, we concluded that in the corrective surgery of cyanotic congenital heart disease, cardiac performance was depressed in the early postoperative period. It improved from postoperative 16 hours, and stabilized from 36 hours after operation. During early postoperative period, mixed venous oxygen saturation should not be used as a predictor of cardiac performance but it could be used as a predictor of cardiac performance from 16 hours after operation.

Surgical correction of congenital cardiac defects in infants and children with an elevated pulmonary arterial pressure or pulmonary vascular resistance carries a significant early postoperative mortality. And accurate assessments of cardiac output is critically important in these patients. From April 1988 through September 1989, serial measurements of cardiac index, ratio of pulmonary-systemic systolic pressure, ratio of pulmonary-systemic resistance, central venous pressure, left atrial pressure, and urine output during the first 48 hours after the cardiac operation were made in 30 congenital cardiac defects associated with pulmonary hypertension. Cardiac index showed significant increase only after 24 hour postoperatively and this low cardiac performance in the early postoperative period should be considered when postoperative management is being planned in the risky patients. There were no variables which showed any significant correlation with cardiac index. In 12 cases[40%], pulmonary hypertensive crisis developed during the 48 hours postoperatively, and they were treated with full sedation, hyperventilation with 100 % 0y and pulmonary vasodilator infusion. In all patient with preoperative pulmonary hypertension, surgical placement of a pulmonary artery catheter is desirable to allow prompt diagnosis of pulmonary hypertensive crisis and to monitor subsequent therapy.

Thirteen patients underwent repair of atrioventricular septal defect [AVSD] from January 1980 to July 1989 at Kyungpook National University Hospital. Two patients had complete AVSD [Rastelli type A] and eleven patients had partial AVSD [ostium primum atrial septal defect and cleft of anterior mitral leaflet]. In all the patients of partial AVSD, atrial septal defect was closed with Dacron patch and the mitral cleft was approximated with interrupted simple sutures. In one patient of complete AVSD, one patch technique was used to close the atrial and ventricular septal defect, and in the other patient of complete AVSD, two patch technique was used. In six patients, there were associated anomalies; four had isolated ostium secundum ASD, two had patent foramen ovale. Postoperative complete A-V block was noted in a patient of partial AVSD, but it was returned to 1st degree A-V block 30 months later and in another case of partial AVSD, severe congestive heart failure [NYHA functional class IV] due to residual mitral insufficiency was developed postoperatively, but this patient was recovered to the state of functional class I after receiving mitral valve replacement. There was one hospital death [8 %] resulting from low cardiac output.

Between Jan. 1962 and Dec. 1988 380 cases of palliative operations were done in 357 patients for congenital heart disease. These includes 55 cases of classic Blalock-Taussig shunt, 212 cases of modified Blalock-Taussig shunt, 17 cases of Glenn shunt, 26 cases of Waterston shunt, 3 cases of Brock procedure, 33 cases of pulmonary artery banding, 6 cases of transpulmonary valvotomy, 4 cases of unifocalization, and 10 cases of open atrial septectomy. We divided the operative procedures into the conventional and the unconventional. Under the unconventional procedures, the cases since April, 1986 were only included. The number of patients who died within the early 30 days after operation is the following: 40 in systemic-pulmonary shunts, 2 in Brock procedure, 12 in PAB, 15 in unconventional procedures. The age of the patients who need palliative operation is lowering more and more and their characteristics of the disease is being transferred to the more complexities. So the role of palliative surgery in the congenital heart disease is changing.

From Nov. 1987 to Aug. 1989, 12 patients with coronary occlusive disease underwent coronary bypass surgery at the Department of Thoracic and Cardiovascular Surgery, Catholic University Medical College. The results were as follows: 1. There were 9 males and 3 females ranged in age from 25 to 69 years with a mean of 50.4 years. 2. The prevalent locations of coronary artery stenosis were left anterior descending branch [9 cases], right coronary artery[4 cases], first diagonal branch[3 cases], left circumflex artery [2 cases] in order of frequency. 3, Among 12 cases, 5 cases had an episode of previous myocardial infarction respectively. 4. We performed triple bypass operation in 3 cases, double bypass in 2 cases and single bypass in 7 cases using great saphenous vein. 5. Postoperative complications were cerebral embolism[1, died], pleural effusion[1], temporary cardiac arrest[1], supraventricular tachycardia[1] and late gastric ulcer bleeding[1]. 6. The follow up periods were ranged from 8 months to 30 months and all survivors were on antiplatelet medication showing free of angina.

A total of 129 patients with a confirmed diagnosis of primary lung cancer were treated at Dep. of Thoracic k Cardiovascular Surgery, National Medical Center, Seoul, Korea, between July, 1981 and Dec., 1988. Particular emphasis was given in this review to the 72 patients that underwent surgical resection of their primary lung lesion. Factors such as histology, type of resection, sex, age, staging, and degree of dissemination were considered possible influences on survival. The age group of fifty k sixty decade occupied 55.8 %, and the youngest being 24 years and oldest 78 years. The incidence ratio of male to female was 3,2:1. The subjective symptoms of the patients were coughing [72.6%], chest pain [48.2%] and hemoptysis [35.6%], which were due to primary local influence. The confirmed diagnostic procedures were bronchoscopic biopsy, sputum cytology needle aspiration biopsy, open lung biopsy, anterior mediastinotomy & lymph node biopsy. By pathologic classifications, the squamous cell carcinoma was the most prevalent, 67 cases [51.9 %], and the adenocarcinoma in 36 cases [27.9%], undifferentiated small cell carcinoma in 13 cases [10.1 %], undifferentiated large cell carcinoma in 9 cases [6.9%], bronchioloalveolar carcinoma was 4 cases [3.1%]. The lymph node dissection with pneumonectomy [42 cases], lobectomy [14 cases] and pneumonectomy [6 cases], lobectomy [9 cases] without lymph node dissection were performed. The post operative TNM Staging[AJC] in 72 cases were Stage I in 24 cases, Stage II in 27 cases, and Stage III in 21 cases. Overall resectable was possible in 72 cases [55.8 %], and the operation mortality was 5.6 % [4 cases].

A total of 178 patients with primary lung cancer who had undergone complete resection of the tumor in combination with complete mediastinal lymphadenectomy were reviewed at the Department of Thoracic and Cardiovascular Surgery of Yonsei Medical Center from January 1980 through July 1989. Materials; 1. There were 45 men and 33 women ranging of age from 25 to 78 years with a mean age of 55.4 years. 2. Histological types were squamous carcinoma in 115 cases [64.6%] adenocarcinoma in 42 cases [23.6 %], bronchioloalveolar carcinoma in 9 cases [5.1%], large cell carcinoma in 8 cases [4.5 %] and small cell carcinoma in 4 cases [2.2%] Results were summarized as follows: 1. The size of primary tumor was not directly proportional to the frequency of mediastinal lymph node metastasis. [P =0.0567] 2. The histologic types of the primary tumor did not related to the incidence of mediastinal lymph node metastasis. [P >0.19] 3. The chance of mediastinal lymph node metastasis in the case with lung cancer located in right middle lobe[31.8%, N=22] and left lower lobe [31.4%, N=32] were the highest and the lowest was the one located in right lower lobe, while over all incidence of mediastinal lymph node metastasis in this series was 25.4 % [N=55]. 4. The rate of mediastinal lymph node metastasis without evidence of regional and hilar lymph node metastasis was 13%. [N=23] The chance of mediastinal lymph node involvement without N1 lymph node metastasis was 16.3 % [N=17] in both upper lobes and 8.2 % [N=6] in both lower lobes. It was statistically significant that the tumors in the upper lobes had greater chance of the mediastinal lymph node metastasis without N1 than the tumors in the lower lobes. 5. In this series majority of the patients with lung cancer the mediastinal lymph node metastasis from the tumor in each pulmonary lobes usually occurs via ipsilateral tracheobronchial and paratracheal lymphatic pathway. Especially the lung cancer located in lower lobes can metastasize to subcarinal, paraesophageal and inferior pulmonary ligamental lymph node through the lymphatic pathway of inferior pulmonary ligament. It can be speculated that in some cases of this series otherwise mediastinal lymph node metastasis can also occur with direct invasion to the parietal pleura and to the mediastinal lymph node via direct subpleural lymphatic pathway .

Between Dec. 1958 and Oct. 1989, we had been experienced 14 cases of the esophageal corrosion carcinoma among 562 cases of corrosive esophageal stricture, which incidence was revealed 5.6 % of total esophageal carcinoma cases and 2.5 9o of total benign esophageal stricture cases. The age distribution was from 15 to 64 years, and the mean age was 45.6 years. Ten of the patients were women. The caustic agents were lye in 12 patients and hydrochloric acid in 2 patients. The latent time from injury to the development of carcinoma was from 12 years to 45 years, and the mean latent time was 29 years. In majority of cases, the developing site of carcinoma was just or just above the benign stricture portion of the esophagus. Corrective surgery were made in seven cases; three cases were made esophagectomy and esophagogastrostomy, and the other four cases were made esophagectomy and colon interposition. Palliative surgery including feeding gastrostomy were made in seven cases. All cases had a longstanding history of difficult oral swallowing especially at the site of stricture. We think chronic food irritations of stricture portion of the esophagus induced the development of corrosion carcinoma. In conclusion, we had to suspect possibility of carcinoma in patient with long standing history of benign esophageal stricture. So we recommended preoperative esophagoscopic biopsy in such cases.

Between May 1979 and April 1989, 213 patients with esophageal injuries visited the Department of the Thoracic and cardiovascular surgery Department, Yonsei University College of Medicine. There were 159 non perforated esophageal injuries accompanied by hematemesis, and 54 perforated esophageal injuries. The causes of non perforated esophageal injuries were Mallory-Weise Syndrome [%], corrosive esophagitis [54], esophageal carcinoma [4], foreign bodies [2], sclerotherapy due to esophageal varices [3]. The causes of perforated esophageal injuries were esophageal anastomosis[13], malignancies[17], esophagoscopy or bougienage[5], chest trauma[5], foreign bodies[5], paraesophageal surgery[3], others[6] In esophageal perforation due to foreign bodies, esophagoscopy or bougienage, there were 6 cervical esophageal perforations and 9 thoracic esophageal perforations. There were no mortalities in the treatment of the cervical esophageal perforations and 5 deaths resulted in the treatment of 9 thoracic esophageal perforations. And four of six patients with thoracic esophageal perforations died in the initiation of treatment over 24 hours, after trauma. There were another 12 deaths in the patients with chest trauma, malignancies or chronic inflammation except esophageal injuries due to foreign bodies or instruments during the hospital stay or less than 30 days after esophageal injuries. One patient with esophageal carcinoma died due to bleeding and respiratory failure after irradiation. Another patient with esophago gastrostomy due to esophageal carcinoma died of sepsis due to EG site leakage. One patient with a mastectomy due to breast cancer followed by irradiation died of sepsis due to an esophagopleural fistula. Two patients with Mallory-Weiss syndrome died; of hemorrhagic shock in one and of respiratory failure due to massive transfusion in the other. One patient with TEF died of respiratory failure and another died of pneumonia and respiratory failure. One patient with esophageal perforation due to blunt chest trauma died of brain damage accompanied with chest trauma.

During a ten-year period from August, 1978 to September, 1989 45 patients with benign esophageal stricture were surgically evaluated. The results are as follows; l. Out of 45 patients, there were 26 males and 19 females ranging from 2 to 70 years of age with a mean of 31.9 years. 2. The most common cause of benign esophageal stricture was corrosive burn due to caustic agents[40 cases, 88.9 %]. Corrosive agents were 15 cases of lye, 22 cases of acid and 3 cases of other agents. Other causes were two cases of esophageal web and each one case of previous surgical result, inflammation and idiopathic mediastinal fibrosis respectively. 3. The most frequent stricture site was whole esophagus as 21 cases[46.7 %] and the next was lower a third thoracic esophagus[10 cases, 25.0%]. 4. In 33 of total 45 cases, colon interposition with right colon was performed without resection of the strictured esophagus except one case which was complicated esophageal cancer. Other procedures were 4 cases esophagogastrostomy with segmental resection, 2 cases of plastic repair and so on. 5. Major postoperative complications which were needed for secondary operation were 5 cases[11.1 %]. [2 cases of stenosis, ileus and ulcer bleeding respectively] Overall mortality rate was 4.4 %.

We have experienced twenty-eight patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Seoul National University Hospital during the period from Jan. 1957 to Jun. 1989. The ratio between male and female patients was 17:11, and their age ranged from 2 years to 61 years old. [average: 30.4 years old] The cause of esophageal perforation were instrumental trauma in 9 cases, caustic perforation in 6 cases, spontaneous perforation in 6 cases, surgical trauma in 2 cases, and others in 5 cases. The most frequent location of perforation was in the lower third portion of the esophagus [13 case, 46 %]. Patients complained of chest pain [86 %], dyspnea [57 %], fever [57 %], subcutaneous emphysema [43 %], and others. The frequent complications of esophageal perforation were empyema [13 cases, 46 %] and mediastinitis [11 cases, 39 %]. The first treatment was supportive care in 3 cases, primary closure and reinforced procedures in 13 cases with 3 deaths, open drainage in 5 cases with 2 deaths, diversion in 4 cases with 2 deaths and closed thoracostomy drainage in 3 cases. After the first treatment, 6 patients received multi-staged operations for several months. Overall mortality was 25 %, and the most frequent cause of death was sepsis[57 %]. We thought that factors affecting the outcome of esophageal perforation are;[1] early diagnosis and adequacy in the first treatment, [2] intensive perioperative management including multi-stage surgical approach, [3] patient`s condition at the diagnosis

The management of esophageal carcinoma continues to be a difficult problem with most surgically treated patients under-going extensive operative procedures for palliation only. Although recent advances in preoperative and postoperative care have decreased the operative mortality rate, survival has not changed significantly. Twenty five patients with esophageal carcinoma who were treated with operative intervention at the Department of Thoracic and Cardiovascular Surgery in Kyung Hee University Hospital between January, 1980 and December, 1987 had been evaluated clinical manifestation and operative results. The stamm typed feeding gastrostomy and Celestin tube insertion were performed for the cases of nonresectable esophageal cancer. Also 14 cases with esophagogastrostomy and are case with esophagocologastrostomy were performed for the resectable cases. Two deaths with resectable cases occurred within 30days of operation, a hospital death rate of 8 per cent. There were significant differences in the survival rate between T.N.M. staging I, II, and III, IV group after the resection of the esophageal cancer. The former group revealed higher one year survival rate than the later group. [p< 0.05]. In conclusion, the clinical manifestations and operative results were similar to the western ones and the postoperative survival rate was very poor. So, the earlier the operation of the esophageal cancer was done, the better result will be achieved. To defect the early esophageal cancer; routine esophagoscopy should be recommended.

A Clinical analysis was performed on 717 cases of the chest trauma experienced at department of thoracic and cardiovascular surgery, Soonchunhyang Chunan Hospital from Mar. 1985 to Jun. 1989. 1. The sex ratio was 2.89:1 with male predominance. The patients in 75 % of total cases was between 3rd to 5th decade. 2. The most common causes were traffic accident in non-penetrating thoracic injury and stab wound by knife in penetrating injury. 3. The hemothorax, pneumothorax and hemopneumothorax were observed in 306 cases[42.7 %]. 4. The left thorax was the preferred site of penetrating and non-penetrating thoracic injury. The rib fracture was prevalent between 4th to 8th rib. 5. The open thoracotomy was performed in 55 cases[7.7 %] 6. The overall mortality was 3.07 %[22 cases] and causes of death were hypovolemic shock, adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal failure and pneumonia.

This report is an review of 40 cases of mediastinal tumors which were treated surgically in the Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital from January, 1985 to September, 1989. In this series, male to female sex distribution was 1.35:1 with the male predominant. The main clinical manifestations were chest pain and dyspnea, and there was no definitive symptom in 5 cases [12.5 %]. The most common mediastinal tumor was thymoma, 11 cases [27.5 %], and next common mass was germ cell tumor, 9 cases [22.5 %]. The half of these were malignant. In operating, all of the benign masses were removed.

Author made a clinical study of 48 cases of primary mediastinal tumors experienced in the dept. of the thoracic and cardiovascular surgery of Pusan National University Hospital during the 12 years period from march 1978 to march 1989. There were 34 males and 14 females. Their age distribution was from 4 months to 70 years, with the mean age of 34.4 years. 8.3 % of the patients were younger than 15 years old. There were teratoma 14 cases[29%], thymoma 11 cases[23%], neurogenic tumor 10 cases[21 %], lymphoma 6 cases[13 %], benign cyst 6 cases[13 %], and one case of fibrous histiocytoma in the histological distribution. The malignant tumors were 12 cases[25 %]. The common symptoms were chest pain and discomfort[35.4], coughing[18.8], general weakness and dyspnea. 16.7% of the patients were asymptomatic at admission. The successful removal was done in all cases of benign mediastinal tumors. In malignant cases, the surgical removal could be done in 5 cases. There was not postop. mortality. The frequent complications were atelectasis, infection, bleeding.

Myasthenia gravis is a disorder of neuromuscular transmission characterized by weakness and fatigue of voluntary muscles. It is now reasonably established to be due to an autoimmune attack directed against the postsynaptic nicotinic acetylcholine receptors of voluntary muscles. Thymectomy has become increasingly important in the treatment of this disease after the successful case of Blalock in 1939. From January 1984 to December 1988, we performed total thymectomy in 25 cases of myasthenia gravis except one, and get the results as follows. l. Among 25 cases, male to female was 10:15 and the age was ranged from 16 years to 65 years. 2. Thymectomy was done in 24 cases and 1 case of malignant thymoma was not resectable. 3. There were 2 deaths after thymectomy due to myasthenic crisis. 4. There were 19 cases [76 %] of improvement after thymectomy as follows; complete remission was 6 cases [24 %], marked improvement was 9 cases [36 %] and subjective improvement was 4 cases [16 %]. 5. The effect of age, and duration of disease on operative result was not statistically significant, but that of thymic pathology was significant.

A clinical study for thymectomy for 23 patients in Myasthenia Gravis was done between May, 1982 and July, 1989. at the department of Thoracic and Cardiovascular Surgery, College of Medicine, Han Yang University. Among Z3 patients, male to female ratio was 11: 12 and Age of onset was ranged from 15 years-old to 52 years-old. Previous symptom duration from diagnosis until operation was ranged from 2 months to 96 months, and Mean duration was 28.74 months. The severity of disease was classified by Osserman`s classification preoperatively. In histopathology of thymus, Thymic hyperplasia 7 cases, Thymoma 7 cases, Invasive thymoma 3 cases, Within Normal Limit 5 cases, and Thymic Atrophy 1 case. Correlation between preoperative symptom duration and postoperative clinical course was statistically significant. The shorter of preoperative symptom duration, The better of postoperative clinical course. Grading of postoperative course was classified by Papatestas in 1975. Follow-up for postoperative course was ranged from 3 months to 7 year and 4 months, Cases of complete remission 1 year postoperative period were 9 cases and cases of Improvement were 8 cases, So totally 17 cases among 23 cases[73.91%] found good results.

A congenital coronary artery fistula is an uncommon anomaly which has a direct communication between a coronary artery and the lumen of any one of the four cardiac chambers, or the coronary sinus, or its tributary veins or the superior vena cava. The right coronary artery is involved most frequently, and the abnormal communication in most often is to the right ventricle followed in incidence by drainage into the right atrium and the pulmonary artery. Recently. we experienced a case of congenital coronary artery fistula associated with valvular heart disease. The fistulous communication was noted between the left circumflex artery and the left atrial appendage. Under the cardiopulmonary bypass, the internal obliteration of the left atrial appendage, mitral valve replacement, and aortic valve exploration were accomplished. Postoperative hospital course was uneventful and the patient was discharged without any problems.

Unroofed coronary sinus syndrome is an uncommon anomaly which is caused by incomplete formation of the left atriovenous fold and it is usually associated with persistent left superior vena cava. It may be diagnosed by cardiac catheterization and cineangiography but, if it is not diagnosed, it can bring out significant complications due to right to left shunt, such as brain abscess, cerebral embolism, transient ischemic attack, arterial desaturation and there will reduced patient`s life expectancy. Therefore corrective operation was needed. A case of unroofed coronary sinus syndrome which combines with valvular heart disease was experienced at the department of thoracic & cardiovascular surgery of Kosin medical college. The patient was 49 years old female and she complained dyspnea on exertion for 2 yrs. Cardiac catheterization with cineangiography and both superior venacavogram were performed for diagnosis and she was diagnosed as unroofed coronary sinus syndrome combined with mitral and tricuspid regurgitation. Surgical correction was accomplished by reroofing of coronary sinus with pericardial patch, closure of atrial septal defect and annuloplasty of both atrioventricular valves. Postoperative results were satisfactory and course of recovery was uneventful. We report a case of unroofed coronary sinus syndrome with review.

An aberrant right subclavian artery is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. Ligation of the aberrant artery through a left thoracotomy has been advocated as the operation of choice. If development of vertebrobasilar insufficiency is anticipated, division and ligation of he aberrant artery and its anastomosis to the right common carotid artery or aortic arch are performed at a second operation. Experience with successful surgical treatment of a patient with an aberrant subclavian artery is described. A right thoracotomy incision was utilized for division of the subclavian artery and for reestablishment of arterial continuity with Dacron graft. Postoperative arteriography demonstrated a good reconstruction and normal blood flow was established to the right upper extremity.

Aortic dissection is a challenging disease and the causes of that are well-known. Blunt chest trauma is one of the causes of aortic dissection. In such cases, nearly all cases involves the isthmic portion of descending aorta, but ascending aorta is involved in about 10. We experienced a patient who had ascending aortic dissection due to automobile accident and who showed spontaneous rupture of the aorta during operation. In this case, after installation of aortic line via left femoral artery, ascending aorta ruptured and a large amount of blood gushed out, which was suckered by cardiotomy sucker. A little delay of cardiopulmonary bypass may cause the fatal outcome in such a case because the bleeding from aorta is too much to be controlled. Fortunately, we controlled the bleeding with cardiopulmonary bypass and got the good outcome of this patient by interpositioning the vascular graft. One should suspect the possibility of aortic dissection in blunt chest trauma, and prepare all the facilities against bleeding due to rupture.

We experienced a rare case of a recanalization and aneurysmal formation of the previously ligated PDA on 18 year-old-girl. Continuous murmur was noted 3 months after operation and this recanalization was confirmed by angiography and cardiac catheterization. It was impossible to mobilize aneurysmal PDA with safety, so we closed the defect using left heart bypass to prevent spinal card injury. Postoperative course was uneventful and the patient was discharged in good condition.

The results of conventional operative resection of diffuse subaortic stenosis[tunnel subaortic stenosis] have been less than satisfactory. We have performed modified Konno operation to enlarge the outflow tract of both ventricle with a patch in three patients with diffuse tunnel subaortic stenosis in the department of Thoracic and Cardiovascular Surgery, Seoul National University Children`s Hospital. Preoperative left ventricular aortic pressure gradients were 135 mmHg, 50 mmHg, 80 mmHg respectively in these patients. After right ventriculotomy, the septotomy was done and extended beyond the limit of the stenosis and fibrous and/or muscular tissue was removed from each edge of septal incision. After adequate widening of the tunnel subaortic stenosis with various patches, right ventricle was closed primarily or with prosthetic patches successfully. One patient who was diagnosed as complete atrioventricular septal defect had complete AV block preoperatively and was implanted permanent pacemaker, and others who were sinus rhythm preoperatively have no serious postoperative rhythm disturbance. One patient developed mild postoperative aortic insufficiency and one who had preoperative aortic insufficiency has still same grade of aortic insufficiency after operation. All had good postoperative hemodynamics without any postoperative residual pressure gradient.

The double aortic arch is the commonest anomaly among the vascular rings are relatively rare congenital vascular anomalies. This anomaly is malformation of the aortic arch system may, by compression of the trachea and esophagus, cause respiratory distress and dysphagia. We experienced one case of double aortic arch with right sided descending aorta with predominant right anterior arch treated surgically at Kyung Hee University Medical Center. 1-year-old male patient with acute airway obstruction due to combination of double aortic arch and right descending aorta. The diagnosis was made by simple X-ray & confirmed by barium esophagogram & aortogram. The operative approach was through left thoracotomy & underwent division of the left aortic arch & division of ligamentum arteriosum & suspension of divided proximal end of anterior arch to anterior thoracic wall. The postoperative courses was uneventful and doing well on the 3 years.

A 17 year old female patient with Ebstein`s anomaly received surgical treatment for WPW syndrome and AV nodal reentrant supraventricular tachycardia[SVT] Electrophysiologic study revealed that an anomalous pathway was located in the right posterolateral portion and antegrade dual AV nodal pathway responsible for AV nodal reentrant tachycardia. The patient was underwent surgery on February 18, 1987. Intraoperative mapping was used to define the location of accessory pathway. The accessory pathway was cryoablated through the epicardium. Simultaneously discrete cryoablation around the perinodal area was performed to prevent AV nodal reentrant SVT. The atrialized right ventricle of Ebstein`s anomaly was plicated with 11 pledget mattress sutures under the cardiopulmonary bypass. Two and half years after surgery, the patient has no evidence of WPW syndrome or supraventricular tachycardia.