• Journal of Chest Surgery
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• v.35 no.12
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• pp.898-901
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• 2002

It is now widely accepted that the complete arterial coronary revascularization has better short and long term results compared to coronary bypass surgery using arterial graft mixed with vein graft mainly due to its superior patency rate. However, sometimes the internal thoracic artery and other conventionally used grafts might be unavailable or it may require caution in using bilateral internal thoracic artery especially in diabetic patient because of the possible risk of the mediastinitis or other associated morbidities. Moreover, there could also be a shortage for arterial graft in case of coronary reoperation. We report our first three cases using thoracodorsal artery(TDA) as an alternative graft in complete arterial coronary revascularization.

• 전기의세계
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• v.45 no.8
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• pp.25-29
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• 1996

동맥에 대한 기계 역학적인 연구역사는 30년에 이르고 있다. 그 연구 성과로 말미암아 동맥의 물성 파악, 동맥의 인조화, 동맥의 의학적인 시술에 대한 공학적인 평가 분석 및 제안, 동맥의 생리학적인 현상에 대한 이해 보강, 병리 현상의 공학적인 분석 및 예고, 공학적인 현상과 조직학적인 현상에 대한 연관성 파악 및 응용등, 많은 공헌을 하고 있다. 동맥에 대한 공학적인 연구학문을 동맥역학(Arterial Mechanics)이라 한다. 동맥역학의 궁극적 분석겨로가는 동맥에 대한 물성과 혈압으로 인한 변형율과 응력에 관한 것이다. 동맥의 물성 파악은 혈류와 Mass Transport의 효과로 인한 동맥의 질병양태에 대한 해석을 돕고 있다. 또한 동맥의 병리현상과 생리현상을 이해하는 데에 변형율과 응력 분포도가 중요한 요소로 역할을 하고 있다. 동맥의 연구 방법론적 고찰의 내용은 실험이나 데이터 분석방법이 비슷하기 때문에 동맥 외의 인체의 soft tissue(피부, 심장, 근육, 눈등)에 대한 연구고찰이라고도 할 수 있다. 본 논문은 현재까지 진행된 주요한 연구를 고찰하고 동맥 역학에 대한 관심과 인식을 고취시키는 데에 그 목적이 있다.

• Journal of Biomedical Engineering Research
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• v.23 no.5
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• pp.375-383
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• 2002

Aneurysm embolisation method using coils have been widely used. Micro coils are introduced via a small catheter, and are packed inside of aneurysm sac, which induces intraaneurysmal flow stagnation and thrombus formation. When partial blocking of an aneurysm is inevitable, the location of coils is important since it changes the flow patterns inside the aneurysm, which affect the embolisation process. We measured the flow field inside the partially blocked lateral aneurysm models in vitro, and tried to suggest the effective locations of coils for aneurysm embolisation. Velocity fields are measured using a particle image velocitimeter for different coil locations- proximal neck, distal neck, proximal dome and distal dome. Flow into the aneurysm sac was significantly reduced in the distally blocked models, and coils at distal neck blocked inflow more effectively comparing to those at distal dome. This study suggests that distal neck should be the most effective location for aneurysm embolisation.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.133-137
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• 2001

배경: 하지에 영향을 미치는 죽상경화증은 복부대동맥과 이에 중요분지인 총장골동맥을 침범할 수 있다. 또한 국소분절을 침범할 수 있으나 다중분절은 침범할 수도 있다. 대상 및 방법: 을지의과대학교 흉부외과학 교실에서는 1995년 1월부터 1999년 12월까지 대동맥총장골동맥의 죽상경화증을 주소로 우회술을 시행받은 23례의 환자들을 후향적으로 조사하였다. 결과: 모든 환자는 남자였고 평균연령은 60.15$\pm$8.7세였다. 전 예에서 흡연의 과거력이 있었으며 동반질환으로 당뇨병 8례, 고혈합 7례, 관상동맥질환 6례, 그리고 판막질환 1례였다. 대동맥장골동맥 죽상경화증에 대한 수술방법으로는 대동맥양측대퇴동맥 우회술(7례), 대동맥양측동맥 우회술 및 대퇴동맥슬와동맥 우회술(8례), 대동맥양측대퇴동맥 우회술(2례), 액와대퇴동맥 및 고고동맥 우회술(3례), 고고동맥 우회술(3례)였다. 훌후 합병증으로 후복막상 출혈 3례, 마비성 장폐색 3례, 폐렴3례, 뇌졸중 1례, 급성신부전 2례, 창상감염 2례였다. 해부학적 우회술을 받은 환자중 3례에서 수술 사망이 발생하였다. 결론: 해부학적 우회술은 대동맥장골동맥의 폐쇄성질환에 표준적인 수술방법이지만 또한 해부학적 우회술 역시 술후 유병률 및 사망률이 낮은 좋은 수술법으로 사료된다.

• Journal of Biomedical Engineering Research
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• v.21 no.6
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• pp.567-573
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• 2000

뇌동맥류는 뇌혈관의 일부가 풍선처럼 부풀어나는 혈관계 질환이며 뇌동맥류의 파열은 사망이나 심각한 후유 장애를 야기한다. 뇌동맥류의 다양한 발생 원인 중 혈관 내부의 혈류의 유동이 중요한 인자로 의심된다. 뇌동맥류의 형성에 미치는 혈류역학적 인자를 규명하기 위해 내경동맥에서 발생한 환자의 내경 동맥류 CT 사진을 이용하여 내경동맥류 모델을 제작하고, 모델 내부의 혈류유동장을 입자영상속도계를 이용하여 측정하였다. 동맥류가 발생한 내경동맥류 모델에서는 동맥류 원위부 목(distal neck)쪽과 반대쪽 내경동맥 벽에서 전단응력이 높게 나타났다. 동맥류 발생에 미치는 혈류역학적 인자를 규명하기 위해 동맥류를 제거한 내경모델을 제작하여 맥동유동에서 내부 유동장을 측정하였다. 심실수축기 동안 휘어진 내경동맥의 바깥쪽 벽에서 혈류의 혈관벽 부딪힘이 관찰되었으며 심실이완기 초반에도 이는 계속 유지되었다. 내경 동맥 내부의 부차적 유동특성을 연구하기 위해 동맥류 발생 위치에서 혈관 축과 수직인 평면의 유동장이 측정되었다. 혈관 단면에서는 휘어진 혈관의 바깥쪽에서 안쪽으로 시계방향의 와류가 형성되었으며, 이로 인해 혈관벽 바깥쪽과 시계방향으로 90도 정도 지역에서 전단응력이 높게 나타났다. 혈류 유동 특성과 동맥류 발생위치를 비교해 보면, 혈류의 혈관벽 부딪힘이 관찰되는 위치와 부차적 유동에 의해 전단응력이 크게 나타난 지역은 동맥류의 발생위치와 일치하였다. 따라서 혈류의 혈관벽 부딪힘과 부차적 유동에 의한 전단력이 동맥류 발생의 혈류역학적 요인으로 의심된다.

• Journal of Chest Surgery
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• v.36 no.4
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• pp.255-260
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• 2003

Background: Stenosis of the left pulmonary artery (LPA) after repair of tetralogy of Fallot (TOF) is troublesome. A new technique of LPA angioplasty using an autologous MPA flap was performed in patients with TOF Material and Method: From October 1998 to January 2001, 24 patients (median age; 10 months, range; 4 to 145 months) underwent total correction of TOF with LPA angioplasty using the autologous MPA flap. Five patients underwent pulmonary angioplasty without any patch over the MPA and LPA. The patches were required to enlarge only the MPA in 4 patients, and transannular RVOT widening was performed in 15. Result: There were no operative or late deaths. During follow-up (range: 6~42 months), reoperation for LPA stenosis was not required in any patients, but balloon angioplasty for branch pulmonary artery stenosis was performed in 3 patients. Echocardiography and CT angiography at the recent follow-up showed an obtuse angle between the MPA and LPA. Conclusion: Although further follow-up is needed, the angioplasty using the autologous MPA flap can be easily performed, avoiding patch-related complications, and allowing growth of the MPA flap. This angioplasty technique creates a more natural and obtuse angle between the MPA and LPA, which can minimize kinking of the LPA, especially in the patients who underwent transannular patch widening.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.688-691
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• 2002

Takayasu's arteritis is a chronic inflammatory disease of unknown cause. It predominantly affects the aortic arch and its branches. Concomitant involvement of coronary and renal arteries is a rare entity. In this report, we described successful treatment of a patient with Takayasu's arteritis associated with coronary and renal arteries stenosis. A 23-year-old woman was presented with chest pain on exertion. Angiographic studies demonstrated left main coronary, bilateral renal, and left subclavian arteries stenosis. She underwent angioplasty and stenting of bilateral renal artery. After one week, coronary artery bypass grafting using greater saphenous veins and aorto-subclavian bypass with PTFE vascular graft were done simultaneously. She was discharged on the 13th postoperative day without any complications.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.371-374
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• 2003

Atherosclerosis has more than 60% of the causes of arterial occlusive diseases. The abdominal aorta and lower extremity arteries are the most common sites of occlusion. We have treated surgically 2 cases who had intermittent claudication and were diagnosed as simultaneous aortobifemoral and bilateral femoropopliteal obstruction by angiography, but had ineffective results from medical treatment or angioplasty. Simultaneously aortobifemoral bypass using Hemashield Y graft and bilateral femoropopliteal bypass using autologous greater saphenous vein were done. After operations, the symptom disappeared and there were no specific post-operative complications except abdominal wound dehiscence. In postoperative angiography, we had obtained good patency of bypass graft. We are following up patients through the out patient department without recurrence up to 16 months.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.734-740
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• 2003

Increasing interest in the use of arterial conduits is based on the better patency of left internal thoracic artery (LITA) than that of saphenous vein (SV) graft and radial artery (RA) is emerging as one of them. We compared the early result of coronary artery bypass grafting (CABG) using UTA and RA (RA group) with CABG using UTA and SV only (SV group). Material and Method: We compared the early operative results of 45 cases in RA group with 45 cases in SV group selected from 165 cases who had CABG between January 2000 and December 2002. The two groups had similar profiles of age, sex, NYHA functional class, left ventricular ejection fraction and coronary angiographic anatomy. We analysed each group on the preoperative risk factors and operative results. Result: There were no statically signigicant difference between groups in operative mortality and each morbidities (stroke, IABP insertion, perioperative MI), respectively. However, the overall incidence of mortality and morbidities was lower in RA group compared to SV group (p < 0.05). RA group (2.93$\pm$0.62 days) had shorter duration of ICU stay than SV group (3.55$\pm$0.95 days) (p<0.001). The patency on postoperative coronary angiography at 7∼14 days after operation in RA group patients were 100% of LITA and RA and 94.9% of SV. Conclusion: We had better early operative results in RA group compared with SV group.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.695-698
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• 2003

Celiac artery aneurysms are rare, their incidence being reported as only 4％ of all visceral artery aneurysms. Atherosclerosis and medial degenerative changes are recognized main pathogenesis. They are usually asymptomatic and diagnosed incidentally, but the mortality rate of ruptured celiac artery aneurysm is approximately 80％. So one should give an aggressive surgical aid to the patients. We report 2 cases of celiac artery aneurysm which were successfully treated by elective aneurysmorrhaphy and anerysmectomy with aortoceliac bypass graft.