• Title/Summary/Keyword: 동맥우회수술

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Repair of Postinfarction Ventricular Septal Defect (심근경색 후 발생한 심실중격결손의 수술)

  • Choi, Jong-Bum;Cha, Byoung-Ki;Lee, Sam-Youn;Choi, Soon-Hoo
    • Journal of Chest Surgery
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    • v.39 no.12 s.269
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    • pp.906-912
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    • 2006
  • Background: Ventricular septal defect(VSD) is rare but feared complication after acute myocardial infarction. The patient could survive by surgery only, but the surgical mortality is still high. We investigate the surgical result and predictors for early surgical mortality. Material and Method: Between August 1993 and February 2006, 8 patients (male, 2: female, 6) with postinfarct VSD underwent surgical repair. Seven patients had one-vessel disease of left anterior descending artery, and 6 of them had wide extension of infarction to posterior septal wall as well as anterior septal wall of both ventricles. One patient had concomitant coronary bypass grafting to a coronary lesion unrelated to the infarction. Two patients had concomitant tricuspid annuloplasty and 1 patient mitral valvuloplasty. Result: Surgical mortality was 37.5%(3 patients). They all had only one-vessel disease of left anterior descending artery, which made extended posterior septal wall infarction as well as anterior septal wall infarction of both ventricles. In preoperative M-mode echocardiographic study of left ventricle, they had lower ejection fraction than survivors($34.9{\pm}4.2\;vs.\;54.8{\pm}12.3$; p=0.036). Conclusion: Most of patients with postinfarction VSD had one-vessel disease of left anterior descending artery. Early surgical mortality occurred in the patients with poor ejection fraction of left ventricle and the wide anterior septal wall infarction extending to the posterior septum.

Aortocoronary Bypass Surgery; with Noncardioplegic Myocardial Protection (관상동맥 우회술;심마비액을 사용하지 않은 수술방법)

  • Seo, Dong-Man;Song, Myeong-Geun
    • Journal of Chest Surgery
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    • v.26 no.4
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    • pp.276-281
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    • 1993
  • During the 3 years through December 1992, 118 cases of coronary bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. They consisted of 80 males and 38 females with the mean age of 59. History of myocardial infarction was noted in 23 cases[20%], congestive heart failure in 11[10%], left ventricular aneurysm in 6, postinfarct VSD in 2, and mitral regurgitation in 1. The angina was stable in 13 cases, and unstable in 104 cases[89%]. Left main stem disease were 41 cases[35%], triple vessel 36[31%], double vessel 30[26%] and single vessel involvement[LAD] in 10. We performed 335 distal bypasses out of 117 cases, with single bypass in 9, double 29, triple 52, quadruple 23, and quintuple 4. Myocardial protections were cardioplegia in 29 and intermittent aortic occlusion 79 and continuous aortic perfusion 7. The ischemic time per graft was 13 minutes[intermittent aortic occlusion group] and 20 minutes [cardioplegia group] respectively, and the mean number of graft per patient is 2.85. Early mortality was 6.8% [8/117]. If we exclude the patients with LV aneurysm, the surgical mortality could be downed to 4.5% [5/111]. The causes of deaths were cardiogenic shock[6], aortic dissection[1], and neurologic complication[1]. We conclude that noncardioplegic myocardial protection may be equally beneficial or sometimes advantageous to cardioplegic technique in aortocoronary bypass graft surgery.

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Early Result of the Coronary artery Bypass Surgery (Analysis with the Postoperative Coronary artery Angiography) (관상동맥 우회수술의 조기성적 (술후 혈관조영술을 통한 분석))

  • 류경민;김삼현;박성식;류재옥;서필원
    • Journal of Chest Surgery
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    • v.33 no.6
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    • pp.487-493
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    • 2000
  • Background: Early patency of the coronary artery bypass grafting is determined mainly by surgical technique and status of coronary artery. We analyzed the early result, focusing on the relationship between postoperative angiographic findings and the patency rate. Material and method: During the period of July 1997- August 1999, 86 cases of CABG were performed and the postoperative coronary artery angiography was done in 76 cases on postoperative day 7 to assess the graft patency. Result: Overall graft patency was 90.2% on the angiographic finding. Factors influencing the early graft occlusion were the surgeon's experience, small coronary artery size less than 1.5mm in diameter, coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site(p<0.001). Operative mortailty was 2.3%. Early recurrence of the symptom was 19.8% during the follow up period. Conclusion: We examined the postoperative coronary angiography and found that the surgeon's experience, small coronary artery size less than 1.5mm in diameter, bypass surgery on the coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site were the factors for the graft occlusion.

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Left Atrium-Femoral Artery Bypass using the Bio-Medicus Centrifugal Pump in Repair of Thoracic and Thoracoabdominal Aortic Aneurysm -Report of 7 cases- (좌심방-대퇴동맥 우회술을 이용한 흉부 및 흉복부 대동맥류 수술에 관한 임상적 고찰 -7례 보고-)

  • Yim, Soo-Bin;Ahn, Hyuk;Rho, Joon-Ryang
    • Journal of Chest Surgery
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    • v.27 no.4
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    • pp.318-324
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    • 1994
  • Cross-clamping of the descending thoracic aorta results in proximal hypertension,increase in left ventricular afterload,and impairment of distal organ perfusion. Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamping of the thoracic aorta. At Seoul National University Hospital, 7 patients were treated for the thoracic or thoracoabdominal aortic aneurysm using left atrium-femoral artery bypass with Bio-medicus centrifugal pump between October,1989, and January,1993. There were atherosclerotic thoracic aneurysm in 3 cases, thoracoabdominal aortic aneurysm due to chronic aortic dissection in 3 cases,aortic rupture due to trauma in 1 case. Total of 7 patients were operated by graft replacement with reimplantation of important branches. None of these cases developed severe complications and hospital death. We believe that the Bio-Medicus centrifugal pump is a simple and safe means of perfusing the lower body, kidneys, and spinal cord without necessitating heparinization.

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Simple and Effective Surgical Repair with Vascular Graft Strip for Ischemic MR (인조혈관대를 이용한 허혈성 승모판막 폐쇄부전의 수술적 치료)

  • 민호기;이승훈;이주현;성기익;박계현;전태국;박표원;이영탁
    • Journal of Chest Surgery
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    • v.36 no.9
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    • pp.646-650
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    • 2003
  • Many surgical techniques for ischemic mitral regurgitation (IMR) have been used with their excellent results and advantages. Here, we report our simple posterior annuloplasty techniques using vascular graft strip with their early results. Material and Method: Twenty two patients (13 male) underwent the operations for IMR (excluding the papillary muscle rupture) from December 2001 to January 2003. Preoperative risk factors were low ejection fraction (<35%, n=9), hypertension (n=13), diabetes (n=9), and renal failure (Cr>2.5, n=4). The wide dissection beneath the both vena cavae and interatrial groove after bicaval cannulation enabled the easy exposure of mitral valve even in the small left atrium. After eight or nine interrupted sutures in posterior annulus for anchoring the 6 mm width vascular graft strip, symmetric (n=8) or asymmetric (n=14) annuloplasty were done. Combined surgeries were CABG (n=21), Dor procedures (n=3), tricuspid valve annuloplasty (n=1), Maze operation (n=1), and aorto-right subclavian artery bypass (n=1). Result: Except for one surgical mortality, all the patients were doing well and the mean grade of regurgitation was decreased from 2.95 to 0.88, however the ejection fraction had not changed significantly just before discharge. Post-operative valve function evaluated before discharge revealed no residual regurgitation in 8 (including 1 patient with mild stenosis due to over reduction), minimal in 11, mild in 2, and mild to moderate regurgitation in 1. One patient who had ischemic cardiomyopathy and renal failure died of the arrhythmia during the hemodialysis. Conclusion: These observations suggest that the annuloplasty with vascular graft strip could be a safe and cost effective techniques for ischemic mitral regurgitation. However, the long term evaluation for the mitral valve function should be defined for the final conclusion.

20-Year Experience of Surgical Treatment for Postpneumonectomy Empyema (전폐절제술 후 사강에 발생한 농흉의 치료)

  • 김형렬;김영태;성숙환;김주현
    • Journal of Chest Surgery
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    • v.35 no.7
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    • pp.542-547
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    • 2002
  • Background: Postpneumonectomy empyema(PPE) is an infrequent but potentially life-threatening complication. To date, various surgical efforts have been made to manage this complication. We reviewed our 20-year surgical experience of PPE and long-term follow-up data. Material and Method: Total of 37 patients who were treated for PPE between fan, 1980 and Jun, 2000 were included. Various clinical factors such as micro-organism, operative method and timing, presence of bronchopleural fistula(BPF), underlying disease and fate of empyema cavity were retrospectively reviewed and analyzed. Result: Majority of patients(34) underwent Eloesser operation for effective drainage. There was only one operative mortality. The causative organisms were Staphylococcus species and Pseudomonas species in 46% BPF was found in 20 cases, among which spontaneous closures took place in 4 cases. The chest wall was closed in 40%(8/20) of patients with BPF, compared to 59%(10/17) without BPF. The closure rate was statistically better in patients without BPF(p=0.006). Even though the patients with benign disease showed higher closure rate(50%) than those with lung cancer (31%), the difference was not significant(p=0.25). Conclusion: Eloesser procedure was an effective method for initial drainage of PPE cavity with low operative mortality. Given the findings of low spontaneous closure rate of BPF, aggressive approach to close the BPF is mandatory to achieve the final goal of chest wall closure. It was found that majority of patients still left their chest cavity opened, even after controlling the active inflammation of the empyema cavity. More aggnessive approach for chest wall closure is recommended in all patents with benign disease and in selective patients with lung cancer if there is no evidence of recurrence at several years after the initial operation.

The cooling effects of a paddy field area during 2006 summer (2006년 여름철 논에 의한 기온저감효과)

  • Kwon, Sung-Il;Kim, Jin-Soo;Park, Jong-Hwa;Oh, Kwang-Young;Song, Chul-Min
    • Proceedings of the Korea Water Resources Association Conference
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    • 2007.05a
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    • pp.628-632
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    • 2007
  • 본 연구에서는 2006년 여름철(2006년 7월 15일${\sim}$9월 30일) 동안 서로 다른 토지피복형태(논, 밭, 도시녹지대 및 도시주택지)에서의 기온변화 특성을 비교하여 논에 의한 기온저감 효과를 파악하였다. 혹서기 동안 총 3회(2006년 8월 3일, 11일, 15일)에 걸쳐 논으로부터의 거리에 따라 기온을 실측한 결과, 논으로부터 거리가 멀어짐에 따라 기온이 상승하였으며, 170m 지점에서의 기온은 논 지점보다 14시에는 $2.3^{\circ}C$, 22시에는 $1.8^{\circ}C$, 익일 06시에는 $1.3^{\circ}C$ 높게 나타났다. 혹서기 동안 논, 밭, 녹지대, 주택지에서의 열대야 완화효과를 비교해보면, 논이 열대야를 완화시키는 효과가 가장 큰 것으로 나타났다. $25^{\circ}C$이하로 낮아지는 평균시각은 논이 22.36시, 밭이 24.0시, 녹지대가 2.2시, 주택지가 2.3시로 나타났고, 이 시각으로부터의 평균 지속시간은 논이 7.7시간, 밭이 7.3시간, 녹지대가 4.3시간, 주택지가 1.0시간으로 나타났다. 또한 평균 일최저기온은 논이 $23.1^{\circ}C$로서 밭과는 동일하게 나타났으며, 녹지대보다 $0.9^{\circ}C$, 주택지보다 $3.0^{\circ}C$ 낮게 나타났다. 그러나 논과 밭에서의 기온저감효과는 큰 차이를 보이지 않았는데, 이는 기온저감효과가 식생피복상태에 의해 크게 좌우되기때문으로 생각된다. 본 연구에서는 논과 밭에 의한 기온저감효과의 메커니즘은 파악되지 않았으나, 이는 다양한 논지대 및 밭지대를 대상으로 열수지 특성을 분석함으로써 구명할 수 있을 것으로 생각된다.자로서는 제방 마루의 토지이용 및 식생구조, 하도의 식생유형, 하도주변 토지이용, 하안(bank) 형상 및 구조, 수종 및 구조, 하도 및 하안 특징 및 구조 등으로 선정, 검토하였다. 이상의 하천교란과 관계되는 지표를 선정하여 물리적, 생태적 조사 및 교란평가기법(안)을 개발, 제시하였다.EX>)를 보였으며, 그 중 3명에서는 혈역학적으로 큰 의미가 없는 잔여단락이 있었다. 결론: 급성 심근경색증 후 심실중격 결손은 수술위험도가 높은 질환이지만, 수술 전 대동맥내 풍선펌프를 삽입하고 조기에 심실중격 결손부의 infarct exclusion 술식과 함께 관상동맥우회술을 시행함으로써 만족할 만한 수술 및 중기 결과를 얻을 수 있었다.출물 투여로 저하되었으나 NC군보다는 높게 나타났다. 간 중 중성지질 함량은 참나물 에탄올 추출물 투여 용량에 따른 유의차가 없었으나, 총콜레스테롤 함량은 고용량 병합투여한 HC-PBH군만 유의하게 저하되었다. 혈청 및 간 중의 지질 함량 변화는 정상식이를 급여한 NC군과 NC-PB군 간에는 유의차가 없었다. 따라서 고콜레스테롤식이를 급여하면서 참나물 에탄올 추출물을 병합투여 시에만 지질대사 개선 효과가 있는 것으로 여겨지며, 고용량 병합투여 시 효능이 더 큰 것으로 나타났다. 고콜레스테롤식이로 인한 산화적 스트레스가 고콜레스테롤혈증을 유발하였으며, 이는 참나물 에탄올 추출물에 함유된 항산화물질을 포함한 여러 생리활성물질이 영향을 미친 것으로 사료된다. 이상의 실험 결과에서 참나물 에탄올 추출물은 고콜레스테롤식이로 증가된 총콜레스테롤, LDL-콜레스테롤 및 중성지질 함량은 감소시켰고, HDL-콜레스테롤과 인지질 함량은 증가시킴으로써 지방간 및 동맥경화의 예방과 치료에 효과적일 것으로 판단되어 진다./hr/g$, 섭취 7일중 $8.123\;{\mu}g/hr/

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The Cox-Maze Procedure for Atrial Fibrillation Concomitant with Mitral Valve Disease (승모판막질환에 동반된 심방세동에서 Cox-Maze 술식)

  • Kim, Ki-Bong;Cho, Kwang-Ree;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.31 no.10
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    • pp.939-944
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    • 1998
  • Background: The sugical results of the Cox-Maze procedure (CMP) for lone atrial fibrillation(AF) have proven to be exellent. However, those for AF associated with mitral valve(MV) disease have been reported to be a little inferior. Materials and methods: To assess the efficacy and safety of the CMP as a combined procedure with MV operation, we studied retrospectively our experiences. Between April 1994 and October 1997, we experienced 70 (23 males, 47 females) cases of CMP concomitantly with MV operation. Results: The etiologies of MV disease were rheumatic in 67 and degenerative in 3 cases. The mean duration of AF before sugery was 66$\pm$70 months. Fifteen patients had the past medical history of thromboembolic complications, and left atrial thrombi were identified at operation in 24 patients. Twelve cases were reoperations. Aortic cross clamp (ACC) time was mean 151$\pm$44 minutes, and cardiopulmonary bypass (CPB) time was mean 246$\pm$65 minutes. Concomitant procedures were mitral valve replacement (MVR) in 19, MVR and aortic valve replacement (AVR) in 14, MVR and tricupid annuloplasty (TAP) in 8, MVR with AV repair in 3, MV repair in 11, MVR and coronary artery bypass grafting (CABG) in 2, MVR and AVR and CABG in 1, redo-MVR in 10, redo-MVR and redo-AVR in 2 patients. The rate of hospital mortality was 1.4%(1/70). Perioperative recurrence of AF was seen in 44(62.9%), and atrial tachyarrhythmias in 10(14.3%), low cardiac output syndrome in 4(5.7%), postoperative bleeding that required mediastinal exploration in 4(5.7%) patients. Other complications were acute renal failure in 2, aggravation of preoperative hemiplegia in 1, and transient delirium in 1 patient. We followed up all the survivors for 16.4 months(3-44months) on an average. Sinus rhythm has been restored in 65(94.2%) patients. AF has been controlled by operation alone in 73.9% and operation plus medication in 20.3%. Two patients needed permanent pacemaker implantation; one with sick sinus syndrome, and the other with tachycardia- bradycardia syndrome. Only two patients remained in AF. We followed up our patients with transthoracic echocardiography to assess the atrial contractilities and other cardiac functions. Right atrial contractility could be demonstrated in 92% and left atrial contractility in 53%.We compared our non-redo cases with redo cases. Although the duration of AF was significantly longer in redo cases, there was no differences in ACC time, CPB time, postoperative bleeding amount and sinus conversion rate. Conclusions: In conclusion, the CMP concomitant with MV operation demonstrated a high sinus conversion rate under the acceptable operative risk even in case of reoperation.

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Surgical Treatment of Primary Lung Cancer (원발성 폐암의 외과적 치료)

  • 김성완;구본원;이응배;전상훈;장봉현;이종태;김규태;강덕식
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.134-141
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    • 1998
  • Primary lung cancer has recently increased progressively in its incidence in Korea. It is clearly evident that surgical resection offers the best offortunity for cure of non-small cell carcinoma. This study was designed to analyse the clinical data of 100 primary non-small cell carcinoma patients who underwent lung resection surgery from January 1992 to July 1995 at the department of Thoracic and Cardiovascular Sugery, Kyungpook National University Hospital. There were 86 males and 14 females(6:1). In the age distribution, the peak incidence was recorded in the seventh decade(43%). The methods of tissue diagnosis were bronchoscopic biopsy in 53 patients(50.5%), percutaneous needle aspiration in 17 patients(16.2%), transbronchial lung biopsy in 11 patients(10.5%), mediastinoscopic biopsy in 2 patients (1.9%), sputum cytology in 2 patients(1.9%), and thoracotomy in 20 patients(19.0%). Fifty-five lobectomies, 22 pneumonectomies, 15 bilobectomies, 2 segmentectomies, 4 sleeve lobectomies, a sleeve pneumonectomy, and a wedge pneumonectomy were performed. Operative mortality occured in 4 cases(sepsis in 2 cases, respiratory failure in 1 case, and acute myocardiac infarction in 1 case). The histologic types of tumor were 67 squamous cell carcinomas, 26 adenocarcinomas, 6 large cell carcinomas, and an adenosquamous cell carcinoma. Eighteen patients with N2 mediastinal lymph node metastases had 8 squamous cell carcinomas(11.9%), 9 adenocarcinomas(34.6%), and a large cell carcinoma(16.7%). The primary tumors in these patients were in the right upper lobe in 4 patients, the right middle and lower lobe in 9 patients, the left upper lobe in 3 patients, and the left lower lobe in 2 patients. With regard to pathologic stages, 45 patients had stage I disease; 13 patients, stage II; 36 patients, stage IIIa; 5 patients, stage IIIb; and 1 patient, stage IV. The overall actuarial survival rate was 77.5% at 12 months, 56.1% at 24 months and 43.7% at 43 months. The actuarial survival rates at 43 months were 81.3% in Stage I, 20.8% in Stage II, 27.9% in Stage IIIa, 25.0% in Stage IIIb and 33.3% in Stage IV. These facts suggest that early detection and surgical resection are recommended for favorable postoperative survival in non-small cell lung cancer.

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Correlation Between Knowledge and Educational Needs Related to Recurrent in Coronary Artery bypass graft patients (관상동맥 우회술환자의 수술 후 재발 관련 지식과 교육요구도와의 상관관계)

  • 김희승;박민정
    • Journal of Korean Academy of Nursing
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    • v.30 no.3
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    • pp.549-559
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    • 2000
  • The purpose of this study was to investigate the correlation between the knowledge and educational needs related to recurrent in coronary artery bypass graft patients as a basis to provide an individual nursing education for the population. The subjects consisted of 110 patients who had coronary artery bypass graft(CABG) at Asan Medical Center in Seoul and Sechong hospital in Buchon. Data was obtained from a knowledge questionnaire and a learning needs questionnaire between November 1998 and February 1999. Data were analyzed using SAS program for Wilcoxon rank sum test and Spearman correlation coefficient. The results were as follows : 1. With regard to the 18 items to measure knowledge, the mean (median) of items 'don't know' was 4.9(4) items. The mean (median) of items answered wrong was 3.2(3) items. The number of items answered 'don't know' tend to show higher in those who had less education, blue color jobs and myocardiac infarction history than in their counter parts. There were higher frequency of items answered 'don't know' in those who had no hypertension 2. With regard to the level of knowledge by questionnaire about CABG, The most "I dont know" (59.1%) highly response was 'He has to be treated with anticoagulant drug to prevent revasculized vessel from obstructing.' The seond highest response (56.4%) was 'If you were hypotensive, the coronary attack would collapse. 'During the hospitalized day, the patient has complete bedrest.' The highest error probability was cholesterol has not to intake.', 'After surgery, the sexual life is need controlled for 1 year. 3. The mean of educational needs was 3.38. With regard to the level of learning needs by sentence about CABG, 'Food that benefit heart disease', 'Recurrence possibility of heart disease', 'Management method of operation site', 'Risk symptom that visit hospital or report immediately' were higher than other sentenses. With regard to the level of learning needs by factor 'food(5 items)', 'disease(9 items)' and 'exercise(3 items)' showed the highest than other factors. The educational needs by patients characteristics tend to show higher in males, under the age of 49, middle or high school degree, previous experience of admission with coronary artery disease, history of myocardial infarction, expierience of PTCA, history of cerebro-vascular accident, previous expierience of smoking than in their counter parts. 4. The number of items answered 'don't know', wrong and correct weren't correlated with the level educational needs. As the results, the number of items answered 'don't know' tend to show higher in those who had less educated, blue color jobs and myocardiac infarction history than in their counter parts. There were higher frequency of items answered 'don't know' in those who had no hypertension .There were higher frequency of items answered 'don't know' on anti-thrombolitic theraphy, hypotension and pain relief. Also there were higher frequency of items answered wrong on bed rest period, cholesterol intake, and sexual life. Educational needs were higher in young age group, had previous experience of procesure and history of other disease. And when we educate CABG patients, education for diet, recurrence possibility of disease, management methods of operation site and risk symptom should be emphasized.

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