• Journal of Chest Surgery
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• v.31 no.11
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• pp.1037-1042
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• 1998

Background: Among the various techniques for the adequate exposure of the mitral valve, the extended transseptal approach is the essential prerequisite for accurate repair or replacement of the mitral apparatus. But the efficacy and safty of the extended transseptal approach has not determined in Korea yet. Materials and methods: Retrospective data of 80 consecutive patients, operated from September 1992 to July 1997 were reviewed. Seventy- eight patients underwent mitral valve replacement and 2 patients underwent excision of left atrial myxoma. Thirty-eight of 78 patients had other concomitant procedures such as aortic valve replacement(n=22), tricuspid annulopasty(n=14), coronary artery bypass graft(n=1) and closure of ventricular septal defect(n=1). Mean follow up was 23.3±15.0 months and total follow up was 1792 patient-months. Results: The hospital mortality rate was 3.8%(3 patients). Two deaths were due to low cardiac output and one due to postoperative bleeding of coagulopathy. Among the 46 patients who had atrial fibrillation preoperatively, 45 had atrial fibrillation postoperatively and 1 converted to sinus rhythm. All 34 patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after the operation. Mean aortic cross clamping time was 62 minutes for isolated mitral procedure and 90 minutes for concomitant procedures. There were no specific complications related to this approach. Conclusions: We suggest that the extended transseptal approach is an easy and good method for mitral valve surgery, especially in patients with small sized left atrium.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.710-717
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• 2008

Background: Atrial fibrillation is associated with several complications such as cerebro-vascular accidents and peripheral arterial embolism. Most of the patients who have this arrhythmia chronically feel their heart beating and so they are frightened; therefore, the quality of a patient's life is decreased. The purpose of this article is to determine the long term results of a modified Maze procedure and the factors that influence the success of the procedure. Material and Method: This study enrolled 88 patients who underwent the modified Maze with using cryoablation between June, 2001 and February, 2007. The 88 consecutive patients were divided into two groups ac cording to how the pulmonary veins were isolated, that is, with or without cryoablation. There were 58 patients who were isolated by cutting and sewing in the right pulmonary veins and by cyroablation in the left pulmonary veins in group 1 (group 1, n=58), and 30 patients who underwent isolation by cryoablation in the right & left pulmonary veins were placed in group 2 (group 2, n=30). The ECG was checked at discharge to determine the sinus conversion rate and we followed up the patients to determine whether or not the patients maintained sinus rhythm. We also checked the ECG at the last visit to determine the patients' heart rhythm. Result: The mean follow up time was $44.3{\pm}19.2$ months. At discharge, 72.4% of the patients in group 1 were in proper sinus rhythm and 66.7% of the patients in group 2 were in proper sinus rhythm. At the last follow up, 81% of the patients in group 1 were in normal sinus rhythm and 60% of the patients in group 2 were in normal sinus rhythm. When we analyzed the data via the Kaplan-Meier method, 86.5% of the patients were free from atrial fibrillation (% free from AF) at 1 year, 80% of the patients were free from atrial fibrillation at 5 year in group 1 and 70% of the patients were free from atrial fibrillation at 1 year and 51 % of the patients in group 2 were free from atrial fibrillation at 5 year. Conclusion: The modified Maze technique using cryoablation was a simple and effective procedure. But the success rate of the Maze technique using cryoblation is lower than that of the standard Maze III. The method using cryoablation shorten the operation time, but we must conduct more studies to get a better result of the modified Maze technique with using cryoablation.

• Journal of Yeungnam Medical Science
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• v.9 no.2
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• pp.321-326
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• 1992

The study consisted of all patients over 35years old undergoing surgical repair of atrial septal defect for the period from June 1985, to August 1992. The following results were observed. 1. ASD was closed with patch in 11(73%) patients. 2. The relationship of pulmonary artery systolic pressure to Qp/Qs ratio was not significant. 3. Before operation 6 patients were in NYHA functional class II, 8 were in class III, After operation 8 patients were in class I, 6 were in class II. 4. Atrial fibrillation has persisted in 3 patients and returned regular rhythm in 1 patient after surgery. 5. There was no operative mortality and we had good surgical results regardless of patient's age.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.537-539
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• 1997

An orthotopic cardiac transplantation was successfully performed in a 40 year-old Jehovah's witness without use of any blood product. Preoperatively, the patient had been on coumadin to prevent left atrial thrombi and the INR(Internation Normalized Ratio)of prothrombin titre was 2.4. During the operation, cell saver was used for shed blood and aprotinin was admini tered intravenously for platelet function. Total postoperative drainage was 860cc and the lowest hemoglobin was 12.2 gmldl. Postoperative course was complicated by central nervous system infection by wisteria monocytogenes and two episodes of rejection, both of which were effectively treated. The patient is on his 5th postoperative month and doing well.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.361-364
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• 2001

자가 폐동맥 판막을 이용한 대동맥 판막 치환술을 항응고제 복용이 필요없고 내구성이 어느정도 입증되어 늘어나고 있으나, 자가 폐동맥 판막을 이용한 승모판막 치환술은 국내에 보고된 예가 없다. 53세 여자 환자로 류마티스성 승모판막 협차가 및 폐쇄부전, 삼첨판막 폐쇄부전, 만성 심방 세동, 그리고 자회전 관상동맥의 폐색등으로 진단받은 환자에서 자가 폐동맥 판막을 이용한 승모판막 치환술 및 maze 술식, 삼천판막 성형술, 관상동맥 우회수술을 시해하였다. 수술후 특별한 문제없이 회복하였으며 술후 시행한 심초음파 검사상 자가 폐동맥 판막의 이상 소견없이 잘 기능하고 있으며 항응고제 복용없이 잘 지내고 있다.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.559-565
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• 2003

By improving the flow pattern in Fontan circuit, total cavopulmonary connection (TCPC) could result in a better outcome than atriopulmonary connection Fontan operation. For the patients with impaired hemodynamics after atriopulmonary Fontan connection, conversion to TCPC can be expected to bring hemodynamic and functional improvement. We studied the results of the revision of the previous Fontan connection to TCPC in patients with failed Fontan circulation. Material and method: From October1979 to June 2002, eight patients who had failed Fontan circulation, underwent revision of previous Fontan operation to TCPC at Yonsei University Hospital. Intracardiac anomalies of the patients were tricuspid atresia (n=4) and other functional single ventricles (n=4). Mean age at TCPC conversion was 14.0$\pm$7.0 years (range, 4.6~26.2 years) and median interval between initial Fontan operation and TCPC was 7.5 years (range, 2.4~14.3 years). All patients had various degree of symptoms and signs of right heart failure. NYHA functional class was 111 or IV in six patients. Paroxysmal atrial fibrillation (n:f), cyanosis (n=2), intraatrial thrombi (n=2), and protein losing enteropathy (PLE) (n=3) were also combined. The previous Fontan operation was revised to extracardiac conduit placement (n=7) and intraatrial lateral tunnel (n=1). Result: There was no operative death. Major morbidities included deep sternal infection (n=1), prolonged pleural effusion over two weeks (n=1), and temporary junctional lachyarrhythrnia (n=1). Postoperative central venous Pressure was lower than the preoperative value (17.9$\pm$3.5 vs. 14.9$\pm$1.0, p=0.049). Follow-up was complete in all patients and extended to 50,1 months (mean, 30.3$\pm$ 12.8 months). There was no late death. All patients were in NYHA class 1 or 11. Paroxysmal supraventricular tachycardia developed in a patient who underwent conversion to intraatrial lateral tunnel procedure, PLE was recurred in two patients among three patients who had had PLE before the convertsion. There was no newly developed PLE. Conclusion: Hemodynamic and functional improvement could be expected for the patients with Fontan circulatory failure after atriopulmonary connection by revision of their previous circulation to TCPC. The conversion could be performed with low risk of morbidity and mortality.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.244-247
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• 2009

A left atrial appendage aneurysm is a very rare medical condition which can develop by an inflammatory reaction or a degenerative change. If there is no accompanying anomaly, a left atrial appendage is considered a congenital disease. The majority of left atrial appendage aneurysms are detected incidentally because they usually do not cause any symptoms. Surgery is indicated, even for asymptomatic patients, because of the risk of life-threatening complications, such as atrial fibrillation, supraventricular tachycardia, systemic embolization, and cardiac arrest. Left atrial appendage aneurysms are usually treated by a median sternotomy with extracorporeal circulation, especially if the aneurysm has a broad base or contains a thrombus, but can treated by thoracotomy without extracorporeal circulation. We report a case of a successfully treated left atrial appendage aneurysm that was misdiagnosed as a partial pericardial defect without extracorporeal circulation in a 13-year old child.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.1-6
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• 2003

Currently, atrial septal defect repair has been considered low risk operation duo to the development of open heart surgery Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. Material and Method: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy(group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. Result: The mean weight of group A was 38.77$\pm$15.57kg and 38.21$\pm$21.82kg in group B. In group A, mean operation (OP) time was 197.6$\pm$61.40min, mean cardiopulmonary bypass(CPB) time was 48.66$\pm$13.02min and mean fibrillation time or aortic cross clamp(ACC) time was 30$\pm$11.64min. In group B, mean OP time was 212.33$\pm$31.95min, mean CPB time was 55$\pm$12.10min, and mean fibrillation or ACC time was 29.33$\pm$9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78$\pm$0.78 hours, mean postoperative ICU stay was 1.2$\pm$0.47 days and mean postoperative hospital stay was 10.20 41.08 days. In group B, mean mechanical ventilation time was 5.95$\pm$3.73 hours, mean post operative ICU stay was 1.41$\pm$0.61 days, and mean postoperative hospital stay was 12.20$\pm$3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33$\pm$90.54cc vs 352.33$\pm$239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block. Conclusion: Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument(p.0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.

• Clinical and Experimental Pediatrics
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• v.45 no.2
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• pp.199-207
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• 2002

Purpose : Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. Methods : Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization $11{\pm}3$ months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. Results : There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range : 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was $18.0{\pm}3.6mmHg$, but baffle pressure, corresponding to right atrial pressure decreased to $14.8{\pm}3.6mmHg$ after TCPC. The size of the pulmonary arteries did not regress after TCPC. Conclusion : The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1342-1346
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• 1996

A right thoracotomy was used for the reoperation or mitral valve of 15 patients who had previously undergone a cardiac operation through a median sternotomy. In our experience. this approach provided dn excellent exposure of the nlitral valve and easy cannulations of both cavie with minimal dissection, ilvoiding any damage of cardiac and major vessels during re-sternotomy Arterial cannulation was performed in the ascending aorta in 13 patients And in the femoral artery in 2 patients. In earlier cases, venous cannulation was done in the SVC And IVC through the right atrium and snared. In later cases, this could be done without snaginly of both cavae or by placing a silgle light-angled catheter into the right atrium. Crystalloid cardioplegic solution was infused for myocardial protection. Hypothermia was controlled at 20\ulcorner$25^{\circ}C$. For defibrillation, internal paddles were used In one patient while sterilized external paddles were used in 10 patients. In the remaining four patients. however. the heart beat spontaneously The respirator could be weaned within 48 hours alter the operation and no pulmonary complication was observed. One out of the 15 patients expired due to sudden attack of ventricular tarchycardid developed ten days after the operation, but the rest of the patients were discharged with good condition.