• Journal of Chest Surgery
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• v.21 no.4
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• pp.748-756
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• 1988

Transaortic closure of ventricular septal defect, suturing a patch on the morphological right ventricular side in patients with congenitally corrected transposition of great arteries might help to avoid postoperative complete heart block if the aorta is large and the subaortic conus is not well developed. In two patients[aged 6 and 16 years] with congenitally corrected transposition of great arteries, ventricular septal defect, and pulmonary stenosis, transaortic closure of ventricular septal defect was performed. No postoperative complete heart block resulted. One hospital death occurred because of sepsis who had underwent reoperation due to bleeding from the aortotomy site. Minimal aortic regurgitation developed in another patient.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.265-272
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• 1986

We operated on 199 patients of VSD from 1976 to April l986. Among them, patients of VSD whose medical records were available were analyzed clinically. Operation on patients of VSD occupied 23.9% of total open heart surgery [832 cases] during those days. Of the 164 patients, 93 patients were male [56.7%]. 71 patients were female [43.3%]. Their age ranged from 6 months to 28 years and the mean age was 9.5 year and 82.2% of the patients were between 2 and 15 year of age. Of the patients, body weight below 10Kg were 19 cases. The most common complaints were frequent URI and DOE. On Kirklin`s anatomical classification, type II defect was most common [60.1%], type I [38.4%], combined type I+II, type III, combined type II+Ill and combined type II+IV in orders. Associated anomaly was found in 66 patients [42.5%>]. Pulmonary stenosis was most commonly associated cardiac anomaly [8.4%] and aortic insufficiency [7.1%], ASD, Lt. SVC and PDA in orders. There were extracardiac anomalies such as polydactyly, cleft palate, hypospadia and congenital aniridia, etc. Relationship between ventricular hypertrophy and defect size and cardiac cath. data was analyzed. The overall mortality was 7.0% [14 cases] and complication rate was 22.5% [35 cases].

• Journal of Chest Surgery
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• v.21 no.6
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• pp.1111-1116
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• 1988

Neurofibromatosis is very rare syndrome characterized by abnormal cutaneous pigmentation and numerous skin tumors was described by Smith in 1849, which is inherited as an autosomal dominant trait. Von Recklinghausen reported 2 cases of multiple skin and subcutaneous tumors in 1982. Malignant peripheral nerve tumors, although generally rare, are one of the most characteristic malignant tumors associated with Neurofibromatosis. We have experienced 3 cases of malignant Schwannoma in neurofibroma patients from 1982 to 1988 for 6 years at Thoracic and Cardiovascular surgery department, College of Medicine, Yonsei University, Seoul, Korea. l. One is 62 years old female who was taken total hysterectomy followed by irradiation treatment due to Uterine Carcinoma 21 years ago. She had a large bulging mass on left anterior chest wall and was taken enbloc resection of tumor including rib confirmed malignant Schwannoma. 2. Another is 18 years old female who had large bulging mass on right chest wall and pleural effusion in right thoracic cavity. Thoracentesis revealed a large amount of lymphocytes misdiagnosed of Tbc, pleurisy with Neurofibromatosis. We performed tissue biopsy on bulging mass and the specimen was confirmed malignant Schwannoma 2 months after first diagnosis of Tbc. pleurisy. She was not accessible to radical resection because of far advanced malignant Schwannoma at that time. 3. Third case is 28 years old male who was taken enbloc resection of tumor including rib due to Neurofibroma with Neurofibromatosis at M. hospital 6 months ago. But he had rapid growing mass at operation site again and taken tissue biopsy confirmed of malignant Schwannoma. He was not accessible to enbloc resection due to malignant Schwannoma extending to mediastinal structures.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.151-156
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• 1985

A clinical analysis was done on 50 cases of ventricular septal defect, operated from April 1981 to March 1984 at the department of Thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. Among 50 cases, 34 cases were males and 16 cases were females. Their age ranged from 1 to 26 years and the mean age was 9.7 years. The main symptoms at admission were frequent upper respiratory infection [50%], exertional dyspnea [42%] and palpitation [34%]. In anatomical classification by Kirklin, type I constituted 20%, type II 76%, type IV 4%. Associated congenital cardiac lesions were pulmonic stenosis [6 cases], patent foramen ovale [5 cases], aortic insufficiency [3 cases] and persistent left superior vena cava [1 case]. When a normal electrocardiogram pattern was present, Qp/Qs, Rp/Rs and pulmonary artery systolic pressure and Pp/Ps were relatively low. Among cases of above 1 cm2/M2 BSA in size of defect, Pp/Ps and pulmonary artery systolic pressure were increased than the cases of below 1 cm2/M2 BSA [P=0.01]. The postoperative right bundle branch block was occurred in 21 cases [75%] among 28 cases of right ventriculotomy approach. The operative mortality was 2% [1 case] among 50 cases and complication rate was 14% [7 cases].

• Journal of Chest Surgery
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• v.17 no.3
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• pp.339-345
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• 1984

Thirty four patients with a ventricular septal defect, aged 2 months to 24 years [median 2.33 years], had lung biopsies during open heart procedures to assess the degree of pulmonary vascular disease. The patients were divided into two groups according to their age; group 1 - under 2 years of age [15 patients], and group 2- over 2 years of age [19 patients]. The, pathologic change of the pulmonary arterioles was correlated with pre-operative hemodynamic data in 34 patients. There was no significant correlation between the severity of pulmonary vascular disease according to Heath-Edwards classification and the patients age [X2=1.8381, P=0.1751 ]. There was a significant correlation between degree of medial wall thickness and arteriolar diameter and the level of preoperative peak pulmonary artery pressure and peak systemic artery pressure [Pp/Ps]. Also, there was a good correlation between the preoperative pulmonary vascular resistance and systemic vascular resistance [Rp/Rs]. There was no significant correlation between wall thickness and Pp/Ps, and Rp/Rs below the age of 2 years. We conclude that, in patients over 2 years of age, there was a significant correlation between the medial wall thickness of the pulmonary arteriole and elevation of Pp/Ps and Rp/Rs. This is not true in patients under 2 years of age.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.688-694
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• 1987

At the Dept. of Thoracic and Cardiovascular Surgery of Pusan National University Hospital, postoperative cardiac catheterizations were performed in 12 patients of ventricular septal defect with severe pulmonary hypertension [Pp/Ps>0.75], who were operated during the period from July 1981 to Dec. 1986. The mean age of the patients preoperatively was 12.4 [range: 4-18] year-old and the mean follow-up duration was 25.8 [range: 8-53] month per patient. In comparison with the preoperative data, the systolic pulmonary artery pressure [SPAP] was decreased from 103.6*18.4 to 70.4*35.9 mmHg [p<0.01] and the Pp/Ps was decreased from 0.89*0.10 to 0.58*0.27 [p<0.01]. But the Rp/Rs and Rp were not meaningfully changed, from 0.31*0.16 and 7.6*0.4 unit to 0.41*0.32 and 8.0*6.6 unit, respectively. The preoperative Qp/Qs was bellow 2.0[mean: 1.6] in 3 out of 4 cases whose postoperative Rp/Rs and Rp were above 0.75 and 15 unit, respectively. On the contrary, the preoperative Qp/Qs was above 2.0 [mean: 3.5] in all of the 8 cases, whose postoperative Rp/Rs and Rp were below 0.50 and 10 unit, respectively.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.122-128
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• 1993

This series compromised 31 patients with pulmonary hypertension of 282 patients of ventricular septal defect(VSD) who underwent operation at the department of Thoracic and Cardiovascular Surgery in Chonnam University Hospital, from January, 1986 to December, 1991. Pulmonary hypertension was noted in 59 of 280 cases of VSD. Of them, 31 cases underwent cardiac catheterization on postoperative 8th to 77th month. Age at operation was ranged from 10 months to 29 years (mean 9.13 years). 17 patients were male and 14 patients were female. Results of follow-up studies were as follows: Cardiothoracic ratio was decreased from 0.59${\pm}$0.04 to 0.54${\pm}$0.03 (p=NS). Postoperative systolic pulmonary arterial pressure (PAPs), mean pulmonary arterial pressure (PAPm), and systolic right ventricular pressure (RVPs) were decreased significantly (p<0.001). And also Rp/Rs was decreased from 0.37${\pm}$0.21 to 0.14${\pm}$0.06 (p<0.02). However, systemic arterial pressure (SAP), right atrial pressure (RAP), and pulmonary capillary wedge pressure (PCWP) were changed insignificantly. There were significant relations of follow-up period with the decrement of PAP(p<0.005). In contrary, ther were no relations between the decrement of PAP and the age at operation. These data suggested that the long-term hemodynamic changes remained to be determined in some of the patients, even though they Were asymptomatic, with pulmonary hypertension.

• Journal of Chest Surgery
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• v.14 no.3
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• pp.254-259
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• 1981

This is a case of successfully surgically treated RVOT obstruction caused by projection of the herniated aortic cusp through subpulmonic supracristal VSD at Department of Thoracic and Cardiovascular Sugery, Hanyang University Hospital. The patient was a 17 year old boy. Congenital heart anomaly was suspected at 2 years of his age. He had palpitation, dyspnea on exertion and epistaxis for 2 years prior to admission to our hospital. On examination, the blood pressure was 170/0mmHg. And the pulse rate was 100/rain. Widening of pulse pressure, water hammer pulse [bounding pulse]. To and fro murmur and head nodding were noted. Cardiomegaly was seen in chest x-ray. EKG, Echocardiography, Cardiac catheterization and angiocardiography were performed. On April 27, 81. Open heart surgery was performed under the impression of VSD combined with AI. On Rt. ventriculotomy, we noticed RVOT obstruction caused by prolapsed rt coronary cusp through a VSD. The subpulmonic supracristal VSD measuring 2.5 x 3 Cm in diameter was closed with Teflon patch graft and then the prolapsed aortic leaflet was plicated by placing three 8-figure suture between the free edge and the base of the leaflet through transverse aortotomy. After operation, excellent result was obtained: B.P, was 110/50mmHg and any sign of AI or residual shunt was not found at discharge.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.630-640
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• 1988

We clinically evaluated 222 cases of ventricular septal defect which we experienced at Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital between July 1981 and March 1988. These patients were occupied 46.2% of all congenital heart disease operated on its same period. Of 222 cases, 132 patients were male and 90 patients were female. Their age distribution ranged from 8 months to 34 years of age and their mean age was 10.3 years. Among these patients, 86 patients had associated cardiac anomalies, which were patent foramen ovale 43 cases[19.5%], Atrial septal defect 18 cases[8.1%], patent ductus arteriosus 8 cases[3.6%], aortic insufficiency 7 cases[3.2%], infundibular pulmonary stenosis 5 cases[2.3%] and etc. There was statistically significant correlationship between VSD size and Qp/Qs, Rp/Rs, Pp/Ps respectively. All cases were operated under cardiopulmonary bypass and 157 patients[70.7%] would be corrected through right atrial approach. 158 patients[71.2%] underwent closure of ventricular septal defect with primary closure and the remained patients[28.8%] with patch closure. In anatomical classification by Kirklin, type I constituted 23.4%, type II 73.4%, type III 0.5%, type I and type II 1.4%, and type II and type III 1.4%. Important postoperative EGG changes were noted in 57 cases[25.7%] and incomplete right bundle branch block was most common[12.6%]. 54 patients[24.3%] developed minor and major postoperative complications and 9 patients died of several complications and overall operative mortality was 4.1%.

• Journal of Chest Surgery
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• v.27 no.8
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• pp.650-655
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• 1994

The author analyzed 99patients with VSD weighting less than 10kg of body weight who underwent surgical correction from 1981 to 1992 at cardiovascular department of Hanyang University hospital. Patients occupied 29.3% of total cases who were underwent surgical corrections for congenital heart diseases during that time. Of the 99 patients, 51 patients were male [52%] and 48 patients[48%] were female. Age ranged from 28 days to 36 months with mean age of 13.6 months. Mean body weight was 7.53kg. According to Kirklin`s anatomical classification, type II defect was most common [61.6%]. Associated anomaly was found in 48 patients [48.5%]. Patent foramen ovale was most commonly associated cardiac anomaly [14.1%] and followed by atrial septal defect [12.1%], patent ductus arteriosus [10.1%]. Cardiac catheterization data were analyzed. The most common range of Qp/Qs, Rp/Rs, Pp/Ps were above 3.0, 0.1 - 0.25, and above 0.75 respectively. Among the indications of surgical correction, there were pulmonary hypertention in 69 patients, congestive heart failure in 44 patients, frequent respiratory infection in 47 patients, growth retardation in 33 patients. The most common surgical approach and method for VSD closure were right atriotomy[48.3%] and dacron patch closure[93.3%]. Complication rate was 13.1% [13 cases], and overall mortality was 17.1% [17 cases]. The cause of death consisted of low cardiac output syndrome[11 cases], acute renal failure[3 cases], sepsis[2 cases] and pulmonary insufficiency[1 case] in order of frequency.