• Journal of Chest Surgery
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• v.29 no.12
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• pp.1392-1397
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• 1996

Over the past two years the free jejunal transfer have been used in 7 consecutive patients to restore alimentary tract continuity artier the resection of esophagus. Six patients had squamous cell carcinomas and one had esophageal stricture . The patients underwent partial esophagectomy with modified radicAl neck dissection or mediastinal Iymph node dissection. The microvascular anastomosis was performed to the neck vessels in 4 patients and to the in ercostal vessels in 3 patients. Postoperative complications were graft necrosis in one patient, and a temporary anastomotic leakage with spontaneous closure in one patient. Reconstruction of the esophagus was successful in 6 of 7 patients. We emphasize that esophagectomy followed by transplantation of a free jejunal transfer is suitable for esophageal carcinoma or intractable esophageal stricture, and involvement of the midesophagus is not a contraindication to the use of the free Jejunal transfer.

• Journal of Chest Surgery
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• v.34 no.1
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• pp.94-96
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• 2001

말기 폐기종 환자의 치료에 있어서 폐이식술은 최근 5년 생존율의 향상으로 점점 확대외어 가는 추세이다. 또한 이식폐의 부족으로 일측 폐이식술이나 이형 혈액형에서의 폐이식술의 시행이 늘고 있는 추세이다. 이형 혈액형에서의 폐이식은 술후 적절한 면역 억제제의 투여로 동형 혈액형에서의 폐이식술에서와 마찬가지로 좋은 결과를 보이고 있다. 저자들은 말기 폐기종으로 호흡 곤란이 심해져 가는 35세 A형 여자 환자에 O형 남자 환자의 좌측 폐를 이식하였다. 술후 면역 억제를 위해 3제 치료(싸이클로스포린, 아자씨오프린, 프레드니졸론)를 실행하였고 수술 중에 항CD3항체(OKT3)를 1회 투여하여 이식 거부 반응을 억제할 수 있었다. 환자는 술후 특별한 문제 없이 18일째에 퇴원할 수 있었다.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.690-692
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• 1999

internal thoracic artery is used in myocardial revascularization because of many advantages. However, it may not be appropriate in the usual extrapleural or intrapleural route, because it can be easily displaced and injured due to the slender and weak characteristics. We introduce here, a simple technique of repositioning the skeletonized left internal thoracic artery in a stable and straight course by creating a tunnel between the left lateral pericardium and thymic tissue.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.50-55
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• 2004

Background: Transcranial Doppler ultrasonography (TCD) can detect microembolic signals (MES) in the patients with a potential embolic source. Clinical significance of MES has not been demonstrated in patients with prosthetic mechanical heart valves. We studied the correlation between cerebral thromboemoblic events after the mechanical heart valve surgery (MHVS) and residual MES during TCD monitoring with 100% oxygen inhalation in patients with mechanical heart valves. Material and Method: Twenty patients with previous cerebral thromboemoblic events after MHVS and a sex- and age-matched control group (n=30) were studied. TCD monitoring was performed from unilateral middle cerebral artery. After baseline monitoring for 20 minutes, 61 of oxygen was inspired for 40 minutes. Result: The site of valve and the duration after MHVS of the patients did not differ from those of controls. During baseline monitoring, there was no significant difference in MES prevalence or counts compared to controls. During oxygen inhalation, patients showed a higher MES prevalence (55%, 27.6%, p=0.045) and a more frequent MES counts (p=0.027) compared to controls. Conclusion: TCD monitoring with oxygen inhalation may be useful to differentiate clinically significant MES in patients with mechanical heart valve.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1159-1164
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• 1998

Background: Although operative outcome is progressing due to the development of operative techniques and myocardial protection, some patients face an increased morbidity and mortality. Therefore, it has become increasingly important to predict the operative morbidity and mortality. Material and Method: This retrospective study reports the results of risk factor analysis of morbidity and mortality of 137 consecutive patients who were underwent coronary artery bypass graft surgery(CABG). Preoperative variables were age, sex, preoperative myocardial infarction, operative priority, left ventricular ejection fraction, obesity and triple vessel disease. Postoperative morbidities were arrhythmia, wound infection, cerebral infarction, prolonged postoperative hospitalization, pneumonia, acute renal failure, prolonged use of ventilator and operative death. Result: The mean age of total patients was 56.7 years, from 27 to 74. The overall mortality was 6.6%(9 of 137) with the mortality of 3.9%(5 of 128) for elective operation, and 44.4%(4 of 9) for emergent or urgent cases. The morbidity of patients over 65 years was stastistically higher than that of under 65 years. Sex distribution showed no difference in morbidity, however operative mortality rate was slightly higher in women (5/41, 12.19%) than in men(4/96, 4.17%). Morbidity of emergent or urgent operation was 100%, much higher than that of the elective operation. Mortality of the patients whose left ventricular ejection fraction was under 50% was higher than that of those over 50%. Conclusion: We concluded that the risk factors of morbidity after CABG were old age above 65 years and emergent or urgent operation, and that risk factors of mortality were low left venticular ejection fraction under 50% and emergent or urgent operation.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.471-474
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• 2002

Transfusion associated graft-versus-host disease is a rare but fatal disease reported after open heart surgeries mainly in Asian people. It can be prevented by pretransfusion gamma irradiation of the fresh whole blood. In this presentation, we report a case of transfusion associated graft-versus-host disease following coronary artery bypass surgery in a 61 year-old male patient. Postoperatively the patient was transfused urgently with 2 units of fresh whole blood from his two sons. He was discharged on postoperative 10 day with only symptom of mild diarrhea. Two days after discharge, he was readmitted because of persistent diarrhea, systemic erythema and high fever. On laboratory examinations, he showed findings of failure in liver, kidney, gastrointestinal tract, and bone marrow. Hemodynamically he deteriorated acutely and died of multiple organ failure on 17th postoperative day. This has been our first experience since we started open heart program at our hospital and we changed our policy for the transfusion of the fresh whole blood after this event.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.101-104
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• 2003

Although lung transplantation has been accepted as the most effective treatment for end-stage pulmonary emphysema, it is not only very hard to find a donor but also to obtain a relatively healthy lung. Furthermore, it is more difficult to match the size of the allograft, considering the height, the weight, and the size of the thoracic cage. The single lung transplatations for the end-stage emphysema have been more commonly performed than bilateral lung transplantation due to the shortage of the donors and the long-term survival rate of the single lung transplantations has shown no reasonable difference compared with that of the bilateral lung transplantationh. Recently, the functional criteria based on a comparison of predicted TLCs(Total Lung Capacities) of the donor and recipient according to height, sex and age, have been accepted at a more suitable.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.543-559
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• 2009

Dr Lillehei (1918$\sim$1999) pioneered cardiac surgery with his landmark operations using cross-circulation in 1954 and 1955. With his dedications to open heart surgery, he is generally considered to be the father of open heart surgery by many medical historians. Dr Lillehei expanded his contributions to cardiac surgery with training 134 cardiothoracic surgeons at the University of Minnesota Hospital and he trained an additional 20 surgeons at the Cornell Medical Center. Dr Lillehei's trainees came from all over the world and Dr YK lee (1921$\sim$1994) of Seoul National University was among them. He joined the University of Minnesota Hospital in 1957 as a part of the Minnesota project. During his stay for two years, in addition to experimental research, he learned clinical cardiac surgery as part of Dr Lillehei's team. In 1959, after returning to Korea, Dr Lee began his career as. a full-time cardiac surgeon with establishing the Division of Cardiac Surgery at Seoul National University. Hospital. Yet he encountered many difficult barriers in the process. During that time, Dr Lillehei was willing to share his experience and he provided many valuable resources for cardiac operations. With Dr Lillehei's kind help, the open heart surgery program was gradually and successfully established at Seoul National University Hospital. These two surgical titans from across the Pacific Ocean died in 1994 (Dr Lee) and 1999 (Dr Lillehei). They are gone, yet the proud Korean people have not forgotten them.

• Journal of Chest Surgery
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• v.38 no.6 s.251
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• pp.445-449
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• 2005

The management of failure of colonic graft or corrosive stricture with impaired colonic circulation continues to be a challenge to surgeons. We present four cases of complicated corrosive esophageal stricture, which were successfully treated using jejunal free graft. As the initial surgical treatment, three patients underwent colonic interposition, and one underwent Whipple's procedure due to panperitonitis. Ore patient underwent transposition of jejunal free patch graft, two underwent interposition of jejunal free graft, and one underwent esophagojejunocolojejunostomy using jejunal free graft. All patients did not show dysphagia after long term follow-up. Complex esophageal reconstruction with jejunal free graft was performed successfully and long term functional outcome was good.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1190-1196
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• 1997

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.