• Journal of Chest Surgery
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• 제25권5호
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• pp.458-468
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• 1992

With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

• Journal of Chest Surgery
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• 제13권4호
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• pp.435-441
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• 1980

Ebstein`s anomaly had been amenable to reparative surgery since 1962. However, neither the role of surgery in Ebstein`s anomaly nor the surgical procedure of choice for its correction are clearly defined. Whether or not the atrialized right ventricle, which plays a major role in the functional abnormalities, should be obliterated in all cases remains unsolved. Four cases of Ebstein`s anomaly treated surgically at Seoul National University Hospital were reported. All had closure of the atrial septal defect, obliteration of the atrialized right ventricle by plication, and insertion of a tricuspid bioprosthesis and an epicardial ventricular pacemaker. One patient had a pulmonic valvotomy due to stenotic bicuspid pulmonic valve also. All but one had discharged with a good result.

• Journal of Chest Surgery
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• 제24권5호
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• pp.515-521
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• 1991

Since Carrel in 1907 reported transfer of a free jejunal segment in dog, reconstruction of the cervical esophagus and hypopharynx has been accomplished successfully with free jejunal transplantation using microvascular technique. Free jejunal graft is useful in cases of failed colonic interpositions. Three patients with benign esophageal stricture had undergone reconstruction with right colon interposition. Because of necrosis and stricture of the interposed colon, in each case the defect was reconstructed with a free jejunal graft by using microvascular technique. The postoperative course in two patients was uncomplicated, and they were able to eat general diet. Graft necrosis occurred in one patient, but she is waiting for a reoperation.

• Journal of Chest Surgery
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• 제30권10호
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• pp.1024-1027
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• 1997

좌 관상동맥 폐동맥 이상 기시증은 드문 선천성 심기형으로 유아기에 심부전을 일으키는 질환으로서 수술적인 치료를 하지 않을 경우 대부분 치명적인 것으로 알려져 있다 대혈관 전위의 교정술이 보편화되면서 신생아에서 관상동맥 이식에 대한 기술이 발전되어 근래에는 좌 관상동맥을 대동맥에 이식하여 이중 관상동 맥 체계를 만들어주는 수기가 본 질환의 일차 선택 수술법으로 인정되고 있다. 본 교실에서는 심부전으로 입원한 생후 44일된 여아에서 좌 관상동맥 폐동맥 이상 기시증이 발견되어 좌 관상동맥 대동맥 이식술로 치 료하여 좋은 결과를 얻었으므로 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제10권1호
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• pp.90-97
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• 1977

This is a report of a. case in which a long narrow segment coarctation of the aorta was successfully corrected with Teflon graft. The patient was 30 year old man with hypertensive symptoms that occurred 7 years prior to operation. Blood pressure measured 230/110 mmHg in the arms and 110/80 mmHg in the legs. Pulses were strongly tensive in radial artery, but very weak in femoral artery and even absent in dorsal pedis artery. Final preoperative diagnosis was made by aortography which showed a long narrow segment between aortic arch and descending thoracic aorta and highly developed collateral circulations. A long hypoplastic narrow segment was located proximal to the ligament arteriosus, and diaphragmatic stenosis of the aorta was located just distal to the ligamentum arteriosus. After prosthetic correction of the coarctation of the aorta, blood pressure were measured 130/ 80 mmHg in the arms and 150/100 mmHg in the legs. Peripheral pulses were palpated normally, and the postoperative course was uneventful.

• Journal of Chest Surgery
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• 제23권4호
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• pp.622-639
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• 1990

The use of aortic valve homograft has been developed since 1962 when Ross and Barratt - Boyes independently replaced a diseased aortic valve with an orthotopically inserted homograft valve. And also surgical treatment of complex congenital cardiac malformations utilizing homograft extracardiac conduit has been tried with better result than any other prosthetic material. The present study was undertaken to clarify the safety tissue viability, sterility, after following our protocol of procurement of heart, dissection of aortic and pulmonic homograft, sterilization, cryopreservation, thawing and dilution, and transplantation on experimental animal, sheep. Tissue viability of valve and great artery was assessed by tissue culture. Sterility was evaluated by bacterial and fungal culture. The method used was proven no deleterious effect on the integrity of the valve. Tissue culture of valve tissue before, and after cryopreservation process resulted that active fibroblast growth was observed from homograft sterilized with antibiotics. And culture of the transplanted homograft from sacrificed animal showed active fibroblast growth. Pathologic examination of implanted valve tissue from sacrificed sheep showed mild calcification and minor change, but there were moderate and severe calcification of wall of great arteries.

• Journal of Chest Surgery
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• 제30권4호
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• pp.449-452
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• 1997

저자들은 흉부식도암의 근치적 절제후 국소재발을 보인 1례를 치험하였기에 보고하는 바이다. 환자는 식도아절제술후 후종격동 경로를 통한 경부식도-위 문합술을 시행받았었다. 수술 20개월후 환자는 연하곤란을 주소로 내원하였고 컴퓨터 단층촬영과 경피적 세침흡인 조직검사등을 통해 국소재발을 확인하였다. 환자는 경부식도절제, 위 분문부의 부분절제 및 후두절제를 시행하고 유리공장 이식 편을 이용하여 재건술을 시행하였다.

• Journal of Chest Surgery
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• 제31권6호
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• pp.567-575
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• 1998

최근 심장 분야 수술의 발달로 여러 가지 고난도의 심장 수술과 심장 이식술의 시행이 증가하고 있으며, 술 후 예후에 크게 영향을 주는 심장의 심근 손상 방지에 대한 다각적인 연구가 행해지고 있는데, 수술 및 이식 전후의 허혈기와 재관류시 발생할 수 있는 심근 손상을 최소화하고, 술 후 심근 기능의 조속한 회복을 위한 목적으로 여러 약제 및 방법을 제시하고 있다. 한편 한국에서는 오래 전 부터 만병 통치의 영약으로 전해져 오고 있는 인삼을 이용한 동물 실험 및 임상 경험을 통해 성분 효과에 대한 여러 결과가 보고되고 있고, 심장 기능에 대한 효과도 약리학적 측면에서 많은 결과가 발표되었다. 그런데 여러 분획 추출물 중 ginsenoside Rg1 mixtures에 대해서는 그 결과가 다소 미비한 상태이고 ginsenoside Rb1과의 이원 작용에 대한 결과가 흥미로울 것으로 판단되었으며 여러 저자들의 결과에 차이가 있어 ginsenoside Rg1을 이용하여 심근의 허혈 후 재관류 시행 10분 및 지속적 관류 상태에서의 심근 손상에 대한 심근 보호 정도를 혈역학적 지표 및 관상 혈류를 통한 관류액의 효소치를 측정하여 실험한 결과 심근 허혈 및 재관류 후 심근 손상 방지와 심근 기능 회복에 효과가 있다고 판단되며 향후 약제의 투여 용량에 따른 심근 보호 정도에 관한 실험이 필요할 것으로 사료되고, 인삼 성분 각 분획의 복합 투여에 의한 결과도 재차 확인하여야 할 것으로 생각된다.

• Journal of Chest Surgery
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• 제32권6호
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• pp.532-535
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• 1999

배경: 하행 흉부 대동맥류에 대한 외과적 치료에 대하여 수술 방법과 술 후 합병증 등에 대하여 알아보고자 하였다. 대상 및 방법: 인제대학교 의과대학 서울백병원 흉부외과학 교실에서는 1987 년 3 월부터 1997년 8월까지 하행 흉부 대동맥류로 수술을 시행한 22예를 대상으로 후향적 조사를 하였다. 결과: 환자는 남자가 18예 여자 4예로 남자가 많았으며 연령은 33세에서 82 세 이었고 평균은 49 세였다. 대동맥류의 원인은 대동맥 박리증 13, 죽상경화증 3, 진균성 3, 외상성 2, 원인불명 1예였다. 수술은 절제 및 이식편 치환술 16, 액와동맥-양측 대퇴동맥 우회로 이식술 2, 대퇴동맥-대퇴정맥 우회로 이식술 1, 동맥류 공치술(exclusion) 1, 동맥류 봉합술 1, 경대퇴동맥 스텐트 삽입술 1예였다. 수술 시 대동맥을 차단하고 수술한 예는 16예였고, 이 중 14예는 대퇴동맥-대퇴정맥 바이패스를 실시하였고, 2예는 우회로 이식술을 먼저 하였다. 평균 대동맥 차단시간은 91분이었고 체외순환 시간은 116 분이었다. 사망 예는 1예로 공치술 한 환자가 술 후 52일에 갑작스런 출혈로 사망하였고, 대마비 1, 급성 신부전증 2, 급성 호흡부전증 1예가 발생하였다. 결론: 하행 흉부 대동맥류 수술은 많은 술 후 합병증이 예상되나 적절한 환자의 선택과 섬세하고 다양한 수술 기법을 사용하면 비교적 적은 합병율로 수술할 수 있다.

• Journal of Chest Surgery
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• 제23권5호
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• pp.844-853
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• 1990

We have performed 27 cases of orthotopic homologous cardiac transplantation using Korean mongrel dogs and one case of sham operation for the evaluation of harmful effect of cardiopulmonary bypass itself on the dog from April, 1989 to June, 1990. Our previous reports have already demonstrated basal hemodynamic and hematologic data on the canine homologous heart transplantation and the fundamental principles of transplantation of the heart. The mean body weight of recipients was 13.2$\pm$1.2kg with a rage of 11 ~ 15kg, and the hemodynamic and hematologic pictures were almost same as the result of previous reports from our hospital, except marked decrease in postoperative platelet count[from 3.18 $\pm$0.80x106/mm3 to 1.41$\pm$0 37x 106/mm3]. Mean survival time was 24.82$\pm$49.40 hours with the longest survival of 264 hours. Donor cardiectomy included coronary vasodilatation with diltiazem, potassium arrest, and the rapid cooling of the heart suspending in the specially designed ice-bath. Median sternotomy provided excellent exposure of the surgical field. 6 \ulcorner0 prolene suture was used for the anastomosis of both atrial cuffs and the great arteries, and we found the fact that stenosis, bleeding, thrombus formation around the anastomotic site could be decreased with the use of everted horizontal mattress suture techniques. Immunosuppression was done with a combination of lower dose Cyclosporin-A, Azathioprine, methyl-prednisolone, but our cases still showed too short survival to worry about graft rejection. Still poor was our quality control of experimental animal, we had much difficulties in postmortem evaluation of the dogs. Low cardiac output due to biventricular failure, intractable supraventricular or ventricular tachyarrhythmia, postoperative massive bleeding, sepsis were most frequent findings that could be thought as a cause of death. A few cases showed subendocardial patch hemorrhage in both ventricular cavity or atrial septum at autopsy, suggesting acute subendocardial infarction. Although our team overcome most of the technical problems of orthotopic heart transplantation, we should pile up further knowledges about donor heart preservation, quality control of animal, infection, rejection, the effect of the cardiopulmonary bypass to improve the results.