• Journal of Chest Surgery
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• v.31 no.1
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• pp.52-54
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• 1998

Recently, several versatile approaches via limited incision have been developed for minimally invasive cardiac surgery. As the incision is limited, it is often dfficult to get a satisfactory operative field, especially for the manipulation of two separate lesions such as simultaneous mitral and aortic valve disease with a single limited incision. Here, we describe a case of successful double valve replacement via ministernotomy, which was followed by two cases of minimally invasive aortic valve replacement via transsternal approach. The operative field was unexceptionally satisfactory and the postoperative patient's acceptance was high. The methodology is described with a review of the relevant literatures.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.246-251
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• 2001

심장 탈장은 심낭을 열고 전폐절제술을 시행 후 드물게 발생되는 합병증으로 수술이 끝날때나 수술직후 발생된, 44세 남자환자에서 심낭을 열고 좌측 폐를 전절제술 후 심낭 결손부위를 인공조직으로 봉합하였다. 수술이 종료될 때 심장탈장이 발생되어 개흉에 의한 응급 복원을 시행하였으나 심한 저 산소성 뇌 손상이 발생되었다.

• Proceedings of the Korea Society for Simulation Conference
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• 1999.04a
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• pp.143-146
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• 1999

수술 시뮬레이션은 의학 교육, 수술 훈련, 수술 계획과 정확한 수술을 위해 그 중요성이 더해지고 있다. 본 논문은 물리적 모델을 기반으로 3차원 객체의 변형을 인터액티브하게 수행할 수 있는 인체 내장 기관에 대한 수술 시뮬레이터의 개발을 목적으로 한다. 물리적 모델은 컴퓨터 애니매이션과 컴퓨터 그래픽 모델에 대한 새로운 시도로써 많이 연구되고 있으며, 본 논문에서는 심장에 대한 3차원 자료를 매스-스프링 모델로 구현 및 변형을 수행하였다. 본 연구의 결과는 일차적으로는 심장 수술 시뮬레이션에 적용 가능하며 나아가 다른 내장 기관의 수술 시뮬레이션 및 non-rigid한 객체에 대한 변형에 적용 가능하다.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.576-582
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• 2003

During the Off-Pump Coronary Arterial Bypass surgery (OPCAB), the manipulation of the heart can depress cardiac contractility and cause hemodynamic instability. In this study, hemodynamic parameters were measured during operation and the laboratory and clinical data were investigated to evaluate their effects on postoperative outcome. Material and Method: From March 2001 to August 2002, 50 consecutive patients who underwent OPCAB were included in this study. During the same period, total number of CABG was 71 The blood pressure, pulmonary artery pressure, mixed venous oxygen saturation, and cardiac index were measured before manipulation, after application of stabilizer, and at the end of anastomosis. Postoperatively, we measured the cardiac enzymes such as CK-MB, troponin 1 and checked the amount of inotropes required, chest tube drainage, the amount of transfusion, duration of ventilator support, and duration of ICU stay. Result: The number of mean distal anastomoses was 2.8$\pm$0.9 per patient. On elevation and stabilization of the heart, systolic blood pressure was depressed and pulmonary artery pressure was elevated significantly, but during each anastomosis no significant changes were detected. The peak level of cardiac markers was 29.2$\pm$46.7 for CK-MB, 0.69$\pm$0.86 for troponin 1 on postoperative day f. Among the intraoperative hemodynamic parameters, the ischemic change of EKG and bolus injection of inotropes significantly affected the posteroperative cardiac enzymes. But, no difference other than the level of cardiac enzymes between the two groups with or without the ischemic change of EKG and bolus injection of inotropes was noticed. Conclusion: The significant hemodynamic changes occurred when the heart was elevated and stabilized, however during anastomoses there were no significant changes. Serum cardiac enzymes rose significantly in the group that showed the ischemic charge of EKG or needed the bolus injection of inotropes for maintaining hemodynamic stability intraoperatively, but it did not affect the postoperative outcome. In conclusion, the ischemic change of EKG and the need for bolus injection of intropes during operation may be very indicative for probable ischemia.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.240-242
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• 2001

임심 중 심폐바이패스를 사용하는 개심수술은 산모뿐 아니라 태아계에도 영향을 끼치기 때문에 중요하다. 임신 중 항응고제 투여을 부적절하게 하여 기계판막 기능부전이 초래된 임신 31주의 산모에서 심장 재수술에 앞서 제왈절개로 태아 출산 후 20시간 뒤 산모의 개시수술을 성공적으로 시행하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.335-341
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• 2004

Traumatic cardiac injury is very rare but mortality is very high when the diagnosis and management are delayed. We reviewed our case retrospectively. Material and Method: From March 1995 to July 2003, 17 patients were diagnosed as having traumatic cardiac rupture. Five patients were stabbed, seven patients were motor vehicle accidents, four patients had fallen down, and the cause was unknown in one patient. Emergency operations were done and six patients were operated under CPB. Result: Four patients died during or after operation. The mean ICU stay period was 3.86$\pm$3.35 days and the mean hospital stay was 18.27$\pm$14.99 days. No mortality was observed in those whose vital signs were stable in the operating room. Conclusion: Preoperative vital status was very important and thoracic traumatic patient should be suspected as having cardiac injury.

• 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.

• Proceedings of the KTCVS Conference
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• 1998.04a
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• pp.32-33
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• 1998

• Proceedings of the KTCVS Conference
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• 1998.04a
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• pp.42-44
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• 1998

• Proceedings of the KTCVS Conference
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• 1998.04a
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• pp.45-51
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• 1998