• Journal of Chest Surgery
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• v.37 no.1
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• pp.108-111
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• 2004

Reoperation on the recurrent aortic aneurysm adjuvent to sternum remains a challenging problem in regard to the risk of the massive hemorrhage at the time of resternotomy resulting from inadvertent entry into the aneurysmal sac. The cardiopulmonary bypass technique of femoral cannulation and deep hypothermic circulatory arrest can provide a safe resternotomy. The left ventricle is likely to distend due to lack of contraction with ventricular fibrillation during core cooling. To prevent ventricular distention during core cooling, sufficient venous drainage is mandatory, We report a technique in which deep hypothermic circulatory arrest is achieved before resternotomy without left ventricular distention by active venous drainage using centrifugal pump.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.5
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• pp.414-418
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• 2008

The role of positron emission tomography (PET) with F-18 fluorodeoxyglucose (F-18 FDG) in the diagnosis of hepatocellulcar carcinoma (HCC) has been limited because of a variable FDG uptake in HCC. However, the usefulness of PET/CT for detecting extrahepatic metastasis and monitoring of the treatment response in HCC has been reported. A 55-year-old man with a hepatitis B surface antigen-positive, was admitted to our hospital due to dyspnea, general weakness and body weight loss for one month. Chest X-ray showed multiple reticulo-nodular densities on both lower lung fields, which implies metastatic lesions. F-18 FDG PET/CT revealed consecutively intense hypermetabolic mass in right hepatic lobe, inferior vena cava and right atrium. We report a case of HCC with IVC and right atrium invasion identified by F-18 FDG PET/CT.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.59-65
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• 1998

Atrial fibrillation is the most common of all cardiac arrhythmias. It is associated with significant morbidity and mortality and is frequently resistant to medical therapy. On the experimental and clinical study, the presence of macroreentrant circuits and the absence of either microreentrant circuits or evidence of atrial automaticity suggests that atrial fibrillation should be amenable to surgical ablation. The results of the maze III procedure are associated with a higher incidence of postoperative sinus rhythm, improved long-term sinus node function, fewer pacemaker requirements, less arrhythmia recurrence, and improved long-term atrial transport function. We had experienced 4 patients with chronic atrial fibrillation. For the first time, Hioki procedure had been performed in the first patient with ASD and atrial fibrillation, regular sinus rhythm showed on postoperative EKG, but junctional rhythm and bradycardia developed postoperative 3 years. The maze III procedure for the rest with mitral valvular disease and atrial fibrillation had been done, followed by regular sinus rhythm for 2 patients and atrial fibrillation for 1 patient, managed with amiodarone, on immediate postoperative state. Echocardiogram documented good contraction of right atrium and hardly contraction of left atrium for 2 patients with regular sinus rhythm postoperative 3 months.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.190-198
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• 1983

The management of cardiac arrhythmias by cardiac pacing has increased greatly since the treatment of complete heart block with an external transcutaneous pacemaker in 1952, followed by the use of myocardial wires connected to an external pulse generation, by external transvenous pacing, and then by transvenous pacing with implantable components in thoracic wall.By now, the three bases of modern cardiac pacing for bradyarrhythmias had been established [1] an implantable device [2] the transvenous approach [3] the ability of the pacemaker to sense cardiac activity and modify its own function accordingly. In transvenous implantation of a pacemaker, any one of four vessels at the root of the neck is suitable for passage of the electrode - cephalic vein, external jugular vein, internal jugular vein, costo-axillary branch of the axillary vein. The new technique of direct puncture of the subclavian vein, either percutaneously or after skin incision only has been made, is invaluable & is used routinely. We have experienced one 25 years old patient who had rheumatic mitral stenosis & minimum aortic regurgitation with sinus bradycardia associated with premature atrial tachycardia & another 54 years old female patient who was suffered from sick sinus syndrome with sinus bradycardia & sinus arrest. The 1st patient was taken open mitral commissurotomy & aortic valvuloplasty and then was taken atrlal pace-maker implantation through If subclavian puncture method in post-op 14 days, and the second patient was taken atrial pacemaker implantation through If subclavian puncture method. Their postop course was in uneventful & were discharged, without complication. Their condition have been good to now.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.371-374
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• 2003

Atherosclerosis has more than 60% of the causes of arterial occlusive diseases. The abdominal aorta and lower extremity arteries are the most common sites of occlusion. We have treated surgically 2 cases who had intermittent claudication and were diagnosed as simultaneous aortobifemoral and bilateral femoropopliteal obstruction by angiography, but had ineffective results from medical treatment or angioplasty. Simultaneously aortobifemoral bypass using Hemashield Y graft and bilateral femoropopliteal bypass using autologous greater saphenous vein were done. After operations, the symptom disappeared and there were no specific post-operative complications except abdominal wound dehiscence. In postoperative angiography, we had obtained good patency of bypass graft. We are following up patients through the out patient department without recurrence up to 16 months.

• Tuberculosis and Respiratory Diseases
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• v.42 no.5
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• pp.781-786
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• 1995

Transcatheter arterial chemoembolization(TACE) was performed in a 61 year old male patient with hepatocellular carcinoma with 10 cc of Lipiodol and 50 mg of doxorubicin. Three days later, he complained of dyspnea and dry cough. The arterial blood gas study revealed moderate hypoxemia and hypocarbia. The chest PA showed acute pulmonary edema with bilateral pleural effusion. To rule out the possibilities of acute respiratory failure caused by infection, pulmonary embolism or congestive heart failure, we performed several laboratory studies. The blood and sputum culture studies revealed negative results for bacterial growth. The echocardiogram was normal. The abdominal CT scan and MR imaging revealed no thrombus or mass lesion in the inferior vena cava. So we concluded pulmonary oil embolism induced by lipiodol as the cause of acute lung injury. Four weeks later, clinical symptoms and chest x-ray were markedly improved with conservative care. We report a case of acute lung injury after TACE with lipiodol and doxorubicin, with review of literatures.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.21 no.2
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• pp.450-460
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• 2017

T wave is cardiac parameters that represent ventricular repolarization, it is very important to diagnose arrhythmia. Several methods for detecting T wave have been proposed, such as frequency analysis and non-linear approach. However, detection accuracy is at the lower level. This is because of the overlap of the P wave and T wave depending on the heart condition. We propose T wave detection algorithm based on target area extraction through QRS cancellation and moving average. For this purpose, we detected Q, R, S wave from noise-free ECG(electrocardiogram) signal through the preprocessing method. And then we extracted P, T target area by applying decision rule for four PAC(premature atrial contraction) pattern another arrhythmia through moving average and detected T wave using RT interval and threshold of RR interval. The performance of T wave detection is evaluated by using 48 record of MIT-BIH arrhythmia database. The achieved scores indicate the average detection rate of 95.32%.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.409-412
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• 1998

This is a case report of an operation for the pulmonary arteriovenous fistula supplied from the systemic arteries instead of the pulmonary artery. The operation of systemic arteriovenous pulmonary fistula has formidable technical challenges due to its extensive collateral circulations. A 16 year-old female patient, diagnosed as systemic arteriovenous fistula with multiple tortuous feeding vessels and with hereditary hemorrhagic telangiectasia, was initially managed with arterial embolization before the operation. A 15${\times}$8cm sized huge vascular malformation was removed by RML and RLL bilobectomy. During the operation, we encountered annoying massive bleeding and pulmonary congestion originated in its extensive collateral circulation. The patient was discharged after conservative management without specific problem on the 15th postoperative day. For the safe operation as well as good operative result, it seemed that meticulous ligation of the multiple collateral vessels should be performed prior to that of pulmonary veins.

• Journal of Chest Surgery
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• v.5 no.2
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• pp.107-112
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• 1972

Recently we experienced a case of the portal hypertension, extrahepatlc origin in the National Medical Center, Seoul. The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceal rupture 6 years later and had recurring esophageal varices with bleeding this time.At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatlvely no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophagenl variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again. In this time, recurring esophageal varices were noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression,and following results were obtained. 1] No postoperatlve troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge. 2] During operation the portal pressure was 300 mm $H_2O$ and immediately lowered to 170 mm $H_2O$ after shunt.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.671-677
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• 1995

Skeletonization of the internal mammary artery [IMA during myocardial revascularization procedures may provide some advantages, compared with the pedicle graft of the artery. In 17 patients undergoing IMA grafting by skeletonization technique, flow through the artery was measured on mean arterial pressure of 50-55 mmHg immediately after cardiopulmonary bypass started [first flow and just before its anastomosis to left anterior descending artery [second flow . In 16 patients except 1 patient whose graft was injured during mobilization, the first flow of IMA graft was 32.3 $\pm$ 7.4 ml/min and the second flow increased to 59.6$\pm$25.9 ml/min without any treatment and the site for anastomosis of the IMA graft was more than 1.0 cm above the bifurcation. On the basis of previous clinical studies, the flow of the skeletonized IMA was greater than that of the pedicle graft [59.6 $\pm$ 25.9 ml/min versus 37.7$\pm$ 14.1 ml/min, p < 0.05 . In comparison between the skeletonized IMA and the IMA graft intraluminally dilated with papaverine solution, there was no significant difference between two flows[59.6 $\pm$25.7 ml/min versus 74.7 $\pm$31.4 ml/min, not significant , but the former showed longer graft and anastomosis of more proximal portion of the graft to left anterior descending artery. In conclusion, the technique of internal mammary artery skeletonization has consistently produced a satifactory conduit for myocardial revascularization procedures. We have adopted IMA skeletonization not only because of the flow, diameter, and vessel length obtained but also because of limited perivascular tissue disruption that occurs during the dissection.