• Journal of the KSME
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• v.27 no.2
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• pp.99-108
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• 1987

국내에서 개발중인 인공심장으로는 서울대학교 공과대학 기계설계학과와 서울대학교병원 의공학과에서 공동으로 개발중인 전기-기계식 인공심장이 있다. 모우터가 내장된 실린더가 모우터의 정.역전에 따라 통 안에서 좌.우로 움직이면서 좌.우심실을 교대로 압축한다. 모우터가 들어 있는 실린더의 위치가 통 안에서 고정되어 있지 않고 움직이므로, 한쪽 심실이 팽창할 때 실린더가 다른 한쪽 심실 공간을 차지하여 결국 전체 체적은 하나의 심실 공간과 모우터 공간만 있으면 되므로 모우터의 위치가 고정된 형식에 비해 체적 감소가 가능하다. 에너지 변환기를 구성하는 기계요소로는 2단의 유성기어열과 랙(rack)뿐으로서 비교적 구조가 간단하여 고장의 가능성이 낮다. 따라서 기존 모델들이 지니고 있는 단점들이 거의 극복 되었다. 현재 모의 순환실험에 성공하고 동물 실험을 준비 하고 있다.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.76-79
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• 2004

The remote location of VSD relative to the aortic valve imposes considerable surgical difficulties in the repair of DORV with noncommitted VSD. We report a successful biventricular repair of the anomaly with VSD rerouting to pulmonary artery followed by arterial switching operation.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.523-526
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• 2003

A 44-year-old man had been admitted for dyspnea on exertion and abdominal distension. The echocardiography revealed abnormal mass in right atrium and tricuspid valve stenosis with right ventricular obliteration. The operation was performed with mass removal, enlargement of tricuspid valve opening, and right ventricular endocardiectormy. And then, atrial septal defect was made due to inadequate right ventricular volume. The patient's symptom was improved and he discharged without events. The endomyocardial fibrosis was diagnosed with microscopic examination. Eighteen months later, the patient was readmitted due to aggravated dyspnea and cyanosis. The right ventricular obliteration was progressed and pulmonary blood flow was severely decreased in follow up echocardiography. Palliative bidirectional cave-pulmonary shunt was performed due to functional single ventricle. The dyspnea and cyanosis was markedly improved. Bidirectional cavo-pulmonary shunt for advanced and isolated right ventricular endomyocardial fibrosis provided effective palliation at early postoperative period, However, long-term follow up is mandatory.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.476-479
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• 2008

The Rastelli operation has been a standard procedure for repairing complete transposition of the great arteries combined with a ventricular septal defect and pulmonary stenosis. Yet this procedure has several shortcomings, including the risk of incurring left ventricular outflow tract obstruction on long-term follow-up. In this regard, aortic translocation has recently been regarded as a potent alternative to Rastelli's operation. We report here on a case of complete transposition of the great arteries that was combined with an inlet-extended perimembranous ventricular septal defect and pulmonary stenosis in a 2-year-old boy. All the problems were successfully repaired using the aortic translocation technique. Postoperative echocardiography showed a straight and wide left ventricular outflow tract.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.181-190
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• 2005

The results of biventricular repair for double outlet right ventricle have been improved in recent series. We studied the surgical and long term results for total correction of double outlet right ventricle by the type of ventricular septal defect. Material and Method: Between November 1979 and December 2003, 126 patients had biventricular repair for double outlet right ventricle. The mean age was 1.8 years (range 1$\~$44) and 86 patients ($68.3\%$) were male. We classified and studied this disease by the type of VSD. Result: The locations of VSD were subaortic in 79 ($62.7\%$), subpulmonary in 17 ($13.5\%$), doubly committed in 16 ($12.7\%$) and noncommitted in 14 ($11.1\%$). 28 patients had palliative operation before total correction and the mean interval to total correction was 41.0$\pm$45.1 months. The methods of total correction were intraventricular baffling in 37 ($29.4\%$), intraventricular baffling with patch enlargement of right ventricular outflow tract in 49 ($38.9\%$), intraventricular baffling with Rastelli procedure in 15 ($11.9\%$), arterial switch operation in 8 ($6.3\%$) and REV procedure in 4 ($3.2\%$), etc. Hospital mortality rate was $10.3\%$ (13 patients) and 25 reoperations were performed in 24 patients ($19.0\%$). The risk factors for hospital mortality and reoperation were cardiopulmonary bypass time (p=0.020) and previous palliative operation (p=0.013), respectively. Follow up was possible in 98 patients and mean follow up period was 118.9$\pm$70.7 months. The percent survival and survival for freedom from reoperation at 15 years were $82.5\%$ and $66.7\%$, respectively. The survival rate was significantly lower (p=0.003) in transposition of great artery type and remote type than in simple ventricular septal defect type and tetralogy of Fallot type, but there was no statistical differences in survival rate for freedom from reoperation. Conclusion: It is thought to be that acceptible surgical and long term results can be obtained with application of appropriate methods of repair for double outlet right ventricle.

• Proceedings of the KOSOMBE Conference
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• v.1995 no.11
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• pp.222-226
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• 1995

인공심장에서의 박출량제어는 전부하에 따른 심박출균형, 심실내 완전충만과 완전구출을 구현하는데 그 목적이 있다. 본 논문에서는 인공심장 내부의 심실간 공간 압력파형을 심박출량의 제어에 활용하였다. 이를 위해서는 심실간 공간의 압력파형을 심실 유입부와 유출부의 혈류량에 대한 정보, 이동작동기의 위치신호와 동기시켜 해석하는 것이 필요하다. 이러한 압력파형의 해석을 바탕으로, 심실간 공간의 음압 크기로 좌,우 심방압을 추정하고 작동기의 좌,우 수축기때 심실간 공간의 음압크기를 비슷하게 유지하도록 작동거리를 제어하면 좌우 심박출 균형을 이룰 수 있음을 확인하였다. 또한, 심실의 완전충만과 완전구출의 실현을 위한 심실 충만 정도를 추정할 수 있게 하는 인자를 제시하였다.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.510-513
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• 2003

Annuloaortic ectasia, aortic regurgitation(AR), and ventricular septal defect(VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hapoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.

• Clinical and Experimental Pediatrics
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• v.46 no.7
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• pp.661-667
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• 2003

Purpose : This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. Methods : Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. Results : Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. Conclusion : The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.933-936
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• 2004

Intravenous leiomyomatosis is a rare disease entity of benign smooth muscle invading into the lumen of veins. We describe a case of intravenous leiomyomatosis originating from the uterus, growing in the inferior vena cava, and extending into the right ventricle association with multiple pulmonary metastasis. A 53-year-old woman with chest discomfort and several times attacks of syncope was treated at our hospital. The tumor was successfully removed with moderate hypothermic cardiopulmonary bypass after total hysterectomy with a bilateral salphingo-oophorectomy, and multiple pulmonary metastasis under simultaneous sternotomy and laparotomy was confirmed.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.588-597
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• 2006

Background: The surgical repair of a tetralogy of Fallot (TOF) has been performed successfully with a favorable early and late outcome. However, the later development of pulmonary regurgitation and stenosis remains a problem. The development of pulmonary regurgitation and stenosis may be changed by the size of right ventricular outflow tract (RVOT) reconstruction at the initial total correction. Hence, it is necessary to investigate the ideal size of RVOT reconstruction. Material and Method: This prospective study was carried out to determine how a surgical strategy and the RVOT size affect the occurrence of pulmonary regurgitation and stenosis. From January 2002 to December 2004, 62 patients underwent the TOF total correction. The RVOT size (diameter of pulmonary valve annulus) of each case was measured after the RVOT reconstruction and converted to a Z value. A pre-scheduled follow up (at discharge, 6 months, 1 year, 2 years and 3 years) was carried out by echocardiography to evaluate the level of pulmonary regurgitation and stenosis. Result: The patients were divided to two groups (transannular group n=12, nontransannular group n=50) according to the method of a RVOT reconstruction. The Z value of RVOT=iameter of pulmonary valve annulus) (transannular group -1, $range\;-3.6{\sim}-0.8;$ nontransannular group -2.1, $range\;-5.2{\sim}-1.5)$ and the average pRV/LV after surgery ${(transannular group 0.44{\pm}0.09,\;nontransannular group\;0.42{\pm}0.09)}$ did not show any significant difference between two groups. The occurrence of pulmonary regurgitation above a moderate degree was more frequent in the transannular group (p<0.01). In nontransannular group, the development of pulmonary regurgitation more than moderate degree occurred to the patients with larger RVOT size (Z value>0, p<0.02) and the progressing pulmonary stenosis more than mild to moderate degree developed in the patients with smaller RVOT size (Z value<-1.5, p<0.05). A moderate degree of pulmonary stenosis developed for 4 nontransannular patients. Three underwent additional surgery and one underwent a balloon valvuloplasty. Their Z value of RVOT were -3.8, -3.8 -2.9, -1.8, respectively. Conclusion: When carring out a TOF total correction, transannular RVOT reconstruction group has significantly more pulmonary regurgitation. In the nontransannular RVOT reconstruction. the size of the RVOT should be maintained from Z value -1.5 to 0. If the Z value is less than -1.5, we should follow up carefully for the possibility of pulmonary stenosis.