• Journal of Chest Surgery
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• v.32 no.1
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• pp.80-83
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• 1999

Complete circulatory arrest with profound hypothermia has been an indispensable adjunct to the safe management of selected giant intracranial aneurysms. For the conduct of cardiopulmonary bypass, there are usually two kinds of methods, open and closed chest methods. We could manage one case of huge intracranial aneurysm that was successfully operated under circulatory arrest using the closed chest method, especially with percutaneous insertion of arterial and venous cannulas for cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.252-255
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• 2001

본 30세 여환은 류마치스성 심장판막질환 진단하네 승모판막 및 대동맥판막 치환술 시행후 종격동염 발생하여 지속적 종격동 세척 및 3주간의 항생제 치료후 퇴원하였다. 외래 추적중 다시 감염 및 염증소견 보여 입원하여 혈액배양검사와 흉부전산화 단층촬영시행하였다. 검사상 종격동염의 이후 3주간의 항생제 치료에도 염증 소견이 지속되어 다시 시행한 흉부 전산화단층촬영상 상행대동맥에 거대 가성대동맥류소견보여 재개흉술을 시행하여 초저체온 완전 순환정지 하에 가성대동맥류를 절제한 후, 우심낭편을 이용하여 대동맥 성형술을 시행하였다. 수술후 환자는 순조롭게 회복하였으며 현재 외래에서 추적관리하고 있다.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1657-1663
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• 2000

The authors report a case of a 72-year-old woman who presented with intraventricular and subarachnoid hemorrhage of Hunt and Hess grade IV after the rupture of a giant aneurysm arising from the right internal carotid artery. The aneurysm was clipped successfully with the aid of cardiopulmonary bypass(closed chest method), deep hypothermic circulatory arrest, and cerebral protection with barbiturate resulting in moderate disability. We discuss the usefulness and problems related to technique of circulatory arrest and cardiopulmonary bypass using closed chest method, and suggest the possible benefits of open chest method in elderly people and the importance of preoperative plan to coordinate anesthesia and operation.

• Proceedings of the Korea Information Processing Society Conference
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• 2008.11a
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• pp.1071-1074
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• 2008

본 논문에서는 센서 네트워크를 이용해서 환자 모니터링 시스템(PVMS : Patient Vital Sign Monitoring System)을 구현하였다. 최근 의료 서비스에 유비쿼터스 컴퓨팅 기술을 적용한 사례들이 늘고 있다. 기존 사례에서는 센서 전지 수명, 이동 통신비, 응급상황 대처 등 개선할 부분이 존재한다. 본 연구에서는 이런 점들을 해결하기 위해 환자의 체온 및 맥박 생체신호를 측정하기 위해 소형센서를 사용하였다. 또한 생체신호 전달을 위해 초저전력 무선통신 노드를 사용하여 언제 어디서나 환자 모니터링이 가능하고 의료진에게 응급상황을 신속하게 전달할 수 있는 웹기반 시스템을 개발하였다. 본 연구의 결과는 병동환자뿐만 아니라 활력증후를 상시로 모니터해야하는 원거리 환자를 위한 의료시스템 구축에도 활용될 수 있을 것이다.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.886-893
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• 2000

배경: 흉복부 대동맥류는 질환 자체가 광범위하고 수술 중 척수를 포함한 각종 장기의 보호 및 허혈 방지라는 면에서 아직도 수술 합병증이 높은 질환이다. 본 연구에서는 그 동안의 임상경험을 바탕으로 치료성적, 합병증 발생, 사망률 등을 검토하였다. 대상 및 방법: 1990년 1월부터 1999년 12월까지 흉복부동맥류로 수술을 시행한 38명의 환자를 대상으로 의무 기록 검토을 통한 후향적 분석을 시행하였다. 결과: 남자가 22명, 여자가 16명, 평륜 연령은 46.2$\pm$12.3세였고, 크로포드 진단분류 상 1형 이 13례(34.2%), 2형이 19례(50%), 3형이 4례(11%), 4형이 2례(4.8%)였다. 만성 대동맥박리증에 관련된 경우가 29례(76.3%)로 가장 많았고, Marfan 증후군이 동반된 경우가 9례(23.7%)에서 있었다. 원위부 대동맥 관류를 35례에서 시행하였으며, 고동맥-고정맥 심폐바이패스를 31례에서, 좌심방-고동맥 바이패스를 4례에서 시행하였다. 심폐바이패스를 이용한 31례중 4례에서 초저체온하 완전순환정지를 이용하였다. 대동맥 차단 중 복강내 주요 대동맥 분지로의 선택적 관류를 시행하였다. 대동맥류의 최대직경은 평균 8.2$\pm$2.4cm이었고, 동맥류가 파열된 경우는 11례(28.9%)에서 있었다. 전례에서 인조혈관을 이용한 대동맥의 치환술을 시행하였다. 단계적으로 흉복부 대동맥을 겸자하면서 인공혈관을 문합하였고, Adamkiewicz 동맥으로 생각되는 부위의 늑간 동맥을 문합해주었는데, 8번째부터 12번째 흉추 사이의 늑간 동맥 중 역류혈류가 나타나고 상대적으로 내경이 큰 것들을 문합해 주었다. 술 후 조기사망은 3례에서 있었으며, 사인은 심폐기 이탈 실패 (2례), 저혈압 및 산증(1례) 등이었다. 조기 합병증으로는 애성 5례, 출혈 5례, 창상간염 3례, 장기간의 인공호흡기보조가 3례 등이 있었다. 치명적인 조기 합병증인 하지마비는 2례(5.3%)에서 발생하였고, 이 중 1례는 대동맥의 심한 석회화로 늑간동맥을 문합해 주지 못했던 경우였다. 35명의 환자에서 평균 추적기간은 103.1$\pm$6.1 개월, 2년 생존율은 93.8%, 5년 생존율은 86.1%, 8년 생존율은 80.7%였다. 추척기간 동안 4례의 만기사망이 관찰되었고, 사인은 2례에서는 갑작스런 의식소실이 발생하여 규명하기 어려웠으며, 대동맥-식도루 발생에 의한 경우가 1례, 경동맥류 파열에 의한 경우가 1례 등이었다. 만기 합병증으로는 복부 대동맥류(2례), 상행 대동맥 및 대동맥 근부 확장(1례), 대동맥-늑막루(1례), 창상 부위 탈장(1례), 역행성 사정(1례) 등이 있었다. 결론: 저자들은 흉복부대동맥류의 수술에 있어 심폐우 회술 혹은 좌심방-고동맥 바이패스를 통한 원위부 관류 및 저체온법, 수술 시 척수의 혈류공급과 관련된 늑간동맥의 연결 등으로 주요 신경합병증의 발생을 줄이고 좋은 성적을 거두고 있다고 판단하였으며 향후 임상 경험 축적과 함께 보다 정련된 위험인자의 분석이 필요하다고 본다.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.113-117
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• 1998

From October 1993 to April 1997, 37 patients(30 male and 7 female patients), ranging in age from 23 to 73 years, were operated for annuloaortic ectasia with or without aortic dissection. Four patients were in New York Heart Association Class I, 10 in Class II, 20 in Class III, and 3 in Class IV. In cases of annuloaortic ectasia with aortic dissection, the surgical treatment in all cases consisted of total replacement of the ascending aorta with composite graft and reimplantation of the coronary arteries to the tube graft. The postoperative complication, as postoperative bleeding or LV dysfunction, was 18%(7 cases) and late mortality for entire group was 2.7%(one death). The period of follow-up ranged from 1 month to 36 months(average 9.6 months). In conclusion, Bentall operation for annuloaortic ectasia with or without aortic dissection is reliable method with low mortality and excellent short-term results.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.292-296
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• 1996

Total anomalous pulmonary venous return is a rare but serious cardiac malformation, accounting for only about 1.5~3% of congenital heart disease. Surgical results have been dramatically improved in the last two decades, largely owing to improved techniques of cardiopulmonary bypass and perloperative management. Seven patients ranging in age from 15 days to 11 years with total anomalous pulmonary venous return underwent repair between 1984 and 1995. The types of anomalous return were supracardiac in 5, and cardiac in 2. There were 5 boys and 2 girls. There were two hospital death, occurred in 15-day-old, and 40-day-old infants with supracardiac type. Follow-up periods have ranged from 3 months to 11 years, and all survivors have remained asymptomatic with normal growth and development.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.970-974
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• 2003

There has been an improvement in the prognosis of tumor thrombi invading the inferior vena cava(IVC) and the right atrium(RA) of renal cell carcinoma with radical nephrectomy and tumor thrombectomy with the aid of cardiopulmonary bypass in the last 10 years. A 30 year old woman was diagnosed with right renal tumor with tumor thrombi invading the right renal vein and the IVC above the right renal vein to the RA. She received radical nephrectomy and removal of tumor thrombi in the infrarenal IVC under hypothermic total circulatory arrest using the cardiopulmonary bypass. The tumor recurred 12 months after the initial operation, she received a second operation for tumor removal from the retroperitoneum, suprarenal IVC, and RA. She died 11 months after the second operation due to lung metastases and recurred hepatic vein tumor extended to the RA and right ventricle.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.513-520
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• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• Journal of Veterinary Clinics
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• v.17 no.1
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• pp.138-144
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• 2000

The studies were carried out to investigate the effects of esophageal thermal tube for rewarming in the hypothermia in rabbits. Thiry-one rabbits were continuously cooled with femoral arterio-venous bypass circulation to 25.0${\pm}$0.3$^{\circ}C$(profound hypothermia) of rectal temperature. The experiment was consisted with 3 esophageal thermal tube groups perfused with circulation water at 38${\pm}$1$^{\circ}C$(low, n=12), 42${\pm}$1$^{\circ}C$(medium, n=12), and 45${\pm}$1$^{\circ}C$(high, n=7). Esophageal thermla tube specially constructed double-lumen esophageal tube with circulating warm water at respective htermal grade. With this device, rewarming of the rabbits as follows; High-esophageal thermal tube group(45${\pm}$1$^{\circ}C$)had a more effect on mean arterial pressure(MAP), heart rate(HR), esophageal temperature, and rectal temperature than others groups, but the circulation water at 45$\pm$1$^{\circ}C$ may cause thermal injuries in the esophagus because esophageal temperature increased to 41.1$^{\circ}C$. Medium-esophageal thermal tube group(42${\pm}$1$^{\circ}C$) had a more effect on RR than others groups, but the circulation water at 42${\pm}$1$^{\circ}C$ may also cause thermal injuries in the esophagus if the temperature exceeds 42$^{\circ}C$ for an extended period of time because its esophageal temperature increased to 39.4$^{\circ}C$. Low-esophageal thermal tube group(38${\pm}$1$^{\circ}C$) had a more effect on MAP, RR, and esophageal temperature than others groups. In conclusion, rewarming of the central core in the treatment of profound hypothermia using the esophageal thermal tube perfused with circulation water at 38${\pm}$1$^{\circ}C$ appears to be a ideal alternative safety zone of the temperature of circulation water avoiding thermal injury in esophagus causing by out of order or lower precise thermostat of water bath to that of others groups.