• Journal of Chest Surgery
• /
• 제25권9호
• /
• pp.925-929
• /
• 1992

Supravalvular aortic stenosis is relatively uncommon form of congenital heart disease and the most important lesion of this anomaly is various narrowing of the aortic lumen just above the sinus of Valsalva. We experienced a case of hourglass type of supravalvular aortic stenosis involving lcm from length from lcm above the sinus of Valsalva. The patient was associated with mental retardation, peculiar facies and dental anomaly. The diagnosis was confirmed preoperatively by retrograde left heart catheterization and left ventriculography. An incision was made in the ascending aorta and into the right coronary and noncornary sinus. Care was taken to protect the right coronary artery. A Y-shaped patch of Dacron was made to enlarge the stenotic portion of aorta. Postoperative pressure gradient between the aorta and left ventricle markedly reduced 36 mmHg in comparison with preoperative pressure gradient 150mmHg. The boy was discharged without any event.

• 한국동물학회:학술대회논문집
• /
• 한국동물학회 1998년도 한국생물과학협회 학술발표대회
• /
• pp.313.1-313
• /
• 1998

No Abstract, See Full Text

• Journal of Chest Surgery
• /
• 제49권3호
• /
• pp.224-224
• /
• 2016

• Journal of Chest Surgery
• /
• 제20권4호
• /
• pp.710-714
• /
• 1987

Over the past 6 years, from July, 1981. through June, 1987., 14 consecutive patient with congenital aortic stenosis underwent corrective surgery in our department of Thoracic and Cardiovascular Surgery. The patient ranged in age from 1 to 20 years. There were 8 male and 6 female patients. According to the operative findings, stenotic site was valvular stenosis [5 cases], subvalvular stenosis [5 cases], supravalvular stenosis [2 cases], valvular and supra valvular stenosis [1 case]. We have performed valvotomy and commissurotomy [5 cases]. Resection of subvalvular membrane [3 cases], patch enlargement of Ascending aorta [2 cases], LV myotomy [2 cases], valvotomy and excision of membrane [1 case], patch enlargement of ascending aorta and valve ring [1 case]. There was one hospital mortality [7.1%]. He died of C-I bleeding and sepsis on the 25th postoperative day. All survivors showed improvement in NYHA functional class in the 160 patient/month follow up period.

• Journal of Chest Surgery
• /
• 제27권7호
• /
• pp.576-580
• /
• 1994

For 26 months since August 1991, 10 consecutive patients with congenital left ventricular outflow tract obstruction underwent corrective surgery in Pusan Paik Hospital. Their ages ranged from 2 to 18 years. There were 6 male and 4 female patients. According to stenotic site, obstruction were classified into supravalvular [n = 5], subvalvular [n = 4], valvular stenosis [n = 1]. We have performed patch enlargement of ascending aorta [n = 2], supravalvular membrane resection and patch enlargement of ascending aorta [n = 3], subvalvular membrane resection [n = 2], subvalvular membrane resection and left ventricular myectomy [n = 2] and aortic annuloplasty with Dacron patch and aortic valve replacement [n = 1]. Preoperative mean value of systolic pressure gradient were 85.0 $\pm$29.2mmHg[supravalvular], 70.0mmHg[valvular], 72.5 $\pm$ 22.5mmHg[subvalvular], and 78.5 $\pm$ 24.3mmHg[total]. Postoperative mean value of systolic pressure gradient were 31.0 $\pm$ 8.9mmHg[supravalvular], 0mmHg[valvular], 15.0 $\pm$ 10.8mmHg[subvalvular], and 21.5 $\pm$ 13.9mmHg[total]. Postoperative systolic pressure gradient was decreased significantly[p = 0.001]. Postoperative course and short-term follow up results were good except one case of transient heart failure.

• 한국동물학회:학술대회논문집
• /
• 한국동물학회 1999년도 공동 춘계학술대회
• /
• pp.79.2-79
• /
• 1999

No Abstract, See Full Text

• Journal of Chest Surgery
• /
• 제52권2호
• /
• pp.100-104
• /
• 2019

Shone complex is a rare congenital disorder that involves 4 obstructive lesions of the left heart, as follows: parachute mitral valve, supravalvular mitral ring, subaortic stenosis, and coarctation of the aorta. Incomplete forms with 2 or 3 of these lesions in adult patients have been rarely reported in the literature, meaning that insufficient general data exist concerning the surgical strategy and clinical follow-up. Herein, we report the case of a 31-year-old woman with a diagnosis of incomplete form of Shone complex with parachute mitral valve and coarctation of the aorta who underwent successful single-stage surgical repair.

• Journal of Chest Surgery
• /
• 제32권2호
• /
• pp.108-118
• /
• 1999

배경: 동맥전환술의 위험인자와 장기 성적을 알아보고자 후향적 연구를 시행하였다. 대상 및 방법: 1988년 1월부터 1996년 12월까지 심실중격이 온전한 대혈관전위증으로 인해 동맥전환술을 시행 받은 58명의 환자를 대상으로 동맥전환술에 따른 조기 및 만기성적에 대하여 후향적 평가를 시행하였다. 술전 처치로 36례(62.1%)에서 풍선심방절개술을 시행하였으며, 32례(51.7%)에서 PGE1을 사용하였고, 좌우심실의 압력비가 평균 0.53$\pm$0.11이었던 6례(10.3%)의 환아에서는 먼저 폐동맥밴딩을 시행하였다. 결과: 수술당시의 평균연령은 24$\pm$26일(범위 1-137일)이었고 수술당시 평균체중은 3.5$\pm$0.8 kg(범위 1.8~6.1 kg)였다. 전체 조기사망율은 24.1%(14/58)였으며, 최근 3년간의 조기사망율은 8.3%(2/24)였다. 사망과 관련된 위험인자 분석에서는 수술 시행 년도가 유일한 위험인자로 나타났다(p-value < 0.01). 조기 사망한 14례 중 8례는 급성심근부전으로 사망하였으며 주된 원인은 관상동맥부전이었다. 44명의 술후 생존자들을 대상으로 2개월에서 8년까지 평균 36$\pm$27개월 동안 추적관찰을 시행하였으며, 대혈관과 관상동맥의 문합부위, 심실기능, 반월판막의 폐쇄부전, 심박동 이상 등에 중점을 두고 연속적인 비관혈적 검사 및 술후 5개월과 32개월 사이에 모두 21례의 심도자술을 시행하였다. 만기 사망한 경우는 5례(11.4%)였으며 사망원인은 관상동맥의 만기 협착 1례, 흡인 2례, 만성 종격동염 1례, 진행성 대동맥판막폐쇄부전과 심부전 1례 등이었다. 혈류역학적으로 가장 흔한 이상은 폐동맥상부의 협착이었고, 폐동맥협착과 대동맥협착을 보였던 몇몇 경우에 있어서는 점차 협착정도가 진행하는 경우도 관찰되었으나 이로 인한 재수술은 없었다. 9례에서 대동맥판막폐쇄부전 소견을보였으며 7례에서는 그 정도가 가벼웠으나 2례에서는 중정도의 폐쇄부전을 보였고 다소 진행하는 경우도 있었다. 수술전후로 심근허혈의 증거가 없었던 2례에서 관상동맥의 폐쇄가 확인되었다. 나머지 생존자들은 동성박동과 정상적인 좌심기능을 유지한 채 양호한 경과를 보이고 있으며 생명표법에 근거한 8년 생존률은 68.8%였다. 결론: 심실중격이 온전한 대혈관전위증에서 해부학적 교정술은 우선적인 수술방법으로 여겨지나 추후 지속적인 추적관찰이 필요할 것으로 사료된다.

• Journal of Chest Surgery
• /
• 제24권7호
• /
• pp.674-684
• /
• 1991

The surgical treatment of tetralogy of Fallot [TOF] was initiated by Blalock and Taussig in 1945 with the establishment of the subclavian artery to pulmonary artery anastomosis. In an imaginative and daring effort, in 1954, Lillehei and collaborators [1955] using controlled cross-circulation, carried out the first intracardiac repair of TOF by closing the ventricular septal defect [VSD] and relieving the pulmonary stenosis under direct vision. Nowadays, total correction is the ideal operation for treatment of TOF and is accomplished with extracorporeal circulation. And the results of surgery for TOF have steadily improved over the years, thanks to important contributions of many surgeons. Nevertheless because of its protean physiologic and anatomic presentation, TOF continues to offer challenges to cardiologist and cardiac surgeons. Thirty two cases of TOF have undergone total corrective surgery using extracorporeal circulation in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, Inje University, from Oct. 1985 to Feb. 1990. Clinical considerations were applied to these cases and the results were obtained as follows. 1. The heart lung machine used for extracorporeal circulation was SarnsO 7000, 5-head roller pump, and the number and type of oxygenators were 10 of bubble type and 22 of membrane type. The mean bypass time was 148.9 minutes and the mean aortic cross clamp time was 123.8 minutes. The GIK [glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 2. 20 cases were male and 12 were female, the mean age was 8 years old and the mean body weight was 25Kg. 3. The preoperative symptoms were cyanosis [29 cases], squatting [27 cases] and etc. The mean values of preoperative Hb., Hct., and SaO2 were 16.5 gm /dl, 50.3%, and 78.5%. 4. Combined anomalies were noticed in 16 cases [50%]. Among them 10 cases were PFO and 6 cases were ASD. 5. The degree of aorta overriding were 25% in 5 cases, 25 ~ 50% in 22 cases and above 50% in 5 cases. The dPA/Ao [ratio of diameter of pulmonary artery trunk to ascending aorta] were below 25% in 5 cases, 25 ~ 50% in 10 cases, 50 ~ 70% in 6 cases and above 75% in 11 cases. 6. The types of RVOT [right ventricular outflow tract] stenosis were valvular and infundibular in 14 cases [43.6%], diffuse hypoplastic type in 12 cases [37.5%], infundibular in 5 cases, and valvular and supravalvular in 1 case. 7. One stage radical corrective surgery was applied to the all cases. In widening of the RVOT, 3 types of patches were used: MVOP [monocusp ventricular outflow patch, Polystan BioprosthesesO] in 3 cases, knitted Dacron vessel patches in 2 cases, and double layer with bovine pericardium and woven Dacron prosthesis in 26 cases. 8. Postoperative complications were occurred in 15 cases. Among them, low output syndrome were occurred in 10 cases [31.3%] and 2 of them were expired postoperatively.

• Journal of Chest Surgery
• /
• 제29권3호
• /
• pp.278-284
• /
• 1996

1989년 5월부터 1994년 5월까지 9명의 대혈관전위증 환자에 대해 동맥전환술을 시행하였다. 연령 분 포는 생후 3일에서 90일까지로 평균 30일 (21일)이 었고 환자는 전례 에서 술전 심초음파 검사로 진단되 었 다. 8례는 심실중격결손을 동반한 대혈관전위증이었으며 1례는 심실중격결손을 동반하지 않은 단순대 혈관잔위증 환아였다. 동반기형으로는 동맥관개존이 8례, 심방중격결손이 7El,대동맥축약이 1례였다. 관동백의 분지 형태는 Yacoub type A가 7례 (77 %), Yacoub type D의 형태가 2례 (23 %)였다. 폐동맥 재 건은 Lecompte 술식을 8례 에서 적용하였고 자가심낭편을 이용하였다. 사망율은 55 %였다. 수술후 1 ~2 일내 사망한 3례는 좌심실 기능부전과 발작성 폐동맥 고혈압이 원인이었고, 수술후 2~3주에 사망한 2례는 술후 감염에 의한 폐혈증이 주원인이었다. 평균 추적 기간은 17개월이 었고 추적관찰에는 심초음파 를 이용하였으며 임상적으로 의미 있는 대동맥 판 폐쇄부전이나 폐동맥 판 상부 협착은 발견되지 않았다. 수술에 따르는 여러 위험 요소들(저체중, 장시간의 체외순환, 체외 순환중 과도한 혈희석, 저체온, 술후 용적 부하, 과도한 \ulcorner\ulcorner\ulcorner사용) 중 술후 과도한 강심제를 사용했을 경우에서만 통계학적 유의성을 가지는 위험인자로 나타났다.