• Journal of Chest Surgery
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• 제27권6호
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• pp.460-471
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• 1994

Between Feb. 1990 and Aug. 1993, 180 cases of the open heart surgery were performed under cardiopulmonary bypass in the Department of Thoracic & Cardiovascular surgery, Gil General Hospital. There were 83 cases with congenital heart diseases [CHD] and 97 cases with acquired heart diseases [AHD]. The CHD consisted of 78 acyanotic[mortality: 3.8 %] and 5 cyanotic cases with heart anomaly[mortality:l case]. The AHD were 97 cases, which contained 53 valvular, 27 ischemic heart diseases, 10 aortic diseases, 5 cases with myxoma, 1 case with post-infarct VSD, and 1 case with removal of infected pacing wire in right ventricle. In the 53 valvular heart diseases, there were 45 cases with valve replacement[MVR 27, AVR 9,MVR + AVR 9] and 8 cases with valvuloplasty. The number of the implanted prosthetic valves were 53. In MVR, 25 St. Jude, 6 Sorin, 3 Carpentier-Edward and 2 Intact medical valves were used. In aortic position, 13 St. Jude, 3 Sorin and 1 Intact medical valves were applied. The operative mortality was 5.6 % [3/53]. The annuloplasty applying artificial ring was performed in 17 patients[4 cases associated with MVR] and the number of the implanted ring was 19, which included 14 Duran ring[10 mitral, 4 tricuspid] and 5 Carpentier ring [3 mitral, 22 tricuspid]. In the 27 ischemic heart diseases, there were 9 cases with left main coronary artery lesions, 7 one vessel, 5 two vessels, and 6 three vessels. Average number of anastomosis was 2.8 per patient. The operative mortality was 14.3 % [4/27]. Among the 10 patients with aortic diseases, 7 cases were aortic dissection[type A: 5, type B: 2] and 3 cases were descending thoracic aortic aneurysm. The operative morality occurred in 3 cases. The overall mortality and the operative mortality of congenital and acquired heart disease was 7.8 %, 4.8% and 10.4%, respectively.

• Journal of Chest Surgery
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• 제51권3호
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• pp.172-179
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• 2018

Background: This study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR). Methods: We conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications. Results: A total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from $225{\times}10^3/{\mu}L$ preoperatively to 94.5, 54.5, and $50.1{\times}10^3/{\mu}L$ on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052). Conclusion: There was no difference in the 30-day mortality of moderate-to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.

• Journal of Chest Surgery
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• 제36권5호
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• pp.335-342
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• 2003

배경: 급성대동맥 박리증의 수술 시 궁부에 내막 파열이 있는 경우 본원에서는 파열 원위부까지 대동맥 박리부를 치환하여 수술해 왔다. 이의 임상 경험을 분석하여 그 결과를 알아보고자 이 연구를 시행하였다. 대상 뜻 방법: 1996년 3월부터 2002년 7월까지 본원에 Stanford A형 급성 대동맥 박리증으로 수술받은 사람 중 대동맥궁 근처에 내막파열이 있었던 환자 31명을 대상으로 후향성 조사를 시행하였다. 환자의 성비는 남자 12명, 여자 19명이었고 나이는 59.6$\pm$9.4세이었다. 수술은 18명에서는 반궁치환술(Hemiarch replacement)을 시행하였고 13명에서는 궁분지치환술(Arch branch replacement)을 시행하였다. 3명은 Clamshell incision을 28명은 정중흉골절개술을 시행하였다. 모든 환자에서 극저체온 순환정지하에서 원위부 문합과 궁부 치환을 시행하였다. 동반 수술은 Bentall 수술이 2예, axillobifemoral bypass 1예, femorofemoral bypass 1예 carotid a bypass가 1예 등이었다. 결과: 술 후 합병증은 급성신부전이 8예, 중추신경합병증이 3예, 저심박출증이 2예, 말초 순환 부전이 2예, 창상 감염이 2예 발생하였다. 사망은 술 후 30일 이내 원내 사망이 4명으로 사인은 급성신부전 1예, 출혈 1예, 저심박출증 1예 및 말초순환장애 수술 후 재관류 손상 1예였다. 술 후 30일 이후 원내 사망은 3예로 사인은 신부전 1예와 다장기 부전증 2예로 총 수술사망률은 22.5%였다. 퇴원 후 만기 사망은 4예로 사인은 뇌출혈 2예와 원위부 파열이 2예였는데 이 중 반궁치환술을 한 경우가 3예였다. 결론: 반궁치환술은 궁분지치환술보다 상대적으로 수술시간이 짧고 수술사망이 적으나, 만기 사망이 많았다. 궁분지치환술은 수술시간이 길고 사망률이 높은 수술이나 대동맥궁 분지부에 길이 파열된 경우 필요한 수술이므로 향후 더 연구가 필요하리라 생각한다

• Journal of Chest Surgery
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• 제11권2호
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• pp.175-180
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• 1978

A rare form of tetralogy of Fallot, in which large ventricular septal defect was located at subpulmonary position rather than beneath a well developed crista supraventricularis was operated in this Department. This case satisfied the criteria for the diagnosis of tetralogy of Fallot, having large ventricular septal defect beneath the aortic valve with overriding of aorta, pulmonary stenosis and right ventricular hypeFtrophy. The operation was done through a median sternotomy using cardiopulmonary bypass. A vertical right ventriculotomy was extended to the pulmonary valve ring. Pulmonary and aortic valve were adjacent to each other, in contrast to the situation of classic tetralogy of Fallot. Pulmonary valvulotomy was done and ventricular septal defect was closed. with Teflon, and right ventricular outflow tract was reconstructed with woven Dacron covered by pericardial patch after minimal resection of septal band. The post-operatiove courses was uneventful except wound infection. The patient was discharged 15 days after open heart surgery.

• Journal of Chest Surgery
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• 제23권5호
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• pp.976-986
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• 1990

We experienced 12 patients with the abdominal aortic aneurysm during last 31 years [Dec. 1958 \ulcornerSep. 1989]. Among them, 10 patients were reviewed. They were all male. The age ranged from 34 to 80 years with the mean age of 59.4 years. The etiology of the aneurysm was atherosclerotic in 8, mycotic in 1, and aortitis in 1. The location of the aneurysm was infrarenal in 8, and suprarenal in 2 cases. Aneurysmectomy and Dacron Y-graft interposition in 8 cases, and lease with Teflon Y-graft were made. In another 1 case, long thoracoabdominal bypass surgery was made. The operative mortality was 30%[3cases]. The postoperative complications were respiratory complications[3cases], acute renal failure[2cases], bleeding[lease], mechanical ileus[ lease], and peritonitis[lease].

• Journal of Chest Surgery
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• 제37권10호
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• pp.880-883
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• 2004

복부 인조혈관 감염증은 매우 심각한 상태로서 문합부 파열로 심한 출혈이나 급성 말초 색전증으로 하지 허혈을 유발하여 사망률이 높고 치료하기 어려운 질환으로 치료에 대한 논란이 많은 질환이다. 저자는 복부대동맥류 수술 후 약 1년 후에 발생한 인조혈관 감염증례를 양 허벅지 심부정맥인 표제성 대퇴정맥을 사용하여 재치환하여 좋은 결과를 얻었기에 문헌과 함께 보고한다.

• Journal of Chest Surgery
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• 제14권3호
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• pp.291-296
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• 1981

Dissecting aortic aneurysm is a disease which is characterized by hemorrhagic intramural seperation of aortic wall and extension for varlng distances proximally, distally, or both from the site of the intimal tear. Most aortas show some type of medial degeneration most commonly described as cystic medial necrosis. DeBackey classified this disease according to involved aorta and site of intimal tear to 3 basic types, such as type I, II and III. Type III is defined that dissecting process arrises in the descending thoracic aorta just distal to origin of the left subclavian artery and extends distally for a varing distance. We expirienced a case of dissecting aneurysm, type III of DeBackey's classification which dissecting process is limited to the descending thoracic aorta in the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital. This patient was 40 year old woman and she had suffered from intermittent sharp back pain for 3 years .before admission. Excision of the aneurysm and Dacron graft were placed successfully under the left atrio-femoral bypass with artificial pump. The hospital course was uneventful.

• Journal of Chest Surgery
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• 제40권9호
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• pp.637-640
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• 2007

유두상 섬유탄력종은 드문 양성 심장 종양으로 대부분 증상이 없으나 전신 색전증의 위험성이 높다. 저자들은 관상동맥우회술을 준비하면서 정기적인 수술실 내 경식도 심장초음파검사를 시행하던 중 우연히 대동맥 판막의 종양을 발견하였다. 좌측 및 우측 대동맥판막 첨판에 부착되어 있던 종양은 수술로 완전절제되었으며, 병리학적 검사에서 유두상 섬유탄력종으로 확진되었다. 이에 저자들은 수술 중 경식도 심장초음파의 중요성에 대하여 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제53권6호
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• pp.403-407
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• 2020

To validate the technique of the single Heartstring aortotomy for multiple off-pump venous bypass grafts (described in 2015), the results of a 38-month follow-up study of 18 patients, including high-risk patients, are presented. No early deaths or cardiac or cerebral complications occurred. During the follow-up period, 2 patients died of non-cardiac causes, and 3 developed coronary ischemia. Ischemia occurred due to late graft occlusion in 2 patients, both of whom had normal postoperative courses and correct graft flow. The presence of acute symptoms 24 months after surgery in these patients indicated that technical graft failure was unlikely. This safe technique combines the advantages of simple and reproducible revascularization, the off-pump approach, and minimal aortic manipulation.

• Journal of Chest Surgery
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• 제25권5호
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• pp.511-517
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• 1992

From January 1988 to December 1990, 18 adult patients with aortic disease underwent surgical repair using hypothermia and total circulatory arrest. The age at operation ranged from 17 years to 64 years[mean 45.2$\pm$10.7 years]. We disease entities included aortic dissection in 12, aortoannuloectasia in 3 and thoracic aortic aneurysm in 3 cases. Partial cardiopulmonary bypass via femoral vessels along with surface cooling was used upon the induction of deep hypothermia[18~20oC]. Modified Bentall operation was performed in 7 cases, ascending aorta replacement in 6, graft interposition in descending thoracic aorta in 3 and others in 2 cases. The circulatory arrest was maintained for periods of 2 minutes to 86 mimutes[mean 34.7$\pm$5.0 minutes]. Overall hospital mortality was 27.8%[5/18]: brain damage was responsible for the death of 2 patients. 4 patients out of 13 survivors experienced postoperative neurologic dysfunction, which was proved to be self-limited except one case showing left hemiparesis. 12 patients were followed up postoperatively with the mean follow-up period 22.7$\pm$10.1 months. There was no death. No new neurologic problems were observed during follow-up period. All but one patient showing recurrent dissection and aortic regurgitation are in exellent clinical condition. These clinical data suggests that the principle of deep hypothermia and total circulatory arrest can be applied rather safely in adult patients, especially in the treatment of patients with aortic disease, it can be a valuable adjunct with better clinical results.