• Journal of Korean Academy of Nursing Administration
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• v.10 no.1
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• pp.11-23
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• 2004

Purpose: The objective of this study was to collect the basic data for improving the quality of nursing education by identifying the teaching efficiency of the ordered clinical nursing education by preceptor which was accepted by Gachongil College since 2001. Method: The data was collected from 30 Sept to 20 Oct 2002. The subjects of this study were 240 nursing students, junior 2nd term trained by the preceptors and 137 preceptors of 12 hospitals located in Inchon, Gyong Ki-do, and Seoul. The scale for measuring the teaching effectiveness, developed by Kim Miae et al.(1998), was employed as a tool for me study. The data was analysed by SPSS using mean value(SD), and ANOVA. Results: Mean value of teaching efficiency of preceptors evaluated by me nursing students scored 3.68(maximum 5). For 5 causal factors classified en the teaching efficiency, the factor of "teaching method and evaluation" showed the highest score, but "available as resource person" get the lowest. Items showing high score en teaching efficiency were "overall effectiveness of teacher", "was able to work with staff in cooperative manner", but the item of was unclear in instructions given to me showed the lowest. The psychiatric ward get the highest score, but cardiac catheterization room showed the lowest. The hospital 10 showed the highest score, but the hospital 8 get the lowest. Conclusion: As the findings from this study, the ordered clinical nursing education by preceptor showed higher teaching efficiency than the conventional education. Thus, cooperative relationship between nursing colleges and hospitals shall be suggested for improving the quality of clinical nursing education, and ordered clinical nursing education system.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.268-273
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• 1977

During the period from March, 1963, to November, 1977, forty-eight patients with secundum type atrial septal defects have undergone surgical repair using cardiopulmonary bypass with a pump oxygenator at the Seoul National University Hospital. Twenty-six [55 percent] of the patients were females and Twenty-two [45 percent] were males. The patients varied in age from 3 years to 51 years. We have divided secundum defects into three types. These are: 1] the high defect; 2] Ovale type defect; and 3] low defect including the defect in the area of the coronary sinus. An ovale type defect was present in forty-one cases [85 percent]. Partial anomalous pulmonary venous connections were present in two patients in the high defect group. All of the forty-eight patients had had right heart catheterization before operation. The pulmonary to systemic flow ratio [Qp/Qs] was determined in our 38 patients. The Qp/Qs was less than 1.5/1 in only five of the 38 patients. Among the 33 patients with moderate and severe left-to-right shunts [Qp/Qs 1.6-3.5/1], the systolic pulmonary artery pressures. ranged from 30 to 80 mm Hg. Large left-to-right shunts [Qp/Qs>3.6/1] were present in 13 patients. The postoperative complications occurred in 13 patients [27. 1 percent]. Postoperative wound infections were the most frequent complications being present in 6 patients [12.5%]. Forty-six of the patients with secundum atrial septal defects survived surgical repair of their defects. Thus the hospital mortality of surgery was 4.2 percent. The causes of death in the early postoperative period were: 1] low cardiac output syndrome related to severe pulmonary hypertension in one case; and 2] postoperative several bleeding in one case.

• The Korean Journal of Nuclear Medicine
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• v.20 no.2
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• pp.47-52
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• 1986

A noninvasive procedure for diagnosis and quantitation of right-to-left intracardiac shunts will enhance the management of patients with cyanotic congenital heart disease. This study describes an application of radionuclide (RN) angiocardiography for quantitation of right-to-left shunt amount. Gamma variate model was fitted to radionuclide data recorded over the carotid artery. Data analysis was performed retrospectively in 35 patients who underwent cardiac catheterization within a week from the day of RN angiocardiography. Thirty one of the patient had right-to-left shunts and 4 of them had left-to-right shunts. Both the radionuclide and Fick measurements correlated well (r=0.93, 0.93, 0.89, p<0.01 in each measurements). Therefore, RN angiocardiography data may be used for accurate calculation of right-to-left shunts in cyanotic congenital heart disease patients.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.148-155
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• 1977

The clinical findings with cardioangiography and successful surgical treatment of a 10 year old girl with double-outlet right ventricle is reported at The Dept. of Thoracic and Cardiovascular Surgery, Korea University Hospital, College of Medicine. The patient has been suffered from intermittent cyanosis, palpitation, and exertional dyspnea since 1 year after NFSD, and a holosystolic ejection murmur of grade 4 at the left 3rd intercostal space with mild cyanosis of the lips was the only physical findings at the time of this admission. Cardiac catheterization revealed ventricular septal defect with left to right shunt of 43% and right to left shunt of 10.2%. On cardioangiography from the left ventricle revealed all of the left ventricular outflow shunted into the right ventricle through the large ventricular septal defect, and the aorta originated from the infundibular chamber of the right ventricle with left, anterior sided pulmonary artery. The atria, viscera, and ventricles were normally located, and right ventricular out-flow was narrowed with infundibular hypertrophy and pulmonary valvular stenosis. Surgical correction was accomplished by closure of the ventricular septal defect in such a way that left ventricular outflow was routed via a Teflon felt prosthetic tunnel to the aorta, and pulmonary valvulotomy with infundibulectomy Was done to pass Hegar`s dilator No. 15 for reconstruction of the right ventricular outflow tract. The patient tolerated complete repair and has continued to improve over a period of three months after operation with normal school life. Details of the disease and method of repair are presented with related references.

• Journal of Chest Surgery
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• v.24 no.3
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• pp.310-321
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• 1991

Between April 1986 and September 1990, 34 patients with a single or dominant right ventricle underwent modified Fontan procedure for definite palliation in Seoul National University Children`s Hospital. Their age at operation ranged from 8 months to 14 years [Mean 5.5 years]. The ventricular chamber was solitary and of indeterminate trabecular pattern in 6 patients. 28 patients had posteriorly located rudimentary chamber, all of which were trabecular pouches having no communication with outlet septum. The patterns of atrioventricular connection were common inlet[9], double inlet [11], left atrioventricular valve atresia [12] and right atrioventricular valve atresia with L-loop [2]. Pulmonary outflow tracts were atretic in 7 patients and stenotic in 26 patients. Major associated anomalies included anomalous systemic venous drainage [15], dextrocardia [12] and total anomalous pulmonary venous connection[3]. Shunt operations were previously performed in 13 patients and pulmonary artery banding and atrial septectomy in 1 patients. Surgery included intraatrial baffling in 26 patients, bidirectional cavopulmonary shunt in 13 patients, atrioventricular valve obliteration in 3 patients and atrioventricular valve replacement in 3 patients. Central venous pressure measured postoperatively at intensive care unit ranged from 18cm H2O to 28cm H2O [mean 23.2cm H2O]. Hospital mortality was 35.3% [12/34], all died out of low output syndrome. Suspected causes of low output syndrome include ventricular dysfunction [8], hypoplastic or tortuous pulmonary artery [2] and elevated pulmonary vascular resistance [2]. 19 patients had 31 major complications including low output syndrome [18], arrhythmia [4], acute renal failure [3] and respiratory failure [3]. Mortality rate was significantly higher in the groups receiving intraatrial baffling and AV valve replacement respectively [p<0.05]. 20 patients were followed up postoperatively with the mean follow-up period 15.0$\pm$11.6 months. There were no late death and follow-up catheterization was performed in 10 patients. Mean right atrial pressure was 15.4$\pm$6.8mmHg and ventricular contraction was reasonable in all but one case. Thus, Fontan principle can be applied successfully to all the patients with complex cardiac anomaly of single ventricle variety and better results can be anticipated with judicious selection of patient and improvement of postoperative care.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.962-967
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• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.7-19
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• 2000

Background :To assess the accuracy of Electron-Beam Tomography(EBT) in following evaluation of the pulmonary vascular system after a shunt operation in the cyanotic con-genital heart disease with pulmonary stenosis or pulmonary atresia. Material and Method : Sixteen patients(M:F=11:5) who received Blalock-Taussig(n=8) bidirectional cavo-pulmonary shunt(n=10) and unifocalization (n=2) were ncluded in the study. We evaluated the patency of the shunt the morphology of intrapericardial and hilar pulmonary arteries(PA) peripheral pulmonary vascularity by background lung attenuation and the abundance of arterial & venous collateral. Angiography(n=12) and echocardiography(n=20) were used as the gold standard for the comparison of EBT results. Result: EBT was consistent with angiogram/ echo in 100% of the evaluation for the patency of the shunt and in 12(by angiogram 100%) and 19(by echo 95%) for the detection the hypoplasia stenosis or interruption of central PA In measuring of PA EBT and angiogram corrlated(r=0.91) better than EBT-echo(r=0.88) or echo-angiogram(r=0.72) Abundant systemic arterial collateral were noted in 4 and venous collateral in 3 cases. In evaluating the peripheral pulmonary vascularity the homogenous and normal-ranged lung attenuation(m=6) decreased but homo-genous attenuation(n=1) segment-by-sgment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) segment-by-segment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) and venous congestion(n=2) were observed nd 12 of them were compatible with the blood flow pattern revealed by cardiac catheterization. Conclusion: EBT was accurate in the integrated evaluation of the pulmonary vascular system after the shunt including the patency of the shunt operaion the morphology and dimension of the central and hilar PAs and the loco-regional pulmonary flow in the lung parenchyma. It suggests the useful information about the need of secondary shunt operation the proper timing time for total repair and the need of interventional procedure prior to total repair.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.547-551
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• 2001

The effects of deep hypothermia and circulatory arrest during aortic arch reconstruction are associated with potential neurologic and myocardial injury. We describe a surgical technique that two patients underwent a modified Norwood procedure without circulatory arrest and myocardial ischemia. One was 13-day-old female patient, weighing 3.1kg, having a variant of hypoplastic left heart syndrome and another was 38-day-old male patient, weighing 3.4 kg, diagnosed Taussig-Bing anomaly with severe aortic arch hypoplasia, coarctation of the aorta, and subaortic stenosis. The arterial cannula was inserted in innominate artery directly. During Norwood reconstruction, regional high-flow perfusion into the inominate artery and coronary perfusion were maintained and there were no neurologic, cardiac, and renal complications in two patients. This technique may help protect the brain and myocardium from ischemic injury in patients with hypoplastic left heart syndrome or other arch anomalies including coarctation or interruption.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.136-142
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• 1995

A clinical study was performed on 69 cases of isolated PDA surgically treated at the Department of Thoracic and Cardiovascular surgery of Kyung-Hee University Hospital from Mar. 1986 to Feb. 1994. Retrospective clinical analysis of these patients were as follows: 1.23 males and 46 females ranged in age from 16 days to 49 years. [mean 8.69yrs.,sex ratio M:F=1:2 2. Chief complaints were frequent URI in 44%, dyspnea on exertion in 16%,palpitation in 8%, easy fatigability in 6%, and no subjective symptoms in 26%. 3. On auscultation, typical continuous machinery murmur heard in 84%, and systolic murmur in 16% on Lt 2nd or 3rd intercostal space. 4. Simple chest x- ray showed increased pulmonary vascularity in 67%, cardiomegaly in 61%,and within normal limit in 16%. 5. EKG findings were LVH in 42%, biventricular hypertrophy in 17%, RVH in 3%, and within normal limit in 38%. 6. Echocardiogram was performed from all patient, and direct visualization of ductus in 93% 7. Cardiac catheterization was performed in 39 patients. The mean value of the results were;Differance SaO2[MPA-RV =11.03$\pm$ 5.26%,Qp/Qs=2.44$\pm$1.35,systolic pulmonary arterial pressure=40.69 $\pm$ 17.69mmHg. 8. 66 patients were operated through the left posterolateral thoracoctomy ; closure of ductus by double ligation in 43 cases, triple ligation in 23 cases.3 patients were operated by simple closure under cardiopulmonary bypass. 9. There was no death associated with the operation. The operative complications were atelectasis in 8 cases, pneumonia in 4 cases recannalization in 2 cases, and hoarseness in one case. 10. Systemic diastolic pressure was increased 8.12$\pm$ 0.13mmHg, and pulse pressure was decreased about 9.52 $\pm$ 1.87mmHg.

• Clinical and Experimental Pediatrics
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• v.56 no.9
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• pp.396-400
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• 2013

Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA) by using an Amplatzer vascular plug (AVP). Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared. Results: The mean age of the patients was $54.9{\pm}45.7$ months old. The PDAs were of type C (n=5), type D (n=12), and type E (n=3). The mean pulmonary end diameter of the PDA was $1.7{\pm}0.6$ mm, and the aortic end diameter was $3.6{\pm}1.4$ mm. The mean length was $7.3{\pm}1.8$ mm. We used 3 types of AVP devices: AVP I (n=5), AVP II (n=7), and AVP IV (n=8). The ratio of AVP size to the pulmonary end diameter was $3.37{\pm}1.64$, and AVP size/aortic end ratio was $1.72{\pm}0.97$. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P=0.002). The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter ($1.10{\pm}0.31$, P=0.032). Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.