• Journal of Chest Surgery
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• 제14권3호
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• pp.302-306
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• 1981

Aorticopulmonary window is a rare anomaly among congenital heart disease. Various terms have been suggested including A-P window, A-P fenestration, fistula, aorticseptal defect etc. The defect lies usually between the left side of the ascending aorta and right wall of the pulmonary artery just anterior to the origin of the right main pulmonary artery. We have experienced one case of aorticopulmonary septal defect which was diagnosed as V5D with pulmonary hypertension in 1 4/12 year old, 7.2 Kg, male patient. Operation was done under the hypothermic cardiopulmonary bypass using 5t. Thomas cardioplegic solution. Vertical right ventriculotomy over the anterior wall of RVOT revealed no defect in the ventricular septum, and incision was extended up to the main pulmonary artery to find the source of massive regurgitation of blood through MPA. Finger tip compression of the aorticopulmanary window was replaced with Foley bag catheter balloon, and the $7{\times}10$ mm aorticoseptal defect located 15mm above the pulmonic valve was sutured continuously wih 3-0 nylon suture during azygos flow of cardiopulmonary cannula which was located distal to the window resulted massive air pumping systemically, and temporary reversal of pumping was tried to minimize cerebral air embolism. Remained procedure was done as usual, and pump off was smooth and uneventful. Postoperatively, patient was attacked frequent opistotonic seizure with no recovery sign mentally and p.hysically. Vital signs were gradually worsen with peripheral cyanosis and oliguria, and cardiac activity was arrested 1485 minutes after operation. Autopsy was performed to find the sutured window and massive edema of the brain.

• Journal of Chest Surgery
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• 제37권9호
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• pp.749-754
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• 2004

심장박동 상태에서 시행하는 관상동맥우회술 (Off-Pump CABG)은 심폐체외순환을 이용한 관상 동맥우회술 (On-Pump CABG)보다 낮은 위험률과 빠른 회복을 가져오는 것으로 알려져 있으며, 특히 수술 전 고위험인자를 가진 환자에서 심폐체외순환의 부작용을 피할 수 있는 이점이 있다. 저자들은 수술 전 고위험인자를 가진 환자들에 있어서 Off-Pump CABG와 On-Pump CABG의 수술성적을 비교하여 고위험군에서 Off-Pump CABG의 효율성에 대해 알아보고자 하였다. 대상 및 방법: 2001년 1월부터 2003년 6월까지 관상동맥우회술만을 시행한 환자 682명(Off-Pump CABG군: 424명, On-Pump CABG: 258명) 중 수술 전 고위험인자를 가진 환자를 대상으로 그 결과를 분석하였다. 수술 전 심장 박출계수 35% 이하, 70세 이상 고령의 환자, 뇌경색의 과거력, 최근 심근경색의 과거력, 과거 관상동맥우회술을 시행받았던 환자, 경동맥 및 말초동맥의 협착, 심부전증의 기왕력이 있는 환자, 신부전증환자 및 만성폐쇄성폐질환 환자 등 9가지 위험인자 중에서 한 가지 이상을 가지고 있는 환자를 고위험군으로 분류하여 대상으로 삼았다. 대상 환자는 Off-Pump CABG군이 192명, On-Pump CABG군이 100명으로, 각 군의 수술 전 위험인자 및 수술 후 결과를 비교하였다. 결과: 남녀 비, 연령 및 수술 전 고혈압 등의 위험요소는 두 군에서 차이를 보이지 않았다. Off-Pump CABG군에서 On-Pump CABG군에 비해 더 많은 동맥편을 사용하였으며, 수술시간, 수술 후 측정한 CK-MB, 뇌경색의 발생률, 강심제사용빈도, 호흡기의 사용시간 및 입원기간이 Off-Pump CABG군에서 통계적으로 유의하게 낮았으며, 이식편수는 On-Pump CABG군에서 유의하게 많았다. 수술 후 사망은 Off-Pump CABG와 On-Pump CABG를 시행 받았던 군에서 각각 0.5% 및 2%로 두 군간의 유의성은 없었으나 Off-Pump CABG를 시행 받았던 군에서 더 낮은 경향을 보여주었다. 그러나 출혈로 인한 재수술, 수술 후 심근경색증, 감염 및 신부전증 등은 두 군간에 통계적 유의성이 없었다. 결론: Off-Pump CABG는 On-Pump CABG 에 비해 수술 후 심근손상을 줄이고, 합병증을 감소시키며 빠른 회복을 보여 주었다. 따라서 고위험 군 환자들의 관상동맥우회술은 Off-Pump CABG로 시행하는 것이 더 좋은 수술방법이 될 것으로 생각한다. 그러나 전향적인 연구 등 더 많은 연구가 필요하리라 생각한다.

• Journal of Chest Surgery
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• 제13권3호
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• pp.274-279
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• 1980

A 21 years old male student was admitted because of mediastinal mass that was noticed in routine physical examination. He complained progressive hoarseness, mild dysphagia, and anterior chest pain on deep respiration. This mediastinal mass was diagnosed as aortic aneurysm involving ascending, transverse, and descending thoracic aorta with aid of aortogram. Total prosthetic replacement of aneurysm was performed successfully using extracorporeal circulation and hypothermia. For myocardial protection during aortic cross clamping, cardioplegic solution was used and topical myocardial cooling was also adapted For simplicity of cardiopulmonary bypass, Y-shaped connectors took cerebral perfusion catheters to the main perfusion line beyond the arterial pump. Total bypass time was 219 minutes, and aortic cross clamp time was 104 minutes. Recovery was uneventful except respiratory insufficiency for first 4 days. Isotope aortogram checked on post operative 30th day showed normal aortic configuration. He was discharged on post operative 35th day. A follow-up chest X-ray study 5 months later showed nearly normal anatomy.

• Journal of Chest Surgery
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• 제28권10호
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• pp.885-891
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• 1995

In order to test the hypothesis that the pulmonic valve, when used to replace the aortic root as a pulmonary autograft, will remain a viable anatomical structure and will grow and develop normally along with the host, we performed aortic valve replacement with the pulmonary autograft in 15 neonatal piglets. The weight of the donor was 9.3 $\pm$ 0.2 kg, the recipient 9.6 $\pm$ 0.3 kg. Measured diameters of pulmonic annulus were 14 $\pm$ 0.2 mm for autograft and 14.2 $\pm$ 0.2 mm for pulmonary artery homograft. Operation was performed under cardiopulmonary bypass with deep hypothermia [20oC at low flow perfusion [70 ml/kg/min . The mean operation time was 227 $\pm$ 10 min., bypass time 152$\pm$ 7.6 min. and aortic cross clamp time 73$\pm$ 4.6 min.. 9 piglets survived more than 12 hours. One survived 12 days and died of pneumonia and the latest one survived in good condition and sacrificed at postoperative 6th week for cardiac catheterization and pathologic examination that revealed the viability and growing of the pulmonary autograft. Currently we are able to complete the operation with good preservation of cardiac function, and our postoperative care has evolved to the extent that we are now confident enough of having an acceptable percentage of long term survivors to undertake a definite study in this regard.

• Journal of Chest Surgery
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• 제43권5호
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• pp.529-533
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• 2010

대동맥궁 대동맥류에 대한 전통적인 수술 치료는 장시간의 심폐기 사용으로 인해 특히 고위험 환자군에서 술 후 합병증의 발생 및 사망률이 높다. 저자들은 원위부 대동맥궁 대동맥류가 있는 고위험 환자에서 Hybrid 술식을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제15권4호
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• pp.402-408
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• 1982

The primary cardiac tumor was considered as a form of disease with poor prognosis in the past and it was hardly diagnosed before post mortem autopsy. But recent development of diagnostic procedure and the cardiac surgery using extracorporeal circulation increased the accuracy of diagnosis and the opportunity of successful treatment. The authors present two cases of left atrial myxoma which experienced during recent 4 years between 1979 and 1982. A 33 year old woman admitted with severe shortness of breath, generalized edema, ascites and the evidence of hepatopathy resulted from right sided heart failure. Preoperatively, the patient was treated with conservative medication to improve general condition for a few days. The tumor mass was removed successfully under the cardiopulmonary bypass. She, however, died of myocardial dysfunction showing low blood pressure. The tumor mass weighed 22gm and measured 5.2x4.5x3.6 cm in size. A 60 year old man admitted with shortness of breath on exertion and an episode of fainting. Following the removal of tumor mass under the cardiovascular bypass, the clinical course was satisfactory with no complication. The tumor mass weighed 105gm and measured 9x4x5 cm in size.

• Journal of Chest Surgery
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• 제16권3호
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• pp.301-309
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• 1983

Twenty-three patients with aneurysm were operated between Jan. 1956 to July 1983 at the Department of Thoracic surgery, Seoul National University Hospital. There were 18 males and 5 females in this series. The age ranged from 14 to 68 years with the mean age of 41 years. The etiology of aortic aneurysms was atherosclerosis in 10, trauma in 2, annuloaortic ectasia in 4, syphilis in 1, and unknown etiology in six cases. Among the 4 patients with ascending aortic aneurysm, aortic valve replacement with aneurysmorrhaphy in three patients and Bentall operation in one patient were performed successfully. One patient with entire aortic arch aneurysm was received Dacron graft replacement with anastomosis of brachiocephalic arteries separately under cardiopulmonary bypass. There was no complication. Among 6 patients involving the descending thoracic aorta, three patients were managed by prosthetic bypass graft and aneurysm resection, and another three patients were also managed by prosthetic graft replacement. There were three hospital deaths. There were two thoracoabdominal aortic aneurysm. One patient in shock state due to preoperative rupture died from cardiac arrest during operative procedure. In another patient who had extensive involvement from the midportion of descending thoracic aorta to the terminal abdominal aorta, the aneurysm was successfully repaired with Dacron graft. In this instance celiac axis, superior and inferior mesenteric arteries and right renal artery were anastomosed separately. Eight of the 10 abdominal aortic aneurysms was replaced with prosthetic graft. One saccular aneurysm was treated by resection and primary closure. In another patient, cardiac arrest occurred during operation before definitive procedure. There was one another hospital death in the patient with preoperative rupture.

• Journal of Chest Surgery
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• 제44권1호
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• pp.9-17
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• 2011

Background: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. Material and Methods: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age $54.4{\pm}15.1$ years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of $DLP^{(R)}$ (Medtronic Inc, Minneapolis, MN) or $RMI^{(R)}$ (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system ($EBS^{(R)}$; Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of $2.4{\sim}3.0\;L/min/m^2$ and an activated clotting time (ACT) of around 180 seconds. Results: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. Conclusion: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.

• Journal of Chest Surgery
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• 제47권3호
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• pp.240-248
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• 2014

Background: Open heart surgery using cardiopulmonary bypass (CPB) is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) is a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in cardiac surgery (CS). Methods: Thirty-seven adult patients undergoing CS with CPB were included in this retrospective study. They had normal preoperative renal function, as assessed by the creatinine (Cr) level, NGAL level, and estimated glomerular filtration rate. Serial evaluation of serum NGAL and Cr levels was performed before, immediately after, and 24 hours after the operation. Patients were divided into two groups: those who showed normal immediate postoperative serum NGAL levels (group A, n=30) and those who showed elevated immediate postoperative serum NGAL levels (group B, n=7). Statistical analysis was performed using Statistical Package for the Social Sciences version 18. Results: Of the 37 patients, 6 (6/37, 16.2%) were diagnosed with AKI. One patient belonged to group A (1/30, 3.3%), and 5 patients belonged to group B (5/7, 71.4%). Two patients in group B (2/7, 28.5%) required further renal replacement therapy. Death occurred in only 1 patient (1/37, 2.7%), who belonged to group B. Conclusion: The results of this study suggest that postoperative plasma NGAL levels can be used as an early biomarker for the detection of AKI following CS using CPB. Further studies with a larger sample size are needed to confirm our results.

• 대한임상검사과학회지
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• 제54권4호
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• pp.293-297
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• 2022

2022년 국내 체외순환사(관류사)는 224명으로 간호사나 임상병리사를 모집해 병원 자체교육이나 위탁교육을 실시하고 있다. 일본의 체외순환사는 2021년에 2,100명이며, 주로 임상공학 기사들이 지원한다. 미국의 체외순환사는 2021년 4,212명으로 석사과정, 학사후 자격증 프로그램, 학사과정 등에서 교육을 받았으며 대부분 보건의료과학 또는 생명과학 전공 졸업생이다. 체외순환사는 인공심폐장치를 운용시키는 기술뿐만 아니라 심장해부학, 생리학, 약리학, 혈류역학, 검사분석, 정도보증 등에 대한 지식이 있어야 하기에 임상병리사와 한 직군이다. 메르 스와 코비드-19라는 두 가지 영향력 있는 위기를 통해 체외순환사의 중요성이 더욱 부각되고 있었다. 현재 심장수술의 체외순환은 물론 최근 급격히 확대되고 있는 체외막산소화장치 영역에서 체외순환사가 큰 역할을 하고 있다. 본 연구를 통해 심장수술 및 감염병 치료를 하는 병원은 자격을 갖춘 체외순환사를 일정한 수 만큼 확보하도록 제도화하고, 대한임상생리검사학회 산하에 체외순환기술회(관류기술회)를 설립하여 학술교류가 실시되기를 기대해 본다.