• Journal of Chest Surgery
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• 제36권6호
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• pp.418-421
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• 2003

심장-폐이식은 현재 선천성 심장 질환에 의한 이차성 폐동맥 고혈압 환자에서 최종적 치료로 알려져 있다. 본 41세 남자 환자는 동맥관 개존증에 의한 이차성 페동맥 고혈압으로 진단되었으며 심도자 검사 결과 대동맥압 130/80 mean 100 mmHg, 폐동맥 130/80 mean 109 mmHg, 우심실 130/20 mmHg, 우심방 mean 20 mmHg이었고 우측 폐동맥의 직경이 7.5 cm로 심한 확장소견이 있어 심폐이식을 필요로 하였다. 장기 공여자는 24세 남자 환자로 교통사고에 의해 뇌 경막하 출혈로 타 병원에서 뇌사 판정을 받았다. 수술은 심폐 바이페스하에 동맥관 개존증을 결찰하고 심폐이식술을 시행하였다. 수술 후 1일째 호흡기를 이탈하였으며 3일째 일반 병실로 전원되었고 33일째 퇴원하였으며 41일째 시행한 심근과 폐 조직 검사 소견에서 거부 반응은 없었다.

• Journal of Chest Surgery
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• 제36권6호
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• pp.444-447
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• 2003

기관분기부에 침범한 악성 종양의 치료로 이용되는 소매 전폐 절제술은 수술 후 높은 유병률과 사망률을 동반하나 기관 분기부위의 악성 종양이 일측 폐를 완전히 허탈시키고 반대편 기관지의 허탈의 가능성이 있는 경우는 좋은 수술적 방법이 될 수 있다. 본 64세된 남자환자는 과거력에서 13년 전에 승모판 협착증 및 삼첨판 폐쇄 부전증으로 타 병원에서 승모판 치환술 및 삼첨판륜 성형술을 시행 받았으며 2년 전에는 성대에 생긴 유두종으로 종양절제술을 시행받았다. 최근에는 혈담을 주소로 내원하여 기관지내시경 및 흉부 컴퓨터단층촬영에서 하부 기관부터 좌측 주 기관지까지 약 3.5 cm의 악성 편평상피세포암이 관찰되었으며 좌측 주 기관지를 완전히 막고 있는 소견이 있었고 grade III의 삼첨판 폐쇄부전이 있었다. 심폐 바이페스 없이 순차적 양측 후측방 개흉술을 통해 좌측 소매 전폐절제술을 시행하였고 수술 후 병리 조직검사에서 T4N0M0인 악성 편평상피세포암으로 확인되었고 수술 후 특별한 문제없이 퇴원하였다.

• Journal of Chest Surgery
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• 제37권12호
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• pp.1010-1014
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• 2004

급성 폐동맥 혈전색전증은 대부분 혈전용해제나 항응고제 등을 이용하여 내과적으로 치료하나, 폐동맥 혈전색전증에 의한 급성 우심실 부전이 발생하는 경우에는 신속히 수술을 하지 않으면, 단시간 내에 치명적인 결과를 가져올 수 있으며, 우심혈전이 동반되어 있는 경우 그 사망률은 훨씬 높아지고, 개방형 난원공을 통한 역리성 색전증(paradoxical embolism)이 보고되고 있다. 그러나 본 증례에서와 같이 우심방의 혈전이 심방중격결손을 통해 좌심방으로 유입되는 것이 관찰되는 예는 극히 드물다. 직장암으로 저위전방절제술을 받은 63세 남자 환자에서 수술 직후 심부정맥혈전증에 의해 생긴 우심실부전을 동반한 급성 페동맥 혈전색전증을 응급개심술을 통해 좋은 결과를 얻었기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제24권9호
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• pp.853-860
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• 1991

A clinical study on 139 cases of operated PDA was performed during period from Aug. 1982 to Apr. 1991 at the Dept. of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital. The following results are obtained. 1. The 35 males and 104 females ranged in age from 6 months to 40 years. [mean 10.2 yrs. ] 2. Chief complaints of the patients were frequent URI in 50%, dyspnea on exertion in 31.2%, palpitation in 11.1%, and no subjective symptoms in 28.78% 3. On auscultation, continuous machinery murmur heard in 79.86% and systolic murmur in 20.14%. 4. Radiologic findings of chest P-A showed increased density of pulmonary vascularity in 80.58%, cardiomegaly in 61.87%, and within normal limit in 19.42% of the patients. 5. The signs of LVH[44.4%], RVH[17.4%], BVH[7.6%] were noted on the EKC. 6. Cardiac catheterizations were performed in 114 patients. The mean Qp/Qs was 2.65 and the mean Pp /Ps was 0.41 and the mean systolic pulmonary artery pressure was 46.6 mmHg. 7. Operative methods were as followed: The 130 cases[93.52%] of ligation and 3 cases[2.16%] of division & suture for PDA were performed through the left posterolateral thoracotomy. And the remained cases were managed under the cardiopulmonary bypass. 8. Operative complications were hoarseness in 8 cases, atelectasis in 6 cases, intraoperative ductal rupture under the left thoracotomy approach 2 cases, recannalization 1 case and others in 3 cases. 9. One patient died due to ductal rupture intraoperatively and the overall mortality was 0.7%.

• Journal of Chest Surgery
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• 제46권6호
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• pp.402-412
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• 2013

Background: Moderate and severe hypothermia with cardiopulmonary bypass during aortic surgery can cause some complications such as endothelial cell dysfunction or coagulation disorders. This study found out the difference of vascular reactivity by phenylephrine in moderate and severe hypothermia. Methods: Preserved aortic endothelium by excised rat thoracic aorta was sectioned, and then down the temperature rapidly to $25^{\circ}C$ by 15 minutes at $38^{\circ}C$ and then the vascular tension was measured. The vascular tension was also measured in rewarming at $25^{\circ}C$ for temperatures up to $38^{\circ}C$. To investigate the mechanism of the changes in vascular tension on hypothermia, NG-nitro-L-arginine methyl esther (L-NAME) and indomethacin administered 30 minutes before the phenylephrine administration. And to find out the hypothermic effect can persist after rewarming, endothelium intact vessel and endothelium denuded vessel exposed to hypothermia. The bradykinin dose-response curve was obtained for ascertainment whether endothelium-dependent hyperpolarization factor involves decreasing the phenylnephrine vascular reactivity on hypothermia. Results: Fifteen minutes of the moderate hypothermia blocked the maximum contractile response of phenylephrine about 95%. The vasorelaxation induced by hypothermia was significantly reduced with L-NAME and indomethacin administration together. There was a significant decreasing in phenylephrine susceptibility and maximum contractility after 2 hours rewarming from moderate and severe hypothermia in the endothelium intact vessel compared with contrast group. Conclusion: The vasoplegic syndrome after cardiac surgery might be caused by hypothermia when considering the vascular reactivity to phenylephrine was decreased in the endothelium-dependent mechanism.

• Journal of Chest Surgery
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• 제12권1호
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• pp.33-42
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• 1979

The present study reports 41 cases of congenital and acquired heart diseases, who received open heart surgery under extracorporeal circulation [ECC] by Sarns Heart-Lung-Machine [HLM] at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the` period between July 1975 and February 1979. The priming of pump oxygenator was carried out by the hemodilution method using Hartman`s solution, whole blood, and fresh human plasma. The rate of hemodilution was in the average of 50.8 ml/kg. ECC was performed at the average perfusion flow rate of 85.0 ml/kg/min [2.43 L./ kg/2] and at moderate hypothermia. In the total cardiopulmonary bypass, arterial pressure ranged between 55 mmHg and 90 mmHg, but generally maintaining over 70 mmHg. Patient age ranged between 2 and 54 year old, in congenital heart diseases, between 2 and 28, in acquired heart diseases, between 17 and 54 Sex ratio of male to female was 20:21. The cases include a case of pulmonary valvular stenosis, 4 cases of atrial septal defect, 9 cases of ventricular septal defect, 9 cases of tetralogy of Fallot, 5 cases of pentalogy of Fallot, 3 cases of atypical multiple anomalies 7 cases of mitral stenosis or insufficiency, a case of myxoma in left atrium, and a case of ruptured aneurysm of Valsalva`s sinus. The surgical managements were 16 valvulotomy for pulmonary valvular stenosis, 2 Teflon patch graft closure and 5 simple suture closure of atrial septal defect, 16 Teflon patch graft closure and 5 simple suture closure of ventricular septal defect, 12 pericardial patch graft for infundibular stenosis of right ventricle, one anastomosis between left superior vena cava and right atrium, 2 open mitral commissurotomy, 5 mitral valve replacement using Starr-Edward`s ball valve, porcine xenograft by Hancock, by Carpentier-Edward, or Angell-Shiley, one removal of left atrial myxoma, and a repair of ruptured aneurysm of Valsalva`s sinus. Four [9.7%] out 41 cases expired postoperatively and the rest of 37 cases survived with satisfactory results. The causes of death were one coronary embolism in tetralogy of Fallot, 2 postoperative lower cardiac output in atypical multiple anomalies, and one right heart failure in large: ventricular septal defect with pulmonary hypertension.

• Journal of Chest Surgery
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• 제10권2호
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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.

• Journal of Chest Surgery
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• 제22권4호
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• pp.698-704
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• 1989

We experienced the seven cases of penetrating and non-penetrating cardiac injuries combined with cardiac tamponade from June 1986 to June 1989 at Seoul and Chun-An Hospital of SOONCHUNHYANG medical college. The results were as follows. l. In sex distribution, 7 cases were male. In age distribution, The fourth decades occupied about 58 % of all cases. 2. In mode of injury, 4 cases were stab wounds, 1 case penetration by metallic fragment, 2 cases blunt chest trauma. 3. We routinely checked the CVP with subclavian vein catheterization in case of suspicious cardiac tamponade. Significant increments were showed in 4 cases. 4. Becks triad [low blood pressure, raised central venous pressure, distant heart sound] were recorded in 43 % of the cases with proven tamponades. 5. The sites of injury included RV in 4 cases, LV in 1 case, RA in 1 case and branch of RCA in 1 case. The RV injuries were the most common. 6. Coronary artery damage occurred in 2 cases. LADA was severed in 1 case combined with RV rupture and branch of RCA was torn 1 case. 7. Pericardiocentesis was performed 1 case at another hospital before referring to our hospital. We have never used the procedure because we think that it is potentially dangerous with no clear benefit. 8. Subxyphoid pericardial window was performed in 2 cases of severe cardiac tamponade. We have employed this method to stabilize the patients who had systolic hypotension. 9. Surgical approaches were performed with median sternotomy in 3 cases, thoracotomy in 4 cases. 10. We undertook the simple closure in 6 penetrating cardiac wounds. The removal of impacted metallic fragment was performed under the cardiopulmonary bypass. Simple ligation was performed in 2 cases of coronary artery severance 11. One patient with no sign of life was urgently intubated and undertaken an emergency room thoracotomy on the stretch car without antiseptic preparation. The cardiorrhaphy in 6 cases were performed in the operating theater 12. One patient undertaken emergency room thoracotomy did not survive due to refractory hypovolemic shock. But the remaining 6 patients recovered.

• Journal of Chest Surgery
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• 제9권2호
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• pp.207-214
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• 1976

Operations for cardiac valvular disease has been progressed in various ways. Since 1949 when Lord Russel operated mitral stenosis by closed technique at Johns Hopkins Hospital then much progress has been achieved and that nowadays severely diseased cardiac valve has been replaced by prosthetic valve, which is almost ideal in hemodynamic aspect, but still it has many problems such as thromboembolism, destruction of red blood cell, pressure gradient, and disturbance of left ventricular function, so in case of delicate situations, valve replacement should be decided carefully. Besides prosthetic valve, there are some kinds of reconstructive procedures and these have been resulted in better prognosis than prosthetic valve replacement in selected cases. So, authors have reviewed 61 Cases of cardiac patients who have been operated reconstructive valvular surgery by cardiopulmonary bypass, at Yonsei University, from Jan. 1963 to Mar. 1976. Out of 61 cases, 9 patients were replaced by prosthetic valve and rest of the patients were operated upon in various reconstructive procedures such as commissurotomy, valvotomy, valvuloplasty, and annuloplasty. Twenty cases of congenital heart diseases with valvular lesion, which had been operated for valvular lesion were also included in this statistics. Out of 9 cases of prosthetic valvular replacement five cases of prosthetic valvular replacement was done combined with other reconstructive procedures after attempted valvuloplasty. Comparative prognosis of both procedures are somewhat variable by reporters, average 19% of mortality after reconstructive surgery and 38% of mortality after prosthetic valve replacement in long term results. Most common cause of death in postoperative period was low output syndrome in both cases. It seems that good preoperative evaluation and proper reconstructive surgery will afford good prognosis in selected cardiac valvular diseased patient.

• Journal of Chest Surgery
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• 제21권6호
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• pp.970-978
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• 1988

There is tendency of increasing number and decreasing age of patients who are indicated for Rastelli operation for their cyanotic congenital heart disease. So there is the need to find the criterion which saves the patients from early postoperative hemodynamic disturbances. We reviewed the 26 patients who had been performed Rastelli operation at Seoul national University Hospital from January 1981 to June 1988. mean age of the patients was 7.8*3.4 years[range 2.5-15years], mean body surface area[BSA] 0.79*0.25m2[range 0.49-1.51m2] and mean hematocrit 57.95*12%[range 48-80%]. We divided these patients into survived group and died group before postoperative 72 hours, and analyzed preoperative arterial oxygen saturation[SaO2], the ratio of diameter of right pulmonary artery to ascending aorta[RPA/AA], the ratio of both right and left pulmonary artery diameter to descending thoracic aorta[RPA+LPA/DTA], pulmonary artery index[PA index], cardiopulmonary bypass time, aorta cross-clamping time, postoperative perfusion state and total amount of dopamine infused postoperatively. The results showed that RPA+LPA/DTA and PA index were statistically significant factors to influence early postoperative cardiac death rate[P< 0.05]. Especially there were good linear correlations between PA index[X] and peripheral perfusion index[Y][Y= - 1.15+0.02 X, r=0.86, P<0.01]and between PA index[X] and total amount of dopamine infused before postoperative 72 hours[mg/kg, Y][Y=61.94 - 0.15 X, r=-0.80, P < 0.01]. Also there were tendencies that the higher RPA+LPA/DTA[Y], the better peripheral perfusion [X] and the lower need of dopamine[X], but no statistical significance.[Y=0.78+1.60 X, r =0. 49, P >0.05] And the discriminate analysis showed that patients with PA index over 221 mm2/BSA could undergo correction with 25 per cent of error rate. In conclusion, early postoperative hemodynamic states could be predicted by preoperatively measured PA index, and which can be used as a criterion for Rastelli operation performed on cyanotic congenital heart disease.