• Journal of Chest Surgery
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• 제41권2호
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• pp.189-201
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• 2008

Dr. Schimert는 1918년 스위스에서 태어나고 항가리와 독일에서 의사 면허를 취득하였다. 세계 이차 대전 직후 미국으로 이민 후 인턴, 레지던트 트레이닝을 계속한 그는 1956년 당시 심장수술로 세계적 명성을 떨치고 있던 미네소타 대학의 Dr. Lillehei의 지도하에 심장수술 트레이닝을 시작하였다. 이 기간 중인 1958년 그는 당시 미네소타 프로젝트의 일원으로 한국의 서울대학병원에 근무를 시작하였다. 이후 15개월 동안 그는 의학 총괄 자문관으로서 전반적인 의학 교육 및 행정에 참여하는 한편 당시 초창기의 흉부외과를 정립시키는데 공헌하였다. 특히 1959년 8월 6일에는 심방중격결손 환자를 대상으로 심폐바이패스를 이용한 개심술을 시행하였으나 환자는 불행히도 수술 6시간 후에 사망하였다. Dr. Schimert는 1959년 10월 미국으로 귀국하여 이듬해인 1960년에는 뉴욕 Buffalo General Hospital의 첫 심장수술 책임자로 부임하였다. 이후 동 병원에서의 기여 및 성과를 인정받아 1985년에는 그를 기념하여 Dr. George Schimert Lectureship and Medical Conference가 제정되었다. 이후 은퇴 생활 중 2002년 12월 7일 병사하였다.

• Journal of Chest Surgery
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• 제46권4호
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• pp.249-255
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• 2013

Background: The continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes. Materials and Methods: Between October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used. Results: There were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients. Conclusion: The simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used.

• 생명과학회지
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• 제17권11호
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• pp.1539-1546
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• 2007

연구저자들은 심장판막 수술 환자를 대상으로 냉각 혈액 심정지액에 마그네슘 첨가(2 g)의 효과를 실험하였다. 수술동안 및 후의 $Mg^{++}$ 농도와 $Ca^{++}$ 농도는 마그네슘군이 대조군보다 유의하게 더 높았다. 수술 후 시기에 총 백혈구 수, CK-MB, troponin-I, interleukin-6의 농도는 마그네슘군이 대조군보다 유의하게 더 낮았다. 수술 후 심방세동 발생률 역시 마그네슘군이 대조군보다 유의하게 더 낮았다. 본 연구의 결과들은 심장수술 시 심정지액에 대한 일정량의 마그네슘 첨가가 특별한 부작용 없이 저마그네슘혈증, 전신염증반응, 심방세동의 발생률을 줄이고 심근보호 효과 역시 가져다줌을 시사하고 있다.

• 대한의용생체공학회:의공학회지
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• 제20권5호
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• pp.609-616
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• 1999

심폐바이패스시 발생할 수 있는 튜브 마모 및 파쇄는 롤러펌프의 반복되는 압박에 의해 롤러펌프에 장착된 튜브 내벽에 균열이 생기고 이로 인해 미세한 비생물적 조각들이 혈액중으로 떨어져 나가는 현상을 말하는데, 임상적으로 치명적인 색전증을 초래할 수 있다. 그러나 아직 롤러펌프 튜브로 사용되는 PVC 및 실리콘 튜브 중 어느 쪽이 마모 및 파쇄 관점에서 더 우수한지는 체계적으로 밝혀지지 않고 있다. 이에 본 연구는 두 종류의 튜브를각각 일정 기간 롤러펌프에 장착하여 작동시킨 뒤 튜브내외면을 육안 및 주사형 전자현미경으로 관찰하였다. 즉 PVC 및 실리콘 튜브 (내경 1/2 인치의)들을 미리 정해진 폐쇄도 조절에 의해 폐쇄 회로 심폐비이패스 롤러펌프 헤드에 장착시키고 4.500ml/min에서 각각 4차례씩 1,2,4,6 시간 작동시켰다. 파쇄에 의한 색전 관찰 실험에서는 회로 중간에 동맥여과기를 설치하고 각각 6,9시간 씩 롤러펌프를 작동시켰다. 실험 후 튜브 및 여과기들을 수거한 후 육안 및 주사형 전자현미경 분석을 시행하였다. 실험후 튜브 및 여과기들을 수거한 후 육안 및 주사형 전자현미경을 분석을 시행하였다. 튜브 외부의 육안 관찰 결과 일반적으로 실라스틱 튜브에서의 외부 마모가 PVC 튜브에 비해 현저하였다. 주사형 전자현미경 관찰에서 PVC 튜브에서의 홈은 좁으면서 경계선이 뚜렷한 특징을 보였고 3시간 이상 롤러와 접촉한 튜브들에게서는 깊은 균열이 간헐적으로 관찰되었다. 반면, 실라스틱에서의 홈은 좁으면서도 경계선이 뚜렷한 특징을 보였고 3시간 이상 롤러와 접촉한 튜브들에게서는 깊은 균열이 간헐적으로 관찰되었다.반면 실라스틱에서의 튜브들에서는 홈이 상대적으로 넓고 경계가 덜 명확했으며, 특징적으로 V 자 모양의 융기부들이 간헐적으로 관찰되었다. 실라스틱 및 PVC 튜브 모두에서 50u 전후의 Craters 가 간헐적으로 관찰되었다. 여과기의 여과망에 대한 주사형 전자현미경 분석 결과 실라스틱과 PVC 튜브 실험군 모두에서 색전입자로 의심되는조각들이 발견되었으나 두군간 정량적 비교는 어려웠다. 결론적으로 롤러펌프에 의한 튜브 마모 및 파쇄현상은 실리콘 및 PVC 튜브의 재질에 따라 그 양상에는 차이가 있으나 임상적인 측면에서는 어느 쪽도 상대적인 우수성이 입증되지 못하였다.

• 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.

• Journal of Chest Surgery
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• 제38권6호
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• pp.441-444
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• 2005

복강내 종양이 혈관을 통해 전이될 수는 있으나 우심장까지 침범되는 경우는 드물다. 자궁에서 기원하는 정맥내 평활근종증은 매우 드물며 조직학적으로는 양성이지만 임상적으로는 하대 정맥, 우심장 또는 폐동맥의 폐쇄를 동반함으로써 치명적인 결과를 초래할 수 있는 질환이다. 치료 방법은 심폐 순환기를 통한 완전 순환정지하에 종괴를 완전절제하는 것이다. 자궁에서 기원한 정맥내 평활근종증을 개복술과 개심술을 이용해 일차 수술로 성공적으로 치유하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제18권4호
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• pp.759-770
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• 1985

This study was experimentally undertaken to evaluate the effect of hypothermic oxygenated cardioplegic solution on myocardial protection during prolonged aortic cross clamping under cardiopulmonary bypass. Dogs were divided into two groups control group [received hypothermic unoxygenated cardioplegic solution] and experimental group [received hypothermic oxygenated cardioplegic solution]. Coronary sinus effluent was obtained at once and 30, 60, 90 minutes after cross-clamping for the determination of pH, PCO2,PO2 and lactate level during the infusion of cardioplegic solution and myocardial biopsies were obtained after cessation of 90 minutes of aortic cross-clamping. The results obtained were as follows: 1. There was no significant differences in the pH and PCO2 between the oxygenated and unoxygenated cardioplegic solution but the PO2 of the oxygenated solution was 4 times greater than unoxygenated solution, and also the oxygenated solution had a significantly greater oxygen content [2.020.05 ml 02/min] and had much more oxygen delivery than unoxygenated solution. 2. The myocardial oxygen consumption and the myocardial oxygen extraction in oxygenated group were 1.63 ml 02/100 ml and 67.32% respectively, which was greater than those in unoxygenated group. 3. Regarding to pH and PCO2 of coronary sinus effluent, there was no significant differences between two groups in early period of infusion of cardioplegic solution, but the pH shifted to acidosis from 60 minutes, PCO2 increased from 90 minutes of aortic cross-clamping, and PO2 markedly decreased from 90 minutes of aortic cross-clamping in unoxygenated group. 4. The lactate concentration of coronary sinus effluent revealed relatively normal in both groups, but showed slight increase up to 27.54.56 mg/100 ml at 90 minutes of aortic cross-clamping in unoxygenated group. 5. On electron microscopic study, the ultrastructural integrity of myocardial cells in oxygenated group was well preserved within 90 minutes. Slight swelling and deformity of mitochondria, interfibrillar widening, and disarrangement of myofibrils were observed at 90 minutes after aortic cross-clamping in unoxygenated group. From these results, the use of hypothermic oxygenated cardioplegic solution seemed to be effective and better method for the preservation of ischemic myocardium during the prolonged aortic cross-clamping.

• Journal of Chest Surgery
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• 제18권4호
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• pp.574-581
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• 1985

Surgical treatment for PDA has been pivotal in historical development of surgery for congenital heart disease. A clinical study on 36 cases of operated PDA were performed during period from Aug. 1981 to Jul. 1985 at the Department of Thoracic & Cardiovascular Surgery in Chonbuk University. The following results are obtained. 1. The 8 males and 28 females ranged in age from 2 yrs, to 24 yrs, [mean 11 yrs.] 2. Chief complaints of the patients were dyspnea on exertion in 61%, palpitation in 39%, frequent URI in 12%, and no subjective symptoms in 11%. 3. On auscultation, continuous machinery murmur heard in 94% and systolic in 14%. 4. Radiologic findings of chest P-A showed increased density of pulmonary vascularity in 94%, cardiomegaly in 69%, and within normal limits in 5% of the patients. 5. EKG findings of the patients revealed LVH in 69%, RVH in 6%, BVH in 6%, and within normal limits in 17%. 6. Of the 36 patients, cardiac catheterization was performed in 34 patients. The results showed mean Qp/Qs = 2.25, mean Pp/Ps=0.42, and mean systolic pulmonary arterial pressure=53mmHg. 7. Surgical methods were as followed: The 32 case of ductal ligation and one case of division & suture technique for PDA through the left posterolateral thoracotomy were done. And 2 cases of ductal ligation one suture closure through the pulmonary artery were performed under the cardiopulmonary bypass. 8. Intraoperative complication was ductal rupture with division 8< suture for PDA and transient hoarseness in 1, recanalization in 1, and urethral stricture in 1 case postoperatively. 9. One patient died due to ductal rupture intraoperatively and operative mortality was 2.8%.

• Journal of Chest Surgery
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• 제21권4호
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• pp.672-680
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• 1988

Munro is generally considered the first person to have demonstrated, in 1888, in an infant cadaver, the feasibility of dissection and ligation of a persistently patent ductus arteriosus. In august, 1938, Robert Gross reported first successful division and suture of the patent ductus of 7 year old girl. Interruption of a ductus is one of the most satisfactory and curative operations in the field of surgery for congenital heart disease. Seventy-eight consecutive cases of closure of patent ductus arteriosus were operated from June 1980 to June 1988 in the department of thoracic and cardiovascular surgery in Maryknoll Hospital. Retrospective clinical analysis of the patients were 1. There were 24 males, 54 females. 2. The age range of the patients were from 7 months to 32 years with the mean age 9.8 years. 3. Chief complaints of the patients were frequent URI[70.5%], dyspnea on exertion[36.9%], palpitation[10.3%], but 15 patients[19.2%] had no subjective symptoms. 4. Continuous machinery murmur could be heard at the 2nd or 3rd intercostal space on the left sternal border in 66 patients[84.6%]. The other 12 patients made systolic murmur. 5. Radiographic findings of the Chest P-A were cardiac enlargement in 55 patients[70%], enlargement of pulmonary conus and/or increasing density of pulmonary vascularity in 68 patients[87%]. 6. Electrocardiographic findings of the patients were within normal limit in 23 patients[36%], LVH in 38 patients[48.7%], RVH in 7 patients[9%], biventricular hypertrophy in 5 patients[6%]. 7. Cardiac catheterization performed in 62 patients. Mean Qp/Qs=2.5, mean pulmonary arterial pressure=45 mmHg. 8. 73 patients were operated through left posterolateral thoracotomy: Closure of the ductus by ligation in 64 cases, division with suture in 6 cases, and division with aortopatch in 3 cases. Ligation through median sternotomy under cardiopulmonary bypass were 5 cases. 9. There was no death associated with operation, but one case was experienced with intraoperative tearing of ductus resulting in massive bleeding. The other complications were transient hoarseness in 2 patients, chylothorax in 2 patients.

• 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.