• Journal of Chest Surgery
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• v.28 no.3
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• pp.233-236
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• 1995

Subepicardial space is one of the regions in which fat in moderate amount is normally deposited. When excess deposits of epicardial fat occur, penetration or infiltration of fat into the connective tissues between muscle bundles is observed. In some cases with very extensive involvement of epicardial fat,myocardial insufficiency and conduction system defect such as heart block have been implicated. More fat is deposited over the right ventricle than over left and the anterior surface contains more fat than dose the posterior surface. We studied 40 patients who underwent open heart surgery under the cardiopulmonary bypass. This study was designed to evaluate the percentage of the area of epicardial fat of the right ventricular anterior surface, which is more accessible area during the operative procedure. Other variables included thickness of subcutanous tissue of anterior chest wall, the ratio of waist to hip circumference, body weight and age. In conclusion, the amount of the epicardial fat correlates with thickness of the subcutaneous fat of the anterior chest wall and simple linear regression analysis indicates good correlation with body weight. Increased age results in large amount of epicardial fat.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.268-273
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• 1995

Budd- chiari syndrome resulting from a membranous obstruction of the inferior vena cava[IVC is a rare congenital anomaly. From January 1989 to December 1993, 8 cases of IVC obstruction was treated in Kyung Hee Univ. Hospital. There were 2 male and 6 female patients between 34 and 66 years of age[mean 47.3$\pm$11.9 years of age . 4 patients were treated with angioplasty by balloon catheter and 4 patients were treated with operative correction using cardiopulmonary bypass, profound hypothermia and total circulatory arrest. These 4 patients were repaired the constricted IVC with autologous pericardial patch. In surgically treated patients, all of the specimens were confirmed to be membranous web histopathologically. Postoperative outcome in operative correcting patients was uneventful and postoperative angiography showed unobstructed flow through the IVC with filling of the hepatic veins.The above 8 patients were followed up from 10 months to 56 months [ mean 36.43 17.24 months and recurrent IVC obstruction or stenosis was not seen.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.383-390
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• 1992

From Oct. 1983 to Dec. 1991, 135 cases of atrial septal defect which were operated at the department of Thoracic and Cardiovascualr Surgery, Chonnam National University Hospital, were analysed retrospectively. They were 23.7% of all congenital heart diseases operated in the same period. Among the 135 cases, 62 cases were male and 73 cases were female. Their ages were ranged from 2 to 54 years and the mean was 18 years old. Main symptoms at admission were exertional dyspnea[70.37%], frequent URI[49.12%] and palpitation[32.59%], but 12 cases[8.88%] were asymptomatic. Electrocardiographic findings wer regular sinus rhythm in 96.99%, RVH in 64.66%, incomplete RBBB in 27.06%, complete RBBB in 42.10%, and first degree AV block in 9.02% All 135 cases were operated under the direct vision with cardiopulmonary bypass. Anatomically, most frequent type was fossa ovalis defect with complete septal rim[78.52%]. 117 of 135 ASD patients were repaired with pathch closure[86.66%] and 14 patients were repaired with direct closure[10.37%] and 4 patients in mutiple ASD were repaired with patch and direct closure[2.96%]. Postoperative complications were occured in 21 cases[15.56%], and they were wound infection, pleural effusion, postoperative bleeding, urinary tract infection, and heart failure mainly. One case died due to epidural hematoma and operative mortality was 0.74%.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.406-411
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• 1992

Thirty-four patients were received bidirectional cavopulmonary shunt[BCPS] from Aug. 1989 to Apr. 1991 at Sejong General Hospital, Puchon, Korea. Their ages were from 43 days to 21 years old with 19 cases of infant, 10 from 1 to 5 years old and 5 cases above 6 years old. Their diagnoses were as follows: 13 cases with uni-ventricular heart, 9 tricuspid atresia, 6 double outlet of right ventricle, 4 pulmonary atresia with intact ventricular septum, and 2 transposition of great arteries with pulmonary stenosis. Among them, 10 patients had received other palliative operations before. The BCPS operations were performed under the cardiopulmonary bypass and 10 patients who had bilateral superior vena cava received bilateral BCPS. Other associated procedures were 9 cases of takedown of Blalock-Taussig shunt, 3 pulmonary artery angioplasty, 1 unifocalization, 1 repair of total anomalous pulmonary venous return, 1 Damus procedure, 1 relief of sub-aortic stenosis, 1 right ventricular outflow tract reconstruction and one case of tricuspid valve obliteration. There were 3 operative deaths[8.8%] and two late deaths. The remainders show good postoperative state and their oxygen saturation was increased significantly. Conclusively, the bidirectional cavopulmonary shunt is very effective and safe palliative or pre-Fontan stage operation for the many complex congenital anomalies with low pulmonary blood flow especially for the patients who have the risk of Fontan repair.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.776-779
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• 2003

An eight-year-old boy was referred to our hospital with cough and high fever. His past medical history included a small sized ventricular septal defect (VSD) at birth. Transthoracic echocardiography disclosed a 10 x 6 mm vegetation on tricuspid valve, a small VSD and the moderate tricuspid valve insufficiency were found. Blood cultures grew methicillin-resistant staphylococcus aureus. Despite proper antibiotic therapy, fever was not controlled and his course was complicated by pulmonary infarction. The patient simultaneously underwent pulmonary resection and open heart surgery. Through the median sternotomy we performed open thrombectomy and lobectomy (right lower lobe) at first, and then vegetectomy, tricuspid valve repair, and direct closure of VSD were done under cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.56-59
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• 2002

The four most common types of congenital malformations involving the right atrium(RA) and the coronary sinus(CS) are congenital enlargement of the RA, single RA diverticulum, multiple diverticula of the RA, and aneurysm of the RA or CS. A previously healthy 6year-old child was presented with signs of upper respiratory tract infection. Chest X-ray and echocardiogram revealed a severely isolated right atrial enlargement. The abnormally dilated right atrim was widely resected under cardiopulmonary bypass. Pathology revealed multifocal myocardial loss associated with mild fibrotic changes of the endocardium and epicardium Our experience on this rare congenital disease is presented along with a review of the literature.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.237-240
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• 2005

Improved operative, anesthetic, and cardiopulmonary bypass (CPB) techniques have significantly reduced postoperative complications; however, neurologic disorders remain a serious complication after open heart surgery. Possible explanations for neurologic complications are microembolism from CPB, decreased cerebral pefusion pressure due to intraoperative hypotension and unexpected metabolic changes. Amomg these, seizure has low incidence and Todd's paralysis after open heart surgery is extremely rare. Todd's paralysis is a complication of a seizure due to neuronal exhaustion mimicking large cerebral infarction after open heart surgery.

• Journal of Chest Surgery
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• v.28 no.9
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• pp.811-816
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• 1995

Repairs of atrial septal defect utilizing cardiopulmonary bypass were performed in 50 adults, ranging age from 16 to 53 years, since April 1986 up to October 1994. They occupied 38.8% of all adult congenital heart disease operated in the same period. Preoperatively, 16 patients were functional class II, 12 patients class III and 4 patients class IV[New York Heart Association Classification , respectively. Five patients combined with atrial fibrillation and the remainders revealed regular sinus rhythm. Cardiac catheterizations were performed in 43 out of 50 patients, and revealed a systolic pulmonary arterial pressure in excess of 51 mmHg in 4 patients but none had reversed shunt. 40 patients[80% were repaired with patch closure and remainings were repaired with direct closure. 49 patients were followed up for 2 months up to 102 months[average 55 months . A comparison of the preoperative and postoperative functional class demonstrated a mean decrease of one NYHA functional level[2.5$\pm$0.63 to 1.4$\pm$0.56 . There was no operative mortality. One patient died during the follow-up period and the death was unrelated to heart disease. Operative treatment is indicated for repair of atrial septal defect with left to right shunt in the adult patient and a considerable clinical improvement can be anticipitated with low mortality.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.209-212
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• 1997

A fifteen-year-old boy was transported to our hospital emmergency room due to sudden onset of chest pain, hemoptysis and dyspnea. He was diagnosed as persistent ductus arteriosus that had developed acute bacterial endocarditis with pulmonic valve vegetation and pulmonary embolism with pulmonary infarction. After conservative antibiotic therapy (vancomycin + aminoglycoside), we operated this patient successfully - patch closer of the ductus and pulmonary valve valvuloplasty - under the cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.205-208
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• 1997

Cardiac rhabdomyomas are the moil common primary tumor in infancy and childhood and are frequently associated with tuberous sclerosis. Although spontaneous regression of cardiac rhabdomyoma has been reported, prognosis of this tumor associated with subaortic stenosis is still considered to be poor and surgery continues to be indicated. A 4-day-old female was admitted due to tachypnea and cyanosis. Single rhabdomyoma arising from the interventricular septum associated with severe subaortic stcnosls as partially removed under cardiopulmonary bypass. Excised tumor sizc was 0.7$\times$0.9$\times$0.4cm in dimension. The postoperative course was uneventful and the infant discharged on the 14th postoperative day.