• Journal of Chest Surgery
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• 제25권12호
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1404-1415
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• 1992

To understand the factors influencing Atrial fibrillation and embolism in mitral valve surgery and prevent their risk, we have reviewed our 324 patients who underwent mitral valve surgery from Fev. 1982 to May 1992. Age, disease duration, lesion type, left ventricular function and left atrial dimension were chosen as preoperative factors influencing the incidence of atrial fibrillation and embolism and their postoperative course, The number and type of replaced valve, site of atriotmy, LA obliteration, ACT and use of Defibrillator were chaser. as operative factors influencing postoperative rhythm change and postop emb-olization. The results of analyses were as follows 1. The incidence of preoperative atrial fibrillation, systemic embolism and LA throbmus was 63. 6%, 10.56% and 19.8% relatively. 2. The preoperative factors of atrial fibrillation onset was old age, prolonged symptom duration, stenotic lesion, lager LAD and lower ejection fraction. In the preoperative systemic embolism preoperative factors were old age, female, stenotic lesion. The left atrial thrombus found more commonly in patients with atrial fibrillation, old age, prolonged symptom duration, stenotic lesion and low ejection fraction. 3. The preoperative atrial fibriation persisted postoperatively in 165[50.9%] and converted to normal sinus rhythm in 50[15.4%]. The preoperative normal sinus rhythm per-eisted in 100[31%] and atrial fibrillation was occured postoperatively in 9[2.7%]. The prolonged symptom duration was the preoperative factor of persist atrial fibrillation. 4. Among 95 long term follow-up patients, atiral fibrillation was continued in 59[60%]. Conversion to normal sinus rhythm was more common significantly in left atriotomy and bileaflet valve replacement. 5. There were 12 patients who had postoperative embolism. Female, persist atrial fibrillation, no LA olbiteration and tilting disc monocusp valve were considered as possible factors influencing postoperative embolism but was impossible to analyse their statistical significance due to small sample size. So we have concluded that the patients with above risk factors need anticoagulant and early surgical intervention. Left atriotomy with minimal atrial injury, left auricular obliteration and bileaflet valve replacement may be needed to reduce postoperative atrial fibrillation persist and embolism.

• Journal of Chest Surgery
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• 제22권2호
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• pp.256-264
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• 1989

Modified Blalock-Taussig operation remains the standard technique of systemic-to-pulmonary artery shunt in patients of congenital heart disease with decreased pulmonary blood flow. We reviewed the 41 patients who had been performed modified Blalock-Taussig operation from March 1985 to Feb. 1988, and angiographically measured pulmonary artery size before and after shunt, and calculated pulmonary artery index [PAI] and ratio of left and right pulmonary artery to descending aorta[[LPA+RPA]/dAo]. The mean duration of palliation after shunt operation was 624 days and mean age of the patient at shunt operation was 3.59 years. Mean PAI increased significantly from 131.15*67.11 mm2/M2 preoperatively to 232.70*84.46 mm2/M2 postoperatively. Mean ratio of right and left pulmonary artery to descending aorta also increased significantly from 1.48*0.40 preoperatively to 1.92*0.50 postoperatively. All patients manifested clinical improvement; there was mean decrease in hematocrit of 8.95%, mean increase in arterial oxygen saturation of 11.08%. Pulmonary arterial growth was not influenced by age at operation, initial pulmonary artery size, or graft size, but significantly influenced by antegrade flow. The patients who have some antegrade flow were in more increase of PAI. There were no linear correlation between change of PAI, change of [[LPA+RPA]/dAo], SaO2, and duration. But, according to Scatterplot between change of PAI and duration, some complex correlation was suggested and mean PAI was decreased after 2-year palliation. We concluded that modified Blalock-Taussig operation is excellent palliative surgery for pulmonary artery growth especially on the patient who have some antegrade flow, and the proper duration of palliation was about 2 years.

• Journal of Chest Surgery
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• 제24권1호
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• pp.15-25
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• 1991

From February 1988 to December 1990, 42 patients underwent so called REV operation for pulmonary stenosis or atresia with or without anomalies of ventriculoarterial connection and truncus arteriosus. The principles of operative technique are mobilization of pulmonary arterial tree beyond the pericardial reflection, transection of pulmonary trunk between the pulmonary ventricle and pulmonary artery, suture of distal pulmonary arterial stump to the upper margin of Pulmonary ventriculotomy site with absorbable suture, and anterior patch with 0.625% glutaraldehyde fixed autologous pericardium with monocusp inside it. Age at operation ranged 3-156months [mean 41.8 month] with twelve of whom infants. Operative indications were pulmonary atresia, with ventricular septal defect[16], and pulmonary stenosis with double outlet right ventricle[8], with ventricular septal defect[16], with double outlet right ventricle[8], with complete transposition of the great arteries[8], with corrected transposition of the great arteries[6], with Fallot`s tetralogy[3], and truncus arteriosus[1]. There were six hospital deaths[14%] and no late death. Twenty-four of 36 survivals were followed up more than 12 months with good clinical results. Postoperative angiocardiogram was performed in fifteen patients. Hemodynamically, two patents had residual pressure gradients along the pulmonary outflow tract, one patient showed severe pulmonary regurgitation; morphologically, there were six significant stenosis of left pulmonary arterial tree, two of whom showed significant pressure gradients. Our present experience with REV operation suggests that this technique make it possible to perform anatomic repair in a wide variety of congenital anomalies of abnormal ventriculoarterial connection associated with pulmonary outflow tract obstruction without using the prosthetic material, even in infants, with relatively low mortality and morbidity.

• Journal of Chest Surgery
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• 제27권12호
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• pp.989-994
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• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.

• Journal of Chest Surgery
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• 제36권1호
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• pp.51-54
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• 2003

환자는 53세 남자로 식도 정맥류 파열로 Sengstaken-Blaceore관을 삽관하였다. Sengstaken-Blaccore관 삽관 이틀 후 좌측에 혈흉이 생겨 본원으로 전원되었다. 식도내시경 소견상 길이 8cm에 이르는 거대 흉부 식도 파열이 관찰되었다. 반복되는 식도 정맥류 출혈과 전신 상태의 악화 등으로 좌측 개흉술을 식도 파열 후 33 일째에 실시하였다 좌측 농흉과 8cm크기의 위아래로 파열된 식도를 관찰할 수 있었다. 파열부위는 변연절제 후 단순 봉합하고, 파열된 식도 부위의 위 아래 경계부위에서 각각 2cm 거리를 두고 비흡수성 스테플러(TA stapler 60 H 4.8)를 이용하여 배제시킨 뒤 흉관을 위치시켰다. 흉부 식도 배제술 6일 후 실시한 식도 조영술에서 위쪽 스테플링한 부위와 연하여 누출이 관찰되었다. 경부식도 배제술을 같은 방법으로 실시하였다. 환자는 파열된 흉부 식도 배제술 137일 후, 이차적인 식도 재건술없이 경구로 음식의 섭취가 가능하였다.

• Journal of Chest Surgery
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• 제33권4호
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• pp.277-284
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• 2000

Background: Coronary artery bypases grafting in the old aged is associated with high mortality and morbidity, and it is difficult to perform if the coronary artery is diffusely disease. Recently it has been known that platelet derived growth factor(PDGF), especially PDGF-BB, stimulates angiogenesis. Material and Method: New Zealand white rabbit were used. In an attempt to achieve effevtive cardiac revasculatrization without vascular anastmosis, we divided into three groups(group I : Left anterior descending artery(LAD) was occluded by ligature, group II : Bilateral internal mammary vascular pedicles were dissected and implanted into myocardium, group III : The vascular pedicles were implanted into myocardium and PDGF-BB was injected into the myocardial tissue). Two weeks after IMA implantation, the proximal region of implanted LAD was ligated. Four days after LAD ligation angiogram, triphenyl tetrazolium chloride(TTD) staining and hematoxylin eosin staining were performed. Result: 1. Survival rate in group II was significantly higher than that in group I (P<0.05), and survival rate in group III was signficantly higher than that in group II(53% vs 93%, P<0.01). 2. There were significant differences in the ratio of area of necrosis to area at risk between group I and group II, and between group II and group III (P<0.01). 3. Microangiogram for angiogenic response revealed wide area of extensive revascularization with patent vessels in group III. 4. Histologic findings of three groups showed that polymorphonuclear leukocyte infiltration was minimal in group II and none in group III. Conclusion: PDGF-BB can establish functinal cardiac revasculatization through systemic vessels implanted directly into the myocardium.

• Journal of Chest Surgery
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• 제30권1호
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• pp.88-91
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• 1997

복잡 심 기 형을 동반한 선천성 기관협착증은 일반적으로 치명적 인 질환으로 간주되고 있다. 본 논문에서는 수술전에 예상하지 못한 선천성 기도 협착을 동반한 복잡 심기형 환자에서, 체외순환하에 동시 교정술을 성공리에 수행하였기에 보고하고자 한다. 환아는 3개월된 여자로 대동맥 교약증, 심실중격결손증 및 동맥관 개존증의 진단으로 전신마취 유도 후 예상치 못한 기관내 삽관의 어려움으로 선천성 기도협착이 있음을 알게 되었고, 자가심낭을 이용한 전방 기관 성형술 및 대동맥 교약증, 심실중격결손증 및 동맥관개존증의 일차 완전 교정술을 체외순환 하에 동시에 시행하게 되었다. 환아는 술후 2년 1개월이 지난 현재 합병증의 증상없이 순조로운 술후경과를 보이고 있다.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1214-1218
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• 1997

폐전이 골 연부조직 육종에 대한 폐절제 및 합병치료의 성적을 분석하였다. 1986년부터 1996년까지 14례 (남자 11례, 여자 3례)에서 15회의 폐절제술을 시행하였는데, 1례에서는 폐전이 육종의 재발로 2회의 폐절제술을 시행하였다. 절제된 폐전이 육종의 수는 1∼5개였다. 폐전이 육종의 병리조직학적 소견상 4례는 골육종 이었으며, 10례는 연부조직 육종이었다 폐절제술후 평균 생존기간은 29.2개월이었으며, Kaplan-Meier식에 의 한 5년생존율은 33.2%였다. 14례중 3례의 종양 자유기간이 3년이상으로 평균 생존기간은 52.6개월이었으며, 3년 이하의 11례는 추적기간중 모두 사망하여 이들의 평균 생존기간은 17.3개월이었다. 결론적으로 폐전이 육종에 대한 폐절제술은 뚜렷한 수명 연장 효과가 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1107-1112
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• 1995

Between December 1993 and December 1994, fifty-eight percent of the mitral valve patients[33/57 had undergone mitral valve repair. Their mean age was 49[SD-16 years[range 11 - 75 and they were consisted with 15 males and 18 females. The causes of mitral disease in 33 patients were classified as follows: 19 cases[58% were degenerative, 9[27% were rheumatic, 3[9% were congenital and 2[6% were infectious. Carpentier`s functional classification was consisted with Class I 4 cases[12% , II 25 [76% and III 4 [12% . Surgical techniques included prosthetic annuloplasty in 32 cases[97% , leaflet resection in 16[48% , chorda shortening in 13[39% , chorda transfer in 9[27% , new chorda formation in 7[21% , commissurotomy in 7[21% , leaflet mobilization in 4[12% , chorda resection in 3[9% , papillary muscle splitting in 2[6% , cleft repair in 2[6% , leaflet patching in 1[3% and vegetation removal in 1[3% . Average number of mitral anatomical lesions per patient was 3.3 and We used average 3.0 procedures upon mitral valve apparatus per patient. Intraoperative transesophageal echocardiography was carried out in 27 patients[82% for providing an immediate and accurate assessment of the adequacy of the reconstruction before closure of the chest. Operative mortality was absent. The mean functional class[NYHA was 2.87 preoperative and improved to 1.03 postoperatively. Postoperative Doppler echocardiography showed much improvement from grade II MR[5 , grade III[5 , grade IV[21 to no MR[26 , only trace MR[3 , grade III MR[2 . Postoperative mean mitral valve area was 2.4$\pm$0.6cm2[range 1.5 - 4.0 . We conclude that cautiously evaluated mitral valve reconstruction is stable and predictable operation with minimal postoperative left ventricular dysfunction.