• Journal of Chest Surgery
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• 제26권3호
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• pp.224-227
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• 1993

We experienced one case of orthotopic cardiac transplantation in a patient with end stage dilated cardiomyopathy. This 50 year-old female recipient was suffered from NYHA functional class IV cardiac failure and dependent upon intravenous inotropic support for 2 months [recipient category 1]. Her preoperative condition was grave with left ventricular ejection fraction of 20% and estimated systolic pulmonary arterial pressure [from Doppler study] was 50mmHg. The brain-dead donor was 31 year-old male with head trauma. The body sizes [weight, height] of the donor/recipient were 70 Kg, 165 cm / 43 Kg, 160 cm and appropriately overmatched. Preoperatively, identical ABO/Rh blood group [A+] and nonreacting HLA crossmatching were confirmed. On November 11 1992 cardiac transplantation was performed without complication. Multiple organ procurement team and heart transplantation team were organized the operation schedule appropriately to minimize the ischemic time. The pump time was 126 minutes and aortic crossclamping time of recipient heart was 73 minutes and, as a result, total ischemic time of the transplanted heart was 75 minutes. Postoperatively, the vital signs were stable with minimal inotropic support. The immunosuppressive therapy was commenced from preoperatively and cyclosporine, azathioprine, and corticosteroid were used as a combination therapy as scheduled and monitored with blood drug concentration, WBC count, renal function and most importantly regular endomyocardial biopsy.Now, 5 months after transplantation, the patient is in NYHA functional class II with minimal cardiac drug support.

• Journal of Chest Surgery
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• 제45권6호
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• pp.390-395
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• 2012

Background: Conventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option. Materials and Methods: From August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared. Results: Although not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed. Conclusion: Compared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.

• Journal of Chest Surgery
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• 제27권4호
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• pp.318-324
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• 1994

Cross-clamping of the descending thoracic aorta results in proximal hypertension,increase in left ventricular afterload,and impairment of distal organ perfusion. Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamping of the thoracic aorta. At Seoul National University Hospital, 7 patients were treated for the thoracic or thoracoabdominal aortic aneurysm using left atrium-femoral artery bypass with Bio-medicus centrifugal pump between October,1989, and January,1993. There were atherosclerotic thoracic aneurysm in 3 cases, thoracoabdominal aortic aneurysm due to chronic aortic dissection in 3 cases,aortic rupture due to trauma in 1 case. Total of 7 patients were operated by graft replacement with reimplantation of important branches. None of these cases developed severe complications and hospital death. We believe that the Bio-Medicus centrifugal pump is a simple and safe means of perfusing the lower body, kidneys, and spinal cord without necessitating heparinization.

• Journal of Chest Surgery
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• 제40권5호
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• pp.376-379
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• 2007

51세 환자가 3개월 전에 심장 자상으로 본원에 입원하여 심장봉합수술을 받았다. 이후 별다른 소견 없이 지내다가 약 2개월 전부터 발생된 호흡곤란을 주소로 내원하였다. 심장초음파상 심한 삼첨판막 페쇄부전이 관찰되었으며 삼첨판막의 건삭치환술과 판윤 성형술을 실시하였다. 이에 저자들은 심장 자상 후에 발생된 삼첨판막 폐쇄부전을 판막성형술로 치료하였기에 증례보고를 하는 바이다.

• Journal of Chest Surgery
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• 제37권1호
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• pp.98-101
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• 2004

복합 국소 동통 증후군은 외상이나 수술을 받았던 환자에게서 수술과 상관없는 사지 말단 부위의 동통, 이상 통증과 피부 온도, 색깔과 일치하지 않는 혈관 운동 이상, 발한 이상, 운동 장애와 위축이 나타나는 경우를 말한다. 말초나 중추에 있는 통증 수용체의 catecholamine에 대한 민감도가 증가되어 생기며 적외선 체열 검사를 통해 온도 차이를 확인하면 진단할 수 있으며 치료는 통증을 덜어주기 위한 치료와 장애가 있는 팔이나 다리의 기능 회복을 위한 재활 치료를 병행한다. 16세 남자에게서 수술 후 통증으로 야기된 수술 외 국소 부위에 생겨난 복합 국소 동통 증후군을 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제16권2호
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• pp.175-183
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• 1983

Ventricular aneurysm which was first described by John Hunter on 18th century, has been experienced by many surgeons after successful using of cardiopulmonary bypass by Cooley on 1958. According to Gorlin, the definition of ventricular aneyrysm is portion of the ventricle which is not motile at systole (akinesis) or which has paradoxical dilatation at systole(dyskinesis). The ventricular aneurysm is classified to anatomical and functional. The anatomical ventricular aneurysm is devided into true or false again. Average age incidence is ranged from 49 to 60 and male predominance is reported. The cause is ischemic coronary artery disease in almost cases but hypertropoc cardiomyopathy, congenital abscence of myocardium, complication after mitral valvular replacement and trauma may also cause the ventricular aneurysm. Angina pectoris and congestive heart failure are most common clinical manifestations Ventricular tachycardia and systemic embolization are also complained. Using cardiopulmonary bypass, aneurysmectomy alone or combination with coronary artery revasculization are currently done for surgical treatment with steady improvenment of mortality. The first patient was 33 years old man who had true type of ventricular aneurysm on inferior wall the left ventricle near apex with protruded huge organized thrombus. The thromboembolic phenomenon was noted on both lower extremities. Under cardiopulmonary bypass, aneurysmectomy and thrombectomy were done. The aneurysmal orifice was repaired with Teflon buttless suture. The second patient was 30 years old female who had large true type of ventricular aneurysm on inferior wall of the left ventricle. Under cardiopulmonary bypass, aneurysmectomy with repair of aneurysmmal orifice defect by means of double layered Dacron patch was done with reinforce by outer silastic sheet covering. She was discharged from hospoital at post op. 15th day uneventfully.

• Journal of Chest Surgery
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• 제19권3호
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• pp.412-420
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• 1986

From 1968 through September 1986, the authors have experienced 34 cases of peripheral arterial surgery using various vascular grafts. Almost all patients [32] were men, and age distribution was variable according to the disease entities. There were twenty eight cases of chronic occlusive peripheral vascular disease including ASO [21], Buerger`s disease [6], Aortoenteric fistula complicating infrarenal abdominal aortic aneurysm [1], four cases of vascular trauma, one case of acute arterial embolism [1] and one case of unknown etiology. The indications of operations for chronic vascular disease was intermittent claudication in 48%, rest pain in 45%, ischemic pregangrene or gangrene in 28%, and sensory change in 10% of patients. Types of operation used were arterial bypass in 28 cases [Aortobifemoral in 5, Aortoiliac in 3, Aortofemoral in 4, Aortoiliac with Aortofemoral in 1, Femorofemoral in 1, Femoropopliteal in 8, Femoroperoneal in 2, Axillofemoral in 3 cases of patients], graft interposition in four and patch angioplasty in three cases. Thirty four prosthetic vascular grafts including Dacron, Gore-Tex, Nylon and two autogenous saphenous vein graft and patch were used for vascular reconstruction in thirty four patients. Unfortunately recently performed one vein bypass was failed immediate postoperatively due to severity of disease and poor case selection. The authors experienced five post operative complications: wound infection [1], graft infection [1], bleeding [1], great saphenous neuralgia [1], pseudoaneurysm [1]. Twenty two of thirty four patients were followed up for more than one month and their cumulative patency rate was 81% [17/22] at 1 month and, 31% [7/22] at 5 month.

• Journal of Chest Surgery
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• 제29권5호
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• pp.569-572
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• 1996

69세 남자 환자가 운동성 호흡곤란으로 입원하였다. 폐관류 스캔에서 좌측폐의 완전 환류결손을 보 였고, 컴퓨터 단층 촬영 혈관조영술에서는 좌측폐동맥의 급작스러운 혈류차단의 소견이 나타났다. 환자 는 외상이나 하지의 이상 증상 그리고 색전증등의 과거력은 없었다. 원인 불명의 만성 폐색전증이라는 진단 하11 흥골 정중절개후 체외순환하에서 주폐동맥을 차단하고, 폐동맥을 절개한 후 색전재거술을 시 행하였다. 술후 폐관류 스캔과 컴퓨터 단층 촬영 혈관조영술에서 거의 정상적인 좌측 폐동맥의 환류가 관찰되 었다. 환자는 별다른 합병증 없이 술후 9일째 퇴원하였다.

• The Korean Journal of Pain
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• 제6권1호
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• pp.109-116
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• 1993

In March of l992, We performed two intentional total spinal blocks for the relief of pain. This was for 2 cases of post-traumatic cervical syndrome whose various symptoms were chronically unresponsive to the usual conservative treatments. We regularly checked the blood pressure, pulse rate, oxygen saturation and observed clinically the changes of respiration, consciousness, lid and light reflexes during the total spinal block. Pain relief was evaluated by using the Visual Analog Scale which is designed to measure the subjective intensity of pain. The results were as follows; 1) The effectiveness of total spinal block was 60% in case 1, 40% in case 2. 2) We observed two complications from the procedure. Firstly during the block, these were transient periods of hypotension. Following the block, accidental procedures related direct neural trauma resulted in anterior chest wall pain. In conclusion we believe that total spinal block is a satisfactory and reliable method for the treatment of post-traumatic cervical syndrome.

• 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.