• Journal of Chest Surgery
• /
• 제39권12호
• /
• pp.906-912
• /
• 2006

배경: 급성 심근경색 후 발생하는 심실중격결손은 드문 치명적인 합병증이다. 수술만이 유일한 치료법이나, 그 수술사망률은 아직도 높다. 저자들은 수술 환자들의 수술 결과와 조기사망의 원인을 알아보았다. 대상 및 방법: 1993년 8월부터 2006년 2월까지 급성 심근경색 후 발생한 심실중격결손 환자 8예(남 2예, 여 6예)를 수술하였다. 그중 7예가 좌전하행지의 단혈관질환을 가지고 있었고, 6예는 전중격뿐만이 아니라 후중격까지 넓은 경색을 가지고 있었다. 1예에서 경색과 무관한 관상동맥우회술을 시행하였으며 2예에서 삼첨판 성형술을, 1예에서 승모판 성형술을 같이 시행하였다. 결과: 수술 사망은 3예(37.5%)였다. 사망 환자들은 모두 경색의 범위가 심실의 전중격뿐만이 아니라 후중격까지 넓게 퍼져 있었고 초음파 M-mode 검사에서 좌심실 기저부의 박출률이 생존자들보다 상대적으로 낮았다($34.9{\pm}4.2\;vs.\;54.8{\pm}12.3$; p=0.036). 결론: 심근경색증에 의한 급성 심실중격결손은 대부분 단혈관질환에서 발생하였다. 심장초음파 검사상 좌심실 기저부의 박출률이 낮고 심실중격의 경색 범위가 넓어 후중격까지 진행된 환자에서 조기 사망률이 높았다.

• Journal of Chest Surgery
• /
• 제37권5호
• /
• pp.448-451
• /
• 2004

개심술 후 폐색전증을 동반한 우심방 혈전의 발생 예는 매우 드물다. 10개월 전 심방중격결손 수술을 받았던 54세 여자 환자가 좌측 흉막통과 호흡곤란을 주소로 응급실에 내원하였다. 폐관류주사 검사에서 다발성 분절성 관류 결손 소견을 보였고 경식도 초음파 검사에서 우심방 벽에 위치하는 크고 줄기가 있는 움직이는 종괴가 발견되었다. 헤파린 치료 시작 13일 후 시행한 심초음파 검사에서 크기가 전혀 줄어들지 않아 개심술하에 종괴를 제거하였다. 병리 소견에서 우심방 기질성 혈전으로 밝혀졌고, 수술 후 환자는 별 문제 없이 회복되었으며 퇴원 후 와파린 치료를 받고 있다.

• Journal of Chest Surgery
• /
• 제23권5호
• /
• pp.962-967
• /
• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
• /
• 제18권3호
• /
• pp.474-481
• /
• 1985

Pulmonary cavity is the result of necrosis of lung parenchyma with evacuation of the necrotic material via the tracheobronchial tree. A communication with the tracheobronchial tree permits air to enter the area of necrosis, so the radiologic result show the a lucent defect. The radiologic characteristics of the wall of a cavity are determined by the reaction of the lung parenchyma to the pathologic process. Therefore, the shadows of the chest films in cavitary lesion were variable in its nature. The author, in 42 cases which have a cavitary lesion in X-ray findings among 172 cases resected lung obtained in P.N.U.H. from 1979 to June, 1985, studied similarities and differences between the pathogenesis of these lesions and the radiologic findings. The author reviewed the 42 cavitary lesions and the following results were obtained. 1. The cavitary lesions were seen in 42 [24.4%] out of 172 cases of resected lung disease. 2. Histopathologically, pulmonary tuberculosis was 47.6% and primary lung cancer was 9.5%. 3. The most common site of the lesion was right upper lobe. 4. The most common size of the cavity was from 3 to 6 cm in diameter. 5. Lobectomy was the most common operated method.

• Journal of Chest Surgery
• /
• 제12권3호
• /
• pp.174-182
• /
• 1979

This is a report on four cases of successful surgical correction of coarctation of the aorta [COA] in Department of the Thoracic & Cardiovascular Surgery, Hanyang University Hospital. The first case was a postductal type of coarctation of the aorta associated with Patent ductus arteriosus [PDA], Persistent left superior vena cava [LSVC] and richly developed collateral circulation. Blood pressure was measured to be hypertensive at the arm, but hypotensive at the legs. The coarctation of the aorta was corrected with following procedure: Partial resection of the aortic wall with diaphragmatic structure lust above and below the coarctating line of the aorta, and then the defect of the aortic wall was closed by lateral aortographic suture. PDA was closed by ligation procedure. The second case a preductal type of coarctation of the aorta associated with PDA, LSVC, ventricular septal defect [VSD] and poorly developed collateral circulation. Normal blood pressure was measured at the arm, but hypotension was observed at the legs. Correction of coarctation of the aorta was performed under the establishment of tube bypass because of poor collateral circulation. After resection of coarctating short segment, end to end anastomosis was performed without any tension. PDA was closed by division procedure. Simple suture closure of VSD was performed by open heart surgery two weeks after correction of COA. The third case was a long segment COA without any other anomaly. Blood pressure was measured to be hypertensive at the arm, but hypotensive at the legs. Vascular prosthesis was performed using Teflon graft tube after resecting coarctating long segment [6.5 cm] of the aorta. The fourth case was a long segment COA associated with aortic insufficiency and richly developed collateral circulation. Normal blood pressure was measured at the arm, but hypotension was observed at the legs. Vascular prosthesis was performed using Teflon graft tube after resecting coarctating long segment [6.0 cm] of the aorta. Both blood pressure and peripheral pulse on the arm and the legs returned to normal postoperatively in all patients.

• Journal of Chest Surgery
• /
• 제39권8호
• /
• pp.637-639
• /
• 2006

심장 내 점액종은 심장에 발생하는 원발성 종양 중 가장 흔하지만, 우심실 유출로 협착을 유발하는 점액종은 비교적 드물다. 15세 여자 환자가 운동 시 호흡 곤란 및 간헐적인 의식 소실을 주소로 내원하였고, 심초음파상 우심실 유출로를 거의 폐쇄하는 $3.6{\times}3.0\;cm$ 크기의 종괴가 발견되어 응급수술이 시행되었다. 우심실 종괴가 폐동맥 직하 부위의 우심실 전벽으로부터 기시하고 있음을 확인하고, 종괴 기시 부위 주위의 우심실 전벽을 광범위하게 절제하면서 종괴를 제거하였고 우심실 전벽의 결손은 Gore-Tex 포편 봉합하였다. 병리학적 검사상 우심실에 발생한 점액종으로 진단되었으며, 환자는 특별한 문제없이 술 후 7일째 퇴원하였다.

• Journal of Chest Surgery
• /
• 제7권1호
• /
• pp.93-100
• /
• 1974

This is a case report of successful surgical correction of coarctation of the aorta associated with the patent ductus arteriosus and the persistent left superior vena cava. The patient was a 15 year old girl and congenital heart anomaly was suspected at the sixth month after birth. Afterward there has been no embarrassing symptoms until the day of operation except slight dyspnea on exertion, The diagnosis of coarctation of the aorta and the patent ductus arteriesus detected by physical signs and X-ray studies including aortography. In the first place, coarctation of the aorta was corrected with following procedure: partial resections of the aortic wall just above and below the coarctating line of the aorta and removal of diaphragmatic structure of coarctation performed by. cross clamping aorta above and below coarctation, and then the defect of the aortic wall was closed by lateral aortorrhapic suture with atraumatic needle 3-0 silk continuously [Fig. 6]. In the second place, the patent ductus arteriosus was closed with double ligation method. The persistent left superior vena cava left as it has been, because there has been no evidence of hemodynamic abnormal shunt. After operation, excellent result was obtained; blood pressure in the upper and lower extremities was normalized and subjective complains of hypertension in the upper extremity was disappeared.

• Journal of Chest Surgery
• /
• 제16권2호
• /
• pp.175-183
• /
• 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
• /
• 제9권2호
• /
• pp.311-314
• /
• 1976

This is a report of leiomyoma in the esophagus. patient had suffered from mild intermittent dysphagia on eating without any other complaints. This complaint had been going for 45 days, but was not progressed. The esophagogram revealed an ovoid walnut-sized smooth filling defect in the midportion of the esophagus. The mucosal folds of the esophagus were not destroyed. A benign intramural tumor of the esophagus, such as leiomyoma, was suspected with X-ray finding and clinical features. On Aug. 13, 1976 a thoracotomy was performed at right 4th intercostal space. A firm, irregular shaped mass in the wall of the esophagus was enucleated by blunt dissection without any injury of the mucosa of the esophagus. The diagnosis of leiomyoma was confirmed with histopathological finding. Postoperative course was uneventful.

• Journal of Chest Surgery
• /
• 제18권2호
• /
• pp.360-370
• /
• 1985

A case of complete interruption of aortic arch with aortopulmonary window, patent ductus arteriosus, and aberrantly originated right subclavian artery from proximal descending aorta, in a four year old boy is reported in detail. This is the only reported case in Korea, who has had a successful one-stage total anatomical correction of this combination of defects. Under deep hypothermia and total circulatory arrest, aortic continuity was established using patent ductus arteriosus and anterior wall of pulmonary artery, which was anastomosed obliquely to anteromedial side of ascending aorta. Aortopulmonary window was closed using Impra patch via pulmonary arteriotomy. Then pulmonary arteriotomy was reconstructed primarily except at the junction of right pulmonary artery and main pulmonary artery, where a small piece of pericardium was used to close the defect to prevent kinking and narrowing of right pulmonary artery. Postoperative cardiac catheterization demonstrated a good reconstruction.