• Journal of Chest Surgery
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• 제26권12호
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• pp.904-908
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• 1993

Twelve patients had undergone repair of atrioventricular septal defects. Age at operation ranged from 2.4 years to 17 years[mean, 8.25 years]. Five patients were male and seven were female. Three patients had complete atrioventricular septal defect[Rastelli type A] associated with Down`s syndrome. One of the three patient with complete atrioventricular septal defect had tetralogy of Fallot. Three patients had the intermediate form and seven patients had the partial form. The primum atrial septal defect was closed with pericardial patch. The atrioventricular valve septal commissure[mitral cleft] was closed with pledgeted sutures. Three complete atrioventricular septal defect were undergone by two-patch technique. A crescent-shaped Dacron patch was used to occlude the ventricular septal defect. One patient of partial form was sudden death 5 days postoperatively. There were no another complications after surgery. One patient underwent reoperation for opened mitral cleft 2.5 years postoperatively. New York Heart Association functional class of patients was improved postoperatively.

• Journal of Chest Surgery
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• 제22권6호
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• pp.990-995
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• 1989

Since 1984, 24 patients underwent repair of atrioventricular septal defect. Nineteen had a partial defect and 5 had a complete atrioventricular septal defect. There were 9 men and 15 women, ranging in age from 1 to 50 years [mean age, 13.3 years]. Four patients had a Downs syndrome. Additional congenital heart defects were present in 11 patients. One patient had palliative operation prior to total correction. In partial defects, the primum atrial septal defect was closed with Xenomedica patch and the mitral valve was repaired with simple closure of the septal commissure. Central incompetence from annular dilatation was repaired by a local annuloplasty. In complete defect, the septal defects were closed with two patches except one. Operative mortality was 5% in partial defects and 60% in complete defects and low cardiac output was the commonest etiology. In a mean follow-up period of 27.9 months [range, 4 to 63 months] there were no late death and no instances of late-onset complete heart block. One patient required reoperation [MVR] for residual mitral regurgitation. The majority of patients were asymptomatic and mean postop. NYHA functional class was 1.2.

• Journal of Chest Surgery
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• 제35권6호
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• pp.460-462
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• 2002

본 저자들은 활로씨 4징증을 동반한 완전방실중격결손 환자에서 완전교정수술을 시행하였다. 술전 검사로 심초음파, 심도자검사, 심조영술을 시행하였다. 수술은 체외순환을 시행하여 두 개의 첩제를 이용하여 방실중격결손을 폐쇄하였고, 우심실절개와 폐동맥판교련술을 통해 우심실 누두부 절제술과 경판륜 첩제를 사용하여 우심실유출로 확장술을 시행하였다. 술후 시행한 초음파 검사상 경도의 승모판과 삼첨판의 폐쇄부전이 나타났으나 혈역학적 이상소견은 없었다.

• Journal of Chest Surgery
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• 제25권8호
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• pp.832-836
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• 1992

A 25-month-old patient with complete atrioventricular septal defect and Tetralogy of Fallot underwent repair of both anomalies. The diagnosis was established preoperatively by 2D-echocardiography, cardiac catheterization and cardioangiogram, Repair was accomplished using cardiopulmonary bypass and profound hypothermia to 18C, Closing of the atrioventricular septal defect was achieved with the use of two Dacron patchs by an atrial approach alone. Infundibulectomy and outflow tract reconstruction with the transannular pericadial patch containing a monocusp were performed. Upon the postoperative evaluation by 2D-echocardiography, mitral regurgitation was absent, but a tiny dehiscence of ventricular patch and minimal tricuspid regurgitation were noticed.

• Journal of Chest Surgery
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• 제23권1호
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• pp.41-48
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• 1990

Thirteen patients underwent repair of atrioventricular septal defect [AVSD] from January 1980 to July 1989 at Kyungpook National University Hospital. Two patients had complete AVSD [Rastelli type A] and eleven patients had partial AVSD [ostium primum atrial septal defect and cleft of anterior mitral leaflet]. In all the patients of partial AVSD, atrial septal defect was closed with Dacron patch and the mitral cleft was approximated with interrupted simple sutures. In one patient of complete AVSD, one patch technique was used to close the atrial and ventricular septal defect, and in the other patient of complete AVSD, two patch technique was used. In six patients, there were associated anomalies; four had isolated ostium secundum ASD, two had patent foramen ovale. Postoperative complete A-V block was noted in a patient of partial AVSD, but it was returned to 1st degree A-V block 30 months later and in another case of partial AVSD, severe congestive heart failure [NYHA functional class IV] due to residual mitral insufficiency was developed postoperatively, but this patient was recovered to the state of functional class I after receiving mitral valve replacement. There was one hospital death [8 %] resulting from low cardiac output.

• Journal of Chest Surgery
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• 제31권9호
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• pp.899-902
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• 1998

최근들어 완전방실중격결손에 대한 해부학적 이해의 증가로 새로운 방법에 의한 교정이 시도되고 있다. 본 부천세종병원 흉부외과에서는 완전방실중격결손환자 2명을 대상으로 기존의 통상적인 수술방법을 간소화 하여 심실중격부위의 큰 결손을 포편을 사용하지 않고 직접봉합해 주었다. 수술후 두 환자 모두 양호한 경과를 보였으며 3개월 까지의 외래 추적에서도 별다른 문제가 없었다. 비록 이렇게 간소화된 수술방법으로 통상적인 교정방법에 필적 할 만한 단기성적을 2 례에서 얻을 수 있었으나 좌심실유출로 협착이나 판막 기능의 장애없이 방실중격결손환자에게 적용될 수 있을 지에 대해서는 좀더 많은 경험과 장기 추적이 요구된다고 하겠다.

• Journal of Chest Surgery
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• 제32권7호
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• pp.628-636
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• 1999

배경: 최근에 완전방실중격결손의 해부학적 구조에 대한 이해가 증가됨에 따라서 본원에서는 수술방법에 있 어서 여러 가지 변형을 시도하게 되었다. 대상 및 방법: 1997년 5월부터 1998년 7월까지 8명의 완전방실중 격결손 환자를 수술하였다. 남녀 각각 3명, 5명이었으며 나이는 2개월에서 28개월까지 분포하였고 평균 몸무 게는 6.0$\pm$2.2 Kg이었다. 심장의 해부학적 구조에 따라서 3명의 환아에서는 심실중격결손을 일차적으로 봉합 하여 수술을 단순화하였다(Group I). 좌심실유출로 협착의 가능성이 있는 2명의 경우에는 통상적인 방법대로 2개의 포편을 이용하였다(Group II). 그리고 불균형 완전방실중격결손의 경우에는 심실중격결손을 막는 포편 을 우심실에 치우쳐서 막고 심방중격을 새로 만들거나 좌측 방실판막의 부족한 판막부위를 자가 심낭막으로 메꾸어 주거나 좌측 방실판막이 parachute valve 인 경우에는 2개의 판막입구를 만들어 주었다(Group III). 결과: 모든 환자가 수술후 만족스러운 혈류역학을 보였으며 7명에서는 평균 3$\pm$1 일만에 인공호흡기 이탈이 가능하였으며 1명의 환자는 심장의 문제없이 폐질환으로 24일만에 인공호흡기를 이탈하였다. 수술후 합병증 으로 III군에서 판막성형을 시행한 좌측 판막이 찢어지면서 판막역류가 점진적으로 심해진 1명에서 2주만에 재수술을 하였다. 조기 및 만기사망은 없었으며 수술후 심장초음파검사에서 약간의 좌측 방실판막협착이 III 군에서 1명 있었으며(평균압력차 6.5 mmHg), 좌측 방실판막역류가 7명(87.5 %)의 환아에서 Grade I 이하였으 며, 우측 방실판막역류는 모든 환아에서 Grade I 이하였다. 결론: 완전방실중격결손의 수술시 해부학적인 구 조에 따라서 선택적으로 일부 환아에서는 심실중격결손을 일차적으로 봉합함으로써 수술을 단순화할 수 있 으며 우심실이 발달된 불균형 완전방실중격결손에서도 변형수술방법을 통하여 양심실성 교정을 하여 좋은 결과를 얻을 수 있었다.

• Journal of Chest Surgery
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• 제20권4호
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• pp.760-764
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• 1987

Fifty seven patients underwent repair of a partial atrioventricular septal defect from January 1980 to December 1986. The ostium primum atrial septal defect was closed with autologous or bovine pericardium. The cleft in the anterior mitral leaflet was present in 53 cases, absent in 4 cases. Of the 53 cases with a cleft in the anterior mitral leaflet, 48 received suture repair of the cleft, 3 received mitral valve replacement. There was no hospital death and all the patients were followed-up for a mean period of 26.4 months. Four required permanent pacemaker implantation due to complete heart block, and one of them died of sudden malfunction of pacemaker. Two received reoperation due to significant residual mitral insufficiency. Suture repair of the cleft in the anterior mitral leaflet resulted in significant decrease in degree of mitral regurgitation. During follow-up period 49 patients were in NYHA class I, 7 patients were in NYHA class II. This report suggests that excellent result can be achieved from repair of the partial atrioventricular septal defect by managing the left A-V valve as a bileaflet structure.

• Journal of Chest Surgery
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• 제51권5호
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• pp.356-359
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• 2018

We report a case of successful repair of truncus arteriosus (TA) associated with complete atrioventricular septal defect (c-AVSD) using a staged approach. TA associated with c-AVSD is a very rare congenital cardiac anomaly. No report of successful staged repair in South Korea has yet been published. We performed bilateral pulmonary artery banding when the patient was 33 days old, and total correction using an extracardiac conduit was performed at the age of 18 months. The patient recovered uneventfully and is doing well.

• Journal of Chest Surgery
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• 제27권11호
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• pp.902-906
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• 1994

Between May 1991 and August 1993, 16 patients underwent repair of complete atrioventricular septal defect without another major anomaly at Cardiovascular Center,Yonsei University College of Medicine. Ages of the patients ranged from 3 months to 38 years with a mean of 42 months. Among 16, 10 patients[63%] are associated with Down`s syndrome. All patients underwent primary repair except and one who received had been repaire of coactation of aorta and patent ductus arteriosus 2 month before. Preoperative mitral valve regurgitation [MR] was evaluated with Doppler echocardiography and angiography which revealed absent or grade I in 1, grade II in 8, grade III in 4, and grade IV in 3. Operative technique was performed under the moderate hypothermic cardiopulmonary bypass with crystalloid cardioplegia. Intraoperative echocardiography was performed epicardial approach [n=7] in the operative table or transthoracic approach [n=9] at intensive care unit. In all patients except 3, MR were improved. But in 3 patients, was not improved or exagerated comparing preoperative one. All of them were died.One patient was showed MR grade IV in intraoperative echocardiography, we re-repaired atriventricular valve with cardiopulmonary bypass. During follow-up period [at a mean of 11 months after repair], doppler echocardiography was performed in all patients. The follow up echocardiography revealed that the degree of MR in immediate postoperative period was not changed except in two patients in whom it was aggravated. Thus it seems that intraoperative and early postoperative echocardiography was employed important role of survival and can be predictable for long term results.