• Journal of Chest Surgery
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• 제18권2호
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• pp.273-278
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• 1985

The case of a patient with abnormal position of the atrial septum resulting in a left atrium with two atrioventricular valves and a disconnected right atrium is presented with review of related articles. Anatomic details showed atrial situs solitus and a left sided cardiac apex. The right atrium received both venae cavae and a coronary sinus. No AV valve was found in the right atrium, and the floor of this chamber was placed above the posterior wall of right ventricular chamber. The atrial septum with secundum ASD was displaced to right anteriorly at its lower portion and inserted to right of tricuspid annulus. The tricuspid and mitral valve configuration was that of so-called partial ECD, i.e. mitral cleft with large anterior mitral leaflets. The ventricular septum was intact and both ventricular chambers were equally well developed with normal relationships. Surgical repair of this anomaly was performed by resecting the abnormally positioned lower part of the atrial septum, repairing the cleft of the anterior mitral leaflet, and septating the atrium for diverting the systemic and pulmonary venous blood to RV and LV, respectively.

• 대한의생명과학회지
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• 제7권2호
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• pp.91-98
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• 2001

The present study was prospectively designed to assess the clinical effect of leukocyte-depleted blood cardioplegic solution (BCS) on myocardium during cardiac surgery with cardiopulmonary bypass (CPB). 30 adult patients scheduled for elective cardiac surgery were divided into control group (n＝15), which infused routine BCS, and leukocyte-depleted (LD) group (n＝15), which infused leukocyte-depleted BCS. Total and differential leukocyte counts in BCS, malondialdehyde (MDA) and troponin-T (TnT) concentrations in coronary sinus blood, and cardiac index (CI) were measured at preoperative and postoperative period. The BCS in LD group had less total leukocyte counts with neutropenia than that in control group (P＜0.01). MDA (3.70$\pm$0.35 vs 5.90$\pm$0.57 $\mu$mol/L, p<0.05) and TnT (0.42$\pm$0.03 vs 0.60$\pm$0.09 ng/mL, p<0.05) were significantly low in LD group compared with control group, while LD group had higher CI (3.28$\pm$0.16 L/min/$m^2$, p<0.05) than control group (2.69$\pm$0.18 L/min/$m^2$). These results suggest that leukocyte-depleted blood cardioplegic solution has a better myocardial protective effect with less generations of oxygen free radicals and ischemia/reperfusion injury.

• Journal of Chest Surgery
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• 제6권1호
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• pp.69-88
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• 1973

Twenty-one cases of open mitral commissurotomy were done between October 1963 and March 1973. 1] Preoperative embolism consists of 7 cerebral and 2 peripheral cases. Two operative cerebral embolism cases were noted. 2] There were two cases of restenosis, one associated valvular disease, three mitral insufficiency cases, and six cases of pulmonary hypertension. 3] Out of 21 cases, 13 cases of atrial fibrillation were found and two cases of atrial fibrillation were found postoperatively among 8 cases of preoperatively normal sinus rhythm. 4] During operation 10 cases of valvular calcification and 6 cases of left atrial thrombus were noted. 5] Complete blood count, electrolyte and acid base balance showed normal range of data. 6] Four helix reservoir whole blood total body perfusion and 17 cases of .hemodilution perfusion utilizing Rygg-Kyvsgaard bag oxygenator with sigma motor were performed. 7] EACA 125 mg/kg intravenous administration before cardiopulmonary bypass resulted in markedly diminished postoperative bleeding. 8] Post-perfusion urine amount was in satisfactory range. 9] There were 2 operative mortality due to coronary embolism and three cases of hospital death, 2 due to severe hepatic failure and one due to cerebral embolism. 10] Sixteen survival cases showed marked clinical improvements and almost all of them returned to their occupation satisfactorily after operation.

• Journal of Chest Surgery
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• 제16권3호
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• pp.331-336
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• 1983

Cor triatriatum is a rare congenital malformation of the heart, in which a septum stretches in a transverse or oblique plane through the left atrium, thus separating it into two compartments. The upper one connects with the pulmonary veins, and the lower one connects with the left ventricle. Due to the rarity of, and great difficulty in-diagnosing, cor trlatrlatum, data On the surgery of this disease are of necessity very limited and so accurate pre-operative diagnosis was very difficult to make. `We experienced a case of the cyanotic congenital heart disease which was diagnosed as a large atrlal septal defect with streaming venous blood from inferior vena cava to left atrium through atrial septal defect in August, 1982. We found that there were transverse septum in the left atrium through atrlal septal defect, the pulmonary venous drainage were located in the upper chamber of the left atrium, and the lower chamber was connected with the left atrial appendage, mitral valve and `left ventricle. But our case had not any opening in this transverse septum and the right atrium was connected with the upper chamber of the left atrium through the upper part of the atrlal septal defect, and was communicated with the lower chamber of the left atrium through the lower part of the atrlal septal defect. We excised the transverse septum and repair this atrial septal defect with Woven Dacron patch accompanying with the drainage of coronary sinus to right atrium. The post-operative course was not eventful and he was discharged with good result on the post-operative 8th day, and has been in good .condition up to now for longer than 10 months.

• Journal of Chest Surgery
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• 제27권6호
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• pp.427-434
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• 1994

A clinical study was designed to evaluate myocardial metabolism during continuous cold blood cardioplegia [Group A, n=10] in comparison with continuous warm blood cardioplegia [Group B, n=10], in a prospective randomized manner. Myocardial metabolism was assessed in two ways: either by collecting blood from coronary sinus before and after cardiopulmonary bypass or by collecting blood from cardioplegic affluent and effluent simultaneously at the beginning and at the end of cardioplegia. The former samples were assayed for gas analysis, lactic acid and cardiac enzyme [CK, LDH, SGOT] and the latter for gas analysis and lactic acid as a maker of anaerobic metabolism. The results were as follows. 1] Myocardial metabolism was shown to be continued in the state of cardioplegia at lower temperature as evidenced by high oxygen extraction of cardioplegic solution in Group A. 2] Anaerobic metabolism occurring at lower temperature in spite of continuous cold blood cardioplegia can be significantly reduced by continuous perfusion of normothermic blood cardioplegics as evidenced by significant reduction of lactate production in Group B [p〈0.05]. 3] Better myocardial protection can be achieved by employing continuous warm blood cardioplegia as evidenced by less cardiac enzyme release in Group B after cardiopulmonary bypass.

• Korean Journal of Radiology
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• 제2권3호
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• pp.121-131
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• 2001

Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of tetralogy of Fallot, and Senning's and Mustard's operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.

• Journal of Chest Surgery
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• 제41권3호
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• pp.313-319
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• 2008

배경: 심방세동의 외과적 치료방법으로는 Cox maze-III 수술이 가장 효과적이다. 그러나 수술시간이 길고 합병증이 증가할 수 있어서 수술시간을 단축하고자 좌측 심방의 maze수술이나 폐정맥분리술만을 시행하기도 한다. 저자들은 절개-봉합법을 이용한 심방세동 수술방법의 변형이 심방세동의 수술결과에 어떤 영향을 주는지 알아보았다. 대상 및 방법: 1999년 2월부터 2005년 6월까지 기존 심장질환과 심방세동을 동반한 40예(남 17예; 여 23예)에서 심방세동 수술을 시행하였다. 23예에서 Cox maze-III 수술을, 10예에서 좌심방 maze 수술을, 7예에서 폐정맥 분리술을 시행하였다. 심방에 전도차단 병변을 만들기 위해 절개봉합법이 이용되었으나, 폐분리절개선에서 승모판륜까지의 심방벽과 관상정맥동의 전도차단에는 냉동프로브가 사용되었다. 결과: 심방세동 수술 후 $50.0{\pm}21.6$개월의 추적결과 Cox maze-III 수술을 받은 23예는 모두 정규리듬(동리듬이나 심방리듬)으로 전환되었고, 좌심방 maze 수술을 받은 10예 중 7예(70%)에서, 폐정맥 분리술을 받은 7예 중 4예(57.1%)에서 각각 정규리듬으로 전환되었다(p=0.002). 결론: 심방세동 수술에서 동리듬이나 심방리듬으로 높은 전환율을 얻기 위해서는 양심방에 Cox maze-III 수술을 시행해야 하며, 좌심방 maze 수술이나 폐정맥 분리술 같은 국한적인 수술방법은 심방세동의 치료율을 떨어뜨릴 수 있다.

• Journal of Chest Surgery
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• 제29권8호
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• pp.850-860
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• 1996

활성산소는 동물실험에서 심근 재관류손상의 중요기전으로 알려져 있으나 실제 임상상황에서의 역할은 아직도 논란이 많다. 본 연구에서는 냉혈 심마비 액을 사용한 심근보호법을 이용하여 관상동맥우회술 을 시행받는 환자들을 대상으로 하여 심근허혈후 재관류시 활성산소에 의한 심근의 손상 정도 및 활성 산소 방어효소계의 변동과 그 기전을 규명하고자 하였다. 관상동맥우회술을 받는 환자(n=10)를 대상으로 하여 관상정 맥동 환류혈액 에서 상행대동맥 차단 전과 재관류 20분 후에 lactate dehydrogenase(LDH), creatinG phosphokinase MB 분획(CK-MB)과 malondialdehyde(MDA)의 농도를 측정하였으며 또한 같은 시각에 심근의 superoxide dismutase(SOD), catalase, glutathione peroxidase(GSHPX), glutathione reductase(GSSGRd) 그BT고 glucose 6- phosphate dehydrogenase(GGPDH)의 활성도를 측정하였다 관상정 맥동혈에서의 LDH(268 $\pm$40.3 to 448 $\pm$ 84.9 ml plasma)와 CK-MB(4.50$\pm$ 2.33 to 27.1$\pm$13.5 Ulml plasma)의 활성도 그리고 MDA(5.87$\pm$2.02 to 10.5$\pm$2.23 nmol/ml plsma)의 양은 상행대동맥 차단 전에 비하여 재관류 후에 현저히 증가하였으 \ulcorner심근의 SOD(13.5$\pm$4.04 to 20.7$\pm$8.56 mg protein), GSHPX(279 $\pm$)7.2 to 325$\pm$51.4 mU/mg protein) 그리고 GSSCRd(97.2$\pm$15.9 to 122 $\pm$25.1 m2/mg protein)의 활성도도 재관류후에 현저히 증가하였다 반면 심근의 catalase와GSPDH의 활성도는의미있는 변화가 없었다 한편 SOD에 대한 Western blot결과 Cu, Zn-SOD의 양이 현저하게 증가되었음을 관찰 하였다. 이상의 결과들로 관상동맥우회술시 상행대동맥차단에 따른 심근허혈후 재관류에 의하여 활성산소에 의한 산화성 심근손상이 일어나지만 동시에 활성산소 방어효소계의 활성 또한 증가됨으로써 심근손상 의 정도가 약화되었을 가능성을 추정할 수 있으며 이러한 활성산소 방어효소의 활성증가는효소단백의 광합성 증가에 의한 것으로 여겨진다.

• Journal of Chest Surgery
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• 제32권2호
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• pp.108-118
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• 1999

배경: 동맥전환술의 위험인자와 장기 성적을 알아보고자 후향적 연구를 시행하였다. 대상 및 방법: 1988년 1월부터 1996년 12월까지 심실중격이 온전한 대혈관전위증으로 인해 동맥전환술을 시행 받은 58명의 환자를 대상으로 동맥전환술에 따른 조기 및 만기성적에 대하여 후향적 평가를 시행하였다. 술전 처치로 36례(62.1%)에서 풍선심방절개술을 시행하였으며, 32례(51.7%)에서 PGE1을 사용하였고, 좌우심실의 압력비가 평균 0.53$\pm$0.11이었던 6례(10.3%)의 환아에서는 먼저 폐동맥밴딩을 시행하였다. 결과: 수술당시의 평균연령은 24$\pm$26일(범위 1-137일)이었고 수술당시 평균체중은 3.5$\pm$0.8 kg(범위 1.8~6.1 kg)였다. 전체 조기사망율은 24.1%(14/58)였으며, 최근 3년간의 조기사망율은 8.3%(2/24)였다. 사망과 관련된 위험인자 분석에서는 수술 시행 년도가 유일한 위험인자로 나타났다(p-value < 0.01). 조기 사망한 14례 중 8례는 급성심근부전으로 사망하였으며 주된 원인은 관상동맥부전이었다. 44명의 술후 생존자들을 대상으로 2개월에서 8년까지 평균 36$\pm$27개월 동안 추적관찰을 시행하였으며, 대혈관과 관상동맥의 문합부위, 심실기능, 반월판막의 폐쇄부전, 심박동 이상 등에 중점을 두고 연속적인 비관혈적 검사 및 술후 5개월과 32개월 사이에 모두 21례의 심도자술을 시행하였다. 만기 사망한 경우는 5례(11.4%)였으며 사망원인은 관상동맥의 만기 협착 1례, 흡인 2례, 만성 종격동염 1례, 진행성 대동맥판막폐쇄부전과 심부전 1례 등이었다. 혈류역학적으로 가장 흔한 이상은 폐동맥상부의 협착이었고, 폐동맥협착과 대동맥협착을 보였던 몇몇 경우에 있어서는 점차 협착정도가 진행하는 경우도 관찰되었으나 이로 인한 재수술은 없었다. 9례에서 대동맥판막폐쇄부전 소견을보였으며 7례에서는 그 정도가 가벼웠으나 2례에서는 중정도의 폐쇄부전을 보였고 다소 진행하는 경우도 있었다. 수술전후로 심근허혈의 증거가 없었던 2례에서 관상동맥의 폐쇄가 확인되었다. 나머지 생존자들은 동성박동과 정상적인 좌심기능을 유지한 채 양호한 경과를 보이고 있으며 생명표법에 근거한 8년 생존률은 68.8%였다. 결론: 심실중격이 온전한 대혈관전위증에서 해부학적 교정술은 우선적인 수술방법으로 여겨지나 추후 지속적인 추적관찰이 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제14권1호
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• pp.40-48
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• 1981

Total anomalous venous return defines a group of congenital heart disease which have in common the entire pulmonary venous drainage returning directly or indirectly to the right atrium instead of to the left atrium. Despite of recent advance in treatment, this severe malformation in its various anatomical forms has a high surgical mortality during early infancy. Because of the high mortality in the untreated infant and the surgical risk in the first year of life, the timing of the operation remains important for optimal result. Three cases of T APV R, two supracardiac types and one mixed type, were treated with extracorporeal circulation during last three years in the Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. The first one was 10 months old male with supracardiac type which drained through left innominate vein, and he was operated with profound hypothermia and total circulatory arrest but failed. The second case was 7 years old male with supracardiac type drained through left innominate vein, and he was well post operatively, and followed periodically for 12 months. The third case was 24 years old female with mixed type drainage (left upper pulmonary vein drained through left innominate vein, and the others through coronary sinus) was successfully corrected, and she was followed for 4 month without problem. All cases were diagnosed with cardiac catheterization and angiocardiogram, and also with echocardiogram in last two cases. In first two cases of supracardiac type, total circulatory arrest was used in brief period during anastomosis between common pulmonary venous trunk and left atrium. In the last case of mixed type, usual cardiopulmonary bypass with moderate hypothermia was used and total circulatory arrest was not needed.