• Journal of Chest Surgery
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• 제30권1호
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• pp.17-26
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• 1997

경상대학교병원 흉부외과에서는 1988년 10월부터 1995년 12월까지 7년 2개월 동안 366례의 선천성 심장기형에 대한 수술을 시행하였다. 남자가 171례, 여자가 195례이었고, 생후 5일부터 64세에까지 분포하였으며 성인(만 15세 이상)이 80례이었다. 비청색증형이 313례(84.2%)이었으며 청색증이 53례(15.8%)이었다 전체 사망율은 10.4%이었는데, 6개월 미만 5)례 중 37%, 6개월과 1년 사이가48례 중 10.6%를 나타내어 12개월 미만 영아 사망율은 24.8%(25/101)이었으며, 50세 이상의 노년 환자 13례에서는 사망이 없었다. 비청색증군은 5.5%, 청색증군은 36.2%의 수술사망이 있었다. 수술사망율에 영향을 미치는 몇 가지 위험 인자들을 통계 분석하였다. 단변수 분석상 개심술의 사망율과 관계가 있는 위험 인자는 연령(p< 0.0001), 체중(p<0.0001), 체외순환시간(p< 0.0001) 및 심근허혈시간(p<0.0001), 완전순환정 지법의 이용 (P<0.0001)그리고 청색증질환(p<0.00이)이었다. 그러나, 다변량 분석상 개심술의 사망율과 관련이 있는 위험인자는 질환의 유형(p=0.002)이었고, 특히 활로4징증 이외의 청색증군이 사망율과 관련이 컸다 (odds ratio=15.3). 청색증군만\ulcorner 분석한 결과, 사망율의 위험인자로 단변수 분석상에서는 연령(p=0. 002)과 질환의 유형(p=0.008)이었으나, 다변량 분석에서는 질환의 유형(p=0.012) 뿐이었다. 저자들의 경험례 중 청색증군에서 사망율이 높았던 것은 질병자체의 영향임을 알 수 있었고,단변수 분석상 나타난 위험인자들 중 기술적 개선이 가능한 요인들에 대해서는 특별한 노력이 있어야 될 것으로 판단되는 것이다.

• 대한흉부심장혈관외과학회:학술대회논문집
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• 대한흉부외과학회 1998년도 제30차 추계학술대회 대한흉부외과학회
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• pp.5-5
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• 1998

• Journal of Chest Surgery
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• 제19권2호
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• pp.250-258
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• 1986

From Aug. 1984 to May 1986, 116 cases of cardiovascular surgery including 85 cases of open heart surgery were performed at Korea Veterans Hospital. There were 108 congenital anomalies and 8 acquired valvular heart diseases. Among 108 congenital malformations 92 operations were done for acyanotic group, and 16 operations for cyanotic group. Thirteen cases of open heart surgery for infants or small children under 10kg of body weight were performed, which occupied 15.3 percent of total open heart surgery done in the same period. Common congenital cardiovascular anomalies were ventricular septal defect [40.7%], patent ductus arteriosus [29.6%], tetralogy of Fallot [12.[%], atrial septal defect [11.1%], and pulmonary stenosis [1.9%] in order of frequency. Valve replacement using lonescu-Shiley or Carpentier-Edwards valve was performed for 8 cases of acquired mitral valve disease, and valve replacement using St. Jude valve was done for a case of patent ductus arteriosus with severe mitral insufficiency. There was no mortality in acyanotic congenital malformations and acquired valve lesions, and 5 cases of mortality in cyanotic congenital malformations. Overall mortality was 4.3 percent for total cases and 5.9 percent for 85 cases of open heart surgery.

• Journal of Chest Surgery
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• 제16권1호
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• pp.18-29
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• 1983

Thirty-two patients with a cyanotic cardiac malformations having more complex intracardiac defects than ones in a tetralogy of Fallot underwent complete intracardiac repairs in a-full-year period from July 1981 to June 1982. Twenty-two patients [68.8%] died within 30 days after surgery: Transposition of the great arteries, seven of 10 patients; Double-outlet right ventricle, four of 6 patients; Tricuspid atresia, four of 6 patients; Single ventricle, all of 4 patients; Pulmonary atresia, two of 3 patients; Double-outlet left ventricle, none of 2 patients; and Truncus arteriosus, one of a single patient. All deaths occurred with a low cardiac output syndrome or a failed off-bypass, and they were almost always accompanied with other grave postoperative complications. The complex intracardiac anatomy itself was one of the risk factors by making a complete intracardiac repair of the defects difficult in a small heart. The reconstruction of the right ventricular outflow carried a difficulty in balancing an adequate relief of the obstruction with an avoidance of making too much pulmonary valvular insufficiency as well. On the other hand, the presence of an elevated pulmonary arterial pressure and a high pulmonary vascular resistance was also the factors affecting the postoperative surviv als. The importance of detailed knowledge of intracardiac anatomy and hemodynamics from the careful preoperative evaluation of the patient was discussed along with the necessity of technical refinement of the correction.

• Journal of Chest Surgery
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• 제11권2호
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• pp.213-226
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• 1978

One hundred cases of open heart surgery were done at this Department in 1977. There were 65 congenital anomaly and 35 acquired diseases. Out of 65 cases of congenital malformation 35 acyanotic and 30 cyanotic cases were found. Fifteen cases of ventricular septal defect and 29 tetralogy of Fallot were noted eight patients expired out of 65 congenital anomaly [12.3%] , 4 out of 35 acyanotic [11. 4%] and 4 among 30 cyanotic anomaly[13.3%]. Among 35 cases of acquired heart disease 3 atrial myxoma [2 left and one right] and 32 valvular lesions were noted. In two cases open mitral commissurotomy, and in 30 valve replacement were done. Twenty-two single valve and 8 double valve replacement were done. Seven patients expired out of 30 patients [23.3%]. Among 22 single valve replacement cases 2 and among 8 double valve 5 died. ~ In eighteen mitral valve replacement cases 2 deaths occurred. One mitral insufficiency patient who expired suffered from severe pulmonary` hypertension [PA=120/67mmHg], tricuspid insufficiency and a large ventricular septal defect. The patient underwent mitral valve replacement, tricuspid annuloplasty and patch closure of ventricular septal defect. Over all mortality rate for 100 open heart surgery cases was 15%. Since 1977 open heart surgery cases were done routinely in this institution and cases are increasing rapidly. With present rapid improvement of economical status and introduction of medical insurance system, open heart surgery will be firmly established in Korea in the very near future.

• Journal of Chest Surgery
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• 제28권5호
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• pp.447-452
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• 1995

From January 1983 to December 1992, 116 patients under 10Kg of body weight were underwent open heart surgery in National Medical Center.There were 64 males and 52 females, and their mean age was 14 2.6 months, ranged from 3 days to 38 months. Their mean body weight was 7.4$\pm$1.2Kg, ranged from 2.4Kg to 10Kg which were less than 3 percentile of normal developmental pattern in 109 out of 116 cases.The composition of the patients was VSD[73 , TOF[18 , ASD[8 , ECD[5 , TGA[4 , PS[3 , TAPVC[2 , TA[1 , cardiac rhabdomyoma with ASD[1 , and Ebstein`s anomaly[1 . The overall surgical mortality was 17.2%.In acynotic group, 11 patients died among 91 patients and the mortality was 12.1%, in cyanotic group 9 patients died among 25 patients, the mortality was 36%.The surgical result of patients under 5Kg of body weight was worse than those over 5Kg of body weight. [56.2% versus 11% The surgical result in this period was improved year by year, but poor surgical results in the group of cyanotic, under 5Kg of body weight should be improved by means of more precise preoperative diagnoses, more advanced surgical techniques and more proper postoperative management.

• Journal of Chest Surgery
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• 제6권1호
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• pp.63-68
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• 1973

Two patients operated upon for tricuspid atresia by Glenn operation are presented. They were five years old and four years old females who were cyanotic shortly after birth, and remained cyanotic. On physical examination, cyanosis on digits and lips, clubbing of fingers, thrill and grade III systolic murmur on 4th I.C.S. along left sternal border were noted. In the first case, chest roentgenograms showed normal pulmonary markings, and the electrocardiogram was interpreted as showing left ventricular hypertrophy with left axis deviation and peaked P-wave in lead IL Right heart catheterization showed high pressure in right atrium and the catheter tip was easily inserted into the left atrium through septal defect. In the second case, chest roentgenograms showed cardiomegaly with sparse pulmonary vascular markings and narrowed vascular pedicle, and the electrocardiogram showed left ventricular hypertrophy with some element of right atrial hypertrophy. Angiocardiogram showed changes characteristic of tricuspid atresia, including "right ventricular window" The findings of right heart catheterization were similar to those of first case. On the basis of these observations, they were diagnosed as tricuspid atresia, and Glenn operation was performed. Normal position of great vessels combined with ventricular septal defect and pulmonary stenosis were noted on the first case, and on second case, transposition of great vessels was additional finding. Postoperative course was uneventful and favorable outcome was obtained.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1192-1202
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• 1992

Postoperative cardiac outputs and other hernoaynamic values were serially measured in fifteen patients of cyanotic congenital heart disease, after use of blood cardioplegic solution. Cardiac indices showed no change untill eight postoparative hours, then it began to decline to reach as low as 3.22$\pm$0.7L/min/m2 at 12 hours. After then gradual increse occ-ured to recover upto immediate postoperative value at 20 hours. Sharp decrese of heart rate and increse of systemic vascular resistance during 8~16 hours and steady increase of stroke indices during the whole study periods were observed. These observations suggested that the myocardium recovered gradually after open heart surgery, and that the decrease of cardiac indices during 8~16 hours could be a result of decrease of heart rates and increase of afterload. The changes of cardiac indices correlated with the changes of heart rate, postoperative time and mixed venous oxygen saturation [p<0.05]. No other hemodynamic values found to be in statistically significant correlation with the changes of cardiac indices. Left ventricular dysfunction seemed to occur more frequently during 8~12 hours, but it was not statistically significant. [p=0.73] In conclusion, great care must be taken during 2~3 days after the operation of cyanotic congenital heart disease, not to fall into a low cardiac output state, by maintaing adequate heart rates and reducing afterload especially when the systemic vascular resistance increases.

• Journal of Chest Surgery
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• 제19권4호
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• pp.633-643
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• 1986

Five hundred cases of open heart surgery were operated in the Dept. of Thoracic and Cardiovascular Surgery, Pusan National University Hospital from July, 1981 to October, 1986. The clinical data were summarized as follows: 1. The age distribution of congenital heart disease patients was 2 to 41 years old and mean age was 13.4 years and of acquired heart disease was 11 to 57 years old and mean age was 32.7 years. 2. There were 319 cases [63.8%] of acyanotic congenital heart anomalies, 56 cases [11.2%] of cyanotic anomalies and 125 cases [25.[%] of acquired heart disease. 3. For myocardial protection, Bretschneider and potassium glucose solution had been used as cardioplegic solution and since 1983, GIK solution is being used repeatedly every 30 to 40 minutes time interval with excellent results. 4. The ingredient of the priming solution is Hartmann`s solution, mannitol, sodium bicarbonate, potassium, chloride, fresh ACD whole blood, calcium chloride, heparin and dexamethasone. 5. There were 94 cases of mild hypothermia, 280 cases of moderate hypothermia and 126 cases of intermediate hypothermia. 6. The overall mortality was 8.2%. And the mortality rate in each disease entity is 2.5% in acyanotic congenital cases, 33.9% in cyanotic congenital cases and 11.2% in acquired heart disease.

• Journal of Chest Surgery
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• 제13권1호
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• pp.1-12
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• 1980

In 1979 during the period of about 10 months 320 cases of open heart surgery were done in Seoul National University Hospital. There were 220 Congenital anomaly cases consisting of 113 acyanotic and 107 cyanotic varieties, and 1 O0 acquired cardiac lesions. Out of 100 acquired lesions 96 were valvular cues. Among 97 valve replacement cases 3 were Ebstein anomaly treated with plication and tricuspid valve replacement. Operative mortality rate for congenital anomaly was 10.6%, with 2.7% for acyanotic and 22.4% for cyanotic group. For acquired lesions over all operative mortality was 7%. Tetralogy of Fallot, ventricular septal defect, and atrial septal defect were the 3 main congenital anomalies, with 88 cues, 69 cases, and 27 cues respectively. In 61 simple ventricular septal defect without other anomalies operative mortality rate was 1.6%, in 27 atrial septal defect no death and, in tetralogy of Fallot 12.2%. Among 69 ventricular septal defect cases 19[27.5%] type I VSDs, after Kirklin-Becu classification, were found, rather high relative incidence of type I compared with Caucasian patients. Among 97 valve replacement cases 20 double valves were replaced-11 mitral with aortic and 9 mitral with tricuspid valves. Over all operative mortality rate for valve replacement was 8.2% with 3.3% in 61 mitral valve replace-merit. The over all operative mortality rate for 320 open heart surgery cases was 10.6%. Bubble type oxygenator and xenograft bioprosthetic valves were utilized In almost all cases.