• Journal of Chest Surgery
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• 제56권5호
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• pp.322-327
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• 2023

Background: Superior vena cava (SVC) stenosis during follow-up is a major concern after heart transplantation, and many technical modifications have been introduced. We analyzed the surgical results of the SVC intima layer-only suture technique in heart transplantation. Methods: We performed SVC anastomosis with sutures placed only in the intima during heart transplantation. We measured the area of the SVC at 3 different points (above the anastomosis, at the anastomosis, and below the anastomosis) in an axial view by freely drawing regions of interest, and then evaluated the degree of stenosis. Patients who underwent cardiac computed tomography (CT) at 2 years postoperatively between June 2017 and May 2020 were included in this study. Results: We performed heart transplantation in 41 patients. Among them, 24 patients (16 males and 8 females) underwent follow-up cardiac CT at 2 years postoperatively. The mean age at operation was 49.4±4.9 years. The diagnoses at time of operation were dilated cardiomyopathy (n=12), ischemic heart disease (n=8), valvular heart disease (n=2), hypertrophic cardiomyopathy (n=1), and congenital heart disease (n=1). No cases of postoperative bleeding requiring intervention occurred. The mean CT follow-up duration was 1.9±0.7 years. At follow-up, the mean areas at the 3 key points were 2.7±0.8 cm², 2.7±0.8 cm², and 2.7±1.0 cm² (p=0.996). There were no SVC stenosis-related symptoms during follow-up. Conclusion: The suture technique using only the SVC intimal layer is a safe and effective method for use in heart transplantation.

• Journal of Chest Surgery
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• 제56권4호
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• pp.255-261
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• 2023

Background: The surgical threshold for bicuspid aortic valve (BAV)-related aortopathy is a matter of debate due to its uncertain etiology and prognosis. This study investigated the prognosis of unrepaired BAV aortopathy in patients undergoing surgical aortic valve replacement (SAVR). Methods: We retrospectively analyzed data from 720 patients (age, 60.8±11.5 years; 246 women) who underwent SAVR for BAV disease without aortic repair between 2005 and 2020 at Asan Medical Center. The clinical endpoints were defined as occurrences of sudden death, aortic dissection or rupture, and elective aortic repair. To estimate postoperative changes in the dimensions of the unrepaired aorta, the individual annual aortic expansion rate was calculated. Multiple linear regression models were used to evaluate the risk of aortic expansion. Results: The mean ascending aortic diameter was 39.5±4.6 mm, and 299 patients (41.5%) had a baseline ascending aorta diameter >40 mm. During 70.0±68.3 months of follow-up, the mean annual aortic expansion rate was 0.39±1.96 mm/yr, no aortic dissection or rupture was observed, and sudden deaths were reported in 12 patients (0.34% per person-year). Linear regression analysis revealed no significant correlation between the baseline ascending aortic diameter and postoperative aortic expansion (R²=0.004, β=-0.84, p=0.082). Conclusion: In selected patients undergoing SAVR for a BAV (<55 mm), the risk of adverse aortic events was very low. As this observation contradicts current practice guidelines advocating for proactive aortic replacement in dilated ascending aortas measuring >45 mm, the study results need further validation by studies involving larger populations or randomized controlled trials.

• 대한영상의학회지
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• 제82권3호
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• pp.688-692
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• 2021

자궁경부 및 질에 발생하는 정맥기형은 매우 드문 질환이다. 표피적 정맥기형에 대한 경화요법은 매우 효과적인 것으로 알려져 있으나, 여성 하부 생식기에서의 정맥기형에 대한 효과는 아직 증명되지 않았다. 52세 여자 환자가 간헐적인 질 출혈을 보였다. 3달 동안 질 출혈의 양은 점차 증가했다. 조영 후 골반 컴퓨터단층촬영에서 자궁경부 및 질 주변으로 다수의 정맥돌 및 확장된 정맥들이 보였으나, 골반 혈관조영술에서 조기 유출 정맥, 핵과 영양동맥은 보이지 않았다. 환자는 자궁 보존 치료를 원하여 수술보다는 질 경유 직접 천자 및 에탄올 경화요법을 시행했다. 총 4회 경화요법 후, 환자는 합병증 없이 질 출혈이 상당 부분 감소했다. 저자들은 질 경유 직접 천자 및 에탄올 경화요법을 이용한 자궁경부 및 질의 정맥기형의 성공적 치료를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 대한영상의학회지
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• 제81권3호
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• pp.701-706
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• 2020

포도상의 윌름스 종양은 신우에서 발생하는 윌름스 종양의 희귀한 변이형이며 태아 혹은 신생아에서 진단된 경우는 아직까지 보고된 바 없다. 저자들은 산전 초음파에서 우연히 발견된 수신증으로 내원한 신생아의 포도상의 윌름스 종양을 경험하여 이를 보고하고자 한다. 출생 후 초음파 검사에서 확장된 신우 및 신배를 채우는 다수의 소엽상의 저에코 종괴가 관찰되었고 종괴 내부는 다양한 정도의 혈류 증가 소견을 보였다. 저자들이 아는 한, 영문으로 보고된 가장 어린아이에서 발생한 윌름스 종양의 증례이다.

• 대한영상의학회지
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• 제83권5호
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• pp.1153-1159
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• 2022

긴머리확장증은 확장, 연장 및 구불구불한 형태의 대뇌동맥을 특징으로 하는 드문 질환이다. 주요 병리기전은 내탄력판의 파괴로 알려져 있으며, 위험요인으로 고령, 만성 고혈압, 그리고 대사성 질환 등이 있다. 긴머리확장증은 주로 후순환계의 척추뇌기저동맥을 침범하는 것으로 알려져 있으나, 전순환계, 특히 전대뇌동맥에 이환되는 경우도 있다. 긴머리확장증이 전순환계와 후순환계를 모두 침범한 사례는 아직 국내에 보고된 바가 없다. 이에 우리는 기저 질환이 없는 젊은 여자 환자에서 전순환계와 후순환계가 모두 이환된 매우 희귀한 형태의 긴머리확장증 사례를 현저한 영상 소견을 토대로 보고하고자 한다.

• 한국동물생명공학회지
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• 제39권1호
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• pp.62-65
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• 2024

Dystocia, a challenging condition in obstetrics, can arise from various causes, including fetal monsters with structural abnormalities. This case report presents a unique case of dystocia due to a fetal monster known as Perosomus Elumbis in a beetal breed goat from Pakistan. The 4-years-old pregnant doe presented with prolonged straining and failure to deliver the fetus after 8 hours of labor. Upon examination, the cervix was dilated, and only the forelimbs of the fetus were visible in the birth canal. The subsequent delivery involved the application of manual traction by using a dystocia kit, and the removal of edematous fluid from the legs. The monster fetus exhibited absence of hair growth, along with the absence of thoracic vertebrae. Two other fetuses were present, with one found dead and the other alive. Posttreatment involved fluid therapy, antibiotics, and supportive care for the doe. This case report sheds light on the occurrence of Perosomus Elumbis fetal monsters and their impact on dystocia in goat breeding. Understanding the underlying causes and implementing appropriate management strategies are crucial for successful outcomes in similar cases.

• Korean Journal of Radiology
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• 제22권6호
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• pp.890-900
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• 2021

Objective: To identify the association between morphological and functional characteristics of the bicuspid aortic valve (BAV) and bicuspid aortopathy and to identify the determinants of aortic dilatation using transthoracic echocardiography (TTE) and cardiac computed tomography (CCT). Materials and Methods: This study included 312 subjects (mean [SD] age, 52.7 [14.3] years; 227 males [72.8%]) who underwent TTE and CCT. The BAVs were classified by anterior-posterior (BAV-AP) or right-left (BAV-RL) orientation of the cusps and divided according to the presence (raphe+) or absence of a raphe (raphe-) based on the CCT and intraoperative findings. The dimensions of the sinus of Valsalva and the proximal ascending aorta were measured by CCT. We assessed the determinants of aortic root and proximal ascending aortic dilatation (size index > 2.1 cm/m²) by Univariable and multivariable logistic regression analyses. Results: Of the 312 patients, BAV-AP was present in 188 patients (60.3%), and 185 patients (59.3%) were raphe+. Moderate-to-severe aortic stenosis (AS) was the most common hemodynamic abnormality (54.8%). The most common type of aortopathy was the combined dilated root and mid-ascending aortic phenotype (62.5%). On multivariable analysis, age and AS severity were significantly associated with aortic root dilatation (p < 0.05), and age, sex, and AS severity were significantly associated with ascending aortic dilatation (p < 0.05). However, the orientation of the cusps, presence of a raphe, and severity of aortic regurgitation were not associated with aortic root and ascending aortic dilatation. Conclusion: BAV morphological characteristics were not determinants of aortic dilatation. Age, sex, and AS severity were predictors of bicuspid aortopathy. Therefore, age, sex, and AS severity, rather than valve morphology, need to be considered when planning treatment for BAV patients.

• 한국간담췌외과학회지
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• 제27권4호
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• pp.388-393
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• 2023

Backgrounds/Aims: Acute cholecystitis is a rare condition in pregnant women, potentially affecting the maternal and fetal prognosis. Our aim was to report the main clinical and paraclinical features of acute cholecystitis during pregnancy and therapeutic modalities. Methods: We conducted a case series analysis recording pregnant patients with acute cholecystitis admitted to our surgery department over a period of 11 years. We collected clinical data, paraclinical features, and management modalities related to cholecystitis. Results: There were 47 patients. Twenty-eight percent was in the first trimester of pregnancy, 40% in the second, and 32% in the third trimester. Abdominal pain was located in the right hypochondrium in 75% of cases. Fever was noted in 21% of cases. C-reactive protein was elevated in 39% of patients. Cholestasis markers were high in four patients. Abdominal ultrasound showed a distended gallbladder in 39 patients, with thickened wall in 34 patients, and gallbladder lithiasis in all cases. No patient had a dilated main bile duct. All patients received intravenous antibiotic therapy. Tocolysis was indicated in 32 patients. Laparoscopic cholecystectomy was performed in 32 cases (68%), and open cholecystectomy in 15 cases (32%). Postoperative course was uneventful in 42 patients, and complicated in 5 patients. Rate of complications was statistically higher after open cholecystectomy (p = 0.003). Morbidity rate was higher in the third trimester (p = 0.003). Conclusions: Delay in the diagnosis of acute cholecystitis during pregnancy can lead to serious complications. Management is based on antibiotic therapy and cholecystectomy. Laparoscopic cholecystectomy appears to be less morbid than open cholecystectomy.

• 대한영상의학회지
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• 제81권1호
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• pp.213-218
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• 2020

관상동맥류는 드문 질환으로 대개 주관상동맥의 주행을 따라 심외막공간에서 발생한다. 본 논문에서 우리는 우연히 발견된 좌심실의 하기저벽에 생긴 거대동맥류 사례를 보고하고자 한다. 가와사키병이나 고혈압을 비롯한 과거력이 없는 43세 여자 환자가 두 달간 지속된 심계항진을 주소로 내원하였다. 심초음파와 심장 컴퓨터단층촬영에서 좌심실에 거대동맥류가 있었고 이것은 좌회선지와 직접 동맥루를 이루었으며, 좌회선지는 우관상동맥과 교통하였다.

• Journal of Chest Surgery
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• 제38권3호
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• pp.221-228
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• 2005

대동맥 축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 수술치료의 한 방법이라고 주장되어 왔다. 저자들은 대동맥판막치환술과 동반 시행한 상행대동맥의 변형 축소성형술에 대한 결과에 대해 알아보았다. 대상 및 방법: 2001년 7월부터 2002년 12월까지 상행대동맥벽의 절제 없이 봉합봉축법에 의한 변형 대동맥 축소성형술을 받은 14명의환자들을 대상으로 하였다. 평균 연령은 63.7$\pm$6.7세(50$\~$75세)였다. 10명의 환자에서 이엽성 대동맥판막이 동반되었다. 10명에서 심한 대동맥판막 협착을 보였으며 6명에서는 III-lV도의 대동맥판막폐쇄부전이 동반되었다. 상행대동맥의 직경은 수술 전과 후 그리고 6개월과 12개월 후에 심장초음파 및 컴퓨터 단층촬영으로 측정하였다. 술 후 평균 추적기간은 14.7$\pm$5.4개월(7$\~$24개월)이었으며 모든 7환자에서 추적이 가능하였다. 결과: 술 후 조기 사망이나 출혈과 같은 합병증은 없었다. 봉합봉축법에 의한 대동맥 축소성형술 후 상행대동맥의 직경은 술 전 49.4$\pm$3.5 mm에서 술 후 33.2$\pm$3.4 mm (P<0.001)로 감소하였다. 추적기간동안 만기 사망이나 상행대동맥의 재확장은 없었다. 결론: 대동맥벽의 절제없이 봉합봉축법에 의한 변형 대동맥축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 양호한 조기 및 중기성적을 보였다. 하지만 본 방법들 사용한 환자들에 대한 장기 추적결과에 추가적인 연구가 필요하리라 생각한다.