• Journal of Chest Surgery
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• 제21권4호
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• pp.716-720
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• 1988

Since Krause first described coronary arteriovenous fistula in 1865, there have been nearly 300 additional patients with this malformation reported in the literature. Increasing numbers of patients with this anomaly are being recognized each year resulting from the widespread use of cardiac catheterization and selective coronary arteriography in the evaluation of a variety of cardiac problems. A 9 month old male was admitted with the chief complaint of cardiac murmur and frequent URI and diagnosed as coronary A-V fistula at the distal portion of left anterior descending coronary artery to the apex of the right ventricle by cardiac catheterization and aortography. On the operative field, the left anterior descending coronary was markedly dilated about 1.5 cm in diameter from the aorta to the apex of the heart. The fistula opening was closed with 5-0 Prolene continuously under cardiopulmonary bypass and moderate hypothermia[28*C]. Postoperative course was uneventful and the patient was discharged without problem.

• Journal of Chest Surgery
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• 제21권4호
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• pp.721-726
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• 1988

Congenital supravalvar aortic stenosis is an obstruction caused by localized or diffuse narrowing of the aortic lumen commencing immediately above the aortic valve. We experienced a case of diffuse supravalvar aortic stenosis involving ascending aorta from just above the sinuses of Valsalva to the proximal l cm of the innominate artery. Supravalvar aortic stenosis in this patient, in contrast to the form seen in infants and children, was not associated with mental retardation, peculiar faces or the syndrome of hypercalcemia. Diagnosis was confirmed by retrograde left heart catheterization and left ventriculography. Surgical correction was performed by the replacement of oval shaped Woven Dacron patch over the narrow segment of aorta under the cardiopulmonary bypass. Blood pressure was controlled sufficiently with some adjunct of Inderal postoperatively. The patient was discharged with much improvement.

• Journal of Chest Surgery
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• 제28권9호
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• pp.811-816
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• 1995

Repairs of atrial septal defect utilizing cardiopulmonary bypass were performed in 50 adults, ranging age from 16 to 53 years, since April 1986 up to October 1994. They occupied 38.8% of all adult congenital heart disease operated in the same period. Preoperatively, 16 patients were functional class II, 12 patients class III and 4 patients class IV[New York Heart Association Classification , respectively. Five patients combined with atrial fibrillation and the remainders revealed regular sinus rhythm. Cardiac catheterizations were performed in 43 out of 50 patients, and revealed a systolic pulmonary arterial pressure in excess of 51 mmHg in 4 patients but none had reversed shunt. 40 patients[80% were repaired with patch closure and remainings were repaired with direct closure. 49 patients were followed up for 2 months up to 102 months[average 55 months . A comparison of the preoperative and postoperative functional class demonstrated a mean decrease of one NYHA functional level[2.5$\pm$0.63 to 1.4$\pm$0.56 . There was no operative mortality. One patient died during the follow-up period and the death was unrelated to heart disease. Operative treatment is indicated for repair of atrial septal defect with left to right shunt in the adult patient and a considerable clinical improvement can be anticipitated with low mortality.

• Journal of Chest Surgery
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• 제57권3호
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• pp.312-314
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• 2024

A 3-year-old boy with Glenn physiology exhibited refractory heart failure with reduced ejection fraction. To improve the patient's oxygen saturation, he underwent ventricular assist device (VAD) implantation with concomitant Fontan completion. The extracardiac conduit Fontan operation was performed with a 4-mm fenestration. For VAD implantation, Berlin Heart cannulas were positioned at the left ventricular apex and the neo-aorta. Following weaning from cardiopulmonary bypass, a temporary continuous-flow VAD, equipped with an oxygenator, was utilized for support. After a stabilization period of 1 week, the continuous-flow VAD was replaced with a durable pulsatile-flow device. Following 3 months of support, the patient underwent transplantation without complications. The completion of the Fontan procedure at the time of VAD implantation, along with the use of a temporary continuous-flow device with an oxygenator, may aid in stabilizing postoperative hemodynamics. This approach could contribute to a safe transition to a durable pulsatile VAD in patients with Glenn physiology.

• Journal of Chest Surgery
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• 제33권10호
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• pp.785-791
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• 2000

Left ventricular dysfuction is common in immediate postoperative periods after surgical correction of heart diseases with chronic left ventricular volume overload. We speculated postoperative changes of left ventricular volume and unction in patients with patent ductus osus(PDA) who had underwent surgical repair at ages older than 16 years. Factors influencing postoperative left ventricular volume and function were also analyzed. Material and Method: From August 1989 to August 1999 thirty-siz adult patients with PDA 28 females and 8 males. were enrolled in this study. Their age ranged from 16 years to 57 years(mean :32 years). Types of surgical repair were division with primary closure in 22, division with patch closure in 6, internal obliteration using cardiopulmonary bypass in 4 and ligation in 4. Aortic clamping was combined during surgical repair in 22(61%) and cardiopulmonary bypass was used in 8(22%) Two-dimensional echocardiography studies were performed in 34(94%) preoperatively and in 25(66%) immediate postoperatively to assess postoperative changes of left ventricular internal dimensions. left ventricular volume and ejection fraction. Duration of postoperative follow-up ranged from 1 month to 99 months (mean:22 months) and 10 patients underwent 16 echocardiographic evaluation during this period Result : Preoperative and postoperative left ventricular systolic dimensions(LVIDs) were 42$\pm$8.0mm and 42$\pm$8.3mm left ventricular diastolic dimensions(LVIDd) were 64$\pm$10.0mm and 56$\pm$7.4mm left ventricular end systolic volumes(LVESV) were 62$\pm$19cc (z=1.87$\pm$0.06) and 59$\pm$24cc(z=1.78$\pm$0.08) left ventricular end diastolic volumes(LVEDL) were 169$\pm$40cc(z-1.17$\pm$0.1) and 112$\pm$29cc(z=0.85$\pm$0.1) and ejection fractions(EF) were 66$\pm$6.7% and 48$\pm$12.6% respectively. There were statistically significant differences between preoperative and postoperative values in LVDIDd(p=0.001) LVEDV(p=0.001) and EF(p=0.0001) while no significant difference is LVIDs and LVESV. Postoperative depression of ejcection fraction was significantly related with z-score of preoperative LVESV and LVEDV by univariateanalysis while LVEDV only was significant risk factor for postoperative LV dysfunction by multiple regressioin analysis ($\Delta$LVEF=-13.3-4.62$\times$LVEDV(z), p=0.001) During the follow-up periods ejection fractions become normalized in all except one patients. Conclusion ; Left ventricular function is usually deteriorated after the surgical correction of PDA in adult age and preoperative LVEDV is a major determinant of postoperative LV function.

• Journal of Chest Surgery
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• 제36권4호
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• pp.273-276
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• 2003

좌심실 가성류로 내원한 39세 남자 환자에 대한 수술 치험 예를 보고하고자 한다. 환자는 4년 전 판막륜 농양을 동반한 감염성 심내막염으로 기계판막을 이용한 대동맥판막 및 승모판막 치환술과 농양 제거수술을 받았다. 수술 후 시행한 심초음파 소견상 좌심실과 농양이 있던 공동 사이에 교통이 있음이 관찰되었고, 추적 관찰 심초음파 검사에서 점차 공동의 크기가 증가하였다. 수술은 심페바이패스와 심정지하에 대동맥판막-승모판막 섬유연속부에 위치한 가성류와 좌심실 사이의 결손을 첩포폐쇄하였다. 수술 후 경과는 양호하였으며 수술 후 9일째에 합병증 없이 퇴원하였다.

• Journal of Chest Surgery
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• 제27권6호
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• pp.460-471
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• 1994

Between Feb. 1990 and Aug. 1993, 180 cases of the open heart surgery were performed under cardiopulmonary bypass in the Department of Thoracic & Cardiovascular surgery, Gil General Hospital. There were 83 cases with congenital heart diseases [CHD] and 97 cases with acquired heart diseases [AHD]. The CHD consisted of 78 acyanotic[mortality: 3.8 %] and 5 cyanotic cases with heart anomaly[mortality:l case]. The AHD were 97 cases, which contained 53 valvular, 27 ischemic heart diseases, 10 aortic diseases, 5 cases with myxoma, 1 case with post-infarct VSD, and 1 case with removal of infected pacing wire in right ventricle. In the 53 valvular heart diseases, there were 45 cases with valve replacement[MVR 27, AVR 9,MVR + AVR 9] and 8 cases with valvuloplasty. The number of the implanted prosthetic valves were 53. In MVR, 25 St. Jude, 6 Sorin, 3 Carpentier-Edward and 2 Intact medical valves were used. In aortic position, 13 St. Jude, 3 Sorin and 1 Intact medical valves were applied. The operative mortality was 5.6 % [3/53]. The annuloplasty applying artificial ring was performed in 17 patients[4 cases associated with MVR] and the number of the implanted ring was 19, which included 14 Duran ring[10 mitral, 4 tricuspid] and 5 Carpentier ring [3 mitral, 22 tricuspid]. In the 27 ischemic heart diseases, there were 9 cases with left main coronary artery lesions, 7 one vessel, 5 two vessels, and 6 three vessels. Average number of anastomosis was 2.8 per patient. The operative mortality was 14.3 % [4/27]. Among the 10 patients with aortic diseases, 7 cases were aortic dissection[type A: 5, type B: 2] and 3 cases were descending thoracic aortic aneurysm. The operative morality occurred in 3 cases. The overall mortality and the operative mortality of congenital and acquired heart disease was 7.8 %, 4.8% and 10.4%, respectively.

• Journal of Chest Surgery
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• 제30권3호
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• pp.263-269
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• 1997

1987년 4월부터 1996년 5월까지 복잡 선천성 심기형을 가진 13명의 환자에서 Norwood술식을적용 하였다. 진단별 분포로는 좌심형성부전증후군이 7례이었고, 상행대동맥과 대동맥궁의 형성부전이 있으 면서 심실중격결손증 및 대동맥하 협착증을 동반한 승모판 협착증, 심실중격결손증, 대동맥축착 및 대 동맥하 헙착증을 동반한 승모판 폐쇄증, 심실중격결손증 및 대동맥하 협착증을 동반한 대동맥궁 단절, 대혈관전위를 동반한 삼첨판 폐쇄증이 각각 1례씩 있었으며 이중입구부 좌심실이 2례 있었다 수술 당 시 나이는 3일에서 8.7개월 (평균 60.5 $\pm$ 71.6일, 중앙값 i9일)이었다. 수술 사망율( <30일)은 46% (6명) 이었으며 만기 사망율은 15% (2명)였다. 모든 수술사망은 술후 24시간 이내에 발생하였으며 체외순환으 로부터 이탈에 실패한 경우가 5례, 술후 갑작스런 혈역학적 불안정으로 사망한 경우가 1례 있었고, 만기 사망은모두 흡인성 폐렴에 의한 것이었다. 5명의 장기 생존자에 대한추후술식으로는2명의 환자에서 Norwood술식 후 각각 12, 17개월에 변형 Fontan수술을 하였으며 1명에서 4.5개월 후에 완전 대정맥폐동맥 단락술을 시행하였고 수술 사망은 없었다. 나머지 2명의 환자에서는 Fontan 술식전의 중간단계 로 양방향성 상대정맥-폐동맥 단락술을 각각 3, 5.5개휠 후에 시행하였으며 수술사망이 1례 있었다. 수 술 사망 및 만기 사망을 포함한 모든 환자에서 1년 생존율은 30.8%였다. 결론적으로 본원에서 경험한 Norwood 술식의 사망율이 다른 주요 심장기 형의 사망율과 비교하여 높지만 이에 대한 경험이 축적되면서 더 좋은 성적을 기대할 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제34권12호
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• pp.901-908
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• 2001

배경 : 관상동맥 질환 환자에게 시행되는 관상동맥 우회술의 수술 성적이 많이 향상되었으나, 아직도 좌심실기능부전이 중등도 이상으로 심한 환자에서의 관상동맥 우회술은 합병증과 사망률이 비교적 높다. 최근 수술기법 및 심근보호법의 발달로 이러한 고위험군의 환자에게 내과적 보존 치료보다는 외과적 재혈관화가 환자의 증상 개선과 장기 생존율을 향상시킨다고 한다. 대상 및 방법 : 이에 저자는 1995년 1월부터 1999년 3월까지 시행한 관상동맥 우회술 843예 가운데 수술 전 좌심실 박출계수가 30% 이하인 환자 31예(4.1%)의 임상자료를 후향적으로 조사하고 수술 전후 측정한 심장 초음파상의 심박출 계수의 변화를 비교 분석하였다. 환자의 연령은 41세에서 72세 사이로 평균 60.7$\pm$2.2세였고, 남자 26예, 여자 5예였다. 수술전 위험인자로 심근경색의 과거력이 있었던 경우가 30예로 대부분이었으며, Thallium heart scan 검사에서 불가역인 심근 손상이 7예였다. 관상동맥 조영술에서 3개 혈관 병변이 26, Rentrop 분류 1도가 16례로 가장 많았다. 관상동맥 우회술 동안에 이식된 혈관의 수는 평균 4.88$\pm$0.8 개/명이었고, 전 예에서 복재정맥을 사용하였으며 내흉동맥을 동시에 사용한 경우는 20예였다 대동맥 차단 및 심실세동 시간은 평균 77.9$\pm$1.6분 이었고 인공 심폐기 가동시간은 평균 244.7$\pm$3.7분 이였으며, 관상동맥 우회술과 동시에 시행된 술식으로는 좌심실류 제거술 2예, 승모판막 성형술 2예, 대동맥 판막 치환술 1예였다. 술후 합병증은 부정맥 3예, 출혈 2예, 흉골 지연 봉합 1예였고 수술 전후의 대동맥내 풍선펌프의 사용이 11예였으며, 2예에서 사망하여 수술 사망률은 6.5%이었다. 수술 후 흉통 및 증상의 개선을 보인 경우는 29예였고 수술 후 시행한 심초음파 검사상 좌심실 박출 계수는 평균 38.5$\pm$11.6%로 술전 평균 측정치 25.3$\pm$2.3%에 비해 유의하게 증가되었다(p 0.001). 환자들의 평균 추적기간은 25.3$\pm$5.6개월이었다. 결론 : 좌심실 기능이 저하된 관상동맥 질환 환자에서 관상동맥 우회술을 시행하여 비교적 만족할 만한 결과를 얻을 수 있었으며, 추후 장기 추적 조사가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제30권2호
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• pp.205-208
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• 1997

심장 횡문근종은 영아나 소아기에서 가장 발생빈도가 높은 원발성 심장종양으로서 결절성 경화증을 빈번히 동반하고, 자연 퇴화가 보고된다 할지라도 좌심실 유출로 폐쇄를 동반한 종양은 아직까지는 예후가 불량하고 수술적 치료가 적응이 된다. 생후 4 일된 신생아가 청색증과 빈 호흡을 주소로 내원하여 생후 4일째에 정중흉골절개를 통한 체외 순환하에 수술을 시행하여 좌심실 유출로를 막고있는 0.7$\times$0.9$\times$0.4cm크기의 종괴를 제거하였다. 수술 후 합병증은 발생하지 않았으며 수술후 14일째에 건강하게 퇴원하였다.