• Journal of Chest Surgery
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• 제17권3호
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• pp.362-370
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• 1984

The term corrected transposition of great arteries [hereafter referred to as corrected TGA] of the heart in which there is both a discordant atrio-ventricular relationship and transposition of the great vessels. Usually situs solitus is present, while the ventricles are inverted showing an l -loop. The great vessels are transposed and in the l-position so that the pulmonary artery arises from the right-sided morphological left ventricle and the anteriorly l- transposed aorta arises from the left-sided morphological right ventricle yielding an SLL pattern. In the majority of cases, associated lesions are common. The most frequent are ventricular septal defect, obstruction to the pulmonary outflow tract, tricuspid valve incompetence and atrio-ventricular conduction abnormalities. In the rare cases, no associated conditions are present and hemodynamic pathways are normal. In the report, we present one case of a 20 year-old male having corrected TGA associated with severe tricuspid valve incompetence, was corrected by tricuspid valve replacement, directly developed a supra-ventricular tachycardia but was controlled by calcium-entry blocker, verapamil, successfully.

• 한국임상수의학회지
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• 제38권3호
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• pp.163-168
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• 2021

A 6-year-old, spayed female, Maltese dog with tachypnea and dry cough was presented to Gyeongsang National University Veterinary Medical Teaching hospital. On physical examination, its respiration rate was 132 per minute. Decreased partial pressure of oxygen, partial pressure of carbon dioxide, and hyperlactatemia were found on arterial blood gas analysis. Its diastolic blood pressure was 80 mmHg. Auscultation revealed arrhythmia. Electrocardiogram revealed P pulmonale, P mitrale, and ventricular premature complexes. Thoracic radiographs revealed mild enlargement of both atrium and moderate enlargement of the left ventricular. There was also a moderate alveolar pattern in the right and caudal part of the left cranial lung lobe. Two-dimensional echocardiography showed enlargement of generalized four chambers without remarkable findings of valvular degeneration. M-mode echocardiography showed decreased left ventricular fractional shortening and enlarged left ventricular internal diameter at both end-systolic and end-diastolic. Color-flow Doppler imaging revealed eccentric turbulent flow starting below the left ventricular outflow tract and extending into the left atrium during systole. Spectral Doppler recordings revealed a high velocity flow through the mitral, tricuspid, aorta, and pulmonic regurgitation. Restrictive transmitral flow revealed high E-wave velocity, short E-wave deceleration time, and reduced A-wave velocity. There was also low ejection velocity thorough left ventricular out tract flow. Based on echocardiographic examination, dilated cardiomyopathy was the tentative diagnosis. The dog was medicated with inotropes, angiotensin converting enzyme inhibitor, and diuretics. At the 10-day following-up, the dog died suddenly. This report describes echocardiographic diagnosis and prognosis of dilated cardiomyopathy rarely reported in small breed dogs.

• 한국임상수의학회지
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• 제32권4호
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• pp.343-346
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• 2015

4년령의 중성화된 수컷 Dachshund가 만성적인 호흡곤란 및 청색증을 주증으로 내원하였다. 혈액검사에서 헤마토크리트 79.7%의 심각한 적혈구증가증이 확인되었다. 흉부 방사선 영상에서는 경도의 우심 종대가 관찰되었다. 심초음파 검사에서 좌심실유출로 대동맥판막 근위부에서 큰 심실 중격 결손이 확인되었으며, 도플러 검사에서 이 결손을 통한 우-좌 션트가 확인되었으며 조영 심초음파를 통하여 최종적으로 확진되었다. 이러한 진단적 결과 및 환자의 임상증상을 바탕으로 환자는 우-좌 단락 심실 중격 결손증으로 진단되었다. 사혈 및 산소 공급을 실시하였으나 환자는 내원 다음날 집에서 사망하였다. 본 증례보고에서는 심초음파를 통한 우-좌 단락 심실 중격 결손증의 진단을 서술하였다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.258-264
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• 1985

The experience with operative treatment for total correction of Fallot at the department of Thoracic and Cardiovascular Surgery, Keimyung University Dong San Medical Center from July 1980 to July 1984 was reviewed. There were 37 males and 12 females and their ages ranged from 3 years to 30 years, with the average age of 12.2 years. Sixty nine point four percent of patients were younger than 15 years of age. The most frequent type of right ventricular outflow stenosis was the combined type [pulmonary valvular and infundibular stenosis] containing 41 patients [83.7%] and there were 9 deaths in this group. The major associated lesions included Patent foramen ovale in 20 patients [40.8%], Atrial septal defect in 7 patients [14.3%], Left superior vena cava in 4 patients [8.2%], Right sided aortic arch in 2 patients [4.1%] and Patent ductus arteriosus in 11 patient [2.0%]. The pulmonary valvotomy was performed in 41 patients and patch graft reconstruction of the right ventricular outflow tract was performed in 23 patients. In 11 patients the monocusp patches were used. Thirty-five patients [71.4%] had the right bundle branch block postoperatively. There were 11 postoperative deaths with hospital mortality rate of 22.4% and the leading causes of death were low output syndrome, bleeding, and cerebral embolism.

• Journal of Chest Surgery
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• 제21권2호
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• pp.211-222
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• 1988

Tetralogy of Fallot is a cyanotic congenital heart disease characterized by large ventricular septal defect[VSD] and stenosis of right ventricular outflow tract[RVOT] and the degree of RVOT stenosis and the state of pulmonary arteries are the major determinant of prognosis of this anomaly after operation. The sum of blood flow through RVOT and collateral flow from systemic arteries determine the total pulmonary blood flow and it is drained to left atrium and left ventricle. Therefore the degree of development of left ventricle not only reflects pulmonary blood flow and the status of peripheral pulmonary arteries but also affects postoperative prognosis as a systemic ventricle. In this article, left ventricular volume and its influence on postoperative cardiac function in tetralogy of Fallot were studied in 34 patients operated on at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital in 1985. Mean age of the patients was 5 1/12*3 9/12 years[range 9/12 - 14 8/12 years], mean body surface area[BSA] 0.65*0.20m2[range 0.38 - 1.22m2], mean body weight 15.6k6.48kg[range 7.0 - 36kg]and mean hematocrit 50.6*9.77%[range 32.0 - 73.5%]. Left ventricular end-diastolic volume[LVEDV] of them were from 11.2 to 113cc and there was a good linear correlation between BSA[m2, X]and LVEDV[cc, Y][Y= - 20.0+923x, r= 0.84, p < 0.005]. Mean LVEDV/m2 was [57.6 * 18.3 cc / m2[range 28.7 - 95.8 cc / m2] and there was a significant reduction of volume compared with normal value. As body surface increases, there was a increasing tendency in LVEDV/m2 but there was no statistical significance. Mean total amount of postoperatively infused dopamine in these 33 patients[except one who expired postoperatively] was 65.6*74.5mg / kg and it was 40.6*44.0mg / kg in routine RVOT widening group [Group I] and 205*49.3mg / kg in transannular RVOT widening group[Group II]. There was a statistically significant difference between two groups. In group I patients there was a good linear inverse correlation between dopamine total amount[mg / kg, Y] and LV volume[cc / m2, X] [Y = 150 - 1.89 X, r = - 0. 77, p < 0.005]. But there were no correlations between dopamine total amount and Hct, cardiopulmonary bypass time and aorta cross clamp time. In conclusion, the patient with small preoperative left ventricular volume required more amount of dopamine as an inotropic agent for the maintenance of a cardiac function in postoperative period. But this is a result of immediate postoperative period and does not reflect the long term effect of left ventricular volume in tetralogy of Fallot. There must be more study for the evaluation of its long term effect.

• Journal of Chest Surgery
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• 제10권1호
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• pp.106-112
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• 1977

Transposition of the great arteries is one of the commonest forms of severe congenital heart disease and produces severe cyanosis threatening survival from the day of birth. Anatomical anomalies which the aorta arises from the infundibulum of the right ventricle and the pulmonary artery arises from the outflow tract of the left ventricle make the deranged circulation. Survival is possible only if additional anomalies are present which allow mixing of the pulmonary and systemic circulations. Preoperative diagnosis as TGA was taken on the 15 day old female via the preoperative examination and the right cordioangiography. As palliative treatment for cyanosis, Blalock-Hanlon operation was performed in this patient. The results were good as 54 mmHg changed from 27 mmHg of $PO_2$ in aorta, but sudden cardiac arrest was developed in postoperative 12 hours. In order to confirm the cause of death and the cardiac anomalies, autopsy was performed on the date of death. The diagnosis of the autopsy showed; [1] Transposition of the Great Arteries. [2] Patent Ductus Arteriosus. [3] Patent Foramen Ovale. [4] Ventricular Septal Defect, 2 Muscular Type. [5] Double Ureter, Right. [6] Artificial Atrial Septal Defect. [7] Total Collapse of the left lung and Intraparenchymal hemorrhage of right lung.

• Journal of Chest Surgery
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• 제27권6호
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• pp.435-443
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• 1994

Surgical procedures to relieve congenital right ventricular outflow tract[RVOT] obstruction of heart were performed on 125 patients from September 1985 to August 1992. There were 65 males and 60 females. Ages ranged from 7 months to 33 years with a mean age of 8 years. All the patients were divided into three main groups[I, II, III] depending on the presence or absence of cyanosis and combined anomalies. The patient were classified into two groups; A and B according to the outcome after surgical repair. Group A included the patients who had a good postoperative outcome with or without mild complications such as wound disruption, or hydrothorax. Group B included the patients who had a poor outcome including hospital death and significant postoperative complications such as heart failure, low output syndrome, respiratory failure, hepatic failure and others. And the results were summarized as follows. 1. There were no significant differences in age, body surface area and aortic dimension among the group I, II, and III, but there were significant differences among groups in pulmonary arterial dimension, ACT[aortic cross clamping time], TBT [total bypass time], preoperative and postoperative ratio of systolic pressure of right and left ventricles [pre PRV/RV and post PRV/LV], and the size of Hegar dilator which passed through the RVOT postoperatively [p<0.05]. 2. In the group A and B, there were significant differences in pulmonary arterial dimension [group A:1.6$\pm$0.5 cm, group B:1.9$\pm$0.6 cm], ACT [group A:102.3$\pm$ 46.0 minute, group B:76.1$\pm$46.1 minute], TBT [group A:133.9$\pm$56.6 minute, group B:94.9$\pm$51.9 minute], pre PRV/LV [group A:1.06$\pm$0.24, group B:0.8$\pm$0.32], post PRV/LV [group A:0.58$\pm$0.18, group B:0.43$\pm$0.16].It has been concluded that postoperative prognosis of RVOT obstruction was influenced by pulmonary arterial dimension, ACT, TBT, severity of RVOT obstruction [pre PRV/LV] and post PRV/LV.

• Journal of Chest Surgery
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• 제31권7호
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• pp.660-667
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• 1998

배경: 이 연구는 폐동맥 유출로 협착을 가진 다양한 복잡 심기형 환아에서 시행한 Lecompte 술식의 효과와 임상 적용에 관한 검증을 위한 것이다. 방법: 1988년 7월부터 1997년 12월까지 서울대학교 어린이 병원 흉부외과에서는 44명의 환아에 대하여 상기 술식을 시행하였다. 남녀비는 24대20이었으며 연령분포는 3개월에서 83개월까지로 평균 29.2개월이었다. 이 중, 심실 중격 결손과 폐동맥 협착(또는 폐쇄)을 동반한 대혈관 전위가 28명으로 가장 많았고(63.6%), 그 외 14명(31.8%)의 폐동맥 협착(또는 폐쇄)을 동반한 양 대혈관 우심실 기시 등이 있었다. 술식의 기본 원칙은 1)심실 중격 결손 부위의 확장 또는 누두부 중격 절제, 2)좌심실-대동맥 간의 심장내 도관 형성, 3)인공 심장외 도관을 사용하지 않는 폐동맥 간과 우심실의 직접 문합 등이었다. 결과: 대상 환자 중 3명에서 병원 내 사망이 있었으며 사인은 지속성 저산소증, 심근 부전, 패혈증으로 각각 판단되었다. 만기 사망 1명은 술 후 3개월에 패혈증에 의한 것이었다. 재수술은 6명에서 시행되었고, 폐동맥 유출로 협착 4명, 잔존한 근육성 심실 중격 결손 1명, 재발성 패혈성 식균증 1명 등이었다. Kaplan-Meier 법에 의한 누적 생존률은 1년, 2년, 4년 이후에 모두 92.7%였고, 재수술 없는 누적 생존률은 1년, 3년, 5년 이후에 각각 92.7%, 92.7%, 70.2%였다. 사망 위험 인자 분석 결과 대동맥 차단 시간이 통계적으로 의미가 있었고(p<0.05), 재발성 폐동맥 협착의 위험 인자인 연령, 폐동맥 지수, 유출로 재건에 사용된 재질 등은 모두 통계적으로 의미가 없었다(p>0.05). 결론: 이상의 연구에서 Lecompte 술식은 폐동맥 유출로 협착을 가진 다양한 복잡 심기형 환아에서 시행할 수 있는 효과적인 치료 술식이라는 결론을 얻었으며, 비교적 어린 나이에 완전 교정이 가능하고 사망률, 이환율 또한 수용 가능한 것으로 판단된다.

• Journal of Chest Surgery
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• 제26권1호
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• pp.36-43
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• 1993

Sixty four children [aged 2 days to 9 years] , 58 with complete transposition of the great arteries, 5 with Taussig-Bing double outlet right ventricle, and 1 with double outlet left ventricle plus left ventricular type single ventricle, have undergone anatomic correction from November 1987 to August 1992. Eleven underwent previous operations: pulmonary artery banding[7], modified Blalock-Taussig shunt[2], coarctoplasty[2], aortic arch reconstruction[1] . Of 58 patients with TGA, Type A coronary arteries of Yacoub were seen in 50[86%]. U-shaped coroanry arterial flaps were transfered to the neoaorta using trap door technique, and neopulmonary arterial tract was constructed using glutaraldehyde fixed autopericardium with Lecompte maneuver. There were 18 hospital deaths [28.1%] with no late mortality. Mean follow-up of 20.4\ulcorner11.9 months were achieved in all survivors. Postoperative cardiac catheterizations were done in 14 cases. Mean pressure gradients of pulmonary and aortic outflow tract were 15.0 $\pm$2.6 and 4.2$\pm$1.4mmHg, mild aortic valve insufficiencies were found in 2, and mean cardiac index was 5.18$\pm$0.19 L/min/M2. We conclude that we should continue anatomic correction for the complex congenital heart anomalies with the malposition of the great arteries because myocardial function seems to be well preserved, though we are still on the learning curve.

• Journal of Chest Surgery
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• 제37권9호
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• pp.727-734
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• 2004

심실대혈관 연결 이상을 교정하기 위한 Lecompte 술식은 폐동맥 협착의 재건을 위해 심장외 도관이 필요없는 장점이 있다. 저자들은 Lecompte 술식의 장기 성적을 분석하여 그 효과와 적용 가능성을 평가하였다. 대상 및 방법: 1988년 7월부터 2004년 4월까지 서울대학교 어린이병원 흉부외과에서는 총 46명의 환아에서 상기 술식을 시행하였다. 평균 연령은 29.2$\pm$20.3 (범위: 3∼83)개월이었다. 술전 진단은 심실중격결손과 폐동맥 협착(또는 폐쇄)을 동반한 완전대혈관 전위가 30명이었고(65.2%), 페동맥 협착(또는 폐쇄)을 동반한 양대혈관 우심실 기시가 14명(30.4%), 방실중격 결손과 페동맥 협착을 동반한 완전대혈관 전위가 1명(2.2%), 폐동맥 협착을 동반한 양대혈관 좌심실 기시가 1명(2.2%)에서 있었다. 결과: 대상 환자 중 2명(4.4%)의 조기 사망이 있었으며, 3명(6.8%)의 만기 사망이 있었다. 평균 추적 관찰 기간은 11.2$\pm$6.9년이었다. 18명(43.9%)에서 30 mmHg 이상의 우심실 유출로 협착이 있었으며, 그 주된 원인은 15명(83.3%)에서 석회화된 단엽 판막 때문이었다. 17명(37.0%)에서 재수술을 시행하였으며, 재수술을 시행한 원인은 우심실유출로 협착이 15명(32.6%), 잔존 심실 중격 결손이 5명, 좌심실 유출로 협착이 4명, 폐동맥판막 폐쇄부전이 3명, 기타 4명이었다. 누적 생존율은 10년에 91.3$\pm$4.2%였으며, 15년에 87.0$\pm$5.8%였다. 잔존 우심실 유출로 협착에 대한 재수술 없이 생존할 확률은 5년에 90.6$\pm$4.5%였으며, 10년에 73.9$\pm$7.3%였으며, 15년에 54.0$\pm$10.4%였다. 결론: Lecompte 술식은 페동맥 협착을 갖는 많은 선천성 심기형에 대한 효과적인 치료 방법이다. 좋은 장기 성적을 보이며, 어린 연령에서도 시행할 수 있으나, 단엽 판막의 퇴행성 변화에 의한 우심실 유출로 협착의 재발이 해결되어야 할 문제이다.