• Journal of Chest Surgery
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• v.37 no.5
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• pp.416-422
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• 2004

Acute renal failure (ARF) is a common postoperative complication after the cardiac surgery. Postoperative ARF have various causes, and are combined with other complications rather than being the only a complication. It deteriorates the general condition of the patient, and makes it difficult to manage the combined complications by disturbing the adequate medication and fluid therapy. We have planned this study to evaluate the effects of postoperative ARF after the on-pump coronary artery bypass surgery (CABG) on the recovery of patients and identify the risk factors. Method and Material: We reviewed the medical records of patients who underwent CABG with cardiopulmonary bypass by a single surgeon from Jan. 2000 to Dec. 2002, We checked the preoperative factors; sex, age, history of previous serum creationism over 2.0 mg/㎗, preoperatively last checked serum creatinine, diabetes, hypertension, left ventricular ejection fraction, intraoperative factors; whether the operation is an emergent case or not, cardiopulmonary bypass time, aortic cross clamp time, the number of distal anastomosis, postoperative factors: IABP. Then we have studied the relations of these factors and the cases of postoperative peak serum creatinine over 2.0 mg/㎗. Result: There were 19 cases with postoperative peak serum creatinine over 2.0 mg/㎗ in a total 97 cases. Dialysis were done in 3 cases for ARF with pulmonary edema and severely reduced urine output. There were 8 cases (42.1%) with combined complications among the 19 patients. This finding showed a significant difference from the 5 cases (6,4%) in the patients whose creatinine level have not increased over 2.0 mg/㎗. The mortalities are different as 1.3% to 10.5%. The risk factors that are related with postoperative serum creatinine increment over 2.0 mg/㎗ are diabetes, the history of previous serum creatinine over 2.0 mg/㎗ and left ventricular ejection fraction. Conclusion: Postoperative ARF after the on-pump CABG is related with preoperative diabetes, the history of previous serum creatinine over 2,0 mg/㎗ and left ventricular ejection fraction. Postoperative ARF could De the reason for increased rate of complications and mortality after on-pump CABG. Therefore, in the patients with these risk factors, the efforts to prevent postoperative ARF like off-pump CABG should be considered.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.25-31
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• 2007

Background: Cerebral protection is one of the most important procedures during aortic arch surgery. We can minimize neurological complications through short period of total circulatory arrest and resuming of brain perfusion. We evaluated 11 patients who underwent arch replacement using antegrade brain perfusion via right axillary artery. Material and Method: Between July 2004 and July 2006, 11 patients (male 9, female 2) underwent aortic arch replacement with antegrade brain perfusion via right axillary artery. Preoperative diagnosis was listed; 5 type A aortic dissections (5/11, 45.5%), 5 aortic aneurysms (5/11, 45,5%) and 1 type A IMH (intramural hematoma, 1/11, 9%). The mean age at the time of operation was $60.3{\pm}12.8$ years. For antegrade brain perfusion, we performed right axillary artery cannulation in all patients. Retrograde brain perfusion was used briefly during total circulatory arrest. Result: The mean total circulatory arrest time was $31.1{\pm}16.9$ minutes and the mean retrograde brain perfusion time was $21{\pm}17.8$ minutes. Mean antegrade brain perfusion time was $77.9{\pm}17.5\;(43{\sim}101)$ minutes. We had neither operative mortality nor permanent neurological complications. Conclusion: By means of antegrade brain perfusion via right axillary artery, that could lead to decrease circulatory arrest time and minimize damages to severely atheromatous arch vessels, we can expect to reduce neurological complications after aortic arch replacement. Further investigation with iarge patient populations will be required.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.103-108
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• 2007

Background: Surgical resection is an important modality in the treatment of pulmonary metastases from various solid tumors. We analyzed 37 patients who underwent surgical treatments of pulmonary metastases in our hospital from 1996 to 2005. Material and Method: Age, sex, disease free interval, operative procedure, the number of pulmonary metastases, and lymphatic metastasis were investigated with admission and operative records, and pathologic reports. Actuarial survival and comparisons between each survival rate were calculated according to Kaplan-Meier method and log-rank test, respectively, Result: Complete resections were carried out in 34 of 37 patients. The primary tumor was carcinoma in 25 cases, sarcoma in 10, and others in 2. The number of pulmonary metastases was 1 in 25 cases and 2 or more in 12 cases. 3-year and 5-year survival rates after complete resection were 50.5% and 35.9%, respectively. 3-year and 5-year survival rates for carcinoma were 64.5% and 45.0%, respectively, and 3-year survival rate for sarcoma was 17.5%. Otherwise, none of the operative procedures, the number of pulmonary metastases, lymphatic metastasis, adjunctive therapy and the disease free interval in the case of carcinoma significantly affected the survival rates. Conclusion: Complete resection of pulmonary metastasis in well selected patients allows high long term survival rate with low mortality and morbidity. Long-term follow up and randomized prospective studies were necessary to determine the prognostic factors of pulmonary metastases after surgical resection.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.414-419
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• 2007

Background: Replacing the ascending aorta is a standard surgical option for treating acute type A aortic dissection. But replacing the aortic arch has recently been reported as an acceptable procedure for this disease. We compared the effects of aortic arch replacement for treating acute type A aortic dissection with the effects of ascending aortic replacement. Material and Method: From 2002 to 2006, 25 patients undewent surgical treatment for acute type A aortic dissection, 12 patients undewent ascending aortic replacement and 13 patients underwent aortic arch replacement. Among the aortic arch group, an additional distal stent-graft was inserted during the operation in 5 patients. 19 patients (11 arch replaced patients and 8 ascending aortic replaced patients) were followed up at the out patient clinic for an average of $756{\pm}373$ days. All the patients undewent CT scanning and we analyzed their distal aortic segments. Result: 4 patients who underwent ascending aortic replacement died, so the overall mortality rate was 16%. Among the 11 long term followed-up arch replacement patients, 2 patients (18.1 %) developed distal aortic dilatation and one of them underwent thoracoabdominal aortic replacement later on. However, among the 8 the ascending aortic replaced patients, 5 patients (62.5%) developed distal aortic dilatation. Conclusion: Aortic arch replacement is one of the safe options for treating acute type A aortic dissection. Aortic arch replacement for treating acute type A aortic dissection could contribute to a reduced distal aortic dilatation rate and fewer secondary aortic procedures.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.420-427
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• 2007

Background: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. Material and Mehod: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: $45.9{\pm}9$ years). The patients were followed up for a mean of 58 months (median: 28 months, range: $6{\sim}169$). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema, Result: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). Conclusion: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to 75-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.749-756
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• 2009

Background: Vascular ring is a rare anomaly of the aortic arch. We did surgical repair procedures on 16 cases of vascular ring over the past 12 years. This article reviews our results. Material and Method: Between 1995 and 2007, 16 patients (5 with double aortic arch, 7 with right aortic arch-left ligamentum, 4 with pulmonary artery sling) underwent surgical repair. Mean age at the time of the operation were as follows: double aortic arch, $5.7{\pm}5.5$ years; right aortic arch-left ligamentum, $6.1{\pm}13.4$ years; pulmonary artery sling, $2.9{\pm}2.6$ years. Five patients (71%) with right aortic arch-left ligamentum had an associated Kommerell's diverticulum. Two patients (40%) with double aortic arch, 2 patients (28.6%) with right aortic arch-left ligament and 4 patients (100%) with pulmonary artery sling had associated airway stenosis. Cardiac anomalies were present in 8 of 16 patients. Result: There was no peri-operative or post-operative mortality. The mean hospital stay was $27.1{\pm}38.2$ days. None of our patients underwent reoperation. Conclusion: Vascular ring is rare, but, it needs surgical correction. It is important to suspect the diagnosis and to validate with echocardiography. Preoperative and postoperative computed tomography and bronchoscopy are useful to evaluate the airway and surrounding structures.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.725-731
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• 2009

Background: Lobectomy and more extended anatomic resection are regarded as standard treatment for stage Ia non-small cell lung cancer, but approximately 15~40% of patients suffer from treatment failures such as cancer recurrence or death. The authors analyzed types and causes of treatment failures in surgically treated cases of stage Ia non small cell lung cancer. Material and Method: We retrospectively reviewed the medical records of 156 patients who had undergone complete resection for stage Ia NSCLC between Jan 1992 and Aug 2005. Patients were divided into two different treatment failure groups: cancer-related deaths and non-cancer-related deaths. Risk factors were analyzed in each group by the Kaplan-Meyer survival method and the Cox proportional hazard model. Result: Among the 156 patients, 93 were males; the mean age was 61. The median follow-up period was 33.8 months. The 5 year survival rate was 87.6%. Microscopic lympho-vascular permeation was reported in 10 patients. Recurrence was reported in 19 patients and 12 patients died due to recurrent lung cancer. Noncancer related deaths occurred in 16 patients. Risk factors for cancer recurrence and cancer related death were microscopic lympho-vascular permeation (HR=6.81, p=0.007, HR=7.81, p<0.001); for non-cancer related death, risk factors were pneumonectomy (HR=25.92, p=0.001) and postoperative cardiopulmonary complications (HR=29.67, p=0.002). Conclusion: After complete resection of stage Ia non small cell lung cancer patients, mortality includes not only cancer related deaths but also cancer unrelated deaths. Adjuvant chemotherapy is advised for patients who show microscopic lympho-vascular permeation, which is a risk factor for recurrence and for cancer related death. Patients who had pneumonectomy or who suffered from cardiac or respiratory complications need meticulous care in order to reduce comorbidity-induced death.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.696-703
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• 2009

Background: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. Material and Method: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed, The mean patient age was 53 years (range: 14~84) The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the MR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. Result: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from $54.6{\pm}8.4$ mm to $38.3{\pm}3.8$ mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from $47.1{\pm}24.4$ mmHg to $15.1{\pm}11.7$ mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. Conclusion: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.83-89
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• 2007

Background: The surgical repair of an isolated coarctation of the aorta, without complex cardiac anomalies, has improved, with very good results. However, despite the success of surgical repair, many long-term complications, such as hypertension, re-coarctation and an aortic aneurysm, still exist. Material and Method: Between 1991 and 2006, 50 patients diagnosed with an isolated coarctation of the aorta were reviewed retrospectively. The incidence of re-coarctation and hypertension were compared with respect to age and surgical methods. Result: There were no early & late mortality, or post operative aortic aneurysms. Hypertension developed in 11 patients (22%). A greater number of patients in the child/adult group had hypertension (52.4%) than in the neonate/infant group (0%). With respect to the surgical methods, the patients in the graft interposition group suffered more hypertension (88.9%) than those in the EEEA (extended end to end anastomosis) group (5.3%). Post operative re-coarctation developed in 2 out of the 29 patients (6.9%) in the neonate/infant group and 2 out of the 21 patients (9.5%) in the child/adult group, but without any statistical difference. There were no statistical differences between the operative type-related groups. Conclusion: Even though the surgical outcomes have greatly improved, an isolated coarctation of the aorta still has many long-term problems, such as hypertension and re-coarctation. An isolated coarctation is accepted as a systemic vascular dysfunction, and often progresses to other cardiovascular diseases. Therefore, patients with a coarctation of the aorta have to be carefully followed-up, and aggressive management must be given when required.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1348-1353
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• 2005

Purpose : Influenza is a respiratory disease which prevails widely every year and shows high morbidity and mortality among not only chronic invalids and the old, but also among infants and young children. To prevent community-acquired influenza infection, to facilitate prompt antiviral therapy and to avoid unnecessary use of antibiotics, an easy, rapid diagnostic method for the influenza virus is needed. We evaluated a lateral-flow immunoassay(QuickVue Influenza Test), compared to viral culture. Methods : During two consecutive years from Jan. 2004 to June 2004 and from Feb. 2005 to Jan. 2005, 408 patients who were suffering from fever, cough and/or sore throat and myalgia were enrolled in our study. A total of 408 patients were tested with $QuickVue^{(R)}$(Quidel Co., San Diego, USA) influenza rapid antigen test and virus cultures at the same time. Results : Of the 408 patients tested, children who showed positive results at the virus culture numbered 77; among them, 55(71.4 percent) were type A/H3N2 and 22(28.5 percent) were type B. QuickVue influenza test had a sensitivity of 71.4 percent and a specificity of 95.8 percent. The positive and negative predictive values were 79.7 percent and 93.5 percent, respectively. Conclusion : In our study, this test had comparable high sensitivity and high specificity and many advantages, such as being easy to perform and simple to interpret, and showing rapid results. If rapid influenza antigen tests are widely applied in the clinic, we can begin treatment more rapidly and reduce influenza complications and the abuse of antibiotics.