• Journal of Chest Surgery
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• v.31 no.8
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• pp.804-810
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• 1998

Background: Multiple trauma patients have rapidly increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Multiple trauma can involve injuries to the heart, lung, and great vessels and influence the lives, necessitate prompt diagnosis and treatment. Most of the thoracic injuries can be managed with conservative method and simple surgical procedures, such as closed thoracostomy, but in certain cases open thoracotomy is necessary. Materials and methods: The author analyzed the surgical result of 70 cases of open thoracotomy after multiple organ injury including thoracic organ. Results: The most common type of thoracic lesion was hemothorax with or without pneumothorax and diaphragmatic rupture was the second. Sixty percent of the patients were associated with bone fractures, 42.9% with abdominal injuries, and 37.1% with head injuries. The modes of operation were ligations of torn vessels for bleeding control(48.6%), repair of diaphragm(35.7%), and repair of lung laceration(25.7%) in this order of frequency and additional procedures were splenectomy(14.3%), hepatic lobectomy (8.6%) and repair of liver lacerations(5.7%). Postoperative complications were atelectasis (8.6%), wound infection (8.6%), and pneumonia(4.3%). Postoperatively six patients died(The mortality rate was 8.6%) and the causes of death were respiratory failure(2), acute renal failure(2), sepsis(1), and hypovolemic shock(1).

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.65-69
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• 2008

A two-month-old baby had acholic stool, neonatal hyperbilirubinemia and congenital heart disease. Atresia of the hepatic duct was confirmed by open cholangiography, which showed a non-opacified intrahepatic bile duct. Liver biopsy and the Kasai operation were performed. Because the liver biopsy pathology revealed a paucity of intrahepatic bile ducts, the patient was diagnosed with the Alagille syndrome. We report the case of an infant diagnosed with the Alagille syndrome with atresia of the hepatic duct.

• Proceedings of the KSME Conference
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• 2008.11a
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• pp.1660-1664
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• 2008

Extra-corporeal Life Support System (ECLS) is the device used in emergency cases to substitute a extracorporeal circulation in open heart surgery, cardiac arrest or in acute cardiopulmonary failure. To obtain the effect of counter-pulsation on hemodynamic response in the ECLS quantitatively, we developed cardiovascular model which consists of 12 compartment model of heldt et al. and 3 compartment model of Schreiner et al. based on windkessel approximation. We compared coronary perfusion, arterial pulse pressure, cardiac output, and left ventricular pressure-volume diagram according to flow configuration such as counter-pulsation, copulsation, and continous flow. When counter-pulsation was applied, 5% higher coronary perfusion, 26% lower pulse pressure, and 2% higher cardiac output than copulsation condition were calculated. We conclude that counter-pulsation configuration in the ECLS is hemodynamically more stable than copulsation and influences the positive effect to recover ventricles.

• Journal of Veterinary Clinics
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• v.35 no.1
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• pp.10-12
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• 2018

Mitral regurgitation is the most frequent cause of cardiac disability and death in dogs. A wide range of medical and surgical treatments have been used for mitral regurgitation. Surgical treatments for complete correction of mitral regurgitation include valve repair and valve replacement, which have the advantages of eliminating or correcting the primary cause. Surgical treatments approach the mitral valve via right- or left-side thoracotomy. Aortic root exposure is needed for cardiopulmonary bypass. To compare right-side and left-side approaches, 10 dog cadavers were used in this study. Subsequently, the left-side surgical approach was used in vivo and in conjunction with cardiopulmonary bypass and cardioplegic arrest. Based on the results, and considering ease of access to the aortic root, valve incision site, and visualization of the surgical field, a left-side approach is recommended.

• Pediatric Infection and Vaccine
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• v.23 no.3
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• pp.209-216
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• 2016

Purpose: This study aimed to evaluate and compare the characteristics of infective endocarditis (IE) between children and adults with congenital heart disease (CHD) at a single tertiary care center. Methods: In this retrospective medical record review, we extracted the demographic characteristics, diagnostic variables, and outcomes of patients diagnosed with IE and CHD between 2000 and 2016. Results: We identified a total of 14 pediatric patients (nine male; median age at diagnosis, 3 years). Of the 14 patients, six had a history of previous open heart surgery, while four had undergone tetralogy of Fallot repair, with transannular patch or Rastelli procedure. Among the 10 children with positive blood cultures, the most common isolated organism was Staphylococcus spp. (8/10, 80%). Eleven adult patients had IE and CHD. Among the adult patients, only four were diagnosed with CHD before IE, and ventricular septal defect was the most common CHD. The most common isolated organism was Streptococcus spp. (6/11, 55%). Compared with adult patients, pediatric patients had a higher incidence of previously diagnosed CHD (P=0.001), with Staphylococcus spp. as the causative organism (P=0.027). The median duration between the onset of symptoms and diagnosis of IE was 9 days in children and 42 days in adults (P=0.012). Conclusions: Significant differences with regard to the diagnosis and progress of IE were observed between children and adults. Age-adjusted and systematic reassessment may be necessary for the diagnosis and management of IE.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.168-179
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• 2007

Background: The recent trend of an increasing number of patients with acute cardiogenic shock or chronic congestive heart failure following myocardial infarction, as well as the considerable number who can not be weaned from cardiopulmonary bypass after open heart surgery, call for immediate efforts to develop affordable ventricular assist devices that are suitable for the Korean physique. Recently, a pneumatic pulsatile ventricular assist device (VAD), named DKUH-75, has been developed by the Department of Biomedical Engineering, in collaboration with the Department of Thoracic and Cardiovascular Surgery of Dankook University College of Medicine. The feasibility of the DKUH-75 VAD was evaluated on the bases of common hemodynamic variables and echocardiographic measurements in pigs, which are subjected to an acute cardiogenic shock state following myocardial infarction, using a novel coronary artery ligation method employing the ischemic preconditioning concept. Material and Method: Acute cardiogenic shock was induced in 10 Yorkshire Landrace Duroc strain pigs by ligating the left anterior descending coronary artery via an ischemic preconditioning process. The hemodynamic variables were monitored, with epicardial echocardiographic measurements performed before and one hour after the ligation. The DKUH-75 VAD was implanted into 5 pigs one hour after the onset of the shock. The hemodynamic variables and echocardiographic measurements were taken one hour after installation of the VAD. Result: The systolic, diastolic and mean systemic arterial pressures were significantly decreased in all the experimental animals one hour after the ligation. The systolic, diastolic and mean pulmonary arterial pressures were increased (Eds note: this completely contradicts the preceding statement? However, if you mean the non-experimental animals this should be stated?). The left ventricular end diastolic pressure (LVEDP) was increased, but the cardiac index decreased, An increase in the left ventricular end systolic dimension and decreases in the fractional shortening and ejection fraction were observed all animals one hour after the coronary artery ligation. In all 5 of the VAD implanted pigs, the systolic and mean systemic arterial pressures were increased, and the pulmonary arterial pressures decreased one hour after the implantation; the LVEDP decreased, but the cardiac index was significantly increased, In the echocardiographic measurements, the left ventricular end systolic dimension decreased after the implantation of the VAD, but the fractional shortening and ejection fraction significantly increased. Conclusion: Significant improvements in the hemodynamic variables and echocardiographic measurements were observed in the 5 VAD implanted animals one hour after installation, which had been subjected to an acute cardiogenic shock state by ligation of the coronary artery, indicating that the DKUH-75 VAD could help in the recovery of the myocardial function. This suggests that the DKUH-75 VAD is feasible in the short term in relation to an acute cardiogenic shock state due to myocardial infarction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.32-40
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• 1989

This study is based on 247 patients(348 cases) with facial bone fracture who were admitted to the department of oral and maxillofacial surgery, Kangnam sacred heart Hospital during the period of Jan. 1983 through sep. 1988. The patients with mandible fracture were analysed with the following items such as complications with treatment method undertaken : Bicortical osteosynthesis vs Monocortical osteosynthesis, advantages and Disadvantages. The results obtained are as follows : 1) The most common age groups for the facial bone fracture were 20 years 2) The ratio of Men to women was 5 : 1 3) The most frequent location of facial bone fractures was the Mandible(76.7%), Maxillae(10.6%), Zygoma(9.5%), Nasal bone(3.2%) 4) The ratio of Mandible to Maxillae was 7.2 : 1 5) In mandible fractures, the most frequent fracture site was Symphysis(48.7%) 6) In maxilla fractures, the most frequent case was Le fort III fracture(51.4%), followed by Le fort I fracture(29.7%), Le fort II fracture(18.9%) 7) The main contributing causes of facial bone fractures were Traffic Accident(37.7%), Fight(31.6%), Accident(27.5%) 8) In open reduction methods of mandible fracture, the frequency of postop, malocclusion was 15% in interosseous wiring, 7% in Bicortical osteosynthesis, 3% in Monocortical osteosynthesis. The miniplates show advantages over other forms of fixation, in that they are malleable and easy to insert, they achieve rigid fixation and stability.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.941-944
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• 1997

Pulmonary infarction is rarely diagnosed with certainty except at postmortem examination. Part of this uncertainty is because of the inability to distinguish between hemorrhage, congestive a electasis, and necrosis clinically and radiographically. The pathogenesis of pulmonary infarction is poorly understood. It is dif%cult to induce pulmonary infarction in animals by ligation of the arterial supply to the lung. Many factors seem to be important in its pathogenesis, in addition to congestive heart failure, malignant tumor, thrombophlebitis, chronic obstructive lung disease, nephrotic syndrome, and postopeiative state. However, pulmonary infarction have not been reported in association with chest trauma. We report a case of pulmonary infarction associated with fractures of right clavicle and multiple ribs. A 45-year-old male had admitted due to right chest pain and dyspnea, which developed after right chest trauma occurred at about 3 weeks ago. He was treated at local clinics under the diagnosis of fractures of right clavicle and ribs until the admission. Chest CT disclosed a huge mass with central low density in right upper lobe, and small masses were also seen on both l ng fields. Open lung biopsy resulted in negativity for the malignancy. Clinical symptoms and radiological findings were not improved by conservative treatment. Right upper lobectomy was done eventually. The final diagnosis was pulmonary infarction. And, the patient has been well after operation.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.190-198
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• 1983

The management of cardiac arrhythmias by cardiac pacing has increased greatly since the treatment of complete heart block with an external transcutaneous pacemaker in 1952, followed by the use of myocardial wires connected to an external pulse generation, by external transvenous pacing, and then by transvenous pacing with implantable components in thoracic wall.By now, the three bases of modern cardiac pacing for bradyarrhythmias had been established [1] an implantable device [2] the transvenous approach [3] the ability of the pacemaker to sense cardiac activity and modify its own function accordingly. In transvenous implantation of a pacemaker, any one of four vessels at the root of the neck is suitable for passage of the electrode - cephalic vein, external jugular vein, internal jugular vein, costo-axillary branch of the axillary vein. The new technique of direct puncture of the subclavian vein, either percutaneously or after skin incision only has been made, is invaluable & is used routinely. We have experienced one 25 years old patient who had rheumatic mitral stenosis & minimum aortic regurgitation with sinus bradycardia associated with premature atrial tachycardia & another 54 years old female patient who was suffered from sick sinus syndrome with sinus bradycardia & sinus arrest. The 1st patient was taken open mitral commissurotomy & aortic valvuloplasty and then was taken atrlal pace-maker implantation through If subclavian puncture method in post-op 14 days, and the second patient was taken atrial pacemaker implantation through If subclavian puncture method. Their postop course was in uneventful & were discharged, without complication. Their condition have been good to now.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.723-728
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• 2000

Background: Minimally invasive techniques for open heart surgery are widely accepted in these days. There are minimally invasive approaches by the right or left parasternal incision and another approaches by mini-sternotomy of upper or lower half or sternum. We report the safety and efficacy of minimally invasive technique with right parasternal incision compared with the routine full sternotomy. Material and Method: From April 1997 through February 1999, 20 patients(Group A) underwent minimally invasive cardiac operations. We chose 41 patients(Group B) whose preoperative diagnosis were the same and general conditions were similar and who underwent routine full sternotomy before April 1997. We compared A group and B group in many aspects. We performed routine full median sternotomy in B group but we did a minimally invasive technique through a small right parasternal incision in A group. Result: mean age was 36.1 years in both groups. In disease entities, there were 11 cases of ASD, 9 cases of mitral valve disease in group A, and 16 cases of ASD, 25 cases of mitral valve diseases in group B. In ASD, operation time, cardiopulmonary bypass time of aortic occulusion time were 263 min, 82 min, and 41 min in group A and 180 min, 53 min, and 32 min in group B. In mitral valve disease, operation time, cardiopulmonary bypass time and aortic occlusion time were 267min, 106 min, and 70min in A group and were 207 min, 82 min, and 69 min in group B. There were significant differences in operation time, CPB time, and ACC time between group A and group B. There was a significant difference in the amount of bleeding in postoperative day 1 between group A and group B of mitral diasease. However, there was no significant difference in the amount of bleeding in other comparisons. Mean length of incision was 8.7 cm in group A. There was no significant difference in postoperative complications between A group and B group. There was no mortality in either group. Conclusion: We conclude that this minimally invasive technique with right parasternal incision is cosmetically excellent but it is not effective in reducing operative time and there was no significant difference in recovery time and postoperative complications compared with routine full sternotomy.