• Journal of Chest Surgery
• /
• 제44권4호
• /
• pp.285-287
• /
• 2011

A 53-year-old man presenting with dyspnea and chest pain was diagnosed with acute myocardial infarction secondary to occlusion of the left circumflex coronary artery. Urgent revascularization by percutaneous stenting was successfully performed. However, the post-echocardiography revealed a ruptured papillary muscle that was causing severe mitral regurgitation and aggravation of congestive heart failure. The patient subsequently underwent mitral valve repair with papillary muscle re-implantation. Postoperative echocardiography showed a competent mitral valve without residual stenosis or regurgitation. The patient was discharged from the hospital with an uneventful recovery and has been doing well on outpatient follow up.

• Journal of Chest Surgery
• /
• 제29권1호
• /
• pp.32-37
• /
• 1996

본 서울중앙병원에서는 1991년 5월에서 1995년 9월까지 심근경색후 합병된 심실중격결손증 7례 환자의 수술을 시행 하였다. 남자환자가 2명, 여자환자가 5명 이었으며, 평균연령은 65세 (범위 : 54~76)였다. 심실중격결손의 위치는 전중격 결손이 6명이 었으며, 전후중격 경계부 심실중격결손이 1명 있었다. 모든 환자에서 술전 심초음파와 심혈관조영술을 시행하여 심실기능과 관상동맥 병변의 위치를 파악하였다. 수술은 심근괴사후 평균 24 $\pm$ 12일 후에 시행하였다. 좌심실 심근괴사 조직을 통하여 Teflon patch로 봉합하였고, 추가적인 수술로 3명 환자에서는 관상동맥 우회 술을 시행하였고, 5명 환자에서 심실류 제거술을 시행하였으며, 1명 환자에서 좌심실혈전 제거술을 시행하였다. 심실중격결손의 봉합시 중격근육전층을 통하여 interuptted pledget 봉합함으로써 심실중격 결손 재발을 막으려고 노력하였으며, 수술후 합병증으로는 폐렴 1명, 좌측대퇴부 피부괴사 1명이 있었다. 조기 사망률은 없었고 외국으로 이민간 1명을 제외하고 6명 모두 수술후 3개월에서 63개월 사이(평균28개월)에 추적 조사상 합병증이나 사망 없이 NYHA I-II상태로 생활하고 있다.

• Journal of Chest Surgery
• /
• 제25권4호
• /
• pp.424-428
• /
• 1992

Post-AMI VSD is an infrequent but often catastrophic complication of acute myocardial infarction In general, the mortality is associated with end organ failure due to low output syndrome. Therefore, a stable hemodynamic is necessary to prevent the end organ failure. If a supportive therapy does not accomplish it, surgical intervention should be considered. Recently, we have experinced a case of post-AMI VSD with cardiogenic shock. Early recognition and surgical repair of post-AMI VSD gave us a good result. Postoperative result was satisfactory and recovery was uneventful. We believe that early surgical repair can be lifesaving in the case of post-AMI VSD with cardiogenic shock.

• Journal of Chest Surgery
• /
• 제22권4호
• /
• pp.661-666
• /
• 1989

Congenital coronary arterial fistulae are the most prevalent hemodynamically significant congenital coronary artery malformations. Definition of congenital coronary arterial fistula is a direct communication between a coronary artery and the lumen of one of the four cardiac chambers or coronary sinus or SVC, pulmonary artery or pulmonary vein close to the heart. It is often associated with additional congenital or acquired heart disease. A 49 year old male patient was admitted with the chief complaints of anginal pain and exertional dyspnea for 9 months. He was diagnosed as the right coronary arterial fistula combined with right coronary arteriosclerotic stenosis and old inferior myocardial infarction by cardiac evaluation. The right coronary arterial fistula was communicated between the just distal portion of acute marginal branch and coronary sinus. The operative procedure was as followings; after suture ligation of fistula opening in the coronary sinus under beating heart, coronary arterial bypass grafting with saphenous vein was performed at the just proximal portion of the posterior descending branch under cardiopulmonary bypass. The postoperative course was uneventful and he was discharged without anginal pain at the 8th postoperative day.

• Journal of Chest Surgery
• /
• 제13권2호
• /
• pp.118-124
• /
• 1980

A double aorto-coronary bypass procedure performed in 2 cases, one with a Prinzmetal`s variant angina and the other with an unstable angina, is presented. The patient with a Prinzmetal`s angina who had a high-grade obstruction of the left anterior descending and the right coronary system showed a marked postoperative improvement with complete disappearance of anginal pain. The other patient with unstable angina had obstruction of the left anterior descending as well as a marginal branch of the left circumflex artery. Following bypass of these vessels, the patient did well during the immediate postoperative period. However, he developed hypotension in the recovery room and died 6 hours postoperatively, in spite of an intensive effort at resuscitation. The most likely cause of death in this patient is a myocardial infarction.

• Journal of Chest Surgery
• /
• 제20권2호
• /
• pp.393-398
• /
• 1987

Unstable angina pectoris is often premonitory to an acute myocardial infarction. Surgical revascularization in this syndrome is of great potential benefit and relatively low mortality. A patient with unstable angina pectoris is reported. A 65-year-old man complained of dyspnea and pain in the left anterior chest. The pain was brought on by mild exercise, occurred at rest and sleeping time. The pain worsened over a month period and more aggravated in intensity and duration. Physical examination showed no abnormalities except hypertension and laboratory data were within normal limits. His anginal pain was not relived by nitroglycerin ingestion. Preoperative coronary angiograms revealed significant obstruction [>90%] of left anterior descending coronary artery. Aorto-left anterior descending coronary bypass with autogenous saphenous vein used as conduit was performed. The postoperative course was uneventful and he was discharged on 16th postoperative day in a healthy condition.

• International journal of advanced smart convergence
• /
• 제9권3호
• /
• pp.71-77
• /
• 2020

This study was conducted in order to determine how reductions in blood pressure during surgery affect intraoperative neuromonitoring. This retrospective study considered a total of 339 patients: 194 patients with normal neuromonitoring findings (57%), 145 (42%) with abnormal neuromonitoring findings, and 34 (10%) with postoperative neurological deficits. Comparisons between the three groups revealed that overall blood pressure during surgery, postoperative blood pressure, and the difference between the maximum and minimum blood pressure could affect the intraoperative neuromonitoring findings. While we indicate that a drop in blood pressure to below 70 mmHg could affect neuromonitoring results, differences in the dosage of anesthetic agents did not significantly affect reductions in blood pressure or neuromonitoring findings. The association of monitoring with blood pressure found in this study is expected to help future examiners. However, this study did not clarify the relationship between anesthesia and blood pressure and how it could affect intraoperative neuromonitoring. Therefore, further research on this part is thought to be necessary.

• Journal of Chest Surgery
• /
• 제39권1호
• /
• pp.64-67
• /
• 2006

제1 대각지 단독 폐쇄에 의한 승모판막 전방 유두근의 파열은 매우 드물다. 66세 여자환자가 심근경색에 이은 심인성쇼크로 전원되었는데, 심초음파 및 관상동맥 조영술 결과 제1 대각지의 완전폐쇄와 승모판막 전방 유두근 파열 및 심한 승모판막 폐쇄부전증이 발견되어 응급 승모판막치환술 및 관상동맥 우회술 후 특별한 문제없이 회복하였다.

• 한국정보통신학회:학술대회논문집
• /
• 한국정보통신학회 2018년도 춘계학술대회
• /
• pp.188-192
• /
• 2018

대뇌혈류를 증가 시키는 수술은 뇌경색의 치료방법중 하나이다. 그러나 수술과 같은 침습적인 방법은 환자에게 수술 후유증 또는 부작용을 부담하게 한다. 이러한 침습적인 방법을 보완하기 위해 사람의 혈압을 이용해, 사지에 압박을 가하여 대뇌 혈류를 증가 시키는 비 침습적인 장치도 등장하였다. 그러나 속도와 정확성이 떨어지는 문제점이 제기되었다. 본 논문에서는, 정확한 측정과 측정하는 데에 걸리는 시간을 기존의 장치보다 개선하기 위해, Blood Oxygen Level Sensor를 이용하여, 양팔에 압력을 주면서 각 팔의 Perfusion Index를 측정하여, Perfusion Index가 일정 값 이하로 떨어지는 순간의 75% 압력을 팔에 가하고, 다리에는 팔에서 구해진 압력 값을 이용해 계산하여 얻은 압력을 가한다. 기존의 혈압 측정식 대뇌혈류증가 장치와 같이, 혈류량을 20%이상 증가시킬 수 있고, 또한 측정 시간도 단축한 결과를 얻어 뇌경색 환자에게 선택적으로 사용할 수 있다.

• Journal of Chest Surgery
• /
• 제49권3호
• /
• pp.171-176
• /
• 2016

Background: A previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI. Methods: The present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to December 2014. Patients who previously underwent PCI (n=38) were compared to patients who did not (n=122). Preoperative, operative, and early in-hospital postoperative data were analyzed. The end points of the study were in-hospital mortality and postoperative major adverse events. Results: Non-significant differences were found between the study groups regarding preoperative demographic data, risk factors, left ventricular ejection fraction, New York Heart Association class, EuroSCORE, the presence of left main disease, reoperation for bleeding, postoperative acute myocardial infarction, a neurological deficit, need for renal dialysis, hospital stay, and in-hospital mortality. The average time from PCI to CABG was $13.9{\pm}5.4$ years. The previous PCI group exhibited a significantly larger proportion of patients who experienced in-hospital major adverse events (15.8% vs. 2.5%, p=0.002). On multivariate analysis, only previous PCI was found to be a significant predictor of major adverse events (odds ratio, 0.16; 95% confidence interval, 0.03 to 0.71; p=0.01). Conclusion: Previous PCI was found to have a significant effect on the incidence of early major adverse events after CABG. Further large-scale and long-term studies are recommended.