• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.1042-1047
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• 1996

The Swyer-James syndrome is a relatively uncommon disease entity presented with unilateral hyperlucent lung due to hypoplasia of a pulmonary artery and bronchiectasis of the affected lung. The main finding is a hyperlucent lung with small hilar shadows on the chest X-ray. Pulmonary angiography is the standard method for diagnosis. We report a case of the Swyer-James syndrome with a brief review of literature.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.7-19
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• 2000

Background :To assess the accuracy of Electron-Beam Tomography(EBT) in following evaluation of the pulmonary vascular system after a shunt operation in the cyanotic con-genital heart disease with pulmonary stenosis or pulmonary atresia. Material and Method : Sixteen patients(M:F=11:5) who received Blalock-Taussig(n=8) bidirectional cavo-pulmonary shunt(n=10) and unifocalization (n=2) were ncluded in the study. We evaluated the patency of the shunt the morphology of intrapericardial and hilar pulmonary arteries(PA) peripheral pulmonary vascularity by background lung attenuation and the abundance of arterial & venous collateral. Angiography(n=12) and echocardiography(n=20) were used as the gold standard for the comparison of EBT results. Result: EBT was consistent with angiogram/ echo in 100% of the evaluation for the patency of the shunt and in 12(by angiogram 100%) and 19(by echo 95%) for the detection the hypoplasia stenosis or interruption of central PA In measuring of PA EBT and angiogram corrlated(r=0.91) better than EBT-echo(r=0.88) or echo-angiogram(r=0.72) Abundant systemic arterial collateral were noted in 4 and venous collateral in 3 cases. In evaluating the peripheral pulmonary vascularity the homogenous and normal-ranged lung attenuation(m=6) decreased but homo-genous attenuation(n=1) segment-by-sgment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) segment-by-segment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) and venous congestion(n=2) were observed nd 12 of them were compatible with the blood flow pattern revealed by cardiac catheterization. Conclusion: EBT was accurate in the integrated evaluation of the pulmonary vascular system after the shunt including the patency of the shunt operaion the morphology and dimension of the central and hilar PAs and the loco-regional pulmonary flow in the lung parenchyma. It suggests the useful information about the need of secondary shunt operation the proper timing time for total repair and the need of interventional procedure prior to total repair.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.742-746
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• 1993

Recent literature reveals that pulmonary embolism secondary of pulmonary tumor embolism are dyspnea, hemoptysis, pulmonary hypertension, and circulatory collapse. We experienced a case of pulmonary embolism secondary to hepatocelluar cancer in 53-year-old man. From 2 months before admission, he began to experience cough and mild shortness of breath. Within a few days these symptoms progressed to near total incapacity. Pulmonary embolism was confirmed by angiography and the diagnosis of hepatocellular cancer was estabillished by abdomen CT and $\alpha$-FP(21,000 ng/ml). There was no evidence of intravascular cogulation elsewhere in deep vein of the extremities or risk factors of deep vein thrombosis. Thus we consider that pulmonary embolism in this patients is related to hepatocellular cancer rather than deep vein thrombosis. Therefore we report the first case which hepatocellular cancer initially presented as pulmonary embolism in Korean literature.

• Journal of Chest Surgery
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• v.15 no.2
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• pp.194-203
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• 1982

In this investigation we undertook to evaluate the utility of radionuclide cardiac angiography in the detection of cardiac shunts before and after surgical correction. Time-activity curves of ventricles and lungs were evaluated after bolus intravenous injection of 99mTc-human serum albumin in 512 preoperative patients and 551 post-operative patients. Omitting 31 cases of technical failure due to poor bolus, we detected shunts in 459 cases of 481 preoperative evaluations, so the detectability was 95.4%. The cases which couldn`t be detected by this method had small amount of shunt. Also the degree of shunt detected by radioisotope methods were well correlated with oxymetry method. [r=0.89, p<0.01 ] In postoperative evaluations, 18 out of 411 patients with left to right shunt and 10 out of 140 right to left shunt were found to have remnant shunts with radionuclide cardiac angiography. Of the 28 cases with failed operation, 2 were confirmed in reoperation, 2 by cardiac catheterization, 2 by two -dimensional echocardiography. All except one .f these patients had membranous ventricular septal defects and those with left to right shunts had moderate to severe pulmonary hypertension and shunt amount. Also those had larger septal defects than control group. We consider that radionuclide cardiac angiography is a simple and noninvasive method which can show the preoperative diagnosis and postoperative follow up of cardiac shunts.

• Journal of Chest Surgery
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• v.26 no.9
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• pp.710-713
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• 1993

Congenital coronary fistula is a rare condition, and with widespread use of cardiac catheterization, angiography and selective coronary arteriography are being recognized with increasing frequency. Fistula originating from the right coronary artery are more common than those from the left coronary artery. The fistula empties into the right side of the heart in 90% of the cases with the right ventricle being the most common recipient chamber, followed by the right atrium and the pulmonary artery. We report a case of congenital coronary artery fistula of the right coronary artery to the left ventricle with significant shunt in a 20 - year old female. It was detected by transthoracic and transesophageal echocardiography and confirmed by cardiac catheterization and coronary angiography. The fistula opening was closed with 6-0 Prolene continuously under cardiopulmonary bypass and moderate hypothermia [ 28 oC ]. Postoperative course was uneventful and the patient was discharged without specific problem.

• Journal of Chest Surgery
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• v.15 no.1
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• pp.112-117
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• 1982

Communications of coronary arteries with the cardiac cavities have first time been described by Krause in 1865 in a case of an accessory artery draining into the pulmonary artery and later Cayla in a case of a right coronary artery entering the right ventricle. The initial cases have been found accidentally at autopsies, however In recent years after the Introduction of angiography and coronary arteriography, the malformation Is diagnosed during life and is corrected surgically. These conditions are unusual entitles since the advent of angiography they are being diagnosed with increasing frequency. Three patients who had surgical correction of coronary-cardiac chamber fistula at our hospital are presented. In the first case and second case, coronary arteriovenous fistula was corrected horizontal mattress suture ligation with pladget under the cardiopulmonary bypass and third case was corrected double ligation with cardiopulmonary bypass standby. The postoperative courses were uneventful. They discharged without any fistula related complica-tions.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.409-411
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• 1995

One patient developing left main coronary stenosis following double valve replacement is reviewed. Angina pectoris developed 5 months postoperatively. Coronary perfusion with a balloon tip perfusion catheter was performed during previous operation and was considered technically satisfactory. Coronary angiography confirmed stenosis of the left main coronary artery. There was no further coronary arterial disease. An anterior approach between the aorta and pulmonary artery to expose the left main coronary artery was used and patch angioplasty was done. Repeat coronary angiography showed a widely patent left main coronary artery with excellent runoff. A careful search for coronary arterial injury should be made in all symptomatic patients following aortic valve replacement.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.495-503
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• 1996

The bidirectional cavopulmonary shunt may be useful as an intermediate procedure before Fontal oper- ation in high-risk patients, because it provides adequate relief of cyanosis and relief of ventricular volume overload. But there are no established theory about the effects of bidirectional cavopulmonary shunt on pulmonary arterial development. The purpose of this article is a study of changes of pulmonary artery size after bidirectional cavopulmonary shunt. Ca diac catheterization and angiography procedures were done on 19 patients who underwent bidirectional cavopulmonary shunt from February 1992 to July 1994, their results were reviewed. Preoperative cardiac catheterization and angiography procedures were performed at a mean interval of ).8 $\pm$4.8($\pm$SEM) months before surgery and following catheterization at a mean postoperative interval of 19.6 $\pm$4.8 months. Pulmonary arterial sixte measurement were standardized for body surface area(Pulmon- arty artery index), and for diameter of descending thoracic aorta(McGoon ratio). Patient's age, body stir- face area, pulmonary angioplasty, preoperative McGoon ratio and follow-up intervals were considered as variables. Before bidirectional cavopulmonary shunt, patient's mean age, body surface area, arterial 02 saturation, diameter of right pulmonary artery, diameter of left pulmonary artery, pulmonary artery Index, McGoon ratio were 13.7$\pm$15.6 months, 0.40$\pm$0.12m2, 71.4$\pm$12.4m2, 7.1$\pm$1.7mm, 6.2$\pm$1 , 191.8$\pm$82.7mm21m2, 1.73 $\pm$0.49, respectively. After bidirectional cavopulmonary shunt, the values were changed to 39.9 $\pm$ 16.2 months, 0.58$\pm$0.07 m2, 83.0$\pm$3.8m2, 9.0$\pm$ 1.5 mm, 7.7$\pm$2.0, 197.3$\pm$57.1 mm2/m2, 1.76$\pm$0.32, respect- ively With patients'development (age, body surf'ace area), diameters of pulmonary arteries were increased, but pulmonary artery indices and McGoon ratios were not changed. And there were no effects of age, body surf'ace area, amount of increased 02 saturation, pulmonary angiography and follow-up duration on the increment of pulmonary ar- tery size. But when the McGoon ratio was as low as 1.2, there were significant increase in postoperative pulmonary artery sizes. There was a significant correlation between preoperative pulmonary artery index (PAI) and McGoon ratio (MGR) ; PAI : MGRxl18.0-12.4 In conclusion, bidirectional cavopulmonary shunt provides adequate increment of arterial 02 saturation and does not increase the pulmonary artery size. Further investi ation is mandatory to evaluate the effect of pulsatile bidirectional cavopulmonary shunt on pulmonary artery growth.

• Tuberculosis and Respiratory Diseases
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• v.52 no.5
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• pp.545-549
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• 2002

A pulmonary arteriovenous fistula is an uncommon malformation. In pregnancy altered hemodynamics and hormones cause changes in a PAVM(pulmonary arteriovenous malformation) that predispose them to deterioration. Therefore, a PAVM can cause serious and life-threatening complications in pregnancy. Death often results from a cerebral abscess and a rupture of the malformation with a massive hemorrhage. Recently, we experienced a case of a multiple PAVM in pregnant 38 year old woman, which could not be observed in the old chest PA, 1 year ago. The PAVM was confirmed by CT and was angiography and treated by percutaneous embolization. The patient is suspected to have HHT (Hereditary hemorrhagic telangiectasia).

• Journal of Chest Surgery
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• v.21 no.1
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• pp.136-142
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• 1988

Between February, 1983, and March, 1987, thirty-one systemic-pulmonary shunts were performed in 28 patients with cyanotic congenital heart disease. Age ranged from 8 months to 28 years [mean age, 5.4 years, Weight ranged from 7 kg to 48 kg [mean weight, 16kg]. There were 4 classic Blalock-Taussig shunts, 5 central polytetrafluoroethylene shunts, 1 aorta-right pulmonary artery shunt with graft, and 21 modified Blalock-Taussig shunts. One patient required another shunt immediately due to insufficient pulmonary blood flow with patent graft. There was no postoperative death. Conduit diameters included 4mm [2 cases], 5 mm [22 cases], and 6 mm [3 cases]. Long term follow up was available in 27 patients [96.4%] with mean period of 20 months [range, 4 months to 49 months]. The effectiveness of shunt was evaluated by cardiac catheterization with angiography [15 patients] or clinically. They showed improvement of systemic oxygen saturation values by 12% and decrease of hemoglobin by 2.3gm/dl [P<0.01]. There were 2 shunt occlusion in central shunts at 32 and 48 months respectively, and one narrowing of graft in modified Blalock-Taussig shunt at 12 months. The patency rate was 91.6% at 24 months for 5 mm grafts in modified Blalock-Taussig shunt.