• Journal of Chest Surgery
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• 제35권9호
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• pp.684-687
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• 2002

만성 색전성 폐동맥 고혈압의 치료는 폐이식을 제외하면 폐동맥 색전제거술이 유일하지만, 수술 사망률이 6.6∼23%로 높게 보고되고 있다. 수술을 시행하기 전에 수술의 적응이 되는 환자인지를 판단하고, 수술을 시행할 때 전체 폐동맥 분지에 대해 충분히 색전을 제거하는 것이 수술의 성공적인 시행을 결정하는 가장 중요한 요인이다. 본원에서는 만성 폐동맥 색전증의 수술적 치료시 완전순환정지를 적용하여 좋은 수술 시야를 확보함으로써 각 구역 폐동맥수준까지 혈전을 제거하는 것이 유용한 방법임을 확인할 수 있었고, 술 후 합병증이 없이 안전하게 시행할 수 있었음을 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제24권5호
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• pp.445-450
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• 1991

Forty eight patients diagnosed as atrial septal defect, had been operated from April 1986 to December 1990 at the Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, were analysed retrospectively. Of the 48 patients, 12 patients, were male and 36 patients were female, Their ranged from 8 months to 51 years old, and the mean was 18.0 years old. The proceeding two symptoms were exertional dyspnea and frequent upper respiratory infection. But 10 patients [20.8%] were asymptomatic. Electrocardiographic findings were regular sinus rhythm in 100.0%, RVH in 29.2%, incomplete RBBB in 27.1%, and first degree AV block in 2.1%. Hemodynamic studies were performed in 38 of 48 patients. Significant pulmonary hypertension[over 50mmHg in systolic pulmonary arterial pressure], which is the most serious risk factor, was developed in 4 patients[8.3%]. There was statistical significance between size of defect[cm2/BSA-M2] and systolic pulmonary arterial pressure[sPAP] retrospectively[p=0.036]. We could not find the correlationship between age and Qs % size. Anatomically, secundum type constituted 97.9%, in which 43 patients were PFO type[91.6%] and 3 patients were IVC type[6.3%]. 38 of 48 ASD patients were repaired with patch closure[72.9%] and remains were repaired with direct closure[27.1%]. The operative result was excellent except two cases of transient postoperative arrhythmia. There was no operative mortality.

• Journal of Chest Surgery
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• 제22권5호
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• pp.753-759
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• 1989

Recently, the arterial switch operation has received more interest and increased application for many patients with TGA [Transposition of the Great Arteries]. Not all patients, however, are suitable candidates for this approach, and its success will be measured against the Senning procedure. From June 1982 through June 1989, 48 consecutive patients underwent correction of TGA by a modification of the Senning procedure in our hospital. 34 were males and 14 females, with ages ranging from 3 months to 99 months [mean age 14 months]. The patients were divided into two groups, group I [TGA with intact ventricular septum or without significant pulmonary hypertension] and group II [TGA with significant pulmonary hypertension]. The hospital mortality was 9.5 % in group I and 55.6 % in group lI. 31 patients were discharged from the hospital after a Senning operation and have been followed a mean of 31.2 months. There were 5 late deaths, 3 in group I and 2 in group II. All patients were followed up with EKG, echocardiogram, and in several cases, Holter monitor and cardiac catheterization and angiography were also performed. There have been arrhythmias in 7, superior vena caval obstruction in 5, pulmonary venous obstruction in 2 and tricuspid insufficiency and/or right ventricular dysfunction in 16 patients. The Senning operation for Simple TGA can be performed with a low operative mortality and morbidity, but tricuspid insufficiency and/or depressed right ventricular function can be a problem with prolonged follow up.

• Journal of Chest Surgery
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• 제40권12호
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• pp.867-870
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• 2007

항인지질 증후군(antiphospholipid syndrome)은 정맥, 동맥의 혈전증, 혈소판 감소증, 반복적인 유산 등과 함께 lupus anticoagulant (LAC)와 anticardiolipin antibody (aCL)가 반복적으로 양성 반응을 보이는 질환을 말하며 호흡기 증후 발현은 상대적으로 드물다. 저자들은 항인지질 증후군 및 전신성 홍반성 루푸스 환자에서 발생한 만성적인 폐혈전색전증에 대하여 폐동맥 내막절제술, 특히 원위부에 있는 폐혈전색전증을 왼쪽 폐의 대열을 분리한 뒤 좌하엽 구역 동맥을 절제하여 혈전색전 제거술을 성공적으로 시행하였기에 문헌고찰과 함께 국내 최초로 보고하는 바이다.

• 대한영상의학회지
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• 제82권3호
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• pp.682-687
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• 2021

체-폐동맥루는 주로 외상, 감염, 종양 등에 의해 유발될 수 있으나 위험 인자가 없는 환자에서 생기는 체-폐동맥루는 매우 드물다. 이들은 감염이나 출혈 혹은 폐 고혈압 등을 유발할 수 있어 치료가 필요하다. 호흡곤란을 주소로 내원한 67세 여자 환자에서 늑간동맥-폐동맥루가 발견되었다. 먼저 배출혈관인 확장된 폐동맥으로 역행성으로 접근하여 코일 색전술로 치료하였으나 5개월 후 인접폐동맥의 확장이 관찰되어 공급동맥인 늑간동맥을 N-butyl cyanoacrylate를 이용하여 색전하였다. 10개월 추적검사에서 환자의 증상과 확장된 폐동맥은 호전되었다. 체-폐동맥루를 치료에서 순차적 혹은 동시에 역방향과 순방향 접근으로 혈관 내 치료하는 것이 효과적일 수 있겠다.

• Journal of Chest Surgery
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• 제39권9호
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• pp.659-667
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• 2006

배경: 저산소증, 공기색전증, monocrotaline 약물 주입 등에 의해 혈관 내막의 손상을 일으켜 폐동맥내세포외간질 단백질 합성을 활성화시키고 혈관의 중막비후나 신생내막의 형성을 일으키는 혈관개조(vascular remodeling) 실험이 활발하게 진행되고 있다. 본 연구는 폐정맥을 폐쇄시킨 후 변화된 혈류에 의해 폐장이 어떻게 반응하는지 확인하고자 동물실험을 실시하였다. 대상 및 방법: $352{\pm}18g$의 흰쥐(n=10)를 이용하여 ketamine 근육내 주사로 마취하여 정중흉골절개술을 시행하고 심장을 노출시킨 후 우측 폐정맥을 크립을 이용하여 폐쇄하였으며, 15일 후 폐동맥압, 좌심실과 심실중격 대비 우심실 무게비(RV/LV+Sweight ratio), 말초 폐동맥의 외측지름대비 벽두께비(percent wall thickness (%WT)) 등을 측정하여 대조군(n=5)과 비교하였다. 결과: 폐정맥 폐쇄군의 폐동맥압은 38{\pm}12 mmHg로 대조군의 $13{\pm}4mmHg$에 비해 의의 있게 증가되었다(p<0.05). 좌심실과 심실중격 대비 우심실 무게비는 대조군의 $0.35{\pm}0.04$에 비해 $0.52{\pm}0.07$로 통계적으로 유의한 우심실 비대 소견을 보였고(p<0.05), 말초 폐동맥의 외측지름대비 벽두께비는 폐쇄군이 $22.4{\pm}6.7%$로 대조군의 $6.7{\pm}3.4%$에 비해 증가되었다(p<0.05). 결론: 한쪽 폐의 폐정맥 폐쇄는 폐동맥고혈압, 우심실 비대, 말초 폐동맥의 중막 비후 소견을 유도하였다. 이는 폐동맥 혈관개조의 병리학적 특성을 나타내는 것으로 일측 폐정맥을 폐쇄하는 경우 반대측 폐장의 폐혈류량 증가뿐만 아니라 혈관개조를 유발하는 내막의 손상을 동반함을 알 수 있었다.

• Journal of Chest Surgery
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• 제17권4호
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• pp.593-606
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• 1984

With the ligation of patent ductus arteriosus by Gross in 1938, surgeons first entered the field of congenital heart disease. Interruption of a ductus is one of the most satisfactory and curative operations in the field of surgery for congenital heart disease. 27 cases of isolated patent ductus arteriosus were operated from Jan. 1978 to July 1984 at the Department of Thoracic & Cardiovascular Surgery in Kyung-Hee University Hospital. Retrospective clinical analysis of these patients were: 1. Sex ratio, female: male, was 2:1. 2. Mean age at operation was 9.85\ulcorner.58 years. The youngest patient was a 23 month-old girl and the oldest one was a 24 year-old male. 3. More than half of the patients had less than 50 percentile of growth retardation. 4. Chief complaints of the patients were frequent URI [52%], dyspnea on exertion [33%], generalized weakness [22%], palpitation [7%], but 7 patients [26%] had no subjective symptoms. 5. Continuous machinery murmur could be heard at the 2nd or 3rd intercostal space on the left sternal border in 22 patients [81%]. The other S patients made systolic murmur with accentuation of the second heart sound and those were associated with pulmonary hypertension. 6. Radiologic findings of Chest P-A were cardiac enlargement in 15 patients [55%], enlargement of pulmonary conus and/or increasing density of pulmonary vascularity in 20 patients [74%]. 7. Electrocardiographic findings of the patients were within normal limit in 13 patients [48%], LVH in 4 patients [15%], biventricular hypertrophy in 3 patients [11%]. 8; echocardiogram was obtained from 11 patients. Ductus was directly visualized in 7 patients. Left atrial enlargement is the secondary change of left to right shunt, 10 patients had LA/Ao ratio more than 1.2. 9. Cardiac catheterization performed in 25 patients. The mean value of the results were:SO2[PA-RV]= 14.72\ulcorner6.01%, Qp/Qs=2.22\ulcorner.80, peak systolic pulmonary arterial pressure=48.28\ulcorner1.60 mmHg. 10. 26 patients were operated through the left posterolateral thoracotomy: closure of ductus by double ligation in 14 cases, triple ligation in 5 cases, and division with suture in 8 cases. One patient suffer from aneurysmal rupture of main pulmonary artery, endocarditis, hemopericardium was treated with cardiopulmonary bypass via median sternotomy and closure of ductus through the ruptured main pulmonary artery. 11.There was no death associated with the operation, but 3 cases were experienced with intraoperative rupture around the ductus resulting in massive bleeding. The other complications were transient hoarseness in one patient, atelectasis in left lower lobe in 3 patients, and postoperative systemic hypertension in 4 patients with unknown etiology. 12. Pulse pressure was reduced, 11.47+5.92 mmHg, postoperatively, as compare to preoperative status. 13. Intraoperative wedge lung biopsy from lingular segment for the evaluation of the pulmonary vascular disease was taken in S patients with severe pulmonary hypertension. The result was Heath-Edward grade I in one case, grade II in two cases, and grade III in two cases.

• Tuberculosis and Respiratory Diseases
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• 제62권5호
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• pp.421-426
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• 2007

진행성 간질환의 합병증으로 발생하는 문맥폐고혈압은, 이차성 폐동맥고혈압 중에서 진행성 간질환에 의한 문맥고혈압과 연관된 폐동맥고혈압으로 분류되며, 독특한 임상적, 병태생리학적 특징을 보인다. 임상양상은 점진적인 운동성 호흡곤란, 흉통 등을 호소하지만, 증상 없이 우연히 발견되는 경우도 있다. 심초음파 검사를 통해 예비적으로, 우심장 도관삽입으로 직접 우심실 및 평균 폐동맥압을 측정하여 진단할 수 있다. 치료는 칼슘통로차단제, 프로스타노이드 등을 사용하지만, 근본적인 치료를 위해서는 간 및 폐이식을 고려해야 한다. 저자들은 53세 여자로 20년 전에 간경변을 진단받은 후 호흡곤란으로 내원한 환자에게서, 간경변의 원인으로 원발성 담관성 간경변을 진단하고, 호흡곤란의 원인으로 문맥폐고혈압을 진단하여 치료하였기에 문헌고찰과 함께 보고한다.

• Journal of Chest Surgery
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• 제50권4호
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• pp.287-290
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• 2017

Herein, we report the case of a 60-year-old man, a smoker with a history of arterial hypertension and diabetes mellitus. After computed tomography (CT) for an episode of hemoptysis, the patient underwent elective thoracic endovascular aortic repair (TEVAR) because of a degenerative aneurysm of the descending thoracic aorta. The area of perianeurysmal pulmonary atelectasis reported on the CT scan was not considered. Three months later, he developed an aortopulmonary fistula without endoleaks. Although TEVAR is a relatively safe procedure, no detail should be overlooked in the preoperative evaluation in order to avoid life-threatening complications. Further, the effectiveness and modality of prolonged antibiotic prophylaxis and/or preoperative respiratory physiotherapy should be assessed in such cases.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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• pp.67-71
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• 2016

Eisenmenger syndrome (ES) is characterized by pulmonary arterial hypertension and right-to-left shunting. The signs and symptoms of ES include cyanosis, shortness of breath, fatigue, hemoptysis, and sudden death. In patients with ES, it is important that the systemic and pulmonary circulations be properly distributed and maintained. General dental treatment is not known to be particularly dangerous. To control pain and anxiety, local anesthetics without epinephrine are usually recommended. However, in cases of difficulty of cooperation, general anesthesia for dental treatment makes the condition worse. In the present case, intravenous deep sedation with propofol and remifentanil was administered for behavioral management during dental treatment successfully.