• Journal of Chest Surgery
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• 제25권3호
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• pp.289-295
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• 1992

We evaluated the correlationship between the predicted defect size at preoperative examination and the actual defect size at operation room, by examining 69 cases of ventricular septal defect operated at the deparment of Thoracic and Cardiovascular surgery, Kyungpook University Hospital from January 1988 to December 1990. We excluded cases associated with other cardiac anomalies. Of the 69 cases, 39 are male and 30 female, forming 1.3:1 sex ratio in males favor. Their age range from 6 months to 16 year, and 4.3 on the average Their body weights are from 6 to 45kg and 15 on the average. According to Soto`s classification, perimembranous type costitutes 42 cases[61%], doubly committed subarterial type 23 cases[33%], and muscular type 4 cases[6%]. The average diameter of defect size is 8.0$\pm$3.5mm measured in 2D-echocardiogram, 5.6$\pm$3.4mm in angiogram, and 7.4$\pm$4.4mm in operative field. There is statistically significant correlation between the size from 2D-echocardiogram and actual defect size[p=0.001], and no significant difference between the two. Especially in the cases without anurysmal formation, they are nearly the same. Cardiothoracic ratio, pulmonary to systemic flow ratio, pressure ratio and resistance ratio also have statistically significant correlation. Main pumonary artery to descending aorta diameter ratio is correlated with the actual defect size. There is statistically significant correlation between the size from angiogram and actual defect size with some difference.

• Journal of Yeungnam Medical Science
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• 제9권2호
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• pp.321-326
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• 1992

영남대학교 의과대학 흉부외과학 교실에서는 1985년 6월 부터 1992년 8월까지 35세이상의 성인 심방중격환자를 수술로 치험한 15례에서 다음과 같은 결과를 얻었다. 1. 수술은 11례(73%)에서 인조포편 및 자가심막을 사용하여 봉합하였다. 2. 단락정도와 수축기 폐동맥압과의 관계에서 특이한 상관관계가 없었다. 3. 술전의 뉴욕심장협회 기능분류 II가 6명, III이 8명 이었는데 술후 I이 8명, II가 6명으로 증상의 호전 있었다. 4. 심방세동 4례중 술후 3례에서 지속적으로 나타났고 1례에서는 정상리듬으로 돌아왔다. 5. 수술사망율은 없었고 수술결과는 만족하였다.

• Tuberculosis and Respiratory Diseases
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• 제42권2호
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• pp.231-237
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• 1995

저자들은 최근 종격동에서 발생하였던 만성 경화성 종격동염 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제22권2호
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• pp.179-190
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• 1989

The experimental study for extracorporeal preservation of the heart-lung preparation by autoperfusion system was performed in 10 dogs. Under intravenous Pentothal endotracheal anesthesia bilateral thoracotomies were performed. A 24F cannula connected to a plastic reservoir bag located 100 cm above the level of the heart was introduced into the aortic arch. Left subclavian, innominate artery, and descending aorta were ligated and divided. Both vena cavae were ligated and divided after the bag was half filled with blood. A 24F catheter inserted into right atrium and connected to the plastic bag in order to keep constant the preload. The thoracic trachea was intubated and the lungs were ventilated. The heart-lung preparations were removed en bloc and floated in a $34^{\circ}C$ bath of Hartmann solution. The preparations were observed for from 2 hours to 8 hours, with the average of 5.2 hours. Hemodynamic and hematologic variables were measured during preharvest and autoperfusion. The pH revealed severe respiratory alkalosis due to very low $PaCO_2$ during autoperfusion ; $PaO_2$ remained constant for 130-140 mmHg; $A-aDO_2$ increased markedly. The static inspiratory pressure [SIP] at late autoperfusion [6hr] increased significantly as compared with at early autoperfusion [2hr]. There was no difference between white blood cell counts from right atrium and those of left atrium. Heart rates remained constant for 110-120/min; cardiac outputs maintained to approximately 0.6L/min; mean aortic pressures, 75 mmHg; mean pulmonary arterial pressures, 15-18 mmHg; mean right atrial pressures, 9-13 mmHg; mean left atrial pressures, 12 mmHg lower than those of right atrium. Serum Na maintained with normal range during autoperfusion; K increased significantly; Ca decreased progressively. Hemoglobin and hematocrit decreased significantly during autoperfusion. The study demonstrated that stable hemodynamics could be maintained throughout the experiment and the preparation of the lung seemed to be inadequate, especially after 3-4 hours, such as high $A-aDO_2$, increased SIP, and scattered atelectasis and edema in their gross appearances.

• Journal of Chest Surgery
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• 제29권12호
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• pp.1401-1404
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• 1996

심장수술시 중심 정맥 상관은 필수적으로 시행해야 하는 수기 중 하나이다. 보통은 내경 정 맥이나 쇄골 하정맥에 경피적 상관을 하는데 기흉이나 혈흉 등의 합병증을 유발할 수 있고,영유아의 경우는 반복된 상관실패로 많은 시간을 허비할 수 있다. 그래서 저자들은 몸무게 10kg이하의 영유아 개심술시 홍골절개가 완료된 상태에서 무명정맥을 노출하여 여기에 삽관을 한다. 술후 중환자실에서 이 무명정맥관은 주로 좌심방이나 폐동맥의 압력을 측정하는데 이용하고 관자가 혈역학적으로 안정되면 우심방이나 상대정맥으로 후퇴시켜 수액보급이나 약물투척 경로로 이용한다. 본원에서는 1989년 이후로 96예에서 시행하여 왔으며 이 삽관술로 인한 기흉이라 혈흉은 없었고 정맥관제거시 출혈에 의한 합병증도 경험하지 않았다.

• Journal of Chest Surgery
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• 제32권2호
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• pp.108-118
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• 1999

배경: 동맥전환술의 위험인자와 장기 성적을 알아보고자 후향적 연구를 시행하였다. 대상 및 방법: 1988년 1월부터 1996년 12월까지 심실중격이 온전한 대혈관전위증으로 인해 동맥전환술을 시행 받은 58명의 환자를 대상으로 동맥전환술에 따른 조기 및 만기성적에 대하여 후향적 평가를 시행하였다. 술전 처치로 36례(62.1%)에서 풍선심방절개술을 시행하였으며, 32례(51.7%)에서 PGE1을 사용하였고, 좌우심실의 압력비가 평균 0.53$\pm$0.11이었던 6례(10.3%)의 환아에서는 먼저 폐동맥밴딩을 시행하였다. 결과: 수술당시의 평균연령은 24$\pm$26일(범위 1-137일)이었고 수술당시 평균체중은 3.5$\pm$0.8 kg(범위 1.8~6.1 kg)였다. 전체 조기사망율은 24.1%(14/58)였으며, 최근 3년간의 조기사망율은 8.3%(2/24)였다. 사망과 관련된 위험인자 분석에서는 수술 시행 년도가 유일한 위험인자로 나타났다(p-value < 0.01). 조기 사망한 14례 중 8례는 급성심근부전으로 사망하였으며 주된 원인은 관상동맥부전이었다. 44명의 술후 생존자들을 대상으로 2개월에서 8년까지 평균 36$\pm$27개월 동안 추적관찰을 시행하였으며, 대혈관과 관상동맥의 문합부위, 심실기능, 반월판막의 폐쇄부전, 심박동 이상 등에 중점을 두고 연속적인 비관혈적 검사 및 술후 5개월과 32개월 사이에 모두 21례의 심도자술을 시행하였다. 만기 사망한 경우는 5례(11.4%)였으며 사망원인은 관상동맥의 만기 협착 1례, 흡인 2례, 만성 종격동염 1례, 진행성 대동맥판막폐쇄부전과 심부전 1례 등이었다. 혈류역학적으로 가장 흔한 이상은 폐동맥상부의 협착이었고, 폐동맥협착과 대동맥협착을 보였던 몇몇 경우에 있어서는 점차 협착정도가 진행하는 경우도 관찰되었으나 이로 인한 재수술은 없었다. 9례에서 대동맥판막폐쇄부전 소견을보였으며 7례에서는 그 정도가 가벼웠으나 2례에서는 중정도의 폐쇄부전을 보였고 다소 진행하는 경우도 있었다. 수술전후로 심근허혈의 증거가 없었던 2례에서 관상동맥의 폐쇄가 확인되었다. 나머지 생존자들은 동성박동과 정상적인 좌심기능을 유지한 채 양호한 경과를 보이고 있으며 생명표법에 근거한 8년 생존률은 68.8%였다. 결론: 심실중격이 온전한 대혈관전위증에서 해부학적 교정술은 우선적인 수술방법으로 여겨지나 추후 지속적인 추적관찰이 필요할 것으로 사료된다.

• Applied Biological Chemistry
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• 제51권2호
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• pp.102-107
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• 2008

본 연구에서는 산삼 배양근이 NO 생성과 NO와 연관된 생리활성에 미치는 효과에 대해 조사하였다. ECV304 세포에 산삼 배양근 열수 추출물(WE) 혹은 부탄올 추출물의 수용액 분획물(ABE)를 처리하게 되면 상당량의 NO가 발생하는 것을 확인하였다. 추출물에 의한 ECV304 세포 내 endothelial nitric oxide synthase(eNOS)의 발현 양 변화는 거의 없었으며 100${\mu}g$의 ABE에 의해 약 6%의 ACE 억제 효과가 관찰되었다. 동맥 혈관에서의 혈관이완 효과는 WE는 2.5 mg/ml일 때 44.8%의 이완율을 나타낸 것에 비해 ABE는 0.1 mg/ml일때 91.3%의 혈관 이완율을 보였다. 선청성 고혈압 쥐인 SHR에서의 단 회 경구투여 시 혈장강화 효과는, 8시간 경과 후 최저혈압(154.5${\pm}$8.6 mmHg)을 보였고, 24시간이 지나면 초기 수준으로 회복되는 것을 확인할 수 있었다.

• Clinical and Experimental Pediatrics
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• 제61권6호
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• pp.187-193
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• 2018

Purpose: The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups. Methods: Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1-4 years). Medical records were reviewed retrospectively. Results: The minimum lumen diameter (MLD) in PAS and CoA increased from $5.0{\pm}1.9mm$ and $8.4{\pm}1.6mm$ to $10.1{\pm}3.6mm$ and $12.3{\pm}2.5mm$, respectively (P<0.01). In the PAS group, pressure gradient decreased from $25.7{\pm}15.6mmHg$ to $10.4{\pm}10.1mmHg$, and right ventricular to aortic pressure ratio from $0.56{\pm}0.21$ to $0.46{\pm}0.19$. In the CoA group, the pressure gradient decreased from $50{\pm}33mmHg$ to $17{\pm}8mmHg$. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%-70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after $29{\pm}12months$. Conclusion: Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.

• Journal of Chest Surgery
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• 제46권5호
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• pp.340-345
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• 2013

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of $16.5{\pm}9.7$. Group II comprised 14 female and 3 male patients with an average age of $18.5{\pm}9.8$ showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was $1.8{\pm}0.2$. The average pulmonary artery pressure was $35{\pm}10$ mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

• Journal of Chest Surgery
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• 제12권3호
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.