• Journal of Chest Surgery
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• 제39권8호
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• pp.588-597
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• 2006

배경: 팔로네징후의 수술적 교정은 좋은 조기 및 만기 성적을 보이고 있다. 그러나 장기적인 추적 관찰 기간 동안 발생하는 폐동맥 판막 역류와 협착은 지속적으로 문제가 되고 있으며, 이는 최초 완전교정술 시 재건한 우심실 유출로 크기 정도에 따라 달라질 수 있다. 이에 폐동맥 판막 역류와 협착의 발생을 줄일 수 있는 적절한 우심실 유출로 크기에 대한 연구가 필요하다. 대상 및 방법: 본 연구는 팔로네징후로 완전교정술을 시행 받은 환자들을 대상으로 장기적으로 폐동맥 판막 역류와 협착의 발생을 줄일 수 있는 적절한 우심실 유출로 크기를 찾기 위한 전향적 연구이다. 2002년 1월부터 2004년 12월까지 팔로네징후 62명(남자 34 명, 여자 28명)의 환자들을 완전교정하였고 우심실 유출로 재건 후 폐동맥 판륜의 크기(직경) 를 측정하였으며, 심초음파를 정기적으로 시행(퇴원 시, 6개월, 1년, 2년, 3년)하여 폐동맥 판막 역류 및 협착 정도를 추적 관찰하였다. 결과: 우심실 유출로를 재건한 방법에 따라 경판륜 그룹(12명)과 비경판륜 그룹(50명)으로 구분하였고 우심실 유출로의 크기는 폐동맥 판륜의 직경을 기준으로 경판륜 그룹에서 Z value -1 $(-3.6{\sim}0.8)$, 비경판륜 그룹에서 2.1 $(-5.2{\sim}1.5)$ 이었다 수술을 마치고 측정한 우심실 /좌심실의 압력 비율은 경판륜 그룹이 평균 $0.44{\pm}0.09$, 비경판륜 그룹이 $0.42{\pm}0.09$로 두 그룹 간에 차이가 없었으며, 폐동맥 판륜 크기와 우심실/좌심실 압력 비율 간의 유의한 상관관계는 없었다. 두 그룹 중에서 중등도 이상의 페동맥 판막 역류의 발생은 경판륜 그룹에서 의미 있게 많았다(p<0.01). 비경판륜 그룹 내에서 수술 시 교정한 폐동맥 판륜 크기에 따른 폐동맥 판막 역류의 발생을 분석하였을 때 Z value가 0보다 크게 교정된 경우 폐동맥 판막 역류가 유의하게 증가하였고(p<0.05) 경도-중등도 이상의 폐동맥 판막 협착의 발생은 Z value가 -1.5보다 작은 경우 유의하게 증가하였다(p<0.05). 관찰 기간 중 비경판륜 그룹 내에서 의미 있는 중등도 이상의 폐동맥 판막 협착은 4명 발생하였고, 이들의 Z value는 각각 -3.8, -3.8, -2.9, -1.8이었으며 3명은 재수술, 1 명은 풍선 판막 성형술을 시행하여 교정하였다. 결론: 팔로네징후의 완전교정술을 시행하였을 때 경판륜 우심실 유출로 재건술을 시행한 그룹은 폐동맥 판막 역류가 현저하게 많았다. 비경판률 재건을 시행하는 경우 우심실 유출로의 폐동맥 판륜 크기를 Z value -1.5 에서 0사이가 되도록 재건하고 1.5 이하인 경우에는 폐동맥 판막 협착 가능성에 대한 면밀한 추적 관찰을 시행하는 것이 필요하다.

• Clinical and Experimental Pediatrics
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• 제59권9호
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• pp.384-385
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• 2016

• Journal of Chest Surgery
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• 제22권2호
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• pp.234-245
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• 1989

Between January 1984 and December 1986, sixty nine patients, aged 16 months to 25 years [mean age 10.05*6.40 years], underwent total correction of tetralogy of Fallot in Kyungpook national university hospital. In 66 hospital survivors, 30 patients were followed up for 12 to 48 months [mean 30.10*10.26 months]. These 30 patients were classified in two groups, TAP [transannular patch] and Non-TAP group. There were 9 patients in TAP group, and 21 in Non-TAP group. There were no significant differences between two groups in terms of age at operation, follow up duration, ACC time, and bypass time. All patients were evaluated by two dimensional echocardiography, Doppler echocardiography, standard 12-lead electrocardiography, and plain chest X-ray. Right ventricular systolic pressure, pulmonary arterial systolic pressure, pressure gradient between the right ventricle and the pulmonary artery, presence or absence of pulmonary regurgitation and its grading, fractional shortening of the left ventricle, and Qp/Qs in case of remnant ventricular septal defect were obtained by echocardiographic examination. Cardiothoracic ratio was measured by plain chest film, and ventricular dysrrhythmia was detected by electrocardiogram. Comparing the data between two groups, there was significant difference in incidence of postoperative pulmonary regurgitation [p< 0.05], 100%[9/9] in TAP group and 47.6 %[10/21] in Non-TAP group, but all the regurgitations were not severe. There were no significant differences in other comparisons, despite of higher incidence of cardiomegaly in TAP group [CT ratio: 59.3*5.3% VS 54.7*6, 4 %].

• Journal of Chest Surgery
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• 제50권1호
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• pp.41-43
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• 2017

A 38-year-old female patient with a history of tetralogy of Fallot repair at 10 years of age underwent pulmonary valve replacement with a mechanical prosthesis, tricuspid annuloplasty, and right ventricular outflow tract cryoablation due to pulmonary regurgitation, tricuspid regurgitation, and multiple premature ventricular contractions with sustained ventricular tachycardia. After surgery, she had an uneventful postoperative course with arrhythmia monitoring. She was discharged without incident, and a follow-up Holter examination showed a decrease in the number of ventricular ectopic beats from 702 to 41.

• Journal of Chest Surgery
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• 제55권3호
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• pp.239-242
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• 2022

Papillary muscle rupture with severe acute mitral regurgitation is a rare complication of acute myocardial infarction (AMI) that causes pulmonary congestion and cardiogenic shock. Moreover, it has a poor prognosis. Surgical intervention, including revascularization, is indicated; however, surgical mortality remains high. We report the case of an 85-year-old woman with cardiogenic shock from severe acute mitral regurgitation, in whom a hybrid intervention, combining percutaneous coronary intervention with mitral valve replacement via minithoracotomy, was performed after post-infarction papillary muscle rupture. She was discharged in a favorable clinical condition. We describe a novel hybrid intervention for treating a rare complication of AMI, which could minimize surgical invasion in elderly patients, prevent disuse syndrome after the intervention, and improve prognosis. However, mitral valve surgery via minithoracotomy for emergency cases requires technical proficiency, as well as collaboration with other healthcare professionals, and the choice to perform this procedure requires careful consideration.

• Journal of Chest Surgery
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• 제30권9호
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• pp.927-931
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• 1997

신생아에서 선천적 삼첨판 폐쇄부전은 자주 보고되지만 건삭파열에 의한 이차성 삼첨판 폐쇄부전은 아주 드물다. 환아는 생후 1일의 남아로 출생 직후부터 심한 호흡곤란, 청색증 및 산혈증이 관찰되었고, 무호흡과 함께 서맥이 빈번히 나타났다. 심초음파도 검사를 시행하여 폐동맥 판막을 통한 우심유출로 혈류가 관찰되지 않아서 폐동맥 폐쇄증으로 진단되었다. 수술 소견에서 폐동맥 및 폐동맥 판막의 기형은 전혀 없었고, 삼첨판의 전방 유두근 건삭파열이 새로이 확인되었다. 삼첨판 폐쇄부전은 건삭 형성술을 실시하여 성공적으로 교정하였으며, 술전 심초음파도에서 주폐 동맥에 폐혈류가 관찰되지 않았던 것은 심한 삼첨판 폐쇄부전 때문이었던 것으로 판단되었다.

• 한국임상수의학회지
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• 제24권4호
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• pp.613-617
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• 2007

중성화된 1년령 말티즈 개(2.4kg)가 간헐적인 기침, 호흡곤란, 운동 불내성을 주요 증상으로 내원하였다. 신체검사 시 제 2음 모순 분열, 확장기 역류성 잡음이 관찰되었으며, 심장초음파에서 주폐동맥의 확장, 심실 중격 비대를 동반한 우심실 편심성 비대, 심각한 삼첨판 역류증과 폐동맥 역류증(5.4m/sec, 3.4m/sec)이 관찰되었다. 이러한 진단 검사 결과를 바탕으로, 본 증례를 선천성 심장 내 단락, 폐쇄성 폐질환, 그리고 우심계의 압력 과부하 또는 폐혈관계과관류와 관련된 전신질환과 감별하여 원발성 폐동맥 고혈압증으로 잠정진단 하였다. 환자는 furosemide와 aspirin을 투여하여, 산소요법을 실시하였다. 본 증례는 드물게 발생하는 개의 원발성 폐동맥 고혈압이다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.106-111
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• 1987

Twenty eight patients with atrial septal defect operated on from May, 1983, to July, 1986 at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, were analyzed retrospectively. Among the 28 patients of atrial septal defect, 8 were male and 20 were female. Their ages ranged from 4.6 years to 52.5 years old with the mean of 15.3 years. The main clinical symptoms on admission were exertional dyspnea [82%], frequent respiratory infection [75%], palpitation [54%] and easy fatigability [25%]. Electrocardiographic findings were as follows: Regular sinus rhythm [100%], RVH [54%], RBBB [25%] and first degree of A-V block [4%]. Hemodynamic studies were performed in all cases and mean pulmonary systolic arterial pressure was 34.1*11.8mmHg. and mean Qp/Qs was 2.6*0.9. All 28 patients were operated under direct vision using extracorporeal circulation. 23 cases were secundum type defect and a single hole was found in 22 cases. The associated cardiovascular anomalies were found in 11 patients: ventricular septal defect in 3, patent ductus arteriosus in 1, partial anomalous pulmonary venous drainage in 2, mitral regurgitation in 2, tricuspid regurgitation in 1, anomalous left atrial septation in 1 and valvular pulmonary stenosis in 1. The defect closed directly in 22 cases and with patches in 6 cases. Postoperative complications were wound infection, arrhythmia bleeding, intracardiac patch detachment, pneumothorax and urethral injury. But there was no operative mortality.

• Journal of Chest Surgery
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• 제24권11호
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• pp.1149-1153
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• 1991

A modified procedure for the operative management of the corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis or atresia was performed in 4 patients. (age ; 18 months-9 years). The operation consists of a venous switch procedure (Senning), intraventricular baffling directing the blood flow from the morphologic left ventricle into the aorta via ventricular septal defect through the right ventriculotomy, and insertion of valved conduit between the morphologic right ventricle and the pulmonary artery. All the four patients had large non-restrictive ventriular septal defects and no evidence of significant mitral valve regurgitation. Both ventricles were well-developed. Three cases had pulmonary atresia, and the remainder had severe subpulmonic stenosis. Postperatively, all patients showed no findings of systemic or pulmonary venous obstruction withnormal sinus rhythm. One patient died of sepsis due to infection by Methicillin-resistant S. aureus on the thirteenth postoperative day. Follow-up is done on the survivors, and all of them are dong well with regular sinus rhythm, with their functional class I or II at 2 to 8 months after the operation.

• Journal of Chest Surgery
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• 제28권7호
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• pp.704-707
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• 1995

The use of the patient`s pulmonary valve for replacement of the patient`s diseased aortic valve was introduced and developed by Mr. Donald Ross. The long term benefits of having a normal, fully viable, trileaflet semilunar valve in aortic position was demonstrated. A 38 year old male had histories of failures of previously implanted aortic prosthetic valves twice and evidence of progressive heart failure. At operation, aortic root abscess was found; the abscess extension to adjacent structures and partial valve dehiscence had occurred. The patient underwent replacement of the aortic root with autologous pulmonary valve, autologous pericardial patch repair of left ventricuar outflow tract and recontruction of the right ventricular outflow tract and pulmonary artery with prosthetic valved conduit. Postoperatively, the patient recovered well. Postoperative doppler echocardiography demonstrated minimal central regurgitation in new aortic valve. Aortic root replacement with pulmonary autograft in a patient of recurrent aortic root abscess and false aneurysm of left ventricuar outflow tract was experienced and reported with follow up echocardiography.