• 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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• 제29권9호
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• pp.951-958
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• 1996

경북대학교병원 흉부외과에서 1991년 11월부터 1993년 12월 사이에 원발성 폐질환이 없이 승모판질환으로 승모판치환술을 받은 남자 2례, 여자 10례의 환자에서 술전 및 술후 평균 9개월에 폐기능검사를 실시하였다. 승모판질환의 종류는 승모판협착이 9례, 승모판폐쇄부전이 3례였다. 술전 환자들의 NYHA 기능등급은 3등급이 11례, 4등급이 1례였는데, 술후 평균 9개월이 경과한 시점에서는 10례(83%)에서 1등급으로 호전되어 있었다. 단순흉부 X·선상의 심흉비는 술전의 평균 60.2%에서 술후에는 평균 56.3%로 유의하게 감소되었다. 전체 환자에서의 폐기능검사성적은, 술전 검사에서는 폐활량과 노력성 호기중 간유량이 경도의 감소소견을 보였고, 술후 검사에서는 노력성 호기중간유량과 최대자발성 호흡량이 경도의 감소소견을 보였다. 그러나 술전후의 폐기능검사성적을 비교하였을 때에는 어느 검사항목도 유의한 차이를 보이지 않았다. 한편 술후의 NYHA 기능등급에 의해 환자들을 두 군으로 구분하였을 때, 2등 급군에서는 술후에 유의하게 변화된 폐기능검사항목이 하나도 없었는 반면에, 1등급군에서는 6가지 검사항목에서 유의한 변화가 있었다.

• Journal of Chest Surgery
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• 제32권3호
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• pp.303-306
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• 1999

본 증례는 Ross 술식에서 동종판막이나 이종판막을 쓰지않고 자가 대동맥 조직과 심낭으로 우심실 유출로를 성공적으로 재건한 보고이다. 선천성 대동맥판막 협착증을 진단 받은 8세 환아에서 시행한 폐동맥 자가 이식편을 이용하여 대동맥판을 교체하고 자가 대동맥 조직과 심낭편으로 단엽 판막을 만들어 우심실 유출로를 재건하였다. 술후 검사에서 심실과 새로운 대동맥판의 기능이 좋아 투약없이 19개월째 외래 추적관찰 중이다.

• Clinical and Experimental Pediatrics
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• 제46권4호
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• pp.315-318
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• 2003

• Journal of Chest Surgery
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• 제11권2호
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• pp.213-226
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• 1978

One hundred cases of open heart surgery were done at this Department in 1977. There were 65 congenital anomaly and 35 acquired diseases. Out of 65 cases of congenital malformation 35 acyanotic and 30 cyanotic cases were found. Fifteen cases of ventricular septal defect and 29 tetralogy of Fallot were noted eight patients expired out of 65 congenital anomaly [12.3%] , 4 out of 35 acyanotic [11. 4%] and 4 among 30 cyanotic anomaly[13.3%]. Among 35 cases of acquired heart disease 3 atrial myxoma [2 left and one right] and 32 valvular lesions were noted. In two cases open mitral commissurotomy, and in 30 valve replacement were done. Twenty-two single valve and 8 double valve replacement were done. Seven patients expired out of 30 patients [23.3%]. Among 22 single valve replacement cases 2 and among 8 double valve 5 died. ~ In eighteen mitral valve replacement cases 2 deaths occurred. One mitral insufficiency patient who expired suffered from severe pulmonary` hypertension [PA=120/67mmHg], tricuspid insufficiency and a large ventricular septal defect. The patient underwent mitral valve replacement, tricuspid annuloplasty and patch closure of ventricular septal defect. Over all mortality rate for 100 open heart surgery cases was 15%. Since 1977 open heart surgery cases were done routinely in this institution and cases are increasing rapidly. With present rapid improvement of economical status and introduction of medical insurance system, open heart surgery will be firmly established in Korea in the very near future.

• Journal of Chest Surgery
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• 제31권12호
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• pp.1222-1225
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• 1998

젊은 연령층 환자를 대상으로 한 대동맥판막치환술은 몇가지 내재하는 문제점을 안고 있는데, 조직판막의 경우 내구성의 제한으로 재치환이 필요하며, 금속판막의 경우 내구성은 좋지만 일생동안 항응고제 치료에 따른 불편을 감수해야 한다. 로스술식은 대동맥판막치환에 대한 하나의 대안으로서 젊은 연령층 환자를 대상으로 점차 널리 시행되는 추세이나 장기적인 관점에서는 우심실유출로 협착 등의 문제로 인해 재수술을 필요로 한다는 사실이 단점으로 지적될 수 있다. 저자 등은 로스술식의 이러한 단점을 보완하기 위해 대동맥판막폐쇄부전을 앓아온 21세 여자 환자를 대상으로 로스술식을 적용하면서 폐동맥판막 위치에 자가 대동맥판막을 이전해 주는 반월판막전환술을 시행하였다. 이러한 반월판막전환술의 결과 폐동맥판막 위치에 이전된 자가폐동맥판막이 병리학적 변화를 수반하더라도 이전 후의 낮은 폐동맥압과 폐혈관저항으로 인해 판막기능이 비교적 만족할 만한 수준으로 호전되는 것을 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제28권4호
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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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• 제41권6호
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• pp.759-763
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• 2008

전폐절제술을 받았던 환자에서 시행하는 심장 수술은 수술 후 합병증과 사망의 위험이 높다. 내원 33년전 폐결핵으로 좌측 전폐절제술을 받았던 71세 남자환자에서 승모판막 치환술 및 삼첨판막륜 성형술을 성공적으로 시행하였기에 증례와 함께 수술 전 후 폐기능 저하의 예방, 수술 중 승모판막의 노출 및 수술 후 발생한 부정맥에 대한 내용을 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제24권3호
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• pp.310-321
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• 1991

Between April 1986 and September 1990, 34 patients with a single or dominant right ventricle underwent modified Fontan procedure for definite palliation in Seoul National University Children`s Hospital. Their age at operation ranged from 8 months to 14 years [Mean 5.5 years]. The ventricular chamber was solitary and of indeterminate trabecular pattern in 6 patients. 28 patients had posteriorly located rudimentary chamber, all of which were trabecular pouches having no communication with outlet septum. The patterns of atrioventricular connection were common inlet[9], double inlet [11], left atrioventricular valve atresia [12] and right atrioventricular valve atresia with L-loop [2]. Pulmonary outflow tracts were atretic in 7 patients and stenotic in 26 patients. Major associated anomalies included anomalous systemic venous drainage [15], dextrocardia [12] and total anomalous pulmonary venous connection[3]. Shunt operations were previously performed in 13 patients and pulmonary artery banding and atrial septectomy in 1 patients. Surgery included intraatrial baffling in 26 patients, bidirectional cavopulmonary shunt in 13 patients, atrioventricular valve obliteration in 3 patients and atrioventricular valve replacement in 3 patients. Central venous pressure measured postoperatively at intensive care unit ranged from 18cm H2O to 28cm H2O [mean 23.2cm H2O]. Hospital mortality was 35.3% [12/34], all died out of low output syndrome. Suspected causes of low output syndrome include ventricular dysfunction [8], hypoplastic or tortuous pulmonary artery [2] and elevated pulmonary vascular resistance [2]. 19 patients had 31 major complications including low output syndrome [18], arrhythmia [4], acute renal failure [3] and respiratory failure [3]. Mortality rate was significantly higher in the groups receiving intraatrial baffling and AV valve replacement respectively [p<0.05]. 20 patients were followed up postoperatively with the mean follow-up period 15.0$\pm$11.6 months. There were no late death and follow-up catheterization was performed in 10 patients. Mean right atrial pressure was 15.4$\pm$6.8mmHg and ventricular contraction was reasonable in all but one case. Thus, Fontan principle can be applied successfully to all the patients with complex cardiac anomaly of single ventricle variety and better results can be anticipated with judicious selection of patient and improvement of postoperative care.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1055-1060
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• 1992

Clinical experience of 21 patients with infective endocarditis was reviewed. Endocarditis involved the left-sided valve in 16 cases, the right-sided valve in 2, and PDA in the remaining 3 patients. Valve abnormalities included leaflet perforation in 9 patients, chordal rupture in 2,; annular abscess in 6; and aorticoleft atnal perforation in 2. Sixteen patients underwent valve replacement[aortic valve replacement in 7 patients, mitral replacement in 4 and double valve replacement in 5], two had VSD closure with pulmonary valve excision, three had ductus arteriousus closure. The patients were classified into two groups. I ] Healed endocarditis group: including the patients who had completed a planned cou-rseof antibiotic therapy[N=10], II ] Active endocarditis group: patients in which operations were performed prior to completetion of antibiotic treatment course[N=11]. The indications for operation included congestive heart failure, embolism, and persistent sepsis. Organisms were predominantly streptococcus[N=5] and staphylococcus [N=4] followed by candida, moraxella, and E-coli. By NYHA functional classification, all patients were in Class III or IV preoperatively. There was only one operative mortality in patient from group II. All patients substantially, improved postoperatively with NYHA classification in class I or II. This study shows that early surgical intervention in patients with active endocarditis has desirable outcome.