• Journal of Chest Surgery
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• 제31권2호
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• pp.168-172
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• 1998

하정맥동 결손(inferior sinus venosus defect)은 하대정맥과 우심방의 경계 부위에 발생하는 심방중격결손의 한 형태로 매우 드문 선천성 심장질환이며, 심방중격의 하부 뒤쪽에 위치하고 한 개 이상의 우 폐정맥의 환류 이상을 동반하고 있어 개심술시 정확한 교정을 요하므로 수술 전 또는 수술 중 정확한 해부학적 진단이 선행되어야 한다. 저자들은 부분 폐정맥 환류이상을 동반한 하정맥동형 심방중격결손 4예를 치험하였다. 1예는 25세 성인이었고 3예는 14개월 미만의 영아 및 소아였다. 4예 모두 심부전 때문에 수술했으며 이중 4개월의 영아는 긴급 수술이 필요했다. 진단을 위해 심초음파 및 도플러 검사와 심도자법을 시행하였다. 수술전 확진은 1예에서 가능했고 3예는 수술전 병변을 의심하고 수술시 확진되었다. 수술방법으로 이상 환류되는 폐정맥이 좌심방으로 환류 되도록 자가심막을 이용하여 심방중격결손을 폐쇄하였다. 4예 모두 수술 결과는 양호하였으며 초음파 검사의 추적에서 하대정맥과 폐정맥의 환류장애 소견은 없었다. 정확한 수술 교정을 위해 수술전 정확한 진단이 필수적이며, 수술전 폐정맥의 부분 환류이상과 심방중격 결손으로 진단된 환자에서는 수술중 하정맥동 결손의 여부를 확인하여 적절한 수술적 교정을 시행해야 할 것으로 사료된다.

• Journal of Chest Surgery
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• 제24권9호
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• pp.930-944
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• 1991

Infants born with TAPVR have a generally unfavorable prognosis, only a bout 20% surviving first year of life. In fact only about 50% survive beyond the age of 3 months, death occurring in the first few weeks or months of life. In 1991, we experienced 1 case of TAPVR of cardiac type in infant[2 months old age, W; 3.4kg] Repair was performed under the deep hypothermia with CPB, and continuous low-perfusion technique. The septum between enlarged coronary sinus opening and left atrium was carefully excised. A patch of pericardium was then sutured around the coronary sinus and ASD, so that the blood from the pulmonary veins and the coronary sinus was diverted in the left atrium. The postoperative course was uneventful except pneumothorax. The patient has been doing well on 6 months follow-up.

• Journal of Chest Surgery
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• 제23권1호
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• pp.158-161
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• 1990

A congenital coronary artery fistula is an uncommon anomaly which has a direct communication between a coronary artery and the lumen of any one of the four cardiac chambers, or the coronary sinus, or its tributary veins or the superior vena cava. The right coronary artery is involved most frequently, and the abnormal communication in most often is to the right ventricle followed in incidence by drainage into the right atrium and the pulmonary artery. Recently. we experienced a case of congenital coronary artery fistula associated with valvular heart disease. The fistulous communication was noted between the left circumflex artery and the left atrial appendage. Under the cardiopulmonary bypass, the internal obliteration of the left atrial appendage, mitral valve replacement, and aortic valve exploration were accomplished. Postoperative hospital course was uneventful and the patient was discharged without any problems.

• Journal of Chest Surgery
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• 제18권1호
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• pp.13-18
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• 1985

Cortriatriatum is rare congenital heart disease characterized by the presence of a fibromuscular diaphragm that subdivides the left atrium into a proximal or "accessory" and a distal or "true" left atrial chamber. A 15 year old girl with cortriatriatum underwent surgical correction at the department of Thoracic and Cardiovascular Surgery, Soonchunhyang College in November, 1984. This case was preoperatively diagnosed as a single atrium with functional tricuspid regurgitation But on operation, we found that there were transverse septum in the left atrium through large ASD, low chamber receives the pulmonary veins, and the upper chamber gives rise to the left atrial appendage and leads to the mitral valve. And the anomalous membrane has no fenestrations. We excised completely the anomalous septum, reconstructed atrial septal defect with dacron patch and performed the tricuspid annuloplasty with DeVega method. Postoperative course was uneventful during follow up, during follow up.

• Journal of Chest Surgery
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• 제10권1호
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• pp.164-172
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• 1977

This is a report of a case in which a left atrial myxoma was successfully removed by total cardiopulmonary bypass with total hemodilution and moderate hypothermia. The patient was a 17 old girl with mitral valvular symptoms that occured suddenly three months prior to operation. After the onset of symptoms. it was progressively aggravated to serious general condition. The preoperative diagnosis of left atrial tumor was made from echocardiography. and the tumor was confirmed as myxoma by the histopathological examination of the tumor tissue removed during operation. The myxoma was unusually originated from posterior wall of the left atrium. which was located between drainage orifices of right and left pulmonary veins, The tumor developed in the left atrial cavity and one of the polypoid processes of the myxoma was prolapsed into the the left ventricle through the mitral orifice. Following operation. there was no evidence for peripheral vascular embolism, and all valvular symptoms disappeared. The postoperative course was uneventful.

• Journal of Chest Surgery
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• 제55권5호
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• pp.425-427
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• 2022

In lung transplantation surgery, the pulmonary veins are anastomosed by connecting each atrium of the donor and recipient. However, occasionally the recipient's left atrium is not suitable for anastomosis for various reasons. In these cases, several techniques for atrial anastomosis have been introduced, but these are somewhat complicated for an inexperienced surgeon. Here, we propose a new atrial anastomosis technique that is easier and safer than previously introduced techniques.

• Advances in pediatric surgery
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• 제4권1호
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• pp.16-26
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• 1998

Parenteral nutrition has been an essential part of postoperative care of neonates requiring major surgery who are unable to tolerate enteral feeding for long periods during the postoperative period. However, TPN via central venous catheters(central TPN), used in increasing trend, still presents significant morbidity. To find out whether TPN via peripheral veins(peripheral TPN) could be used as a viable alternative for postoperative parenteral nutrition in neonates, a clinical study was carried out by a retrospective analysis of 53 neonates subjected to peripheral TPN for more than 7 days after surgery. Operations consisted of procedures for esophageal atresia with tracheoesophageal fistula, gastroschisis and omphalocele. Surgery was performed at the Division of Pediatric Surgery, Department of Surgery, Hanyang University Hospitall, from 1983 to 1994. The mean total duration of TPN was 13.3 days (range; 7-58 days), the average daily total fluid intake was 117.6 ml/kg during TPN and 158.6 ml/kg during subsequent oral feeding. The average daily total calorie intake was 57.7 kcal/kg during full strength TPN and 101.3 kcal/kg during subsequent oral feeding. The mean urine output was maintained at 3.5 ml/kg/ hour during TPN and at 3.6 ml/kg/hour during subsequent oral feeding. The increment of body weight observed during TPN was 132 g in TEF, 53 g in gastroschisis and 3 g in omphalocele patients, while loss of body weight was not observed. The mortality rate was 5.7 %(3/53) and was related to the underlying congenital anomalies, not the TPN. The most common complication of peripheral TPN observed was laboratory findings suggestive of liver dysfunction in 23 cases(43.4 %) with no significant clinical symptom or signs in any case, transient pulmonary edema in one case, and generalized edema in one case. None of the major complications usually expected associated with central TPN were observed. The result of this study suggest that peripheral TPN can be used for adeguate postoperative nutritional support in neonates requiring 2 to 3 weeks of TPN.

• Journal of Chest Surgery
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• 제55권3호
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• pp.206-213
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• 2022

Background: Surgical repair of partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) using the Warden procedure has favorable outcomes. However, there remain some concerns after the Warden procedure, such as sinoatrial nodal dysfunction and systemic or pulmonary venous stenosis. We investigated the outcomes of the Warden procedure for repair of PAPVR to the SVC. Methods: This retrospective study included 22 consecutive patients who underwent the Warden procedure for PAPVR between 2002 and 2018. The median age and body weight at operation were 27.5 months (interquartile range [IQR], 5.0-56.8 months) and 13.2 kg (IQR, 6.5-16.0 kg), respectively. The median follow-up duration was 6.2 years (IQR, 3.5-11.6 years). Results: There were no cases of early or late mortality. No patients had postoperative heart rhythm problems, except 1 patient who showed transient sinoatrial nodal dysfunction in the immediate postoperative period. Procedure-related complications requiring reintervention occurred in 5 patients, including 3 of 4 SVC stenosis cases and 2 pulmonary venous stenosis cases during follow-up. The rate of freedom from reintervention related to the Warden procedure was 75.9% at 10 years. Conclusion: In cases requiring extension or creation of an atrial septal defect to achieve a sufficient venous pathway, or interposition of an entire circumferential conduit between the SVC and right atrium due to the shortness of the SVC in the Warden procedure, stenotic complications of the venous pathway occurred. Careful observation of changes in the pressure gradient or anatomical stenosis is required in such patients.

• Clinical and Experimental Pediatrics
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• 제52권2호
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• pp.194-198
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• 2009

목 적 : 총폐정맥 환류이상은 드문 선천성 심장질환이나, 진단 즉시 완전 교정 수술이 필요한 질환이며 폐정맥 협착 동반 유무에 따라 수술 사망률과 예후가 다르게 보고되고 있다. 이번 연구는 총폐정맥 환류이상 환아를 조사하여 이들의 임상적 특성과 수술 후 경과를 살펴보고자 시행하였다. 방 법 : 1994년 1월부터 2008년 2월까지 14년간 경북대학교병원에서 총폐정맥 환류이상으로 진단된 환아 27명의 의무 기록 정보를 후향적으로 분석 하였다. 결 과 : 총폐정맥 환류이상 환아 27명은 남아 17명, 여아 10명이었고, 진단 시 나이는 평균 $28.1{\pm}33.4$일(1-126일), 평균 체중은 $3.6{\pm}0.9$ kg (1.9-6.3 kg)였다. 병원을 방문한 주 증상으로 빈호흡, 저산소증 등의 호흡기 증상이 7명, 수유 시 청색증이나 전신 청색증이 13명, 심잡음이 7명이었다. 13명(48.1%)에서 심부전 소견을 보였다. 심초음파 검사로 진단된 해부학적 형태로 심상부형이 15명(55.6%), 심형이 6명(22.2%), 심하부형이 5명(18.5%)이고 혼합형은 1명(3.7%)있었다. 수술 전 폐정맥 협착이 동반된 경우는 7명으로 심상부형에서 5명, 심형과 심하부형에서 각각 1명이었다. 본원에서 수술 받은 환아는 총 24명으로 수술 중 경식도 초음파 검사는 14명(58.3%)에서 시행하였다. 수술 중 경식도 초음파 검사를 사용한 경우의 사망률은 0%이고 사용하지 않은 경우의 사망률 40%로 유의한 차이(P<0.05)를 보였다. 수술 사망은 4명(16.7%)으로, 수술하지 않고 사망한 환아 2명을 포함하여 전체 사망률은 22.2%였다. 그러나 수술 시기를 2000년을 기준으로 구분하여 살펴보면, 사망한 4명 모두 2000년 이전이었으며(사망률 50%, 4/8명), 2000년 이후에는 수술 후 사망이 한 명도 없었다(사망률 0%, 0/18명). 수술 후 폐정맥의 협착은 심초음파 검사로 진단하여 5명에서 발생하였다. 5명중 3명은 수술 부위의 협착이고 나머지 2명은 폐정맥 자체의 협착이었다. 수술 부위의 협착을 보인 3명은 재수술을 시행하였고(평균 기간 : 24일) 재수술 후 사망률은 0%이며, 현재 모두 약물치료는 시행하지 않으며 특별한 증상도 보이지 않으나 3명 모두 정기적으로 시행한 심초음파에서 후기 재 협착 소견을 보였다. 이들이 수술 부위의 후기 재 협착이 진단되기까지의 평균 기간은 31.3개월(17-54개월)이었다. 폐정맥 자체의 협착을 보인 환아는 2명으로, 교정 수술 후 심초음파 검사로 진단되기까지의 기간은 각각 3개월과 84개월이었다. 추적 관찰되었던 환아 20명에서 평균 관찰 기간은 $24.2{\pm}24.9$개월(2-80개월)이었다. 결 론 : 수술 후 폐정맥 협착 및 수술 부위의 재 협착이 발생할 수 있으므로 수술 중 경식도 초음파 검사의 적극적 이용과 수술 후 정기적이고 지속적인 관리가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제24권6호
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• pp.533-540
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• 1991

We have performed 14 single lung transplantation in mongrel dogs transplanting the left lung exclusively from December 1989 to January 1991, in the department of thoracic surgery of Seoul National University Hospital. In the donor dogs, the main pulmonary artery was divided proximal to its bifurcation, and the left atrium was incised freeing the left veins with a generous atrial cuff. We used cold saline in the first 7 transplantation[group I ] and a Euro Collins solution in the remaining 7 transplantations[group II ] as a lung preservatives. The bronchus was divided at two cartilage rings proximal to the upper lobe bronchus take off. In the recipient procedure, we used a Fogarty catheter as a bronchus block. Left atrial anastomosis was performed first using 5 - 0 prolene and the pulmonary artery was anastomosed using 6 - 0 prolene. The bronchus was anastomosed next with 4 - 0 Vicryl interruptly and covered with a greater omentum which had been prepared previously. In group I the three dogs died at eleven hours, 5 days, and 14 days, postoperatively and the remaining four doings were killed at 5 days, 5 days, 6 days, and 12 days, respectively. In group II the two dogs died during the operation, one dog died at 6 hours, two dogs died at 6 days postoperatively. Two dogs were killed at 5 days, and 7 days. No significant difference was noted between the two groups in survival time, lung infiltration of transplanted lungs, and perfusion defects in perfusion lung scans. Of the 8 dogs which died naturally, the causes of death were as follows: 2 cases of sepsis, 2 cases of ventricular fibrillations, 2 cases of malnutrition, and 2 cases of respiratory failures.