• Journal of Chest Surgery
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• 제49권5호
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• pp.337-343
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• 2016

Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous return (TAPVR) repair. However, the surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following in situ TAPVR repair without total circulatory arrest (TCA), and to identify the risk factors associated with surgical outcomes. Methods: We retrospectively reviewed 29 cases of surgical intervention for TAPVR conducted between April 2000 and July 2015. All patients were newborns or infants who underwent in situ TAPVR repair without TCA. Results: Four anatomic subtypes of TAPVR were included in this study: supracardiac (20 cases, 69.0%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%), and mixed (1 case, 3.4%). The median follow-up period for all patients was 42.9 months. Two (6.9%) early mortalities occurred, as well as 2 (6.9%) cases of postoperative pulmonary venous obstruction (PVO). Preoperative ventilator care (p=0.027) and preoperative PVO (p=0.002) were found to be independent risk factors for mortality. Conclusion: In situ repair of TAPVR without TCA was associated with encouraging mid-term outcomes. Preoperative ventilator care and preoperative PVO were found to be independent risk factors for mortality associated with TAPVR repair.

• Journal of Chest Surgery
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• 제26권8호
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• pp.595-603
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• 1993

We analysed 60 consecutive patients who got Senning operation for transposition of the great arteries [TGA] with or without ventricular septal defects [VSD]. There were 41 simple TGA [group I] and 19 TGA with VSD [Group II], the operative mortality was 20 % [in group I 4.9 %, group II 52.6 %]. Among the survivors [n=48], the mean follow-up period was 7 years [range, 1 year to 13.5 years] and the actuarial survival rate at 13 years were 95 % in group I and 42 % in group II. Preoperative high left ventricular pressure and high pulmonary arterial pressure affected the surviving [p<0.01]. There occurred various type of arrhythmia like junctional rhythm, first degree atrioventricular [AV] block, sick sinus syndrome and complete AV block, and we inserted 2 permanent pacemakers for these patients. The incidence of arrhythmia were 28.2 % [11/39] in group I and 55.6 % [5/9] in group II, and the actuarial freedom from arrhythmia at 13 years after operation was 66 % [71 % in group I, 44 % in group II]. Increased aortic cross clamping time had affected the development of arrhythmia [p<0.05] which meant the complexity of the operation. The total incidence of left ventricular outflow tract obstruction [LVOTO] was 31.3 % [15/48], but only 3 patients [6.25 %] showed the significant gradient requiring reoperation. The pulmonary venous pathway obstruction [PVO] were found in 3 patients, all in group I, and among them only one required the reoperation. The estimated freedom from PVO was 89 % at 13 years [87 % in group I, 100 % in group II], but we couldn`t find any significant systemic venous obstruction in our series. There occurred 27.1 % [13/48] mild degree tricuspid valve regurgitation without necessary surgical correction. We experienced 14.6 % [7/48] reoperation rate: 3 residual VSD, 3 LVOTO, 1 PVO, 3 atrial baffle leakage. For this high incidence of complication rate after Senning operation and high mortality in TGA with VSD, We do not use this kind of surgical modality any more and do the Jatene operation for all the TGA patients since several years ago.

• Journal of Chest Surgery
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• 제33권10호
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• pp.830-833
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• 2000

Homograft has been the conduit of choice in various types of congenital malformations which require right ventricular outflow tract reconstruction. However it has been proven to be less than ideal in young age group because of early failure of the conduite due to valve dysfunction and calcification. Furthermore limitation of availability of homograft particularly small sized conduits for neonates and infants is the most serious problem. A 19 month old female patient with pulmonary atresia and ventricular septal defect was operated on with a bovine jugular venous valved conduit as an alternative to the homograft for her right ventricular outflow tract reconstruction. Postoperative hemodynamic performance of the conduit was excellent without pressure gradient or valve regurgitation. With this early result bovine jugular venous valved conduit seems to be another excellent conduit because of good hemodynamics and size availability but long term follow up is necessary.

• 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.

• Tuberculosis and Respiratory Diseases
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• 제39권1호
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• pp.95-101
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• 1992

저자들은 최근 심한 늑막액이 반복되는 환자에서 재발성 일측성 폐정맥 폐쇄증을 진단후 추적관찰하였기에 문헌고찰과 함께 보고하였다.

• Journal of Chest Surgery
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• 제13권4호
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• pp.448-454
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• 1980

The juxtaposition of atrial appendage may possibly be diagnosed by angiography recently, and it is widely regarded as an ominous sign of severe cyanotic congenital heart disease. However, it is apparently rare congenital cardiac anomaly in which the atrial appendages lie side by side, both to the left or right of the great arteries, known as left or right juxtaposition of the atrial appendages. Juxtaposition of the atrial appendages has no functional significance, since it does not, itself, cause any hemodynamic disturbance. But it`s presence always indicates the coexistence of other major cardiac anomalies. In review of literatures TGA and VSD are invariable present, and ASD is common. Other anomalies, such as, tricuspid atresia, pulmonary outflow that, obstruction bicuspid pulmonic valve, persistent SVC etc. are relatively high incidence. In this report, we present one case of 6 year old female child having left juxtaposition of atrial appendage combined with TGA [D-looping, D-transposition], TAPVD, large ASD, small VSD, and vertical vein.

• Journal of Chest Surgery
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• 제34권9호
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• pp.672-679
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• 2001

배경: 폐정맥 및 상대정맥의 폐쇄와 동방결절의 기능장애 등은 상대정맥으로 환류되는 부분폐정맥 연결이상의 수술교정 이후 발생할 수 있는 합병증으로 술 후 정기성적을 결정하는 요인이 되어왔다. 저자들이 시행하고 있는 수술방법을 기술하고 조기결과를 분석하였다. 대상 및 방법: 1999년 4월부터 2000년 1월까지 세종병원과 대구가톨릭대학병원에서 5명의 환자가 상대정맥으로 환류되는 부분폐정맥 연결이상으로 교정수술을 받았다. 환자의 나이는 생후 2개월부터 66세까지였다. 수술방법은 우심방 피판(2례)이나 첨포(3례)를 사용하여 이상폐정맥을 심방간 통로를 통하여 좌심방으로 정상환류시키고, 상대정맥을 이상폐정맥의 상부에서 절단한 후 근위부를 폐쇄하고 상대정맥의 원위부를 우심방이에 단단문합함으로써 상대정맥과 우심방의 혈류를 재건하였다. 결과: 모든 환자가 합병증 없이 술 후 9일과 15일 사이에 퇴원하였다. 퇴원 후 본국으로 돌아간 러시아 환아를 제외한 4명의 환자는 평균 17.75$\pm$4.27 개월의 추적기간 동안 증상 없이 정상동율동을 보였다. 술후 12개월에서 24개월에 시행한 심장초음파검사상 폐정맥이나 상대정맥의 협착 및 잔류단락은 보이지 않았다. 결론: 저자들은 상대정맥으로 환류되는 부분폐정맥 연결이상 환자에서 기술한 수술방법으로 폐정맥 및 상대정맥 혈류의 협착 없이 좋은 결과를 얻을 수 있었다. 상대정맥과 우심방접합부위를 가로지르는 절개를 피함으로써 동방결절 및 그 동맥의 손상을 최소화 할 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제17권3호
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• pp.371-380
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• 1984

Corrected transposition of the great arteries [C-TGA] is one of the rare congenital heart disease in which there is both a discordant atrioventricular relationship and transposition of the great vessels. With this arrangement, systemic venous blood passes through the right atrium into the morphologic left ventricle and out the pulmonary artery. Pulmonary venous blood returns to the left atrium, flows into the morphologic right ventricle and out the aorta. Thus, in the rare case when no additional cardiac anomaly is present, a hemodynamically normal heart exists. But more often they are symptomatic as a result of one or several of the commonly associated defects. This paper describes 13 patients who underwent repair of one or more cardiac anomalies associated with corrected transposition at SN UH, from June 1976 through June 1984. 1.8 were males and 5 females, with ages ranging from 3 years to 27 years. 2. Segmental anatomy was {S,L,L} in 12, or {I,D,D} in 1. 3.Associated anomalies were ventricular septal defect in 10, pulmonary outflow tract obstruction in 6, tricuspid insufficiency in. 4, atrial septal defect in 3, subaortic stenosis in 1, mitral insufficiency in 1, and patent ductus arteriosus in 1. 4.None had complete heart block preoperatively, and 3 developed complete heart block intraoperatively. But one of them recovered sinus rhythm on the postoperative 7th day spontaneously. 5.There were 3 cases of hospital morality. But there was no morality since Dec. 1980. 6.Patients with single ventricle, hypoplastic ventricle or those who had palliative surgery alone are not included in this review.

• Journal of Chest Surgery
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• 제24권1호
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• pp.1-7
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• 1991

This report describes our 10-year experience with intracardiac repair in 42 patients older than 16 year with tetralogy of Fallot. The mean age was 22.0$\pm$5.18 years[range 16~41]. The preoperative clinical manifestations were cyanosis & clubbing[93%], frequent URI [55%], anoxic spell[40%], pulmonary tuberculosis[21%], tuberculous empyema[7%], chronic renal failure[7%], congestive heart failure[7%] and subacute bacterial endocarditis [2%], etc. The previous shunt procedure for palliation had been performed in 7 patients. The type of VSD were typical perimembranous type[67%], total canal defect[28%] and combined type[5%]. The right ventricular outflow tract obstruction were combined type[69%], infundibular type[21%] and valvular type[10%]. Transannular patch was used in 50% of patients. Associated cardiovascular anomalies were ASD[33%], PFO[31%], Rt. aortic arch[10%], Lt. SVC[10%], single Rt. pulmonary artery, single Lt. coronary artery, ASI, proximal stenosis of Rt. pulmonary artery and anomalous systemic venous return, etc. Hospital mortality was 7.1%[3 cases]in overall. The causes of hospital deaths were revealed low cardiac output & acute renal failure[2 cases], postoperative bleeding[1 case]. There were 2 late deaths 3 & 68 months after surgery. Residual intracardiac shunt was detected in 2 patients. one patient was successfully reoperated and another patient had Qp /Qs ratio less than 1.5.

• Journal of Chest Surgery
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• 제32권6호
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• pp.510-517
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• 1999

배경: 신생아나 조기영아에서 전폐정맥연결이상은 아직도 외과적으로 쉽게 치료되지 않는 심기형 중 하나이다. 본 연구는 조기 영아기에 외과적으로 교정된 중요한 다른 심기형이 동반되지 않은 전폐정맥연결이상 환아들의 조기 및 중기 성적을 분석하기 위해 시행되었다. 대상 및 방법: 1993년 1월부터 1998년 8월까지 본 교실에서 외과적으로 교정술을 시행받은 전폐정맥연결이상 환아들중 조기 영아 15명의 의무기록을 후향적으로 분석하였다. 남아가 8명, 여아가 7명이었으며 나이는 생후 4일에서 3.5개월(중심나이 생후 22일)이었다. 체중은 1.75 kg에서 4.9kg(평균체중 3.54 kg)이었다. 심기형을 형태별로 보면 심장상부형이 11례, 심장형이 3례, 심장하부형이 1례였다. 6례(40%)에서 폐정맥환류의 협착이 있었다. 13례에서 수술방법으로 완전순환 정지법을 사용하였고 심장상부형과 심장하부형은 우심방 뒤에서 측방으로 접근하여 공통폐정맥과 좌심방을 문합하였는데 매우 가는 비흡수사인 polypropylene 사를 이용하여 연속봉합을 이용하였다. 결과: 1명의 환아가 술후 17일째 패혈증으로 사망하여 수술사망율은 6.7%였다. 이 환아는 술전 인공호홉이 필요하였던 상심실형의 신생아였다. 두명의 만기사망이 있었는데 그 중 1명은 수술 3년 후 집에서 급사하였는데 원인을 알 수 없었고 다른 한명은 술후 폐정맥협착으로 재수술을 시도하고 좋은 상태로 퇴원하였으나 재수술 3개월후 재발된 폐동맥고혈압으로 사망하였다. 두명의 환아에서 폐정맥협착으로 첫 수술 5개월, 10개월후에 각각 재수술이 시행되었다. 이 중 한명은 현재 계속되는 폐동맥고혈압은 있으나 비교적 좋은 상태로 잘 지내고 있다. 만기사망 및 재수술 환아 3명을 제외한 11명(78.6%)의 환아는 25.8$\pm$20.4개월(0.5개월에서 67개월)의 평균 추적기간동안 심초음파검사상 폐정맥환류의 협착이나 폐동맥고혈압의 증거없이 모두 NYHA class I으로 잘 지내고 있다. 결론: 조기 영아에서의 전폐정맥연결이상은 비교적 낮은 수술사망율로 교정 될 수 있었으나 술후 폐정맥 혹은 문합부협착증이 2례(14.3%)에서 발생하였고 재수술의 결과도 좋지 못하였다. 그러나 술후 폐정맥환류에 협착이 없었던 환아들의 상태는 매우 양호하였다.