• Journal of Chest Surgery
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• 제27권2호
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• pp.161-165
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• 1994

We have experienced a case of ventricular septal defect due to blunt chest trauma. A 22 year old male patient was admitted due to chest pain after Motor cycle accident on July 1st,1993. On 5th hospital day, sudden onset of dyspnea was noted and auscultation represented newly developed systolic murmur. A cardiac catheterization and Left ventriculogram revealed ruptured septum at the apical portion. Because there was open wound on anterior chest wall and congestive heart failure was medically controlled, the patient was discharged for elective operation. He was readmitted on August 14th, 1993.At operation, ventricular septal defect was found in apico-posterior muscular septal area, about 2.0 x 1.5 cm in size. The defect was repaired by double velour patch with interrupted suture and ventriculotomy was closed with Teflon felt. The patient`s postoperative course was uneventful and discharged 10 days postoperatively without complication. The patient have been followed up~ for 2 months. He is on functional class I with small amount of residual shunt at the ventricular septum.

• Journal of Korean Neurosurgical Society
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• 제39권6호
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• pp.438-442
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• 2006

The sylvian aqueduct syndrome is a global rostral midbrain dysfunction induced by a transtentorial pressure gradient through the aquaeductus. Several months after ventriculoperitoneal shunt, a patient with hydrocephalus began experiencing a constellation of midbrain dysfunction symptoms, including bradykinesia, medial longitudinal fasciculus syndrome, third nerve palsy, and mutism. These were indicative of cerebral aqueduct syndrome. In addition, the patient showed posture-dependent underdrainage or overdrainage. All symptoms were resolved after distal catheter elongation and floating cranioplasty. We present a case of reversible parkinsonism, which developed in a patient with shunted hydrocephalus and aqueductal stenosis, and discuss the diagnosis and treatment of the sylvian aqueduct syndrome. We also review the literature to address problems of drainage and potential treatment modalities.

• Journal of Chest Surgery
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• 제38권9호
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• pp.633-636
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• 2005

출생 직후 Carpentier-Edward D형의 Ebstein 기형을 진단 받은 신생아가 심한 저산소증 및 심부전의 증상을 보여 생후 16일째 응급수술을 시행하였다. 수술 소견 상 거대한 우심방 및 심방화 우심실, 작은 기증적 우심실, 삼천 판막의 중격엽 및 후엽의 심한 하향 전위 및 전엽의 우심실 전벽 유착 등이 관찰되었고, 전형적인 협착성 엡스타인 기형으로 양심실 교정이 북가능한 상태로 판단되어 변형 starnes 술식을 적용하였다. 즉 폐동맥판막 및 전위된 삼첨판막 개구창을 일차 봉합 폐쇠하고 광범위한 심방 중격 절제술 등을 시행한후 우심실 전벽과 심실 중격 사이를 우심 첨부에서부터 다중 봉합하여 막성 중격 주변으로 10mm 정도 남기고 심방화 우심실 내부를 모두 봉합 폐쇄하였다. 또한 폐혈류 유지를 위하여 4mm ringed Gore-Tex 도관을 무명동맥에서 주폐동맥까지 연결하였다. 환자는 수술 후 경과가 양호하여 술 후 17일째에 퇴원하였으며, 6개월 후 큰 문제없이 양방향성 상대정맥-폐도맥 단락술을 시행할 수 있었다. 저자 등은 심한 협착성 엡스타인 기형 환자에게 간편하면서도 안전하게 심방화 우심실을 혈역학으로부터 제외시키는 변형 Starnes 방법을 적용하여 좋은 성적을 얻었기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제29권4호
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• pp.440-443
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• 1996

삼첨 판막 심내막염은 감수성이 있는 항생제에 효과적으로 치료될 수 있다. 그러나 패혈증이 지속되거 나, 중증의 심부전, 다발성 폐 색전증 그리고 실 초음파상 증식증 (vegetation)이 있는 경우는 수술이 필요 하다. . 19세횝 남자환자가 감염성심내막염으로 입원하였다. 환자는 9년전에 perimembranous type의 VSD로 수술받은 병 력 이 있다. 심초음파상 삼첨판의 전엽부에 커다란 증식증의 소견이 보였고,과거에 VSD를 봉합했던 부위에 누 출 (leakage)을 통한 좌우단락이 관찰되었다. 항생제치료와 함께 인공판막치 환술을 시행하였다. St. Jude Medical 양엽판막 (size 33 mm으로 삼첨 판막 대 치술을 시 행하였고 잔여 VSD는 단순봉합으 로 폐쇄하였다. 술후 시행한 심초음파검사에서 치환된 삼첨 판막의 기능은 좋았고, 증식증과 좌우단락의 소견은 보이지 않았다. 환자는 합병증없이 술후 25일째에 퇴원하였다. 저자들이 경험한 본 증례는 잔여 VSD로 인해 생긴 감염성심내막염을 초기에 적극적인 수술을 시행 하여 좋은결과를 얻었음을 보여준다. 이 에 문헌고찰과 더불어 보고하는 바이다.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.248-251
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• 2013

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

• Journal of Chest Surgery
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• 제40권10호
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• pp.696-700
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• 2007

심한 엡스타인 기형을 갖고 있는 한 신생아에서 Starnes 수술 후 중기 수술 결과를 보고한다. 환아는 출생 당일 청색증과 함께 심한 심비대로 입원하였다. 생후 19일째 심방화 우심실의 축소술과 함께 삼첨판 성형술을 시도하였으나 실패하였고 관상정맥동을 우심실 족에 두면서 삼첨판을 첩포로 폐쇄시키고 체폐동맥 단락술을 시행하였다. 생후 16개월에 양방성 상공정맥-폐동맥 문합술을 시행하였고 30개월에 심외도관 폰탄수술을 시행하였다. 현재 환아는 생후 56개월로 특별한 신체적 제한 없이 잘 지내고 있다. 최근 추적 심장검사에서 동율동 상태로 매우 작은 우심실과 함께 정상적 좌심기능을 보여주고 있고 우심실에 혈전 형성의 증거는 없었다.

• 한국임상수의학회지
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• 제30권6호
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• pp.468-472
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• 2013

12연령의 암컷 잡종개 (체중 6.2 kg)가 심한 복부 팽만, 지속적 기침 그리고 운동 불내성을 주증으로 진료 의뢰 되었다. 진단상에 복수, 경정맥 노장, 심한 좌우 심첨부 수축기 잡음 (4/6 단계), 후대정맥 확장을 동반한 전반적 심비대와 좌심방 확장이 관찰되었다. 심장 초음파에서는 퇴행성 이첨판막 그리고 삼첨판막 심내막증과 양심실성 울혈성 심부전이 관찰되었다. 좌우단락의 난원공 개존증 또한 있었다. 좌심실 수축능은 용적 과부하의 정도와 관계되어 떨어져 있었다. 진단적 결과에 기초하여, 본 증례는 ISACHC IIIa 심부전의 이첨판막과 삼첨판막 심내막증이 합병된 난원공 개존증으로 진단되었다. 이 개는 푸로세마이드 (2 mg/kg, q12hr, PO), 피모벤단 (0.3 mg/kg, q12hr, PO)와 스피로노락톤 (1 mg/kg, q12hr)으로 치료되었다. 임상 증상들은 약물 치료 후에 점차적으로 개선되었다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 추계학술대회
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• pp.478-481
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• 1997

A technique or the preparation of porous polyurethane vascular prostheses was investigated. Small-diameter vessels are not in general clinical use due to their limited long-term biocompatibility and low patency rates in experimental trial. These limits are mainly due to the failure of mechanical unction of the vascular grafts. This failure has been suggested to result partially from compliance mismatch. The long-term patency is considered to depend critically on the properties of the material and the fabrication process of the graft. So the control of pores is very important and main points to develop a available vascular grafts. Two-kind polymer sheets was compared. One was the porous PU-sheet made at room temperature by the solvent/non-solvent exchange. And the other was the porous PU-sheet which was fabricated by thermal phase transition and solvent-/non-solvent exchange using the thermal controller. The polymer sheets had a uniform pore size and pore occupation. According to the result of the above experiments, polyurethane solution was injected into a mold designed or U-type tube. The average pore size and pore occupation were easily changed by changing polyurethane concentration, freezing temperature, and methods. This technique can give a proper pore size ($10{\sim}45\;{\mu}m$) or tissue in growth, and suitable compliances or matching with arteries and veins. Besides, the fabrication of more complicated shaped vessels such as the U-type vascular grafts is easily controlled by using the fixed mold. this method might give a desired compliant graft or artificial implantation with the presently valid medical polymers.

• Journal of Chest Surgery
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• 제25권1호
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• pp.32-41
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• 1992

From August 1982 to December 1991, 58 consecutive infants with tetralogy of Fallot underwent primary repair. Age ranged from 22 days to twelve months [n=58, 8.7$\pm$2.7 months] and body weight from 3.1 to 13 kilograms [n=58, 7.8$\pm$1.7 kilograms]. Qne infant had absence of the pulmonary valve; one had Ebstein`s anomaly and one had supramitral ring. Thirty-two patients [56%] experienced anoxic spell. Preoperative pulmonary artery indices were measured in 38 cases, ranging 126-552mm2/M2BSA[n=38, 251$\pm$79mm2/M2BSA]. All infants required a right ventricular outflow tract patch; in 41, the patch extended across the pulmonary valve annulus, in 13 of them, monocusps were constructed. All had patch closure of ventricular septal defect. Two infants had REV operation for avoiding injury to the canal branch of the right coronary artery which cross the right ventricular out flow tract. Post repair PRV/LV were measured at operating room in 40 cases, which revealed mean value of 0.49$\pm$0.12 [range: 0.25-0.74]. The hospital mortality was 10.3% [6 patients], and causes of deaths were right heart failure due to sustained right ventricular hypertension[4] and right ventricular outflow tract obstruction, intractablesuraventricular tachyarrhythmia[1], hypoxia[1] due to residual right to left shunt across the atrial septal defect in patient associated with Ebstein`s anomaly. All infants were doing well at follow-up from 1 to 101 months[20.6 months /patient, 1, 072 patient-month] Serial postoperative echocardiograms revealed no residual ventricular septal defects and estimated RVOT gradients between 0 and 40 mmHg except 3 cases [50, 50, 60 mmHg]. There were no late deaths and late ventricular arrhythmias or congestive heart failure. Redo operations were done in 2 cases because of residual right ventricular outflow tract obstruction. This experience with infants with tetralogy of Fallot suggests that, if mortality is tolerable, eletive repair of tetralogy of Fallot could be reasonably undertaken during the first year of life, and even better results could be anticipated along with improvement of methods of myocardial protection and postoperative care.

• Journal of Chest Surgery
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• 제24권2호
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• pp.153-160
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• 1991

Tetralogy of Fallot was repaired by a transatrial-transpulmonary approach in 91 of 250 patients treated surgically [including redo operations] between April 1986 and December 1989. Their age ranged from 6 months to 14 years [mean 39.7 months]. Associated cardiovascular anomalies were right aortic arch [n=22], ASD [n=12], PDA [n=5], persistent left SVC [n=5], and others [n=6]. PA index was measured pre-operatively since 1987 to estimate pulmonary artery size and safe total correction[mean 289$\pm$110mm2/BSA]. Eight patients received previous shunt take down procedure concomitantly. Pulmonary arteriotomy was extended through small pulmonary annulus to a minimal distance upon the right ventricular infundibulum and transannular patch was applied in 38 patients [41.3%], in 31 of them monocuspid patch was utilized. pRV/LV was measured at operation room in 77 patients [mean 0.58$\pm$0.36]. Operative mortality was 6.6% [6/91]. The causes of death were low cardiac output [n=5], arrhythmia[n=1] and respiratory failure [n=1]. At follow-up between 12 months and 57 months [mean 30.8 months] most patients were in New York Heart Association class I without cardiac medication. There was no late death, but reoperations were required in 3 patients to relieve residual right ventricular outflow obstruction. Thus successful repair of tetralogy of Fallot can be accomplished in most patients including infants by transatrial-transpulmonary approach and the better result can be anticipated with respect to postoperative right ventricular function and arrhythmia than the conventional transventricular approach.