• Clinical and Experimental Pediatrics
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• v.57 no.1
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• pp.19-25
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• 2014

Recently, surgical outcomes of repair of tetralogy of Fallot (TOF) have improved. For patients with TOF older than 3 months, primary repair has been advocated regardless of symptoms. However, a surgical approach to symptomatic TOF in neonates or very young infants remains elusive. Traditionally, there have been two surgical options for these patients: primary repair versus an initial aortopulmonary shunt followed by repair. Early primary repair provides several advantages, including avoidance of shunt-related complications, early relief of hypoxia, promotion of normal lung development, avoidance of ventricular hypertrophy and fibrosis, and psychological comfort to the family. Because of advances in cardiopulmonary bypass techniques and accumulated experience in neonatal cardiac surgery, primary repair in neonates with TOF has been performed with excellent early outcomes (early mortality<5%), which may be superior to the outcomes of aortopulmonary shunting. A remaining question regarding surgical options is whether shunts can preserve the pulmonary valve annulus for TOF neonates with pulmonary stenosis. Symptomatic neonates and older infants have different anatomies of right ventricular outflow tract (RVOT) obstructions, which in neonates are nearly always caused by a hypoplastic pulmonary valve annulus instead of infundibular obstruction. Therefore, a shunt is less likely to preserve the pulmonary valve annulus than is primary repair. Primary repair of TOF can be performed safely in most symptomatic neonates. Patients who have had primary repair should be closely followed up to evaluate the RVOT pathology and right ventricular function.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.437-440
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• 2013

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.627-632
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• 1986

This report describes our 17-years experience with intracardiac repair in 123 patients older than 15 years with tetralogy of Fallot. Major clinical manifestation was cyanosis and clubbing [102 Pts], but other minor associated manifestation were infective endocarditis, pulmonary tuberculosis, brain abscess, congestive heart failure, nephrotic syndrome, and tuberculous spondylitis. Prior palliative shunts had been performed in 10 patients. Preoperative hemoglobin ranged from 9.7 gm/dl to 25 gm/dl [mean 19 gm/dl]. The type of ventricular septal defect were typical perimembranous type, and total canal defect [13%]. The right ventricular outflow tract obstruction was due to combined [58.5%], infundibular [35%], and valvular stenosis [6.5%]. Transannular patch was used in 17% of patients. Hospital mortality was 9.8% in overall, but decreased to 1.7% since 1982. There was two late death [12 year actuarial survival [97%] due to fulminant hepatitis, residual abnormalities [PS, VSD]. Ninety two percent of survivors at follow-up are asymptomatic and leading an active normal life. Residual ventricular septal defect was detected with radionuclide single pass study in 15.3% of patients but almost cases were Qp/Qs less than 1.5, and only two patients had been candidates for reoperation.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.55-61
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• 1988

This report provides follow-up data on 116 patients with congenital cyanotic heart disease, aging 1 month to 13 years [median: 1.8 years], who underwent the modified Blalock-Taussig shunt using polytetrafluoroethylene graft at Seoul National University Hospital between September, 1984 and June, 1987. Among 116 patients complete follow-up studies were done on 95 patients. The mean preoperative arterial oxygen tension was 36 torr. Thirty-Six patients [38%] underwent operation in infancy. Conduit diameters included 4mm [15 cases], 5mm [47 cases], and 6mm [33 cases] sizes. The mean postoperative arterial oxygen tension was 52 torr [P<0.001]. The effectiveness of shunts was evaluated clinically and by shunt murmur, echocardiography and cardiac catheterization with angiography 1 to 31 months after operation. The incidence of shunt occlusion was 9.5% and the mortality was 14.8%. The actuarial patency rate was 83.1 * 6.4% and the actuarial survival rate was 82.5 * 4.5% at 30 months` follow-up for all patients. The effectiveness of the 4mm diameter conduit may be limited. Blalock-Taussig procedure is an effective alternative to the classic B-T shunt in congenital cyanotic heart disease.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.861-863
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• 2006

We report a case of a 46-year-old man with end-stage renal failure who developed a giant aneurysm after a brachiocephalic arteriovenous shunt. The patient had complaints of pulsating pain and swelling of his left upper extremity The patient had abandoned use of the arteriovenous shunt and had a second arteriovenous shunt procedure over his right extremity. The giant venous aneurysm was removed just distal to his anastomosis. The patient's postoperative course was uneventful.

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.286-292
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• 1990

Iliopelvic lymphoscintigraphy was performed to visualize the changes of the lymphatic system using Technetium-99m antimony sulfide colloid in carcinoma of uterine cervix. There were no differences between various indices and clinical stages, but comparison with computed tomographic and postoperative findings, there was meaningful difference in index of decrease and increase, respectively. And lymphoscintigraphy showed by pass way of lymphatic channel in 42 cases (16%) and this suggested the presence of normal shunts of lymphatic channels. Iliopelvic lymphoscintigraphy may be useful for evaluation of lymphatic system in carcinoma of uterine cervix, expecially for screening method.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.408-411
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• 2015

Pulmonary arteriovenous malformations (AVMs) are caused by abnormal vascular communications between the pulmonary arteries and pulmonary veins, which lead to the blood bypassing the normal pulmonary capillary beds. Pulmonary AVMs result in right-to-left shunts, resulting in hypoxemia, cyanosis, and dyspnea. Clinical signs and symptoms vary depending on the size, number, and flow of the AVMs. Transcatheter embolization is the treatment of choice for pulmonary AVMs. However, this method can fail if the AVM is large or has multiple complex feeding arteries. Surgical resection is necessary in those kind of cases. Here, we report the case of a patient with a 6-cm pulmonary AVM with multiple feeding arteries that was successfully treated by repeated coil embolization without surgery.

• Journal of Chest Surgery
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• v.16 no.3
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• pp.342-348
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• 1983

The Fontan principle of redirecting systemic venous blood into the pulmonary arteries via a conduit was initially proposed for Tricuspid Atresia, but it and its modifications have now gained a much wider application than initially intended. From September 1978 to July 1983, Atriopulmonary anastomosis has been performed in 23 patients, 2 months to 19 years of age, Seoul National University Hospital. The diagnoses were Tricuspid Atresia [TA] in 13, Univentricular Heart [UVH] in 9 and one case of Double Outlet of Right Ventricle [DORV]. Previous procedures included two Glenn shunts and one Blalock-Taussl8 shunt. Among these 23 patients, 10 patients had Right Atrial to Pulmonary Artery conduit, with a valve in 7 and without in 3. The remaining 13 patients had direct anastomosis between RA to PA. There were 14 early deaths, 7 of 13 TA patients, 6 of 9 UVH patients and one DORV, and the total hospital mortality was 60%. But there were no later deaths, 9 of these 23 patients survived operation and are presently alive. The Fontan procedure can be done with an acceptable low mortality with good functional results for Tricuspid Atresia and other complex lesion in foreign hospital, but till now our results revealed much higher risks. For our good operative results and effective patients selection, we must clarify the exact condition of pulmonary arterial system and accumulate much more experiences and technique.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.461-466
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• 2007

Two dogs were admitted with a history of anorexia, ataxia, shivering, lethargy, hypersalivation and seizure. Patients were suspected for portosystemic shunts on the basis of clinical signs, increased hepatic serum profiles on the blood test, microhepatica on plain abdominal radiographs, and an abnormally dilated and tortuous vessel on abdominal ultrasonographs. To diagnose PSS and to further evaluate type, shape, and location of shunt and hepatic vasculatures, the computed tomography (CT) angiography for portal and systemic circulation was performed. The shape, location and pathway of extrahepatic single shunt were confirmed in two dogs. Dual phases (the arterial phase and the venous phase) CT angiography and reformatted and three-dimensional images offered good understanding of PSS and planning surgical treatment.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.123-129
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• 2019

Objective : Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision. Methods : The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the 'double incision' whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision. Results : Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection. Conclusion : The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.