• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1195-1203
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• 2000

Objective : To confirm the efficacy of functional hemispherectomy and peri-insular hemispherotomy on treatment of intractable epilepsy. Materials & Methods : From April 1997 to February 1999, we performed 1 functional hemispherectomy and 6 peri-insular hemispherotomy in 7 consecutive patients. These procedures result in completely disconnected hemisphere while maintaining the disconnected portion of the hemisphere intact within the surgical cavity. The indications were hemimegalencephaly in 2 cases, infarction with encephalomalacia in 2, Sturge-Weber syndrome in 1, hemiconvulsion hemiplegia epilepsy syndrome in 1, cortical dysplasia with leptomeningeal cyst in 1. Mean follow-up is 15.8 months(range 8-28 months). Results : Among 7 patients, 1 patient died immediately after peri-insular hemispherotomy. Five patients became seizure free with reduced doses of medications. One patient developed rare disabling seizure with medication. In 6 patients, there were improvements in the function of the hemiparetic limbs in the postoperative phase. A 3-year-old boy with infarction and encephalomalacia died few hours after surgery due to postoperative hypothermia. Two patients required shunt after surgery. Two patients developed postoperative brain swelling but were successfully managed with conservative care. Conclusion : In conclusion, functional hemispherectomy and peri-insular hemispherotomy may provide substantial seizure control in selected cases of young hemiplegic patients with intractable epilepsy.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.307-312
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• 2023

Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepatic portal hypertension. A spontaneous superimposed hepatic arterioportal fistula can lead to pre-sinusoidal portal hypertension, further exacerbating its physiology. This report describes a young woman with long-standing EHPVO presenting with repeated upper gastrointestinal variceal bleeding and symptomatic hypersplenism. Computed tomography scan demonstrated a cavernous transformation of the portal vein and a macroscopic hepatic arterioportal fistula between the left hepatic artery and portal vein collateral in the central liver. The hepatic arterioportal fistula was associated with a flow-related left hepatic artery aneurysm and a portal venous collateral aneurysm proximal and distal to the fistula, respectively. Endovascular coiling was performed for the hepatic arterioportal fistula, followed by proximal splenorenal shunt procedure. This case illustrates an uncommon association of a spontaneous hepatic arterioportal fistula with EHPVO and the utility of a combined endovascular and surgical approach for managing multifactorial non-cirrhotic portal hypertension in such patients.

• Journal of Chest Surgery
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• 제32권8호
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• pp.702-708
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• 1999

배경: 미숙아 동맥관 개존증의 약물적 치료로 Indomethacin을 사용하는데 이때 발생하는 합병증, 부적응증, 또는 동맥관이 다시 열릴 경우 외과적으로 교정함으로써 수술에 따른 위험성 및 합병증이 적고 지속적인 동 맥관 폐쇄가 가능하다. 대상 및 방법: 1996년 4월부터 1998년 8월까지 동맥관 개존증을 동반한 미숙아중 수 술 당시의 체중이 1.5 kg 이하인 11명의 환아(남아: 5, 여아: 6)를 대상으로 하였다. 술전 동반질환으로 선천 성 심질환(7), 유리질막증(6), 폐렴(4), 뇌실내 출혈(4), 기흉(3), 고빌리루빈혈증(2), 괴사성 장염(2), 신부전증 (1), 간질(1), 수두증(1) 등이 있었다. 사용된 외과적 술식은 헤모클립을 사용한 경우(8)와 동맥관을 결찰한 경 우(3)가 있었다. 동맥관의 크기는 3~6 mm(5.0$\pm$1.2)였다. 결과: 동맥관을 폐쇄한후 수축기 및 확장기 혈압이 상승하였고 심박동수는 감소하였다. 동맥혈 개스 결과도 호전되었다. 수술과 관련된 합병증은 없었다. 술후 6명의 환아에서 호흡기 증상의 호전과 함께 인공호흡기이탈이 가능했고 모두 외래 추적 관찰중이다(3개월~ 12개월). 술후 5명의 환아가 사망하였는데 사망 원인은 유리질막증(2례), 기관지폐 이형성증과 폐렴(1례), 패 혈증(1례), 심부전증과 특발성 호흡곤란증(1례)이었다. 결론: Indomethacin에 부적응증 혹은 합병증이 있거나, Indomethacin용법에 효과가 없거나 또는 혈역학적으로 의미있는 단락을 동반하는 미숙아 동맥관의 우선 치료 법은 조기 외과적 교정술이다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.22-29
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• 1987

From Sep. 1978 to Aug. 1986, 44 cases of Fontan operation were performed at Seoul National University Hospital. 1] The diagnoses were TA in 13 [38.6%], UVH in 21 [47.79`], DORV in 3 [6.8%], TGA in 2 [4.5%] and C-ECD with DORY in 1[2.3%]. 2] There were 20 operative deaths [44.5%]. 3] The operative risk factors were early date of operation between 1978 and 1983, young age below 3 years old, direct atriopulmonary anastomosis without roofing, and postoperative high CVP above 25cmH,O. But the relation between operative mortality and various cardiac diseases was absent. 4] survived patients were followed from 1 to 54 months except 3 patients who were lost to follow up. 16 patients were in functional class I and 1 in class II, 2 of the above 17 patients were reoperated due to residual right to left shunt. In remained 4 patients, 3 patients persisted cyanosis after operation and 1 patients died 1 month postoperatively due to pulmonary embolism. 5] As 4 result, the Fontan procedure can be done with a good result for tricuspid atresia and other complex lesions. The operative mortality can be reduced further with a correct anatomical diagnosis preoperatively, rigid operative criteria to pulmonary vascular resistance, direct atriopulmonary anastomosis with roofing, and use of `Venous Assist Device` postoperatively in low cardiac output patients.

• Journal of Chest Surgery
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• 제20권3호
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• pp.536-543
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• 1987

The Fontan procedure was physiological correction which was initially applied to tricuspid atresia. We had used the modified Fontan operation in 8 cases at National Medical Center, Seoul, from Aug. 1984 to Oct. 1986. Age range was 20 months to 15 years [mean: 9 years] and male: female ratio was 5:3. 5 patients had tricuspid atresia [lb: 2 cases, Ic: 1 case, lib: 1 case, & llc: 1 case], 2 Patients had univentricular heart of left ventricular type, and one patient had transposition of great arteries with complete endocardial cushion defect. The operative principle was direct anastomosis between right atrium and pulmonary artery, whether main pulmonary artery or right pulmonary artery without any conduits. Postoperatively all patients needed high central venous pressure for adequate hemodynamic status in both survival [20-24 CmH2O] and mortality groups [20-24 CmH2O]. The fatal complications were as follows: empyema with bronchopleural fistula [1 case], bleeding tendency & brain damage [1 case], low cardiac output syndrome & acute renal failure [2 cases], and right to left shunt of unknown origin [1 case]. There were 5 hospital deaths; 3 of 5 tricuspid atresia patients, 1 of 2 univentricular heart patients, and 1 of 1 transposition of great arteries with complete endocar4ial cushion defect patient. The overall mortality was 62.5%. 3 survivors were nearly compatible with Choussat & Fontan criteria. Thus appropriate patient selection and experienced surgical technique were required for good results.

• Journal of Chest Surgery
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• 제20권2호
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• pp.404-410
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• 1987

An 18-day-old male neonate with hypoplastic left heart syndrome underwent surgical intervention by modification of the Norwood procedure on September 23, 1986. Hypoplastic left heart syndrome is a serious congenital cardiac anomaly that has a fatal outlook if left untreated. Included in this anomaly are [1] aortic valve atresia, and hypoplasia of the ascending aorta and aortic arch, [1] mitral valve atresia or hypoplasia, and [3] diminutive or absent left ventricle. Patent ductus arteriosus is essential for any survival, and there is usually a patent foramen ovale. Coarctation of the aorta is frequently associated with the lesion.z With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the ductus arteriosus was excised. The main pulmonary artery was divided immediately below its branches, and the distal stump of the divided pulmonary artery was closed with a pericardial patch. The aortic arch was incised, and a 1 5mm tubular Dacron prosthesis was inserted between the main pulmonary artery and the aortic arch. A 4mm shunt of polytetrafluoroethylene graft was established between the new ascending aorta and the right pulmonary artery to provide controlled pulmonary blood flow. Following rewarming, the heart started to beat regularly, but the patient could not be weaned from cardiopulmonary bypass. At autopsy, the patient was found to have hypoplasia of the aortic tract complex with mitral atresia and aortic atresia. A secundum atrial septal defect was noted. Right atrial and ventricular hypertrophy was present, and the left ventricle was entirely absent. Although unsuccessful in this case report, continuing experience with hypoplastic left heart syndrome will lead to an improvement in result.

• Journal of Chest Surgery
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• 제7권1호
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• pp.93-100
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• 1974

This is a case report of successful surgical correction of coarctation of the aorta associated with the patent ductus arteriosus and the persistent left superior vena cava. The patient was a 15 year old girl and congenital heart anomaly was suspected at the sixth month after birth. Afterward there has been no embarrassing symptoms until the day of operation except slight dyspnea on exertion, The diagnosis of coarctation of the aorta and the patent ductus arteriesus detected by physical signs and X-ray studies including aortography. In the first place, coarctation of the aorta was corrected with following procedure: partial resections of the aortic wall just above and below the coarctating line of the aorta and removal of diaphragmatic structure of coarctation performed by. cross clamping aorta above and below coarctation, and then the defect of the aortic wall was closed by lateral aortorrhapic suture with atraumatic needle 3-0 silk continuously [Fig. 6]. In the second place, the patent ductus arteriosus was closed with double ligation method. The persistent left superior vena cava left as it has been, because there has been no evidence of hemodynamic abnormal shunt. After operation, excellent result was obtained; blood pressure in the upper and lower extremities was normalized and subjective complains of hypertension in the upper extremity was disappeared.

• Journal of Chest Surgery
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• 제30권1호
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• pp.83-87
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• 1997

Tausslg-Bing 기형은 드물게 대동맥궁 중단과 병발되며, 이 경우 양대혈관의 크기 가 현저히 달라 대동맥 전환술을 시행함에 어려움이 있다. 생후 20일 된 환아가 상기 진단으로 내원하여, 다장기부전에 대한 3주간의 집중관리 후 수술을 받았다. 수술은 심실중격 결손의 복원, 대동맥 전환술 및 광범위한 대동맥궁형성술로 이루어졌으며, 대혈관들의 크기 차이는 상행 및 하행 대동맥의 절편을 이용하여 원위신대동맥(distal neoaorta)를 형성하므로써 극복하였다. 환아는 큰 문제 없이 회복하였으며, 수술후 시행한 심도자상의 결과도 양호한 상태로 16개월간 추적 관찰중이다.

• Journal of Chest Surgery
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• 제28권1호
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• pp.18-22
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• 1995

From January 1989 to December 1993, cardiac catheterization and open heart surgery for ventricular septal defect closure were performed in 115 pediatric patients who were selected as meeting the criteria for elective closure of restrictive ventricular septal defect. These criteria included age greater than 1 year and less than 15 years, no evidence of congestive heart failure, Qp/Qs 2.0, pulmonary artery systolic pressure 35mmHg, and no associated cardiac anomalies. Mean age of patients was 5.25$\pm$ 3.53, and 72 patients were male, 43 patients were female[male:female=1.9:1 . Mean systolic pulmonary artery pressure was 19.66$\pm$4.79mmHg, and mean pulmonary to systemic flow ratio was 1.27$\pm$ 0.28. Aortic cusp prolapse was present in 30 patients [26% , aortic insufficiency was present in 1 paient, and 1 patient had prior bacterial endocarditis. There were no instances of complete atrioventricular dissociation, reoperations for bleeding, or reoperations for recurrent ventricular septal defect, but wound infection was present in 1 patient, and there were 7 patients who had the hemodynamically insignificant remnant shunt. There were no early or late deaths or major morbidity.

• Advances in pediatric surgery
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• 제9권1호
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• pp.35-40
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• 2003

Inguinal hernia is the most frequent problem requiring surgery in children. Moreover, subsequent contralateral occurrence after repair of the symptomatic unilateral inguinal hernia(UIH) is not rare, This study is to evaluate the diagnostic value of inguinal ultrasonography (IUS) for potential bilateral inguinal hernia (BIH). A prospective study was performed for preschool children less than 6 years of age who were diagnosed as UIH from July 1999 to December 2000. We selected 58 cases with potential BIH, based on the past history, such as prematurity, ventriculo peritoneal shunt, family history of BIH. hernia on the left side (LIH), age below 2, female, and contralateral positive silk glove sign on the physical examination, Screening with IUS and bilateral surgical exploration were applied on these cases. Forty-seven cases were males (81.0%) and 11 cases were females (19.0%). Thirty four were infants. Symptomatic right inguinal hernia (RIH) were 28 (48.3%), and LIH were 30 cases (51.7%). Six cases had no evidence of contralateral patent process vaginalis (PPV) by IUS but showed contralateral PPV by operation. Two cases were suspicious to contralateral PPV under IUS, but operative findings were negative. Fifty cases showed contralateral PPV by IUS as well as operation. The detection rate of contralateral PPV under IUS was 86.2%. The preoperative IUS may reduce contralateral exploration.