• Journal of Chest Surgery
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• v.30 no.11
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• pp.1121-1124
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• 1997

This is a report of a successful, rapid two-stage arterial switch operation in an infant with dextrotransposition of great arteries with an intact ventricular septum beyond the appropriate time for arterial switch operation.'A 4-month-old female infant was admitted due to severe cyanosis, respiratory insufficiency, and frequent dia rhea secondary to ischemic colitis. Echocardiographic examination presented marked leftward deviation of the interventricular septum, and left and right ventricular pressures as measured by cardiac catheterization were 40/4 mmHg and 85/2 mmHg, respectively. Fifteen days after a preparatory operation (pulmonary artery band with modified right Blalock-Taussig shunt), left ventricular-right ventricular systolic pressure ratio increased to 105/90. Arterial switch operation associated with the division of the right Blalock-Taussig shunt and the removal of pulmonary artery band was performed. A(leer the operation, the infant showed normal cardiac function with no postoperative complication.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.809-814
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• 1997

Continuous epidural pain block with a local anesthetic agents is a commonly employed technique for pain relief after thoracotomy. In this study, we evaluated the effectiveness of the continuous epidural pain block in 19 patients undergoing elective lateral or posterolatrral thoracotomy with control group(n=19) from November 1994 to July 1995, Epidural lidocaine and morphine mixtures were injected via an epidural catheter as a bolus after operation, and then bupivacaine and morphine mixtures were injected continuously following 5 or 6 days. The pain score, upper arm elevation(ROM score), and respiratory rate were significantly changed(P<0.05) from 30min after injection. The CO2 tension of arterial blood was decreased significantly(P<0.05) from 2hr after injection. The postoperative hospital days were decreased significantly(P<0.05). Side effects of the epidural pain block were urinary retention(n= 10), urticaria(n=2) and a case of headache. There was no postoperative lung atelectasis. We conclude that the continuous epidural pain block is good for prevention of the postoperative lung complication and early recovery after thoracotomy.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.363-366
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• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Clinical and Experimental Pediatrics
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• v.55 no.10
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• pp.377-382
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• 2012

Purpose: This single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA). Methods: TGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status. Results: Twenty-eight patients (17 boys and 11 girls, mean age=$10.6{\pm}21.5$ days) were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13); group II, TGA with ventricular septal defect (VSD, n=12); and group III, TGA/VSD with pulmonary stenosis (n=3). Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication). Group II showed the highest incidence of heart failure (P<0.05). Usual and unusual coronary anatomy patterns were observed in 20 (71%) and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III), respectively. Postoperative complications included cardiac arrhythmias (8 patients), central nervous system complications (3 patients), acute renal failure (1 patient), infections (3 patients), and cardiac tamponade (1 patient), and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P<0.05). One patient underwent reoperation, and 1 died. The overall mortality rate was 4%. Conclusion: Our study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were inadequate to evaluate the risk factors for reoperation and mortality owing to the small number of patients and short follow-up duration.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.79-83
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• 2011

Pulmonary sequestration is a rare anomaly, in which a local area of a lung is supplied separately by an anomalous artery that arises from the aorta or one of its branches. Infection, mainly bacterial, is a major complication of sequestration. We report the case of a 17-year-old male patient, who presented with cough and fever. The contrast-enhanced chest computer tomomgraphy (CT) scans revealed an aberrant artery that originated from the descending thoracic aorta. He underwent a left-lower lobectomy. Macroscopically, the abnormal segment presented as multiple heterogenous cystic and solid lesions, and the cysts were filled with mucoid and pus-like material. Histology showed that the pulmonary parenchyma had been replaced by caseating epitheloid granulomas. The mycobacterial culture of his sputum was positive. On the basis of these results, the diagnosis of tuberculosis was established. The patient was treated with anti-tuberculous medication for 6 months, and 1 year later, his clinical status remained excellent.

• Tuberculosis and Respiratory Diseases
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• v.67 no.5
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• pp.467-470
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• 2009

A traumatic pulmonary pseudocyst is a rare complication of blunt thoracic trauma. The clinical symptoms and signs are similar to other respiratory diseases, such as pulmonary tuberculosis. Therefore, a trauma history with the resulting radiologic and clinical findings is important for making a diagnosis. A 26-year-old male was admitted to our hospital due to cough for 3 days. The chest x-ray revealed diffuse infiltrations and a cavitary lesion at the left lung. His left chest had hit a tree as a result of motorcycle accident one day before admission. Initially, it was assumed that his symptoms and chest X-ray might be due to a tuberculosis infection. However, bronchoscopy revealed old blood clots at both lungs, particularly in the left lower lobe bronchus. A transbronchial lung biopsy showed alveolar hemorrhage. A traumatic pulmonary pseudocyst was diagnosed from his trauma history and these findings. Computed tomography of the chest performed 4 months later showed regression of the cavitary lesion.

• The Korean Journal of Pain
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• v.26 no.1
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• pp.21-26
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• 2013

Background: Postherpetic neuralgia (PHN) is a serious complication resulting from herpes zoster infections, and it can impair the quality of life. In order to relieve pain from PHN, various treatments, including pharmacological and interventional methods have been used. However, little information on the recommendations for the interventional treatment of PHN, along with a lack of nation-wide surveys on the current status of PHN treatment exists. This multicenter study is the first survey on the treatment status of PHN in Korea. Methods: Retrospective chart reviews were conducted on the entire patients who visited the pain clinics of 11 teaching hospitals from January to December of 2011. Co-morbid disease, affected site of PHN, routes to pain clinic visits, parenteral/topical medications for treatment, drugs used for nerve block, types and frequency of nerve blocks were investigated. Results: A total of 1,414 patients' medical records were reviewed. The most commonly affected site was the thoracic area. The anticonvulsants and interlaminar epidural blocks were the most frequently used pharmacological and interventional methods for PHN treatment. For the interval of epidural block, intervals of 5 or more-weeks were the most popular. The proportion of PHN patients who get information from the mass media or the internet was only 0.8%.The incidence of suspected zoster sine herpete was only 0.1%. Conclusions: The treatment methods for PHN vary among hospitals. The establishment of treatment recommendation for PHN treatment is necessary. In addition, public relations activities are required in order to inform the patients of PHN treatments by pain clinicians.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.540-543
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• 1998

A patient with post-pneumonectomy empyema was treated sucessfully by modification of Clagett's operation after closure of bronchopleural fistula using a transsternal, transpericardial approach. His primary disease was pulmonary tuberculosis, and he had a past history of left upper lobe lobectomy 34 year ago. Recently recurred pulmonary tuberculosis with aspergilloma in the remaining left lung, empyema with bronchopleural fistula had developed on the post-operative 4th day after completion pneumonectomy. Closed thoracostomy was done at the lowest point of the left pleural cavity immediately. The pleural cavity was irrigated with small amount of normal saline through pigtail catheter. The 2nd operation was done by closure of bronchopleural fistula using a stapler through transsternal, transpericardial approach, and then the pleural space was irrigated with normal saline with Tobramycin which shows sensitivity to isolated organism from pleural cavity. After negative conversion of pleural fluid culture, we performed modified Clagett's operation under local anesthesia. The patient had no evidence of recurrence of empyema and discharged from hospital after 10 days of the 3rd procedure.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.635-642
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• 1985

Double outlet left ventricle [DOLV] is a rare cardiac anomaly in which both great arteries arise entirely, or predominantly above the morphologically left ventricle. About 100 cases of DOLV have been reported in the literatures by 1984. We have experienced eight cases of DOLV at Seoul National University Hospital during the period from October 1981 to July 1905. Ages of the patients were ranged from 12 months to 24 years old, and chief complaints on admission were frequent URI and DOE in 5 cases and cyanosis in other 3 cases. In all eight patients, Cardiac catheterization and cineangiography were performed but pre-operative diagnoses were incorrect except one case [VSD in 2 cases, DORV in 2cases, c-TGA in 2 cases and TOF in one case] We have performed total corrective surgery in seven patients. In case I, patch closure of VSD aligning aorta and pulmonary artery with LV, ligation of proximal pulmonary artery and the use of external valved conduit from RV to PA have been employed. In other 6 cases, intraventricular repair using boomerang shaped Dacron patch with correction of associated anomalies were employed. In remaining one patient who had coexistent PDA and coarctation of aorta, we have performed coarctoplasty and PDA ligation initially and the patient is waiting for subsequent total corrective procedure. In seven patients whom we have performed total corrective surgery, there is one hospital mortality due to right heart failure and one complication of complete heart block necessitating permanent pacemaker implantation. All survivors are doing well in follow up period of 9 months to 4 years. To our knowledge, this is the first report of surgical experiences for DOLV in the Korean literature.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.537-541
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• 1985

Recently, we met a 12 year old female patient who suffered from bacterial endocarditis and pericarditis which were complicated by patent ductus arteriosus. She was admitted to our hospital because of dyspnea, fever, headache, and generalized ache for 10 days. The initial diagnosis was bacterial endocarditis and pericarditis complicated by patent ductus arteriosus and congestive heart failure. At first, we tried to treat the patient medically with digitalis, diuretics, and massive antibiotics. On echocardiography large amount of pericardial fluid was accumulated mainly right anterior aspect and also noted a large vegetation at pulmonary valve area. With vigorous medical treatment including repeated pericardiocentesis, the patient showed no improvement. So we decided to perform pericardiectomy for elimination of the most probable septic focus. On operation, we encountered an unpredicted event, the pericardium was thickened, distended, and its surface showed pulsating which meant connecting to systemic circulation. We decided to close the operative wound and reoperate her under cardiopulmonary bypass later. On the next day, we operated her under cardiopulmonary bypass later. On the next day we operated her under cardiopulmonary bypass. The operative findings were ruptured main pulmonary artery about 1.5cm in diameter on its ventral portion, the blood from the ruptured main pulmonary artery was filled up the localized pericardial sac due to previous pericarditis. Through the ruptured main pulmonary artery, we also found 0.5cm diametered patent ductus arteriosus. With the aid of partial cardiopulmonary bypass and inserting 24F ballooned Foley catheter at aorta, pericardiectomy was performed first. After completion of the pericardiectomy, total cardiopulmonary bypass was established. With minimum pump flow [0.3L/min/m2] the PDA was closed with two Teflon-felted 4-0 Prolene interrupted sutures. The ruptured main pulmonary artery was also closed using thickened pericardium with three Teflon-felted 4-0 Prolene interrupted sutures. The operation was successful and postoperative course was uneventful. She was discharged on the 16th POD. We report this case as a very rare secondary complication of bacterial endocarditis complicated by patent ductus arteriosus.