• Journal of Chest Surgery
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• 제30권5호
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• pp.533-536
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• 1997

이화여자대학교 흉부외과에서는 매우 드물게 발생하는 흉부둔상에 의한 삼첨판막 역류증 환자에 있어서 mE를 사용하여 새로운 건삭을 만들어 주고 판막링을 이용하여 판막륜 성형술을 시행하여 좋은 결과를 얻었기에 보고하는 바이다. 환자는 3층 높이의 건물에서 떨어져서 응급실을 방문했으며 심에코 검사상 전유두근의 파열에 의한 심한 삼 첨판막 역류증의 소견을 보였으나 증상이 경미하여 퇴원하였다. 그러나 호흡곤란 및 심비대가 증가하여 외 상후 4개월에 수술을 시행하였으며 수술후 시행한 심에코상 삼첨판막 역류증은 보이지 않았고 호흡곤란도 사라졌다.

• Journal of Chest Surgery
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• 제18권3호
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• pp.391-397
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• 1985

Ebstein`s anomaly is a rare congenital cardiac malformation and characterized by downward displacement of an abnormal tricuspid valve cusps. But until now, the ideal surgical correction is still controversial. We present a case of Ebstein`s anomaly experienced lately. The patient was 13 year old girl with the complaints of dyspnea on exertion, fatigability and cyanosis. Echocardiography revealed downward displacement of septal leaflet of tricuspid valve and atrialized right ventricle. Cardiac catheterization and cineangiography revealed ASD and large right atrium. During operation, the atrialized right ventricle was plicated and tricuspid annuloplasty was done. And the two secundum type ASD`s were closed by direct suture closure. The patient`s postoperative course was uneventful and discharged on the 24th postoperative days.

• Journal of Chest Surgery
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• 제11권3호
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• pp.281-295
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• 1978

Last year in this department 100 cases of open heart surgery were done annually. This year 200 cases of open heart surgery were scheduled. During the first 6 months of this year 112 open heart surgery cases were done with 13 deaths [11.6%]. There were 72 cases of cougenital malformation with 9 operative deaths [12.5%], consisting of 23 acyanotic cases with one death [4.5%] and 49 cases of cyanotic cases with 8 deaths [16.3%]. Out of 40 tetralogy of Fallot, 6 cases expired [15%]. For 39 cases of acquired valvular heart disease and one Ebstein anomaly valves were replaced with 4 operative deaths [10%]. Single valve replacement in 33 with 3 operative deaths and double valve replacement in 7 cases with one death were noted. Two patients expired among 28 mitral valve replacement cases [7.1%]. Among 7 double valve replacement patients, consisting of 3 mitral and aortic and 4 mitral and tricuspid valve replacement one case expired. In a case of Ebstein anomaly, tricuspid valve was replaced with plication of atrialized right ventricle successfully. The operative result was excellent.

• Journal of Chest Surgery
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• 제29권11호
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• pp.1202-1206
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• 1996

Ebstein기형은 삼첨판, 우심실 및 우심방의 특징적인 변형를 보이는 희귀한 선천성 심질환으로, 삼첨판의 후판막첨과 중격판막첨이 우심실로 나선형의 변형을 보이는 것이 특징적이다. 본 교실에서는 1988년 1월 1일부터 1995년 12월 31일까지 7년간 11명의 환자를 경험하였으며 평균연령은 29.6$\pm$11.1세, 성비는 남자 5명 여자 6명이었고, 주증상으로는 운동시 호흡곤란이었다. 모든례에서 삼첨판의 전형적인 변형을 보였으며 동반된 심기형으로는 개방성 난원창, 심방중격결손, 심실중격결손이 있었다. 9명은 Danielson씨 삼첨판성형술과 주름성형술을 시행하고 2명은 삼첨판막치환술과 주름성형술을 시행하였으며 동반된 심기형을 교정하였다. 수술후 5명의 환자에서 저심박출증, 부정맥, 창상감염 등의 합병증이 발생하였으며 수술사망례는 없었다. 술후 평균 33.3개월의 추적관찰 결과 모든 환자에서 술전보다 양호한 심기능을 보였다.

• Journal of Chest Surgery
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• 제17권3호
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• pp.362-370
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• 1984

The term corrected transposition of great arteries [hereafter referred to as corrected TGA] of the heart in which there is both a discordant atrio-ventricular relationship and transposition of the great vessels. Usually situs solitus is present, while the ventricles are inverted showing an l -loop. The great vessels are transposed and in the l-position so that the pulmonary artery arises from the right-sided morphological left ventricle and the anteriorly l- transposed aorta arises from the left-sided morphological right ventricle yielding an SLL pattern. In the majority of cases, associated lesions are common. The most frequent are ventricular septal defect, obstruction to the pulmonary outflow tract, tricuspid valve incompetence and atrio-ventricular conduction abnormalities. In the rare cases, no associated conditions are present and hemodynamic pathways are normal. In the report, we present one case of a 20 year-old male having corrected TGA associated with severe tricuspid valve incompetence, was corrected by tricuspid valve replacement, directly developed a supra-ventricular tachycardia but was controlled by calcium-entry blocker, verapamil, successfully.

• 대한수의학회지
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• 제44권1호
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• pp.125-129
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• 2004

A 2-year-old, female, American cocker spaniel dog presented for a 1-year history of severe ascites, exercise intolerance, tachypnea. At that time, she was in an emergency state. First, the dog was stabilized with oxygen therapy. A diagnosis of cardiac problem was made from history, auscultation, radiograph, ECG, and echocardiography. Jugular pulsation was palpated and a harsh, systolic murmur of tricuspid regurgitation was prominent at the right cardiac apex. Tricuspid valve dysplasia (TVD) was confirmed with echocardiography, accompanying enormous myocardial hypertrophy. The clinical signs had been improved for 8 months with careful therapy and periodic abdominocentesis, and ascites was well controlled. The situation, however, became worse quickly in a week because the client did not follow our management schedule. Finally, she died due to dyspnea and shock. After the spontaneous death, necropsy and histopathological examination were performed and when we opened the thorax, a significantly large heart was observed. On histopathological findings, grossly myocardium appeared pale initially, then progressed to yellow and white. Microscopically, there was an extensive hemorrhage along with loss of myocardial striations. Interstitial fibrosis and various degenerative alterations in myocytes were also present.

• Journal of Chest Surgery
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• 제14권1호
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• pp.17-25
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• 1981

In 1980, 416 cases of open heart surgery were done in this Department with over all operative mortality of 12.3%. 1. There were 288 congenital anomalies consisting of 174 acyanotic and 114 cyanotic varieties, which showed operative mortality of 6.9% and 25.4% respectively. 2. There were 128 cases of acquired lesions, 124 valvular disease and 3 myxoma being the main lesions. 3. There were 128 cases of valve replacement with operative mortality of 7.8%. 4. The most frequently operated anomaly was VSD, 90 pure VSD and 21 cases were associated with one or 2 cardiac anomalies. Over all operative mortality in 111 VSD cases was 8.1% but in 90 pure VSD cases it was 6.7%. 5. Tetralogy of Fallot showed the highest incidence in cyanotic group with 88 cases, consisting of 68 pure and 20 with other cardiac anomalies. Over all mortality in 88 cases was 19.3% but in pure form 16.2%. 6. In 128 valve replacement cases over all mortality was 9.4%. There were 85 mitral, 11 aortic, 2 tricuspid, 21 mitral with aortic, 6 mitral with tricuspid, 3 mitral, aortic, and tricuspid valve replacement cases. For mitral valve replacement operative mortality was 5.9%. 7. Twenty-one cases of babies under 10kg body weight were operated on with over all operative mortality of 28.6%. Sixteen cases of VSD were found with operative mortality of 25%. 8. Among 128 cases of valve replacement 7 were under the age of 15 years and 12 were between 15 and 20 years old. Five pediatric cases underwent mitral valve replacement without mortality, 9 year old boy was the youngest among them. In this Department open heart surgery for infancy and complex anomalies showed still hip operative risk which should be improved in the coming years. For open heart surgery Shiley oxygenators and 2 sets of A-O de-lux 5 head roller pump were utilized exclusively. For valve replacement Ionescu-Shiley bovine pericardial xenografts were mainly used. In pediatric and rural patients Persantin with aspirin regimen was satisfactorily administered for anticoagulation after valve replacement. Routinely Coumadin was administered for one year after valve replacement* In patients who had thrombus on valve sites, chronic atrial fibrillation, and giant left atrium Persantin-Aspirin regimen was used when one year coumadin administration was discontinued.

• Journal of Chest Surgery
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• 제43권4호
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• pp.413-416
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• 2010

47세 남자 환자가 교통사고로 인한 감속 손상후 흉부 통증 및 호흡곤란을 주소로 내원하였다. 청진시 우 흉골연에서 수축기 심잡음이 들렸고 심전도에서는 분당 120∼130회의 동빈맥을 보였다. 경흉부 심장 초음파에서 삼첨판막의 전엽이 동요하는 형태를 보였고 유두근의 파열과 함께 심한 판막 폐쇄 부전이 관찰되었다. 수술은 통상적인 심폐기하에서 우심방절개를 통해 접근하여, 전엽의 유두근과 후엽의 건삭이 파열되어 있는 것을 확인하였다. 전엽과 후엽에 각각 우심실내의 유두근으로 새로운 인공 건삭을 조성하였다. 또한 De-Vega 판륜 성형술을 병행하여 시행하였다. 저자들은 매우 드물게 발생한다고 알려져 있는 외상후 유두근 파열로 인한 삼첨판막의 기능부전의 수술을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제48권2호
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• pp.126-128
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• 2015

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.

• Journal of Chest Surgery
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• 제30권9호
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• pp.927-931
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• 1997

신생아에서 선천적 삼첨판 폐쇄부전은 자주 보고되지만 건삭파열에 의한 이차성 삼첨판 폐쇄부전은 아주 드물다. 환아는 생후 1일의 남아로 출생 직후부터 심한 호흡곤란, 청색증 및 산혈증이 관찰되었고, 무호흡과 함께 서맥이 빈번히 나타났다. 심초음파도 검사를 시행하여 폐동맥 판막을 통한 우심유출로 혈류가 관찰되지 않아서 폐동맥 폐쇄증으로 진단되었다. 수술 소견에서 폐동맥 및 폐동맥 판막의 기형은 전혀 없었고, 삼첨판의 전방 유두근 건삭파열이 새로이 확인되었다. 삼첨판 폐쇄부전은 건삭 형성술을 실시하여 성공적으로 교정하였으며, 술전 심초음파도에서 주폐 동맥에 폐혈류가 관찰되지 않았던 것은 심한 삼첨판 폐쇄부전 때문이었던 것으로 판단되었다.