• Journal of Chest Surgery
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• 제47권4호
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• pp.344-349
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• 2014

Background: The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used. Methods: We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed. Results: There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up. Conclusion: The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.

• 대한의용생체공학회:의공학회지
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• 제19권1호
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• pp.33-38
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• 1998

심장내 이식형 축류 혈액 펌프의 개발을 시도하였다. 이 펌프는 해부학적인 적합성이 좋고, 혈액과 접촉하는 면적이 적으며, 심장판막의 위치에 이식할 수 있어 이식술이 용이한 등의 이점이 있다. 축류혈액펌프는 입펠러와 소형 모터에 의해 구성되었으며, 모터축과 펌프의 본체의 밀봉은 자성유체 축봉이 이용되었다. 본 연구에서 개발한 혈액펌프의 펌프 특성은 4매 임펠러의 경우 회전수 7091[rmp], 6매 임펠러의 경우 회전수 6402[rpm]에서 유량 5[l/min], 차압 100[mmHm]을 얻을 수 있었으며, 자성유체 축봉의 내압 특성은 회전수 7000[rpm], 압력ㄹ 150[mmHg]에서 24시간 이상의 내구성을 얻을 수 있었다. 그리고, 용혈에 대하여 검토한 결과 4매 임펠러의 1H 는 0.0561[g/100L]이고, 6매 임펠러의 경우는 1H=0.214[g/100L]을 얻을 수 있었다. 이상의 실험결과는 심장내 이식 축류형 혈액펌프의 실현 가능성을 보여 주는 것으로 앞으로 큰 기대를 걸수 있다고 생각된다.

• Journal of Chest Surgery
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• 제25권4호
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• pp.438-444
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• 1992

We analysed 7,180 annual cases of surgical treatment performed by Department of Thoracic and Cardiovascular Surgery of 6 major institutes in Seoul Korea, All cases were applied to 101 of 140 coded items applicable to the field of Thoracic and Cardiovascular Surgery, in the book of "Standard Price List for Medical Service" which was notified by the Ministry of Health and Social Affairs, and of them, applied field specific items were 70 of 93 applicables. The most frequently applied items were those associated to ECC[extracorporeal circulation] 1,510 cases, and then item of closed thoracostomy 751 cases was next. Except the items associated to ECC, the coded item of the highest "Total cost[fee x total applied numbers]" was mitral valve replacement 182,356,570 won[534,770 won x 341 cases]. 140 items were arranged in "Total cost" order, and then categorized into 5 groups. Medical insurance fees of each group were modified by different grades without changes in sum of total fees. Fees of Group 1, the highest group in "Total cost" were pulled up, on the other hand, Group 4, the lowest group, were pulled down, Group 5, composed of overlapping items with other fields, were not changed. The result of adjustment by grouping showed 21.2% increment effect[535,749,105 won] in real income. And we found that new coded items for modern high technological procedures should be added to "Standard Price List for Medical Service “Standard Price List for Medical Service".

• Journal of Chest Surgery
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• 제35권8호
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• pp.594-598
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• 2002

아미오다론은 일반적인 항부정백 약물로 잘 치료되지 않는 상심실성 부정맥이나 심실성 부정맥의 치료에 효과적이라고 알려져 있는 요오드화된 벤조푸루란 유도체이다. 아미오다론으로 치료받은 환자들에게서, 속발되는 수술적 치료는 흔히 동반되는 과정이지만, 애석하게도 아미오다론으로 수술중과 수술후에 야기될 수 있는 합병증에 대해서 정확한 자료를 가지고 있지 못한 것이 현실이다. 일부 보고들에 따르면, 아미오다론으로 치료받던 환자들에게서 알파 교감 수용체와 베타 교감 수용체에 차단을 야기하고, 이는 수술후 혈역학적 지지에 더 많은 심근 자극과 에피네프린등의 약물을 필요로 하게 된다고 알려져 있다. 또한, 심각한 사망률과 유병율을 야기하는 아주 심각한 형태의 급성호흡부전증을 야기하게 된다고 알려져 있다. 본 교실은 승모판막치환술 후에 아미오다론으로 인하여 유발된 급성호흡부전증으로 사망한 환자를 경험하였기에 간략한 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1017-1022
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• 1999

Background: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. Material and Method: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. Result: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. Conclusion: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.

• Journal of Chest Surgery
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• 제21권3호
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• pp.488-496
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• 1988

Thirty-seven patients of aortic aneurysm underwent operations during January 1984 December 1987 at our hospital. Twenty-six patients had aneurysms involving ascending aorta, three patients had aneurysms involving both ascending aorta and abdominal aorta. and eleven patients had aneurysms involving descending thoracic or abdominal aorta. Among the patients who had aneurysms involving ascending aorta, annuloaortic ectasia with aortic regurgitation were thirteen and all of these underwent ascending aorta graft replacement + AVR with composite graft. The patients who had aortic regurgitation due to ascending aortic dissection were three and all of these underwent intraluminal ringed graft insertion at ascending aorta + aortic valve resuspension. Intraluminal ringed graft insertion was safe, simple, and fast method in the operation for aortic aneurysm. Eleven patients were underwent this operation and the results were good. Major causes of death of the patients who underwent aortic aneurysm operation are underlying cardiovascular diseases or delayed rupture of the aneurysm or complications related newly appeared aneurysm. Among our patients, dissection progressions were appeared in two but neither severe nor complicated. And no patient died from delayed rupture of aneurysm or complications related newly appeared aneurysm. All patients were followed up via OPD and were controlled hypertension or heart failure if present. Operative mortality is 18.9\ulcornera in all, 23% in patients who had aneurysms involving ascending aorta and 7.6` who had aneurysms involving descending thoracic or abdominal aorta. Comparing with other reports, our operative mortality is still high but improved steadily. So we recommend aggressive surgical management of the aortic aneurysm.

• Journal of Chest Surgery
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• 제42권2호
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• pp.248-251
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• 2009

비폐쇄성 장간막 허혈(nonocclusive mesentericic ischemia, NOMI)은 개심술 후 약 0.05%에서 발생하는 아주 드문 합병증으로 주요 장 혈관의 폐색 없이 내장 말초 혈관의 심한 혈관 경련(vasospasm)에 의해 장 허혈이 발생하는 것을 일컫는다. 본 증례에서는 상행 대동맥을 통한 동맥관 삽입시 발생한 급성 대동맥 박리로 수분간의 저혈압 상태에서 상대적으로 중요한 심장과 뇌의 혈류를 유지하기 위한 장 혈관의 수축으로 NOMI가 발생한 경우로 비교적 빠른 진단과 치료가 이루어졌음에도 장 경색으로 진행되어 사망하였다. 임상적으로 NOMI가 의심되는 경우 조기 진단 및 치료만이 생존률을 높일 수 있으므로, 빠른 대동맥 조영술 및 혈관 확장제의 선택적 주입이 필요할 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제56권6호
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• pp.235-241
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• 2013

Repair of tetralogy of Fallot (TOF) has shown excellent outcomes. However it leaves varying degrees of residual hemodynamic impairment, with severe pulmonary stenosis (PS) and free pulmonary regurgitation (PR) at both ends of the spectrum. Since the 1980s, studies evaluating late outcomes after TOF repair revealed the adverse impacts of residual chronic PR on RV volume and function; thus, a turnaround of operational strategies has occurred from aggressive RV outflow tract (RVOT) reconstruction for complete relief of RVOT obstruction to conservative RVOT reconstruction for limiting PR. This transformation has raised the question of how much residual PS after conservative RVOT reconstruction is acceptable. Besides, as pulmonary valve replacement (PVR) increases in patients with RV deterioration from residual PR, there is concern regarding when it should be performed. Regarding residual PS, several studies revealed that PS in addition to PR was associated with less PR and a small RV volume. This suggests that PS combined with PR makes RV diastolic property to protect against dilatation through RV hypertrophy and supports conservative RVOT enlargement despite residual PS. Also, several studies have revealed the pre-PVR threshold of RV parameters for the normalization of RV volume and function after PVR, and based on these results, the indications for PVR have been revised. Although there is no established strategy, better understanding of RV mechanics, development of new surgical and interventional techniques, and evidence for the effect of PVR on RV reverse remodeling and its late outcome will aid us to optimize the management of TOF.

• The Korean Journal of Pain
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• 제31권2호
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• pp.93-101
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• 2018

Background: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. Methods: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv $25{\mu}g$ fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. Results: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption ($30.8{\pm}7{\mu}g$ in group 1 vs. $69{\pm}18{\mu}g$ in group 2, and $162{\pm}3$ in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. Conclusions: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

• Journal of Yeungnam Medical Science
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• 제10권1호
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• pp.253-259
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• 1993

본원에서는 출산 후 지속되는 호흡곤란, 전신부종을 주소로 내원한 환자에서 임신과 관계된 De Bakey유형II의 대동맥해리를 진단하고 성공적으로 수술을 시행한 1례를 경험하였기에 보고하는 바이다.