• Journal of Chest Surgery
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• 제47권2호
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• pp.117-123
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• 2014

Background: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. Methods: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. Results: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. Conclusion: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

• Journal of Chest Surgery
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• 제47권2호
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• pp.94-99
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• 2014

Background: Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications. Methods: Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials. Results: No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months). Conclusion: Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction.

• Journal of Chest Surgery
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• 제31권6호
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• pp.619-623
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• 1998

우측 팔의 부종과 압통을 주소로 내원한 51세 만성 신부전증 환자에서 정맥 촬영술의 결과 반복된 쇄골하정맥 도관삽관술후에 생긴 중심정맥(우쇄골하정맥, 우내경정맥, 우상완두정맥과 좌무명정맥)의 폐쇄증을 Goretex 인조혈관을 이용하여 우쇄골하정맥-상공정맥에 10 mm Goretex 인조혈관 우회로 조성술과 좌쇄골하정맥-10 mm Goretex 인조혈관사이에 8 mm Goretex 인조혈관 우회로 조성술을 실시하여 좋은 결과를 얻었다.

• Journal of Chest Surgery
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• 제12권1호
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• pp.33-42
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• 1979

The present study reports 41 cases of congenital and acquired heart diseases, who received open heart surgery under extracorporeal circulation [ECC] by Sarns Heart-Lung-Machine [HLM] at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the` period between July 1975 and February 1979. The priming of pump oxygenator was carried out by the hemodilution method using Hartman`s solution, whole blood, and fresh human plasma. The rate of hemodilution was in the average of 50.8 ml/kg. ECC was performed at the average perfusion flow rate of 85.0 ml/kg/min [2.43 L./ kg/2] and at moderate hypothermia. In the total cardiopulmonary bypass, arterial pressure ranged between 55 mmHg and 90 mmHg, but generally maintaining over 70 mmHg. Patient age ranged between 2 and 54 year old, in congenital heart diseases, between 2 and 28, in acquired heart diseases, between 17 and 54 Sex ratio of male to female was 20:21. The cases include a case of pulmonary valvular stenosis, 4 cases of atrial septal defect, 9 cases of ventricular septal defect, 9 cases of tetralogy of Fallot, 5 cases of pentalogy of Fallot, 3 cases of atypical multiple anomalies 7 cases of mitral stenosis or insufficiency, a case of myxoma in left atrium, and a case of ruptured aneurysm of Valsalva`s sinus. The surgical managements were 16 valvulotomy for pulmonary valvular stenosis, 2 Teflon patch graft closure and 5 simple suture closure of atrial septal defect, 16 Teflon patch graft closure and 5 simple suture closure of ventricular septal defect, 12 pericardial patch graft for infundibular stenosis of right ventricle, one anastomosis between left superior vena cava and right atrium, 2 open mitral commissurotomy, 5 mitral valve replacement using Starr-Edward`s ball valve, porcine xenograft by Hancock, by Carpentier-Edward, or Angell-Shiley, one removal of left atrial myxoma, and a repair of ruptured aneurysm of Valsalva`s sinus. Four [9.7%] out 41 cases expired postoperatively and the rest of 37 cases survived with satisfactory results. The causes of death were one coronary embolism in tetralogy of Fallot, 2 postoperative lower cardiac output in atypical multiple anomalies, and one right heart failure in large: ventricular septal defect with pulmonary hypertension.

• Journal of Chest Surgery
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• 제38권10호
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• pp.729-732
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• 2005

특이 병력 없던 15세 남자가 내원 한 달 전부터 시작된 우측 흉통과 함께 기침을 호소하여 본원 응급실로 내원하였다. 흉부 전산화 단층촬영에서 $10\times15\times16cm$크기의 전 종격동 종양으로 상대 정맥과 심장을 압박하면서 침범하고 있는 소견을 보였다. 수술 절제가 불가능한 것으로 판단하여 항암 및 방사선 치료를 시행하였다. 이후 종양 표지자는 거의 정상화되었으나 오히려 종양의 크기가 증가하는 소견을 보여, 종격동의 성장 기형종 증후군(Mediastinal Growing Teratoma Syndrome)으로 판단되어 수술을 시도하였다. 종양의 수술적 제거 후 환자는 24개월째 잔존 종양 및 재발 없이 외래 관찰 중이다.

• Neonatal Medicine
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• 제16권1호
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• pp.71-75
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• 2009

9번 염색체 장완의 중복은 거의 드문 형태의 염색체 이상이며, 특징적인 얼굴형태와 손가락 형태, 정신지체 등이 나타나는 것으로 알려져 있다. 얼굴 형태는 정상이었으나 선천성 심장기형과 수신증, 음낭 탈장이 동반된 미숙아에게서 46,X,Y,dup(9)(q21.2q22.1)를 확인하였고, 표현형이 정상인 환아의 아버지에게서 유래된 것으로 생각되어진 예를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제35권10호
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• pp.740-744
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• 2002

초저체온 하에 체외순환정지와 역행성 뇌관류는 대동맥궁 병변의 수술에서 뇌손상을 피하기 위해서 흔히 이용되는 수술과정이다. 좌측 개흉으로 원위 대동맥궁과 하행대동맥 병변을 수술할 때 역행성 뇌관류를 상대정맥으로 시행하기 어려울 경우 대퇴정맥에서 우심방으로 넣은 정맥 캐뉼라를 통해 전신정맥 관류를 시행하여 역행성 뇌관류(우심방-역행성 뇌관류)를 시행하는 것이 더 쉬운 방법일 수 있다 이러한 역행성 뇌관류 방법의 안전한 시간은 명확하지 않다. 저자들은 94분의 우심방-역행성 뇌관류 하에 대동맥궁 하행대동맥 병변을 수술하여 신경학적 이상 없이 환자를 회복시킬 수 있었다. 이 결과에서 초저체온의 순환정지 상태에서 90분 이상의 우심방-역행성 뇌관류로 뇌의 허혈을 극복할 수 있다고 생각된다.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1262-1266
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• 2000

Objective : Flat back syndrome constitutes a syndrome complex characterized by the loss of normal lumbar lordosis. Various techniques of correction for flat back syndrome have been reported. Posterior extension osteotomy has certain drawbacks. Forceful hyperextension of the spine may result in vascular complications such as rupture of the aorta or the inferior vena cava and stretching of superior mesenteric artery, and pseudoarthrosis. We describe a rationale and technique of transvertebral posterior extension osteotomy to avoid complications of posterior extension osteotomy and to achieve an correction of 30 degrees of flat back syndrome. Method : A 63-year-old woman with degenerative lumbar kyphosis presented with low back pain, thigh pain, knee pain and walking difficulty. Transpedicular fixation from L1 vertebra to S1 vertebra was accomplished for lumbar degenerative kyphosis. After 6 months, the patient presented with flat back syndrome. A second operation was performed with transvertebral posterior extension osteotomy. Result : With short segemental fusion, early bone fusion and correction of 30 degrees were achieved. Conclusion : Transvertebral posterior extension osteotomy provide an 30-60 degrees of correction of flat back syndrome. This technique is considered to be good method for the revision of lumbar degenerative kyphosis.

• Tuberculosis and Respiratory Diseases
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• 제42권2호
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• pp.231-237
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• 1995

저자들은 최근 종격동에서 발생하였던 만성 경화성 종격동염 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제49권8호
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• pp.902-905
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• 2006

중심 정맥 도관술은 미숙아들의 출생과 생존율의 증가로 현재 신생아실에서 많이 시행 되고 있는 수기이며, 최근 중심 정맥 카테터 사용이 증가함에 따라 혈전이나 색전, 혈관 손상과 파열, 흉막 삼출, 화학적 폐렴과 같은 합병증이 보고되고 있다. 이에 저자들은 경피 중심 정맥 카테터 삽입 후 우측성 흉막 삼출액이 발생하여 시행한 혈관조영술에서 카테터가 홀정맥에 위치하였던 초극소 저출생 체중아에서 경피 중심 정맥 카테터를 제거한 후 흉막 삼출액이 호전되었던 1례를 경험하였기에 보고하는 바이다.