• Journal of Chest Surgery
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• 제21권4호
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• pp.716-720
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• 1988

Since Krause first described coronary arteriovenous fistula in 1865, there have been nearly 300 additional patients with this malformation reported in the literature. Increasing numbers of patients with this anomaly are being recognized each year resulting from the widespread use of cardiac catheterization and selective coronary arteriography in the evaluation of a variety of cardiac problems. A 9 month old male was admitted with the chief complaint of cardiac murmur and frequent URI and diagnosed as coronary A-V fistula at the distal portion of left anterior descending coronary artery to the apex of the right ventricle by cardiac catheterization and aortography. On the operative field, the left anterior descending coronary was markedly dilated about 1.5 cm in diameter from the aorta to the apex of the heart. The fistula opening was closed with 5-0 Prolene continuously under cardiopulmonary bypass and moderate hypothermia[28*C]. Postoperative course was uneventful and the patient was discharged without problem.

• Journal of Chest Surgery
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• 제27권5호
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• pp.399-401
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• 1994

We experienced one case of surgical treatment of A-V fistula between the right common iliac artery and the right common iliac vein after lumbar laminectomy. The average vascular surgeon does not have extensive experience with this disorder owing to its rarity. Arteriovenous fistula of the aorta and its major branches present an unparalleled challenge in patient care. Because of their central location, blood flow through these fistulas may be massive;the associated complications are usually dramatic, resulting in severe refractory congestive heart failure, massive venous hypertension, or extensive hemorrhage during an illfated surgical repair.For this reason, it behooves one to become well acquainted with the problem in order to avoid morbid complications and thus ensure optimal patient care.

• Journal of Chest Surgery
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• 제48권1호
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• pp.78-81
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• 2015

This study reports our early experience with thoracoscopic division of vascular rings. Three patients were reviewed; their ages at surgery were 25 months, 4 years, and 57 years. All patients were suffering from complete vascular rings involving combinations of the right aortic arch, left ligamentum arteriosum, Kommerell's diverticulum, and retroesophageal left subclavian artery. The median surgical time was 180.5 minutes, and the patients showed immediate recovery. Three complications, namely chylothorax, transient supraventricular tachycardia, and left vocal cord palsy, were observed. Our early experience indicates that thoracoscopic division of a vascular ring may provide early recovery and could be a promising operative choice.

• Journal of Chest Surgery
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• 제48권1호
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• pp.52-54
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• 2015

Idiopathic pulmonary arterial hypertension eventually leads to right-sided heart failure and sudden death. Its mortality rate in children is still high, despite improvements in pharmacological therapy, and therefore novel treatments are necessary. The Potts shunt, which creates an anastomosis between the left pulmonary artery and the descending aorta, has been proposed as a theoretically promising palliative surgical technique to decompress the right ventricle. We report the case of a 12-year-old girl with suprasystemic idiopathic pulmonary hypertension and right ventricular failure who underwent a Potts shunt for palliation with good short-term results.

• Journal of Chest Surgery
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• 제51권6호
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• pp.395-398
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• 2018

Neo-aortic insufficiency associated with root enlargement following an arterial switch operation is a serious late complication. To achieve successful surgical correction of this condition, multiple factors should be considered, including the individual patient's anatomy, the challenging nature of the redo procedure, and the patient's young age. However, limited publications have described the use of valve-sparing techniques for the treatment of neo-aortic insufficiency associated with root enlargement following an arterial switch operation. Herein, we report our recent experience of a valve-sparing aortic root procedure with ascending aorta and hemiarch replacement despite the presence of a discrepancy in leaflet size and nearby severe adhesions.

• 한국임상수의학회지
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• 제39권6호
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• pp.366-372
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• 2022

A 2-year-old, spayed female, American shorthair cat presented with acute weight loss, tachypnea, and dyspnea. The cat had grade V holosystolic murmur and systemic hypotension. Echocardiography showed a 9 mm defect in the ventricular septum, left-to-right dominant bi-directional shunt, right ventricular hypertrophy, pulmonary stenosis, pulmonary hypertension, and overriding aorta. The cat was diagnosed with a Tetralogy of Fallot. The cat was treated with furosemide, pimobendan, ramipril, and sildenafil. Treatment reduced pulmonary infiltration, pulmonary vessel enlargement, and main pulmonary artery bulging. However, right-to-left flow increased over time and right ventricular outflow tract velocity was elevated. Currently, the patient has maintained an improved state for 1 year. This case report described a severe inherited feline Tetralogy of Fallot case that was successfully managed for a long time.

• Childhood Kidney Diseases
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• 제27권2호
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• pp.133-138
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• 2023

Nutcracker syndrome (NCS) is a disease caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Immunoglobulin A (IgA) nephropathy (IgAN) is characterized by the predominance of IgA deposits in the glomerular mesangial area. Hematuria and proteinuria can be present in both diseases, and some patients can be concurrently diagnosed with NCS and IgAN; however, a causal relationship between the two diseases has not yet been clarified. Here, we report two pediatric cases of NCS combined with IgAN. The first patient presenting with microscopic hematuria and proteinuria was diagnosed with NCS at the initial visit, and the second patient was later diagnosed with NCS when proteinuria worsened. Both patients were diagnosed with IgAN based on kidney biopsy findings and treated with angiotensin-converting enzyme inhibitors and immunosuppressants. A high index of suspicion and timely imaging or biopsy are essential for the proper management of NCS combined with glomerulopathy.

• Journal of Chest Surgery
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• 제39권2호
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• pp.91-98
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• 2006

배경: 관상동맥우회술에서 동맥이식편의 장기개통률이 우수하다는 사실이 알려지면서 요골동맥의 사용이 늘어나는 가운데 근위부 문합방법에 따른 차이에 대해 논의가 분분하다. 이에 본 교실에서는 요골동맥 문합방법에 따른 임상적, 영상적 차이를 비교하였다. 대상 및 방법: 강동성심병원 흉부외과에서 2003년 1월부터 2004년 12월까지 요골동맥을 사용하여 관상동맥우회술을 시행받은 환자 48명을 대상으로 요골동맥을 독립적으로 대동맥에 근위부 문합을 시행하여 관상동맥우회술을 시행받은 환자들(독립절편군, 1군)과 좌속 가슴동맥에 요골동맥을 문합하여 관상동맥우회술을 시행받은 환자들(복합절편군, II군)과의 임상결과 및 관상동맥조영술 결과를 비교하였다. 결과: 48예 중 I군은 33예(남 26예, 여 7예, 평균연령 61.93$\pm$6.56세), II군은 15예(남 13예, 여 2예, 평균연령 59.53$\pm$6.02세)였고 두 그룹 간 술 전 변수에 따른 유의한 차이는 없었다. 심폐우회술 시간의 경우 I군이 169.36$\pm$40.28분으로 II군의 139.40$\pm$20.45분보다 유의하게(p=0.026) 길었고 환자당 요골동맥을 연속문합으로 사용한 경우 5/33 ($15.2\%$)와 l1/15 ($73.3\%$)로 II군에서 높게 나타났다(p <0.05). 근위부 문합에 사용된 정맥편은 47/117 ($40\%$)과 9/48 ($18\%$)로 I군에서 유의하게 많았고(p=0.011) 이외 수술직후의 합병증과 사망률의 차이는 없었다. 평균 추적 관찰기간은 15.87$\pm$7.33 ($1{\~}28$)개월과 21.40$\pm$2.85($17{\~}25$)개월로 II군에서 더 길었고(p=0.015) 술 후 관상동맥조영술은 I군에서 17/33 ($51.5\%$), II군에서 14/15 ($93.3\%$)에서 시행하였다. 조기 완전 개통률은 좌전하행지의 경우 15/17 ($88.2\%$)와 12/14 ($85.7\%$)로 (p=1.00) 나타났고, 요골동맥의 경우 I군에서 17/20 ($85\%$)와 II군에서 30/30 ($100\%$) (p=0.058)로 통계학적으로는 유의한 차이가 없었다. 추적 관찰 기간동안 만기사망의 경우 I군에서 1/33 ($3.0\%$), II군에서 1/15 ($6.7\%$)였다. 결론: 두 군에서 심폐우회술 시간, 환자당 연속문합의 수와 근위부 문합에 사용된 정맥편 수의 차이 이외에 임상적, 술 후 관상동맥 조영술상 통계적으로 유의한 차이는 존재하지 않았다.

• Journal of Chest Surgery
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• 제46권4호
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• pp.274-278
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• 2013

Background: Coronary involvement in Takayasu's arteritis is a rare but fatal disease. The aim of this study was to evaluate the early and mid-term results of Takayasu's arteritis patients who underwent coronary artery bypass grafting (CABG). Materials and Methods: Of 2,280 patients who underwent isolated CABG from January 1998 to June 2012, Takayasu's arteritis was identified in 5 patients. There were 3 female patients, and the mean age was $58{\pm}9$ years. Takayasu's arteritis was diagnosed during preoperative evaluation for coronary artery disease in 4 patients, and the initial manifestation was angina pectoris in 4 patients. All of the patients underwent anaortic off-pump CABG (OPCAB) using the in situ left or right internal thoracic arteries (ITA); 3 patients had severe stenosis of the proximal left subclavian artery and the in situ right ITA was used instead. Medical treatment for inflammatory arteritis during the perioperative and follow-up period was performed if indicated. Early, 1-year, and 5-year angiographic results and clinical outcomes were analyzed. Results: There was no surgical mortality, and all of the patients were discharged without complications on postoperative $8{\pm}2$ days. Early postoperative (postoperative $2{\pm}1$ days) angiography demonstrated a graft patency of 100% (12 of 12 distal anastomoses). One-year ($13{\pm}3$ months) angiography was performed in 4 patients, and all of the grafts were patent (100%, 9 of 9 distal anastomoses). Conclusion: By performing anaortic OPCAB in patients with Takayasu's arteritis, we were able to avoid complications associated with manipulating an atherosclerotic and severely calcified ascending aorta. The early and mid-term graft patency of OPCAB in Takayasu's arteritis was maintained when concomitant with medical treatment.

• Journal of Chest Surgery
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• 제39권6호
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• pp.440-448
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• 2006

서론: 하행 흥부 대동맥 및 흉복부 대동맥 수술은 척수 손상을 포함한 신경학적 손상의 가능성이 높은 수술로서 이에 대한 상당한 주의를 요한다. 이 연구의 목적은 하행 흉부 대동맥 및 흉복부 대동맥 수술 후의 척수 손상과 뇌 손상의 발생빈도와 위험요소를 알아봄으로써 신경학적 손상을 예방하는데 기여하고자 한다. 대상 및 방법: 1995년 10월부터 2005년 7월까지 하행 흉부 대동맥 및 흉복부 대동맥 수술을 시행 받은 33명의 환자를 후향적으로 분석하였다. 하행 흉부 대동맥 수술은 23예, 흉복부 대동맥 수술은 10예였고, 원인 질환으로는 대동맥 박리증이 23예, 대동맥류가 10예였다. 신경학적 손상에 대한 위험인자를 알아내기 위해 수술 전 및 수술 중 변수에 대한 단변량 및 다변량 분석을 시행하였다. 결과: 하지마비가 2예(6.1%)에서 발생하였고 이 중 1예는 영구적 손상이었다. 뇌 손상은 7예 (21%)에서 발생하였고 영구적 뇌 손상은 4예(12%), 일시적 뇌 손상은 3예 발생하였다 척수 손상에 대한 위험인자로는 흉복부 대동맥질환 분류의 Crawford II III형(p=0.011)과 늑간 동맥 문합을 시행한 환자군(p=0.040)으로 나타났다. 뇌 손상에 대한 위험인자로는 심폐기 가동시간이 200분 이상(p=0.023), 좌심방 vent를 시행한 환자군(p=0.005)으로 나타났으며 좌심실 부분 바이패스(left heart partial bypass)는 뇌 손상을 예방하는 인자로서 의미 있게 나타났다(p=0.032). 결론: 하행 흥부 대동맥 및 흉복부 대동맥 수술 후에 발생하는 신경학적 손상 중에서 뇌 손상의 발생빈도가 척수 손상에 비해 높았다. 좌심실 부분 바이패스를 시행한 군에서는 뇌 손상이 발생하지 않았으며 뇌 보호 측면에서 유리한 것으로 나타났다. 또한 척수 손상의 위험이 높은 Crawford II III형 환자나 늑간 동맥 문합이 필요한 환자들에서는 척수 보호를 위한 별도의 조치와 세심한 주의가 필요하다.