• 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.

• Transactions on Electrical and Electronic Materials
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• 제17권6호
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• pp.375-379
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• 2016

Increasing fat tissue of obese people, increases the rate of cardiovascular disease, diabetes, metabolic syndromes and dyslipidemia. An increase in the focal tissue of pancreas is a known risk factor of these diseases. Although there exists sufficient research on the diagnosis and treatment of pancreatic cancer, studies have been done on fatty pancreas. In this study, based on ultrasound imaging and using a texture characteristic of GLCM, fatty pancreas was divided into three categories: mild, moderate and severe. We compared and analyzed the three groups was by Pancreatic ultrasonography and body characteristics, serological tests, pressure and the degree of arteriosclerosis, against normal control group. The following parameters of control and test groups were measured: WC (waist circumference),BMI (body mass index), TC (total cholesterol), TG (triglyceride), HDL-C (High-density lipoprotein cholesterol) and LDL-C (Low-density lipoprotein cholesterol), SBP (systolic blood pressure), BST (Blood Sugar Test) and aortic PWV (pulse wave velocity). We observed the values correspondingly increasing fat deposition. However, ABI (Ankle Brachial pressure index) stenosis and HDL-C levels decreased with increasing fat deposit (p <0.05); a drop in these parameters are known to be harmful to the human body. The difference in texture characteristics between normal control group and pancreatic fatty group (mild, moderate, and severe) was statistically confirmed. Ultrasound imaging of pancreatic steatosis categorized the disease as mild, moderate and severe based on the characteristic texture. In conclusion, we observed on increase in metabolic syndrome, dyslipidemia, and arteriosclerosis, proportional to the degree of pancreatic fat deposition. The escalation of these diseases was confirmed and was directly related with predictors of cardiovascular diseases.

• Journal of Chest Surgery
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• 제26권9호
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• pp.667-676
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• 1993

Boprosthetic cardiac valves fail from biological and metabolic as well as mechanical reasons, and the limited durability is the main factor of marked withdrawal in their clinical use. Starting the use of bioprosthetic valves in 1976, up to the end of 1992, the consecutive 178 patients have undergone re-replacement of glutaraldehyde-treated xenograft valves for primary tissue failure [PTF]among the patients who had initial valve replacement at Seoul national University Hospital. The explanted valves were 69 porcine aortic [51 Hancock, 12 Angell-Shiley and 6 Carentier-Edwards] and 141 bovine pericardial [129 standard-profile and 12 low-profile ionescu-Shiley] valwes, with an overall incidence of PTF of 15.2%. The operative mortality rate of re-replacement was 5.1%. Calcific degeneration and tissue damage in relation to calcification were the most frequent modes of PTF on gross examinatin of the explanted valves resulting hemodynamically in valvular regurgitation. The number of Hancocg porcine and the standard-profile Ionescu-Shiley valves in valves in mitral position failed more often from tissue damage [tears, holes, and loss or destruction of cuspal tissue] than calcification [68.3% vs. 39.0%, p<0.01] with resultant regurgitation in 61%, the Ionescu-Shiley valves in the same position in 53%. The tendency of more calcification than tissue damage[71.3% vs. 33.3%, p<0.001]with stenosis in 53%. The tendency of more calcification and immobility of cusps in the latter group was partly explainable by the inclusion of patients of pediatric age. Observation made in this study suggest : many of bioprosthetic valves would fail from calcification and tissue damage : some fail prematurely because of mechanical stress probably owing to the valve design in construction ; andeven those valves escaped early damage would be subject to calcify in the prolonged follow-up period. In conclusion, at the present time, the clinical use of bioprostheticxenograft valves seems to be quite limited until further improvement in biocompatibility and refinement in valve design in manufacture are achieved.

• Journal of Chest Surgery
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• 제37권9호
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• pp.796-799
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• 2004

환아는 대동맥 축착을 동반한 Taussig-Bing기형으로 벽속 주행(intramural course)이 의심되는 관상동맥, 대혈관 크기의 현저한 차이, 호전되지 않는 폐렴과 심부전, 잠재적 대동맥하 협착으로 생후 52일에 대동맥궁 재건을 포함한 고식적 Damus-Kaye-Stansel (DKS) 술식을 시행받았다. 생후 45개월에 시행된 완전 교정술은 좌심실에서 폐동맥(신대동맥)으로의 심실중격결손을 폐쇄하고 DKS 술식해체 후관상동맥 전이를 통한 동맥전환술에서 자가 신폐동맥의 판막 기능을 유지한 채 우심실 유출로를 재건하였다. 완전 교정술 후 19개월째 외래 관찰 중으로 심장약은 복용하지 않으며 심초음파 검사에서 특이 소견은 관찰되지 않고 있다. 저자들은 DKS 술식을 받은 Taussig-Bing 기형 환자에서 인조 판막도관의 삽입이 필요한 Rastelli 술식을 피하고 DKS 술식해체과 동맥전환술로 양대혈관 판막을 모두 보존하는 완전 교정술을 시행하여 좋은 성적을 보였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.139-150
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• 1985

From 1977 through 1984, 97 patients of V.S.D. were treated surgically at Department of Thoracic and Cardiovascular Surgery, Korea University college of Medicine. Among 97 patients, 3 patients were treated by PDA ligation, 3 patients were treated by PDA ligation and subclavian flap aortoplasty, 1 patient were treated by pulmonary artery banding. All of the above patients were analyzed clinically. The results were as follows; 1. Of the patients, 52 patients were male [55.5%] and 45 patients were female [44.5%]. Their age ranged from 7 days to 32 year, and the mean age was 9 year of age and 28.9% of patients were between 4 and 8 year of age. 2. The most common clinical symptoms were frequent U.R.l. and D.O.E.. 3. The most common chest PA findings were cardiomegaly and increased pulmonary vascularity. 4. Associated anomaly was founded in 27 cases and PDA was most common associated anomaly and others were A.S.D., pulmonary stenosis, aortic regurgitation, D.C.R.V.. 5. Pulmonary hypertension was founded in 37 patients and it`s incidence was increased by patient age and shunt amount. 6. On Kirklin`s anatomical classification, type 11 defect was most common [45.5%], and type 1 was 35.5%, and type 111 was 4.4%, and type 1V was 4.4%. 7. Mean E.C.C. time was 69.1 min. and varied by closing method and associated anomaly as in case of simple closure; 47.8 min., in case of patch closure; 77.2 min., in cases with associated anomaly; 92.7 min.. 8. Mean postoperative ventilatory assisted time was 7.3 hour and varied by preoperative pulmonary artery pressure and E.C.C. time, as the group with pulmonary hypertension; 10.5 hour, the group without pulmonary hypertension; 5.5 hour, the group of short E.C.C time [within 1 hour]; 4.4 hour, the group of long E.C.C. time [over 1 hour]; 8.4 hour. 9. Overall operative mortality was 9.3% [9 cases].

• Journal of Yeungnam Medical Science
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• 제5권2호
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• pp.101-110
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• 1988

영남대학교 의과대학 흉부외과학 교실에서는 1984년 4월부터 1988년 9월까지 459예의 심장혈관 환자들을 대상으로 수술하여 다음과 같은 성석을 얻었다. 1. 전 459예중 개심술이 355예였고 비개심술이 104예였다. 2. 환자의 연령은 최저 생후 1일에서 최고 65세까지였다. 3. 남녀비는 1:1.3으로 여자에서 조금 많은 분포를 보였다. 4. 개심술중 선천성 심장질환이 270예, 후천성 심질환이 85예로 선천성 심질환이 월등히 많았다. 5. 선천성 심장혈관 질환중 심실중격결손증이 38.7%로 가장 많았고 그 다음이 동맥관개존증, 심방중격결손증, 활로씨 사증후군, 폐동맥 협착증의 순이었다. 6. 수술후 합병증은 60예에서 관찰되었으나 전예에서 경쾌퇴원하였다. 7. 술후 사망은 전체 심장혈관 질환 459예중 15예로 3.3%를 보였고 개심술로 인한 사망은 355예중 14예로 3.9%였다.

• Journal of Chest Surgery
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• 제38권5호
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• pp.382-384
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• 2005

소아의 우심실-폐동맥 연결에 이용되는 판막 도관에는 여러가지가 있다. 현재까지 동종이식편(homograft) 판막도관이 가장 이상적인 것으로 알려져 있으나 유아에서는 크기 및 공급에 제한점이 있다. 최근에는 다양한 크기의 이종이식편(xenograft) 판막도관이 상업적으로 이용 가능하여 하나의 대안으로 여겨지지만 이 역시 많은 문제점을 가지고 있다. 선천성 대동맥판 협착증으로 Ross 수술을 시행한 2예에서 우심실 유출로 도관으로 이용한 $Shelhigh^{(R)}$ porcine-valved conduit (SPVC)에 심한 가성내막껍질형성(Pseudointimal peel formation)으로 조기에 도관 교환이 필요했기에 문헌고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제55권10호
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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.

• The Korean Journal of Physiology
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• 제30권1호
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• pp.21-31
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• 1996

To investigate the mechanisms of increased endothelium-dependent contraction by acetylcholine in hypertensive rats, the relationship between endothelium-dependent contraction by acetylcholine and blood pressure was studied in spontaneously hypertensive rats (SHR), one-kidney, one clip Goldblatt hypertension (1K,1C-GBH) rats, and Wistar-Kyoto rats (WKY). SHR were treated orally with enalapril or nicardipine in order to prevent development of hypertension or suppress the developed hypertension. 1K,1C-GBH rats were made by renal artery stenosis with contralateral nephrectomy in 8 week-WKY. 1. Endothelium-dependent contractions by acetylcholine $(10^{-6}{\sim}10^{-5}\;M)$ in SHR were significantly greater than those in WKY. 2. Chronic treatment with enalapril or nicardipine reduced the endothelium-dependent contraction in SHR 3. The degree of reduction of endothelium-dependent contraction was greater in SHR which was prevented from developing hypertension than in SHR of which high blood pressure was suppressed. 4. In aortic rings from 1K,1C-GBH rats, endothelium-dependent contractions by acetylcholine were augmented as compared with WKY. 5. There is good relationship between the value of blood pressure and magnitude of endothelium-dependent contraction. Thus, it is suggested that increased endothelium-dependent contraction in hypertensive rats may he due to the high blood pressure and endothelium-dependent contraction may not be a cause of the initiation of hypertension in SHR.

• Journal of Chest Surgery
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• 제25권7호
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• pp.685-692
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• 1992

In spite of multiple technical advances, large amount of homologous blood transfusions usually required for open heart surgery. Because the complications associated with transfusion are increased as the number of homologous transfusion increase, especially as transfusion related acquired immunodeficiency syndrome has appeared in recent years, such risks have stimulated recent interest in the use of autologous blood. This is a report concerning 23 consecutive adult autologous donors[autologous group] who had elective cardiac surgery at the Yonsei Cardiovascular Center, Yonsei University College of Medicine, from march, 1990 to august, 1991. A similar group of 23 patients operated during the same periods without autologous blood donation was used for comparison [control group] to investigate the effect of predonated autologous blood in decreasing the need of homologous transfusion and to investigate predonation related adverse effect. Autologous group consisted of 15 men and 8 women. Control group consisted of 7 men and 16 women. There were no significant differences in mean age, hemoglobin, hematocrit, RBC count, platelet count and prothrombin time on admission between the two groups. The mean autologous blood donation in autologous group was 2.2 units. In 10[43.5%] of the 23 atuologous group patients, no homologous RBC products transfusion was required. However, all patients required homologous transfusion in control group. In autologous group, patients required less homologous RBC products than control patients[2.1 units versus 5.3 units; p<0.001]. There were no significant differences in hemoglobin, hematocrit, RBC count and platelet count between the two groups before discharge. There were no serious complications related to preoperative blood donation, although 3 patients complained of mild dizziness during donation We conclude that preoperative autologous predonation of blood is a safe and effective method for reducing homologous transfusion and is recomended in all patients undergoing elective cardiac surgery except limited contraindications such as severe aortic valve stenosis or unstable angina pectoris.