• Journal of Chest Surgery
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• 제39권8호
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• pp.619-625
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• 2006

배경: 죽상동맥경화성 하지동맥폐쇄증은 대부분의 경우에 전신 동맥 경화증이 동반되며 사망의 원인으로는 주로 반 이상이 관상동맥질환에 의하여 발생한다. 또한 만성 동맥폐쇄증 수술 후 수술 사망 원인은 심장 합병증에 의한 사망이 가장 빈번한 것으로 알려져 있다. 특히 죽상동맥경화성 하지동맥폐쇄증 환자에게 과거에 심질환이 없거나 허혈성 심질환의 주증상이 없던 경우에 수술 후 높은 사망률을 보이는데 이런 이유로 이 환자군에 대한 관상동맥질환의 동반 여부에 대한 수술 전 검사의 필요성이 제기되는 바이다. 대상 및 방법: 2001년 2월부터 2004년 10월까지 죽상동맥경화성 하지동맥폐쇄증으로 입원한 환자 중 과거력상 심질환이 있었거나 허혈성 심질환이 주증상이었던 환자를 제외한 52명의 환자를 대상으로 관상동맥조영술과 하지동맥조영술을 동시에 시행하여 죽상동맥경화성 하지동맥폐쇄증에서 관상동맥질환의 동반 빈도를 파악하였다. 또한 죽상동맥경화성 하지동맥폐쇄증의 중증도를 나타내는 AVO score와 동반된 관상동맥질환과의 상관관계를 비교하였다. 결과: 죽상동맥경화성 하지동맥폐쇄증에서 관상동맥질환을 동반한 경우는 63%(33명)였고, 고령, 당뇨, 고혈압, 흡연력, 고콜레스테롤혈증 등의 동맥 경화증의 위험인자 중 고령과 고혈압이 관상동맥 질환을 동반하는 죽상동맥경화성 하지동맥폐쇄증의 중증도와 통계학적인 의미를 보였다. AVO score가 높을수록 관상동맥 질환의 동반이 흔하였고 관상동맥질환의 중증도 역시 증가되는 소견을 보였다. 관상동맥질환이 동반된 죽상동맥경화성 하지동맥폐쇄증 환자에서 관상동맥 우회술 및 관상동맥 중재적 시술을 병합하여 하지동맥 우회술을 시행한 경우, 하지동맥 우회술의 단독시행에 비해 사망률이 현저히 감소하였다. 결론: 과거력상 심질환이 없거나 허혈성 심질환의 주증상이 없는 죽상동맥경화성 하지동맥폐쇄증 환자에서 특히, 고령, 고혈압, AVO score가 높은 환자군에서는 수술 전 관상동맥조영술을 시행하여 동반되는 관상동맥 질환을 파악한 뒤 이에 대한 적극적인 치료를 시행하여야 한다.

• Journal of Chest Surgery
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• 제33권3호
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• pp.252-256
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• 2000

There have been few reports documenting the outcome of arterial swich operations(ASO) in selected patients with transposition of great arteries(TGA) and with left ventricular outflow tract obstruction(LVOTO). In the case of TGA with LVOTO, if the atrial septal defect(ASD) is large and the ventricular septal defect(VSD) is restricive, this deprives the left ventricle(LV) of approporiate preload and could lead to underdevelopment of the ventircular mass and lead poor LV performance after the arterial switch operation, dspite a high pressure in the LV preoperatively. Because an increase in the systolic ventricular pressure is not necessarily paralleled by an increase in ventricular mass, which is also essential for optimal ventricular performance after the operation. We report here a case of rapid LV training after ASO in TGA with unprepared LV (because of large ASD and restrictive VSD) despite a high pressure in the LV(due to LVOTO) preoperatively.

• Journal of Chest Surgery
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• 제25권1호
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• pp.1-16
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• 1992

The quantitatively measured local myocardial perfusion rates with microspheres are used as an objective indicator of even distribution of cardioplegic solution, and the efficacy of the retrograde right atrial route of cardioplegia is evaluated in hearts with various levels of coronary arterial obstruction. After initial antegrade cardioplegia under the median sternotomy and aortic cannulation, 60 hearts from anesthetized New Zealand white rabbits are divided in random order as normal group [ligated left main coronary artery ; MA, MR] and diagonal group [ligated proximal diagonal artery ; LA, LR]. Half of each group [N=10] are perfused with antegrade cardioplegia[A] under the pressure of 100 cmH2O and the other half with retrograde right atrial route[R] under the pressure of 60 cmH2O[St. Thomas cardioplegic solution mixed with measured amount of microspheres]. The myocardium is subdivided into segments as A[atria], RV[right ventricle]. S[septum], LV[normally perfused left ventricular free wall], ROI[ischemic myocardium of left ventricular free wall]. LV and RQI are further divided into N[subendocardium] and P[subepicardium]. The resulting local myocardial perfusion rates and N /P of each group are compared with Wilcoxon rank sum test. The weight of the hearts is 5.94$\pm$0.66g, and there are no statistically significant dif-ferences[p>0.05, ANOVA] between six compared group. The mean flow rate[F: ml /g / min] of MR group is comparable with MA group[p>0.05], but in N and L group, there are significantly depressed F with right atrial route of cardioplegia, which means elevated perfusion resistance with this route. In spite of no significant differences in delivered doses of microsphere[DEL] between compared groups[p>0.05, ANOVA], there are significantly depressed REC and NF in hearts with right atrial cardioplegia which suggests increased requirement of cardioplegic solution with this route. The interventricular septum shows poor perfusion with right atrial route of cardioplegia without obstruction of supplying coronary arteries. But, with obstruction of coronary artery supplying septum as in M group, the flow rate is superior with right atrial route of infusion. The left ventricular free wall perfusion rates of every RQI with R route are superior to that of A route[p<0.05]. But, in LV segments, there are unfavorable effects of right atrial cardioplegia in L group, although the subendocardial perfusion is well maintained in N group. The LV free wall of left main group shows depressed perfusion rates with antegrade route as compared with RQI segments of diagonal group. But, by contraries, there are increased perfusion rates and superior N /P ratio with retrograde right atrial route. It implies more effective perfusion with right atrial route of cardioplegia in more proximal coronary arterial obstruction[i.e., M group as compared with L group]. As a conclusion, all region of ischemia have superior perfusion rates with right atrial car-dioplegia as compared with antegrade route, and especially excellent results can be obtained in hearts with more proximal obstruction of coronary arteries which would otherwise result in more severe ischemic damage. But, the depressed perfusion rates of the segments with normal coronary artery in hearts with coronary arterial obstruction may be a problem of concern with right atrial cardioplegia and needs solution.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.226-231
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• 2009

Objective : We describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with a review of the literature. The types of thromboembolic complications were divided and the treatment modalities for each type were described. Methods : Between August 2004 and March 2009 we performed endovascular embolization with Guglielmi detachable coils for 173 patients with 189 cerebral aneurysms, including ruptured and unruptured aneurysms at our hospital. Sixty-eight patients were males and 105 patients were females. The age of patients ranged from 22-82 years (average, 58.8 years). We retrospectively evaluated this group with regard to complication rates and outcomes. The types of thromboembolic complications were classified into the following three categories: mechanical obstruction, distal embolic stroke, and stent-induced complications, which corresponded to types I, II, and III, respectively. A comparison of the clinical results was made for each type of complication. Results : Only eight patients had a thromboembolic complication during or after a procedure (4.6%). Of the eight patients, two had a mechanical obstruction as the causative factor; the other three patients had distal embolic stroke as the causative factor. The remaining three patients had stent-induced complications. In cases of mechanical obstruction, recanalization occurred due to the use of intra-arterial thrombolytic agents in one of two patients. Nevertheless, a poor prognosis was seen. In the cases of stent-induced complications, in one of three patients in whom a thrombus developed following stent insertion, a middle cerebral artery territory infarct developed with a poor prognosis despite the use of wiring and an intra-arterial thrombolytic agent. In the cases of distal embolic stroke, all three patients achieved good results following the use of antiplatelet agents. Conclusion : Treatment for thromboemboic complications due to mechanical obstruction and stent-induced complications include antiplatelet and intra-arterial thrombolytic agents; however, this cannot guarantee a sufficient extent of effectiveness. Therefore, active treatments, such as balloon angioplasty, stent insertion, and clot extraction, are helpful.

• Journal of Chest Surgery
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• 제27권6호
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• pp.435-443
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• 1994

Surgical procedures to relieve congenital right ventricular outflow tract[RVOT] obstruction of heart were performed on 125 patients from September 1985 to August 1992. There were 65 males and 60 females. Ages ranged from 7 months to 33 years with a mean age of 8 years. All the patients were divided into three main groups[I, II, III] depending on the presence or absence of cyanosis and combined anomalies. The patient were classified into two groups; A and B according to the outcome after surgical repair. Group A included the patients who had a good postoperative outcome with or without mild complications such as wound disruption, or hydrothorax. Group B included the patients who had a poor outcome including hospital death and significant postoperative complications such as heart failure, low output syndrome, respiratory failure, hepatic failure and others. And the results were summarized as follows. 1. There were no significant differences in age, body surface area and aortic dimension among the group I, II, and III, but there were significant differences among groups in pulmonary arterial dimension, ACT[aortic cross clamping time], TBT [total bypass time], preoperative and postoperative ratio of systolic pressure of right and left ventricles [pre PRV/RV and post PRV/LV], and the size of Hegar dilator which passed through the RVOT postoperatively [p<0.05]. 2. In the group A and B, there were significant differences in pulmonary arterial dimension [group A:1.6$\pm$0.5 cm, group B:1.9$\pm$0.6 cm], ACT [group A:102.3$\pm$ 46.0 minute, group B:76.1$\pm$46.1 minute], TBT [group A:133.9$\pm$56.6 minute, group B:94.9$\pm$51.9 minute], pre PRV/LV [group A:1.06$\pm$0.24, group B:0.8$\pm$0.32], post PRV/LV [group A:0.58$\pm$0.18, group B:0.43$\pm$0.16].It has been concluded that postoperative prognosis of RVOT obstruction was influenced by pulmonary arterial dimension, ACT, TBT, severity of RVOT obstruction [pre PRV/LV] and post PRV/LV.

• Tribology and Lubricants
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• 제15권3호
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• pp.272-277
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• 1999

The objective of this investigation is to examine the influence of the micro catheters, which mimic the intravascular micro active endoscopes, on local pressure changes and flow rate in an arterial branch model similar to the femoral artery of human. The effects of branch to main lumen flow rate ratios and the locations of a catheter tip were found to be significant on the local pressure changes. Relatively large pressure drops and an increase in shear stress due to the obstruction effects may induce an endothelial cell damage and a change in arterial wall permeability, which have been reported to be the primary cause of the initiation of the atherosclerosis and other major vascular diseases.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제25권4호
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• pp.361-366
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• 1999

Intermaxillary fixation is routine procedure to oral and maxillofacial area in jaw bone fracture, surgical correction of jaw deformity, osseus reconstruction of jaw. After transoral surgery, accompanied by intermaxillary fixation, dysphagia or airway obstruction may be followed due to blood clot, vomitus, or laryngeal spasm resulting from irritation by blood or secretions. Lingual or pharyngeal edema is other contributing factors of airway obstruction. In addition, intermaxillary fixation itself may cause obstruction of airway. In this study, pulmonary function test and arterial blood gas analysis were evaluated before and after intermaxillary fixation in 30 patients suffered from mandibular fractures. Comparative analysis was performed by estimated values. The results were as followed. 1. The spirometric values of FEV1, FEV1/FVC and FEF25-75% without intermaxillary fixation were reduced from 97.57%, 85.1%, 98.3,% to 71.7%, 66.5%, 61.2% with intermaxillary fixation, indicating the presence of obstructive pulmonary impairment. 2. Spirometric value of MVV, as the most influencing value of sensitive to extrapulmonary factors, was changed from 84.5% to 46.48%. 3. After intermaxillary fixation, the spirometric value of FVC, as indicator of restrictive pattern of pulmonary function, was not reduced significantly as measured from 94.47% to 89.97%. 4. $O_2$ saturation of arterial blood gas analysis without intermaxillary fixation was 97.86%. While intermaxillary fixation, $O_2$ saturation was 97.47%. The results indicate that careful airway management is mandatory undergoing intermaxillary fixation of various oral and maxillofacial surgery.

• Journal of Chest Surgery
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• 제17권2호
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• pp.250-256
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• 1984

Eisenmenger syndrome is a condition which systemic arterial blood oxygen unsaturation occurs if obstruction in the pulmonary capillaries raises the pulmonary vascular resistance and pulmonary arterial pressure to or beyond systemic levels and then a significant right to left shunt develops across a preexisting cardiac septal defect or an aortopulmonary communication-We have experienced 3 cases of similar condition. Case I is 24 year old man who has had cyanosis and dyspnea on exertion since childhood. His pulmonary arterial pressure was 110/80mmHg. He was operated under diagnosis of the mitral stenosis and tetralogy of Fallot, but it was finally discovered that he had patent ductus arteriosus and ventricular defect was closed with perforated prosthetic patch, but the patient expired due to right heart failure low cardiac output. Case II was 16 year old female who had pulmonary hypertension of 110/85mmHg. She was diagnosed as Eisenmenger syndrome combining with atrial septal defect and patent ductus arteriosus. Case III was 20 year old male. His pulmonary arterial pressure was 110/70mmHg and the underlying defect was patent ductus arteriosus.

• Journal of Chest Surgery
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• 제26권11호
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• pp.881-885
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• 1993

In the last few years there has been a resurgenceof interest in in-situ saphenous vein arterial bypass for lower extremity revascularization because of improved patency rates. we performed 1 in situ bypass oreration using the intraluminal valve-disruption tecnique. A 65-year-old female who had ztherosclerotic obstruction in the superficial and popliteal arteries underwent in situ saphenous vein arterial bypass. After harvesting of saphenous vein, we used LeMaitre retrograde valvulotome for valve-disruption technique. Completion of the arterrigraphy was performed to evaluate bothh the anastomoses. The two side brances were all ligated. In situ saphenous vein arterial bypass has become the procedure of choice for distal reconstruction in severely ischemic lower extremities because of improved long-term patency compared with reversed-saphenous vein bypass procedure.

• Journal of Chest Surgery
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• 제24권12호
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• pp.1173-1184
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• 1991

This report is a review of 55 cases of peripheral arterial disease, who were treated at the department of thoracic and cardiovascular surgery, Masan Koryo General Hospital from January, 1986 to December, 1990. The result are summerized as follows ; 1. The incidence of peripheral arterial disease were as follows that : Arterial injury was in 21 cases(38.2%), arteriosclerosis oblitrans 18cases(32.7%), thromboembolism 9cases(16.4%), Buerger's disease was in 7cases(12.7%). 2. Overall male to female ratio was 6.8 : 1, the prevalent age was 3rd and 4th decade in arterial injury, 7th and 8th decade in atherosclerosis and thromboembolism and 5th and 6th decade in Buerger's disease. 3. The farmer was the first ranked occupation of these patients with chronic occlusive arterial disease, which was composed of 17 cases (68%). 4. 23 cases of patients with chronic occlusive disease has been smoking and most of them have been smoking over 10 years. 5. The clinical symptoms in acute and chronic arterial obstruction were pain, claudication, gangrene and coldness in order. 6. The duration of symptom of chronic arterial occlusive disease was less 1 years in 15 cases(60%). 7. The lower extremity were more affected than upper extremity in peripheral arterial disease. 8. The cause of arterial injury was traffic accident 9 cases(42.9%) stab wound 8 cases (38.1%), postangiography 2 cases(9.5%) and belt injury 1 case. 9. The etiologic factors of acute arterial occlusion was arterial fibrillation myocardial ischemia and postangiography in order. 10. Lumber sympathectomy in Buerger's disease, artificial bypass graft in atherosclerosis and thromboembolctomy in thromboembolism, end to end with vein graft in arterial injury were performed frequently. 11. Conclusively overall result was satis factory but 3 cases was below knee amputated after operation of chronic arterial occlusive disease.