• Journal of Chest Surgery
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• v.30 no.12
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• pp.1175-1183
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• 1997

Background. Infective endocarditis s an uncommon but serious disease in children. Optimal treatment strategy, especially surgical indications, continues to evolve. Method. In this report, we retrospectively reviewed 19 patients who underwent operations in Seoul National University Children's Hospital for infective endocarditis between September 1986 and February 1996. There were 8 male and 11 female patients(mean age 70.6 months) and their main symptoms were fever and dyspnea. Preoperative echocardiography detected vegetation in 14 cases out of 19. Congenital anomalies were in 15 cases and acquired forms were in 4 cases. Causative organisms were identified in 12 cases and Gram-positive cocci were in 7 cases. Adequate preoperative antibiotic management was done. Result. With cardiopulmonary bypass in all cases, surgical corrections including vegetation removal were performed. 4 patients died after operations(21.1%). All the mortality cases were having underlying complex cardiac anomalies. There were no late deaths. Act arial survival rate was 79.0% at 1 year and 79.0% at 5 year and reoperationfree survival rate was 73.7% at 1 year and 73.7% at 5 year. Collclusion. Despite advances in antibiotic therapy, early surgical treatment is imperative in a significant subset, and concurrent intracardiac repair should be appropriate.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1205-1213
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• 1997

This study reviewed useful aspects of the intraoperative transesophageal echocardiography among the patients in whom heart surgery were undertaken between January 1996 and July 1996 at St.Pauls hospital, Medical College of Catholic University, Seoul, Korea. During that period, 61 patients were operated on because of valvular heart disease(25 patients), coronary artery disease(22 patients), congenital heart disease(13 patients), and combined coronary artery disease and valvular heart disease(1 patient). Two patients(1 redo-VSD and 1 valvular heart diease) needed repeated aortic cross clamping and complementary procedures because of incomplete initial procedures. There was no incidence of air embolism. We could observe significant relationship of cardiac output monitoring methods either by thermodilution technique and transesophageal echocardiography by linear regression analysis(p<0.001). We tested myocardial response(percentage of systolic wall thickness, PSWT) with low dose dobutamine challenge to predict post-CABG myocardial perfusion. And the test showed statistically significant resp.onse(sensitivity 76%, specificity 94.7%, positive predictive value 95%, negative predictive value 75%). These results suggest that cardiac surgeon could draw more benefits by intraoperative transesophageal echocardiography.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.331-335
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• 1993

From January 1981 to December 1991, forty patients with localized advanced carcinoma of the pancreas were treated at the Department of Therapeutic Radiology, Seoul National University Hospital. The treatment protocol consisted of two split course external radiation therapy with each 2000 cGy over two weeks separated by two week rest period. Intravenous 5-fluorouracil (5-FU) was administered on the first three days of each radiotherapy course. Twenty three of these patients were treated by maintenance 5-FU or FAM (5-FU, adriamycin, mitomycin) chemotherapy. Median survival was 9 months and the 2-year survival rate was $10.0\%.$ Good prognostic indicators were good performance status, palliative bypass surgery and tumor located in the head of pancreas.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.712-723
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• 2002

Substantial alterations in cerebral blood flow(CBF) are known to occur during cardiopulmonary bypass(CPB). Many investigators have speculated that these changes may be responsible for both minor and major cerebral damages after CPB. More recently, these changes in CBF have been observed to be intimately related to the arterial carbon dioxide tension(Pa$CO_2$) maintained during CPB. The present study was prospectively designed to investigate the clinical effects of normocapnic and hypercapnic CPB on the cerebral oxygen metabolism in cardiac surgery Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to either normocapnic group (Pa$CO_2$35~40 mmHg, n＝18) or hypercapnic group(Pa$CO_2$, 45~55 mmHg, n＝18) with moderately hypothermic nonpulsatile CPB(nasopharyngeal temperature of 29~3$0^{\circ}C$). In each patient, middle cerebral artery blood flow velocity( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), cerebral oxygen extraction(COE), cerebral metabolic rate for oxygen(CMR $O_2$), cerebral oxygen transport( $T_{E}$ $O_2$), $T_{E}$ $O_2$/CMR $O_2$ ratio, cerebral desaturation(internal jugular bulb blood oxygen saturation $\leq$ 50%), and arterial and jugular bulb blood gas were evaluated throughout the operation. Postoperative neuropsychologic complications were assessed in all patients. All variables were compared between the two groups. Result: VMCA(169.13 $\pm$ 8.32 vs 153.11 $\pm$8.98%), TE $O_2$(1,911.17$\pm$250.14 vs 1,757.40$\pm$249.56), $T_{E}$ $O_2$,/CMR $O_2$ ratio(287.38$\pm$28.051 vs 246.77$\pm$25.84), $O_2$ tension in internal jugular bulb (41.66$\pm$9.19 vs 31.50$\pm$6.09 mmHg), and $O_2$saturation in internal jugular bulb(68.97$\pm$10.96 vs 58.12$\pm$12.11%) during CPB were significantly lower in normocapnic group(p＝0.03), whereas hypercapnic group had lower C(a-v) $O_2$(3.9$\pm$0.3 vs 4.9$\pm$0.3 mL/dL), COE(0.3$\pm$0.03 vs 0.4$\pm$0.03), CMR $O_2$(5.8 $\pm$0.5 vs 6.8$\pm$0.6), and arterial blood pH(7.36$\pm$0.09 vs 7.46$\pm$0.07, p＝0.04) during CPB. Hypercapnic group had lower incidence of cerebral desaturation than normocapnic group(3 vs 9 patients, p=0.03). Duration of the neuropsychologic complication(delirium) were shorter in hypercapnic group than in normocapnic group(36 vs 60 hrs, p＝0.009). Conclusion: These findings suggest that hypercapnic CPB may have salutary effects on the cerebral oxygen metabolism and postoperative neurologic outcomes in cardiac surgery.surgery.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.534-543
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• 2006

Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.210-215
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• 2008

Background: Drug-eluting stents are contributing to the exponential growth of percutaneous coronary intervention, and even in the patients with left main coronary artery disease, owing to the decreased restenosis rate. Our study aimed at comparing the one-year results after coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents in patients with left main coronary artery disease. Material and Method: Those patients who underwent coronary bypass surgery or stenting at our hospital under the diagnosis of left main coronary artery disease were divided in two groups. The variables for comparison were the preoperative disease severity, the length of the hospital stay, the early mortality and the cumulative incidence of mortality, myocardial infarction and repeated revascularization. Result: There were 101 cases in the surgery group and 78 cases in the stent group. Age, gender, the risk factors, the left ventricular ejection fraction and the proportion of acute coronary syndrome showed no significant differences between the two groups. The surgery group showed a more severe condition according to the Euroscore, a greater incidence of urgency, a longer hospital stay and a greater incidence of multi-vessel disease. The early mortality and one-year cumulative mortality were not different between the groups. The Euroscore-matched comparison for the surgery group (41 patients) and the stent group (78 patients) showed no significant differences in the Euroscore, age, gender, risk factors and the proportion of acute coronary syndrome. The surgery group in the Euroscore-matched comparison showed more multi-vessel disease and a longer hospital stay. The surgery group showed lower early mortality and lower one-year cumulative mortality, but this was statistically insignificant (0% vs 2.6%, respectively, p=0.55; 0% vs 6.6%, respectively, p=0.30). The rates of repeated revascularization and major adverse events (death or myocardial infarct) were lower in the CABG group, but this was not statistically significant (13.3% vs 6.3%, respectively, p=0.48; 10.0% vs 0%, respectively, p=0.09). Conclusion: Percutaneous coronary intervention using drug-eluting stents in low-risk patients with left main coronary artery disease resulted in a shortened length of the hospital stay, as compared with that of the CABG group of patients. However, the patients who underwent percutaneous coronary intervention using drug-eluting stents showed a tendency for an increased rate of repeated revascularization and higher one-year cumulative mortality. Further studies with large populations and longer follow-up will be necessary to reaffirm our findings.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.278-284
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• 1996

Nine infants with transposition of great arteries have undergone arterial switch operation from May 1989 to May 1994 in the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. Patients' age ranged from 3 days to 90 days, averaging 30$\pm$21 days. Diagnosis was made by two-dimensional echocardiography in all patients. Eight patients were diagnosed as transposition of great arteries with ventricular septal defect and one patient was a simple transposition of great arteries. Associated anomalies were patent ductus arteriosus (8), atrial septal defect (7) and coarctation of aorta(1). The anatomy of the coronary arteries were 7 (77 %) type A and 2 (23 %) type D according to the Yacoub classification. Pulmonary artery reconstruction was done according to Lecompte maneuver with tautologous pericardial patch in 8 patients. Overall operative mortality rate was 55% Left heart failure and pulmonary hypertensive crisis were the cause of death on postoperative 1~2 days in three patients, and two succumbed to death due to sepsis on postoperative 2~ 3 weeks. The mean follow-up period was mean 17 months. No patient had clinically significant postoperative aortic regurgitation and supravalvular pulmonary stenosis. The excessive use of inotropic support postoperatively was identified as a stastically significant risk factor following the arterial switch operation. But other variables such as low body weight, long cardiopulmonary bypass time, excessive hemodilution during cardiopulmonary bypass, hypothermia and volume loading were not significant risk factors.

• Journal of Chest Surgery
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• v.34 no.1
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• pp.45-50
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• 2001

배경: 관상동맥우회술은 허혈성 심질환 환자에서 증상을 완화하고 급사를 방지할 수 있는 효과적인 치료방법으로 확립되었다. 그러나 80년대에 들어와 지금까지 사용되었던 대복재정맥편에 비해 동맥이식편의 장기개통율이 월등함이 알려지면서 좌내유동맥과 함께 사용할 수 있는 동맥이식편에 대한 관심이 증가하였다. 본원에서는 1998년부터 다동맥이식편을 이용하여 관상동맥 우회술을 시행하고 있으며, 조기성적에 대해 대복재정맥을 사용한 경우와 비교하고자 하였다. 대상 및 방법: 1998년 6월부터 1999년 5월까지 본원에서 관상동맥우회술을 시행받았던 355명의 환자중 심정지액을 이용하여 시행했던 153명을 대상으로 하였다. 76명의 단일 동맥편을 사용한 환자를 I군, 두 개 이상의 다동맥편을 사용한 77명의 환자를 II군으로 분류하여 수술전후 임상기록, 심초음파 및 관상동맥 조영술 소견등을 후향적으로 분석하였다. 결과: 술전 양군간에는 II군의 환자가 I군의 환자에 비해 더 젊고 흡연자가 많다는 것 이외에는 통계학적으로 차이는 없었다. 술후 조기사망은 각 군에서 1례씩 있었고 환자당 문합갯수에 통계학적으로 차이가 있는 것 이외에는 수술과정 및 술후 결과에서 차이는 없었다. 결론: 다동맥편을 이용한 관상동맥우회술을 시행한 결과 본원에서 학습기(learning period)임에도 불구하고 조기성적에 있어 대복재정맥을 이용한 경우와 차이가 없었다. 물론 중기 및 장기성적에 대한 지속적인 추적관찰이 필요하겠으나 이러한 조기성적은 동맥이식편을 이용한 관상동맥우회술이 환자의 장기생존에 도움을 줄 수 있으리라 사료된다. 또한 이러한 결과를 토대로 완전 동맥이식편 관상동맥우회술로의 전환이 이루어질 수 있으리라 생각된다.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.171-176
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• 1996

From March, 1983 to June, 1994, twenty-two patients underwent coronary artery and combined operations. The ages of the patients ranged from 42 years to 72 years (mean 60.4$\pm$8.2 years). There were 17 male and 5 female patients. The left ventricular (LV) ejection fraction ranged from 25% to 65% (mean 46.9$\pm$14.2%). Nine patients had mechanical complication of myocardial infarction (MI), of which 5 were LV aneurysm, 3 ventricular septal defect and 1 mitral regurgitation. Nine patients had rheumatic valvular heart disease of whom 7 with aortic valve disease and 2 with mitral valve disease. Two other patients had left atrial thrombi, only one with atrial septal defect a d another with aneurysm of ascending aorta. An average of 2.1$\pm$1.0 bypasses was done, ranging from one to four. There were 3 postoperative complications; 2 perioperative MI and 1 leg wound infection. Among complicated patients, mortality was 1 patient (4.5%) due to low cardiac output syndrome after perioperative MI. With 3 to 136 months follow-up (mean 41.1$\pm$40.2 months), late mortality was 1 patient due to cerebral vascular accident. Among long-term survivors, all patients are in New York Heart Association functional class I or II. Although the number of patients was small, our surgical results were favorable. Therefore we think that coronary revascularization combined with heart operation does not increase the operative risk when associated coronary artery disease is present, and it reduces the occurrence of late death.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.754-758
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• 2006

Background: Surgical role for acute coronary syndrome has been reduced in recent years due to development of drug eluting stent. We evaluated the surgical results of acute coronary syndrome in our hospital. Material and Method: Between January 2001 and August 2005, 416 patients underwent coronary artery bypass grafting (CABG) under diagnosis of non-ST-elevation acute coronary syndrome (NSTE ACS). Mean age was $61.8{\pm}9.0$ years and 276 (66.3%) patients were male. 324 (77.9%) patients had triple vessel disease and 92 (22.1%) had left main disease at angiographic study. 236 (56.7%) patients had hypertension and 174 (41.8%) had diabetes mellitus. Conventional on-pump CABG was performed in 194 patients (46.6%) and off-pump CABG in 222 (53.4%). Total arterial revascularization with no touch technique was done in 97 patients (23.3%). The number of total distal anastomosis was 1,306 and the number per patient was $3.21{\pm}1.71$. Result: Surgical mortality rate was 1.0% (4 patients) and postoperative complication rate was 15.6% (65 patients). Graft patency was checked at mean $3.7{\pm}7.6$ months (from 1 to 37 months) postoperatively with multi-directional computed tomography in 152 patients. Left internal mammary artery was patent in 95.3%, right internal mammary artery in 98.1%, radial artery in 92.2% and saphenous vein in 89.0%. Conclusion: The surgical treatment of NSTE ACS showed relatively low mortality rate and good graft patency rate. Further study is needed to compare the long term results with drug eluting stent.