• Journal of Chest Surgery
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• v.32 no.5
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• pp.471-479
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• 1999

Background: Patients with tetralogy of Fallot(TOF), pulmonary atresia(PA) and major aortopulmonary collateral arteries(MAPCAs) have been managed by heterogenous surgical strategies. We have taken 5 different surgical approaches to this lesion. In this study, relative advantages and disadvantages of each strategy were discussed by analyzing our surgical results. Material and Method: Between January 1986 and June 1998, 50 patients aged 1 to 177(39${\pm}$31) months at a various morphologic spectrum of this lesion were treated at our institution. The groups, which were classified according to the initial approaches, consisted of one-stage unifocalization(A-1, n=9), staged unifocalization(A-2, n=11), right ventricle to pulmonary artery connection(RV-PA)(B-1, n=11), one-stage RV-PA plus unifocalization (B-2, n=11), and one-stage definitive repair(C, n=8). Morphologic charateristics, operative mortalities, and probabilities of definitive repair were compared between the groups and the causes of death, complications and the follow-up results were described. Result: Mean ages at the first operation were 57${\pm}$18(A-1), 42${\pm}$48(A-2), 18${\pm}$14(B-1), 52${\pm}$55(B-2), and 32${\pm}$34(C) months (p<0.05). Mean numbers of MAPCAs were least in group C (A-1=4.3${\pm}$1.0, A-2=4.5${\pm}$1.3, B-1=4.1${\pm}$1.9, B-2=4.1${\pm}$1.6, C=3.4${\pm}$1.8 : p<0.05). The ratios of the direct and the indirect MAPCAs in each group were not different between the grousps (A-1=91%/9%, A-2=78%/22%, B-1=80%/20%, B-2=80%/20%, C=81%/19% : p>0.05). Nineteen patients had more than 1 dependent MAPCAs. True pulmonary arteries were not present 13 patients and they were confluent in 29. A total of 101 operations were performed. Operative mortalities of initial procedures were 33%(3/9, A-1), 18%(2/11, A-2), 0%(0/11, B-1), 36%(5/11, B-2) and 13%(1/8, C) (p<0.05). Percentages of the definitive repair among the patients of each group were 22%(2/9, A-1), 18%(2/11, A-2). 45%(5/11, B-1), 27%(4/11, B-2), and 100%(8/8, C)(p<0.05). Hypoxic respiratory and cardiac failure(6), hypoxic encephalopathy(2) and sepsis(4) were the major causes of death. Phrenic nerve palsy occured in 5 patients. Thirty-one patients among the survivals have been followed up for a mean duration of 74${\pm}$42(3-145) months. One and five year actuarial survival rates were 73% and 73 %. Conclusion: In conclusion, Right ventricle to pulmonary artery connection used in patients with TOF/PA/MAPCA as an inital procedure appeared to be highly successful in enhancing the chance of satisfactory definitive repair without the significant surgical risks. One-stage total repair at an ealier age group could be performed safely with the resonable outcomes. Unifocalization approach, whether it was performed in a single stage or in the multiple stages, resulted in the high operative mortality and the lowest chance of definitive repair, however more tailored selection of the patients and the long follow-up is mandatory to prove the usefulness of this approach.

• Journal of the Daesoon Academy of Sciences
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• v.27
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• pp.171-200
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• 2016

This paper will analyze the filial piety based ethics of Daesoonjinrihoe (大巡眞理會) and the traditional filial piety of Confucianism (儒敎), Buddhism (佛敎) and Taoism (道敎) through comparing and contrasting their unique systems. The traditional Korean ethics regarding filial piety are in great need of reformation as the relationship between the parents and children should not be vertical or unilateral but parallel and reciprocal. However, there have not been sufficient in-depth studies on this specific ideology and alternative approaches. Regarding this prospect, one representative Korean indigenous new religion, Daesoonjinrihoe has emerged and directly engages in the collision between traditionalism and modernity. The modernity of Daesoonjinrihoe, enables the observation of how the filial piety based ethics have developed within a system of doctrine and thereby provides an exemplary model of traditional filial piety reimagined in accordance with modern sensibilities. A brief summary of comparative findings is as follows: First, Daesoonjinrihoe and Confucianism have taken serving parents with respect as an ethic within filial piety, but Confucianism engenders this ideal through the unilateral and unconditional sacrifice of younger people based on patriarchal feudalism whereas Daesoonjinrihoe has rejected such unilateral sacrifice and instead promotes mutual beneficience between parents and children. This difference occurs, in part, due to the filial piety of Confucianism rising in the midst of the feudal order whereas the ideology of Daesoonjinrihoe contains ideals such as "the reciprocation of favor for mutual beneficence (報恩相生)" and "respect for humanity (人尊)," both of which serve as key principles of the new religious world as envisioned by Daesoonjinrihoe. Second, filial piety in Buddhism and Taoism tends to be passive and inactive and is often expressed by praying for happiness and longevity for one's parents while they are alive and later praying for the heavenly rebirth of one's parents after they die. The filial piety of Daesoonjinrihoe also partially contains such ideas, however; they are extended much further and arrive upon novel and profound expressions. The spectrum of the filial piety in Daesoonjinrihoe expands to the extent children perform actions to resolve their parent's sins and pave a new road for their parents. This filial piety requires a cultivation practice from both parents and children. This system of dual cultivation was established because the world-view of Daesoonjinrihoe enables both parents and children to enjoy happiness and wealth both of which are achieved through the completion of religious objectives following cultivation practice. Third, Confucianism and Daesoonjinrihoe hold memorial services for ancestors with sincerity as an expression of filial piety. Filial piety in the Confucian context excludes ideas from Shamanism and thereby memorial services are held for impersonal entities, however; in the Daesoonjinrihoe context, memorial services are held for personal-entities. Accordingly, holding a memorial service for ancestors with sincerity has a greater sense of realism in Daesoonjinrihoe than it does in Confucianism. Fourth, while Confucianism and Daesoonjinrihoe both aim to requite the grace received from ancestors, the contents of grace and reciprocation of favors (報恩) are viewed differently. In Confucianism, since the ancestors existed previously and bestowed the gift of life to their children and indirectly, all of their descendents. Therefore, memorial services for ancestors are held to convey gratitude and filial piety. However, in Daesoonjinrihoe, ancestors not only bestowed the gift of earthly life to their descendents, in the spirit realm, ancestral spirits also spend sixty years accumulating the merit necessary to imbue each of their descendents with spiritual insight. Consequently, filial piety is expressed through memorial services as well as spiritual cultivation. Fifth, in Confucianism, achieving the fame and prestige indicative of success in the mundane world can be an act of filial piety as it would bring pride to one's ancestors, but in Daesoonjinrihoe, succeeding in religious objectives through spiritual cultivation is considered to be a higher form of filial piety. Sixth, Confucianism, Buddhism and Taoism all observe filial piety as system of familial ethics based in morality. This is likewise true of Daesoonjinrihoe, however; Daesoonjinrihoe confers greater importance on filial piety as an essential form of ethics for religious redemption. This is due to the Daesoon interpretation that the absence of filial piety was the direct cause which led to the sickened state of the world and its collapse. Forgetting the grace of parents who have given the gift of life or the grace of ancestral spirits who have accumulated merit on behalf of their descendents are acts of ingratitude which are unacceptable during the period of Reordering of the Universe. Judging from these findings, Daesoonjinrihoe embraces parts of traditional filial piety as it exists in Confucianism, Buddhism and Taoism, but it does so on the ground of its own unique culture. Through re-interpretation and re-creation, ideas regarding filial piety are being further developed. Namely, filial piety in Daesoonjinrihoe is regulations founded upon the reciprocation of favors for mutual beneficence and respect for humanity. Therefore, it is understood as a concept wherein one's own cultivation practice is performed in order to reach religious objectives, the perfection of personal character, and spiritual insight. This requires that even recipents of filial piety (i.e., parents) perform certain cultivation practices to enjoy happiness and wealth. Additionally, filial piety in Daesoonjinrihoe manifests a reinforced religious character and also serves as a system ethics which is soteriologically essential for salvation during the period known as the Reordering of the Universe.