• Journal of Chest Surgery
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• 제47권2호
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• pp.137-140
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• 2014

A 50-year-old female was admitted to Pusan National University Hospital with complaints of fatigue and sweating. Echocardiography showed a small patent ductus arteriosus (PDA) and highly mobile vegetations on the aortic valve. Emergency operation was performed due to the high risk of embolization and severe aortic regurgitation. When the pulmonary artery opened, we found unexpected fresh vegetation. The tissue of the PDA was fragile and infected. We successfully removed the infected tissue, closed the PDA with a patch, and replaced the aortic valve with a mechanical prosthesis.

• Journal of Chest Surgery
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• 제19권2호
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• pp.250-258
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• 1986

From Aug. 1984 to May 1986, 116 cases of cardiovascular surgery including 85 cases of open heart surgery were performed at Korea Veterans Hospital. There were 108 congenital anomalies and 8 acquired valvular heart diseases. Among 108 congenital malformations 92 operations were done for acyanotic group, and 16 operations for cyanotic group. Thirteen cases of open heart surgery for infants or small children under 10kg of body weight were performed, which occupied 15.3 percent of total open heart surgery done in the same period. Common congenital cardiovascular anomalies were ventricular septal defect [40.7%], patent ductus arteriosus [29.6%], tetralogy of Fallot [12.[%], atrial septal defect [11.1%], and pulmonary stenosis [1.9%] in order of frequency. Valve replacement using lonescu-Shiley or Carpentier-Edwards valve was performed for 8 cases of acquired mitral valve disease, and valve replacement using St. Jude valve was done for a case of patent ductus arteriosus with severe mitral insufficiency. There was no mortality in acyanotic congenital malformations and acquired valve lesions, and 5 cases of mortality in cyanotic congenital malformations. Overall mortality was 4.3 percent for total cases and 5.9 percent for 85 cases of open heart surgery.

• Journal of Chest Surgery
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• 제29권7호
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• pp.777-779
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• 1996

미숙아에 동반된 동맥관 개존증에서 indomethacin에 의한 폐쇄치료법이 소개된후 비수술적 치료방법 으로 각광을 받아왔으나, 증상이 있는 동맥관 개존증의 수술적 폐쇄는 가장 확실하고 안전한 치료법으 로 다시 평가받고 있다. 저자들은 최근에 체중 540gm과 1395gm 미숙아에서 indomethacin에 반응하지 않는 개존동맥 관을 clip 결찰하였다. 540gm의 미숙아는 술후 28시간에 사망하였는데 심한 혈소판 감소증을 보이는 등 출혈성 소인으로 이한 출혈이 원인이 되었다. 두 번째 미숙아 역시 indomethacin치료에도 호전이 없었으며 입원 8일째 괴 사성 소장결장염 합병으로 인한 회장천공으로 수술받았다. 체중증가가 없고 인공호흡기 이탈이 불가능 하여 입원 34일에 개존동맥관을 결찰하고동시에 회장조루복원술을시행하였다. 술후 6일째 인공호흡 기를 제거할 수 있었고 술후 33일에 체중 2050gm에 달하여 양호한 상태로 퇴원하였다.

• Journal of Chest Surgery
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• 제20권2호
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• pp.404-410
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• 1987

An 18-day-old male neonate with hypoplastic left heart syndrome underwent surgical intervention by modification of the Norwood procedure on September 23, 1986. Hypoplastic left heart syndrome is a serious congenital cardiac anomaly that has a fatal outlook if left untreated. Included in this anomaly are [1] aortic valve atresia, and hypoplasia of the ascending aorta and aortic arch, [1] mitral valve atresia or hypoplasia, and [3] diminutive or absent left ventricle. Patent ductus arteriosus is essential for any survival, and there is usually a patent foramen ovale. Coarctation of the aorta is frequently associated with the lesion.z With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the ductus arteriosus was excised. The main pulmonary artery was divided immediately below its branches, and the distal stump of the divided pulmonary artery was closed with a pericardial patch. The aortic arch was incised, and a 1 5mm tubular Dacron prosthesis was inserted between the main pulmonary artery and the aortic arch. A 4mm shunt of polytetrafluoroethylene graft was established between the new ascending aorta and the right pulmonary artery to provide controlled pulmonary blood flow. Following rewarming, the heart started to beat regularly, but the patient could not be weaned from cardiopulmonary bypass. At autopsy, the patient was found to have hypoplasia of the aortic tract complex with mitral atresia and aortic atresia. A secundum atrial septal defect was noted. Right atrial and ventricular hypertrophy was present, and the left ventricle was entirely absent. Although unsuccessful in this case report, continuing experience with hypoplastic left heart syndrome will lead to an improvement in result.

• Journal of Chest Surgery
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• 제22권1호
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• pp.95-105
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• 1989

The records of 248 patients over 16 years of age who had undergone a surgical correction of a congenital cardiovascular malformation during the period of 10 years from August, 1978 to July, 1988 were reviewed. During this period, the incidence of congenital cardiovascular malformation in adult was 18.2% of 1376 total heart disease operated on and 25.5% of 986 congenital heart defects. Among them, there were 200 patients in acyanotic group and 48 patients in cyanotic group. Male versus female ratio was 1:1.28. The oldest patient was 59 years old female who had atrial septal defect. The mean age was 24.4 years old. The distribution of the lesions showed a large preponderance of atrial septal defects [37.19o] followed in frequency by ventricular septal defects [918.1%], patent ductus arteriosus [17.3%], tetralogy of Fallot [16.1%], and a variety of other complex malformations[3.2%]. In the pediatric age group, relative frequency was different from that of this adult group, showing ventricular septal defects, tetralogy of Fallot, patent ductus arteriosus and atrial septal defects in order of incidence. The hospital mortality and late mortality were 6.0% and 1.7% respectively. The causes of hospital death were low cardiac output in 10 patients, arrhythmia in 2, air embolism in 1, sepsis in 1 and respiratory failure in l. Clinical improvement upto NYHA functional class I or II postoperatively has been achieved and sustained in all patients following repair except the patients of late death and receiving reoperation. This result confirms that congenital heart defects in the adults can be corrected with a good outcome and an aggressive operative approach seems justified.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.334-337
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• 2014

Objective : The purpose of this study is to identify the risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) and the relationship of the severity of disease and prematurity. Methods : A total of 168 premature neonates whose birth weight ${\leq}1500g$ or gestational age ${\leq}34$ weeks were examined by cranial ultrasound (CUS) for detection of GM-IVH among the babies admitted between January 2011 and December 2012 in our medical center neonatal intensive care unit. The babies were divided into two groups : GM-IVH and non-IVH. Clinical presentations, precipitating factors of the patients and maternal factors were analyzed. Results : In univariate analysis, gestational age, birth weight, delivery method, presence of premature rupture of membrane (PROM) and level of sodium and glucose were statistically meaningful factors (p<0.05). But only two factors, gestational age and presence of patent ductus arteriosus (PDA) were statistically meaningful in multivariate logistic regression (p<0.05). Delivery method [normal vaginal delivery (NVD) to Caeserean section] was borderline significant (p<0.10). Conclusion : Presence of PDA and gestational age were the important risk factors associated with development of GM-IVH.

• Journal of Chest Surgery
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• 제26권12호
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• pp.915-919
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• 1993

The management of Patent Ductus Arteriosus[PDA] with heart failure and cardiac cachexia in premature infants have been a disturbing and controversial problem in the field of pediatric cardiovascular surgery.We analysed our experiences to determine the rationale of surgical closure of PDA in infants . During a period of 7 years from January 1986 to December 1992, 12 infants under 2 months of age underwent operations for "hemodynamically significant" PDA which had caused severe heart failure.There were 6 male and 6 female patients. Their mean gestational age was 33.8 weeks and their mean body weight was 1990 g. ranged from 710 g. to 2900 g. Mean age at operation was 28.5days. Seven patients had history of Indomethacin trial. All patients were operated with double ligation technique under general anesthesia.There was no mortality and blood transfusion was not necessary in any patient during the operation.In all cases, we could confirm the complete closure of PDA after operation by follow-up echocardiography.Two patients died during their hospital stay and 1 patient died at 6 months after operation. The causes of death were sepsis with congestive heart failure, necrotizing entero colitis and pneumonia respectively.We can not detect any operation related complication which resulted in permanent sequelae as well as delayed complications related to nerve damage. These results indicate that surgical ligation of PDA in infants with severe heart failure is relatively safe and effective.effective.

• Journal of Chest Surgery
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• 제18권4호
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• pp.542-548
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• 1985

In 1966 Porstmann was the first to successfully apply a new method by which a PDA was closed by a Plug transported by catheters through the femoral artery. We Successfully closed the isolated PDA in 6 consecutive patients using the transfemoral catheter method. To Perform this technique more safely and reliably, some instrumental and technical improvements was made. The Indications for this method have been Expanded to include the cylindrical or window Type ductus as well as the conical-shaped ductus. Classification into three Groups of the configuration of the by Angiography has been useful in selecting the shape of the closing plug. Whenever feasible, we consider the catheter technique to be the method of choice to close the ductus.

• 한국임상수의학회지
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• 제28권2호
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• pp.236-239
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• 2011

10년령의 암컷 말티즈견이 지속성 심잡음을 주증으로 내원 하였다. 환축은 2차원 색채 도플러 심초음파 및 컴퓨터 단층촬영을 통해 동맥관개존증 (PDA)으로 진단되었다. 심혈관조영술을 통해 동맥관의 형태 및 크기에 대해 정확히 평가한 뒤, 동맥관 폐쇄를 위해 경도관 coil 색전술이 실시 되었다. 환자는 단일 coil을 이용하여 동맥관의 완전폐쇄가 이루어 졌으며, 폐쇄직후 지속성 심잡음이 사라지고 잔류혈류가 관찰되지 않았다. 시술 후 합병증은 발생하지 않았다. 임상증상, 심장검사 그리고 혈청 troponin-T 농도의 정기적인 평가를 통하여 환자의 상태를 관찰 하였는데, 변화가 없었다. 결론적으로 본 증례의 경우 coil색전술을 이용한 성공적인 동맥관개존증 폐쇄술에 대한 국내 첫 증례보고이다.

• Journal of Chest Surgery
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• 제12권2호
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• pp.105-109
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• 1979

Since 1973, 40 patients with Patent Ductus Arteriosus were operated in The Department of Thoracic and Cardiovascular Surgery, Korea University Medical College. Clinical analysis of these cases: 1. Age ranged from 8 months old to 28 years old Sex ratio was 22 females to 18 males. 2. Pulse pressure widening above 50 mmHg was appeared in 27 patients. In 31 patients, continuous machinery murmur was heard on left second and third intercostal space, but 9 patients has holosystolic murmur on left sternal border. 3. Retrograde Aortography was performed in 11 patients and right heart catheterization, 17 patients, In 8 patients, pulmonary hypertension [above 30 mmHg in` systole] was noted. 3 out of 8 patients was combined with Ventricular Septal Defect. Severe pulmonary hypertension [above 80mmHg in systole] was presented in 3 patients. 4. In 38 patients, operative method was performed with multiple suture ligation of PDA, and in 2 patients, suture closure through pulmonary arteriotomy under cardiopulmonary bypass. 5. One operative death occurred in a patient in this group. Cause of death was right heart failure after multiple suture ligation of PDA and pulmonary artery bandings.