• Journal of Chest Surgery
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• 제21권4호
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• pp.649-655
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• 1988

One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.

• 한국임상수의학회지
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• 제32권3호
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• pp.243-246
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• 2015

9개월령 암컷 치와와(체중 1.5 kg)가 운동 불내성과 좌측 흉벽 심기저부의 큰 심잡음으로 의뢰되었다. 방사선 검사의 배복상에서 좌심실 종대 및 주폐동맥, 대동맥, 좌심방 확장의 전형적인 소견인 트리플범프(triple bump)가 확인 되었다. 심초음파 검사에서 동맥관이 확인되었으며 대동맥과 주폐동맥 사이에 좌우 방향의 연속적인 와류(최고 속도 5.73 m/s)가 측정되었다. 이 환자는 대퇴 정맥(정맥을 통한 접근)으로 접근하여 Amplatzer$^{(R)}$ vascular plug를 이용해 동맥관을 성공적으로 폐쇄하였다. 본 증례는 PDA를 대퇴 정맥으로 접근하여 vascular plug를 이용해 막은 국내 최초보고이다.

• 한국전자파학회논문지
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• 제21권8호
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• pp.900-904
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• 2010

본 논문에서는 주파수 가변이 가능한 영차 공진 안테나를 구현하였다. 제안된 안테나의 영차 공진 특성은 composite right/left-handed(CRLH) 전송 선로를 이용하여 구현하였고, 안테나의 소형화를 극대화하기 위해 버섯 구조의 접지 평면에 사각 슬롯을 설계하였다. 또한, 주파수 가변을 위해 슬롯이 있는 접지 평면에 가변 소자를 삽입하였다. 슬롯이 있는 접지 평면에 위치한 가변 소자의 on/off 상태에 따라, CRLH 전송 선로의 병렬 인덕턴스 값을 변화시킴으로 인해 안테나의 공진 주파수가 바뀌게 된다. 실험 결과, 제안된 안테나의 공진 주파수는 4.92 GHz에서 2.96 GHz로 변했다. 한편, 제안된 안테나의 크기는 일반적인 반파장 패치 안테나보다 최대 94.24 % 크기를 감소시킬 수 있었다.

• Journal of Chest Surgery
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• 제30권6호
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• pp.625-630
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• 1997

56세 남자 환자가 신경과에 내원하였는데, 그는 최근에 심해지는 우측 세번째에서 다섯번째 수지의 반복 적인 저린 통증과 파악력의 약화를 주소로 하였다. 이와 함께 보행시 하지 동통을 호소하였다. 경동맥 조영술상 우내경동맥이 완전히 막혀 있었고 좌우총경동맥과 외경동맥, 좌내 경동맥은 심각한 협착이 있었다. 함께 시행한 대동맥 조영술상 신동맥이하는 완전한 폐색을 보였고 양측 대퇴 동맥은 지연 조영 을 보였다. 두개의 동맥 병변에 대해 단계별로 수술 계획을 세웠다. 양측 경동맥 병변은 경동맥 내막절제술을 시행 하였다. 이 때 좌측은·경동맥 션트를 사용하였다. 복부대동맥 병변은 2주후에 시행되었으며 복강동맥하방의 대동맥을 결찰하고 허혈시 신장을 보존하기위 해 신보존액을 주입하였다. 역 Y 회로 이식술과 신보존을 시행하여 린분간의 허혈동안에도 성공적으로 시술되었으며 별다른 문제없이 술 후 보름만에 퇴원하였다.

• 대한의용생체공학회:의공학회지
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• 제19권2호
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• pp.163-170
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• 1998

인공심장의 주된 합병증인 혈전과 감염의 문제를 줄이고 장착 환자의 삶의 질을 높이기 위하여 체내 완전 매립형 전기 유압식 인공심장을 개발하고 있는 것과 이 모델을 이용한 동물실험에 대하여 보고하는 바이다. 이 인공심장은 혈액펌프, 유압구동기, 구동제어회로, 경피적 에너지-정보 전송시스템, 체내 받테리 등으로 구성되어 있다. 실험동물은 체중 62Kg의 송아지를 이용하였다. 흉강내 이식하는데 어려움은 없었고, 수술 후 생존하는 동안 혈역학적으로 문제는 없었으며 특이한 합병증도 발생하지 않았다. 그러나 이식 11일째 기계적인 결함으로 작동이 정지하였다. 앞으로 기계적 수명이나 생체적 합성 등의 문제 등히 해결되어야 할 것이다.

• 한국임상수의학회지
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• 제39권5호
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• pp.240-245
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• 2022

A 15-year-old, neutered male, Shih-Tzu, was presented at the Chonnam National Veterinary Medical Teaching Hospital for evaluation of acute onset of persistent coughing, exercise intolerance, and abnormal heart sound. On thoracic auscultation, a split-second heart sound and a wheezing sound were detected on both sides of the chest walls. On physical examination, the dog's body condition score (BCS) was 7/9, and had stenotic nares. Thoracic radiographs revealed right-sided enlargement of the cardiac silhouette (vertebral heart score (VHS) 11.2; reference interval = 8.9-10.1), mild main pulmonary artery (MPA) bulging, mild interstitial infiltration, and hepatomegaly. The electrocardiogram showed right axis deviation, suggesting right ventricular hypertrophy. The echocardiographic study showed moderate pulmonary hypertension and moderate tricuspid regurgitation. There were no findings of a tracheobronchial disease, pulmonary thromboembolism, congenital shunt, left heart disease, or parasitic disease. Based on clinical signs and diagnostic findings, the dog was diagnosed with pulmonary hypertension secondary to brachycephalic syndrome. To rectify respiratory exacerbating factors, the dog was recommended weight control by restricting dietary intake and managing concurrent Cushing's syndrome. Treatments included sildenafil, pimobendan, furosemide, and ramipril. After five months of taking medications and weight control, the severity of pulmonary hypertension improved from moderate to mild. The clinical signs of the patient, including coughing and exercise intolerance, improved a lot. For 5 months of follow-up, the patient has not reported further recurrence of respiratory distress.

• Journal of Chest Surgery
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• 제29권3호
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• pp.263-270
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• 1996

1986년 7월부터 1994년 12월까지 22명의 복잡심장기 형이 동반된 완전방실중격 결손증 환자 가 완전교 정 수술을 받았다. 연령 분포는6개월에서 11세까지로 평균연령은49.6$\pm$35.8개월이었으며 남녀 분포 는 남자가 7명, 여자가 15명이었다. 동반된 복잡심장기형은 팔로사징이 11명으로 가장 많았으며, 양대혈 관우심실기시증이 6명, 완전대 혈관전위가 4명, 수정 대 혈관전위가 1명이었다. 또한 다운 증후군은 팔로 사징 이 동반된 5예와 양대 혈관우심실기시증이 동반된 1예를 포함하여 6예 (27.3%)에서 있었다. 완전방 실중격 결손증의 Rastelli type은 대 부분이 Rastelli type C에 속하였다(type A ,3, typeB;2, type C: 17). 수술 방법은 전례에 있어 완전교정수술을 시 행하였고, 완전교정수술전 단락 수술을 시 행했던 경우가 6 예 있었다 22명의 환자 중 7명의 환자가 수술과 관련된 원 인으로 사망(31.8%)하였으며, 교정수술 후 기도내 흡 인에 의 한 폐렴 으로 1명의 환자가 수술 61일 후 사망하였다. 사망 원인으로는 수술후 심 폐 기 weaning failure, 저심 박출증 및 이로 인한 급성 신부전, 그리고 좌측 방실 판막의 중등도 이상의 폐쇄부전증과 우 핌 퓽\ulcorner綏括\ulcorner협착으로 재수술을 시행 받은 환자에서의 저심박출증 및 지속적 인 폐동맥고혈압, 심부전, 패혈증 등이 있었다. 완전교정술 후 재수술은 4명의 환자에서 시행 (18.2%)하였늘데 좌측방실판막의 폐 쇄부전증과 우심실유출로의 협착이 주된 이유였다. 외래추적관찰 기간은 평균 66.0 $\pm$ 26.7개월 (16.3개월~8.9년)이 었으며, 추적관찰 기간 중 실시한 심에코검사에서 좌측방실판막 폐쇄부전의 정도 및 우심유 출로의 헙착이 증가하여 좌측방실판막륜성형술과 우심유출로확장술을 받은 환자가 1명 있었다. 전반적으로 14명의 환자에서 양호한 경과(New York Heart Association functional class I~II)를 보이고 있다.

• Journal of Chest Surgery
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• 제44권6호
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• pp.392-398
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• 2011

Background: The tetralogy of Fallot (TOF) with pulmonary atresia (PA) and a ductus-dependent pulmonary circulation (no major aorto-pulmonary collateral arteries (MAPCAs)) has been treated with staged repair or primary repair depending on the preference of surgeons or institutions. We evaluated the 19-year outcome of staged repair for this anomaly to find out whether our surgical strategy should be changed. Materials and Methods: Forty-four patients with TOF/PA with patent ductus arteriosus (PDA) who underwent staged repair from June 1991 to October 2010 were included in this retrospective study. The patients with MAPCAs were excluded. The average age at the first palliative shunt surgery was $40.8{\pm}67.5$ days (range: 0~332 days). Thirty-one patients (31/44, 70%) were neonates. The average weight was $3.5{\pm}1.6$ kg (range: 1.6~8.7 kg). A modified Blalock-Taussig (BT) shunt was performed in 38 patients, classic BT shunt in 4 patients, and central shunt in 2 patients. Six patients required concomitant procedures: pulmonary artery angioplasty was performed in 4 patients, pulmonary artery reconstruction in one patient, and re-implantation of the left pulmonary artery to the main pulmonary artery in one patient. Four patients required a second shunt operation before the definitive repair was performed. Thirty-three patients underwent definitive repair at $24.2{\pm}13.3$ months (range: 7.3~68 months) after the first palliative operation. The average age at the time of definitive repair was $25.4{\pm}13.5$ months (range: 7.6~68.6 months) and their average weight was $11.0{\pm}2.1$ kg. For definitive repair, 3 types of right ventricular outflow procedures were used: extra-cardiac conduit was performed in 30 patients, trans-annular patch in 2 patients, and REV operation in 1 patient. One patient was lost to follow-up after hospital discharge. The mean follow-up duration for the rest of the patients was $72{\pm}37$ months (range: 4~160 months). Results: Ten patients (10/44, 22.7%) died before the definitive repair was performed. Four of them died during hospitalization after the shunt operation. Six deaths were thought to be shunt-related. The average time of shunt-related deaths after shunt procedures was 8.7 months (range: 2 days~25.3 months). There was no operative mortality after the definitive repair, but one patient died from dilated cardiomyopathy caused by myocarditis 8 years and 3 months after the definitive repair. Five-year and 10-year survival rates after the first palliative operation were 76.8% and 69.1%, respectively. Conclusion: There was a high overall mortality rate in staged repair for the patients with TOF/PA with PDA. Majority of deaths occurred before the definitive repair was performed. Therefore, primary repair or early second stage definitive repair should be considered to enhance the survival rate for patients with TOF/PA with PDA.

• Journal of Chest Surgery
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• 제20권1호
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• pp.22-29
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• 1987

From Sep. 1978 to Aug. 1986, 44 cases of Fontan operation were performed at Seoul National University Hospital. 1] The diagnoses were TA in 13 [38.6%], UVH in 21 [47.79`], DORV in 3 [6.8%], TGA in 2 [4.5%] and C-ECD with DORY in 1[2.3%]. 2] There were 20 operative deaths [44.5%]. 3] The operative risk factors were early date of operation between 1978 and 1983, young age below 3 years old, direct atriopulmonary anastomosis without roofing, and postoperative high CVP above 25cmH,O. But the relation between operative mortality and various cardiac diseases was absent. 4] survived patients were followed from 1 to 54 months except 3 patients who were lost to follow up. 16 patients were in functional class I and 1 in class II, 2 of the above 17 patients were reoperated due to residual right to left shunt. In remained 4 patients, 3 patients persisted cyanosis after operation and 1 patients died 1 month postoperatively due to pulmonary embolism. 5] As 4 result, the Fontan procedure can be done with a good result for tricuspid atresia and other complex lesions. The operative mortality can be reduced further with a correct anatomical diagnosis preoperatively, rigid operative criteria to pulmonary vascular resistance, direct atriopulmonary anastomosis with roofing, and use of `Venous Assist Device` postoperatively in low cardiac output patients.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1542-1549
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• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.