• The Korean Journal of Nuclear Medicine
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• v.7 no.2
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• pp.27-34
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• 1973

Pulmonary perfusion scan with radioactive $^{113m}In$-iron hydroxide particle was performed in the 25 cases of heart disease which had been diagnosed by cardiac catheterization prior to surgery from July, 1972 to July, 1973 at the Department of Radiology and Nuclear Medicine, Yonsei Medical College. It consists of 7 mitral stenosis, 2 mitral insufficiency, 1 aortic insufficiency, 3 atrial septal defect, 5 ventricular septal defect, 2 patent ductus arteriosus, 1 transposition of great vessel and 4 Tetralogy of Fallot. Findings of pulmonary perfusion scan in relation to hemodynamic data of cardiac catheterization were examined. 1) Out of 10 cases of acquired valvular heart disease, In 6 cases of mitral stenosis and 1 case of aortic insufficiency, radioactivity was increased at both upper lung. This finding is noted when pulmonary wedge or venous pressure was elevated above 22 mmHg and arterial systolic pressure above 33 mmHg. 2) Out of 15 cases of congenital heart disease. In almost all cases of atrial septal defect and ventricular septal defect except 2 cases, radioactivity was even at both entire lung. In 2 cases of patent ductus arteriosus, radioactivity was decreased especially at the left lung. It is observed that in acyanotic congenital heart disease, radioactivity of lung is not related with pulmonary arterial pressure. In 3 cases of Tetralogy of Fallot, radioactivity was even at both entire lung and in 2 of them, extrapulmonary radioactivity of liver or kidney which depends on size of defect and volume of right to left shunt reversible, was noted.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.828-841
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• 1988

To predict the postoperative hemodynamic status of right ventricle preoperatively, a retrospective analysis was undertaken to determine the influence of pulmonary artery size on postoperative right ventricular pressure in 32 consecutive patients with tetralogy of Fallot who underwent total correction between July, 1987 to June, 1988 at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. We have related the ratio of the postrepair peak systolic pressure in the right ventricle and the systemic systolic arterial pressure[PRV/Ao] to the preoperative cineangiographic measurement of pulmonary arterial tree, expressed as pulmonary artery index[PAI], the ratio of diameter of the right pulmonary artery to diameter of ascending aorta[r.PA/A.Ao], the ratio of right and left pulmonary artery to diameter of descending aorta[r.I.PA/D.Ao] There was tendency that the postrepair PRV/Ao seems to be related to the preoperative diameter of right and left pulmonary artery, but there were no statistically significant correlation with PAI, r.PA/A.Ao, r.l.PA/D. Ao to the ratio of the postoperative peak systolic right ventricular pressure and systemic systolic arterial pressure[PRV/Ao]. There was tendency to decrease the postoperative right ventricular pressure[PRV/Ao] about 11.2%[P < 0.025] within several hours than immediately after repair, but after then, there was no change of right ventricular pressure[PRV/Ao] significantly. There was good correlation of pressure change between the immediate and late postrepair right ventricular pressure[48 hour], and the derived linear regression line was; y=0.68534 0.1994[r=0.57294, P < 0.001]. There was no operative death due to residual high right ventricular pressure[PRV/Ao >0.75] related to hypoplastic pulmonary arterial development, thus we expect, for symptomatic patients even infants, that complete repair can be attempted when the pulmonary artery index[PAI] is over 108mm2/BSA, RPA/AAo is over 0.35, RPA LPA/D. Ao is over 1.36.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.639-645
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• 1996

A 14-year-old male patient with previous surgical repair of tetralogy of Fallot was admitted with hemodynamically significant ventricular tachycardia (VT). On preoperative electrophysiologic study (EPS), the morphology of documented VT was RBBB of vertical axis with 320 msec cycle length. The endocardial mapping during VT delineated the origin of VT at right ventricular outflow tract (RVOT), where the patch was attached. The clinical VT had a clockwise reentry circuit around the patch with the earliest activation at the same site seen during the preoperative EPS. The previously placed right ventricular outflow patch and fibrous tissue were removed. During a postoperative EPS, it was no longer possible to induce the VT. Ventricular tachycardia following repair of tetralogy of Fallot seen in this patient was caused by a macro-reentry around the right ventricular outflow patch. We were able to ablate the VT with the aid of a detailed mapping of its epicardial activation sequence.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.627-632
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• 1986

This report describes our 17-years experience with intracardiac repair in 123 patients older than 15 years with tetralogy of Fallot. Major clinical manifestation was cyanosis and clubbing [102 Pts], but other minor associated manifestation were infective endocarditis, pulmonary tuberculosis, brain abscess, congestive heart failure, nephrotic syndrome, and tuberculous spondylitis. Prior palliative shunts had been performed in 10 patients. Preoperative hemoglobin ranged from 9.7 gm/dl to 25 gm/dl [mean 19 gm/dl]. The type of ventricular septal defect were typical perimembranous type, and total canal defect [13%]. The right ventricular outflow tract obstruction was due to combined [58.5%], infundibular [35%], and valvular stenosis [6.5%]. Transannular patch was used in 17% of patients. Hospital mortality was 9.8% in overall, but decreased to 1.7% since 1982. There was two late death [12 year actuarial survival [97%] due to fulminant hepatitis, residual abnormalities [PS, VSD]. Ninety two percent of survivors at follow-up are asymptomatic and leading an active normal life. Residual ventricular septal defect was detected with radionuclide single pass study in 15.3% of patients but almost cases were Qp/Qs less than 1.5, and only two patients had been candidates for reoperation.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.749-755
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• 1998

Background: Twelve patients with acyanotic tetralogy of Fallot(TOF), characterized by the combination of a malaligned ventricular septal defect(VSD) and infundibular pulmonic stenosis with the clinical finding of acyanosis at rest, underwent surgical correction between January 1988 and July 1997. Materials and methods: 9.92% of patients with the diagnosis of TOF were acyanotic TOF in the same period. Ages ranged from 12 to 42 months(mean 25.2 months). 2D-echocardiographic studies, cardiac catheterization, and angiocardiograms were performed in all patients before operation. The preoperative mean systemic arterial oxygen saturation was 93.5%. According to the 2D-echocardiographic analysis, there was Lt-to-Rt shunt through VSD in 4 patients, bidirectional shunt in 2 patients, and no shunt in 6 patients. Results: The preoperative mean right ventricle to pulmonary artery(RV-PA) pressure gradients were 52.3 mmHg on 2D- echocardiogram and 48.4 mmHg on cardiac catheterization. The repair of ventricular septal defect was performed through a right atrial approach and the hypertrophic infundibular muscle bundles were resected by the transatrial and transpulmonary approach. Six patients(50%) received a transannular patch. The mean cardiopulmonary bypass time was 135.0 minutes, and the aortic crossclamp time was 87.8 minutes. Postoperative complications included bleeding necessitating reentry in one and chylothorax in one. No patient died after operation and there were no late deaths. Postoperative 2D-echocardiograms revealed tiny patch dehiscence in 5 cases and a moderate RV-PA pressure gradients(mean 15.3 mmHg). All patients were in New York Heart Association functional class 1 after operation. Conclusions: acyanotic TOF is the uncommon form of TOF, and acyanotic TOF can be repaired with a good outcome.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.122-133
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• 1986

Thirteen patients with cyanotic cardiac malformations having more complex intracardiac defects, hemodynamics and operative procedures than ones in Tetralogy of Fallot undertaken total surgical corrections from July 1981 to August 1985. The cases of corrective surgery for complex cardiac malformations were 3.9% of all congenital cardiac malformations and 12.6% of cyanotic cardiac malformations. Six patients died within 30 days after surgery. So operative mortality was 46%; Transposition of the great arteries, two of 4 patients, due to low cardiac output syndrome and tracheal bleeding ; Univentricular heart, one of 3 patients, due to bleeding; Corrected transposition of the great arteries, one of 2 patients, due to acute heart failure; Tricuspid atresia, one of 2 patients, due to low cardiac output syndrome; Double outlet right ventricle, one of single patient, due to respiratory failure. The cases of surgical correction for complex cardiac malformations are progressively increasing in numbers. The more accurate evaluation of anatomical condition and hemodynamics in preoperative diagnosis, studies on applicable surgical procedure and perioperative care of patients are necessary in the improvement of clinical and surgical results.

• Journal of Chest Surgery
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• v.11 no.3
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• pp.281-295
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• 1978

Last year in this department 100 cases of open heart surgery were done annually. This year 200 cases of open heart surgery were scheduled. During the first 6 months of this year 112 open heart surgery cases were done with 13 deaths [11.6%]. There were 72 cases of cougenital malformation with 9 operative deaths [12.5%], consisting of 23 acyanotic cases with one death [4.5%] and 49 cases of cyanotic cases with 8 deaths [16.3%]. Out of 40 tetralogy of Fallot, 6 cases expired [15%]. For 39 cases of acquired valvular heart disease and one Ebstein anomaly valves were replaced with 4 operative deaths [10%]. Single valve replacement in 33 with 3 operative deaths and double valve replacement in 7 cases with one death were noted. Two patients expired among 28 mitral valve replacement cases [7.1%]. Among 7 double valve replacement patients, consisting of 3 mitral and aortic and 4 mitral and tricuspid valve replacement one case expired. In a case of Ebstein anomaly, tricuspid valve was replaced with plication of atrialized right ventricle successfully. The operative result was excellent.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.654-658
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• 1990

Between January of 1980 and December of 1989, we are encountered 121 cases of Down syndrome here at Yonsei University Medical Center. of these being endocardial cushion defect, ventricular septal defect, tetralogy of Fallot, atrial septal defect, patent ductus arteriosus and complicated anomalies. The mean age was 1 month 2 years with the sexual division at 31 males and 29 females. Among these 60 patients, 10 of them were treated trough surgical management, 8 of them being open heart surgeries, the 8 open heart surgeries are broken down as follow: 4 total correction of ECD, 2 patch repair of VSD, 1 total correction of TOF, 1 patch repair of ASD secundum. Another 2 operative management are ligation of PDA and modified Blalock - Taussig shunt of TOF. Postoperatively all patients were weaned and extubated on an artificial ventilator without any respiratory complications, and were discharged without incident.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.247-258
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• 1979

Two hundred and six cases of open heart surgery were done with over all mortality of 8.3% during 1978 in this Department. There were 130 congenital and 76 acquired cases. In congenital anomaly 58 cases were acyanotic and 72 cyanotic, which showed 3.4% and 12.5% of operative mortality respectively. Thirty-six cases of ventricular septal defect and 10 atrial septal defect were repaired without mortality but in 60 cases of tetralogy of Fallot it was 10%. In 76 cases of acquired lesions 74 were valvular cases. There were 75 cases of valve replacement with over all operative mortality of 8%. In 75-valve replacement one case of Ebstein anomaly was found. There were 62 cases of single valve and 13 double valve replacement. In every case tissue valve was utilized and coumadin and Persantin 75 were administered as anticoagulant treatment for one year.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.116-121
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• 1999

Unilateral hypoplasia of the pulmonary artery is an uncommon anomaly, which commonly develops in combination with congenital cardiovascular defects such as tetralogy of Fallot, patent ductus arteriosus and septal defect of atrium or ventricle, but may also present as an isolated lesion. We have recently experienced a case of the left pulmonary artery hypoplasia in adult by chance of during the general health screen, which diagnosed by chest X-ray, chest spiral CT, lung perfusion and ventilation scan, digital substraction angiogram and bronchoscopy, then presented hereby with the review of relevant literature.