• Journal of Chest Surgery
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• 제16권1호
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• pp.34-39
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• 1983

The syndrome of anomalous muscle bundle dividing the right ventricle into two pressure chambers has been described by many authors. The malformation should not be confused with tetralogy of Fallot itself because the obstructive hypertrophic bands are usually proximal to the right ventricular infundibulum. One case [11 years old male] of double chambered right ventricle due to aberrant muscle bundle with intact ventricular septum is presented. The pressure gradient was 68 mmHg between inflow and outflow tracts of right ventricle on cardiac catheterization. On opening the right ventricle, there noted stenosis of outflow tract by infundibular membrane, hypertrophied anomalous muscle bundle, thickened moderator band & hypertrophied anterior papillary muscle. Open heart surgery was carried out with the aid of extracorporeal support, Anomalous muscle bundle [1.0 cm x 4.0 cm] and infundibular membrane were resected safely. The hypertrophied moderator band was cut at mid-portion and anterior papillary muscle was split vertically. The postoperative course was uneventful and discharged in good condition 2 weeks later.

• Journal of Chest Surgery
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• 제17권4호
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• pp.636-643
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• 1984

For the purpose of avoiding postoperative massive pulmonary insufficiency after transannular outflow tract reconstruction in patients with tetralogy of Fallot, we have used monocusp bearing outflow patch since June 1983. Right heart catheterization and pulmonary arteriography were performed in 7 patients among the total 11 patients corrected with monocusp bearing outflow patch during postoperative 14th day to 22nd day. Particular attention was paid to the evaluation of the pulmonary valve competence, and the results were; 1.One patient died of acute renal failure secondary to low cardiac output and the operative mortality was 9.1%. 2.The average PRV/FA ratio was 0.491 and the average systolic pressure gradient between right ventricle and pulmonary artery was 17.7mmHg. The average Qp/Qs was 1.13. 3.Inspite of using monocusp bearing outflow patch, the hemodynamic and pulmonary arteriographic results were unsatisfactory in respect to pulmonary valve competence.

• Journal of Chest Surgery
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• 제26권12호
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• pp.904-908
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• 1993

Twelve patients had undergone repair of atrioventricular septal defects. Age at operation ranged from 2.4 years to 17 years[mean, 8.25 years]. Five patients were male and seven were female. Three patients had complete atrioventricular septal defect[Rastelli type A] associated with Down`s syndrome. One of the three patient with complete atrioventricular septal defect had tetralogy of Fallot. Three patients had the intermediate form and seven patients had the partial form. The primum atrial septal defect was closed with pericardial patch. The atrioventricular valve septal commissure[mitral cleft] was closed with pledgeted sutures. Three complete atrioventricular septal defect were undergone by two-patch technique. A crescent-shaped Dacron patch was used to occlude the ventricular septal defect. One patient of partial form was sudden death 5 days postoperatively. There were no another complications after surgery. One patient underwent reoperation for opened mitral cleft 2.5 years postoperatively. New York Heart Association functional class of patients was improved postoperatively.

• Journal of Chest Surgery
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• 제17권2호
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• pp.250-256
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• 1984

Eisenmenger syndrome is a condition which systemic arterial blood oxygen unsaturation occurs if obstruction in the pulmonary capillaries raises the pulmonary vascular resistance and pulmonary arterial pressure to or beyond systemic levels and then a significant right to left shunt develops across a preexisting cardiac septal defect or an aortopulmonary communication-We have experienced 3 cases of similar condition. Case I is 24 year old man who has had cyanosis and dyspnea on exertion since childhood. His pulmonary arterial pressure was 110/80mmHg. He was operated under diagnosis of the mitral stenosis and tetralogy of Fallot, but it was finally discovered that he had patent ductus arteriosus and ventricular defect was closed with perforated prosthetic patch, but the patient expired due to right heart failure low cardiac output. Case II was 16 year old female who had pulmonary hypertension of 110/85mmHg. She was diagnosed as Eisenmenger syndrome combining with atrial septal defect and patent ductus arteriosus. Case III was 20 year old male. His pulmonary arterial pressure was 110/70mmHg and the underlying defect was patent ductus arteriosus.

• Clinical and Experimental Pediatrics
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• 제50권5호
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• pp.462-468
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• 2007

목 적 : 활로씨 4징 교정 수술을 받은 환자들에서 추적관찰 기간 동안 신호 평준화 심전도, 표준 12 유도 심전도 검사를 반복적으로 시행하고, 신호 평준화 심전도 상의 후전위, 심전도상의 QRS 기간, QT 간격 및 JT 간격, QRS 기간 분산, QT 간격 분산 및 JT 간격 분산을 측정하여 우심실 용적 부하 기간에 따른 변화를 알아보고자 하였다. 방 법 : 1985년 이후 경북대학교병원에서 활로씨 4징 교정 수술을 받고 1999년과 2005년에 표준 12 유도 심전도와 신호 평준화 심전도를 추적 관찰할 수 있었던 환자 9명을 대상으로 하였다. 대상 환자에서 1999년을 시점 1로, 2005년을 시점 2로 하여 각 시점별로 시행된 12 유도 심전도와 신호 평준화 심전도를 검토하여 표준 12 유도 심전도에서는 QRS 기간, QT 간격 및 JT 간격, QRS 기간 분산, QT 간격 분산 및 JT 간격 분산, SAECG에서는 f-QRS, HFLA, RMS, MV를 측정하였다. 결 과 : 시점 1과 시점 2 사이에서 JT 간격 분산은 통계학적으로 의미 있는 감소가 있었고($101.11{\pm}50.11$ vs $71.11{\pm}22.61ms$, P<0.05), HFLA는 통계학적으로 의미 있는 증가가 있었다($24.67{\pm}13.19$ vs $32.89{\pm}14.21ms$, P<0.05). 그러나 다른 계측치들은 유의한 차이가 없었다. 결 론 : 활로씨 4징 환자의 교정 수술 후 발생할 수 있는 폐동맥 역류증, 우심실 확장, 심실성 부정맥, 급사 등의 후기 부작용을 발견하기 위해 추적 관찰 기간 동안 심전도 및 신호 평준화 심전도를 시행 하였고,일부 계측치에서 유의한 변화를 발견할 수 있었다(JT dispersion, HFLA). 그러나 이러한 계측치의 유의한 변화와 활로씨 4징 환자의 수술 후 예후간의 관계를 규명하기 위해 더 많은 환자에서 더욱 장기적인 추적 관찰이 필요하다.

• 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.

• Clinical and Experimental Pediatrics
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• 제50권10호
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• pp.976-981
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• 2007

목 적 : 팔로 4징 교정술 후 만기 추적 관찰 중인 청소년 및 성인환자에서 대동맥근 확장정도를 평가하고, 이를 통해 장기 추적 관찰 상 발생하는 대동맥근 확장과 대동맥판 폐쇄 부전의 관련 요인 및 환자군의 특성에 대해 알아보고자 하였다. 방 법 : 본원에서 활로 4징의 완전 교정술을 받은 후 장기 추적 관찰중인 15세 이상의 청소년 및 성인 총 130명의 환자를 대상으로 대동맥근 직경의 측정치와 기대치의 비가 1.5이상인 대동맥근 확장군(n=17)과 비확장군(n=113)으로 분류하여 임상적 특성과 교정술 시행 후 얻을 수 있는 첫 심초음파 검사 소견과 최근 추적관찰상의 대동맥근 직경 및 변화율의 차이를 조사하였다. 결 과 : 활로 4징의 완전 교정술을 받은 총 130명의 환자들 중 대동맥근 확장군은 17명(13%), 대동맥근 비확장군은 113명이었다. 동반된 폐동맥판 폐쇄의 빈도와 체폐 단락술의 백분율은 대동맥근 확장군에서 더 높았으나 교정술시의 연령, 추적관찰기간, 고식술과 교정술사이의 시간간격, 우측 대동맥궁의 빈도는 두 군 간의 유의한 통계적 차이는 없었다. 진단 당시와 최근의 대동맥근 직경 지수와 대동맥근 직경의 측정치/기대치 비는 모두 대동맥근 확장군에서 높았다. 또한 대동맥근 확장군에서 대동맥근 직경과 대동맥근 직경 지수의 변화율이 높았고 중등도 이상의 대동맥판 폐쇄부전이 더 많았으며 좌심실 확장기말 용적도 더 컸다. 결 론 : 팔로 4징의 교정술 후 장기 추적 관찰에 있어 일부 환자에서는 진행적인 대동맥 확장과 대동맥판 폐쇄 부전이 나타날 수 있어, 과거에 교정술을 시행받고 장기 추적 관찰 중인 성인 환자에서 더욱 중요하게 검토해야 할 요인으로 생각된다.

• Journal of Chest Surgery
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• 제24권7호
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• pp.674-684
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• 1991

The surgical treatment of tetralogy of Fallot [TOF] was initiated by Blalock and Taussig in 1945 with the establishment of the subclavian artery to pulmonary artery anastomosis. In an imaginative and daring effort, in 1954, Lillehei and collaborators [1955] using controlled cross-circulation, carried out the first intracardiac repair of TOF by closing the ventricular septal defect [VSD] and relieving the pulmonary stenosis under direct vision. Nowadays, total correction is the ideal operation for treatment of TOF and is accomplished with extracorporeal circulation. And the results of surgery for TOF have steadily improved over the years, thanks to important contributions of many surgeons. Nevertheless because of its protean physiologic and anatomic presentation, TOF continues to offer challenges to cardiologist and cardiac surgeons. Thirty two cases of TOF have undergone total corrective surgery using extracorporeal circulation in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, Inje University, from Oct. 1985 to Feb. 1990. Clinical considerations were applied to these cases and the results were obtained as follows. 1. The heart lung machine used for extracorporeal circulation was SarnsO 7000, 5-head roller pump, and the number and type of oxygenators were 10 of bubble type and 22 of membrane type. The mean bypass time was 148.9 minutes and the mean aortic cross clamp time was 123.8 minutes. The GIK [glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 2. 20 cases were male and 12 were female, the mean age was 8 years old and the mean body weight was 25Kg. 3. The preoperative symptoms were cyanosis [29 cases], squatting [27 cases] and etc. The mean values of preoperative Hb., Hct., and SaO2 were 16.5 gm /dl, 50.3%, and 78.5%. 4. Combined anomalies were noticed in 16 cases [50%]. Among them 10 cases were PFO and 6 cases were ASD. 5. The degree of aorta overriding were 25% in 5 cases, 25 ~ 50% in 22 cases and above 50% in 5 cases. The dPA/Ao [ratio of diameter of pulmonary artery trunk to ascending aorta] were below 25% in 5 cases, 25 ~ 50% in 10 cases, 50 ~ 70% in 6 cases and above 75% in 11 cases. 6. The types of RVOT [right ventricular outflow tract] stenosis were valvular and infundibular in 14 cases [43.6%], diffuse hypoplastic type in 12 cases [37.5%], infundibular in 5 cases, and valvular and supravalvular in 1 case. 7. One stage radical corrective surgery was applied to the all cases. In widening of the RVOT, 3 types of patches were used: MVOP [monocusp ventricular outflow patch, Polystan BioprosthesesO] in 3 cases, knitted Dacron vessel patches in 2 cases, and double layer with bovine pericardium and woven Dacron prosthesis in 26 cases. 8. Postoperative complications were occurred in 15 cases. Among them, low output syndrome were occurred in 10 cases [31.3%] and 2 of them were expired postoperatively.

• Journal of Chest Surgery
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• 제20권1호
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• pp.30-38
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• 1987

Sixty-eight consecutive patients have been subjected to total corrective surgery of tetralogy of Fallot at the Hanyang University Hospital between August 1975 and December 1984. Of these, the pressure of chambers and great arteries were measured, before and immediately following an operation in 39 of the survived group and 11 of the expired group. The values of postoperative peak pressure were correlated with the outcome of the operation. The result are as followings; 1] Compared to the average peak pressure of right atrium in the survived group, 14.46*4.16 mmHg, that in the expired group, 19.36*8.19 mmHg, was significantly lower, 2] Compared to the average systolic pressure of right ventricle in the survived group, 56.72z16.37 mmHg, that in the expired group, 70.45*15.26 mmHg, was significantly lower. 3] Compared to the average systolic pressure of pulmonary artery in the survived group, 33.26*12.95 mmHg, that in the expired group, 37.55*11.63 mmHg, was higher. But the difference was not significant. 4] Compared to the average peak pressure of left atrium in the survived group, 17.41*6.90 mmHg, that in the expired group, 31.18*12.47 mmHg, was significantly higher. 5] Compared to the average systolic pressure of left ventricle in the survived group, 103.82~12.83 mmHg, that in the expired group, 90.55*20.02 mmHg, was significantly lower. 6] Compared to the average value of the right ventricle-pulmonary artery systolic pressure gradient [RV-PA] in the survived group, 24.95a15.44 mmHg, that in the expired group, 35.09*17.01 mmHg, was significantly higher. 7] Compared to the average value of the right ventricle to left ventricle systolic pressure ratio [RV/LV] in the survived group, 0.55*0.15, that in the expired group, 0.80a0.20, was significantly higher. 8] Compared to the average value of the pulmonary artery-left atrium peak pressure gradient [PA-LA] in 15.85x12.29 mmHg that in the expired group, 4.18x6.00 mmHg, was significantly lower. It is, therefore, suggested that in the operating room, PA-LA is as valuable as RV - PA, RV/LV in making important surgical decision and predicting the prognosis.

• 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.