• Journal of Chest Surgery
• /
• 제30권7호
• /
• pp.656-662
• /
• 1997

대동맥판막 질환에 대한 판막 성형술이 판막 치환술의 대치 방법으로 대두되고 있는 가운데, 서을 대학교 병원 흉부외과에서는 1995년 3월부터 1996년 8월까지 14명의 환자에서 자가 심낭 편을 이용한 판막첨 연장 술로 대동맥 판막성형술을 시행하였다. 평균 연령은 34.8$\pm$15.3세이었으며, 남자가 11명, 여자가 3명이었다. 수술전 시행한 심초음파 검사 및 심도자 검사에서 협착증을 동반하지 않은 대동맥판막 폐쇄부전증 환자로 폐쇄부전 정도는 평균 3.4$\pm$0.65였으며, 이중 4명의 환자에서 중등도 이상의 승모판 폐쇄부전증을 동반하고 있었다. 수술은 0.625% glutaraldehyde 용액에 15분간 고정시킨 자가 심낭 편을 이용하였으며, 12명의 환자에 서는 세 개의 판막첨을 모두 연장시켜 주었으나, 2명의 환자에서는 상대적으로 짧은 판막의 판막첨만을 연장 시켜 주었으며, 승모판 폐쇄부전증을 동반한 4명에서 승모판 성형술을 동시에 시행하여 주었다. 14명 모두에 서 수술중 경식도 심초음파 검사를 시행하여 폐쇄부전이나 협착이 없는 것을 확인하였다. 수술 후 평균 7.4 $\pm$2.1일에 심초음파 검사를 시행하였으며, 경도의 대동맥판막 폐쇄부전이 3명에서 나타 돛만\ulcorner 승모판 성형 술을 시행한 환자 중 1명에서 경한 정도의 승모판 폐쇄부전이 나타났다. 좌심실의 수축기말과 확장기말 구획 은 수술 후 통계적으로 유의한 정도(p<0.05)의 감소를 보였다. 수술 직후의 사망 환자는 없었다. 수술 후 평균 7.9$\pm$5.9개월간 추적 조사 기간 중 만기 합병증은 2명에서 나타났다. 심내막염 및 대동맥 판막의 증식물이 수술 후 7개월 째 발견되어 대동맥 판막 치환술을 시행 받은 환자가 1명 있었으며, Behcet증후군 환자에서 수술 후 3개월 째 갑작스런 대동맥판막 폐쇄부전증이 나타나 Ross수술을 받은 환자가 1명 있었다. 대동맥 판막의 판막첨 연장술의 조기 성적은 만족할 만한 결과를 보였으며, 특히 젊은 연령의 폐쇄부 전증 환자에서 판막치 환술의 대치술로 우수한 것으로 판단된다. 그러나 자가 심방편의 비후,석회화,또는 파열 등의 내구성에 대한 오랜 기간의 추적 검사가 필요하리라 본다.

• Journal of Chest Surgery
• /
• 제29권3호
• /
• pp.331-336
• /
• 1996

Glutaraldehyde용액에 고정시킨 자가심낭을이용해서 판막첨 연장을시키는대동맥 판막 성형술을4 례에서 시행하였다 이 4례의 환자들은 수술전 심초음파 검사 및 심도자검사에서 모두Grade W의 대 동맥 판막 폐쇄부전증이 있었으며 이중 2례는 류마티스성 열이 원인이었고, 1례는 퇴행성 변화였으며 나머 지 1례는 원 인을 알 수 없었다. 사용된 자기성남은 0.625% Glutaraldehyde 용액 에 15분간 고정시킨 뒤, 생 리식 염수로 15분간 잘 씻어낸 후 사용하였다. 이 4례의 환자들은 판막첨 의 모양 및 크기 등이 서로 달랐고,따라서 각 병변에 맞게 판막첨 연장술을시행하였기에 각례의 수술들이 모두다른 형태로이루 어겼다. 병 원 사망율은 없었고, 항응고제 치료를 시행하지 않았으며, 혈전증 등의 합병증은 없었다. 모든 예에서 수술후 단순흉부촬영상 심장의 크기가 현저 히 감소됐으며, 수술후 시 행한 심초음파 검사에서 좌심실 수축기말 구획 (LVESD)과 착장기 말 구획 (LVEDD)도 현저히 감소되었다. 이 판막첨 연장술은그내구성과오랜기간 동안의 추적검사 결과가 아직 미지수이지만,비교적 간단하고 안전한 술식이라고 판단되며, 대동맥 판막 성형술에 효\ulcorner적 이라고 생각된다.

• Clinical and Experimental Pediatrics
• /
• 제49권9호
• /
• pp.917-929
• /
• 2006

Over the last several decades there has been a remarkable change in the therapeutic strategy of congenital heart disease. Development of new tools and devices, accumulations of experience, technical refinement have positively affected the outcome of interventional treatment. Many procedures including atrial septostomy, balloon valvuloplasty, balloon dilation of stenotic vessel with or without stent implantation, transcatheter occlusion of abnormal vascular structure, transcatheter closure of patent arterial duct and atrial septal defect, are now performed as routine interventional procedures in many institutes. In diverse conditions, transcatheter techniques also provide complementary and additive role in combination with surgery. Intraoperative stent implantation on stenotic vessels, perventricular device insertion, and hybrid stage 1 palliative procedure for hypoplastic left heart syndrome have been employed in high risk patients for cardiac surgery with encouraging results. Transcatheter closure of ventricular septal defect has been performed safely showing comparable result with surgery. Investigational procedures such as percutaneous valve insertion and valve repair are expected to replace the role of surgery in certain group of patients in the near future. Continuous evolvement in this field will contribute to reduce the risk and suffering from congenital heart disease, while surgery will be still remained as a gold standard for significant portion of congenital heart disease.

• Journal of Chest Surgery
• /
• 제12권1호
• /
• pp.50-55
• /
• 1979

The development of aortic insufficiency radically alters the physical findings which are generally associated with ventricular septal defect that was not hemodynamically significant, and the combination of the two lesions produces a typical clinical picture, that may be serious and life-threatening when it is left untreated. Therefore, the selection of patients, type and timing of surgical treatment is considered to be important. Among 114 cases of ventricular septal defect treated surgically utilizing cardiopulmonary bypass in the Department of Thoracic Surgery, Seoul National University Hospital, 7 cases were associated with aortic insufficiency. 1. Five cases were male, and 2 cases were female. Ages were from 4 years to 24 years, and mean age was 11.9 years. 2. In all cases, ventricular septal defect was closed with Teflon patch. In a case, a aortic valvuloplasty and in another, a aortic valve replacement with Hancock valve 23 mm., 5 months after the closure of ventricular septal defect were done. 3. Four cases were type I ventricular septal defect by Kirklin`s classification, 3 cases were type II ventricular septal defect, and diameters of ventricular septal defect were from 3.5 cm. to 0.7 cm. A PDA. was combined to a type I ventricular septal defect. 4. In 5 cases, herniation of the aortic cusp through the ventricular septal defect and in a case, annulus dilatation on the aortic valve was noted. 5. Two cases with type I ventricular septal defect and severe pulmonary hypertension expired. A re-opened case with type II ventricular septal defect expired. 6. Four cases were alive, and all of them show decrease of pulse pressure and aortic insufficiency.

• Journal of Chest Surgery
• /
• 제19권2호
• /
• pp.280-287
• /
• 1986

Between March 1978 and August 1985, 29 cases at various congenital heart diseases were reoperated because of remnant shunt of residual anomalies at Seoul National University Hospital. They were consisted of 10 cases of Tetralogy, 4 simple VSD, 6 complicated VSD. 3 partial ECD, and 5 other rare congenital anomalies. The interval between the initial and the second procedure ranged from 1 day to 122 months [mean; 26.9 months]. In 4 cases of them, the second procedure was done during initial hospitalization within 3 weeks post-operatively. The primary operation intended to be corrective surgery except four whose primary operation was palliative or exploratory one even though it was done with extracorporeal circulation. The indication for second operation was mainly residual shunt or valvular obstruction due to patch detachment or inadequate relief of stenotic lesion. Others were paravalvular leak, valvuloplasty failure, prosthetic valve failure, and inadequate primary diagnosis. Four patients were dead [14.3%]; three complicated VSD`s and one Tetralogy. There were 7 cases of nonfatal complication with subsequent improvement except one [diffuse cerebral dysfunction].

• Journal of Chest Surgery
• /
• 제30권2호
• /
• pp.209-212
• /
• 1997

15세 남자환자가 갑자기 발생한 흉통과 각혈, 호흡곤란을 주소로 본원 응급실로 내원하였다. 환자는 동맥관 개존증 및 감염성 심내막염띠 합병된 폐색전증으로진단되었다. 3주간 적절한 항생제 치료를 한 후 체외순환하에 동맥관 개존증 패취봉합 및 폐동맥 판막 성형술을 시행하였다. 이후 환자는 순조롭게 회복되어 퇴원 하였다. 동맥관 개존증에 합병된 급성심내막염으로 폐동맥 혈전증이 발생한 환자를 수술 치험하여 좋은 결과를 얻었기 에 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제18권3호
• /
• pp.407-413
• /
• 1985

Ruptured aneurysms of the sinus Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Five patients underwent operative treatment in Catholic Medical Center in recent 2.5 year period. Three patients were male and two patients were female, ages ranged from 20 to 54 years. Bacterial endocarditis was suspected or proved in 3 patients. In 3 patients in our series had a ruptured congenital aneurysms and in 2 patients acquired aneurysms by bacterial endocarditis. Associated cardiac lesions were common; such as aortic insufficiency in 3 patients, atrial septal defect in 2 patients, mitral stenoinsufficiency in 1 patient and tricuspid insufficiency in 1 patient. All aneurysmal ruptures of the sinus Valsalva arose from right coronary sinus and in 4 patients ruptured into right ventricle and in 1 patient into right atrium. Surgical techniques consisted of direct closure 4 in patients and closure with Dacron patch in 1 patient. And we preferred double approach, that is, through both the aorta and the involved cardiac chamber in cases in whom aortic insufficiency was present. So additional aortic valve replacement performed in 2 patients due to severe aortic insufficiency and aortic valvuloplasty performed in 1 patient. One patient who underwent direct closure of ruptured sinus Valsalva and double valve replacement died due to low cardiac output syndrome just after the operation. Operative results were relatively good in remainders.

• 한국동물위생학회지
• /
• 제40권3호
• /
• pp.215-217
• /
• 2017

A 3-year-old chow chow dog with abdominal distention was referred to the Veterinary Teaching Hospital of Chungnam National University. The dog was diagnosed as Cor triatriatum dexter based on echocardiographic results, which demonstrated an abnormal membrane partitioning the right atrium. Echocardiography also revealed turbulent intra-atrial blood flow between the two chambers of the atrium. The dog was treated with balloon dilatation to enlarge the perforation in the abnormal membrane and to improve blood flow. As a result, although the membrane remained, increased perforation reduced the turbulent intra-atrial blood flow. Clinically the patient improved and eventually was discharged. This case is the first domestic Korean clinical veterinary report on the use of balloon valvuloplasty to treat Cor triatriatum dexter in a dog.

• Journal of Chest Surgery
• /
• 제40권3호
• /
• pp.232-235
• /
• 2007

외상성 대동맥판막 손상 환자에게 대동맥 판막 성형술과 대동맥 판막 치환술로 각각 치료한 2예를 보고한다. 한 명은 18세 남자 환자로 대동맥 판막 성형술을 시행하였으나 수술 후 5년째 중등도의 잔존한 대동맥판막폐쇄부전증으로 추적관찰 중이며 다른 64세 남자 환자는 기계판막 치환술 후 관찰 중이다. 신중하게 선택된 일부의 환자를 제외한 외상성 대동맥판막폐쇄부전증에는 판막치환술을 우선적 수술 방법으로 귄유한다.

• Journal of Chest Surgery
• /
• 제21권4호
• /
• pp.641-648
• /
• 1988

Between April 9, 1986 and September 2, 1987, 134 patients underwent open heart surgery with hypothermic cardiopulmonary bypass and cold blood cardioplegia. There were 65 patients[48.5%] of acyanotic congenital cardiac anomalies, 19 patients[14.2%] of cyanotic congenital cardiac anomalies, and 50 patients[37.3%] of acquired heart diseases, which included 49 valvular diseases and 1 myxoma. In 84 congenital cardiac anomalies, 44 patients were male and 40 patients were female ranged in age from 2 years to 57 years. In 50 acquired heart diseases, 18 patients were male and 32 patients were female ranged in age from 10 years to 65 years. The common congenital defects operated were VSD in acyanotic cardiac patients, and Tetralogy of Fallot in cyanotic cardiac patients. Among 50 acquired heart diseases, 49 patient underwent operation for cardiac valvular lesions. 33 patients had mitral valve replacement and 7 patients had aortic valve replacement. 1 patient underwent aortic valvuloplasty and 8 patients had double valve replacement. The operative mortality rate was 3.1%[2 out of 65 patients] in acyanotic cardiac patients, 5.3%[1 out of 17 patients] in cyanotic cardiac patients, and 12.0%[6 out of 50 patients] in acquired cardiac patients, with overall mortality rate of 6.7%[9 out of 134 patients].