• Journal of Chest Surgery
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• v.34 no.1
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• pp.57-63
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• 2001

배경: 대동맥판막협착증 환자는 판막질환으로 인한 만성적인 후부하의 증가에 대한 보상성 좌심실 심근비후가 일어나게 된다. 대동맥 판막 치환 후 좌심실 심근 비후의 감소가 이루어지는 것으로 알려져 있으나 21mm이하의 작은 인공판막으로 치환시 좌심실 심근 변화에 대해 논란이 있다. 대상 및 방법: 1994년 9월부터 1998년 7월까지 한림대학교 강동성심병원 흉부외과에서 대동맥판막협착증으로 진단받고 판막치환술을 시행한 20명을 대상으로 하였다. 환자는 남녀 각각 13명, 7명이며 평균나이 61$\pm$13.8세 체표면적은 평균 1.57$\pm$0.14m$m^2$이었다. 환자의 추적관찰은 수술 전, 수술 후 초기(평균 10.4일) 및 수술 후 만기(평균 29.9개월)에 심초음파로 시행하였다. 환자들은 사용된 판막에 따라 2개의 군(1군;21mm 이하, 2군;23mm이상)으로 나누었다. 결과: 모든 군에서 NYHA Functional class의 유의한 감소가 있었다. 좌심실 구추률은 수술 전후 1군은 유의한 차이가 없었으나 2군에서는 유의한 차이가 있었다. 그러나 수술 전 좌심실 구출률이 2군에서 1군에 비해 유의하게 감소되어 있었다(p=0.044). 좌심실근량지수는 1군은 수술후 초기에 유의한 감소가 없었으나 수술후 만기에는 유의한 감소를 보여주었다. 그러나 2군은 수술후 초기와 만기에 모두 유의한 감소를 보여주었다. 결론: 21 mm이하 군과 23 mm이상 군 모두 임상적 호전이 있었다. 그러나 19 mm판막군이 2례로 적어 19 mm 판막의 사용시 환자의 나이와 체표면적, 운동량을 고려하여 신중한 판막선택이 고려된다.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.110-115
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• 2008

Malperfusion of a major organ with aortic dissection has various clinical features according branch. The morbidity and mortality rate can increase without suspicion especially postoperative period. Surgical outcomes and prognosis are influenced by early expeditious diagnostic and therapeutic measures are mandatory for successful treatment. The authors report four successful cases of acute aortic dissection with mal perfusion of various organs, such as the brain, kidney, and the lower extremities.

• The Journal of the Korea Contents Association
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• v.12 no.7
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• pp.232-239
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• 2012

The purpose of this study was to investigate the relationship among functional evaluation systems, the Selective Motor Control Scale (SMC scale), the Gross Motor Function Classification System (GMFCS), the Gross Motor Function Measure (GMFM) and Activities of daily living in children with spastic cerebral palsy and to provide the foundation data about SMC scle for evaluation system of abilities of selective motor control in children with spastic cerebral palsy. For this, sixty eight children with spastic cerebral palsy were participated in this study. The children were evaluated by using the SMC scale for their selective motor control ability and by using the GMFCS and GMFM for their gross motor function. The activities of daily living were assessed by using the Functional Independence Measure of Children (WeeFIM). There were a significant correlation between the SMC scale and the GMFCS (r = -.485, p < .05). The good correlation between the SMC scale and GMFM was found (r = .482, p < .05). The activities of daily living were not a significant correlation with SMC scale (r = .019, p > .05). The SMC scale in practice will provide usefulness for assessment of abilities of selective motor control in children with spastic cerebral palsy.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.510-513
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• 2003

Annuloaortic ectasia, aortic regurgitation(AR), and ventricular septal defect(VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hapoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.79-86
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• 2009

Background: Background: Computed tomography (CT) is the main tool for detecting abnormalities of the thoracic aorta, but conventional CT only shows the cross-sectional images. These CT images have some limitations fo accuratly measuring the thoracic aortic diameters at various levels. Multidetector computed tomography (MDCT) overcomes these limitations. We measured the thoracic aortic diameter perpendicular to the loop-shaped thoracic aortic course and this was studied in relation to age, gender, height, weight, the body surface area, the body mass index and the presence of hypertension. Material and Method: Thirty hundred thirty one patients (males: 141 patients and females: 190 patients) who had no abnormalities of the thoracic aorta were investigated using MDCT aortography. They were divided into three age categories: 20~39 years old, 40~59 years old and over age 60. The image was reformed with multiplanar reconstruction and the diameter of the aorta was measured perpendicular to the aortic course at 5 anatomic segments. Level A was the mid-ascending aorta, level B was the distal ascending aorta, level C was the aortic arch, level D was the aortic isthmus and level E was the mid-descending aorta. Result: The mean age was 49.5 years old for males and 54.9 years old for females (p<0.05). The mean diameter of the thoracic aorta at level A was 31.1 mm, that at level B was 30.2 mm, that at level C was 26.5 mm, that at level D was 24.0 mm and that at level E was 22.6 mm. The diameters at all the levels were gradually increased with age. Hypertensive patients had larger diameters than did the non-hypertensive population. There was a positive correlation between the ascending aortic diameter (levels A&B) and height and the body surface area, but there were no statistical differences at the aortic arch (level C) and the descending aorta (levels D&E). There were no statistical differences of the weight and body mass index at all levels. Conclusion: The diameters of the thoracic aortas were directly correlated with gender, age and hypertension. Height and the body surface area were only correlated with the ascending aorta. Weight and the body mass index have no statistical difference at all levels. We measured the age related thoracic aortic diameters and the upper normal limits and we provide this data as reference values for the thoracic aortic diameter in the Korean population.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.573-579
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• 2008

Background: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. Material and Method: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was $43.7{\pm}14.1$ years old (range: $6{\sim}65$ years) and the male and female ratio was 21:4 (84% : 16%). The patients' follow-up was 100% complete, and the mean follow-up period was $60.7{\pm}50.4$ (range:$1{\sim}162$) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was $177.2{\pm}44.9$ minutes and the mean aortic cross clamping time was $123.4{\pm}34.1$ minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. Result: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. Conclusion: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.833-838
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• 2004

Background: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. Material and Method: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). Result: Mean age was $41\pm14$ years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of $38\pm17$ months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from $1.9\pm0.6$ to $1.2\pm0.5$ (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from $45\pm9$ and $67\pm10$ to $37\pm10$ and $56\pm10,$ respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative $(3.1\pm1.2)$ to post-bypass $(0.9\pm0.7).$ However, the grade at last follow-up $(1.7\pm1.1)$ was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. Conclusion: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.43-49
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• 2004

Background: Acute thoracic aortic dissections involving the aortic arch differ in diagnosis, surgical procedures, and operative results compared to those that do not involve the aortic arch. In general cerebral perfusion under deep hypothermic circulatory arrest (HCA) is performed during the repair of the aortic arch dissection. Here, we report our surgical results of the aortic arch dissection repair using retrograde cerebral perfusion (RCP) and its safety. Material and Method: Between January 1996 and June 2002, 22 consecutive patients with aortic arch dissection underwent aortic arch repair. In 20 of them RCP was performed under HCA. RCP was done through superior vena cava in 19 patients and by systemic retrograde venous perfusion in 1, in whom it was difficult to reach the SVC. When the patient's rectal temperature reached 16 to 18$^{\circ}C$, systemic circulation was arrested, and the amount of RCP amount was 481.1 $\pm$292.9 $m\ell$/min with perfusion pressure of 20∼30 mmHg. Result: There were two in-hospital deaths (4.5%) and one late death (9.1%). Mean circulatory arrest time (RCP time) was 54.0$\pm$ 13.4 minutes (range, 7 to 145 minutes). RCP time has no correlation with the appearance of consciousness, recovery of orientation, or ventilator weaning time (p=0.35, 0.86, and 0.92, respectively). Ventilator weaning was faster in patients with earlier recovery of consciousness and orientation (r=0.850, r=926; p=0.000, respectively). RCP of more than 70 minutes did not affect the appearance of consciousness, recovery of orientation, ventilator weaning time, exercise time, or hospital stay (p=0.42, 0.57, 0.60, 0.83, and 0.51, respectively). Conclusion: Retrograde cerebral perfusion time under hypothermic circulatory arrest during repair of aortic arch dissection may not affect recovery of orientation, ventilator weaning time, neurologic complications, and postoperative recovery.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.363-372
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• 1997

One hundred forty-four patients underwent operation for coarctation of the aorta at Seoul National University Children's Hospital between June 1986 and Decembsr 1995. Age ranged 0.1 to 191 months. Of these 78.5%(113) were infants. We classified the patients in terms of the anatomic location of coarctatiln and the associatCd anomalies(I[401= primary coarctation, 11(741=isthmic hypoplasia, lIIf30)=tubular hypoplasia involving transverse arch, Ar63 =with ventricular septal defect, B(28)=with other major cardiac defects). Subcalvian flap coarctoplasty(60), resection & anastomosis(44), extended aortoplasty(26), and onlay patch(14) were used as surgical methods. Overall operative mortality was 16.0(23/144)%. The hospital mortality was signific'antly higher in patheints with type 111, subtype B, younger age(under 3 months), extended aortoplasty(p(0.01). However, one-stage total repair in patients with subtype A or B were not found to be a predictor of hospital death. Restenosis had occured in 18 patients among 121 survivals(14. 9%). The mean follow-up period was 29.1 $\pm$28.8(0~129.2) months. Preoperative, immediate postoperative(within 3 months after operation) and postoperative(later than 6 months after operation) echocardiographic data on the dimensions of ascending aorta(AA), transverse arch(TA), an4 aortic isthmus(Al) were available in 77 patients(I=20, ll=42, 111= 15). Preoperative and postoperative aortic isthmus(All) and tra sverse arch indices(TAI), defined as TAIAA & AIIAA respectively, were compared. Immediate postoperative All in type 1, II and TAI in type 111 were significantly smaller in stenotic than non-stenotic group suggesting incomplete relieves of stenotic segment Younger age, subclavian coarctoplasty in patient under 3 months of age were round to be the risk factors for restenosis in this series. In conclusion, We found that aortic arch index and transverse arch index can be a useful tool to figure out the anatomic and clinical characteristics of the patients with aortic coarctation, and that anatomy, associated anomalies, age, and surgical methods may influence the surgical outcome of the coarctation repair.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.439-448
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• 2002

Pulmonary artery banding (PAB) in the functional univentricular heart (UVH) is a palliative procedure for staging toward the Fontan procedure; however, it is known to be a risk factor. Material and method： The records of all 37 patients with functional UVHs who underwent surgical palliation using PAB between September 1989 and August 1999 were reviewed retrospectively. We investigated the aortic arch obstruction, the development and progression of subaortic stenosis after PAB, and risk factor of mortality according to surgical method. Result： In 37 neonates and infants with single ventricular physiology, aortic arch obstruction was combined in 7. There were 6 early deaths (16.2%) after PAB and 3 late deaths (8.1%) after Fontan operation. The actuarial overall survival including early mortality at 3 and 5 years were 80.7$\pm$6.6%, 72.2$\pm$8.2% respectively. Among 31 patients who survived PAB, 27 patients (87.1 %) could become candidates for Fontan operation； 22 patients (71.0%) completed Fontan operation with 3 deaths and 5 were waiting bidirectional cavopulmonary shunt(BCPS) or Fontan operation (follow-up mean 4.5 year, minimal 2 year). Subaortic stenosis developed in 8 patients after PAB (8/29, 27.6%)； 3 cases in the patients without arch anomaly (3/22, 13.6%) and 5 in those with arch anomaly (5/7, 71.4%). The subaortic stenosis was managed with Damus-Kaye-Stansel procedure (DKS) in 6 patients without operative mortality and conal septum resection in 2 without long-term survivor. Analysis of risk factors established that aortic arch obstruction was strongly associated with subaortic stenosis (p＜0.001). The only risk factor of late mortality was Fontan procedure without staged palliation by BCPS (p=0.001). Conclusion： PAB is effective as an initial palliative step in functional UVH. And the high risk group of patients with aortic obstruction can undergo effective short-term PAB as an initial palliative step, with subsequent DKS for subaortic stenosis. This strategy, initial PAB and careful surveillance, and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later Fontan procedures.