• Journal of Chest Surgery
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• v.31 no.11
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• pp.1070-1075
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• 1998

Background: With the advent of thoracoscopy, there has been increasing interest in less invasive surgical bullectomy and pleurodesis. The recurrence rate, however, has been reported higher in surgery with thoracoscopy than with open thoracotomy and it is thought to be caused by inappropriate mechanical pleurodesis during thoracoscopic surgery. Materials and methods: We compared the short-term recurrence rates according to the intensities of pleural abrasion in 62 patients who underwent VATS for treatment of spontaneous pneumothorax from April 1996 to August 1997. The patients were divided into 2 groups: group A(n=32) included patients who received relatively weak pleural abrasion using Endo-forcep instrument for grasping the gauze, and group B(n=30) received strong pleural abrasion using conventional instrument wrapped tightly with gauze. Each intensity of pleural abrasion allowed petechia on the parietal pleura in group A, and some tearing and bleeding in group B. Results: Indications for operation, sex distribution, and age were comparable in both groups. There were no differences in chest tube indwelling time(3.78±3.35 vs 3.80±2.49 days), hospital stay(4.72±1.87 vs 4.67±2.20 days), and the amount and duration of analgesics required postoperatively. Persistent air-leak more than 7 days after surgery occurred in 4/32(12.5%) and 2/30(6.7%) in group A and B, respectively. No bleeding-related complication occured. Pneumothorax recurred 12.5%(4/32) and 0%(0/30) of patients at a mean follow-up of 9.7 and 9.6 months in group A and B, respectively, and it was statistically significant(p<0.05). Conclusions: Proper intensity of pleural abrasion is very important factor to reduce recurrence after VATS for spontaneous pneumothorax. During short-term follow-upafter surgery, we could achieve excellent result in reducing recurrence rate with VATS and strong pleural abrasion which is comparable to thoracotomy.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.177-181
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• 2002

Background: Follow-up studies have shown that although outcomes have improved substantially over time, results of the Fontan operation and its modifications remain suboptimal. In this study, we reviewed our experience with the extracardiac conduit Fontan operation, with a focus early and midterm change of internal diameter of PTFE conduit. Material and Method: Between April 1997 and July 2000 were reviewed. Twelve patients (M:6, F:6, mean age 42.04 $\pm$ 12.43months, mean body weight 13.80$\pm$ 1.94kg) underwent extracardiac conduit Fontan operation with expanded PTFE graft. Mean cardiopulmonary bypass time was 109.7$\pm$26.99minute and mean operation time was 455$\pm$89.51minute. Intraoperative fenestration was performed in 10 patients. The aortic cross clamping was not performed in all patients. Result: There was no early deaths and no postoperative dysrhythmia. Postoperative protein losing enteropathy and prolonged pleural effusion occurred in 1(8.3%) and 4 patients(33.3%). Conduit patency was evaluated by magnetic resonance imaging studies. A 9.84$\pm$3.84% mean reduction in conduit internal diameter and there was no statistical correlation between the change of internal diameter of conduit and the postoperative duration after partial correlation analysis(r=0.019, p=0.955). Conclusion: These results demonstrate that the extracardiac conduit Fontan operation provies good early and midterm results and may reduce the prevalence of late arrhythmia. And there is no correlation between the change of internal diameter of conduit and the postoperative duration after extracardiac conduit Fontan operation with the expanded PTFE graft conduit.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.717-720
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• 2005

Here we report a case of posterior left ventricular (LV) free wall rupture following postinfarct ventricular septal rupture (VSR). A 58-year-old man was transferred to the hospital under the impression of acute myocardial infarction. Posterior VSR was seen on echocardiographic examination. The intraaortic balloon pump catheter was introduced percutaneously and the emergent operation was proposed. Sudden circulatory collapse was developed shortly after the anesthetic induction and the patient's chest was hurriedly opened while on cardiopulmonary resuscitation. The acute cardiac tamponade was seen and the blood was seen pumping from the longitudinal tear at the mid-level of LV posterior wall, measuring 2 cm in length. The cardiopulmonary bypass was set and LV reconstruction was done. The postoperative recovery was delayed due to the brain injury presumably caused by preoperative cardiac arrest.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.426-433
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• 2009

Background: Remarkable progress has recently been made in achieving successful early repair of congenital heart disease with using cardiopulmonary bypass in the neonatal period. The aim of this study is to evaluate our short-term outcomes for performing neonatal cardiac surgery under extracorporeal circulation. Material and Method: Fifty five neonates underwent open heart surgery from February 2002 to December 2007. The mean ages and body weight was 13.5 days. and 3.2 kg, respectively. The diagnoses of the patients were transposition of the great arteries (14), total anomalous pulmonary venous connection (7), large ventricular septal defect (VSD) (7), coarotation of the aorta with VSD (6), interrupted aortic arch (5) and others (16). Result: Six patients had difficulties being weaned from extracorporeal circulation. Four patients left the operating room with an open sternum. Low cardiac output syndrome and acute renal insufficiency were observed in 3 patients each, respectively. Post-operative complications were observed in 27 patients (49.1%). The postoperative mortality was 12.7% (7 patients); 5 patients experienced early hospital death and 2 experienced late death (2). Conclusion: In our hospital, early surgical repair with extracorporeal circulation in neonates was feasible with tolerable mortality. Further follow-up required to establish the long-term survival and complications.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.685-692
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• 2005

Background: Wall motion abnormalities may be a significant predictor for long-term survival after coronary bypass surgery (CABG). The aim of this study is to see whether post-infarction wall motion abnormality of left ventricle affect on the long-term survival after CABG. Material and Method: One-hundred and thirty-three patients (male/female, 92/41) undergoing CABG more than 9 years ago were included in this study. Fifty-six patients (M/F, 42/14; mean age, $59.2\pm9.2$ years) with LV wall motion abnormalities were compared to 77 patients (M/F, 50/27; mean age, $58.0\pm7.6$ years) without the wall motion abnormalities. Most patients (112/133, $84.2\%$) had undergone on-pump CABG with the in-situ left internal thoracic artery and free grafts of saphenous vein, in which the proximal and distal anastomoses were done for the single aortic cross-clamping period. Result: Ejection fraction of left ventricle was lower in the group with LV wall motion abnormalities (mean ejection fraction, $48.7\pm13.2\%$) compared to the group without wall motion abnormalities (mean ejection fraction, $57.1\pm10.1\%$)(p=0.0001). Risk­unadjusted survivals after CABG in the group without wall motion abnormalities were $85.7\pm4.0\%,\;76.2\pm4.9\%,\;and\;57.2\pm10.3\%$ at 5, 10, and 13 years, respectively, and in the group with wall motion abnormalities were $80.4\pm5.3\%,\;58.7\pm7.3\%,\;and\;51.9\pm7.9\%$ at 5, 10, and 13 years, respectively (p=0.1). In univariate analysis, predictable factors of long-term survival in the patients with LV wall motion abnormalities were LV ejection fraction and post operative outpatient treatment. In multivariate analysis, predictable factor of long-term survival in the patients with the wall motion abnormalities was postoperative outpatient treatment, and that in those without the wall motion abnormalities was female. Conclusion: Although there was no significant survival difference after CABG between the group with LV wall motion abnormalities and that without wall motion abnormalities, the survival in the group with wall motion abnormalities seems to be more decreased. For the patients with LV wall motion abnormalities after myocardial infarction, the post-CABG outpatient treatment is suggested to be an important factor for the long-term survival.

• Proceedings of the Korea Water Resources Association Conference
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• 2004.05b
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• pp.1310-1315
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• 2004

용수수요 추정의 기본은 수도계획에 사용할 수 있는 실사용량에 대한 조사로 이에 대한 자료가 거의 없기 때문에 각 수도사업별로 제시되는 추정방법이 조금씩 상이하며, 추정방법의 진위를 가릴 수 없이 수요추정의 악순환을 초래하고 있는 실정이다. 기존 물사용량 예측은 급수량 기준의 도시 전체에 내한 평균 LPCD를 이용함에 따라 물사용 특성을 충분히 고려찬 수 없어 지역별 실제 물사용량과 큰 오차가 유발되었다. 그러므로 수도계획 및 설계에 사용할 수 있는 신뢰성 있는 설계인자를 도출하기가 불가능하여 물수요 관리정책 수립, 수도요금체계 조정 및 누수방지계획 수립 등 경제적인 수도시설의 건설에 애로를 겪고 있다. 본 연구에서는 생활용수 중 가정용수에 대하여 세탁기, 변기, 싱크대 등 수도전에 유량계를 설치 실제 가정에서 사용하고 있는 용도별 사용량을 실측, 파악하였으며, 이로부터 얻은 용도별 사용량에 대한 기간별 소비특성을 분석하였다. 이로부터 생활용수 사용량의 소비패턴 및 시간대별 부하율 산정이 가능하며, 각종 용도별 사용수량의 소비형태를 찾아낼 수 있었다. 또한 가정용수 중 용도별 물 사용비율은 세탁용수, 변기, 주방, 목욕용수의 순으로 나타났으며 주택유형별로는 아파트 연립주택, 다세대 주택, 단독주택의 순으로 단독주택에서의 물사용량이 가장 적게 나타났다. 생활용수 공급량에 내해서는 시간별, 주별, 월별 그리고 계절변동 총량을 파악하였으며 시간대별로는 오후 3시경이 최대 소비량을 보였고, 주별로는 월요일 그리고 월별로는 7월의 용수사용량이 가장 큰 것으로 조사 되었다. 본 연구로부터 도출된 용도별 실측 물사용량 자료 및 분석결과로부터, 지금까지 공급량 기준의 계획수립이 이루어져왔던 파종 수도시설 규모결정시 합리적인 용수수요예측 및 수요관리가 이루어질 수 있을 것으로 판단되며, 용수수요의 과다예측 오해 해소 등 경제적, 과학적 물관리 정책수립을 위한 기초자료를 제공할 수 있을 것으로 기대된다.는 경제적인 방법이 될 수 있다. 하천수 등의 상호 관계 분석을 통해 장기간의 유역 물순환체계 변화를 분석할 수 있었다.골풀과, 닭의장풀과가 각 1종씩으로, 조사지점( I )보다 좀 더 많은 종이 분포하는 것으로 조사되었다. 또한 어류는 조사지점( I )에서 3회에 걸쳐 총 396개체가 채집되어 3목 8과 21종이었다. 이 중 한국 고유종은 11종이었고, 외래 어종은 검정우럭과 2종이 조사되었으며, Zacco platypus(피라미), Zacco temmincki(갈겨니), Acheilongnathus koreanus(칼납자루), Odontobutis platycephala(동사리), Coreoleuciscus splendidus(쉬리) 순으로 분포하고 있었고, Acheilognathus signifer(묵납자루)는 댐 건설 전에는 많이 분포하였으나 현장조사에서 서식을 확인 할 수 언어 개체수의 큰 감소내지 멸종된 것으로 추정되었다.에서 동시에 시행하였다. 수술 후 1년 내 시행한 심초음파에서 모든 환아에서 단지 경등도 이하의 승모판 폐쇄 부전 소견을 보였다. 수술 후 조기 사망은 없었으며, 합병증으로는 유미흉이 한 명에서 있었다. 술 후 10개월째 허혈성 확장성 심근증이 호전되지 않아 Dor 술식을 시행한 후 사망한 예를 제외한 나머지 6명은 특이 증상 없이 정상 생활 중이다 결론: 좌관상동맥 페동맥이상 기시증은 드물기는 하나, 영유아기에 심근경색 및 허혈성 심근증 또는 선천성 승모판 폐쇄 부전등을 초래하는 심각한 선천성 심질환이다. 그러나 진단 즉시 직접 좌관상동맥-대동맥 이식술로 수술적 교정을 해줌으로써 좋은 성적을 기대할 수 있음을 보여주었다.특히 교사들이 중요하게 인식하는 해방적 행동에 대한 목표를 강조하여 적용할 필요가 있음을 시사하고 있다.교하여 유의한 차이가 관찰되지 않았다. 또한 HSP 환자군에서도 $IL1RN^{*}2$ allele 빈도와 carriage rat

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.3.2-3
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• 1981

This paper was attemped to analize 55 cases of fiberoptic bronchoscopy during period of 3 years from Feb. 1978 till Feb. 1981 in Chung Ang University hospital. The results were as follow; 1) In age distribution; Most common age group was 5th decade (15 cases, 27.2%) and the other age groups showed relatively even distribution. 2) The ratio of male to female was 3 to 1. 3) The chief complaints were presented in following order; cough (52%), hemoptysis(25%), dyspnea(23.6%), chest pain(18%), chest disomfort(9%). 4) Direct smear of bronchoscopic aspiration material; Not found 33 cases (60%) were most common finding. In the founded bacteria Gram positive cocci 2 cases (3.6%), Gram negative cocci 2 cases (3.6%), Gram positive bacilli 1 cases (1.8%), Gram negativebacilli 2 cases (3.6%), mixed form 15 cases(27.2%) were presented. 5) Bacterial culture of bronchoscopic aspiration material; No growth 28 cases (50.9%) were most common finding. In the bacterial growth, alpha hemolytic streptococci 10 cases (18.2%), Neisseria group 7cases(12.7%), Klebsiella 2 cases (3.6%), Pseudomonas 2 cases (3.6%), mixed culture 6 cases (10.9%) were presented, 6) The diagnosis of bronchoscopic appearance, laboratory exam., and pathologic exam. of biopsed specimen were 21 cases (38.1%) primary carcinoma of bronchus, 8 cases (14.5%) pulmonary tuberculosis, 7 cases (12.7%) bronchitis in orders.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.1-11
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• 2008

Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.97-107
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• 1999

Background: This study was designed to develop a Korean version of the heparin-coated vascular bypass shunt by using a physical dispersing technique. The safety and effectiveness of the thrombo-resistant shunt were tested in experimental animals. Material and Method: A bypass shunt model was constructed on the descending thoracic aorta of 21 adult mongrel dogs(17.5-25 kg). The animals were divided into groups of no-treatment(CONTROL group; n=3), no-treatment with systemic heparinization(HEPARIN group; n=6), Gott heparin shunt (GOTT group; n=6), or Korean heparin shunt(KIST group; n=6). Parameters observed were complete blood cell counts, coagulation profiles, kidney and liver function(BUN/Cr and AST/ ALT), and surface scanning electron microscope(SSEM) findings. Blood was sampled from the aortic blood distal to the shunt and was compared before the bypass and at 2 hours after the bypass. Result: There were no differences between the groups before the bypass. At bypass 2 hours, platelet level increased in the HEPARIN and GOTT groups(p<0.05), but there were no differences between the groups. Changes in other blood cell counts were insignificant between the groups. Activated clotting time, activated partial thromboplastin time, and thrombin time were prolonged in the HEPARIN group(p<0.05) and differences between the groups were significant(p<0.005). Prothrombin time increased in the GOTT group(p<0.05) without having any differences between the groups. Changes in fibrinogen level were insignificant between the groups. Antithrombin III levels were increased in the HEPARIN and KIST groups(p<0.05), and the inter-group differences were also significant(p<0.05). Protein C level decreased in the HEPARIN group(p<0.05) without having any differences between the groups. BUN levels increased in all groups, especially in the HEPARIN and KIST groups(p<0.05), but there were no differences between the groups. Changes of Cr, AST, and ALT levels were insignificant between the groups. SSEM findings revealed severe aggregation of platelets and other cellular elements in the CONTROL group, and the HEPARIN group showed more adherence of the cellular elements than the GOTT or KIST group. Conclusion: Above results show that the heparin-coated bypass shunts(either GOTT or KIST) can suppress thrombus formation on the surface without inducing bleeding tendencies, while systemic heparinization(HEPARIN) may not be able to block activation of the coagulation system on the surface in contact with foreign materials but increases the bleeding tendencies. We also conclude that the thrombo-resistant effects of the Korean version of heparin shunt(KIST) are similar to those of the commercialized heparin shunt(GOTT).

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.496-500
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• 2005

There was no difference between the bileaflet mechanical valves on the midterm and longterm clinical outcome. We reviewed the hemodynamic comparison between recently available mechanical valves by Doppler Echocardiography. Material and Method: We retrospectively reviewed 396 postoperative hemodynamic datas (EOA, MDPG, and MSPG) by doppler echocardiography in 345 patients. Mechanical valves from 5 venders (Sorin Bicarbon, SJM, ATS, On-X, and Edward MIRA) were compared. There were 232 valves in mitral position, 162 in aortic, and 2 in tricuspid. Result: There were 178 men (mean age; $50.6\pm13.9$ years old) and 167 women $(52.6\pm,4.6)$. MDPG/EOA of 27 mm in mitral position was Sorin; $4.2\pm1.5 mmHg/3.0\pm0.9cm^2,\;SJM;\;2.3\pm1.2/3.5\pm0.6$. In 29mm, Sorin, SJM, ATS, On-X, MIRA revealed $3.4\pm1.2/3.1\pm0.6,\;3.3\pm1.1/2.7\pm0.4,\;3.8\pm0.8/3.2\pm0.6,\;4.0\pm3.0/3.1\pm0.9,\;2.9\pm0.9/3.0\pm0.8$ In 31mm, Sorin, SJM, ATS, MIRA revealed $3.9\pm1.9/2.9\pm0.6,\;3.5\pm1.2/3.0\pm0.6,\;3.4\pm0.8/2.8\pm0.2,\;3.7\pm1.5/2.7\pm0.7$. In 33mm, Sorin, SJM, MIRA revealed $4.4\pm0.9/2.5\pm0.4,\;3.4\pm1.5/3.3\pm0.5,\;4.7\pm2.4\3.0\pm0.3$. MSPG/EOA of 19mm aortic position was Sorin, SJM, ATS, On-X, MIRA $18.0 mmHg/1.2cm^2,\;25.6\pm8.7/1.1\pm0.3,\;25.9\pm12.6/1.2\pm0.3,\;23.0/1.3,\;27.9\pm7.1/1.2\pm0.1$ in that order. In 21mm, SJM, ATS, On-X, MIRA revealed $18.3\pm6.7/1.5\pm0.5,\;13.7\pm2.1/1.7\pm0.3,\;17.0/1.4,\;17.1\pm5.5/1.8\pm0.5$. In 23mm Sorin, SJM, ATS, On-X, MIRA revealed $14.0\pm4.6/1.7\pm0.6,\;12.8\pm3.2/2.0\pm0.2,\;16.8\pm12.2/2.1\pm0.9,\;14.0/1.5,\;15.0\pm5.5/1,8\pm0.5$. In 25mm, SJM and MIRA revealed $14.0\pm5.1/1.8\pm1.0,\;11.0/2.3$. There was no statistically significant difference in these values between the venders given the same position and size. 2 redo valve replacements were performed, 1 due to severe hemolysis in ATS and 1 due to leaflet immobilization in SJM. Conclusion: Postoperative hemodynamic comparison by doppler echocardiography shows no statistically significant difference between recently available mechanical valves in this country.