• Journal of Chest Surgery
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• 제37권9호
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• pp.768-773
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• 2004

판막하 조직 변형에 기인한 승모판 건삭 연장 및 파열 등은 판막성형술시 부적절한 건사 조직 때문에 판막 수술을 복잡하고 쉽지 않게 만든다. 저자들은 Expanded Polytetrafluoethylene (ePTEF)을 이용한 인공 건삭으로 판막성형술을 시행하여 그 성적을 알아보고자 하였다. 대상 및 방법: 1997년 3월부터 1999년 2월까지 본원에서 인공건삭을 이용해서 승모판막성형술을 시행한 26령 환자를 대상으로, 술 전, 술 중, 퇴원 전 그리고 마지막 외래 방문 시에 증상 및 심초음파 검사 소견을 비교 분석하였다. 성별분포는 남자 15명, 여자 11명, 평균 연령은 51.2$\pm$13.4세, 원인 병변은 퇴행성 18예, 류마티즘 6예 및 감염 1예 그리고 허혈성 1예였으며, 건삭 병변은 파열 18예, 연장 6예, 연장 및 파열 2예였다. 동반 판막 질환은 심방중격결손 2예, 삼첨판폐쇄부진증 7예, 동맥판폐쇄부전증 4예 및 삼첨판폐쇄부전증과 동맥판폐쇄부전증이 동반된 경우가 2예 있었다. 판막성형술 시 사용한 인공 건삭 수는 3.6$\pm$1.6개였고, 모든 예에서 판륜성형술을 시행하였으며, 인공심폐기시간은 182.1$\pm$63.7분, 대동맥차단시간은 133.1$\pm$45.6분이었다. 결과: 술 후 조기 사망은 없었으며, 판륜성형술 부위 이상과 술 후 심낭삼출액으로 재수술은 2예가 있었다. 술 후 마지막 외래 방문 시 NYHA class I: 22예(88%), II： 2예(8%), III: 1예(4%), 승모판폐쇄부전 정도＊ 0/IV: 20예(78%), I/IV 4예(15%), II/IV 1예(5%)이었으며, 승모판 면적 2.2$\pm$0.35 $\textrm{cm}^2$＊이였다(＊: p<0.05). 결론: 승모판막 병변 시 인공 건삭을 이용하여 다른 승모판막 성형술과 함께 시술하여 단기 및 중기 결과의 호전이 있어서, ePTEF을 이용한 인공건삭은 승모판막 성형술 치료 성적을 호전시킬 수 있을 것으로 생각한다.

• Journal of Chest Surgery
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• 제42권4호
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• pp.447-455
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• 2009

배경: 인공판막 심내막염은 자연판막 심내막염보다 초기 임상양상이 불량하고, 심내막의 감염 뿐 아니라 주변 조직으로 염증 파급이 용이하다. 특히, 합병증을 동반하여 악화된 임상양상으로 술 전 충분한 항생제 치료를 기대할 수 없는 상태(활동성 심내막염)에서 판막 재치환술을 시행하는 경우는 만족스럽지 못한 술 후 예후를 가진다. 본 연구는 활동성 인공판막 심내막염의 임상 양상, 검사 소견 및 중기 수술 성적 알아보기 위해 수행되었다. 대상 및 방법: 1998년 1월부터 2008년 7월까지 감염성 심내막염으로 진단 및 수술이 이루어진 276명의 환자 중 인공판막 심내막염으로 수술이 이루어진 경우는 31명이었다. 이 중 24명의 활동성 인공판막 심내막염 환자를 연구 대상으로 하였다. 결과: 열감이 가장 흔한 임상증상이었으나, 전신성 색전증을 동반한 경우도 8예(33.3%)였으며, 이 중 5예(20.8%)는 중추신경계가 이환되었다. 경식도 초음파 검사상 우종(vegetation)이 가장 많이 관찰된 소견이며, 포도상 구균(Staphylococcus species)이 배양된 주된 원인 균주였다. 42.1$\pm$36.9달의 평균 추적 관찰 기간 동안 조기사망 4예, 만기사망 4예 있었으며, 누적 생존율은 1년 후에는 79%, 3년 후에는 73%, 5년 후에는 66%, 7년 후에는 49.5%였다. 결론: 악화된 임상양상 등의 이유로 술 전 충분한 항생제 치료를 기대할 수 없는 활동성 인공판막 심내막염은 술 후 불량한 예후를 가진다. 그럼에도 불구하고, 조기 수술은 물론, 정상 조직이 노출이 될 때까지 광범위한 염증 조직 제거하는 것이 환자의 생존율을 높일 수 있는 방법이라 생각된다.

• Journal of Chest Surgery
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• 제38권4호
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• pp.312-315
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• 2005

심내막 심박조율기 이식 후 도자에 의한 심장 천공으로 출혈이 발생하는 경우는 드물다. 본원에서는 영구 경정맥 심박조율기 이식 후 우심실 천공에 의한 좌측 혈흉이 발생하였던 환자를 경험하였기에 보고하는 바이다. 수술 소견 상 심박조율기 도자가 우심실 천공 후 심낭막과 흉막을 차례로 관통하였으나 혈심낭 소견은 관찰되지 않았다.

• Journal of Chest Surgery
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• 제15권2호
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• pp.259-265
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• 1982

We have designed a new type of bubble oxygenator (KOREA-KIM VENOTHERM OXYGENATOR) made of PVC sheet and deforming mesh incorporated in the heat exchanger, and evaluated in experimental animal for the analysis of it`s efficiency. The Oxygenator has low priming volume with high flow rate up to 6 L/rain, and efficiency of heat exchanger was excellent as 1-$1.5^{\circ}C.$ using total cardiopulmonary bypass method under moderate to deep hypothermia. Average priming volume of 1317 ml with 30% hemodilution method was perfused with an average of 1.1-3.0 L/min.$M^2$of arterial blood and pure oxygen at a rate of 2-3.4 L/min for 49.6 minutes continuously in average. During total cardiopulmonary bypass, average $PaO_2$ was $159.8{\pm}60$mmHg, $PaCO_2$ $41.0{\pm}3$mmHg respectively under $SaO_2$ over 96% with systolic arterial pressure of 70 mmHg and CVP of 5-10 cm$H_2O$. Plasma free Hemoglobin was $7.0{\pm}4$ mg/dl with 25% drop of hemoglobin and hematocrit at the end of cardiopulmonary bypass. This KKV Oxygenator was observed to have excellent capabillty of oxygen and carbon dioxide gas transfer with small amount of blood trauma, and the efficiency of heat exchanger was satisfactory during cooling and rewarming of the bubbled blood. Disadvantages have included the somewhat poor deforming effect due to loose PVC fiber mesh, the extracompact character of Teflon filters, and the rough inner surface of the heat exchanger copper pipes.

• Journal of Chest Surgery
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• 제24권11호
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• pp.1074-1080
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• 1991

A total and consecutive 62 patients between 13 and 58 years of age receiving biological prosthetic heart valves at the Korea University Hospital from January 1978 through October 1983 were analyzed. Out of 71 valves replaced, 64 were Carpentier-Edwards valves, 4 were Ionescu-Shiley valves, 2 were Angell-Shiley valves, 1 was Hancock valve. Early mortality within 30 days after operation was noted in 4 cases[6.4%]. There were no cases of valve-related early death. The 58 early survivors were followed-up for a total 387 patient-year over a period of 3 years to 12 years[Mean$\pm$S.D: 6.37$\pm$2.51 years] at the follow-up end of April 1991. During follow-up, seven patients died and late mortality rate was 12%. There were two major late complications: the one is thromboembolism[1.6% /patient-year], the other is primary tissue failure[2.76% /patient-year]. Ten patients underwent re-replacement of 13 tissue valves because of primary tissue failure[nine Carpentier-Edwards, two Ionescu-Shiley, two Angell-Shiley]. There was operative mortality. The probabilities of freedom from primary tissue failure were 95.4% and 75.3% at 5 and 10 years after operation respectively, The actuarial survival rates were 86.2% and 81.8% at 5 and 10 years after initial surgery respectively.

• Journal of Chest Surgery
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• 제16권1호
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• pp.115-120
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• 1983

We implanted pacemakers using screw-in sutureless myocardial electrode in 40 patients between February, 1980 and November, 1982 at Seoul Nation University Hospital. Mean age of total patient who received the pacemaker implantation was 39.9 years, but excluding the patient who received the open heart surgery, mean age was 49.3 years. Cause of pacemaker implantation was complete A-V block in 13 patients, symptomatic sick sinus syndrome in 12 patients, complete A-V block after open heart surgery in 12 patients, second degree A-V block with dizziness in one patient, and atrial fibrillation with slow ventricular response in two patients. In thirty nine cases, electrodes were implanted by subxiphoid approach, on the diaphragmatic surface of right ventricle. I n one case, electrode was implanted through the left anterior thoracotomy. Acute stimulation threshold, measured in 35 patients, varied from 0.1 to 2.5 mA [mean 0.85 mA.], and R-wave amplitude [sensitivity], measured in 19 patients, varied from 2.9 mV to 11.5 mV [mean 7.6 mV]. There was no hospital death. The postoperative complications included wound seroma in two patients [5%], wound hematoma in three patients [7.5%], and pacing failure in one patient [2.5%]. The subxiphoid implantation of the pacemaker using sutureless myocardial lead was valuable in obtaining safe, reliable and long-term impulse generation.

• Journal of Chest Surgery
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• 제17권3호
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• pp.356-361
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• 1984

During the period from January 1982 to June 1984 we implanted permanent pacemakers in 18 patients who received open heart surgery at Yonsei University Hospital. 1.In 11 patients, open heart surgery was performed at Yonsei University Hospital and new surgical induced heart blocks were developed and implantations of permanent pacemaker were done. 2.Total 1035 open heart surgeries were done and implantations of pacemaker were performed in 11 cases. [1.06%]. After total correction of TOF [215 cases] implantations of pacemaker were done in 3 cases. [1.4%] Implantations of pacemaker were 0.37% after VSD repair, 0.78% after ASD repair, 5.9% after ECD repair, 0.48% after MVR and 2.0% after AVR. 3.Causes were complete A-V block, sick sinus syndrome and A-V dissociation. 4.Heart blocks were developed immediately after bypass stop in 8 patients. 5.Implantations of pacemaker were done at more than 2 weeks after open heart surgery. 6.Local anesthesia was done in adult and general anesthesia in infants. Locations of pulse generator were subxiphoid, subcostal & subclavian. Position of pulse generator was between subcutaneous fat layer and muscle layer. 7.Types of pulse generator were VVI, VDD and AAI. 8.The postoperative complications included infection, pacing failure, sensing failure and lead dislodgment.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1990년도 춘계학술대회
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• pp.9-12
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• 1990

He impregnated a highly porous, knitted polyester (Dacron) graft with a biodegradable nonproteinaceous material, algin. This new vascular graft is blood tight but still retains high porosity in the body. It does not need to be preclotted with blood before implantation and has good tissue ingrowth and biological healing properties due to the high porosity. The algin impregnated graft was investigated by "in vitro" examinations in this study. It was characterized by ESCA analysis, SEM observation, and measurements of water permeability, algin coating weight, mechanical properties and whole blood clotting time. The water permeability of the graft was reduced more than 99% by the algin impregnation treatment without changing any mechanical properties. "In vivo" examinations of the algin impregnated vascular graft are on progress.

• Journal of Chest Surgery
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• 제26권3호
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• pp.191-195
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• 1993

Among 25 consecutive cases having undergone mitral valve surgery between March 1991 and June 1992 in Gill General Hospital, 11 patients[44%] who had undergone mitral valve reconstruction using prosthetic rings is evaluated and presented. Patients` mean age is 43 + 19 years[range:16-72], and they are consisted with 4 males and 7 females. Mitral valve insufficiency is due to degenerative disease in 6 cases[55%] and rheumatic disease in 5 patients[45%]. Carpentier`s functional classification I is 2 cases, II is 6 cases, and III is 2 cases. Surgical techniques include prosthetic ring annuloplasty[11 patients, 100%], chorda shortening[6, 55%], leaflet mobilization[4,36%], new chorda formation[2, 18%], chorda transposition[1, 9%] commissurotomy[3, 27%], and papillary muscle splitting[3, 27%]. Average number of mitral anatomic lesions per patient are 2.7 and we used average 2.8 procedures upon mitral valve apparatus per patient. There were no surgical mortality and no late valve related admission during the mean follow up period of 17 months. The mean functional class[NYHA] is 2.81 preoperatively and improved to 1.10 postoperatively. Doppler echocardiography showed much improvement from grade II MR [1 case], grade III MR [1 case] and 9 cases of grade IV MR to 6 cases of patients showed no MR, only trace MR in 4 cases, and grade I MR was found only in one patient with NYHA functional class II postoperatively. The postoperative mean mitral valve area is $2.10+0.28cm^2$. We conclude that mitral reconstruction is a predictable and stable operation.

• Journal of Chest Surgery
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• 제30권7호
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• pp.719-723
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• 1997

저자들은 대동맥 판막치환술 후 생긴 대동맥 판막 주위 누출과 관련된 대동맥동류의 심실 중격 박리를 경험하였다. 37세 남자 환자가 호흡 곤란의 증가를 주소로 응급실을 통하여 입원하였다. 그는 6년전 대동맥판 폐쇄 부전과 승모판 폐쇄 부전으로 인공 기계 판막(Carbomedic 23mm와 31mm)으로 치환 수술을 받고 정기적으로 추적 검진 중이었다. 진단은 경흉부및 경식도 심초음파로 이루어졌고, 대동맥 조영술로 확인되었다. 폐동맥판 동종이식편(Pulmonary homoyaft)를 사용하여 대동맥 판막 치환술을 다시 시행하였다. 심실중격내의 낭 입구에서 3-0 prolene을 사용하여 심근 내막, 외막과 homograft muscle shoulder를 한꺼번에 연속 봉합하였다. 술후 경과는 양호하여 환자는 수술 후 11일째 퇴원하였다.