• Journal of Chest Surgery
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• v.43 no.5
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• pp.557-561
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• 2010

In the treatment of myasthenia gravis, thymectomy is generally accepted as the standard of therapy. For thymectomy, there have been various conventional open approaches including sternal splitting, but recently minimally invasive approaches have been increasingly applied. A 28-year-old man presenting with weakness of both hands and fatigability was diagnosed as having myasthenia gravis with thymic hyperplasia. He underwent a robot-assisted thymectomy with the 'da Vinci' surgical system. Through the right thoracic cavity, two thirds of the thymic gland was dissected, and the remainder was resected through the left; these procedures took, respectively, 1 hour and 30 minutes. The patient was discharged on the 8th postoperative day without complications. The minimally invasive approach with the 'da Vinci' surgical system is emerging as a popular choice and various advantages have been reported. Here we report the first successful case of robot-assisted thymectomy.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.786-790
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• 2006

An anastomotic pseudoaneurysm after the aortic replacement surgery is a rare complication which could be lethal when it ruptures. So it should be corrected whenever it is found after the aortic surgery. The authors performed three surgical corrections in 2 cases. The first case is type 8 chronic aortic dissection with abdominal aortic aneurysm. After an abdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm. We treated him with a thoracoabdominal aortic replacement. The second case is ruputred throacoabdominal aortic aneurysm. After a thoracoabdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm in the proximal anastomosis. We treated her with aortic arch replacement. But She developed another pseudoaneurysm in the aortic root anastomotic site. So we performed secondary operation to reinforce the anastomosis. They all recovered from the operations without any complication and are being followed up.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.903-910
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• 2004

Background: The total aortic arch replacement is one of the most difficult operations with high mortality rate. But the arch first technique with subclavian arterial perfusion has been reported to be a safe methods for arch replacement. Material and Method: Between Feb 2003 and July 2004, 18 patients, 10 men and 8 women, underwent total aortic arch replacement with arch first technique. Their mean age was $59.3\pm12.9$ years. The patietns received 11 acute aortic dissections, 3 chronic aortic dissectiong aneurysms, and 4 ruptured aortic arch aneurysms. Result The mean admission period was $20.2\pm7.4$ days. There was one early mortality case which died of low cardiac output syndrome and another late mortality case which died of cerebral hemorrhage. The others were discharged without any sequelae and they were followed up for an average period of $180\pm156.3$ days. Conclusion: The total aortic arch replacement with arch first technique and subclavian arterial perfusion is a good method that will reduce the surgical mortality and the possibility of secondary late reoperation from the remnant distal aortic problems.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.49-54
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• 2008

Background: Aortic diseases tend to involve the entire aorta. Hence, there is the constant possibility of the need for a secondary operation at the remnant aorta. This study analyzed our cases of secondary aortic surgery in order to determine its characteristics and problems. Material and Method: Between April 2003 and June 2007, 12 patients (6 male and 6 female) underwent thoracoabdominal aortic replacement as a secondary aortic operation. Their clinical courses were analyzed. Four of the patients underwent lower thoracobadominal aortic replacement under the normothermic femorofemoral bypass, and the others underwent an entire thoracobdominal aortic replacement under deep hypothermic circulatory arrest. Result: There was no death or paraplegia. As local complications, there were 3 cases of wound infection and 2 cases of an immediate reoperation caused by bleeding and one case of delayed wound. revision for a contaminated perigraft hematoma. As a systemic complication, there was one case of renal insufficiency, which required hemodialysis and one case of respiratory insufficiency that needed prolonged ventilator care. The mean admission period was $30{\pm}21$ days. All the patients were followed up for $626{\pm}542$ days without reoperation or other problems. Conclusion: Using properly selected patients and a careful approach, thoracoabdominal aortic replacement can be performed safely as a secondary aortic surgery.

• Journal of Chest Surgery
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• v.39 no.3 s.260
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• pp.194-200
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• 2006

Background: Thoracoabdominal aortic replacement is an extensive operation that opens both the pleural cavity and abdominal cavity, which has high mortality and morbidity rate. The authors have reported 9 cases of the thoracoabdominal aortic replacement in 2001. Since 2003 we have applied the deep hypothermic circulatory arrest to the Crawford type I and II thoracoabdominal aortic replacement. Therefore, we analysed the effect of the changes in operative techniques. Material and Method: Between 1996 and 2005, we have performed 20 cases of thoracoabdominal aortic replacement. The underlying diseases were 8 cases of atherosclerotic aneurysm with 4 cases of ruptured aneurysm and 12 cases of aortic dissection with 10 cases of a previous operations. According to Crawford classification, there were 2 cases of type I, 7 cases of type II, 1 case of type III, 7 cases of type IV, and 3 cases of type V. We compaired the results of the patients who underwent thoracoabdmoninal replacement before 2001 which already has been reported and after then. Result: Before 2001 we have performed 9 cases of thoracoabdominal replacement and 5 patients were died of the operation. All three patients with type I and II were died. There was no case of thoracoabdominal replacement between 2001 and 2002, but after 2003 we have performed 11 cases of thoracoabdominal replacement which involved 1 case of type I, 5 cases of type II, 1 case of type III, 2 cases of type IV and 2 cases of type V. There was no mortality and no fetal complications. Conclusion: The deep hypothermic circulatory arrest is a safe method of extended thoracoabdominal aortic replacement.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.494-501
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• 1998

From May 1, 1993 to May 31 1995, the authers studied retrospectively 211 patients who underwent cardiovascular operation with cardiopulmonary bypass(CPB). Because we were interested in new development of ARF(prevalence, mortality rate, and main risk factors), we performed a multivariate statistical analysis about data of patients with preoperative serum creatinine values of less than 1.5 mg/dL. Normal renal function before operation(serum creatinine level less than 1.5 mg/dL) was registered in 198(74%) patients. Of these, 27(14%) patients showed postoperative renal complication, including 20(10%) patients classified as renal dysfunction(serum creatinine level between 1.5 and 2.5 mg/dL) and 7(4%) patients as acute renal failure(serum creatinine level higher than 2.5 mg/dL). The mortality rate was 5.8% in normal patients, 5% in patients with renal dysfunction, and 43% when acute renal failure developed(p=0.036). Indeed, the renal impairment proved to be an independent predictor of mortality(odd ratio 2.52∼11.25), along with cardiovascular(odd ratio 4.20) and respiratory(odd ratio 2.18) complications. Multivariate analysis identified the following variables as independent risk factors for postoperative renal impairment : advanced age(odd ratio 1), need for emergency operation(odd ratio 3.78), low-output syndrome(odd ratio 3.66), respiratory complication(odd ratio 1.30), need for deep hypothermic circulatory arrest(odd ratio 1.4). The 13 patients(7%) with preoperative renal failure showed a significantly higher morbidity and mortality rate than those without renal complications before operation. We concluded that the likelihood of severe renal complications is resonably low in the patients undergoing cardiac operation without preexisting renal dysfunction, but associated mortality remains high. A prominant role of hemodynamic factor in the development of postoperative acute renal failure must be recognized during preoperative, intraoperative, and postoperative periods.

• The Journal of Korean Philosophical History
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• no.41
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• pp.9-38
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• 2014

Hanhweon-dang Kim Goeng-pil(1454~1504) sublimated ethics whose lead was opened up by Jeong Mong-ju in late Goryeo as one scholarly tendency. Kim Goeng-pil was called 'the father of ethics in Joseon' and has been respected as a model of ethicist for 400 years since then. Following Kim Goeng-pil, Confucian scholars of Joseon cultivated perseverance through Xiaoxue and the perseverance was sublimated to Confucian scholars' energy and then that of state, which served as driving force to keep the national legacy. Kim Goeng-pil suggested how to study with Xiaoxue and sought moral human beings and ethically ideal societies based on strong practicability which is required in Xiaoxue. Individuals' cultivation and social reform are not at a different dimension. Spirit of 'self-cultivation' that Kim Goeng-pil himself demonstrated advanced to pursuit of ethical, ideal state when reaching a level of Jo Kwang-jo. Kim Goeng-pil thought that teaching in Xiaoxue could be achieved through 'Gyeong (敬, respect).' It is the key of Neo-Confucianism in Joseon to control one's mind through the cultivating method of 'Gyeong.' Kim Goeng-pil settled Joseon's Confucianism as 'practical ethics(心學).' Before Kim Goeng-pil, no scholars had well presented the aspects of practical ethics. After King Myeongjong and Seonjo, Confucianism in Joseon worked as the cornerstone of practical ethics. Since mid-17th century, the system of practical ethics had been firmly established with focus on 'Gyeong. Literary men of Kim Goeng-pil and scholars they fostered led the academic and political world of Joseon after mid-16th century. They played the lead in Sarim faction's(士林派) ruling after King Seonjo came to throne. The very foundation which sublimated Joseon to the ethically ideal state and made the Dynasty a 'state of Sarim' was actually laid by Kim Goeng-pil.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.366-375
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• 2006

Background: Hypomagnesemia is a common complication after cardiac surgery with cardiopulmonary bypass. The purpose of this study was to assess the clinical beneficial effect of administration of magnesium sulfate in cardiac surgery. Material and Method: Thirty five patients scheduled for elective cardiac surgery were randomly assigned to magnesium group (n=20) which received magnesium sulfate in priming solution (1 g) and cardioplegic solution (1 g) or control group (n=15) which did not receive it. Arterial blood samples were drawn for measuring $Mg^{++}$ and electrolytes contents, blood gas analysis, CBC, total protein, albumin, blood urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, tumor necrosis factor-${\alpha}$ $(TNF-{\alpha})$, interleukin-6 (IL-6), interleukin-10 (IL-10), creatine phosphokinase (CpK), creatine kinase-MB (CK-MB), lactate dehydrogenase(LDH), troponin-1 (TNI), prothrombin time (PT) and activated pratial thromboplastin time level (aPTT). Venous blood samples were drawn before and after the operation for measuring activated clotting time level (ACT). Result: $Mg^{++}$ levels in magensium group were higher than those of control group at intraoperative and post-operative periods (p<0.05). dysrhythmias were lower in magnesium group (8 cases out of 17 patients, 46.4%) than in control group (10 cases out of 10, 100%, p=0.050). Conclusion: These results showed that administration of low dose magnesium sulfate during cardiac surgery prevented hypomagnesemia and lowered incidence of dysrhythmia.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.313-321
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• 2004

Excellent clinical results of the arterial switch operation and the limited availablity of the intraventricular rerouting has recently made an arterial switch operation to become the therapeutic method of choice for the repair of double-outlet right ventricle (DORV) with subpulmonary ventricular septal defect (VSD). The early and midterm outcomes of arterial switch operation for this anomaly were evaluated. Material and Method: Between August 1994 and July 2002, 13 patients underwent an arterial switch operation for the correction of double-outlet right ventricle with subpulmonary VSD at Dong-A university hospital.. The 50% rule was used to define DORV. Median age and mean body weight were 27 days (range, 3-120 days) and 3.8$\pm$0.7kg (range, 2.92-5.3kg) respectively. Aortic arch anomalies were associated in 6 cases (46.2%), which were all repaired through one-stage operation. The relationship of the great arteries were side-by-side in 8 cases (61.5%) and anteroposterior in 5 (38.5%). Coronary artery patterns were 1 LCx-2R in 6 cases, retropulmonary left coronary artery (LCA) in 6, and intramural LCA in 1 respectively. The enlargement of VSD was required in 1 patient and the patch enlargement of right ventricular outflow tract was performed in another one patient. The Lecompte maneuver was used in all but 3 patients with a side by side relationship of the great arteries. Result: Overall postoperative hospital mortality was 23.1 % (3/13). All operative deaths were occurred in the patients with aortic arch anomalies. There was one late death related to the postoperative complication of the central nerve system during the mean follow-up of 41.3$\pm$30.7 months. Pulmonary valvar stenosis (＞30mmHg of pressure gradient) developed in 1 patient (10%) and left pulmonary artery stenosis in 2 (20%), among them, one required reoperation 52 months after repair. There was an asymptomatic patient with moderate aortic regurgitation. 5-year survival rate including operative deaths was 68.3%. Conclusion: Although the operative mortality is high in the patients with aortic arch anomaly, the arterial switch operation for DORV with supbpulmonary VSD can be performed with low operative mortality and low reoperation rate in the patients Without arch anomaly. The arterial switch operation can be considered a good option for this complex anomaly.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.375-380
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• 2010

Background: Primary cardiac tumors are extremely rare. The most common type are benign myxomas, and these are almost completely curable with early surgery. Malignant tumors, however, such as sarcomas, are difficult to remove surgically, and their prognosis is known to be poor. In this study, data on patients who had undergone surgical treatment of cardiac tumor in the authors' hospital were collected and analyzed. Material and Method: The subjects included 28 patients who had undergone surgical treatment of cardiac tumor from August 1993 to December 2008. Their medical records were reviewed and retrospectively analyzed. Result: The patients were aged from 20 to 76 years (mean age: $54.2{\pm}15.6$), and 11 were male (39%) and 17 female (61%). Fifteen of them (54%) underwent emergency surgery to improve heart failure symptoms. The most common preoperative symptom was dyspnea (15 cases, 54%). Preoperative echocardiography was performed on all the patients. The average size of the tumor as measured during the operation was $7.0{\pm}6.9cm$ (the average length of the long axis was 2∼40 cm), and the sites of tumor attachment were the interatrial septum (18 cases, 64%), the left atrium (9 cases, 32%), the mitral valve annulus (2 cases, 7%), and the left ventricle (2 cases, 7%). The operation was performed with an incision through both atria in all the patients, and a complete excision was made in 25 cases (89%). According to the biopsy results, there were 4 cases of sarcoma (14%), 1 case of lipoma (4%), and 23 cases of myxoma (82%). The three cases in which the tumors were not completely excised were sarcomas. No operative deaths occurred after the operations. Outpatient follow-up was possible for 24 cases (86%), with a mean follow-up period of $46.8{\pm}42.7$ months. Late death occurred in 3 of the 24 patients; each of these patients had sarcomas. Of these patients, the first had undergone two repeat surgeries, the second had metastatic sites removed, and the last had only chemotherapy. The average recurrence time was $12.7{\pm}10.8$ months, and the average metastasis time was $20.5{\pm}16.8$ months. Conclusion: Most cardiac tumors are benign myxomas. In principle, they should be surgically treated because they can create risks such as embolism, and can be radically treated when surgically removed. In most cases, however, malignant sarcomas are already considerably advanced with severe infiltration into the neighboring tissues at the time of diagnosis. The surgical removal of malignant sarcomas is known to be difficult because of the advanced stage and degree of infiltration. We suggest that excision of the removable portion of the tumor sites to alleviate symptoms such as heart failure can improve quality of life.