• Journal of Chest Surgery
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• v.23 no.4
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• pp.769-775
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• 1990

Congenitally corrected transposition of the great arteries is defined as the anomaly of atrioventricular and ventriculoarterial discordance. Although this condition is compatible with longevity, it is usually associated with other congenital cardiac anomalies, which result in a greatly shortened life span. This report describes a 2 years old female patient who had congenitally corrected transposition of the great arteries associated with ASD, VSD and pulmonary stenosis. The ASD was closed directly through the right atriotomy and the VSD was closed using Dacron patch through right ventriculotomy and the pulmonary[valvular, supra and subvalvular] stenosis was repaired with the use of a valved conduit woven Dacron vessel graft between the pulmonary ventricle and the main pulmonary artery.

• Journal of Chest Surgery
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• v.33 no.4
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• pp.316-319
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• 2000

Double-outlet left ventricle with ventricular septal defect and pulmonary stenosis was conventionally repaired with extracardiac conduit or pulmonary artery translocation. Here, we report an anatomically repaired double-outlet left ventricle without extracardiac conduit or pulmonary artery translocation in an 11 month old patient who had undergone palliative systemic-pulmonary shunt at a nonatal period. The location of ventricular septal defect, both great arteries and coronary arteries made it possible to reconstruct the right ventricular outflow tract using on-lay patch after incision and undercutting the tissue between the ventriculotomy and the pulmonary arteriotomy.

• Journal of Chest Surgery
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• v.16 no.3
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• pp.310-315
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• 1983

The combined anomaly of pulmonary stenosis with atrial or ventricular septal defects is usually associated with decreased pulmonary blood flow and right to left shunt, and result in generalized cyanosis. Non-cyanotic pulmonary stenosis patients have generally been considered to have isolated pulmonary stenosis with intact septa. We are going to report a case of pulmonary stenosis with septal defects who have no frank cyanosis at rest because of the predominant intracardiac shunt from left to right. Recently, we managed surgically a case of pulmonary valvular stenosis combined with secundum type atrial septal defect, type II ventricular septal defect, and patent ductus arteriosus. The clinical manifestations of this patient were exertional dyspnea, frequent upper respiratory infection, chest discomfortness and lethargy since late childhood and these had been progressively aggravated. Pulmonary valvular stenosis, atrial septal defect and ventricular septal defect were closed through simply right atriotomy and patent ductus arteriosus through pulmonary arteriotomy. Immediate postoperative course was uneventful and one year follow up is excellent.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.452-455
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• 2004

We report a case of a 40-year-old woman whose right ventricular out-flow tract was moderately obstructed by a heavily calcified pericardial ring. It was passing over the base of pulmonary artery and mid-portion of left ventricle but the other parts of the pericardium was mildly fibrotic. The pericardium and calcified ring were completely removed under cardiopulmonary bypass. The patient was recovered uneventfully and we could not find the specific cause of calcified pericardial ring.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1140-1143
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• 1999

Acquired pulmonary artery stenosis which is secondary to tuberculosis is so rare that only a few scattered cases have been reported. We report one case of pulmonary stenosis caused by pulmonary tuberculosis.l A 50 year old man who gradually developed dyspnea was diagnosed as bilateral pulmonary stenosis, he underwent bypass surgery between the main diagnosed as bilateral pulmonary stenosis. he underwent bypass surgery between the main pulmonary artery and the right pulomonary artery with a 13mm Gortex ringed straight graft. The left pulmonary artery was too small to restore the perfusion. The patient was discharged on the 33rd day after the operation. Acquired pulmonary stenosis could be treated successfully with one-side pulmonary arery reconstruction.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.641-646
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• 1997

Understanding of the surgical anatomy of patients with double outlet right ventricle (DORV) is important in the planning of biventricular repair From May 1995 to September 1996, 7 patients underwent biventricular repair for DORV with remote ventricular septal defect. There were 5 males and 2 (tamales. Age at operation varied from 2 to 9 years(mean 3.4$\pm$ 2.7years). Preoperative diagnostic assessment was made by two-dimensional echocardiography and cardiac catheterization. Ventricular septal defect was perimembranous inlet type in all patients. Associated cardiac anomalies were pulmonary atresia in two, pulmonary stenosis in five and tricuspid chordal attachment to zonal septum in five. The operations were performed intraventricular repair and pulmonary enlargement in two, REV operation in two, and Rastelli operation in three. There was no early postoperative deaths and complications. The follow-up period war from 1 month to 18mon1hs, averaging 10: 6.1 months. In the past, we considered the Fontal operation indicative as primary choice when DORV was associated with abnormal tricuspid chordal attachment to the zonal septum, but now we believe that biventricular repair is feasible for those cases by making conal flap or reattachment method. Biventricular repair has theoretic advantages because it estabilishes normal anatomy and physiology, and it was concluded that the precise preoperative evaluation using both echocardiography and cardiac catheterization was essential to the successful surgery.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.650-659
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• 1998

Between August 1996 and August 1997, 22 patients underwent extracardiac Fontan operations. The basic diagnoses included univentricular heart of the right ventricular type (n=12); univentricular heart of the left ventricular type (n=4); tricuspid atresia (n=4); left isomerism, transposition of great arteries, ventricular septal defect and pulmonary stenosis (n=1); and criss-cross heart with uneven ventricle (n=1). The median age of the 14 men and 8 women was 29 months (range from 21 months to 26 years). Previous procedures included bidirectional cavopulmonary shunt (n=15, interval=15.6$\pm$3.4 months), Kawashima operation (n=4, interval=37.5$\pm$20 months), and classic Glenn shunt (n=1, interval=14 years). In 2 patients, extracardiac Fontan operations were done without any previous procedures. A 16- to 22-mm flexible Gore-Tex tube graft (n=18), Hemashield graft (n=3), or, alternatively, a nonvalved aortic allograft (n=1) was cut and anastomosed end-to-end between inferior vena cava and undersurface of pulmonary artery using Gore-Tex or Prolene suture in a running fashion. In risk Fontan patients (n=12), a communication between the extracardiac conduit and the right atrium was constructed. In the most 13 recent patients, the procedures were done without cross-clamping of the aorta and with a beating heart. Operative mortality was 9.1% (n=2). Complications included persistent chest tube drainage for more than 7 days (n=5), chorea (n=2), and low cardiac output (n=1). There were no late deaths. Follow-up echocardiogram (mean: 6 months) demonstrated satisfactory hemodynamic results in the surviving 20 patients. Potential advantages of this technique consist of minimization of surgical manipulation of atrial tissue, reduction or elimination of myocardial ischemia, creationof a uniform and stable inferior vena cava-to-pulmonary artery conduit, and increased flexibility and safety in certain high-risk patients such as those with increased pulmonary vascular resistance, pulmonary hypertension, and impaired ventricular function. Further investigations during a longer follow-up are needed to confirm the intermediate and long-term results, especially the reduction of late atrial arrhythmias.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.193-199
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• 2007

Background: Reoperation is usually required for a right ventricle to pulmonary artery conduit obstruction caused by valve degeneration, conduit peel formation or somatic growth of the patient. An autologous tissue reconstruction (peel operation), where a prosthetic roof is placed over the fibrotic tissue bed of the explanted conduit, has been used to manage conduit obstructions at our institute since May 2002. Herein, the early and midterm results are evaluated. Material and Method: Between May 2002 and July 2006, 9 patients underwent obstructed extracardiac conduit replacement with an autologous tissue reconstruction, at a mean of 5.1 years after a Rastelli operation. The mean age at reoperation was $7.5{\pm}2.4$ years, ranging from 2.9 to 10.1 years. The diagnoses included 6 pulmonary atresia with VSD, 2 truncus arteriosus and 1 transposition of the great arteries. The preoperative mean systolic gradient was $88.3{\pm}22.2mmHg$, ranging from 58 to 125 mmHg. The explanted conduits were all Polystan valved pulmonary conduit (Polystan, Denmark). A bioprosthetic valve was inserted in 8 patients, and a monocusp ventricular outflow patch (MVOP) was used in 1 patient. The anterior wall was constructed with a Gore-Tex patch (n=7), MVOP (n=1) and bovine pericardium (n=1). Pulmonary artery angioplasty was required in 5 patients and anterior aortopexy in 2. The mean cardiopulmonary bypass time . was 154 minutes, ranging from 133 to 181 minutes; an aortic crossclamp was not performed in all patients. The mean follow-up duration was 20 months, ranging from 1 to 51 months. All patients were evaluated for their right ventricular outflow pathway using a 3-D CT scan. Resuit: There was no operative mortality or late death. The mean pressure gradient, assessed by echocardiography through the right ventricular outflow tract, was 20.4 mmHg, ranging from 0 to 29.6 mmMg, at discharge and 26 mmHg, ranging from 13 to 36 mmHg, at the latest follow-up (n=7, follow-up duration >1 year). There were no pseudoaneurysms, strictures or thrombotic occlusions. Conclusion: A peel operation was concluded to be a safe and effective re-operative option for an obstructed extracardiac conduit following a Rastelli operation.

• Journal of Chest Surgery
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• v.38 no.4 s.249
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• pp.277-283
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• 2005

Arterial oxygen saturation $(SaO_2)$ instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for $SaO_2$ instability after shunt operations, and possible mechanisms were speculated on. Material and Method: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5kg to 51kg (median: 4.1kg) and $10.7\~24.3$ gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. $SaO_2$ instability was defined as $SaO_2$ less than $50\%$ for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. Result: 10 patients $(10.7\%)$ showed $SaO_2$ instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for $SaO_2$ instability included older age at operation (p=0.039), lower preoperative $SaO_2$ (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). Conclusion: $SaO_2$ instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.822-827
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• 1996

Ross procedure is an ideal operative modality for diseased aortic valve especially in children, but homogrart for right ventricular outflow tract(RVOT) reconstruction is not easily available in Korea. We tried to perform REV procedure for RVOT reconstruction in 10 young piglets(15.3 $\pm$ 1.3 kg) In an attempt to e clude the use of homograft in Ross operation. 3 of them survived after operation and raised till adult pig(about 70 kg), then examined their pulmonary arteries and hearts. Without any stenotic residues in the great arteries, we only found the deformed monocusp patch with severe calcification, which deprived the adequate valve function, but kept the pig growing normally We are sure that this operative modality (REV + Ross procedure) could be extendedly applied to the diseased human aortic valve, but we need to develope the anti-calcification method for the heterograft patch.