• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.377-381
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• 2005

Background: Extra-anatomic bypass was performed in the patient who could not use anatomic bypass due to many causes. The purpose of this study is to evaluate the efficacy of extra-anatomic bypass surgery. Material and Method: We reviewed 31 patients who underwent extra-anatomic bypass surgery at Pusan national university hospital. We analysed the combined diseases, etiologic diseases, symptoms, patency rate and the factors affecting patency rate retrospectively. Result: There were 26 cases of femoro-femoral bypass and 5 cases of axillo-bifemoral bypass among 31 patients. The mean age was 70.23 years. Combined disease were hypertension, hyperlipidemia, and ischemic heart disease in order of frequency. The indications for surgery were disabled claudication, tissue necrosis, rest pain, and a cute ischemia. We analysed the ages, smoking history, hypertension, ischemic heart disease, severity of limb ischemia, and hyperlipidemia as factors affecting patency rate. We could not find any statistical differences between these factors. The primary graft patency rates were $73.65\%$ one year, $73.65\%$ two year, and $65.46\%$ three year respectively according to the Kaplan-Meier method. Conclusion: Nevertheless extra-anatomic bypass has a relatively low patency rate, it has good merits that is less dangerous, simple and easy re-do surgery compared to anatomic bypass. We think that extra-anatomic bypass is one of the good treatment modalities for the high risk vascular patients.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.298-303
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• 2006

Background: This study was performed to investigate the outcomes of vascular operations that were done in patients with atheroscerosis obliterans (ASO) of lower limb. Material and Method: Forty patients underwent vascular operations from December 1996 to June 2004. The patient's records were analyzed retrospectively. Mean age was $66{\pm}8$ years (range, $47{\sim}81$ years). Gender ratio was 37:3 (male:female). Result: The operations were done on 50 lower limbs of 40 patients. The names of operations were femoropopliteal bypass in 12 patients (30%), femorofemoral bypass in 12 (30%), femorofemoral bypass and femoropopliteal bypass in five (12.5%), aorta-lower limb artery bypass in five (12.5%), axillofemoral bypass in two (5%), iliopopliteal bypass in two (5%), and endarterectomy in two (5%). All bypass surgeries were done with prosthetic conduits. Mean follow up period was $33.2{\pm}23.2$ months (range, $3.8{\sim}90.2$ months). The cumulative patency rates of 1 and 5 years were 75.5 and 58.7% respectively. In six patients, amputation of the lower limb was done. In eight patients, 12 complications occurred. After the first operation, 10 patients underwent reoperations. Conclusion: Our lower limb arterial bypass surgery revealed acceptable patency rate, but not a few patients required reoperations. An epochal treatment modality that can inhibit the progress of ASO and improve long term patency should be established.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.777-779
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• 1996

Recently we operated on two cases of PDA in premature infant. In both cases, indomethacin therapy had failed to close the PDA. The extremely small baby(body weight 540gm) died 28hrs postoperatively by unexpe ted intrathoracic bleeding probably due to coagulopathy related to septic condition and thrombocytopenia. The clinical course of the second case(body weight 1395gm) was complicated by ileal perforation sec- ondary to necrotizing enterocolitis. The baby underwent segmental resection of ileum with ileostomy on the 8th hospital day. On the 34th hospital day surgical closure of the PDA was done and the ile'ostomy was repaired simultaneously. Ventilator weaning was possible on the postoperative 6th day. The baby discharged on the postoperative 33th day with the body weight of 2050gm.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.4
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• pp.355-369
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• 1991

미세수술을 이용한 재건외과 분야에서 빈번히 혈관이식이 요구된다. 이러한 경우 자가정맥이 가장 널리 사용되고 있으며 그의 신뢰성도 인정되어 있다. 그러나 정맥 채취에 따르는 부가적인 수술이 요구되며 혈관 공여부에 또다른 결손을 초래한다. 동결건조동종정맥은 이러한 점을 보완하고 자가정맥을 대체할 수 있는 잠재성이 있다. 이에 동결건조동종정맥의 효율성을 알아보고자 2.5cm 길이의 가토대퇴정맥을 $-65^{\circ}C$, 200 mtorr의 음압으로 동결건조시킨 다음 대퇴동맥 결손부에 동종이식하고(n=24), 신선한 가토대퇴정맥 동종이식군(n=24)과 자가정맥이식군(n=24)을 1주 간격으로 4주간 비교 관찰하였다. 2주 개존율은 동결건조동종정맥 이식군, 100%;동종정맥이식군, 50%; 자가정맥이식군, 100%이었으며 4주 개존율은 동결건조동종정맥이식군, 83.3%;동종정맥이식군, 50%;자가정맥이식군, 100%로서 동결건조처치만으로 동종정맥이식의 생존율을 증가시켰다. 미세임파구세포독성검사에서는 동결건조정맥의 항원성이 상당히 낮아져있음을 알 수 있었다. 그러나 동결건조정맥의 내막세포화가 주사전자현미경 및 광학현미경 소견상 자가정맥보다 지연됨이 관찰되었다. 이러한 결과를 종합해 볼 때 동결건조동종정맥은 아무런 처치를 하지않은 신선 동종정맥보다 현저한 장점이 있었지만, 자가정맥이식을 대신할 수 있는 보다 더 좋은 대체방법이라는 견지에서는 임상 적용이 어려울 것으로 사료되었다.

• Journal of Yeungnam Medical Science
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• v.6 no.2
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• pp.71-78
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• 1989

Horizontal mattress suture technique on microvascular anastomosis of rat(body weight : 200-250gm) femoral artery was evaluated. The present study was conducted to compare the horizontal mattress suture with simple interrupted suture on the suture time, patency rate of the sutured vessels, and the histological changes of surgical site of the vessel wall during wound healing period. The mean suture time of the vessel wall with horizontal mattress suture technique was 15min. 49sec. ${\pm}$ 2.14, which is significantly shorter than that of simple interrupted suture technique. The patency rate of the sutured vessel in both groups was statistically not different each other till post-operative 3rd day but patency rate of horizontal mattress suture was higher than that of simple interrupted suture at post-operative 3rd week. The histological findings such as intimal noss, medial degenention and intimal regeneration were similar in both groups.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.554-558
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• 1996

A case of distal aortopulmonary septal defect associated with aortic origin of right pulmonary ar- tery, patent ductus arteriosus and hypoplasia of aortic isthmus in a 50-day-old female infant is presented. Ligation of patent ductus arteriosus, resection and end-to-end anastomosis of hypoplasia of aortic isthmus, implantation of rlght pulmonary artery to main pulmonary artery and autologous peri- cardial patch repair of aortopulmonary septal defect were performed under cardiopulmonary bypass as one-stage approach. Deep hypothermic total circulatory arrest was applied during repair of hypoplasia of aortic isthmus. The p stoperative course was uneventful.

• Journal of Chest Surgery
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• v.34 no.1
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• pp.35-40
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• 2001

배경: 혈역학적으로 문제가 되며 인도메타신 치료가 불가능한 미숙아 동맥관 개존증에서 동맥관 결찰술은 비교적 안전하고 효과적인 치료법으로 알려져 있다. 대상 및 방법: 1995년 1월부터 2000년 5월까지 동맥관 개존증을 가진 50명의 미숙아를 대상으로 인도메타신 치료와 동맥관 결찰술의 치료성적을 검토하였다. 결과: 50례의 미숙아 동맥관 개존증 중 28례에서 혈역학적으로 문제가 되어 치료가 요구되었고 그 중 5례에서는 인도메타신 치료를, 나머지 23례는 인도메타신 치료의 금기가 되어 동맥관 결찰술을 시행하였다. 제태기간과 출생시 체중은 치료를 시행하지 않았던 군(32.1$\pm$2.1주, 1731$\pm$450.9g)과 인도메타신 치료군(32.0$\pm$2.1주, 1830$\pm$165.5g)보다 동맥관 결찰술군(29.6$\pm$2.1주, 1435$\pm$431.0g)이 가장 짧았다(p<0.05). 치료를 시행한 28례에서 치료시 나이(8.6$\pm$5.5일, 7,3$\pm$4.4일)는 인도메타신 치료군과 동맥관 결찰술군 간에 차이가 없었으나, 체중(1670$\pm$43.6g, 1211$\pm$22.4g)은 동맥관 결찰술군에서 의의있게 적었다(p<0.05). 치료후 생존율은 100%와 73.9%로 인도메타신 치료군에서 높았고 술후 사망은 23.7$\pm$22.4일(6-68일)째 발생하였으며 사망원인은 패혈증 5례, 뇌실질내 출혈과 기관지폐이형성증이 각각 2례, 패혈증 쇼크와 기흉이 각각 1례로 수술과는 직접적인 관련이 없었다. 결론: 미숙아 동맥관 개존증에서 조기에 동맥관 결찰술을 시행하는 것은 비교적 안전하고 효과적이며, 특히 인도메타신 치료를 시행할 수 없는 경우와 초저체중의 미숙아에서도 안전하게 적용 될 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.42-47
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• 2006

Background: The new Multidetector Computed Tomography (MDCT) is useful in visualization of complex coronary artery anatomy. We investigated usefulness comparing of invasive coronary angiography with noninvasive MDCT in judgment of functional degree of coronary arteries grafts after coronary artery bypass graft operation. Material and Method: We analyzed the patency of 52 conduits from 15 patients whom consented to take both 32 Channel MDCT and coronary angiography from November 2003 to November 2004. Comparisons were performed for sensitivity, specificity, positive prediction value and negative prediction value between coronary angiography and 3 dimensional reconstruction image using MDCT. Result: The average graft used was 3.4 $\pm$ 0.8 per patient. Average heart rate during MDCT was 86/minute (Range, 60$\∼$110/minute) without administration of $\beta$-blocker. All patients could hold breath as much as necessary. The average graft patency obtained through corollary angiography was 96.2$\%$. In MDCT group, the sensitivity, the specificity, the positive predictive value and the negative predictive value for diagnosis was 100$\%$, 98.0$\%$, 100$\%$ and 66.6$\%$ respectively. Conclusion: The effectiveness of 32 Channel MDCT may be compared to coronary angiography in grasping about patency and bloodstream of graft conduits after coronary artery bypass graft. Also MDCT has the advantage of noninvasiveness and inexpensiveness compared to coronary angiography.

• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.1-8
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• 1995

장시간 허혈상태의 토끼 이개를 실험대상으로 하여 유로키나제와 헤파린을 병용 또는 단독으로 사용시와 또한 약물을 사용하지 않았을 때, 이들이 모세혈관의 개존성과 아울러 미세수술후의 조직 생존율에 미칠 수 있는 효과를 보기 위하여 허혈상태의 토끼 이개를 미세수술로 접합한 후 모세혈관으로의 혈류를 측정하기 위하여 레이저 초음파 혈류측정기(Laser doppler flowmetry)를 이용하였으며 방사선 구슬들(Cobalt-57 with plastic material with average diameter 15 micron)을 주입한 결과 유로키나제 조합에서 통계적으로 유효한 성적을 얻었다. 광학현미경 소견은 유로키나제와 헤파린을 병용한 조합에서 모세혈관내 내피세포의 배열이 유지되어 있었으며 헤파린을 사용한 조합에서도 유사한 소견을 보였으나 약물을 사용하지 않은 조합에서는 국소적인 내피세포의 배열이 결핍되어 있었다. 전자현미경 소견에서 유로키나제와 헤파린을 병용한 조합에서 내피세포가 혈관내벽에 배열되어 있었고 또 불규칙한 세포질이 돌출되어 있었다.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.709-714
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• 1999

Background: When internal thoracic artery (ITA) and saphenous vein graft are anastomosed to the same coronary artery, the patency rate of the internal thoracic artery graft with relatively narrow diameter may be decreased owing to competition of pressure and flow rate. We evaluate the clinical outcome and the patency of the ITA graft in patients undergoing dual grafting to the same coronary artery. Material and Method: In 14 patients with the ITA graft having relatively low flow, the ITA and saphenous vein graft were anastomosed to the same coronary artery. During the mean follow-up period of 33.5 months, coronary angiography was performed in 6 patients who complained of recurrent angina, needed confirmation of graft flow, or showed postoperative Q wave. Result: In all 6 patients, the ITA and saphenous vein grafts were patent without stenosis or obstruction. Two patients showed good flow in both grafts, 2 showed competitive flow in the ITA graft, and the remaining 2 showed poor flow in the ITA graft. Conclusion: Early operative closure When saphenous vein grafting was added to the same coronary artery that the internal thoracic artery was anastomosed to, the perfusion to the coronary artery was satisfied and the dual grafting did not affect the short-term and mid-term patency rate of the ITA.