• 대한한의진단학회지
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• 제9권1호
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• pp.59-68
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• 2005

Background and purpose: Cardiovascular disease will undoubtedly rise along with the aging of the 'baby-boom' generation. The purpose of this study is to find the new index of the cardiovascular aging. Methods: The effects of aging on the heart and the arterial system are surveyed in the point of structure and function. Results: Arterial stiffening is due to the fatiguing effects of periodic stress on the arterial wall and is the main reason for increasing pulse wave velocity. The systolic hypertension is caused by the early return of wave reflection. The increased after-load by the arterial change leads to the development of left ventricular hypertrophy. The reduction in left ventricular compliance cause the impairments of the diastolic function. In contrast to the lower limb, aging effect in the upper limb are almost due to the ascending aortic pressure wave and the reflected wave from the lower limb. Conclusion: We have the following points. (1) The change of physiological pulse pattern by age can be explained by the early returning of reflected wave. (2) The atrial pulse in old age are generated by the left ventricular hypertrophy.

• Journal of Chest Surgery
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• 제49권6호
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• pp.421-426
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• 2016

Background: Median sternotomy is the standard approach for atrial septal defect (ASD) closure. However, minimally invasive cardiac surgery (MICS) has been introduced at many centers in adult/grown-up congenital heart patients. We retrospectively reviewed the results of right anterolateral thoracotomy compared with conventional median sternotomy (CMS) for ASD closure at Seoul National University Hospital. Methods: We retrospectively analyzed 60 adult patients who underwent isolated ASD closure from January 2004 to December 2013 (42 in the CMS group, 18 in the MICS group). Preoperative, operative, and postoperative data were collected and compared between the 2 groups. Results: The MICS group was younger (44.6 years vs. 32.4 years, p=0.002) and included more females (66.7% vs. 94.4%, p=0.025) than the CMS group. Operation time (188.4 minutes vs. 286.7 minutes, p<0.001), cardiopulmonary bypass time (72.7 minutes vs. 125.8 minutes, p<0.001), and aortic cross-clamp time (25.5 minutes vs. 45.6 minutes, p<0.001) were significantly longer in the MICS group. However, there were no significant differences in morbidity and mortality between groups. Only chest tube drainage in the first 24 hours (627.1 mL vs. 306.1 mL, p<0.001) exhibited a significant difference. Conclusion: MICS via right anterolateral thoracotomy is an alternative choice for ASD closure. The results demonstrated similar morbidity and mortality between groups, and favored MICS in chest tube drainage in the first 24 hours.

• Journal of Chest Surgery
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• 제49권3호
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• pp.195-198
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• 2016

We report a 72-year-old male with known myelodysplastic syndrome who presented to the emergency department with a 7-day history of fever and dyspnea. Echocardiography revealed a round echogenic mass $13{\times}16mm$ in size attached to the atrial side of the tricuspid valve. Considering the high risk of infective endocarditis in the patient with a low absolute neutrophil count ($130/mm^3$), emergency surgery was performed. Intraoperatively, a single gelatinous neoplasm was resected, and subsequent reconstruction of the involved leaflet was accomplished using autologous pericardium. The tumor was pathologically confirmed as papillary fibroelastoma with no evidence of infective endocarditis. Papillary fibroelastoma is a rare cardiac neoplasm that occurs in either the mitral or aortic valves. Interestingly, a few cases of tricuspid valve papillary fibroelastoma have been reported so far. Similar echocardiographic findings between vegetation and tricuspid valve neoplasm make it difficult to distinguish these two disease entities.

• Journal of Chest Surgery
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• 제35권9호
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• pp.688-691
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• 2002

Takayasu씨 동맥염은 원인이 잘 모르는 만성 염증성 질환의 일종이다. 이 질병은 주로 대동맥궁과 대동맥의 주분지를 잘 침범하는 것으로 알려져 있으며, 관상동맥과 신동맥을 동시에 침범하는 경우는 극히 드물다. 최근 고려대학교 흉부외과학교실에서는 관상동맥과 신동맥을 동시 에 침범한 Takayasu씨 동맥 염 환자를 성공적으로 치료하였기에 보고하는 바이다. 환자는 23세 여자로, 운동시의 흉통을 주소로 내원하였다. 혈관조영술상 좌주관상동맥, 양측의 신동맥, 좌쇄골하동맥의 협착 소견을 보였다. 치료로는 양측의 신동맥에 스텐트를 삽입하는 혈관성형술을 시행하였고, 1주일 뒤 대복재정맥을 이용한 관상동맥우회술과 인조혈관(PIFE)을 이용한 대동맥-쇄골하동맥간 우회술을 동시에 시행하였다. 환자는 수술 후 13일째 특별한 합병증 없이 퇴원하였다.

• Journal of Chest Surgery
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• 제26권2호
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• pp.141-147
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• 1993

A total of 40 patients having a diagnosis of atherosclerotic coronary arterial disease were analysed on the operative outcomes according to variables as follows: 1) preoperative risk factors such as age, sex, CCS (Canadian Cardiovascular Society) functional class, type of angina, number of diseased vessel, presence of left main coronary artery stenosis, previous history of habitual smoking and presence of other medical diseases (diabetes mellitus, essential hypertension), 2) preoperative management such as intravenous infusion of nitroglycerine, preoperative IABP (intra-aortic balloon pump) support and whether the operation was scheduled as emergency or not, 3) intraoperative variables such as infusion method and composition of cardioplegic solutions, number of distal anastomosis, use of internal mammary artery, total cardiopulmonary bypass time and total cross clamp time. Complications included operative death in 12.5％, perioperative myocardial infarction in 25.0％ and perioperative arrhythmia in 17.5％. Nineteen perioperative variables were analyzed to identify risk factors for these end points. For operative death, presence of left main coronary artery stenosis (p = 0.056) and cardiopulmonary bypass time (p = 0.029) were significant in the univariate analysis, but presence of left main coronary artery lesion (p = 0.011, $\chi$$^2$= 6.45) and abscence of preoperative of IABP support (p = 0.069, $\chi$$^2$ = 3.30) were independent predictor in multivariate analysis (stepwise linear logistic regression).

• Journal of Chest Surgery
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• 제41권4호
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• pp.480-483
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• 2008

질환에 따라서 많은 논란이 있으나, 최근 선천성 심기형의 수술적 교정시 조기의 일단계 완전 교정술을 시행하는 쪽이 장점이 부각되고 있다. 저체중(low birth weight) 미숙아에서 체외순환을 통한 개심술은 여러 가지 이유로 수술이 쉽지 않아 환자의 체중 및 장기 기능이 발달할 때까지 단계적으로 수술을 시행하는 경우가 대부분이다. 본 증례에서는 심실 중격 결손을 동반한 대동맥축착증을 가진 태내주수 29주, 출생체중 1,280 g, 수술 당시 체중 1,250 g의 미숙아의 성공적인 일단계 완전 교정술을 보고하고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1609-1613
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• 2015

Purpose: To determine the rate of lymph node metastasis, oncologic and pregnancy outcomes in apparent early-stage malignant ovarian germ cell tumor (MOGCT). Materials and Methods: Medical records of apparent early-stage MOGCT patients undergoing primary surgical treatment at Siriraj Hospital, Bangkok, Thailand, between January 2006 and December 2013, were retrospectively reviewed. Results: Thirty-eight patients had apparent stage I-II MOGCT. The mean age was $22.1{\pm}7.7years$ (median, 20.8 years; range, 7.7-35.6 years). The mean tumor size was $17.8{\pm}6.5cm$ with a median of 20 (range 4-30) cm. Three most common histopathologies were dysgerminoma (12 patients, 31.6%), immature teratoma (12 patients, 31.6%), and endodermal sinus tumor (6 patients, 15.8%). Twenty-seven of 38 patients underwent lymphadenectomy; 13 patients (48.2%) were stage IA and 8 patients (29.6%) were stage IC. The rate of retroperitoneal nodes metastasis was 7.4% (2/27 patients). At 26.1 months of median follow-up time (range 1.9-88.5 months), 9 patients retained fertility functions, with uneventful pregnancies in 3 of these. Only one patient (2.6%) had progression of disease at 4.9 months after surgery. The 5-year survival rate was 97.4%. Conclusion: As the rate of pelvic or para-aortic node metastasis in MOGCT is considerable, lymphadenectomy should be incorporated in surgical staging procedures.

• Journal of Chest Surgery
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• 제39권2호
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• pp.145-149
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• 2006

폐동맥 협착과 심실 중격 결손을 동반한 대혈관 전위를 갖는 환자들에 대한 수술은 Rastelli 수술법이나 Lecornpte 수술법이 전통적으로 시행되어 왔으나, 심실 내 터널에 의한 뒤틀린 좌심실 유출로와 부자연스러운 우심실 유출로에 의해 장기 성적은 만족스럽지 않다. 이에 대한 대안으로 저자들은 이 기형으로 진단된 3세 환아(체중 9.6 kg)에서 반회전 동맥간 전환술(half-turned truncal switch operation)을 시행하였다. 술 후 심초음파 검사에서 좌심실유출로와 우심실유출로가 곧고 넓게 형성되어 향후 좋은 장기 결과가 기대된다.

• Journal of Chest Surgery
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• 제13권1호
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• pp.77-81
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• 1980

We present one case of 26-year-old male having saddle block combined with mitral valvular disease [NYHA Class IV] with auricular fibrillation. The most common cause of emboli is atrial fibrillation. The clinical manifestations of saddle emboli are relatively slow due to development of collateral circulation and large size of lumen of the aorta. The 5month duration of saddle emboli in this case led to severe atrophic changes, coldness, peripheral cyanosis on the both lower extremities, and flexion deformity on the knee and ankle joint of the left lower extremity. We planned staged operation for the saddle block and for mitral stenoinsufficiency and tricuspid insufficiency, because of poor general condition of the patient. The thromboembolectomy of aortic bifurcation was performed through the transabdominal approach without trial of Fogarthy catheter embolectomy, because of expectation of the secondary inflammatory changes of the vessel wall and thrombi which was 3 cm X 1 cm X 0.5 cm in size with irregular surfaced solid in consistency. 1 month later, after thromboembolectomy, mitral valve replacement and tricuspid annuloplasty were performed, with successful early operative result. During operation organized thrombi [1 cm X 0.5 cm] in the left auricle was removed. We wonder if simple management using Fogarthy catheter might be possible to remove the thromboemboli instead of thromboembolectomy by aortotomy in this case.

• Journal of Chest Surgery
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• 제5권1호
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• pp.19-24
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• 1972

The recent development of cardiovascular surgery as well as aortoarteriogaphy has been established excellent operative result with great aid of limb-salvage. However, less consideration or less experience still exists on the regard of vascular accident and vascular disease, as well as vascular surgery in Korea. During the last 13 years, we experienced only two cases of aorto-iliac occlusion,acute and chronic, regardless of having had more than 300 cases of mitral valvotomy and gradual increasing tendency of arteriosclerosis and hypertension in Korea. Therefore it is noteworthy to report the cases in order to promote the consideration for vascular surgery. Case 1; 52 year old female who had 20 years history of mitral stenosis with uricular fibrillation and received medical treatment for recent 1 year in the medical department. 10 days before admission, acute saddle emboli developed and 15 days after the onset, embolectomy through both common femoral arteries on the groin and abdominal approach was made. The progression of emboll to the right popliteal bifurcation was found by arteriography on operating table and retrograde flushing with heparin solution by the polyethylene catheter inserted through posterior tibial artery. The operation was successful, but 9 hours after operation sudden death occurred. Considering this case, first, mitral valvotomy already before might prevent peripheral embolizatlon, secondarily, the more early detection and surgery might also prevent the progression of emboli. Thirdly, although preoperative or postoperatlve heparinization is controversial for mitraI stenosis, heparinization might prevent additional emboli to vital organs in this case Cases 2; 66 year old female who had 4 years history of left hip and calf intermittent claudication and has had rest pain, inability to walk and ischemic necrosis on the the left leg since last 3 months prior to admission to the orthopedic department under the suspicion of herniated disc. Absence of pulsation on the groin and aortography evidenced aortoillac occlusion predominantly on the left side. Thromboendarterectomy was made and the operative result was successful with absence of claudication, healing of ulcer and aortographic patency of occlusive site. This chronic occlusion is considered to result from arteriosclerosis in origin with the evidence of moderate hypertension, x-ray evidence of calcified plaque on the aortic knob and operative finding of palpable plaques.