• Journal of Chest Surgery
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• 제25권11호
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• pp.1346-1353
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• 1992

From Febrary 1984 to July 1992, 138 cases of multiple valve replacements were performed at the Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University. There were 81 females and 57 males, and their ages ranged from 19 to 60 years [mean age, 40.1$\pm$10.9 years]. Thirteen of these patients had undergone previous cardiovascular procedures, with an average of 76.3 months between procedures[range, 3 to 180 months]. Mitral and aortic valve replacement were done in 135 patients, 2 underwent triple valve replacement and 1 underwent mitral and tricuspid valve replacement. Associated procedures were necessary in 20 patients[14.5%]. The operative mortality was 5.8% and the most common cause was low cardiac output. Late follow-up of 83% has been accomplished in 130 early survivors, with a late mortality of 5.9%. The late mortality was due to valve thrombosis in 2 patients, cerebral infarction in 1, heart failure in 1, arrhythmia in 1, and bleeding in l. Of those patients who survived, New York Heart Association functional class improved significantly[from 70% class III and IV before to 88% class I and II after]. Actuarial survival rate including all deaths was 88.8% at 8 years. The follow-up studies revealed that thromboembolism, reoperation and bleeding rate were 1.2%/patient-year, 0.85% /patient-year and 0.57%/patient-year at 8 years postoperatively. We concluded that valve thrombosis, embolism, and anticoagulant-related hemorrhage were the main risk factors of longterm survival of patients.

• Journal of Chest Surgery
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• 제26권7호
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• pp.526-531
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• 1993

Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

• Journal of Chest Surgery
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• 제24권10호
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• pp.951-959
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• 1991

The level of serum potassium concentration is very important aspect in postoperative cardiac patients The postoperative cardiac arrhythmia and digitalis intoxication are known to be closely related with hypokalemia and also to cause the irreversible cardiac dysfunction. In this study, the changes of the level in serum and urine concentrations during, after extracorporeal circulation[EGG], Predict and Postdict periods are analyzed and compared statistically with postoperative cardiac patients 46 persons according to divided 8 groups. 1. There was no difference significantly in concentrations of serum and urine potassium in each period according to age, sex and disease types. 2. There was no difference significantly in concentrations of serum and urine potassium in each period according to the use of normothermia and hypothermia. 3. There was no difference significantly in concentrations of serum and urine potassium in each period according to the length of extracorporeal circulation time and aortic cross clamping time. 4. There was no difference significantly in concentrations of serum and urine potassium in each period according to the amount of the infused cardioplegic solution and level of Hct.

• Journal of Chest Surgery
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• 제28권1호
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• pp.11-17
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• 1995

Fourty-three infants underwent intracardiac repairs within the first 12 months of life. Mean age was 7 months and mean weight was 6.7 kg. A quarter of them were below 5 kg. Overall mortality including complex anomalies was 17.9%. Thirty-four infants with a ventricular septal defect[VSD were treated. Three infants[8.8% died in the early postoperative period, but only one[3.7% of the infants without having associated lesions was dead. VSD was repaired either by the incision on the right atrium, pulmonary artery, or right ventricle. Postoperative right bundle branch block[RBBB occurrence were different according to the approach: 30.8 % in pulmonary arteriotomy, 37.5 % in atriotomy, and 42.8 % in ventriculotomy. Surgically induced heart block did not occur in any patient, but 10 had temporary arrhythmia, and 11 patients were under temporary pacing from one day to 4 days without any persisting rhythm disturbances. Pulmonary hypertension was present in 29 infants preoperatively, and seven of them developed postoperative elevation of the pressure. Infants complicated with pulmonary hypertensive crisis were managed successfully. Inotropics were necessary in 55.8 % of the infants and vasodilators in 37.2 %. Platelet transfusion were needed in 10 cases who required 272 ml in average, but one who died from sepsis consumed 5,370cc of platelets. And we discuss complications and causes of deaths.

• Journal of Chest Surgery
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• 제45권1호
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• pp.30-34
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• 2012

Background: The long-term results of homografts used in systemic circulation are controversial. We assessed the long-term results of using a cryopreserved homograft for an aortic root or aorta and its branch replacement. Materials and Methods: From June 1995 to January 2010, 23 patients (male:female=15:8, $45.4{\pm}15.6$ years) underwent a homograft replacement in the aortic position. The surgical techniques used were aortic root replacement in 15 patients and aortic graft interposition in 8 patients. Indications for the use of a homograft were systemic vasculitis (n=15) and complicated infection (n=8). The duration of clinical follow-up was $65{\pm}58$ months. Results: Early mortality occurred in 2 patients (8.7%). Perioperative complications included atrial arrhythmia (n=3), acute renal failure (n=3), and low cardiac output syndrome (n=2). Late mortality occurred in 6 patients (26.1%). The overall survival rates at 5 and 10 years were 66.3% and 59.6%, respectively. Six patients (28.6%) suffered from homograft-related complications. Conclusion: Early results of homograft replacement in aortic position were favorable. However, close long-term follow-up is required due to the high rate of homograft-related events.

• Journal of Chest Surgery
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• 제53권3호
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• pp.127-131
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• 2020

Background: This study was conducted to evaluate the safety and efficacy of left atrial appendage (LAA) excision using a vascular stapler. Methods: Fifty consecutive patients (mean age, 68±9 years) who underwent LAA excision using a vascular stapler during concomitant cardiac surgery were enrolled. In all patients, the excision site was evaluated using computed tomography at a median of 7 days (interquartile range, 5-13.3 days) postoperatively. The safety endpoint of this study was the occurrence of LAA excision-related events, which were defined as bleeding from the excision site that required reinforcement sutures or reoperation due to excision site bleeding. The efficacy endpoint was LAA excision failure, which was defined as a remnant LAA (a stump >1 cm in maximum length) or extravasation of radiocontrast dye. Results: LAAs were excised using 60- and 45-mm vascular staplers in 49 patients and 1 patient, respectively. Reinforcement sutures were needed in 4 patients due to staple-line bleeding and in 4 patients due to bleeding of the surrounding tissues. No patient underwent reoperation due to staple-related bleeding. A remnant LAA was observed in 2 patients, while extravasation of radiocontrast dye was not observed in any patients. Conclusion: LAA excision using a vascular stapler may be an effective technique for LAA exclusion. Delicate handling of the stapler device and LA tissue is required to prevent procedure-related complications.

• Journal of Chest Surgery
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• 제25권2호
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• pp.176-182
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• 1992

From April 1977 to March 1991, 44 patients have undergone excision of intracardiac myx-omas, 36 cases were located in the left atrium[81.6%], 3 cases in the right atrium[6.6%], 2 cases in the right ventricle[4.5%], 3 cases in the left ventricle[6.6%], There were 32 female and 12 male. The mean age of patients was 39.6$\pm$12.3 years[ranged 11 to 67 years]. The major preoperative symptoms included exertional dyspnea in 35[79.6%], palpitation in 23[52.3%], syncopal episodes in 9[20.4%], and signs of systemic illness; low-grade fever, weight loss, arthralgia, headache and so on. The diagnosis was made by echocardiography alone in 7[15.9%], and by combination of angiography and echocardiography in 37[84.1%]. The weight of the tumor ranged from 15 to 115gm[mean weight, 47.6$\pm$27.6gm], and the volum of the tumor was 129.1cm3[$\pm$149.0]. Follow-up time ranged from 0.6 to 9 years[mean follow-up, 65$\pm$3.22 years]. There were no early and late deaths during the follow-up period. Tumor recurred in one patient with left atrial myxoma 8 years later, who underwent successful reoperation. Postoperative complications occurred in 12 patients: episodes of sup-raventricular arrhythmia in 7, convulsion in 2, wound problem in 2, tricuspid valve regurgitation in 1, massive bleeding in 1, and intubation granuloma in one. In conclusion, surgical excision of the myxoma can be considered curative with excellent long-term result.

• 생명과학회지
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• 제17권11호
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• pp.1539-1546
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• 2007

연구저자들은 심장판막 수술 환자를 대상으로 냉각 혈액 심정지액에 마그네슘 첨가(2 g)의 효과를 실험하였다. 수술동안 및 후의 $Mg^{++}$ 농도와 $Ca^{++}$ 농도는 마그네슘군이 대조군보다 유의하게 더 높았다. 수술 후 시기에 총 백혈구 수, CK-MB, troponin-I, interleukin-6의 농도는 마그네슘군이 대조군보다 유의하게 더 낮았다. 수술 후 심방세동 발생률 역시 마그네슘군이 대조군보다 유의하게 더 낮았다. 본 연구의 결과들은 심장수술 시 심정지액에 대한 일정량의 마그네슘 첨가가 특별한 부작용 없이 저마그네슘혈증, 전신염증반응, 심방세동의 발생률을 줄이고 심근보호 효과 역시 가져다줌을 시사하고 있다.

• Journal of Chest Surgery
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• 제38권8호
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• pp.529-537
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• 2005

배경: 이소성증후군과 기능적 단심실을 동반한 환자들은 체정맥 또는 폐정맥의 연결이상, 폐쇄부전을 동반한 공통 방실판막, 우심실형의 단심실과 부정맥이 많이 동반되어 폰탄 수술의 결과가 좋지 않은 것으로 알려져 있다. 이 환자들에 대한 심장외 도관 폰탄 수술의 치근 결과를 연구하였다. 대상 및 방법: 1996년부터 2005년까지 기능적 단심실로 폰탄 수술을 받은 62명(연령: $54.79\pm33.97$개월)의 이소성증후군 환자들에 대하여 심장외 도관 폰탄 수술을 시행하였다. 좌측 이소성 환자가 21명이었고, 우측 이소성 환자가 41명이었다. 2명을 제외한 모든 환자들에서 양방향성 대정맥폐동맥 단락술을 시행하였으며, 천공은 좌측 이소성에서 더 적게 필요하였다. 걸과: 좌측 이소성 군에서 하대정맥 단절과 폐동정맥루가 더 많았으며, 우측 이소성 군에서 페정맥의 연결 이상,공통 방실판막과 우심실형의 단심실이 더 많았다. 병원 내 사망은 3예$(4.8\%)$였으며, $48.8\pm31.0$개월간 추적 관찰하여 만기 사망은 3예$(5.2\%)$였다. 누적생존율은 8년에 좌측 이소성에서 $90.5\pm6.4\%$와 우측 이소성에서 $88.6\pm5.4\%$로 차이가 없었다(p=0.94). 재수술의 자유도는 8년에 좌측이소성에서 $73.9\pm11.3\%$와 우측 이소성에서 $82.3\pm6.7\%$ 로 차이가 없었다(p=0.87). 술 후 이소성증후군에서 방실판막 페쇄부전이 진행하였으며, 좌측 이소성 군에서는 폐동정맥루에 대한 재수술과 동결절 기능장애에 의한 인공심박조율기 삽입이 더 필요하였다. 걸론: 이소성증후군이 있는 기능적 단심실 환자는 심장외 도관 폰탄 수술, 천공, 단계적 수술과 동반된 기형의 적극적인 수술로 폰탄 수술 후 생존율은 호전되었다. 그러나 수술 후 방실판막 폐쇄부전, 부정맥, 그리고 페동정맥루에 대한 술 후 지속적인 추적 관찰이 필요하다.

• Journal of Chest Surgery
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• 제40권12호
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• pp.805-810
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• 2007

배경: 저자들은 저자들의 센터에서 일정 기간 동안 시행한 폰탄 술식의 중장기 성적을 알아보고자 하였으며, 특히 심장외 도관을 사용한 폰탄 술식과 가측 터널 폰탄 술식의 성적을 비교하고자 하였다. 대상 및 방법: 1996년 1월부터 2006년 12월에 걸쳐 67명의 가측 터널 폰탄 술식, 98명의 심장외 도관 폰탄 술식을 시행하였다. 환자들의 나이, 성별, 체중, 수술 전 심도자 검사 결과, 방실 판막의 역류 정도, 술전 부정맥의 여부 등에 대하여 조사하였으며 수술 후 성적에 대해서 조사 분석하였다. 결과: 수술 사망률은 가측 터널 폰탄 술식에서 4.5%, 심장외 도관 폰탄 술식에서 2.0%를 보였다. 수술 직후의 혈역학적인 측면에서 경폐압력차이와 중심정맥압은 심장외 도관 폰탄 술식에서 통계학적으로 의미있게 낮게 측정되었으나, 병원 재원 기간, 중환자실 체류 기간, 흉관 삽관 일수 등은 양 술식에 따른 의미있는 차이를 보이지 않았다. 추적 관찰 기간은 가측 터널 폰탄 술식 환자는 74.1개월, 심장외 도관 폰탄 술식 환자는 38.1개월이었으며, 기간 중에 1명의 만기 사망이 있었다. 10년간의 생존율은 가측 터널 폰탄 술식 환자에서 92%, 심장외 도관 폰탄 술식 환자에서 89%를 보였으며, 추적관찰 기간중의 부정맥 발생의 측면에서 살펴볼 때, 심장외 도관 폰탄 술식 환자에서 다소 낮은 발생률을 보였다. 결론: 폰탄 술식은 과거 10여 년 동안 비교적 만족할 만한 수술 성적을 보이고 있으며, 특히 심장외 도관 폰탄 술식을 사용하는 경우 부정맥의 발병이 비교적 낮았다. 이에 대해서는 보다 장기적인 추적관찰이 필요할 것이다.