• Journal of Chest Surgery
• /
• 제12권3호
• /
• pp.297-305
• /
• 1979

Occlusive coronary artery disease presents a potential threat to a significant population in the United States. According to many case reports, the increasing incidence of coronary artery disease due to atherosclerosis is noted in Korean, recently. Operative vascular procedures have increased steadily in number over the past 20 years in the United States. There have been many isolated case reports about coronary artery surgery, but these had little clinical impact. Nowadays, major three coronary bypass surgery has developed principally at three cardiac centers in the United States since 1967. Among three coronary bypass operation, the aorta-coronary artery saphenous vein bypass graft was first demonstrated by Favolaro and Effler at the Cleveland Clinic in 1967. We experienced one case of coronary artery disease, which was treated successfully by aorta-coronary saphenous vein graft with mild hypothermia under extracorporeal circulation in May, 1977. Saphenous vein was removed from above the knee and was 2.5 mm in diameter. The left ventricle was not vented for the left ventricle was not overdistended. Temporary artificial pace-maker-Medtronic-was implanted for the prevention and treatment of post-operative arrhythmia and heart block in post-operative first day. He is a 57 year old male businessman who had been suffered from hypertension [200 mmHg in systolic pressure] since 4 years ago, who had intermittent conservative treatment at local clinic. He had been afflicted with severe chest pain with choking sensation for 50 days. This symptom was aggravated exposing cold weather, or cold water, but was respond to rest. Pre-operative ECG revealed no any other ischemic sign except sinus bradycardia. Significant S-T segment depression was noted at lead II, AVF after double 5 minutes exercise, indicating positive Master`s test. Serum cholesterol was slight elevated to 253 mg/dl. Final pre-operative diagnosis was made by coronary arteriogram, which showed about 1.0-cm segmental 90 % occlusive atherosclerotic lesion in the proximal part of right coronary artery above the origin of acute marginal artery. Left coronary artery revealed good patency and there was no collateral circulation between right and left coronary artery .Hospital course was not eventful. He was discharged with good result on the post-operative day. He has been free from chest pain for longer than 2 years. And also the arterial flow in the coronary bypass graft is auscultated with the pocket-sized ultrasonic velocity detector, which shows the patency of the coronary bypass graft good.

• Journal of Chest Surgery
• /
• 제32권10호
• /
• pp.903-909
• /
• 1999

Background: The current study was undertaken to investigate the results of a modification in the conventional Maze III Procedure devised by the authors. The aim of the technical modification was in improving the left atrial contractility. Material and Method: Between July 1997 and December 1998, 34 patients with chronic atrial fibrillation for more than 1 year duration underwent a modified Maze III procedure. The assessment of the left atrial function was made by various echocardiographic measurements and SA nodal recovery was evaluated by HRV Holter monitoring. Result: All 34 patients were in sinus rhythm. On echocardiography, right atrial contraction was detected in 32 patients(94.1%) and left atrial contraction in 33 patients(97.1%). The echocardiographic A wave at 1, 6, and 12 months or more were 50.5$\pm$31.5, 62.1$\pm$25.1, 66$\pm$20.6 cm/sec, respectively, and the E wave measurements at the same time points were 152$\pm$31.1, 134.4$\pm$35.2, 133$\pm$27.5 cm/sec. The corresponding A/E ratios were 0.32$\pm$0.13, 0.48$\pm$0.18, 0.5$\pm$0.15, showing a rising trend. Treadmill evaluation at 6 months showed a mean 82% increase in heart rate after excising, and the SDNN and SDANN upon HRV Holter at 1 and 3 months postoperatively were 65.3$\pm$28.1/87.8$\pm$27.2 ms, and 60.0$\pm$24.1/83.4$\pm$25.7 ms, respectively, showing a predoinant autonomic recovery in the parasympathetic system(PSDNN = 0.01, PSDANN =0.015). Conclusion: The results of our data suggest that the current modification in the conventional Maze III Procedure was efective in enhancing the postoperative left atrial contractility.

• 대한치과마취과학회지
• /
• 제9권2호
• /
• pp.116-118
• /
• 2009

The automatic implantable cardioverter defibrillator (AICD) has been widely used to treat recurrent malignant ventricular arrhythmia. Here, we case report 18 yr old patients implanted with Automatic implantable cardioverter defibrillator (AICD) who underwent surgical extraction under intravenous sedation and discuss the anesthetic implications for surgery.

• Journal of Chest Surgery
• /
• 제45권1호
• /
• pp.11-18
• /
• 2012

Background: The aim of this study is to evaluate the clinical and rhythm outcomes of atrial fibrillation (AF) ablation through a port access approach compared with sternotomy in patients with AF associated with mitral valve diseases. Materials and Methods: From February 2006 through December 2009, 135 patients underwent biatrial AF ablation with a mitral operation via either a port-access approach (n=78, minimally invasive cardiac surgery [MICS] group) or a conventional sternotomy (n=57, sternotomy group). To adjust for the differences in the two groups' baseline characteristics, a propensity score analysis was performed. Results: After adjustment, there were no significant differences in the two groups' baseline profiles. The cardiopulmonary bypass time was significantly longer (p=0.045) in the MICS group ($176.0{\pm}49.5$ minutes) than the sternotomy group ($150.0{\pm}51.9$ minutes). There were no significant differences (p=0.31) in the two groups' rate of reoperation for bleeding (MICS=6 vs. sternotomy=2, p=0.47) or the requirement for permanent pacing (MICS=1 vs. sternotomy=3). The major event-free survival rates at two years were $87.4{\pm}8.1%$ in the MICS group and $89.6{\pm}5.8%$ in the sternotomy group (p=0.92). Freedom from late AF at 2 years was $86.8{\pm}6.2%$ in the MICS group and $85.0{\pm}6.9%$ in the sternotomy group (p=0.86). Conclusion: Both the port-access approach and sternotomy showed tolerable clinical outcomes following biatrial AF ablation with mitral valve surgery.

• Journal of Chest Surgery
• /
• 제48권4호
• /
• pp.252-257
• /
• 2015

Background: Lobectomy is the generally accepted standard treatment for early-stage non-small cell lung cancer (NSCLC). However, especially in elderly patients, it is often necessary to perform pneumonectomy in order to maximize the likelihood of curative treatment, although pneumonectomy is a challenging procedure. Methods: We analysed patients who were clinically diagnosed with stage I NSCLC and underwent pneumonectomy with curative intent from 2004 to 2011. The patients were divided into an elderly group (${\geq}70$ years) and a younger group (<70 years). We retrospectively analysed the outcomes of these groups of patients in order to characterize the role of pneumonectomy as a treatment for elderly patients with clinical stage I NSCLC. Results: Thirty patients younger than 70 years of age (younger group) and fourteen patients 70 years of age or older (elderly group) who underwent pneumonectomy were enrolled in the present study. The median follow-up period was 35 months (range, 0 to 125 months). The perioperative mortality rate (within 90 days after the operation) was 7.1% in the elderly group and 6.7% in the younger group (p=0.73). No significant differences between the two groups were observed regarding the occurrence of pneumonia, acute respiratory distress syndrome, cardiac arrhythmia, bronchopleural fistula, and vocal cord paralysis. The overall five-year survival rate was 79.4% in the younger group and 35.7% in the elderly group, which was a significant difference (p=0.018). The five-year disease-free survival rate was 66.7% in the younger group and 35.7% in the elderly group, but this difference was not statistically significant (p=0.23). Conclusion: Although elderly patients with early stage lung cancer showed a worse long-term survival rate after pneumonectomy than younger patients, the outcomes of elderly patients were similar to those of younger patients in terms of perioperative mortality and postoperative complications. Patients should not be denied pneumonectomy solely due to old age.

• Journal of Chest Surgery
• /
• 제31권11호
• /
• pp.1056-1062
• /
• 1998

연구배경 : 개심술 후의 부정맥은 빈번하게 발생하는 합병증이며 그 종류도 다양할 뿐 아니라, 수술후 발생하는 부정맥은 심박출량의 저하 등 심각한 결과를 초래할 가능성이 있다. 재료 및 방법 : 본 연구는 이러한 부정맥의 예방과 치료의 방침을 결정하는데 기본적인 자료를 제공하고자 1994년 6월부터 1995년 5월까지 1년간 서울대학교병원 흉부외과에서 개심술을 시행 받은 성인 환자들을 대상으로 술후 부정맥의 양상을 전향적으로 분석하여 위험인자를 유추하였다. 결과 : 총 302명을 대상으로 하였는데, 그 중 남자가 150명이었고 여자는 152명이었으며, 평균 연령은 43.9세 (16세부터 75세까지) 였다. 대상환자 모두 술전 및 술후 표준 12-lead EKG 및 중환자실에서의 24시간 심전도 감시장치로 부정맥을 진단하였으며 수술직후 집중감시병동에서는 동맥혈 가스분석 및 혈중 potassium 농도를 측정하여 이상이 있으면 교정하였고 단순히 산혈증이나 저칼륨혈증에 의한 부정맥은 연구대상에서 제외하였다. 술후 부정맥의 전체 발생률은 58.3%이었는데, 판막 재수술의 경우 부정맥이 77.8%에서 나타났고, 단순 판막 수술, 관상동맥 우회술, 대동맥 수술, 선천성 심기형의 수술후의 부정맥 발생률들은 각각 70.8%, 45.3%, 40.0%, 29.5% 이었다. 연령별 발생은 의미있는 차이를 보이지 않았으며 심정지액의 종류도 의미있는 차이는 보이지 않았다. 반면에 수술의 종류, 술전 부정맥의 유무, 체외순환 및 대동맥 차단시간, 그리고 술전 시행한 심초음파상의 좌심실 확장기말과 수축기말 내경, 좌심방의 내경 등은 부정맥의 발생률과 통계적으로 유의한 상관관계를 보여주었다 (p< 0.05). 결론 : 향후 질병, 수술방법 등이 균질화된 집단을 선정하여 전향적인 연구를 진행함으로써 개심술후 부정맥의 발생, 치료 및 예방에 관한 보다 정확한 결론에 접근할 수 있을 것으로 생각한다.

• Journal of Chest Surgery
• /
• 제38권11호
• /
• pp.776-779
• /
• 2005

대동맥과 주폐동맥 사이의 좌관상동맥동에서 이상기시하는 우관상동맥은 급사, 실신, 부정맥, 심근허혈을 일으킬 수 있다. 이러한 기형에서 관상동맥의 혈류에 제한을 주는 기전은 확실하지 않으며, 관상동맥우회로술이나 관상동맥의 이식, 폐동맥의 전위, Unroofing 술식과 같은 여러 가지의 수술적 치료방법이 보고되고 있다. 저자들은 Unroofing 술식을 이용하여 대동맥과 주폐동맥 사이의 '좌관상동맥동에서 이상기시하는 우관상동맥을 교정하여 보고하는 바이다

• Journal of Chest Surgery
• /
• 제46권6호
• /
• pp.426-432
• /
• 2013

Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

• Journal of Chest Surgery
• /
• 제47권3호
• /
• pp.233-239
• /
• 2014

Background: As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). Methods: Consecutive 314 patients (mean age, $62.5{\pm}10.8$ years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ${\geq}10$ times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value. Results: There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049). Conclusion: PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.

• Journal of Chest Surgery
• /
• 제44권2호
• /
• pp.137-141
• /
• 2011

Background: There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. Materials and Methods: We reviewed the clinical course of 57 patients (mean age: $63.54{\pm}5.59$ years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was $6.8{\pm}4.5$ years. Results: One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. Conclusion: Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.