• Journal of Chest Surgery
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• 제37권1호
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• pp.35-42
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• 2004

배경: 허혈성 좌주간 관동맥 협착병변은 돌연사의 위험성이 높아 조속한 재관류를 요한다. 본 교실에서는 단독 좌주간 관동맥 협착병변으로 좌측 내흉동맥에 요골동맥이나 우위대망동맥을 Y모양으로 연결하여 관상동맥우회로 조성술을 시행했던 경우를 분석함으로써 내흉동맥만으로 심근의 혈액요구량을 충분하게 감당할 수 있는지의 여부와 경계부 협착을 보이는 좌주간 관동맥 협착병변에서 경쟁혈류에 의한 우회혈관의 재구성이 초래되는가를 알아보았다. 대상 및 방법: 2000년 3월부터 2003년 4월까지 관상동맥우회로 조성술을 시행받은 247명의 환자 중 단독 좌주간 관동맥 협착병변으로 진단되어 동맥이식편만을 이용한 관상동맥우회로 조성술을 시행받은 12명(4.8%)의 환자를 대상으로 하여 의무기록과 본 교실의 database를 기초로 역행성 연구를 시행하였다. 결과: 좌전하행지 문합은 전예에서 인공심폐기를 사용하지 않고 시행하였으나 둔각변연분지 문합 중 2예에서는 인공심폐기 가동 후 심박동하에서 문합하였다. 직경이 1 mm 이상되는 좌회선분지가 없어 문합을 시행하지 못한 1예를 제외한 11예에서 Y-도관을 이용한 완전재관류를 시행하였으며 환자 1인당 문합 수는 평균 2.0개이었다. 좌주간동맥의 협착이 75% 이하이었던 경우에서는 좌전하행지 문합 중 1예에서 좌내흉동맥에 string sign을 보였으며 좌회선분지 문합 7예 중 완전히 막힌 경우 2예, slender sign 1예가 있었으며 문합 원위부 관상동맥 혈류 형태가 도관의존성인 경우는 없었다. 그러나 이와는 반대로 90% 이상의 협착 병변에서는 문합된 관상동맥 모두에서 도관의존성의 원위부 혈류 형태를 보였다. 결론: 90% 이상의 협착을 보인 좌주간동맥 협착병변에서는 동맥이식편을 V-도관으로 만들어 TAR를 시행하더라도 심근의 혈류요구량을 충분하게 감당할 수 있을 것으로 판단된다. 그러나 경계부 협착을 가진 환자의 경우에는 고정된 치료방침을 택하기보다는 면밀한 진단을 통하여 정맥도관이나 동맥도관의 대동맥에 직접 문합 또는 경피적 관동맥중재술과의 보완 치료 등 좀 더 유연하고 신중한 치료방침의 결정이 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제26권3호
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• pp.245-248
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• 1993

Recently we experienced a case of Takayasu`s arteritis involving the major aortic branches. A 30 year-old female patient admitted with the complaints of dizziness, visual disturbance, headache and tingling sensation of upper extremities. Aortogram revealed nearly complete obstruction of the origin site of both common carotid arteries and right vertebral artery, and irregular luminal narrowing of the origin site of innominate artery and left subclavian artery, but opacification of right subclavian artery and left vertebral artery. Successful surgical treatment was accomplished with a bypass from the ascending aorta to the left common carotid artery using a tube graft. The left subclavian artery and right axillary artery were revascularized distal to the stenosis with tube grafts that extended from the aortic graft. Postoperative complications were atelectasis, lymph leakage and left phrenic nerve palsy. She discharged uneventually at postoperative 22 days and most of symptoms were relieved.

• Journal of Chest Surgery
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• 제46권3호
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• pp.165-177
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• 2013

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.

• Journal of Chest Surgery
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• 제50권2호
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• pp.105-109
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• 2017

Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation.

• 대한족부족관절학회지
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• 제9권2호
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• pp.224-226
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• 2005

In diabetic foot with arterial occlusive disease, skin defect on heel was tried to treat with free flap or local flap, but couldn't be treated well. Therefore below knee amputation was perfomed mostly. But we treated a patient of large heel defect with using of artificial bypass graft and antero-lateral thigh perforator flap.

• Journal of Chest Surgery
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• 제29권4호
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• pp.393-396
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• 1996

본 인제대학교 서울백병원 흉부외 과에서는 지난 8년간 술전 적극적 인 항고혈압제 투여에도 불구하 고 혈압 조절에 실패한9명의 신혈관성 고혈압 환자를 수술 치험하였다. 수술방법은9명중8명에서는 자가복재 정맥을 이용한 대동맥 신동맥간우회술을시행하였으며,나머지 1명은내장골동맥을이용한 신동맥 재건술을 시행하였다. 술후 9명의 환자중 사망한 예는 없었으며, 수술전후 비교한 혈압 수치의 선정 기준은, 술전에는 환자의 여러 차례 측정된 혈압중 대표적 인 혈압수치로 선정하였고, 술후혈압은 최종적으로 외래 추적 관찰한 혈 압수치를 선정 하였다. 술후 장기 추적한 걸과 9명의 환자 모두에서 혈압 호전을 보여 좋은 수술 결과를 얻었기 에, 중증 신혈관성 고혈압환자에 있어서 수술적 치료가 가장 효과적이고 유용한 치료법으로 생각 되는 바이다.

• Journal of Chest Surgery
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• 제40권11호
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• pp.773-776
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• 2007

47세 남자 환자로 양측 하지의 파행을 주소로 내원하였는데 심한 흡연력, 당뇨와 고혈압을 가지고 있었다. 평소 허혈성 심질환의 증상과 뇌혈류의 역류로 인한 증상은 없었지만 상 하지 혈관조영술과 동시에 시행한 관상동맥조영술 검사에서 좌측쇄골하동맥 폐색을 포함한 말초혈관질환과 관상동맥에 심한 협착이 관찰되었다. 수술은 좌측 늑강을 경유한 상행대동맥-좌액와동맥 혈관우회술을 시행 후 우내흉동맥을 좌전하행지에 문합하고 복재정맥을 사선지와 인조혈관에 문합하였다. 하지 말초혈관의 폐색은 술 후 18일에 혈관우회술로 교정되었고 결과는 양호하였다.

• Journal of Chest Surgery
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• 제22권1호
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• pp.1-9
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• 1989

We have performed one case of autotransplantation and 11 cases of orthotopic homotransplantation using Korean mongrel dogs, and have scrutinized the hematologic and hemodynamic results. The mean weight of recipients was 15.42*1.2kg and varied from 14kg to 20kg. During the operation, anesthesia and other technical procedures including cardiopulmonary bypass were similar to the usual methods in human cardiac transplantation. It was found that the hematologic values were similar to those of human beings although there was wide variance. Hemodynamically the mean systolic and diastolic arterial pressures were 165.0* 12.9 mmHg and 100.0 *11.8 mmHg respectively, and the mean heart rate was 155.5*23.5/min. All cases died within 24hrs, and the mean survival in all but 6 cases where operative death occurred was 6.83*8.01 hrs[range 2-21 hrs]. The major causes of deaths were bleedings in 7 cases, failure to protect myocardium during the procedure in 2 cases, pulmonary edema in 1 case and multiorgan failure in 2 cases. From the above results we concluded that the most frequent complication was bleeding, and the cardiopulmonary bypass flow of 50-500ml/kg min was not suitable to the dog in CPB. In further experiment after this study, the technical and the bypass flow was increased. Bleeding was not significant. And the immunosuppresion during operation and postoperative period was tried.

• 대한의생명과학회지
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• 제11권3호
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• pp.407-416
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• 2005

Cardiopulmonary bypass (CPB) for cardiac surgery induces the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that causes postoperative major organ dysfunctions. We performed a randomized, prospective study to investigate clinical effects of preoperative treated-methylprednisolone for preventing inflammation in pediatric cardiac surgery with CPB. Thirty pediatric patients scheduled for elective cardiac surgery were randomized to either control(n=15) or steroid group (n=15, 10 mg/kg of methylprednisolone). Arterial blood samples were taken before and after the operations for measuring total leukocyte (T-WBC) and differential counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), neuron specific enolase (NSE), troponin-I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine levels. Postoperative parameters such as pulmonary index (PI, $PaO_2/FiO_2$), 24 hrs and total bleeding volumes, mechanical ventilating (MVP) and intensive care unit (ICU)-staying periods, and hospitalization were assessed. T-WBC, neutrophil fraction, IL-6, MPO, NSE, TNI, AST and creatinine levels, bleeding volumes, PI, and MVP at the postoperative periods were lower or shorter in steroid group than in control group (P<0.05). These findings indicated that preoperative administration of methylprednisolone attenuated CPB-induced inflammatory reactions, contributing to postoperative recovery of patients underwent cardiac surgery.

• Journal of Chest Surgery
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• 제33권2호
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• pp.151-159
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• 2000

background: The right gastroepiploic artery(RGEA) has been use in coronary artery bypass grafting from 1987. The RGEA is the most useful arterial conduit in coronary artery bypass grafting(CABG) followed by the internal mammary artery, Materials and method: From Septermber 1998 to February 1999 the RGEA was used for coronary artery bypass grafting in 11 patients 10 males and 1 female. Postoperative angiography was performed in all of the patients before discharge Result: Early patent rate of the RGEA was 100%. The flow competition of the REGA graft was seen in 4 patients(36.4%) The flow pattern war RGEA dependent type in the inner diameter of the recipient coronary artery 1.5 mm the inner diameter of the RGEA 2.5 mm and the rtio of inner diameter of the RGEA and the recipient coronary artery 1(p<0.05) Conclusion : Early results of CABG with RGEA was satisfactory. However the RGEA graft has a tendency of flow competition in relation to the inner diameter of graft. Preoperative angiographic evaluation for RGEA and meticulous operative technique are required for a good surgical results.