• Journal of Chest Surgery
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• v.25 no.12
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• pp.1542-1549
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• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.

• Journal of Chest Surgery
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• v.24 no.7
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• pp.701-711
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• 1991

We experienced 6 cases of primary cardiac tumor, all received operation for removal of tumor. Mean age was 43.8 years-old ranging from 17 years-old to 66 years-old. Five cases were female, one case was male. Five cases were benign, myxoma, all located within left atrium. One case was malignant, angiosarcoma within right atrium. All patient showed cardiac manifestations. One case was in NYHA functional class II, two were in III, three were in IV. Four patients showed constitutional symptoms, but no one showed evidence of embolic phenomenon. All case of myxoma showed cardiomegaly except one malignancy. Only one case was regular sinus rhythm, three were sinus tachycardia 8z two were atrial fibrillation. The most common site of tumor origin was fossa ovalis limbus[four of all]. Two of five myxomas received emergency operation, one patient died postoperatively. Lived four patients showed no evidence of recurrence[mean follow-up, 3,5 years], but one patient has Grade II /IV mitral regurgitation & in OPD follow-up now, One malignant case, 17 years-old cerebral palsy female, was angiosarcoma occupied most of right atrial chamber originated from anterior wall of right atrium, received emergency operation which was removal of mass & reconstruction of right atrium with artificial pericardial patch. This patient died on postoperative 36th day due to persistent LCOS[low cardiac output syndrome] with combined sepsis.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.630-632
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• 1995

Bichamber cardiac rupture is less frequent compared to unichamber cardiac rupture. We report a patient who was successfully treated after the diagnosis of penetrating stab wound of both ventricles. The key to improved outcome of management of cardiac trauma lies in the rapid transportation to a general hospital where cardiac surgery is available. Aggressive primary intervention and immediate operation are also major factors.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.1036-1043
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• 1989

Seventy eight patients underwent operation for combined multiple valve disease, with an overall early mortality of 14.1 % from January, 1983 to September, 1988 in the department of thoracic and cardiovascular surgery of Pusan National University Hospital. All of the above cases had combined multiple valve procedures. There were 33 mitral valve replacements and tricuspid annuloplasties, 33 aortic and mitral valve replacements, 5 aortic and mitral valve replacements with tricuspid annuloplasties, 3 aortic valve replacements and mitral annuloplasties, 1 open mitral commissurotomy and tricuspid annuloplasty and, 1 mitral valve replacement and primary closure of tricuspid valve cleft, 1 mitral valve replacement and aortic commissurotomy, 1 mitral, aortic and tricuspid valve replacement were done. 44 were male and 34 were female and the age distribution was from 14 to 57 with mean 38 year old. According to NYHA[New York Heart Association] classification, 49 patients were class I, 19 patients were class Il and 10 were class IV. Average perfusion time was 205.3 minutes. The live patients perfusion time was 178.7 minutes while that of dead ones was 272.0 minutes. Early deaths within 30 days from operation were 11 cases, 6 of which were due to low cardiac output, 3 were acute renal failure and 2 were cardiac rupture. The 65 patients were followed up from 2 to 30 months for a total 20.6 patient years. 1 patient committed suicide because of postoperative depression 1 year after operation. All of the survivors were enjoying their daily life and their NYHA class was superior to the preoperative ones.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.89-100
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• 1975

Sixteen cases of cardiac valve replacements have been done in this department since 1970. Twelve cases of mitral valve replacement were done with Beall valve, 2 cases of aortic valve replacement with Starr-Edwards and Magoven valve and 2 cases of double valve replacement using Beall valve for mitral and Magovern valve for aortic. Three patients [18.8%] died during operation. Two cases [12.5%] of hospital mortality occurred because of congestive heart failure and asphyxia due to tracheomalacia 3 months after operation. Follow-up studies from two to 27 months showed excellent results except three cases of late mortality [18.8 %]. Thromboembolism occurred in two double valve replacement patients[12.5%]who were fatal.

• Journal of Chest Surgery
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• v.45 no.4
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• pp.213-224
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• 2012

Tetralogy of Fallot (TOF) is an index lesion for all paediatric and congenital heart surgeons. In designing an appropriate operation for children with TOF, the predicted postoperative physiology must be taken into account, both for the short and long term. A favourable balance between pulmonary stenosis (PS) and pulmonary insufficiency (PI) may be critical for preservation of biventricular function. A unified repair strategy to limit both residual PS and PI is presented, along with supportive experimental evidence. A strategy for dealing with coronary anomalies and some comments regarding best timing of operation are also included.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.760-765
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• 1989

Cardiac injury remains one of the most spectacular injuries which the present day cardiac surgeon is called upon to treat. Eight consecutive patients with penetrating or blunt injury to the heart underwent operation at the Department of Thoracic and Cardiovascular Surgery, Masan Koryo General Hospital from April 22 88 to April 6 89. l. Among the 8 cases of cardiac injured patients, 7 cases were penetrating injury [stab injury] and one case was blunt injury [traffic accident]. 2. The site of cardiac injury was LV mainly and the next RV, SVC-RA junction in order. 3. The all patients were admitted to our hospital via ER and most of cases, CVP was elevated above 15 cmH2O and 7 of 8 cases were shock state. 4. In 6 of 8 cases revealed cardiomegaly in simple chest X * ray. 5. 7 cases were operated through the median sternotomy, 1 case the right anterolateral thoracotomy. 6. Associated injuries in penetrating cardiac injury were hemothorax, pneumothorax, sternal fracture, lung laceration, LAD transaction in blunt injury, hemoperitoneum.

• Journal of Chest Surgery
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• v.44 no.1
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• pp.9-17
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• 2011

Background: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. Material and Methods: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age $54.4{\pm}15.1$ years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of $DLP^{(R)}$ (Medtronic Inc, Minneapolis, MN) or $RMI^{(R)}$ (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system ($EBS^{(R)}$; Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of $2.4{\sim}3.0\;L/min/m^2$ and an activated clotting time (ACT) of around 180 seconds. Results: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. Conclusion: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.641-648
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• 1988

Between April 9, 1986 and September 2, 1987, 134 patients underwent open heart surgery with hypothermic cardiopulmonary bypass and cold blood cardioplegia. There were 65 patients[48.5%] of acyanotic congenital cardiac anomalies, 19 patients[14.2%] of cyanotic congenital cardiac anomalies, and 50 patients[37.3%] of acquired heart diseases, which included 49 valvular diseases and 1 myxoma. In 84 congenital cardiac anomalies, 44 patients were male and 40 patients were female ranged in age from 2 years to 57 years. In 50 acquired heart diseases, 18 patients were male and 32 patients were female ranged in age from 10 years to 65 years. The common congenital defects operated were VSD in acyanotic cardiac patients, and Tetralogy of Fallot in cyanotic cardiac patients. Among 50 acquired heart diseases, 49 patient underwent operation for cardiac valvular lesions. 33 patients had mitral valve replacement and 7 patients had aortic valve replacement. 1 patient underwent aortic valvuloplasty and 8 patients had double valve replacement. The operative mortality rate was 3.1%[2 out of 65 patients] in acyanotic cardiac patients, 5.3%[1 out of 17 patients] in cyanotic cardiac patients, and 12.0%[6 out of 50 patients] in acquired cardiac patients, with overall mortality rate of 6.7%[9 out of 134 patients].

• Journal of Chest Surgery
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• v.26 no.2
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• pp.102-107
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• 1993

Human atria play an important role in extracellular homeostasis through release of atrial natriuretic peptide. To evaluate the relationship between plasma level of atrial natriuretic peptide (ANP) and many changes which can develop during extracorporeal circulation, we studied 16 patients undergoing, 12 cardiac operation and 4 thoracic operation. Plasma level of ANP in cardiac patients group was significantly higher and more changeable than thoracic patients group. After aortic cross clamp release, blood was filled at right atrium and right atrial pressure was rapidly increased. At the same time, plasma level of ANP was rised suddenly. Increase of ANP level was correlated (p<0.05) with the increase of total bypass time, but was not correlated statistical with aortic cross clamp time. ANP level did not fall rapidly after aortic cross clamp while both atria were completely empty. This result was explained by intraoperative hypothermia at that time, which can inactivate plasmal endopeptidase and catalytic receptors of ANP. The ANP level of atrial fibrillation group in cardiac patients were generally higher than normal sinus group, but there was no statistical correlation.