• Journal of Chest Surgery
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• v.21 no.1
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• pp.36-47
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• 1988

610 cases of open heart surgery was performed in the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital from July 1981 to September 1987. The clinical data was summarized as follows: 1. The age distribution of congenital heart surgery patients was 2 to 41 years old [mean; 13.2 years] and surgery for acquired heart disease was 10 to 57 years old [mean: 32.8 years]. 2. There were 389 cases [63.8%] of acyanotic congenital heart anomalies, 63 cases [10.3%] of cyanotic congenital anomalies and 158 cases [25.9%] of acquired heart disease. 3. For myocardial protection, Bretschneider and potassium glucose solution had been used as cardioplegic solution and then since 1983, GIK solution has been used with repeated infusion method once for every 20 to 30 minutes of time interval after starting initial cardioplegia during operation with excellent results. 4. The ingredient of the priming solution is Hartmann`s solution, sodium bicarbonate, mannitol, potassium chloride, fresh ACD whole blood, calcium chloride, heparin and dexamethasone. 5. There were 96 cases [15.7%] of mild hypothermia, 333 cases [54.6%] of moderate hypothermia and 181 cases [29.7%] of intermediate hypothermia. 6. The mortality rate was 2.3% [9 out of 389 cases] in acyanotic congenital heart disease, 36.5% [23 out of 63 cases] in cyanotic congenital heart disease and 10.8% [17 out of 158 cases] in acquired heart disease, with overall mortality rate of 8.0% [49 out of 610 cases].

• Journal of Chest Surgery
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• v.21 no.1
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• pp.136-142
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• 1988

Between February, 1983, and March, 1987, thirty-one systemic-pulmonary shunts were performed in 28 patients with cyanotic congenital heart disease. Age ranged from 8 months to 28 years [mean age, 5.4 years, Weight ranged from 7 kg to 48 kg [mean weight, 16kg]. There were 4 classic Blalock-Taussig shunts, 5 central polytetrafluoroethylene shunts, 1 aorta-right pulmonary artery shunt with graft, and 21 modified Blalock-Taussig shunts. One patient required another shunt immediately due to insufficient pulmonary blood flow with patent graft. There was no postoperative death. Conduit diameters included 4mm [2 cases], 5 mm [22 cases], and 6 mm [3 cases]. Long term follow up was available in 27 patients [96.4%] with mean period of 20 months [range, 4 months to 49 months]. The effectiveness of shunt was evaluated by cardiac catheterization with angiography [15 patients] or clinically. They showed improvement of systemic oxygen saturation values by 12% and decrease of hemoglobin by 2.3gm/dl [P<0.01]. There were 2 shunt occlusion in central shunts at 32 and 48 months respectively, and one narrowing of graft in modified Blalock-Taussig shunt at 12 months. The patency rate was 91.6% at 24 months for 5 mm grafts in modified Blalock-Taussig shunt.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.605-614
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• 1985

The principal aim of surgery for congenital heart anomalies is the establishment of normal hemodynamic function. Palliative and corrective operations are selected with time to attain this end with minimal risk. In recent years, as operative mortality after primary total correction is lower than the mortality after early palliation and delayed correction, corrective operations in infants have increasingly supplanted palliative ones. Two hundred and eighteen infants below 10 kg with congenital heart anomalies underwent primary surgical intervention at Yonsei Medical Center from March 1979 to June 1985. There were 155 infants with VSD, 35 Infants with TOF, 5 infants with ECD, 4 infants with TGV, 3 infants with DORV, 3 infants with Pulmonary atresia, 3 infants with ASD and PDA, 2 infants with DOLV, and the remainders were Sinus Valsalva rupture, residual mitral regurgitation after total correction of ECD, PAPVR, Cor triatriatum, Truncus arteriosus, and Tricuspid atresia. The overall surgical mortality was 15.1%. In the acyanotic group, 13 infants died among 168 infants, and mortality was 7.7%. But in the cyanotic group, the mortality rate was very high and 20 infants died among 50 infants raising the mortality to 40.0%. These poor surgical results in the cyanotic or complicated group was due to inaccurate diagnosis, improper surgical methods and inadequate post-operative care which should be improved.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.25-34
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• 1986

Recently, radionuclide angiocardiogram is one of the most common procedure for assessment of ventricular performance due to its distinctive advantages such as safety, accuracy, and ease of repeated studies. Also, measurement and comparison between pre and postoperative left ventricular ejection fraction [LVEF] are meaningful for assessing the severity of myocardial damage which occurred during open heart surgery and the status of myocardial recovery. We obtained pre and post operative LVEF using radionuclide angiocardiogram on 30 patients composed of atrial septal defect, ventricular septal defect, cyanotic congenital heart disease, and valvular heart disease who undergone the open heart surgery from March to august 1984. The study revealed that ventricular septal defect and mitral valvular heart disease showed 8.1% and 6.2% decreases of postoperative LVEF, respectively. But, there are little increases of postoperative LVEF in the atrial septal defect and cyanotic congenital heart disease. In ventricular septal defect, each group of Qp/Qs over 2.0 and systolic pulmonary artery pressure over 50mmHg showed significant 17% and 14.7% decreases of postoperative LVEF, respectively. Considering the duration of the aortic cross clamping times and closing methods of VSD, each group of duration over 30 min. and of patch closure showed 13.9% and 14.2% decreases of LVEF between pre and postoperative status respectively which was significant finding statistically.

• Journal of Chest Surgery
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• v.21 no.6
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• pp.957-969
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• 1988

There is tendency of increasing number and decreasing age of patients who are indicated for Rastelli operation for their cyanotic congenita heart disease. So there is the need to find the creiterion which saves the patients from early postoperative hemodynamic disturbances. We reviewed the 26 patients who had been performed Rastelli operation at Seoul national University hOipital from January 1981 to June 1988. mean age of the patients was 7.8 $\pm$ 3.4 years (range 2.5-1.5 years), mean body surface area(BSA) 0.79 $\pm$ 0.25 $m^{2}$(range 0.49-1.51 $m^{2}$) and mean hematocrit 57.95 $\pm$ 12%(range 48-80%). We diveded these patients into survived group and died group before postoperative 72 hours, and analysed preoperative arterial oxygen saturation($SaO_{2}$), the ratio of diameter of fight pulmonary artery to ascending aorta(RA:/AA), the ratio of both right and left pulmonary artery diameter to descending thoracic aorta(RPA+LPA/DTA), pulmonary artery index(PA index), cardiopulmonary bypass time, aorta cross-clamping time, postoperative perfusion state and total amount of dopamine infused postoperatively. The results showed that RPA+LPA/DTA and PA index were statistically significatn factors to influence early postoperative cardiac death rate (P<0.05). Especially there were good linear correlations between PA index(X) and perpheral perfusion index(Y)(Y = -1.15 + 0.02 X, r = 0.86, P<0.01) and between PA index(X) and total amount of dopamine infused before postoperative 72 hours(mg/kg, Y)(Y = 61.94 - 0.15 X, r = - 0.80, P<0.01). Also there were tendencies that the higher RPA + LPA/DTA(Y), the betterperipheral perfusion (X) and the lower need of dopamine(X), but no statistical significance. (Y = 0.78 + 1.60 X, r = 0.49, P>0.05) And the discrimant analysis showed that patients with PA index over 221 $mm^{2}$/BSA could undergo correction with 25 per cent of error rate. In conclusion, early postoperative hemodynamic states could be predicted by preoperatively measured PA index, and which can be used as a criterion for Rastelli operation performed on cyanotic congenital heart disease.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.945-951
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• 1998

Background: Although profound hypothermia with total circulatory arrest(TCA) is a valuable maneuver in cardiac surgery, its applications have been limited due to serious complications, especially cerebral damage. In this study, the possible role of creatinine kinase-BB(CK-BB), an index enzyme of ischemic cerebral damage, was assayed as a parameter for the assessment of the cerebral complications after TCA. Hemoglobin(Hb), ionized calcium(Ca++), and blood glucose levels were also assessed as clinical parameters involved in cerebral damage. Materials and methods: Among patients with congenital heart disease, 18 patients who had been operated on with TCA were randomly selected and divided into two groups: 6 with acyanotic and 12 with cyanotic heart disease. Arterial blood from each patient was collected before and after TCA at scheduled times(15 min., 30 min, 1, 2, 4, 8, and 12hr). The levels of CK-BB, Hb, Ca++, and blood glucose were assessed in each sample. Results: As a whole, correlation between CK-BB level and blood sampling time after TCA was not statistically significant. Also, the difference in the level of CK-BB after TCA was not significant between the acyanotic and cyanotic groups. The levels of Hb and CK-BB correlated significantly. Conclusions: The results, which showed no correlation between the alterations in CK-BB level and the TCA duration, suggest that the single assay of the CK-BB level is not a representative measurement for the assessment of cerebral damage after TCA. Also, the cyanotic congenital heart disease group is not more vulnerable to cerebral damage induced by TCA.

• Journal of Chest Surgery
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• v.26 no.3
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• pp.163-169
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• 1993

This is the result of the annual statistic analysis of thoracic and cardiovascular surgical cases in 1992 Korea. Overall 17, 520 cases of surgery [11, 732 cases of thoracic surgery by 54 institutes / 5, 788 cases of cardiovascular surgery by 48 institutes] were done. 1. Tumor [N=2, 532] : Lung was the most frequently involved organ by tumor [54.9%],and the remainders were mediastinum [16.2%] / esophagus [14.8%] / chest wall [11.7%] / tracheobronchus [1.3%] / pleura [1.1%] in order. Of 1, 082 cases of primary lung cancer surgery,the frequency of cell type was squamous [62.6%] / adeno [21.6%] / small cell [7.1%] / large cell [2.7%]. Of 411 cases of mediastinal tumor surgery,the frequency of cell type was neurogenic [28.8%] / thymoma [27.6%] / teratoma [17.7%] / congenital cystic [17.2%]. Of 376 cases of esophageal tumor surgery,primary cancer were the most [85.4%]. 2. Infection [N=3, 157] : Pleura was the most frequently involved organ [59.0%],and the remainders were lung [31.3%] / chest wall [8.6%] / mediastinum [1.1%] in order. 3. Miscellaneous [N=6, 043] : Lung and pleural disease esp. pneumothorax [85.1%] was the most frequent surgical indication. The remainders were chest wall anomaly [3.4%] / benign esophageal disease [3.4%] / diaphragmatic pathology [2.4%] / myasthenia [1.4%] in order. Of 85 cases of thymectomy for myasthenia gravis,thymoma was noted in 58.8%. 1. Congenital heart disease [N=3, 363] : The ratio of noncyanotic to cyanotic heart disease was 3:1. Of 2, 516 cases of noncyanotic heart disease,the frequency of disease entity was VSD [44.1%] / ASD [26.0%] / PDA [19.4%] / PS [3.3%],and that of 847 cases of cyanotic heart disease was TOF [29.4%] / ECD [15.6%] / TGA [9.7%] / DORV [7.6%]. Overall mortalities were 2.1% in noncyanotic and 12.2% in cyanotic heart surgery. 2. Acquired heart disease [N=1, 929] : Of 1, 422 cases of valvular surgery,single mitral pathology was the most frequent candidate [48.0%],and total 1, 574 prosthetic valves which were mainly mechanical [95.6%] were used. Of 376 cases of coronary surgery,triple vessel was the most [35.9%],and the frequency of bypassing grafts was great saphenous vein [52.9%] / internal mammary artery [44.7%] / artificial vessel [2.4%]. Overall mortalities were 3.4% in valvular and 4.5% in coronary surgery. 3. Pericardium,Cardiac tumor,Arrhythmia,Aortic aneurysm,Assist device,and Pacemaker : There were no specific changes compared to previous survey1]. This nation-wide inquiry will be continued and reported annually by KTCS Society.

• Journal of Chest Surgery
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• v.17 no.3
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• pp.484-487
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• 1984

A 12-yr-old patient was admitted due to severe hemoptysis and known cyanotic CHD. In chest P-A and echocardiogram, pulmonary aspergilloma in left upper lobe was associated with TOF. The cardiac catheterization couldnt be done because of frequent hypoxic spell and severe hemoptysis. Surgical management was performed. After left posterolateral thoractomy, modified Blalock-Taussig shunt operation and left upper lobe lobectomy were done at same time. Postoperative PaO2 was elevated and hemoptysis was disappeared.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.462-470
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• 1988

1,597 cases of operation on the cardiovascular disease were performed at the Hanyang University Hospital from 1972 to 1987. Of these, 1,005 cases were open heart surgery. It was started from July 1975. Among the open heart cases, 725 were congenital heart diseases and 280 were acquired heart diseases. In congenital heart cases, 554 were acyanotic and 171 were cyanotic. The operative results were as follows; the overall mortality of cardiovascular surgery was 7.1%, the open heart mortality was 9.5%. This analyses were reported in memory of the achievement of 1,000 cases of open heart surgery.

• Journal of Chest Surgery
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• v.25 no.2
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• pp.167-175
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• 1992

During a 4 year period from 1987 to 1991, 152 patients underwent open heart surgery for congenital heart disease and acquired heart disease. Over all operative mortality was 6.6%. There were 76 congenital anomalies consisting of 73 acyanotic and 3 cyanotic and 76 acquired heart disease. The age distribution of 152 cases was 3 months to 62 years. Mean age was 13.0 years in congenital heart anomalies and 38.9 years in acquired heart disease patients.