• Journal of Chest Surgery
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• v.17 no.4
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• pp.620-624
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• 1984

The optimal surgical management of the coarctation of the aorta associated with ventricular septal defect is still debated. Sixteen patients with the coarctation of the aorta and VSD were operated upon between November, 1980 and September 1984 at Seoul National University Hospital. They were 11 males and 5 females. All presented between 5 months and 11.5 years of age [mean= 5.5 years]. Presenting symptoms were congestive heart failure in 11 [69%], cyanosis on crying in 3 [19%], and frequent upper respiratory infection in 2 [13%]. In all cases two-stage operation was applied except one in which one stage procedure was taken. Resection and end-to-end anastomosis was used in 3, Dacron graft in 5, Gortex graft in 1, and left subclavian flap angioplasty in 4. Remaining two were missed on the operating table before correction of the coarctation of the aorta. Overall operative death in repair of the coarctation of the aorta were 3[20%]. Among the 12 survivors after repair of the coarctation of the aorta, 4 required patch closure of VSD, 2 required primary closure, 2 showed spontaneous closure [17%], one [8%] showed decrease in its size, 3 were under observation. It might be safe to approach the coarctation of aorta plus VSD with initial repair of the coarctation of the aorta without banding of main pulmonary artery and later management of VSD as usual manner in simple VSD.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.124-129
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• 1999

Background: Ventricular septal defect(VSD) that causes pulmonary hypertension increase right ventricular workload. Echocardiographic assessment of right ventricular systolic time interval (RVSTI) has been used to predict pulmonary artery pressure in various cardiopulmonary diseases. This study was undertaken in infants with simple VSD to observe the alteration of the right ventricular workload through the changes of RVSTI after repair of VSD. Material and Method: We evaluated heart rate, the ratio of the left atrium/aortic root diameter (LA/Ao), right ventricular pre-ejection period(RVPEP), right ventricular ejection time(RVET), and its ratio(RVPEP/RVET) as a predictor of right ventricular workload in 12 children with simple VSD. These were measured three times at the preoperative period, at the 3 month and between 6 month and 1 year(average 9.5${\pm}$1.8month) after repair of VSD by M-mode & Doppler echocardiograph from the pulmonic valve echogram. Result: Heart rate was decreased significantly after repair(137.1${\pm}$13.7 vs 114.4${\pm}$21.1 and 104.1${\pm}$10.2, p<0.01). LA/Ao ratio was decreased significantly after repair(1.71${\pm}$0.32 vs 1.47${\pm}$0.33 and 1.39${\pm}$0.23, p<0.05). RVPEP/RVET were decreased after repair (0.38${\pm}$0.09 vs 0.32${\pm}$0.08 and 0.29${\pm}$0.09, p<0.01). Heart rate corrected RVPEP/RVET were significantly decreased only after 6 months(0.32${\pm}$0.03 vs 0.30${\pm}$0.05 and 0.28${\pm}$0.06, p<0.05). Conclusion: We found elevated right ventricular workload was progressively decreased until more than 6 months after repair and the RVSTI may serve a useful guide in postoperative care for children with VSD.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.263-269
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• 1997

From April 1987 to May 1996, 13 infants underwent a Norwood operation for complex congenital heart diseases including hypoplastic left heart syndrome (n : 7), mitral stenosis with small VSD and subaortic stenosis (n : 1), mitral atresia with ventricular septal defect, coarctation of aorta, and subaortic stenosis (n = 1), interrupted aortic arch with ventricular septal defect and subaortic stenosis (n : 1), tricuspid atresia with transposition of the great arteries (n = 1), and complex double-inlet left ventricle (n : 2). All patients without hypoplastic left heart syndrome were associated wit hypoplasia of ascending aorta and arch. Age at operation ranged from 3 days to 8.7 months (mean 60.6 $\pm$ 71.6 days, median 39 days). The operative mortality( < 30 days) was 46% (6 patients). Late mortality was 15% (2 patients). All operative deaths occured during the Erst 24 hours after the operation as a result of cardiopulmonary bypass weaning failure (5 patients) and sudden hemodynamic instability postoperatively (1 patient). Late death was due to aspiration pneumonia in two cases. There are 5 long-term survivals (39%). Three of them have undergone a two-stage repair with a modified Fontan operation in two and total cavopulmonary shunt in one at 12, 17, 4.5 months after Norwood procedure with no mortality. Two patients have entered a three-stage repair strategy by undergoing a bidirectional cavopulmonary shunt at 3 and 5.5 months after initial operation with 1 operative death. The actuarial survival rate for all patients at the first-stage operation, including hospital deaths and ate death was 30.8% at 1 year. In conclusion, the operative mortality of Norwood operation was relatively high compared to other operation for major cardiac anomalies, continuing experience will lead to an improvement in result.

• Journal of Chest Surgery
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• v.14 no.3
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• pp.302-306
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• 1981

Aorticopulmonary window is a rare anomaly among congenital heart disease. Various terms have been suggested including A-P window, A-P fenestration, fistula, aorticseptal defect etc. The defect lies usually between the left side of the ascending aorta and right wall of the pulmonary artery just anterior to the origin of the right main pulmonary artery. We have experienced one case of aorticopulmonary septal defect which was diagnosed as V5D with pulmonary hypertension in 1 4/12 year old, 7.2 Kg, male patient. Operation was done under the hypothermic cardiopulmonary bypass using 5t. Thomas cardioplegic solution. Vertical right ventriculotomy over the anterior wall of RVOT revealed no defect in the ventricular septum, and incision was extended up to the main pulmonary artery to find the source of massive regurgitation of blood through MPA. Finger tip compression of the aorticopulmanary window was replaced with Foley bag catheter balloon, and the $7{\times}10$ mm aorticoseptal defect located 15mm above the pulmonic valve was sutured continuously wih 3-0 nylon suture during azygos flow of cardiopulmonary cannula which was located distal to the window resulted massive air pumping systemically, and temporary reversal of pumping was tried to minimize cerebral air embolism. Remained procedure was done as usual, and pump off was smooth and uneventful. Postoperatively, patient was attacked frequent opistotonic seizure with no recovery sign mentally and p.hysically. Vital signs were gradually worsen with peripheral cyanosis and oliguria, and cardiac activity was arrested 1485 minutes after operation. Autopsy was performed to find the sutured window and massive edema of the brain.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.241-249
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• 1985

Twenty-one patients with Double Chambered Right Ventricle [DCRV] associated with Ventricular Septal Defect [VSD] were treated by open heart surgery under cardiopulmonary bypass with moderate hypothermia in the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital between June 1982 and October 1984. The following results were obtained 1. The symptoms and physical signs, specific for DCRV, could not be identified. 2. The radiologic findings on simple chest X-ray, specific for DCRV, could not be identified. 3. Electrocardiographic findings, specific for DCRV, could not be identified. 4. Cardiac catheterization was found to be the most important diagnostic method, revealing pressure gradient between proximal chamber and distal chamber in the right ventricle. The average pressure gradient between two chambers showed 48.1523.29 mmHg[varying from 15mmHg to 94mmHg]. 5. Cardiac angiography was found to visualize the anomalous muscle bundles in right ventricle [in 17 cases, 81%] but the evidence of pressure gradient between two chambers within right ventricle is considered necessary for the diagnosis of DCRV. 6. Via surgical observation, anatomical and pathologic findings of the anomalous muscle bundles, associated DCRV were identified. 7. As the direct pressure was measured on the operating table before and after surgery, the average pressure gradient across the muscle bundles showed 40.5219.75mmHg [varying from 16 to 89mmHg] preoperatively and 8.909.72mmHg [varying from 0 to 32mmHg] postoperatively, indicating significant surgical correction of the obstruction present. 8. The presence of anomalous muscle bundles, dividing the right ventricle into two separated chambers, and the presence of the pressure gradient over 15mmHg are considered necessary for the diagnosis of DCRV.

• Neonatal Medicine
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• v.16 no.1
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• pp.71-75
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• 2009

There are few cases of partial trisomy of 9q, known as partial 9q trisomy syndrome with low birth weight, microcephaly, hypotelorism, beaked nose, small lip, long finger, hypertrophic pyloric stenosis, ventricular septal defect, and mental retardation. We report partial trisomy of 9q derived from a paternal chromosome, which has different features of other syndromes, including prematurity, atrial and ventricular septal defect, patent ductus arteriosus, persistent left superior vena cava, congenital hydronephrosis, and scrotal hernia.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.962-967
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• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.243-245
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• 2001

여호와의 증인을 부모로 둔 환아는 생후 4개월, 5.6kg이었다. 심초음파상 완전 대혈관 전위와 심실 중격 결손, 심방 중격 결손, 동맥관 개존중 및 양측상대 정맥이 관찰되었다. 수술전 혈색소 값은 14.9 g/dl이었다. 수혈없이 심실 중격 결손 교정과 대혈관 치환술을 시행하였으며, 별문제 없이 수술 후 16일에 환아는 퇴원하였다. 퇴원 당시 혈색소 값은 12.8 kg/dl 였다. 복잡 심기형을 가진 영아에서 수술전 eryrhropoietin의 투여, 수술중 철저한 지혈 및 초여과법등의 방법으로 수혈 없이 완전 교정술이 가능하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.404-410
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• 1987

An 18-day-old male neonate with hypoplastic left heart syndrome underwent surgical intervention by modification of the Norwood procedure on September 23, 1986. Hypoplastic left heart syndrome is a serious congenital cardiac anomaly that has a fatal outlook if left untreated. Included in this anomaly are [1] aortic valve atresia, and hypoplasia of the ascending aorta and aortic arch, [1] mitral valve atresia or hypoplasia, and [3] diminutive or absent left ventricle. Patent ductus arteriosus is essential for any survival, and there is usually a patent foramen ovale. Coarctation of the aorta is frequently associated with the lesion.z With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the ductus arteriosus was excised. The main pulmonary artery was divided immediately below its branches, and the distal stump of the divided pulmonary artery was closed with a pericardial patch. The aortic arch was incised, and a 1 5mm tubular Dacron prosthesis was inserted between the main pulmonary artery and the aortic arch. A 4mm shunt of polytetrafluoroethylene graft was established between the new ascending aorta and the right pulmonary artery to provide controlled pulmonary blood flow. Following rewarming, the heart started to beat regularly, but the patient could not be weaned from cardiopulmonary bypass. At autopsy, the patient was found to have hypoplasia of the aortic tract complex with mitral atresia and aortic atresia. A secundum atrial septal defect was noted. Right atrial and ventricular hypertrophy was present, and the left ventricle was entirely absent. Although unsuccessful in this case report, continuing experience with hypoplastic left heart syndrome will lead to an improvement in result.

• Clinical and Experimental Pediatrics
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• v.52 no.12
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• pp.1364-1369
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• 2009

Purpose : To analyze abnormal ventricular activation in childhood congenital heart disease induced by postoperative changes in ventricular volume and pressure and ventricular scar formation using signal-averaged electrocardiography (SAECG). Methods : Fifty-two patients who had undergone open heart surgery (OHS) were enrolled. Patients were divided into the following 3 groups: right ventricular volume overload (atrial septal defect, group1), left ventricular volume overload (ventricular septal defect, group2), and right ventricular pressure overload (tetralogy of Fallot, group 3). The patients were monitored by standard 12-lead ECG and SAECG before and 2 months after the operation. QRS duration, QT and QTc intervals, filtered QRS (f-QRS), high frequency low amplitude potential (HFLA), and root mean square (RMS) voltage in the terminal 40 ms of SAECG were determined. Results : In the preoperative period, group1 showed significant increase in QRS (P=0.011) compared to those of the other 2 groups. In the postoperative period, group3 showed significant increase in the QTc interval (P=0.004) compared to those in the other 2 groups. SAECG parameters showed no significant differences among the groups in the pre- or postoperative period. Of the 52 patients, 12 (23%) in the preoperative period and 21 (40%) in the postoperative period had at least 1 SAECG abnormality. The prevalence of SAECG abnormalities was significantly higher in the postoperative group 2 and group 3 (preoperative: 20% versus postoperative: 28%, P<0.001, preoperative: 14% versus postoperative: 64%, P<0.001, respectively). Conclusion : Abnormal SAECG patterns may be attributed to postoperative scars, OHS itself, and/or ventricular overload.