• Journal of Chest Surgery
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• 제27권12호
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• pp.1031-1035
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• 1994

Mechanical valve thrombosis is a serious and potential lethal complication unless early diagnosis & prompt therapy are made. We have been experienced 3 cases of valve thrombosis. From Aug. 1988 to July 1994, reoperations of mitral valve replacement [MVR] with mechanical prostheses [all mitral] were performed in three patients[2 men, 1 woman] due to valve thromboses. All three patients were diagnosed by means of cineradiography. Preoperative status of was shock status and he was applied intra-aortic balloon pump [IABP]. All three cases of prosthetic valve failure [PVF] were treated by Redo-MVR. Time intervals of reoperations were 5months, 40months, and 35months, respectively. In all cases, valve thromboses were excised successfully. Cineradiography provided an accurate diagnosis in all cases, which was utilized as safe, reliable & noninvasive imaging modalities. There were no operative death & complication. All three patients were fully recovered and returned to their employements, and active lives.

• Journal of Chest Surgery
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• 제26권6호
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• pp.492-495
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• 1993

We experienced one case of surgical treatment of abdominal aortic aneurysm using retroperitoneal approach. The transperitoneal route has been the standard surgical approach for elective and emergency treatment of aneurysmal or occlusive disease. Among its cited advantages for aortic reconstruction are familarity with the exposure, easy access to the infrarenal aorta and iliac vessels, possibility of simultaneous inspection of the intra-abdominal viscera, and speed of opening and closure.Despite the proved versatility of the transperitoneal approach, it is commonly associated with prolonged ileus, increased third space fluid loss, and significant pulmonary complications. The retroperitoneal approach, on the other hand, has many advantages; excellent exposure for the repair of juxtarenal or suprarenal abdominal aortic aneurysms and visceral vessel occlusive disease, fewer postoperative complications, decreased postoperative third-space fluid losses from intraoperative evaporation and ileus, and improved postoperative pulmonary function. Atherosclerosis was most common cause of abdominal aortic aneurysm. Dacron graft[18mm] was replaced successfully.Postoperative course was uneventful and he was discharged in good condition.

• Journal of Chest Surgery
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• 제36권8호
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• pp.619-622
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• 2003

위장관 간질종양(Gastrointestinal stromal turners, GIST)은 매우 드문 질환이다. 대개 위나 소장에서 발생하는 것으로 되어 있으나, 식도에서의 생기는 경우는 흔하지 않다. 위장관 간질종양은 위장관에서 발생하며 다양한 형태학적 소견을 보일 수 있으며, 기원이 분명치 않은 종양으로 알려져 왔다 저자들은 66세 여자의 하부 식도에서 발생한 악성 위장관 간질종양 1예를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.

• Journal of Chest Surgery
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• 제15권4호
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• pp.373-380
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• 1982

Experience with intracardiac surgery in infants indicates that for most anomalies the operation and late mortality after primary total correction is lower than the combined mortality after early palliation and delayed correction. In addition, there are secondary benefits of primary total correction in terms of reversal of retarded physical growth and social development and alleviation of parental anxiety. One hundred and fifteen infants under 2 years of age with congenital cardiac anomalies underwent primary surgical intervention at Seoul National University Hospital from Jan. `78 to Sep. `82. There were 70 patients with VSD, 17 patients with TOF, 10 patients with TGA, 4 patients with ASD, 4 patients with TA, 3 patients with TAPVR, and the remainders are Coronary AV Fistula, partial ECD+COA, SV, DORV, PA, Trilogy+PDA. The overall surgical mortality was 18.3%. In acyanotic group 6 patients died among 76 operated patients, and surgical mortality was 6.6%. But in cyanotic group, the mortality was very high as41.0% [16 patients among 39 patients]. This poor surgical result in cyanotic group was due to Improper pre-, intra- and post-operative care, and we are convincing that these factors soon be improved as experiences accumulated.

• Journal of Chest Surgery
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• 제32권9호
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• pp.840-843
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• 1999

저자는 심장의 우심실내에 입구와 출구를 막는 커다란 전이성 흑색종 1례를 수술치험하였기에 보고한다. 49세 여자환자로 호흡곤란과 전신부종의 증상을 보였다. 심초음파상 우심실내에 커다란 종괴와 심낭액을 보 였다. 심폐 체외순환후 심실내 종괴를 제거하였고, 악성 흑색종으로 판명되었다. 환자는 수술후 30일 현재 양호하다.

• Journal of Chest Surgery
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• 제47권2호
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• pp.100-105
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• 2014

Background: We evaluated the safety and efficacy of percutaneous extracorporeal membrane oxygenation (ECMO) in patients with primary graft dysfunction after heart transplantation. Methods: Of 65 patients (44 males and 21 females) who underwent heart transplantation from January 2006 to December 2012, 13 patients (group I) needed peripheral ECMO support due to difficulty in weaning from cardiopulmonary bypass (CPB) and 52 patients (group II) were weaned from CPB without mechanical support. The mean age of the patients at the time of operation was $54.4{\pm}13.6$ years. There were no differences in the preoperative characteristics of the two groups. Multivariable analysis was performed to identify the risk factors for ECMO therapy. Results: All group I patients were successfully weaned from ECMO after $53{\pm}9$ hours of circulatory support. Early mortality occurred in four patients (1 [7.7%] in group I and 3 [5.8%] in group II, p>0.999). There were no differences in the postoperative complications between the two groups, with the exception of reoperation for bleeding. A greater number of group I patients underwent reoperation for bleeding (5 [38.5%] in group I vs. 6 [11.5%] in group II, p=0.035). In multivariable analysis, preoperative mechanical support (ECMO and intra-aortic balloon pump) and longer CPB time were the risk factors of ECMO therapy for graft dysfunction (odds ratio, 6.377; 95% confidence interval, 1.519 to 26.77; p=0.011 and odds ratio, 1.010; 95% confidence interval, 1.001 to 1.019; p=0.033). Conclusion: Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.

• Journal of Chest Surgery
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• 제33권1호
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• pp.32-37
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• 2000

Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

• Journal of Chest Surgery
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• 제42권4호
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• pp.456-463
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• 2009

배경: 동맥도관이 정맥도관에 비해 개통률이 우수하다고 알려져 있으나, 재관상동맥 우회술시 동맥도관의 이용은 제한적으로 보고되고 있다. 또한 일차 관상동맥 우회술에 비해 재관상동맥 우회술은 수술 위험도가 높은 것으로 알려져 있어 본 연구는 동맥도관을 이용한 재관상동맥 우회술의 안전성과 효용성을 평가하고자 하였다. 대상 및 방법: 2001년 3월에서 2008년 7월까지 본원에서 동맥도관을 이용하여 시행한 33예의 재관상동맥 우회술에 대해 후향적으로 분석하였다. 수술 시 환자의 평균 연령은 62.6$\pm$9.0세(41$\sim$75)였고 25명(75.8%)은 남자였다. 첫 수술로부터 재수술까지의 평균 기간은 100.1$\pm$67.3개월이었고 수술 당시 평균 좌심실 구출률은 52$\pm$12.5%였다. 수술은 인공심폐기 보조하에서 24예(심정지액을 사용한 경우가 17예, 심박동하 7예)를 시행하였고 인공심폐기의 보조없이 심박동하에 시행한 관상동맥우회술은 7예, 최소침습적 관상동맥우회술은 2예였다. 사용된 도관은 내흉동맥(34예: 우측내흉동맥 28예, 좌측내흉동맥 6예), 요골동맥(14예), 우위대망동맥(14예), 복재정맥(4예) 등이었고, 목표 원위부는 좌전하행지가 23예, 사선분지가 10예, 둔각분지가 25예, 원위 우관상동맥이 4예, 후하행지가 16예, 후측분지가 8예, 중간지(ramus intermedius)가 5예였다. 26명의 환자에서 동맥 복합도관을 이용하여 수술하였고 이들 중 5예에서는 원위치 이식 도관(in situ)으로 좌측 내흉동맥을 혈액공급원으로 다른 동맥과 복합도관을 만들어 사용하였고 10예에서는 일차 관상동맥 우회술 시 사용되어진 좌측내흉동맥을 재이용하였다. 또한 5명에서는 원위치 이식 도관으로서 우측내흉동맥을 혈액공급원으로, 6명에서는 다양한 동맥 유리 도관(arterial free graft)으로 대동맥을 혈액공급원으로 하여 복합도관을 만들어 사용하였다. 평균 원위 문합수는 2.8$\pm$0.9였다. 결과: 수술 사망 및 주요 상처감염은 없었다. 평균 추적관찰 기간은 31.1$\pm$22.7개월이었고 4명은 추적관찰 중 사망하였다. 수술 후 합병증으로는 수술 후 심근 경색이 2예(6%), 대동맥내 풍선 펌프 삽입을 한 환자가 1예(3%), 심방세동이 5예(15.1%), 신경학적 합병증이 3예(9.1%) 있었다. 수술 후 3년 및 5년 누적 생존율(cumulative survival rate)은 각각 87.04%였다. 결론: 현재 심근 보호법과 수술 수기의 발달 및 경험 축적 등으로 인해 다양한 동맥도관을 이용한 재관상동맥 우회술은 비교적 안전하게 시행될 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제38권2호
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• pp.132-138
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• 2005

배경: 승모판막 성형술은 승모판막 폐쇄부전증에서 적절한 치료이지만 승모판막 폐쇄부전의 재발과 그에 따른 재수술이 제한점이다. 본 연구는 승모판막 성형술 후 재발의 원인에 대해 술기와 판막 요인에 대하여 분석하였다 대상 및 방법: 1994년 1월부터 2002년 1월까지 승모판막 폐쇄부전증으로 승모판막 성형술을 받은 493명을 대상으로 하였다. 승모판막 폐쇄부전의 원인으로는 퇴행성이 252예$(51.5\%)$, 류마티스성이 156예$(31.6\%)$, 다른 원인이 85예$(16.9\%)$였다. 성형술은 링을 사용한 판막륜성형술이 446예$(90.5\%)$, 신건삭 재건술이 227예$(46\%)$, 사각 절제술이 125예$(25.3\%)$, 건삭 전이술이 28예 $(5.7\%)$, Alfieri 방법이 8예$(1.6\%)$였다. 평균 추적 관찰 기간은 $29.04\pm22.81$개월이었다. 결과: 5예의 조기 사망$(1.01\%)$과 5예의 만기 사망$(1.01\%)$이 있었다. 재수술율은 $1.42\%$였다. 승모판막 폐쇄부전의 재발은 45예$(9.1\%)$에서 있었다. 24예에서 술기와 동반된 재발이 발생하였는데, 불완전한 성형술로 인한 재발이 14예, 신건삭 길이의 부적합으로 인한 재발이 8예, 기타 원인으로 인한 재발이 2예 있었다. 21예에서 판막 요인에 의한 재발이 발생하였는데, 류마티스성 질병 진행으로 인한 재발이 10예, 건삭의 연장이나 탈출로 인한 재발이 5예, 기타 원인으로 인한 재발이 6예 있었다. 심한 승모판막 폐쇄 부전은 불완전한 성형술 후 많이 나타났으며(p<0.001),판막 요인에 의한 재발은 류마티스성 진행과 강한 상관관계를 보였다(p<0.05). 결론: 승모판막 성형술의 내구성을 결정하는 위험 인자로 수술의 완전성이 가장 중요하므로, 초기 성형술 후 수슬장에서 경식도 초음파로 검사하는 것이 필수적이다.

• Tuberculosis and Respiratory Diseases
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• 제70권4호
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• pp.330-337
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• 2011

Background: The clinicopathologic characteristics of patients with non-small cell lung cancer (NSCLC) have been changing. Recently, Positron emission tomography-computed tomography (PET-CT) has usually been used for diagnosis, follow-up to treatment and surveillance of NSCLC. We studied the pattern of recurrence and prognosis in patients who underwent complete resection for NSCLC according to histologic subtype. Methods: All patients who underwent complete resection for pathological stage I or II NSCLC between January 2005 and June 2009 were identified and clinical records were reviewed retrospectively, especially the histologic subtype. Results: Recurrences were identified in 50 of 112 patients who had complete resection of an NSCLC. Sites of recurrence were locoregional in 15 (30%), locoregional and distant in 20 (40%), and distant in 15 (30%). Also, sites of recurrence were intra-thoracic in 29 (58%), extrathoracic and intra-thoracic recurrence in 15 (30%), and extrathoracic in 6 (12%). In locoregional recurrence, there was 37% recurrence for non-squamous cell carcinoma (non-SQC) and 25% for squamous cell carcinoma (SQC). In distant recurrence, there was 39% recurrence for non-SQC and 18% for SQC. Locoregional recurrence in the bronchial stump was more common in SQC than non-SQC (14% vs. 45%, p=0.025). Prognosis of recurrence was not influenced by histologic subtype and the recurrence-free survival curve showed that the non-SQC group did not differ from the SQC group according to stage. Conclusion: The prognosis for recurrence does not seem to be influenced by histologic types, but locoregional recurrence in the bronchial stump seems to be more common in SQC than non-SQC in completely resected stage I and II NSCLC.