• Journal of Dental Anesthesia and Pain Medicine
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• 제20권5호
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• pp.331-335
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• 2020

Various anesthetic techniques have been utilized for maxillo-mandibular fixation. We report the case of a patient with bilateral condylar and zygomatic arch fractures who had severe pulmonary dysfunction. The patient was administered bilateral image-guided Gasserian ganglion block through the foramen ovale to achieve surgical anesthesia. The technical details, advantages, and disadvantages of this rather unusual technique are discussed. The procedure could be a feasible technique when performed meticulously in cases where other approaches are deemed difficult.

• Journal of Chest Surgery
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• 제41권3호
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• pp.313-319
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• 2008

배경: 심방세동의 외과적 치료방법으로는 Cox maze-III 수술이 가장 효과적이다. 그러나 수술시간이 길고 합병증이 증가할 수 있어서 수술시간을 단축하고자 좌측 심방의 maze수술이나 폐정맥분리술만을 시행하기도 한다. 저자들은 절개-봉합법을 이용한 심방세동 수술방법의 변형이 심방세동의 수술결과에 어떤 영향을 주는지 알아보았다. 대상 및 방법: 1999년 2월부터 2005년 6월까지 기존 심장질환과 심방세동을 동반한 40예(남 17예; 여 23예)에서 심방세동 수술을 시행하였다. 23예에서 Cox maze-III 수술을, 10예에서 좌심방 maze 수술을, 7예에서 폐정맥 분리술을 시행하였다. 심방에 전도차단 병변을 만들기 위해 절개봉합법이 이용되었으나, 폐분리절개선에서 승모판륜까지의 심방벽과 관상정맥동의 전도차단에는 냉동프로브가 사용되었다. 결과: 심방세동 수술 후 $50.0{\pm}21.6$개월의 추적결과 Cox maze-III 수술을 받은 23예는 모두 정규리듬(동리듬이나 심방리듬)으로 전환되었고, 좌심방 maze 수술을 받은 10예 중 7예(70%)에서, 폐정맥 분리술을 받은 7예 중 4예(57.1%)에서 각각 정규리듬으로 전환되었다(p=0.002). 결론: 심방세동 수술에서 동리듬이나 심방리듬으로 높은 전환율을 얻기 위해서는 양심방에 Cox maze-III 수술을 시행해야 하며, 좌심방 maze 수술이나 폐정맥 분리술 같은 국한적인 수술방법은 심방세동의 치료율을 떨어뜨릴 수 있다.

• Journal of Chest Surgery
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• 제33권6호
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• pp.476-486
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• 2000

Background: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. Material and method: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). Result: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. Conclusion: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05$\leq$Z-value of T-value of T-valve$\leq$2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve$\leq$4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.

• Journal of Chest Surgery
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• 제39권2호
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• pp.145-149
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• 2006

폐동맥 협착과 심실 중격 결손을 동반한 대혈관 전위를 갖는 환자들에 대한 수술은 Rastelli 수술법이나 Lecornpte 수술법이 전통적으로 시행되어 왔으나, 심실 내 터널에 의한 뒤틀린 좌심실 유출로와 부자연스러운 우심실 유출로에 의해 장기 성적은 만족스럽지 않다. 이에 대한 대안으로 저자들은 이 기형으로 진단된 3세 환아(체중 9.6 kg)에서 반회전 동맥간 전환술(half-turned truncal switch operation)을 시행하였다. 술 후 심초음파 검사에서 좌심실유출로와 우심실유출로가 곧고 넓게 형성되어 향후 좋은 장기 결과가 기대된다.

• Journal of Chest Surgery
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• 제24권7호
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• pp.693-700
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• 1991

A rare case of the association of distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, intact ventricular septum, patent ductus arteriosus and interrupted aortic isthmus in a 40-day-old infant is reported. The infant was suffered from two operations with an interval of nine days. At the first operation a 10mm polytetrafluoroethylene prosthesis was inserted instead of the interrupted aortic isthmus and ductus was ligated via the left posterolateral thoracotomy. But the patient could not be weaned from the respirator because of large amount of left-to-right shunt. So the total correction was subsequently performed after an interval of nine days. At the second operation, tunneling of the right pulmonary artery to the main pulmonary artery through the aortopulmonary septal defect was performed using the Dacron patch via a longitudinal transaortic approach and a separate autologous pericardial patch was applied to the longitudinally incised margins of the anterior wall of the ascending aorta. The second postoperative course was relatively uneventful except some respiratory distress and nutritional problems. Now he is at 6 months of age and thrives well without any symptom. Because the success of the surgical repair of this complex anomalies depends upon the accurate diagnosis and meticulous design of each step of procedure prior to operation these problems are also discussed.

• Tuberculosis and Respiratory Diseases
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• 제87권1호
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• pp.40-51
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• 2024

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia with a very poor prognosis. Accurate diagnosis of IPF is essential for good outcomes but remains a major medical challenge due to variability in clinical presentation and the shortcomings of existing diagnostic tests. Medical history collection is the first and most important step in the IPF diagnosis process; the clinical probability of IPF is high if the suspected patient is 60 years or older, male, and has a history of cigarette smoking. Systemic assessment for connective tissue disease is essential in the initial evaluation of patients with suspected IPF to identify potential causes of interstitial lung disease (ILD). Radiologic examination using high-resolution computed tomography plays a pivotal role in the evaluation of patients with ILD, and prone and expiratory computed tomography images can be considered. If additional tests such as surgical lung biopsy or transbronchial lung cryobiopsy are needed, transbronchial lung cryobiopsy should be considered as an alternative to surgical lung biopsy in medical centers with experience performing this procedure. Diagnosis through multidisciplinary discussion (MDD) is strongly recommended as MDD has become the cornerstone for diagnosis of IPF, and the scope of MDD has expanded to monitoring of disease progression and suggestion of appropriate treatment options.

• Journal of Chest Surgery
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• 제27권8호
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• pp.700-704
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• 1994

Congenital coronary arteriovenous fistula is relatively rare congenital heart disease which has formation of fistula between coronary artery and cardiac ventricle, atrium, or pulmonary artery, but that can be repaired with simple surgical procedure. We experienced three cases of congenital coronary arteriovenous fistula, which were repaired surgically under cardiopulmonary bypass, so we report these cases with review of the literatures.

• Journal of Chest Surgery
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• 제55권4호
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• pp.307-312
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• 2022

Adverse events or emergency situations that are unacceptable in the context of lung transplantation may occur during the procedure. These adverse events and circumstances are not problems that are caused by insufficient experience or can be solved by increasing surgical experience. The purpose of this review is to describe the adverse events and circumstances that occur during lung transplantation and to identify an appropriate surgical approach through an analysis of case reports in the global literature.

• Journal of Chest Surgery
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• 제30권10호
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• pp.1024-1027
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• 1997

좌 관상동맥 폐동맥 이상 기시증은 드문 선천성 심기형으로 유아기에 심부전을 일으키는 질환으로서 수술적인 치료를 하지 않을 경우 대부분 치명적인 것으로 알려져 있다 대혈관 전위의 교정술이 보편화되면서 신생아에서 관상동맥 이식에 대한 기술이 발전되어 근래에는 좌 관상동맥을 대동맥에 이식하여 이중 관상동 맥 체계를 만들어주는 수기가 본 질환의 일차 선택 수술법으로 인정되고 있다. 본 교실에서는 심부전으로 입원한 생후 44일된 여아에서 좌 관상동맥 폐동맥 이상 기시증이 발견되어 좌 관상동맥 대동맥 이식술로 치 료하여 좋은 결과를 얻었으므로 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.320-326
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• 1985

Pulmonary sequestration occurs when some disturbance produces a cystic mass of nonfunctioning lung tissue which lacks normal communication with the tracheobronchial tree. Between 1971 and 1985, pulmonary sequestration was diagnosed in 11 patients, ranging age from 3 to 29 years. All sequestration were intralobar type. Definitive diagnosis can only be obtained by aortography and/or surgical exploration in 10 cases. The other one was confirmed by pathologic examination postoperatively. The presenting complaints were mostly recurrent local pulmonary infection, but in 2 cases mediastinal mass with respiratory symptoms was presented, and cardiac murmur was only finding in one case. Preoperative diagnostic procedure revealed 3 associated anomalies which were funnel chest, right aortic arch, and pulmonic stenosis with vascular ring. Operative treatment for sequestration was lobectomy in 10 cases, and a segmentectomy in one. There was no operative mortality, but 3 complications [empyema, B-P fistula, post-op bleeding] which were controlled by subsequent operations or conservative measure. Aortography is strongly advocated not only for its diagnostic value, but for its preoperative localization of the aberrant vessels that are the major concern to the surgeon.