• Journal of Chest Surgery
• /
• 제20권2호
• /
• pp.404-410
• /
• 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.

• Journal of Chest Surgery
• /
• 제54권4호
• /
• pp.239-245
• /
• 2021

Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.

• Journal of Chest Surgery
• /
• 제55권3호
• /
• pp.239-242
• /
• 2022

Papillary muscle rupture with severe acute mitral regurgitation is a rare complication of acute myocardial infarction (AMI) that causes pulmonary congestion and cardiogenic shock. Moreover, it has a poor prognosis. Surgical intervention, including revascularization, is indicated; however, surgical mortality remains high. We report the case of an 85-year-old woman with cardiogenic shock from severe acute mitral regurgitation, in whom a hybrid intervention, combining percutaneous coronary intervention with mitral valve replacement via minithoracotomy, was performed after post-infarction papillary muscle rupture. She was discharged in a favorable clinical condition. We describe a novel hybrid intervention for treating a rare complication of AMI, which could minimize surgical invasion in elderly patients, prevent disuse syndrome after the intervention, and improve prognosis. However, mitral valve surgery via minithoracotomy for emergency cases requires technical proficiency, as well as collaboration with other healthcare professionals, and the choice to perform this procedure requires careful consideration.

• Journal of Chest Surgery
• /
• 제2권1호
• /
• pp.3-12
• /
• 1969

Prior to availability of antibiotics, lung abscess has been recognized as one of the most serious pulmonary disease, and despite of diminished morbidity and mortality rate with the advent of antibiotics and development of better technique in the fields of surgery on pulmonary disease it continues to be a virulent form of pulmonary supuration. It is the purpose of this paper to present a clinical review of 115 lung abscess treated by surgically at "The National Medical Center" during past 9 years. 1. The most common age of occurrence is between the age of 30 and 50, and 105 cases were male and 31 cases occurred in female. 2. Numerous etiological factors may play a role in the formation of a pulmonary abscess; aspiration in 36 patients of which 2 patients had diabetes, 54 patients had preceding URI or pneumonia, and 5 patients followed liver abscess, one of which in hematogenous route. In 20 patients, no predisposing factor could be determined- 3. Clubbing digits were presented in 26 of 1315 patients suggesting chronicity of the disease, and gastric ulcer were combined in 3 of 136 patints. 4. Apparently the onset was insidious, and the progress was masked by indiscriminate administration of antibiotics for URI and TB remedies under impression of pul. tbc. Previous TB treatments were done in 56.%[76 cases] for one week to two years and administration of antibiotics in 51 cases. 5. 89 cases were on tbe right and 2t5 cascs were on the left side. 51 cases of pneumonectomy and 8 of open drainage, of which 4 of Monaldi procedure, were made and operative mortality rate was 5.2%. Numerous complications such as 8 of empyema, 4 of each bleeding and atelectasis, 2 of BPF, 1 of esophageal fistula and one of pneumothorax which were responded well to prolonged treatment with good results, were obtained. 6. The incidence of Klebsiella and Pseudomonas were increased recently. In these results, we submit the surgery should be performed if the conservative therapy had failed. The resection was most favorable operation for pulmonary abscess though drainage procedure may be of value in certain patients with grave systemic menifestations. In chronic long standing abscess, more complications and high mortality rate were assumable although the prognosis has been improved with the advent of antibiotics, the development of improved surgical technique and complete preoperative care.

• Journal of Chest Surgery
• /
• 제46권4호
• /
• pp.241-248
• /
• 2013

Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

• Journal of Chest Surgery
• /
• 제49권5호
• /
• pp.344-349
• /
• 2016

Background: Monocusp reconstruction with a transannular patch (TAP) results in early improvement because it relieves residual volume hypertension during the immediate postoperative period. However, few reports have assessed the long-term surgical outcomes of this procedure. The purpose of the present study was to evaluate the mid-term surgical outcomes of tetralogy of Fallot (TOF) repair using monocusp reconstruction with a TAP. Methods: Between March 2000 and March 2009, 36 patients with a TOF received a TAP. A TAP with monocusp reconstruction (group I) was used in 25 patients and a TAP without monocusp reconstruction (group II) was used in 11 patients. We evaluated hemodynamic parameters using echocardiography during the follow-up period in both groups. Results: At the most recent follow-up echocardiography (mean follow-up, 8.2 years), the mean pulmonary valve velocities of the patients in group I and group II were $2.1{\pm}1.0m/sec$ and $0.9{\pm}0.9m/sec$, respectively (p=0.001). Although the incidence of grade 3-4 pulmonary regurgitation (PR) was not significantly different between the two groups (group I: 16 patients, 64.0%; group II: 7 patients, 70.0%; p=0.735) during the follow-up period, the interval between the treatment and the incidence of PR aggravation was longer in group I than in group II (group I: $6.5{\pm}3.4years$; group II: $3.8{\pm}2.2years$; p=0.037). Conclusion: Monocusp reconstruction with a TAP prolonged the interval between the initial treatment and grade 3-4 PR aggravation. Patients who received a TAP with monocusp reconstruction to repair TOF were not to progress to pulmonary stenosis during the follow-up period as those who received a TAP without monocusp reconstruction.

• Advances in pediatric surgery
• /
• 제16권2호
• /
• pp.154-161
• /
• 2010

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The anomaly is characterized by absence of communication with the tracheobronchial tree and isolated blood supply from an anomalous systemic vessels. With the utilization of antenatal ultrasound, the diagnosis of asymptomatic neonatal PS has increased. Treatment options include observation, arterial embolization and surgical resection. The aim of the present study is to review the clinical course of PS and to share our experience with thoracoscopic resection. A total of 96 patients with PS were treated at Asan Children's Hospital between 1999 and 2010. The diagnosis of PS was established by CT in the cases managed by observation or embolization, and by tissue pathology in the surgical cases. Medical records and radiographic images were retrospectively reviewed. Thirty-nine patients were managed by embolization and 30 patients by surgery. The remaining 27 patients have been under observation without any procedures. Among 27 observation patients, 1 patient regressed completely and 10 patients were lost to follow up. Of the 39 embolizations patients, 2 had their lesion regress and sepsis was suspected after embolization. In 1 patient, the microcoil migrated to the iliac artery during the embolization procedure, and another patient developed renal abscess caused by renal artery embolization. Among 30 surgical cases, resection by thoracotomy was performed in 27 at the Department of Thoracic Surgery, and thoracoscopic resection in 3 at the Division of Pediatric Sugery. Only one wound complication ocurred. We conclud that surgical excision should be recommended for pulmonary sequestration, whether the sequestration is symptomatic or not because of the risk of infection, the low rate of natural regress, poor compliance, severe complications after embolization, and to exclude other pathology. In summary, thoracoscopic resection of the pulmonary sequestration is feasible, efficacious, safe and cosmetically superior even in neonatal period.

• Journal of Chest Surgery
• /
• 제23권5호
• /
• pp.944-952
• /
• 1990

In 1989, We experienced 2 cases of T.A.P.V.D. corrected successfully under cardiopulmonary bypass. The first case was 27 years old male with mild dyspnea on exertion and easy fatigability. All clinical symptoms, physical examinations, laboratory findings, echocardiogram, cardiac catheterization and angiogram revealed supracardiac type T.A.P.V.D. drained through left innominate vein. Operation was done by manner of modified Schumacker procedure. The other case was 6 years old male with cardiac type drained to right atrium through coronary sinus. Two patients were well in postoperative 15 and 8 months.

• Journal of Chest Surgery
• /
• 제31권5호
• /
• pp.472-480
• /
• 1998

서울대학교 어린이병원 흉부외과에서는 1990년부터 1996년까지 104례의 기능적 단심실을 가진 선천성심기형 환아에 대하여 심장내 외측통로술을 이용한 완전폰탄술을 시행하였다. 환아의 연령 및 체중분포는 각각 평균 35.9(범위 10-72) 개월, 12.8 (범위 6.5-37.8) kg이었다. 술전진단은 삼첨판폐쇄증(18), 단심실연결을보이는 중복개구심실(53) 및 기타 기능적 단심실을 동반한 복잡심기형(33)이었다, 50례의 환아에 대하여 체폐동맥 단락술 (37), 폐동맥밴딩(13), 외과적 심방중격절제술(15), 동맥전환술(2), 대동맥하 누두부제거술(2), 총폐정맥이상연결증(2), 폐동맥-대동맥봉합술(Damus-Stansel-Kaye, 1) 등의 고식술이 시행되었다. 완전폰탄술식전 19례의 양방향성 체정맥-폐동맥단락술과 1례의 전(全)체정맥-폐동맥단락술(Kawashima procedure)이 진행되었다. 술전 혈역학소견상, 평균 폐동맥압/폐혈관저항은 14.6 (범위 5-28mmHg) / 2.2 (범위0.4-6.9)wood.unit였으며, 폐혈류/체혈류비가 평균 0.9 (범위0.3-3.0)였다. 이완기말심실압은 평균 9.0 (범위 3.0-21.0) mmHg였고 동맥혈의 산소포화도는 평균 76.0 (범위 45.6-88.0) %였다. 수술은 분계능(terminal crest) 2cm 외측으로 우심이부터 우심방-하공정맥경계부에 종절개를 가하고 하공정맥개구부부터 상공정맥개구부 또는 우심이까지 Gore-Tex 인조도관을 이용하여 외측통동을 형성시키는 방법으로 시행하였으며 필요한 경우 통로상에 4-5.5 mm 직경의 구멍을 만들어 주었다. 동시에 시행한 술식은, 폐동맥성형술(22), 심방중격절제술(21), 폐정맥이상연결증 교정(4), 영구적인 인공심박동기거치(3) 등이었고, 32례에 대하여 통로내 구멍을 만들어 주었으며 그중 1례는 조절형(adjustable)으로 시행하였다. 심방-폐동맥 연결 방법으로 시행한 폰탄술 후 4년후에 발생한 재발성 난치성 상심실형 부정맥환아 1례에 대하여 외측통로형의 변환 폰탄술식이 시행되었다. 수술 직후 혈역학 소견상 평균 폐동맥압, 이완기말심실압, 실온에서 동맥혈의 산소포화도가 각각 12.7 (8-21)mmHg, 7.6 (범위4-12)mmHg, 89.9 (범위68-100) %였다. 병원사망율은 6.7 (7/104) %였고 술후 합병증으로 지속적인 늑막삼출(11), 부정맥(8), 유미흉(9), 중추신경계손상(5), 감염 및 염증(5), 급성신부전(4)이 발생하였다. 평균 27.2 (범위1-85) 개월동안의 외래 추적결과 5명의 만기 사망이 있었다. 저자등은 본연구결과를 토대로 심장내 외측통동폰탄술식이 기능적 단심실 환자에 대하여 비교적 낮은 사망율 및 합병증과 우수한 혈역학으로 시행될수 있는 수술방법이란 사실을 입증하였다.

• Tuberculosis and Respiratory Diseases
• /
• 제54권2호
• /
• pp.219-229
• /
• 2003

배경 및 목적 : 농흉과 합병된 부폐렴성 흉막 삼출의 치료에서 가장 중요한 것은 적절한 항생제 투여와 빠른 배액이다. 흉관 삽관은 소방이 형성되는 경우나 접근이 어려운 경우 성공률이 낮으며, 혈흉, 장기손상, 횡격막 파열, Hornor 증후군 등의 합병증이 보고되는 침습적 술기로, 최근에는 영상 유도에 의한 pigtail 도관 배액술(pigtail catheter drainage, PCD)이 시행되고 있다. 이에 저자 등은 농흉 및 합병된 부폐렴성 흉막 삼출 환자에서 PCD의 유용성을 알아보고자 후향적 연구를 시행하였다. 대상 및 방법 : 1998년 1월부터 1999년 6월까지 가천 의대 길병원에서 농흉 및 합병된 부폐렴성 흉막삼출로 진단되어 PCD시술을 받은 45명을 대상으로, 진단 당시 증상, 음주 및 흡연력, 혈액 검사 소견, 흉수 검사 소견, 방사선 소견(도관 삽관시, 도관 제거시, 도관 제거 한달 후), 삽관 후 24시간 배액량, 삽관 기간, 삽관 후 입원 기간, 외과적 처치여부 등을 조사하여 다음과 같은 결과를 얻었다. 결 과 : 대상환자의 남녀비는 42 : 3, 연령은 중앙값 52세(21~74)이었다. 농흉 환자는 23명, 합병된 부폐렴성 흉막 삼출 환자는 22명이었고, 이 중 PCD만을 시행받았던 4명(3명 : 부폐렴성 흉막삼출, 1명 : 농흉)의 환자가 추적관찰에서 탈락되었다. 이들을 제외한 나머지 환자들 중 36명(80%)에서 PCD 또는 PCD와 유로키나제 사용으로 배액이 가능하였으며, 농흉 환자 23명 중 5명(27.1%)만이 외과적 수술을 시행받았고(흉막 박피술 1명, 개방성 흉강 배액술 3명), 이 중 1명이 사망하였다. PCD만 시행 받은 환자군과 PCD와 유로키나제를 사용한 환자군에서 삽관 기간, 삽관 후 재원 기간 및 24시간 평균 배액량은 유의한 차이가 없었다. PCD만 시행 받은 환자군과 수술적 처치를 받은 군 간에 24시간 평균 배액량의 유의한 차이는 없었으며, 삽관 기간($9.4{\pm}5.25$일 vs. $19.2{\pm}9.42$일, p<0.05), 삽관 후 재원 기간($15.9{\pm}10.45$일 vs. $38.60{\pm}11.5$일, p<0.01)이 수술적 처치를 받은 군에서 더 긴 것으로 나타났다. 또한 PCD와 유로키나제를 사용한 군과 수술적 처치를 받은 군 사이에서도 24시간 평균 배액량의 차이는 없었고 삽관 기간($11.1{\pm}7.35$일 vs. $19.2{\pm}9.42$일, p<0.05)과 삽관 후 재원 기간($17.5{\pm}9.17$일 vs. $38.6{\pm}11.46$일, p<0.01)에 유의한 차이가 있었다. PCD 단독 또는 PCD와 유로키나제를 병행하여 사용한 40명의 환자 중 추적관찰시 탈락된 4명을 제외하고 16명(44.4%)에서 도관 제거시 75% 이상 흉수가 감소하였으며, 17명(47.2%)에서는 50~75%, 1명에서는 25~50% 감소하였고, 2명에서는 25% 미만으로 감소하였다. 도관 제거 한 달 후에는 1명을 제외한 35명(97.2%)이 50% 이상의 호전을 보였다. 추적 관찰 기간 중 pigtail 도관 삽관시 특기할 만한 합병증은 없었다. 결 론 : PCD는 농흉 및 합병된 부폐렴성 흉막 삼출 환자에서 심각한 합병증 없이 효과적으로 조기에 배액할 수 있는 유용한 시술로 사료된다.