• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.1
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• pp.61-68
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• 1996

In Fibrous dysplasia(FD) of the jaws, the majority of cases can await the cessation of growth before surgical intervention, and it seems prudent to delay surgery whenever possible until growth has ceased. In craniofacial FD, however, the dangers of dystopia, dystopia and loss of vision may require early surgery to prevent or control cranio-orbital complications. Delaying surgery in those circumstances may be significantly detrimental to such patients. Conservative surgical management of FD is widely practised and we advocate an extension to this conservative treatment by combining surgical recontouring with appropriate osteotomies if indicated, to achieve an optimal esthetic and functional results in craniofacial FD. One case will be presented to illustrate the feasiblility of such combined treatment, to report the uneventful healing of osteotomies in the FD of the jaws, and to demonstrate the use of titanium miniplate fixation in dysplastic bone. The other case had expansile disease of the left facial and fronto-temporal bones and osteolytic change left mandible. This patient complained of severe spontaneous bleeding of left mandibular premolar area and it was suspected as central hemangioma of the left mandible and craniofacial FD. Angiogram disclosed generalized dilation of the external carotid artery and its branches, especially terminal branches of the left facial and inferior alveolar arteries. But no specific abnormalities, such as A-V shunt, venous lake, or early venous drainage, was seen. So it was diagnosed craniofacial FD with hypercellularity and generalized bony recontouring was performed via coronal and transoral approaches.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.649-655
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• 1988

One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.

• Korean Journal of Radiology
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• v.20 no.8
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• pp.1285-1292
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• 2019

Objective: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. Materials and Methods: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. Results: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). Conclusion: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.665-671
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• 2007

Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

• Journal of Veterinary Clinics
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• v.30 no.2
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• pp.87-94
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• 2013

This retrospective study reviewed the clinical and diagnostic features, therapeutic outcome and compilations of interventional ductal occlusion in 37 dogs with patent ductus arteriosus (PDA). Malteses and female dogs were over-presented. Bounding pulse and left basal continuous murmur were most common findings in physical examination, while the differential cyanosis was rarely observed. Left ventricular (LV) enlargement patterns and sinus tachycardia were common in the ECG. Typical radiographic findings included LV elongation and triple bumps indicating left atrial (LA), aortic and pulmonary dilation. Echocardiographic features were typical shunt flow at the ductus arteriosus and marked LV dilation with mild to moderate mitral regurgitation (MR). The 32 of 37 dogs were interventionally treated with either thromboemolic coils (TCE) or Amplatz canine ductal occluder (ACDO). Transient hemoglobinuria caused by incomplete closure was occurred in 2 dogs treated with TCE, although the hemoglobinuria was disappeared within a week of intervention. The dislodgement of occlusion device was occurred in 2 dogs with TCE and 1 dog with ACDO. However there were no significant complications associated with this dislodgement, since those were dislodged at the lower pulmonary vasculature. We also found that no serious complications and no further medical intervention in 29 dogs having long-term follow-ups.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.494-498
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• 2009

Purpose : Applicability of transcatheter closure of atrial septal defect (ASD) has been expanded by accumulation of clinical experiences and evolutions of the device. This study was performed to evaluate the safety and efficacy of transcatheter closure of ASD with Amplatzer septal occluder (ASO) in young children less than 3 years of age. Methods : From May 2003 to December 2005, 295 patients underwent transcatheter closure of ASD with ASO in the Severance Cardiovascular Hospital, Yonsei University Health System. Among them, 51 patients less than 3 years of age were enrolled in this study. We investigated procedural success rate, rate of residual shunt, frequency of complications, procedure/fluoroscopy time, and need of modified techniques for device implantation. Results : The median age was 2.1 years and median body weight was 12 kg. Implantation of device was successful in 50 patients (98%). Seven patients (15%) showed a small residual shunt 1 day after the procedure, but complete occlusion had been documented at 6 month follow-up in all patients (100%). The pulmonary to systemic flow ratio (Qp/Qs), peak systolic pulmonary artery pressure, and peak systolic right ventricular pressure had decreased significantly after closure of ASD. There were 2 complications including device embolization (1, 2%) and temporary groin hematoma (1, 2%). Conclusion : Transcatheter closure of ASD with ASO can be performed with satisfactory results and acceptable risk even in young children less than 3 years of age. We could suggest that even in very young children with ASD, there is no need to wait until they grow to a sufficient size for the transcatheter closure.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.749-755
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• 1998

Background: Twelve patients with acyanotic tetralogy of Fallot(TOF), characterized by the combination of a malaligned ventricular septal defect(VSD) and infundibular pulmonic stenosis with the clinical finding of acyanosis at rest, underwent surgical correction between January 1988 and July 1997. Materials and methods: 9.92% of patients with the diagnosis of TOF were acyanotic TOF in the same period. Ages ranged from 12 to 42 months(mean 25.2 months). 2D-echocardiographic studies, cardiac catheterization, and angiocardiograms were performed in all patients before operation. The preoperative mean systemic arterial oxygen saturation was 93.5%. According to the 2D-echocardiographic analysis, there was Lt-to-Rt shunt through VSD in 4 patients, bidirectional shunt in 2 patients, and no shunt in 6 patients. Results: The preoperative mean right ventricle to pulmonary artery(RV-PA) pressure gradients were 52.3 mmHg on 2D- echocardiogram and 48.4 mmHg on cardiac catheterization. The repair of ventricular septal defect was performed through a right atrial approach and the hypertrophic infundibular muscle bundles were resected by the transatrial and transpulmonary approach. Six patients(50%) received a transannular patch. The mean cardiopulmonary bypass time was 135.0 minutes, and the aortic crossclamp time was 87.8 minutes. Postoperative complications included bleeding necessitating reentry in one and chylothorax in one. No patient died after operation and there were no late deaths. Postoperative 2D-echocardiograms revealed tiny patch dehiscence in 5 cases and a moderate RV-PA pressure gradients(mean 15.3 mmHg). All patients were in New York Heart Association functional class 1 after operation. Conclusions: acyanotic TOF is the uncommon form of TOF, and acyanotic TOF can be repaired with a good outcome.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.370-377
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• 2009

Objective : There is no definite adjustment protocol for patients shunted with programmable valves. Therefore, we attempted to find an appropriate method to adjust the valve, initial valve-opening pressure, adjustment scale, adjustment time interval, and final valve-opening pressure of a programmable valve. Methods : Seventy patients with hydrocephalus of various etiologies were shunted with programmable shunting devices (Micro Valve with $RICKHAM^{(R)}$ Reservoir). The most common initial diseases were subarachnoid hemorrhage (SAH) and head trauma. Sixty-six patients had a communicating type of hydrocephalus, and 4 had an obstructive type of hydrocephalus. Fifty-one patients had normal pressure-type hydrocephalus and 19 patients had high pressure-type hydrocephalus. We set the initial valve pressure to $10-30\;mmH_2O$, which is lower than the preoperative lumbar tapping pressure or the intraoperative ventricular tapping pressure, conducted brain computerized tomographic (CT) scans every 2 to 3 weeks, correlated results with clinical symptoms, and reset valve-opening pressures. Results : Initial valve-opening pressures varied from 30 to $180\;mmH_2O$ (mean, $102{\pm}27.5\;mmH_2O$). In high pressure-type hydrocephalus patients, we have set the initial valve-opening pressure from 100 to $180\;mmH_2O$. We decreased the valve-opening pressure $20-30\;mmH_2O$ at every 2- or 3-week interval, until hydrocephalus-related symptoms improved and the size of the ventricle was normalized. There were 154 adjustments in 81 operations (mean, 1.9 times). In 19 high pressure-type patients, final valve-opening pressures were $30-160\;mmH_2O$, and 16 (84%) patients' symptoms had nearly improved completely. However, in 51 normal pressure-type patients, only 31 (61%) had improved. Surprisingly, in 22 of the 31 normal pressure-type improved patients, final valve-opening pressures were $30\;mmH_2O$ (16 patients) and $40\;mmH_2O$ (6 patients). Furthermore, when final valve-opening pressures were adjusted to $30\;mmH_2O$, 14 patients symptom was improved just at the point. There were 18 (22%) major complications : 7 subdural hygroma, 6 shunt obstructions, and 5 shunt infections. Conclusion : In normal pressure-type hydrocephalus, most patients improved when the final valve-opening pressure was $30\;mmH_2O$. We suggest that all normal pressure-type hydrocephalus patients be shunted with programmable valves, and their initial valve-opening pressures set to $10-30\;mmH_2O$ below their preoperative cerebrospinal fluid (CSF) pressures. If final valve-opening pressures are lowered in 20 or $30\;mmH_2O$ scale at 2- or 3-week intervals, reaching a final pressure of $30\;mmH_2O$, we believe that there is a low risk of overdrainage syndromes.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.272-275
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• 2012

Objective : Choroid plexus papillomas (CPPs) are generally regarded as benign tumors with typical radiologic and pathologic findings. However, they sometimes have unusual findings. We have analyzed radiologic findings and pathologic growth patterns on CPPs. Methods : The study group included 5 male and 5 female patients (age range, 3 months to 58 years : median, 29 years). The study group included 3 pediatric and 7 adult patients. All patients underwent surgery; 9 patients had a gross total resection and 1 patient had a subtotal resection. We analyzed the radiologic findings (location, size, mottle-like appearance, enhancement, calcifications, and hydrocephalus) and pathologic growth patterns (typical papillary, papillary and solid, and papillary and tubular). Results : The median follow-up duration was 21.3 months (range, 4-47.8 months). There were no recurrences after initial treatment. All patients had benign CPPs. Pediatric CPPs were 3.2 cm masses (range, 2.7-4 cm) with homogeneous enhancement and a mottle-like appearance, which pathologically showed the papillary growth pattern. Hydrocephalus was present in all pediatric patients. Postoperatively, subdural hygroma had occurred in two patients. In adults, CPPs were located in the fourth ventricle in 6 patients and suprasellar area in 1 patient. The size varied from 0.5-4.2 cm. Hydrocephalus and calcifications occurred in 3 and 4 patients, respectively. Three patients showed the heterogeneous enhancement without a mottle-like appearance and pathologically showed combined papillary and solid growth in 2 patients and papillary and tubular growth in one. Postoperatively, two patients with large masses had injuries of the brainstem and underwent shunt procedures for aggravation of hydrocephalus. Conclusion : CPPs may show unusual radiologic findings, which preoperatively give the difficulty to be differentiated from other tumors. CPPs with unusual radiologic findings showed the combined pathologic growth patterns.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.591-594
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• 2011

A 9-month-old, intact female Maltese dog and one-year-old, intact female beagle dog were presented with continuous heart murmur. These 2 dogs were diagnosed as patent ductus arteriosus (PDA) based on the two-dimensional echocardiography and angiography. Due to the large shunt size, commercially available ductal occlude device was used for transcatheter occlusion of PDA. After Amplatzer$^{(R)}$ vascular plug placement, cardiac murmur was abruptly disappeared in Maltese dog and mildly decreased in beagle dog. Complications and safety after the procedure were evaluated regularly in these 2 dogs. This is first clinical application of Amplatzer$^{(R)}$ vascular plug for transcatheter closure of PDA in two dogs in Korea.