• Journal of Chest Surgery
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• 제36권2호
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• pp.73-78
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• 2003

기능적 단심증에 대한 Fontan 술식은 수술 방법에 많은 변형을 거치면서 그 임상 성적 또한 향상되어 왔다. 그럼에도 불구하고 추적과정 중에 발생하는 치명적인 합병증은 장기 성적에 많은 영향을 미친다고 할수 있다. 따라서 이러한 합병증에 대한 수술적 치료가 필요하며 빈도 또한 증가하고 있다. 대상 및 방법: 1988년 4월부터 20n년 1월까지 Fontan 수술 후에 발생한 합병증에 대한 수술적 치료를 받은 16명의 환자를 대상으로 하였다. 재수술 당시 평균 연령은 8.8$\pm$5.5년이었다. Fontan수술에 적용된 술식은 심방-폐동맥 연결술 및 완전 체정맥-폐동맥 연결술이 각각 8예로 완전 체정맥-폐동맥 연결술 중 5예는 심장내 외측터널, 3예는 심장외 외측터널을 시행하였다. 이 중 천공을 추가한 경우가 5예 있었다. 재수술의 적응증은 잔존 우좌단락 6예, 폐정맥 협착 3예, 심방 조동 3예, 방실판막 폐쇄부전 2예, Fontan 유출로의 협착 1예, 단백상실성 장병증이 1예 있었다. 결과: 조기 및 만기 사망이 각각 3예 있었다. 잔존 단락이 있었던 환자에서는 2예에서 단락 부위를 일차 봉합하였고 2예에서는 체정맥과 폐정맥을 분리하기 위한 심방내 중격을 재형성하였으며 2명의 환자에서는 심장내 외측통로 및 부분 양심실 교정술로 전환하였다. 폐정맥이나 Fontan유출로의 협착이 있었던 4명의 환자에서는 3예에서 협착 부위 확장술을 시행하였고 1예에서는 좌폐 전절제술을 시행하였다. 심방 조동이 발생한 3예는 모두 심방-폐동맥 연결술에서 심장내 외측터널로 술식을 전환하였다. 2예의 방실판막 폐쇄부전 환자는 기계 판막 치환술을 시행받았으며 단백소실성 장병증이 발생한 1예는 개흉술을 통해 대동맥-폐동맥 측부 혈행을 폐쇄하였다. 4명의 환자에서 부정맥 치료의 추가적인 방법으로 냉동 절제술을 동시에 시행하였다. 결론: Fontan수술 후에 발생하는 합병증은 치료가 어렵고 상당한 유병율 및 사망률을 가지고 있다. 그러나 Fontan 생리에 대한 보다 깊은 이해와 수술 술기의 발전은 Fontan 수술 자체뿐 아니라 그 합병증의 치료 가능성을 증대시켰다. 비록 모든 환자에서 만족할 만한 결과를 얻지는 못하였으나 이러한 환자에 대한 적절한 외과적 치료로 생존환자에서 증상의 완화 및 기능적 분류의 호전을 볼 수 있었다.

• Journal of Chest Surgery
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• 제23권1호
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• pp.162-168
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• 1990

Unroofed coronary sinus syndrome is an uncommon anomaly which is caused by incomplete formation of the left atriovenous fold and it is usually associated with persistent left superior vena cava. It may be diagnosed by cardiac catheterization and cineangiography but, if it is not diagnosed, it can bring out significant complications due to right to left shunt, such as brain abscess, cerebral embolism, transient ischemic attack, arterial desaturation and there will reduced patient`s life expectancy. Therefore corrective operation was needed. A case of unroofed coronary sinus syndrome which combines with valvular heart disease was experienced at the department of thoracic & cardiovascular surgery of Kosin medical college. The patient was 49 years old female and she complained dyspnea on exertion for 2 yrs. Cardiac catheterization with cineangiography and both superior venacavogram were performed for diagnosis and she was diagnosed as unroofed coronary sinus syndrome combined with mitral and tricuspid regurgitation. Surgical correction was accomplished by reroofing of coronary sinus with pericardial patch, closure of atrial septal defect and annuloplasty of both atrioventricular valves. Postoperative results were satisfactory and course of recovery was uneventful. We report a case of unroofed coronary sinus syndrome with review.

• Journal of Chest Surgery
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• 제20권1호
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• pp.218-222
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• 1987

Unroofed coronary sinus syndrome is an uncommon anomaly, Unroofed coronary sinus syndrome is caused by incomplete formation of the left atriovenous fold, and it usually is associated with Left SVC. If it is not diagnosed, a residual reversed or bidirectional shunt will result, and its complications will reduce life expectancy. We experienced 3 cases of unroofed coronary sinus syndrome which combines TOF with PLSVC, partial ECD, primum type ASD. In case of Unroofed coronary sinus syndrome which combines TIF with PLSVC, preoperative diagnosis was not made. In corrective operation for TOF of this case, pump weaning was failed due to hypoxia and cardiac arrest, and he expired at operation room. At autopsy of this case, complete unroofed coronary sinus was found. In the other 2 cases, partial unroofed coronary sinus syndrome was found in operation field and corrective operation was performed successfully. We report these 3 experiences with its review. ^u ++ Noninvasive Assessment of Pressure Gradients across Prosthetic Heart Valve by Doppler Ultrasound - A comparative study of the Duromedics Bileaflet Valves in mitral position and Normal Mitral Valves -with its review.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1103-1106
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• 2000

We have recently experienced a third ventricular tumor from a 63-year old woman who presented with paraparesis, voiding difficulty and general weakness. Histopathologic study of the tumor was compatible with recently reported and newly termed chordoid glioma. Clinical behavior of the reported tumors were mostly benign but because of its very close proximity to the hypothalamus, some of the subtotally removed tumors recurred or some of the patients died of postoperative complications. The presenting patient regained normal leg power after removal of the tumor followed by ventriculoperitoneal shunt and discharged on her own feet.

• Journal of Chest Surgery
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• 제28권4호
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• pp.335-339
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• 1995

Secundum atrial septal defect occupies about 10 to 15% of congenital heart diseases, and the surgical accomplishment is outstanding, so that the operative mortality is getting near to zero percent. But, the methods of correction, direct closure versus patch closure are still controversial and there is no absolute method about it. Some surgeons prefer direct closure technique for its simplicity and lesser thrombogenicity but others, afraid of arrhythmia and suture detachment after closure of large defect, prefer patch closure. Usually most surgeons use direct suture technique in small and moderate sized defects and patch closure in large defects. In our hospital, 156 cases of isolated secundum atrial septal defect were closed directly by double continuous over and over suture using 5-0 polypropylene[prolene , regardless their sizes and the amounts of shunt flow. There were no operative mortality and no serious complications such as heart block, suture detachment and embolism.

• Journal of Chest Surgery
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• 제38권5호
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• pp.389-390
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• 2005

대퇴동맥을 통한 검사 후 대퇴동맥 천자부위를 다루는 기준적인 방법은 수동적으로나 기계적으로 압박을 가한 후 4시간 내지 8시간 동안 침상안정을 취하는 것이었다, 그러나 이러한 방법은 심한 불편함과 퇴원을 지연시키는 문제점이 발생하였다. 이에 따라 최근에 지혈을 위한 많은 장치들이 계발되었다. 이러한 장치들은 국소적인 지혈을 촉진하기 위해 콜라겐을 사용하고 있다. 하지만 이런 장치들을 사용함에 따른 많은 문제점들이 국제적으로 보고되고 있다. 그리고 본원에서는 안지오-씰 사용으로 인한 우측 대퇴동맥과 슬와 동맥에 발생한 혈전증을 수술로 성공적으로 치료한 결과를 얻어서 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제23권4호
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• pp.654-658
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• 1990

Between January of 1980 and December of 1989, we are encountered 121 cases of Down syndrome here at Yonsei University Medical Center. of these being endocardial cushion defect, ventricular septal defect, tetralogy of Fallot, atrial septal defect, patent ductus arteriosus and complicated anomalies. The mean age was 1 month 2 years with the sexual division at 31 males and 29 females. Among these 60 patients, 10 of them were treated trough surgical management, 8 of them being open heart surgeries, the 8 open heart surgeries are broken down as follow: 4 total correction of ECD, 2 patch repair of VSD, 1 total correction of TOF, 1 patch repair of ASD secundum. Another 2 operative management are ligation of PDA and modified Blalock - Taussig shunt of TOF. Postoperatively all patients were weaned and extubated on an artificial ventilator without any respiratory complications, and were discharged without incident.

• Journal of Chest Surgery
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• 제54권3호
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• pp.214-217
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• 2021

In rare cases, levoatrial cardinal vein may occur as an isolated condition without additional congenital anomalies. Depending on the direction and flow of the shunt, this pathology may produce symptoms; alternatively, it may be asymptomatic, as in the case presented in this study. In asymptomatic cases, complications, such as paradoxical embolism and brain abscess, can arise later. In the 11-year-old patient whose case is presented here, the levoatrial cardinal vein was asymptomatic and incidentally detected. The percutaneous closure method was applied first. However, by 16 hours after the procedure, the occluder device had embolized to the iliac artery. Emergency surgery was performed; first, the occluder device was removed, and levoatrial cardinal vein ligation was then performed via a mini-thoracotomy. The symptoms, diagnosis, and treatment modalities of isolated levoatrial cardinal vein are discussed in the context of this case described herein.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권2호
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• pp.119-129
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• 2024

Knowledge of the venous anatomy is essential for appropriately treating dural arteriovenous fistulas (AVFs). It is challenging to determine the overall venous structure despite performing selective angiography for dural AVFs with feeder from multiple selected arteries. This is because only a part of the veins can be observed through the shunt in the selected artery. Therefore, after performing selective angiography of all vessels to understand the approximate venous anatomy, the venous anatomy can be easily understood by closely examining the source image of computed tomographic angiography or magnetic resonance angiography. Through this, it is possible to specify the vein that is to be blocked (target embolization), thereby avoiding extensive blocking of the vein and avoiding various complications. In the case of dural AVF with feeder from single selected artery, if the multiplanar reconstruction image of the three-dimensional rotational computed tomography obtained by performing angiography is analyzed thoroughly, a shunted pouch can be identified. If embolization is performed by targeting this area, unnecessary sinus total packing can be avoided.

• Journal of Korean Neurosurgical Society
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• 제29권2호
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• pp.231-239
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• 2000

Objectives : A postoperative hydrocephalus is compromises the clinical outcome of patients with aneurysmal clippings as one of the major complications of SAH. Subdural hygroma is often complicated after aneurysmal clippings, which subsides spontaneously as simple hygroma, or progresses to shunt-dependent hydrocephalus (SDHC). To predict development of SDHC from the hygroma, and to improve clinical outcome of patients with aneurysmal clippings, we analyzed clinical predisposing factors between 2 subgroups, simple hygroma and SDHC. Patients and Methods : A retrospective study of 232 consecutive cases of clipped aneurysmal patient was undertaken in our hospital for last two years. The 46 patients(19.8%) developed hygromas after aneurysmal clippings. There were 22 cases with simple hygroma(9.5%), and 24 patients with SDHC(10.3%). Comparison of 2 subgroups was made for various clinical and radiological factors. Results : Older age(p＝0.03), poor preoperative clinical grade(p＝0.01), high Fisher grade(p＝0.005), large amount of hygroma(p＝0.014) and increased size of lateral ventricle ipsilateral to hygroma(p＝0.001) were correlated significantly with SDHC. There was no statistical significance in sex, aneurysmal location and presence of acute preoperative ventricular dilatation between 2 subgroups. Conclusion : The clinical factors, such as older age, poor preoperative clinical grade, high Fisher grade, large amount of hygroma and increased size of lateral ventricle ipsilateral to hygroma showed statistical sinificance for differentiating SDHC from simple hygroma.