• Journal of Chest Surgery
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• 제41권4호
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• pp.516-519
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• 2008

개심술 이후 발생한 대동맥 피부 누공의 합병증은 드물지만 한 번 발생하면 매우 치명적이므로 빠른 진단과 수술적 치료가 요구된다. 국립의료원에서는 대동맥 판막과 승모판막 치환술 이후 4년 8개월 동안 흉골감염이 반복되다가 갑작스런 출혈로 응급실에 내원해서 대동맥 혈관 촬영술을 통해 대동맥 피부 누공을 진단하여 응급 체외순환하에 일차 봉합만으로 더 이상의 재발없이 2년간 외래 추적 관찰 중이다.

• Journal of Chest Surgery
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• 제19권4호
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• Journal of Chest Surgery
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• 제18권2호
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• pp.299-304
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• 1985

The partial A-V canal defect consist of ostium primum type atrial septal defect with a cleft mitral anterior leaflet. The clinical findings depend upon the site and size of the left-to-right shunt, the degree of A-V valvular regurgitation, and the degree of resultant pulmonary artery hypertension. We experienced 3 cases of similar condition. The data were as follow: 1. Chest P-A showed increased pulmonary vascularity and moderate cardiomegaly with left atrial enlargement. 2. E.K.G. showed left axis deviation, left atrial enlargement, and left ventricular hypertrophy. 3. Right heart catheterization showed significant 02 step up of SVC-RA and left-to-right shunt. 4. Left ventriculogram showed mitral regurgitation and filling of both atrium. Operative findings were as follow: 1. Primum type atrial septal defect [2x2 cm]. 2. Cleft in the anterior leaflet of the mitral vave. 3. No evidence of ventricular septal defect and tricuspid anomaly. Through a right atriotomy with moderate hypothermia, the mitral cleft was approximated with interrupted sutures. The interatrial communication was closed by a patch of Dacron/pericardium. The patch was attached to junction of the mitral and tricuspid valves along the crest of the ventricular septum using interrupted sutures and the other site using continuous sutures. Postoperative course was uneventful and discharged in good general condition except postoperative bleeding in case 3.

• Journal of Chest Surgery
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• 제18권2호
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• pp.273-278
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• 1985

The case of a patient with abnormal position of the atrial septum resulting in a left atrium with two atrioventricular valves and a disconnected right atrium is presented with review of related articles. Anatomic details showed atrial situs solitus and a left sided cardiac apex. The right atrium received both venae cavae and a coronary sinus. No AV valve was found in the right atrium, and the floor of this chamber was placed above the posterior wall of right ventricular chamber. The atrial septum with secundum ASD was displaced to right anteriorly at its lower portion and inserted to right of tricuspid annulus. The tricuspid and mitral valve configuration was that of so-called partial ECD, i.e. mitral cleft with large anterior mitral leaflets. The ventricular septum was intact and both ventricular chambers were equally well developed with normal relationships. Surgical repair of this anomaly was performed by resecting the abnormally positioned lower part of the atrial septum, repairing the cleft of the anterior mitral leaflet, and septating the atrium for diverting the systemic and pulmonary venous blood to RV and LV, respectively.

• Journal of Chest Surgery
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• 제20권2호
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• pp.300-308
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• 1987

Clinical and pathologic data were reviewed in 20 patients who had have surgery for isolated aortic valvular heart disease between April 1978 and April, 1987. Hospital mortality was 10%, with no additional late mortality during a mean follow-up period of 24.1 months. Prosthetic valve failure developed in 3 patients and two had reoperation. Niety four percent of the survivors who were in NYHA Funtional class III or IV before operation are now in class I or II. Ninety percent of all patients are still alive at a maximum follow up of 9 years. The clinical histories, gross and histologic examination of valves estabilished the causes for isolated aortic valve disease: 3 rheumatic, 2 congenital bicuspid, 2 hypertention, 2 aortitis and each one case of floppy valve, medial cystic necrosis of aorta, bacterial endocarditis. But etiology was unknown in 8 cases. Sixteen patietns had myxoid degeneration, defined as significant disruption of the valve fibrosa and its replacement by acid mucosaccharides and cystic changes. Myxoid degeneration was also the primary pathologic abnormality in the patients with 2 hypertention, 2 rheumatic, 1 aortitis, 1 bacterial endocarditis, 1 floppy valve, 1 congenital bicuspid. The patients with myxoid degeneration of uncertain origin were 8. Histologic finding of all of them revealed nonspecific patients with myxoid degeneration of uncertain orgin were 8. Histologic finding of all of them revealed nonspecific chronic valvulitis with myxoid degeneration. This finding may indicate that the etiology w uld be infectious.

• Journal of Chest Surgery
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• 제36권4호
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• pp.273-276
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• 2003

좌심실 가성류로 내원한 39세 남자 환자에 대한 수술 치험 예를 보고하고자 한다. 환자는 4년 전 판막륜 농양을 동반한 감염성 심내막염으로 기계판막을 이용한 대동맥판막 및 승모판막 치환술과 농양 제거수술을 받았다. 수술 후 시행한 심초음파 소견상 좌심실과 농양이 있던 공동 사이에 교통이 있음이 관찰되었고, 추적 관찰 심초음파 검사에서 점차 공동의 크기가 증가하였다. 수술은 심페바이패스와 심정지하에 대동맥판막-승모판막 섬유연속부에 위치한 가성류와 좌심실 사이의 결손을 첩포폐쇄하였다. 수술 후 경과는 양호하였으며 수술 후 9일째에 합병증 없이 퇴원하였다.

• Journal of Chest Surgery
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• 제49권1호
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• pp.42-45
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• 2016

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intraoperative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.

• Childhood Kidney Diseases
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• 제23권2호
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• pp.116-120
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• 2019

Bilateral renal obstruction is a rare critical condition, requiring a prompt diagnostic approach and treatment to restore the renal function. The most commonly observed obstructive uropathy in children is congenital malformation, such as posterior urethral valves and bilateral ureteropelvic junction obstruction. Malignant pelvic masses obstructing the ureter are widely reported in adults but are rarely observed in children. The treatment of ureteral obstruction related to pelvic malignancy is a therapeutic challenge with a median survival duration of 3-7 months in adults; however, pediatric patients with pelvic malignancy leading to ureteral obstruction had better outcomes, with a reported 5-year mortality rate of 20%, than the adult patients. Here, we report a rare case of bilateral ureteral obstruction associated with pelvic rhabdomyosarcoma presenting with acute kidney injury treated by ureteral diversion with double J stent, and concommittent emergency hemodialysis, leading to restoration of good renal function. We suggest that bilateral ureteral obstruction should be released as soon as possible using surgical or interventional approach to minimize the obstruction period, and subsequential chemotherapy may contribute to improvement of survival and recovery of renal function.

• Journal of Chest Surgery
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• 제33권5호
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• pp.391-397
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• 2000

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

• Journal of Chest Surgery
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• 제40권5호
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• pp.341-350
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• 2007

배경: 조기진단과 적극적인 수술치료에도 불구하고 감염성 심내막염의 수술은 여전히 높은 사망률과 합병증을 보이고 있다 저자들은 감염성 심내막염으로 수술을 받은 환자들의 중단기 성적과 함께 원인균주에 따른 임상양상, 합병증과 수술사망의 위험인자, 특히 광범위 절제 및 심기 저부 재건술과 같은 보다 적극적인 수술법이 사망률과 이환율에 어떠한 영향을 미치는지 알아보기 위해 된 연구를 시행하였다. 대상 및 방법: 1995년 1월부터 2006년 6월까지 감염성 심내막염으로 진단되어 수술을 받은 79명의 성인 환자를 대상으로 시행하였다. 자가판막 심내막염이 63명이었고 인공판막 :감염은 16명이었다. 침범된 판막으로는 승모판 29예(36%), 대동맥판막 27예(34%), 승모판-대동맥판막 동시 침범 17예(21.5%) 삼첨판 3예, 폐동맥판막 3예였다. 균 동정이 안 되었던 경우가 27예(34.17%)였고 연쇄상 구균이 26예, 포도상 구균이 15예 기타 11예였다. 13예(16.5%)에서 판막 성형술을, 66예(82.9%) 에서 판막치환술을 시행하였는데 10예의 동종이식을 포함한 26예에서 조직판막이 사용되었고 40예에서는 금속판막이 사용되었다. 판막 성형 혹은 치환과 더불어 총 28예(35.4%)에서 대동맥 근부 치환 혹은 재건, 심기저부 재건, 농양배제술(abscess exclusion)과 같은 보다 더 침습적인 수술이 병행되었다. 결과: 조기사망은 4명(5.1%)이 심부전, 폐렴, 급성호흡부전 증후군, 범발성 혈관 내 응고장애로 사망하였으며, 2명이 외래관찰기간 중 만기 사망하였다. 2명에서 심내막염이 재발하여 2.6%의 재발률을 보였다. 포도상 구균에 의한 감염, 응급에 준하는 수술, 활동성 심내막염 상태에서 수술한 경우가 단일변량 분석에서 술 후 사망 및 주요 합병증 발생에 영향을 미치는 것으로 나타났다. 감염조직의 광범위 절제 후 필수 불가결한 보다 더 침습적인 재건술 및 근부치환의 시행 여부는 술 후 사망률에 영향을 미치지 않았고 주요 조기 합병증의 발생과도 무관하였다(p=0.51). 배양 음성인 경우 사망 및 주요 합병증 발생에 영향을 미치지 않았고 침범하는 판막의 종류(인공판막 대 자기판막)도 통계적으로 유의성이 없었다. 걸론: 감염성 심내막염에 있어 수술 전 진단 및 내과적 치료 과정에 많은 주의를 기울여야 하며 수술의 적응증이 된다면 환자의 임상적 상태가 악화되기 전 시점에 외과적 치료가 이루어져야 술 후 결과가 향상될 수 있을 것으로 판단된다. 침습적인 재건술이나 근부치환을 적용하더라도 술 후 사망률 및 주요 합병증 발생에 통계적 유의성을 보이지 않으므로 보다 적극적인 감염원의 제거와 해부학적 재건이 요구된다.