• Journal of Chest Surgery
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• 제9권2호
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• pp.251-264
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• 1976

Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

• Journal of Chest Surgery
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• 제39권8호
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• pp.579-587
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• 2006

배경 : 단심실 교정을 시행함에 있어 수술 전 위험 인자가 많지 않다고 판단되는 경우에도 수술 후 장기간의 흉관 배액, 단백 소모성 장질환, 폐혈관 색전증, 사망 등의 불량한 결과를 얻을 수 있다. 이러한 측면에서, 단심실 교정에 대한 기존의 위험 인자 분석은 수술 결과를 예측함에 있어 미흡한 점이 있다고 할 수 있다. 저자 등은 폐혈관 유순도를 새로이 정의하고, 낮은 폐혈관 유순도가 수술 후 흉관 배액 기간을 길게 한다는 가설을 세워 이를 증명하고자 하였다. 대상 및 방법 : 2002년 1월부터 2005년 5월까지 심장 외 도관을 이용한 단심실 교정을 받은 총 96 명의 환자들의 기록을 후행적으로 분석하였다. 동 기간 중 기존의 단심실 교정을 심장 외 도관으로 교체한 경우는 연구 대상에서 제외하였다. 수술 후 늑막 삼출 기간의 위험 인자 분석에는 12가지 수술 전 위험 인자들을 지수화한 Fontan risk score (FRS) 및 기타 다양한 수술 전, 수술 중 위험 인자들을 포함시켰으며, 본 연구를 위하여 전기로 analogue를 폐순환에 적용하여 계산된 폐혈관 유순도 (pulmonary vascular compliance, PVC, $mm^2/mmHg/m^2)$를 위험인자로 추가하였다. 전기 회로 analogue에 의하면 PVC는 폐동맥 지수 (pulmonary artery index, $mm^2/m^2$)를 총폐저항 (total pulmonary resistance, Wood $Unit{\cdot}m^2$) 및 폐 혈류량 (pulmonary blood flow, $L/min/m^2$) 으로 나눈 값으로 정의되며, 이는 폐혈관의 크기와 저항, 폐 혈류량 등을 동시에 고려하는 변수라고 할 수 있다. 결과 변수인 흉관 거치 기간은 자연로그를 취해 정규 분포화하고 이를 log indwelling time (LIT)으로 정의하였으며, 분석 대상 위험 인자들과 LIT 의 관계에 대한 다중 선형 회귀분석을 시행하였다. 결과 : 조기 사망은 없었고 만기 사망은 4 명 (4.2%)이었으며, 단심실 교정시 fenestration이 추가된 경우는 1예 있었다(1 %). 수술 전 PVC, 흉관 거치 기간, LIT는 각각 ${6{\sim}94.8\;mm^2/mmHg/m^2}$ (중간값:24.8), $3{\sim}268$일 ( 간값 : 20 일 ), $1.1{\sim}5.6$ ( 평균: 2.9, 표준 편차: 0.8) 이었다. 단변 수 분석상 FRS, PVC, 체외 순환시간 (CPB) 및 술 후 12 시간째의 중심 정맥압 등이 LIT와 연관되었으나, 다변수 분석상 PVC (p=0.0018) 및 CPB (p=0.0024)만이 독립적으로 LIT를 예측하였다. 두 변수는 LIT 변이에 대하여 21.7%의 설명력이 있었으며, 두 변수를 이용한 회귀 분석식은 다음과 같았다. LIT=2.74-0.0158 PVC+0.00658 CPB. 결론: 새로이 정의된 폐혈관 유순도는 심장 외 도관을 이용한 단심실 교정 후의 흉관 거치 기간을 결정하는 중요한 예측 인자로서, 수술 전 위험 인자 분석에 유용하게 사용될 수 있다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.22-29
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• 1987

From Sep. 1978 to Aug. 1986, 44 cases of Fontan operation were performed at Seoul National University Hospital. 1] The diagnoses were TA in 13 [38.6%], UVH in 21 [47.79`], DORV in 3 [6.8%], TGA in 2 [4.5%] and C-ECD with DORY in 1[2.3%]. 2] There were 20 operative deaths [44.5%]. 3] The operative risk factors were early date of operation between 1978 and 1983, young age below 3 years old, direct atriopulmonary anastomosis without roofing, and postoperative high CVP above 25cmH,O. But the relation between operative mortality and various cardiac diseases was absent. 4] survived patients were followed from 1 to 54 months except 3 patients who were lost to follow up. 16 patients were in functional class I and 1 in class II, 2 of the above 17 patients were reoperated due to residual right to left shunt. In remained 4 patients, 3 patients persisted cyanosis after operation and 1 patients died 1 month postoperatively due to pulmonary embolism. 5] As 4 result, the Fontan procedure can be done with a good result for tricuspid atresia and other complex lesions. The operative mortality can be reduced further with a correct anatomical diagnosis preoperatively, rigid operative criteria to pulmonary vascular resistance, direct atriopulmonary anastomosis with roofing, and use of `Venous Assist Device` postoperatively in low cardiac output patients.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.879-882
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• 2011

Purpose: Superior orbital fissure syndrome is a rare neurological complex. Superior orbital fissure syndrome may result from a variety of inflammatory, infectious, neoplastic, iatrogenic, traumatic, vascular cause. The author report a patient who suffered from superior orbital fissure syndrome after inferior orbital wall reduction. Methods: A 26-year-old female suffered from inferior orbital wall fracture with inferior gaze limitation and orbital soft tissue herniation. On posttrauma 10 day, inferior orbital wall was reduced using endoscope and porous polyethylene ($Medpor^{(R)}$) was inserted. On immediate postoperation, she reported that extraocular movement was limited in almost any directions. She underwent exploration surgery to release the presence of extraocular muscle impingement. But, there was no observation of extraocular muscle impingement. On postoperative one day, high-dose steroid therapy was started to release superior orbital fissure syndrome which was defined in postoperative computed tomography. Results: After one month of high-dose steroid therapy, extraocular movement limitations improved progressively in all directions. In four months, extraocular movement recovered completely. Conclusion: Superior orbital fissure syndrome may occur after surgical procedure of orbital wall reduction. Prompt diagnosis and treatment with mega-dose corticosteroid is an effective option for avoiding disaster from compressive syndrome.

• Archives of Plastic Surgery
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• 제50권2호
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• pp.188-193
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• 2023

Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

• Journal of Korean Neurosurgical Society
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• 제58권1호
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• pp.83-88
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• 2015

Organized hematoma is a rare complication that can develop following gamma knife radiosurgery (GKS) for cerebral arteriovenous malformation (AVM). Here, we describe 5 patients with growing organized hematomas that developed from completely obliterated AVMs several years after GKS. The patients were 15, 16, 30, 36, and 38 years old at the time of GKS, respectively, and 3 patients were female. Four AVMs were located in the lobe of the brain, and the remaining AVM were in the thalamus. Between 2-12 years after GKS, patients developed progressive symptoms such intractable headache or hemiparesis and enhancing mass lesions were identified. Follow-up visits revealed the slow expansion of the hematomas and surrounding edema. Steroids were ineffective, and thus surgery was performed. Histology revealed organized hematomas with a capsule, but there was no evidence of residual AVMs or vascular malformation. After surgery, the neurological symptoms of all patients improved and the surrounding edema resolved. However, the hematoma continued to expand and intraventricular hemorrhage developed in 1 patient whose hematoma was only partially removed. GKS for cerebral AVM can be complicated by growing, organized hematomas that develop after complete obliteration. Growing hematomas should be surgically evacuated if they are symptomatic. Radical resection of the hematoma capsule is also strongly recommended.

• Journal of Chest Surgery
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• 제39권2호
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• pp.171-175
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• 2006

최소 침습성 흉부수술은 최근에 가장 발전되어온 중요한 수술의 한 분야이다. 선천성 낭종성 선종양 기형은 비교적 드물게 발생하는 폐질환으로 누두흉, 선천성 심장 및 폐혈관 질환 같은 여러 가지 선천성 기형 등이 동반될 수 있다. 저자들은 우하엽 폐에 선천성 낭종성 선종양 기형이 있으며 누두흉이 동반된 5세 된 남아 환자를 최소 침습적인 방법으로 치료 경험하였다. 저자들은 흉강경을 이용하여 우하엽 폐절제술을 실시하였고, 동시에 누두흉에 대해서는 흉골 하 금속막대를 이용한 너스 술식으로 교정하였다. 이와 같이 이러한 질환에 대한 최소 침습적인 수술방법은 유용하고 미용적으로 우수하다.

• Journal of Chest Surgery
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• 제50권1호
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• pp.1-7
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• 2017

Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The F ET technique is also indicated in acute type A aortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the F ET technique for the treatment of complex aortic disease of the thoracic aorta.

• Journal of Korean Neurosurgical Society
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• 제49권5호
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• pp.262-266
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• 2011

Objective : The endocrine dysfunction after the operation for suprasellar arachnoid cysts is not rare. The careful operation to prevent structures can prevent this complication, but it is not enough and effective to prevent it. Authors present technical surgical considerations to prevent this complication with a review of our suprasellar arachnoid cyst patients who had postoperative endocrine dysfunction. Methods : From January 2002 to December 2009, eight patients who had suprasellar arachnoid cysts with visual impairment underwent surgery. The mean age was 57.1 years (range, 33-77). Preoperatively, their endocrine function was clinically normal, and laboratory hormonal levels were within normal ranges. Cyst fenestration was performed by craniotomy (n=6) or by a neuro-endoscopic procedure (n=2), and, simultaneously, along with a cyst wall biopsy. Results : The surgery was uneventful in all eight patients, and there were no neurological morbidities. However, in four patients, endocrine dysfunction occurred postoperatively. We compared these four patients (group A) to the other 4 patients without endocrine dysfunction (group B) with intraoperative findings and with the histopathological findings of the cyst wall biopsy. The group A patients had more abundant vasculature on the cystic wall than the group B patients according to both the intraoperative findings and the histopathological findings. Conclusion : When performing a surgical cyst wall fenestration, surgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae.

• Journal of Chest Surgery
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• 제48권1호
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• pp.46-51
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• 2015

Background: Maintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion. Methods: From January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively. Results: There were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B ($24.5{\pm}21.9$ months versus $17.7{\pm}13.6$ months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402). Conclusion: Graft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF.