• Journal of Chest Surgery
• /
• 제17권4호
• /
• pp.703-708
• /
• 1984

Fibrothorax is the end stage of chronic pathologic processes of pleura such as hemothorax, empyema, or tuberculous effusion. The pleural space become adherent and obliterated, and the lung parenchyma is covered by a thick, fibrous, unexpandable "peel", so the lung function is diminished markedly with impaired ventilation and oxygenation. Constrictive pericarditis is often accompanied fibrothorax, also cardiac and hemodynamic function is deteriorated. Surgical relief of these fibrous peels causes remarkable improvement in pulmonary function, cardiac and hemodynamic function, and subjective symptoms. We experienced a case of bilateral fibrothorax combined with constrictive pericarditis which occured 3 years after bilateral tuberculous effusion. Decortication and percardiectomy were done at the same time through bilateral submammary thoracotomy with sternal transection. Comparing postoperative Peripheral venous pressure, Circulation time, Pulmonary function test, Arterial blood gas analysis, Subjective symptoms with preoperative conditions showed noticeable improvement.provement.

• Journal of Chest Surgery
• /
• 제50권1호
• /
• pp.22-29
• /
• 2017

Background: The aim of this study was to analyze the preoperative attributes and clinical impacts of complete pericardiectomy in chronic constrictive pericarditis. Methods: A total of 26 patients were treated from January 2001 to December 2013. The pericardium was resected as widely as possible. When excessive bleeding or hemodynamic instability occurred intraoperatively, a cardiopulmonary bypass (CPB; n=3, 11.5%) or an apical suction device (n=8, 30.8%) was used. Patients were divided into 2 groups: those who underwent ${\geq}80%$ resection of the pericardium (group A, n=18) and those who underwent <80% resection of the pericardium (group B, n=8). Results: The frequency of CPB use was not significantly different between groups A and B (n=2, 11.1% vs. n=1, 12.5%; p=1.000). However, the apical suction device was more frequently applied in group A than group B (n=8, 30.8% vs. n=0, 0.0%; p=0.031). The postoperative New York Heart Association functional classification improved more in group A (p=0.030). Long-term follow-up echocardiography also showed a lower frequency of unresolved constriction in group A than in group B (n=1, 5.60% vs. n=5, 62.5%; p=0.008). Conclusion: Patients with chronic constrictive pericarditis demonstrated symptomatic improvement through complete pericardiectomy. Aggressive resection of the pericardium may correct constrictive physiology and an apical suction device can facilitate the approach to the posterolateral aspect of the left ventricle and atrioventricular groove area without the aid of CPB.

• Journal of Chest Surgery
• /
• 제13권3호
• /
• pp.280-284
• /
• 1980

This is report of two cases of annular constrictive pericarditis. Since January 1959 to December 1979 the authors experienced 48 cases of chronic constrictive pericarditis treated surgically at the Department of Thoracic and Cardiovascular Surgery, the National Medical Center in Seoul. These cases simulated valvular heart disease. One case, as mitral stenosis, revealed rumbling apical diastolic murmur [II/VI], atrial fibrillation and right ventricular hypertrophy pattern on E.C.G., the other, as infundibular pulmonic stenosis, presented pressure gradient between right ventricle and main pulmonary artery at infundibular level of 76 mmHg in systole. Both patients underwent operation successfully and one of them was assisted by E.C.C. during pericardiectomy and result was excellent. It is difficult to make the diagnosis of these conditions preoperatively so consideration about these might be important to make the diagnosis accurately.

• Journal of Chest Surgery
• /
• 제35권8호
• /
• pp.605-607
• /
• 2002

Harmonic Scalpel(Echicon Endo-Surgery Cincinnati, OH)은 초음파를 이용하여 근육자극이 전혀 없으며, 열이나 연기가 적게 나며, 지혈도 쉽고, 수술시야가 좋아서 수술에 많은 이점을 가지고 있다. 교착성 심막염 환자에서 심막절제술을 시행할 때 Harmonic Scalpel을 사용하여 도움이 되었기에 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제7권2호
• /
• pp.179-188
• /
• 1974

An analysis of &5 cases of constrictive pericarditis treated surgically in this department of Seoul National University Hospital between the years 1958 and 1974 has been presented. 1.Of the patients with constrictive pericarditis,29 were males and 6 were females. Their ages averaged 23.8 years. 2. All patients who had pericardiectomy showed excellent postoperative results, and no operative mortality was noted in this group of patients but 3 hospital death [9.1%] occurred. 3. Besides shortening of circulation time elevated venous pressure was restored to normal range after pericardiectomy from a preoperative average 25.8cm $H_2O$ to a postoperative average 14.8cm $H_2O$. 4. Electrocardiographic changes consisted chiefly of low voltage complexes, P-wave and T-wave changes and characterized by vertical or semivertical heart position. The ECG was returned to normal or near normal after Pericardiectomy. 5. There were seven postoperative complications in this series. 6. In ten cases [32.3%], the pathology revealed evidence of tuberculosis in the pericardium or the myocardium, and others were described as chronic, proliferative, fibrous pericarditis or hyalinization of the pericardium.

• Tuberculosis and Respiratory Diseases
• /
• 제44권6호
• /
• pp.1218-1224
• /
• 1997

세기관지를 침범하는 많은 질환들이 세기관지에 유사한 병리소견을 일으킴으로 이들의 원인, 병인, 진단을 위하여서는 임상 및 병리소견을 연관시킴이 거의 필수적이다. Small airways disease를 포함한 세기관지 질환의 병리소견 특히 호흡성 세기관지염, bronchiolitis obliterans organizing pneumonia, constrictive bronchiolitis obliterans 등에 대하여 중점적으로 기술하였다. BOOP은 어떤 급성 폐손상에 대한 비특이성 소견이며 조직병리적인 기술이다. 반면 Idiopathic BOOP은 COP와 동의어로써 특정한 질환이며 이의 주된 병리소견이 BOOP인 것으로 이해하는 것이 좋겠다. Constrictive bronchiolitis obliterans는 임상적으로나 병리학적으로 BOOP과는 다르다고 하겠다.

• Tuberculosis and Respiratory Diseases
• /
• 제43권4호
• /
• pp.613-622
• /
• 1996

교착성 세기관지염은 매우 드문 소기도질환의 하나로서 변리학적으로 증식성 세기관지염과 더불어 폐쇄성 세기관지염의 양축의 하나를 점하고 있다. BOOP로 대표되는 증식성 세 기관지염은 임상경과가 비교적 빠르고 방사선학적으로도 간질성 또는 폐포성 음영 을 동반하는 비정형 폐렴과 유사한 발현을 보이므로 실제의 빈도가 적지 않다는 점은 제외하더라도 비교적 쉽게 의심하고 진단에 이를 수 있는 질환인 반면, 교착성 세기관지염은 그 빈도 자체가 매우 드물 뿐더러 방사선 소견이 거의 정상이고 폐기능검사 소견도 폐쇄성 양상을 보이므로 임상적으로 대개는 만성폐쇄성폐질환으로 간과되기 쉬운 질환으로써 그 진단이 쉽지 않다. 치료적인 면에서도 증식성 세기관지염이 부신피질호르몬제에 대해 극적인 반응을 보이는 반면 교착성 세기관지염은 세기관지벽 전체가 섬유성 반흔으로 대치되어 비가역성 기도폐쇄가 초래하는 병리학적 특성이 시사하는 바와 같이 치료에 대한 반응이 매우 미약한 치명적 질환이다. 그 원인으로서는 증식성 및 교착성 세기관지염 모두에서 독성 물질에 의한 흡입성 폐손상, 약제성, 감염성, 교원질환 관련성, 장기 이식 후등 선행 요인이 있는 경우와 원발 요인이 없는 경우를 특발성이라 한다. 같은 선행 요인에 의해 두가지 다른 질환군이 초래된다는 사실에서 이들이 같은 질환의 한 spectrum상에 있다는 설명도 있고, 여러 원인에 대해 같은 조직 소견이 관찰된다는 점에서 질환 특이적 병리 소견이라기보다는 비특이적 조직 반응의 하나라는 설명도 있지만 이에 대해서는 추후 연구가 필요한 실정이다. 저자 등은 비 Hodgkin 림프종을 진단 받은 동일한 시점에서 비교적 빠르게 진행하는 만성기도폐쇄 양상을 나타내고, 만성폐쇄성폐질환에 대한 위험 인자가 없고 흉부 방사선 소견상 정상소견을 나타내는 47세 여자 환자에서 개흉폐생검을 실시하여 교착성 세기관지염을 진단하였기에 문헌 고찰과 함께 보고하는 바이다. 상기한 선행 요인이 확인되지 않아 특발성이라 판단되며, 악성 종양, 특히 림프종과의 관련성 여부에 대해서는 현재로서는 확언하기 어렵고 향후 연구가 필요한 사항이라 생각된다.

• Journal of Chest Surgery
• /
• 제22권1호
• /
• pp.67-73
• /
• 1989

Forty two patients with chronic constrictive pericarditis, who were admitted to the Yonsei University College of medicine over a period of 18 years from January, 1970 to August, 1988, were analyzed retrospectively. Mean age of the patient was 33.5 year ranging from 6.8 to 60 years old. Male to female ratio was 1.3 to 1. Twenty-one cases [50%] were tuberculous origin [based on either associated pulmonary tuberculosis and/or caseous necrosis in thickened pericardial specimen] and 17 cases [40.5%] were idiopathic [non specific chronic inflammatory change was considered to be idiopathic]. Dyspnea on exertion was evident in 30 cases [71.4%] and abdominal distention in 21 cases [50%]. On physical examination, hepatomegaly [83.3%], neck vein distention [54.8%], distant heart sound [47.6%] and ascites were found. Thirty-nine patients showed low voltage of QRS and/or T wave flattening or inversion on EKG. Thirty-one cases had undergone cardiac catheterization which showed data compatible with chronic constrictive pericarditis. Midsternostomy group [n=15] had shown the most remarkable CVP decline [12.20 mmHg] as compared with bilateral submammary incision group [n=25, 8.96 mmHg] and left thoracotomy group [n=2, 7.75 mmHg] but difference was not significant statistically There was four early death among 42 patients [9.5%] including 3 cases of left ventricular failure and one cardiac tamponade. Main postoperative complications were wound infection [6 cases] and arrhythmia [3 cases]. Follow-up of 24 patients [mean; 55.3 months, ranging from 2 months to 155 months] revealed good functional status.

• Journal of Chest Surgery
• /
• 제38권8호
• /
• pp.576-578
• /
• 2005

38세 남자 환자가 호흡곤란과 좌측의 어깨 통증을 주소로 내원하였다. 심장 초음파 등의 검사로 이의 원인을 결핵성 심낭염으로 판단하고 약 1년 반 동안 내과 치료를 하였다. 내과 치료에 반응하지 않아 심낭 절제술을 시행하였고, 이를 통한 조직 검사 결과 악성 심낭 중피종으로 진단하였다. 종양은 심외막 및 심근에 심하게 유착되어 있어 완전 절제는 불가능하였으며, 환자는 현재 항암제 치료를 받고있다.

• Journal of Chest Surgery
• /
• 제20권2호
• /
• pp.317-322
• /
• 1987

Records of 15 patients who underwent operation for constrictive pericarditis at this department from 1976 through 1984 were reviewed. All had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. There were 12 males and 3 females in this series. Range of age varied from 7 years to 51 years. Clinical and histological study revealed granulomatous pericarditis compatible with the diagnosis of tuberculosis in 5 patients, non-specific chronic inflammatory changes in 6 patients and pyogenic pericarditis in 2 patients. Pericardiectomy was performed through a median sternotomy [11 cases] or bilateral anterior thoracotomy [4 cases]. The postoperative complications were observed in 4 patients. Low cardiac output was the most common complication [2 patients]. In 13 cases, excluding 2 operative deaths, preoperatively all were in New York Heart Association Class III or IV. At the time of discharge II [85%] were in Class I or II. 4 Cases were reoperated after original pericardiostomy and all resulted in marked improvement. Early surgical intervention is advisable in all patients in whom cardiac constriction is caused by either a thickened pericardium or a pericardial effusion before myocardial dysfunction occurs.