• Journal of Chest Surgery
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• 제19권2호
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• pp.250-258
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• 1986

From Aug. 1984 to May 1986, 116 cases of cardiovascular surgery including 85 cases of open heart surgery were performed at Korea Veterans Hospital. There were 108 congenital anomalies and 8 acquired valvular heart diseases. Among 108 congenital malformations 92 operations were done for acyanotic group, and 16 operations for cyanotic group. Thirteen cases of open heart surgery for infants or small children under 10kg of body weight were performed, which occupied 15.3 percent of total open heart surgery done in the same period. Common congenital cardiovascular anomalies were ventricular septal defect [40.7%], patent ductus arteriosus [29.6%], tetralogy of Fallot [12.[%], atrial septal defect [11.1%], and pulmonary stenosis [1.9%] in order of frequency. Valve replacement using lonescu-Shiley or Carpentier-Edwards valve was performed for 8 cases of acquired mitral valve disease, and valve replacement using St. Jude valve was done for a case of patent ductus arteriosus with severe mitral insufficiency. There was no mortality in acyanotic congenital malformations and acquired valve lesions, and 5 cases of mortality in cyanotic congenital malformations. Overall mortality was 4.3 percent for total cases and 5.9 percent for 85 cases of open heart surgery.

• Journal of Chest Surgery
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• 제9권2호
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• pp.215-219
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• 1976

Anticoagulation therapy with Warfarin and Dipyridamole is useful after prosthetic heart valve replacement for the prevention of thromboembolic accidents. Here presented a case of right ovarian hematoma, 41 years old, female who has been already treated double valve replacement due to mitral insufficiency with 27 mm $Bj{\ddot{o}}rk-Shiley$ mitral, and 29 mm Hancock tricuspid valve successfully on 27th, April, 1976. Just after the operation, patient was treated the anticoagulation therapy with Dipyridamole 300 mg, and Heparin, and later switched to Warfarin 3.75 mg or 5 mg po, as the maintenance dose. Three and half months after the anticoagulation therapy, patient complained the lower abdominal pain and vaginal spotting and which revealed right ovarian hematoma due to ovulation, manifested due to anticoagulation therapy. Patient was discharged postoperative 15 th day with the maintenance dose 5 mg Warfarin and Dipyridamole 300mg po to maintain the prothrombin time 30%, after the uterus and both. ovaries and both adnexae are resected out for the prevention of the further hemorrhage of ovary.

• Journal of Chest Surgery
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• 제27권11호
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• pp.902-906
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• 1994

Between May 1991 and August 1993, 16 patients underwent repair of complete atrioventricular septal defect without another major anomaly at Cardiovascular Center,Yonsei University College of Medicine. Ages of the patients ranged from 3 months to 38 years with a mean of 42 months. Among 16, 10 patients[63%] are associated with Down`s syndrome. All patients underwent primary repair except and one who received had been repaire of coactation of aorta and patent ductus arteriosus 2 month before. Preoperative mitral valve regurgitation [MR] was evaluated with Doppler echocardiography and angiography which revealed absent or grade I in 1, grade II in 8, grade III in 4, and grade IV in 3. Operative technique was performed under the moderate hypothermic cardiopulmonary bypass with crystalloid cardioplegia. Intraoperative echocardiography was performed epicardial approach [n=7] in the operative table or transthoracic approach [n=9] at intensive care unit. In all patients except 3, MR were improved. But in 3 patients, was not improved or exagerated comparing preoperative one. All of them were died.One patient was showed MR grade IV in intraoperative echocardiography, we re-repaired atriventricular valve with cardiopulmonary bypass. During follow-up period [at a mean of 11 months after repair], doppler echocardiography was performed in all patients. The follow up echocardiography revealed that the degree of MR in immediate postoperative period was not changed except in two patients in whom it was aggravated. Thus it seems that intraoperative and early postoperative echocardiography was employed important role of survival and can be predictable for long term results.

• Journal of Chest Surgery
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• 제24권3호
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• pp.280-286
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• 1991

Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta which originates just distal to the level of the origins of the coronary arteries It may be localized or diffuse. Enlargement of the aorta with a diamond-shaped patch of the noncoronary sinus of Valsalva was reported in 1961 by McGoon and associates But this reconstruction is asymmetric and the aortic obstruction may remain. In 1977, Dotty and associates reported the extended aortoplasty, the supravalvular ring was incised at two points in the noncoronary and in the right coronary sinuses of Valsalva closed with a tubular Dacron prosthesis of inverted Y-shape tailored to reconstruct the aorta We experienced three cases of the supravalvular aortic stenosis. The 11-year-old female and 4-year-old male with localized supravalvular aortic stenosis in William`s syndrome were operated with an inverted Y-shaped aortotomy toward the non-coronary sinus and the right coronary sinus and closed with "Hemashield`s collagen impregnated Dacron" tube graft, fashioned into "pantaloon" form patch. The 12-year-old male with localized supravalvular aortic stenosis and mitral insufficiency in William`s syndrome were operated with same procedure as two other patient above-mentioned for relief of supravalvular aortic stenosis and with mitral valve replacement. Postoperative course has been good.ourse has been good.

• Journal of Chest Surgery
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• 제40권12호
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• pp.825-830
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• 2007

배경: 최소 침습적 심장 수술은 전통적인 정중 흉골 절개술에 비해 수술 후 조기 회복 및 우수한 미용적 효과 등의 장점이 있지만 승모판막 성형술과 같이 복잡한 개심술에서의 성적은 아직 국내에 보고된 바 없다. 본 연구에서는 승모판 폐쇄 부전증의 환자군에서 로봇을 이용한 최소 침습적 승모판 성형수술의 유용성에 관해 정중 흉골 절개술과 비교하여 알아보고자 하였다. 대상 및 방법: 1993년 12월부터 2005년 12월까지 승모판막 폐쇄 부전으로 승모판막 성형술을 시행받은 520명의 환자를 연구대상으로 하였다. 이 중 정중 흉골 절개술을 통하여 승모판 성형술을 시행한 군을 S군(n=432), 최소 침습적 우측 개흉술을 이용한 환자군을 M군(n=88)으로 하여 임상 결과를 비교하였다. 우측 개흉술시에는 AESOP (Automated Endoscopic System for Optimal Positioning) 3000이라는 로봇을 이용하여 5 cm 이하의 절개로 수술을 시행하였다. 결과: 양 군 간의 나이, 성별, 수술 전 좌심실 구출률 등은 양 군 간의 차이는 없었다. S군에서 2예의 조기 사망이 있었으나 M군에서는 수술 사망예가 없었다. M군이 대동맥 차단 시간과 심폐기 가동 시간은 S군에 비해 유의하게 길었지만, 중환자실 재원기간과 수술 후 재원 일수는 S군에 비해 유의하게 짧았다. 제한된 절개에도 M군에서 승모판막 성형술식에 사용된 수술 술기는 제한이 없었으며, 술 후 의미있는 잔존 승모판막 폐쇄부전증의 빈도는 양 군에서 유사하였다 결론: 최소 침습적 우측 개흉술을 통한 승모판막 성형술을 시행하더라도 조기 성적은 차이가 없었다. 향후 최소 침습적 승모판막 성형술의 중-장기 성적의 관찰을 요하며 본 연구를 바탕으로 승모판막 성형술의 일차적인 접근 방법으로 최소 침습적 개흉술이 보다 폭넓게 시행될 수 있을 것으로 기대한다.

• Journal of Chest Surgery
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• 제38권5호
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• pp.357-365
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• 2005

배경: 관상동맥 질환에 동반된 허혈성 승모판막 폐쇄부전증을 가진 환자들은 장기 생존율이 좋지 않다. 게다가 중등도의 승모판막 폐쇄부전에 대한 치료방법은 아직 확립되어 있지 않은 상태이다. 따라서 본 저자들은 후향적 연구를 통하여 중등도의 허혈성 승모판막 폐쇄부전 환자에서 관상동맥 우회술만을 시행한 군과 승모판막 수술을 함께 시행한 군을 비교하여 승모판막 수술의 유용성을 알아보고자 하였다. 대상 및 방법: 1997년 1월부터 2003년 12월까지 중등도의 허혈성 승모판막 폐쇄부전증으로 진단받은 34명을 대상으로 관상동맥 우회술만을 시행한 군을 I군(n=23), 승모판막 수술을 동시에 시행한 군을 II군(n=11)으로 하였다. 각 군의 평균 추적관찰 기간은 $69.3\pm4.3$개월과 $53.1\pm4.9$개월이었다. 결과: 양 군에서 수술 사망은 없었고, 만기 사망은 I군에서 1명 있었다. II군에서 모든 환자들은 고리(Ring)를 이용한 승모판륜 성형술을 시행받았다. 수술 직후 승모판막 폐쇄부전의 정도는 II군에서 더 만이 감소하였고, 마지막 추적 관찰한 심초음파 검사 상 승모판막 폐쇄부전의 정도를 제외한 나머지 인자들은 양 군간 차이를 보이지 않았다. 양 군의 5년 생존율 또한 차이가 없었다($95.5\%\;vs\;100\%$, p=0.48). 결론: 본 연구 결과에 의하면 중등도의 허혈성 승모판막 폐쇄부전을 가진 선택된 환자에서는 관상동맥 우회술만으로 만족할 만한 결과를 얻을 수 있었으나 수술 전 심박출계수가 낮거나 NYHA class가 낮은 환자들에서는 수술 후 승모판막 폐쇄부전이 지속적으로 남아있는 것을 볼 수 있었다. 따라서 이러한 환자들에서는 승모판막 수술을 시행하는 것이 좋다고 생각된다. 또한, 승모판막 수술을 시행한 환자들에서 좌심실용적과 승모판막 폐쇄부전의 정도가 많이 감소하였는데 심실기능과 장기 생존율에 대한 이러한 인자들의 영향을 알아보기 위해서는 더 많은 환자를 대상으로 한 연구가 필요하다고 생각된다.

• Journal of Chest Surgery
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• 제12권1호
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• pp.33-42
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• 1979

The present study reports 41 cases of congenital and acquired heart diseases, who received open heart surgery under extracorporeal circulation [ECC] by Sarns Heart-Lung-Machine [HLM] at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the` period between July 1975 and February 1979. The priming of pump oxygenator was carried out by the hemodilution method using Hartman`s solution, whole blood, and fresh human plasma. The rate of hemodilution was in the average of 50.8 ml/kg. ECC was performed at the average perfusion flow rate of 85.0 ml/kg/min [2.43 L./ kg/2] and at moderate hypothermia. In the total cardiopulmonary bypass, arterial pressure ranged between 55 mmHg and 90 mmHg, but generally maintaining over 70 mmHg. Patient age ranged between 2 and 54 year old, in congenital heart diseases, between 2 and 28, in acquired heart diseases, between 17 and 54 Sex ratio of male to female was 20:21. The cases include a case of pulmonary valvular stenosis, 4 cases of atrial septal defect, 9 cases of ventricular septal defect, 9 cases of tetralogy of Fallot, 5 cases of pentalogy of Fallot, 3 cases of atypical multiple anomalies 7 cases of mitral stenosis or insufficiency, a case of myxoma in left atrium, and a case of ruptured aneurysm of Valsalva`s sinus. The surgical managements were 16 valvulotomy for pulmonary valvular stenosis, 2 Teflon patch graft closure and 5 simple suture closure of atrial septal defect, 16 Teflon patch graft closure and 5 simple suture closure of ventricular septal defect, 12 pericardial patch graft for infundibular stenosis of right ventricle, one anastomosis between left superior vena cava and right atrium, 2 open mitral commissurotomy, 5 mitral valve replacement using Starr-Edward`s ball valve, porcine xenograft by Hancock, by Carpentier-Edward, or Angell-Shiley, one removal of left atrial myxoma, and a repair of ruptured aneurysm of Valsalva`s sinus. Four [9.7%] out 41 cases expired postoperatively and the rest of 37 cases survived with satisfactory results. The causes of death were one coronary embolism in tetralogy of Fallot, 2 postoperative lower cardiac output in atypical multiple anomalies, and one right heart failure in large: ventricular septal defect with pulmonary hypertension.

• Journal of Chest Surgery
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• 제13권1호
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• pp.77-81
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• 1980

We present one case of 26-year-old male having saddle block combined with mitral valvular disease [NYHA Class IV] with auricular fibrillation. The most common cause of emboli is atrial fibrillation. The clinical manifestations of saddle emboli are relatively slow due to development of collateral circulation and large size of lumen of the aorta. The 5month duration of saddle emboli in this case led to severe atrophic changes, coldness, peripheral cyanosis on the both lower extremities, and flexion deformity on the knee and ankle joint of the left lower extremity. We planned staged operation for the saddle block and for mitral stenoinsufficiency and tricuspid insufficiency, because of poor general condition of the patient. The thromboembolectomy of aortic bifurcation was performed through the transabdominal approach without trial of Fogarthy catheter embolectomy, because of expectation of the secondary inflammatory changes of the vessel wall and thrombi which was 3 cm X 1 cm X 0.5 cm in size with irregular surfaced solid in consistency. 1 month later, after thromboembolectomy, mitral valve replacement and tricuspid annuloplasty were performed, with successful early operative result. During operation organized thrombi [1 cm X 0.5 cm] in the left auricle was removed. We wonder if simple management using Fogarthy catheter might be possible to remove the thromboemboli instead of thromboembolectomy by aortotomy in this case.

• Journal of Chest Surgery
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• 제24권2호
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• pp.123-134
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• 1991

Twenty eight patients had undergone repair of an isolated complete atrioventricular septal defect between April 1986 and September 1990 in Seoul National University Children`s Hospital. The group comprised 13 male and 15 female patients. They ranged in age from 2 months to 8 years[mean 18.6months] and in weight from 3. 4kg to 23kg[mean 9.0$\pm$4.6kg]. They were analysed as Rastelli type A in 17 patients, Rastelli type B in 2 patients, and Rastelli type C in 9 patients. Seven patients had concomitant Down`s syndrome. All patients had large left-to-right shunt[mean pulmonary to systemic flow ratio 3.5 $\pm$2.2 ranging from 0.68 to 10.0] and high pulmonary systolic pressure[mean 74$\pm$18.8mmHg, ranging from 35 to 110]. In 11 patients, one patch technique was used to close the atrial and ventricular septal defect and 16 patients were undergone by two patch technique. We urgently managed only one patient by pulmonary artery banding whose anatomy was Rastelli type C and severe mitral regurgitation was identified. Postoperative complete A - V block was noted in 3 patients, two of whom were dead in operating room due to combined LVOTO and myocardial failure, and one patient with Rastelli type C was undergone by VVI type permanent pacemaker insertion 1wk later after two patch technique, but we had to manage him by modified Konno operation and total correction due to LVOTO and VSD leakage and severe mitral regurgitation 3 years later. Another two reoperation cases due to severe mitral regurgitation after two patch technique were undergone, one of whom we managed by mitral annuloplasty 3 months later but aggravated mitral regurgitation made us to control him by MVR 3 months later. Another one case of VSD leakage and tricuspid regurgitation was managed by total correction but she died of respiratory insufficiency 14 days later. We experienced pulmonary hypertensive crisis in 3 patients, who were dead in two cases comparing with one control case. So operative mortality is 9/27[33.6%], in one patch group of 3/11[29.2%] comparing with two patch group of 6/16[37.5%]. In summary, causes of death were pump weaning failure, myocardial failure and low cardiac output syndrome and pulmonary hypertensive crisis, resp. failure, complete AV block. Mean follow up period is 15.8$\pm$10.7 months[ranging from 3months to 37 months]

• Journal of Chest Surgery
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• 제34권9호
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• pp.724-728
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• 2001

8세 11개월된 남자 환자로 좌관상동맥의 폐동맥 기시 이상증(ALCAPA)에 대해 수술교정 후 심한 삼첨판 폐쇄부전이 발생하였기에 보고한다. 경흉부 심장초음파 검사와 관상동맥조영촬영으로 좌관상동맥의 폐동맥 기시 이상 및 허혈성 승모판 폐쇄부전과 경도의 삼첨판 폐쇄부전을 확인하였다. 수술교정은 좌관상동맥에도 동맥혈관 심정지액을 공급할 수 있도록 주폐동맥에 추가로 동맥 캐뉼라를 삽입하는 방법을 이용하여 좌관상 동맥을 대동맥 근부에 직접 연결해 주었다. 술후 경식도 초음파 검사에서 좌관상동맥의 대동맥 문합 부위에서 전향성 혈류가 잘 유지되고 있었고 삼첨판 폐쇄부전이 Gr III-IV/IV로 심하게 발생하였다. 체외순환을 다시 가동 후 Kay 형 판륜성형술 및 인공 건삭 형성, 그리고 건삭 단축술로 삼첨판 성형술을 하였다. 술후 경식도 초음파 검사에서 삼첨판 역류 정도는 경도 미만이었다.