• Journal of Chest Surgery
• /
• 제23권6호
• /
• pp.1118-1127
• /
• 1990

Arterial switch operation for repair of nineteen cases of transposition of the great arteries associated with ventricular septal defect and three cases with double outlet right ventricle with subpulmonary ventricular septal defect[Taussig-Bing type DORV] was performed from November 1987 to September 1990 at the Seoul National University Children`s Hospital. Sixteen of them were under six months of age, and three were under one year of age with body weight ranged from three to fourteen kilograms. Preoperative cardiac catheterization was done in eighteen patients, in which the pressure of the left ventricle was greater than 70% of the right ventricle in all but one. Patent ductus was associated in thirteen cases[68.4%] of TGA+VSD, and atrial septal defect or patent oval foramen was in sixteen cases. Four atrial septostomy, one modified Blalock- Taussig shunt, one pulmonary artery banding, one coarctoplasty using subclavian arterial flap, were perfomed before arterial switch operation. There were five hospital deaths, all in the. patients with transposition of the great arteries with ventricular septal defect[overall mortality rate 22.7%]. Lecompte Maneuver was used in all patients, and in all patient the U-shaped flap of coronary arteries were transposed to V-shaped cleavage created in the neoaorta. Arterial defect in the neopulmonary artery was covered with 0.0625% Glutaraldehyde fixed autogenous pericardium There have been no late deaths, Postoperative cardiac catheterization and angiocardiogram in four patients has revealed no stenosis in the neopulmonary artery or neoaorta with reasonable P[RV/LV], Anatomic correction for transposition and double outlet right ventricle with subpulmonary ventricular septal defect would seem to be a good operative alternative to intraatrial switch procedures, with the advantage of incorporating the left ventricle to systemic circulation.

• Journal of Chest Surgery
• /
• 제41권4호
• /
• pp.536-539
• /
• 2008

52세 여자는 승용차 조수석에 앉아가다가 타차와 충돌후 다발성 늑골골절과 혈기흉과 함께 다량의 출혈을 야기한 우측 전완의 절단에 가까운 손상을 입었다. 응급실에 도착시 명료하지 못한 의식과 저혈압의 소견을 보였다. 혈액량 감소 쇼크로 판단되어 다량의 혈액과 수액을 급속수액주입기(레벨 1)를 이용하여 좌측 쇄골하정맥관을 통해 주입하였다. 폐좌상의 소견이 호전되었을 때 일반 흉부 X선 사진의 좌폐야에 이물질이 확인되었다. 폐동맥조영술에서 15 cm 정도의 이물질이 좌측 폐기저동맥에 있었다. 경피적 중재시술을 통해 혈관 겸자로 잡아 제거할 수 있었다.

• Journal of Chest Surgery
• /
• 제46권4호
• /
• pp.274-278
• /
• 2013

Background: Coronary involvement in Takayasu's arteritis is a rare but fatal disease. The aim of this study was to evaluate the early and mid-term results of Takayasu's arteritis patients who underwent coronary artery bypass grafting (CABG). Materials and Methods: Of 2,280 patients who underwent isolated CABG from January 1998 to June 2012, Takayasu's arteritis was identified in 5 patients. There were 3 female patients, and the mean age was $58{\pm}9$ years. Takayasu's arteritis was diagnosed during preoperative evaluation for coronary artery disease in 4 patients, and the initial manifestation was angina pectoris in 4 patients. All of the patients underwent anaortic off-pump CABG (OPCAB) using the in situ left or right internal thoracic arteries (ITA); 3 patients had severe stenosis of the proximal left subclavian artery and the in situ right ITA was used instead. Medical treatment for inflammatory arteritis during the perioperative and follow-up period was performed if indicated. Early, 1-year, and 5-year angiographic results and clinical outcomes were analyzed. Results: There was no surgical mortality, and all of the patients were discharged without complications on postoperative $8{\pm}2$ days. Early postoperative (postoperative $2{\pm}1$ days) angiography demonstrated a graft patency of 100% (12 of 12 distal anastomoses). One-year ($13{\pm}3$ months) angiography was performed in 4 patients, and all of the grafts were patent (100%, 9 of 9 distal anastomoses). Conclusion: By performing anaortic OPCAB in patients with Takayasu's arteritis, we were able to avoid complications associated with manipulating an atherosclerotic and severely calcified ascending aorta. The early and mid-term graft patency of OPCAB in Takayasu's arteritis was maintained when concomitant with medical treatment.

• Journal of Chest Surgery
• /
• 제22권4호
• /
• pp.698-704
• /
• 1989

We experienced the seven cases of penetrating and non-penetrating cardiac injuries combined with cardiac tamponade from June 1986 to June 1989 at Seoul and Chun-An Hospital of SOONCHUNHYANG medical college. The results were as follows. l. In sex distribution, 7 cases were male. In age distribution, The fourth decades occupied about 58 % of all cases. 2. In mode of injury, 4 cases were stab wounds, 1 case penetration by metallic fragment, 2 cases blunt chest trauma. 3. We routinely checked the CVP with subclavian vein catheterization in case of suspicious cardiac tamponade. Significant increments were showed in 4 cases. 4. Becks triad [low blood pressure, raised central venous pressure, distant heart sound] were recorded in 43 % of the cases with proven tamponades. 5. The sites of injury included RV in 4 cases, LV in 1 case, RA in 1 case and branch of RCA in 1 case. The RV injuries were the most common. 6. Coronary artery damage occurred in 2 cases. LADA was severed in 1 case combined with RV rupture and branch of RCA was torn 1 case. 7. Pericardiocentesis was performed 1 case at another hospital before referring to our hospital. We have never used the procedure because we think that it is potentially dangerous with no clear benefit. 8. Subxyphoid pericardial window was performed in 2 cases of severe cardiac tamponade. We have employed this method to stabilize the patients who had systolic hypotension. 9. Surgical approaches were performed with median sternotomy in 3 cases, thoracotomy in 4 cases. 10. We undertook the simple closure in 6 penetrating cardiac wounds. The removal of impacted metallic fragment was performed under the cardiopulmonary bypass. Simple ligation was performed in 2 cases of coronary artery severance 11. One patient with no sign of life was urgently intubated and undertaken an emergency room thoracotomy on the stretch car without antiseptic preparation. The cardiorrhaphy in 6 cases were performed in the operating theater 12. One patient undertaken emergency room thoracotomy did not survive due to refractory hypovolemic shock. But the remaining 6 patients recovered.

• Journal of Chest Surgery
• /
• 제18권2호
• /
• pp.139-150
• /
• 1985

From 1977 through 1984, 97 patients of V.S.D. were treated surgically at Department of Thoracic and Cardiovascular Surgery, Korea University college of Medicine. Among 97 patients, 3 patients were treated by PDA ligation, 3 patients were treated by PDA ligation and subclavian flap aortoplasty, 1 patient were treated by pulmonary artery banding. All of the above patients were analyzed clinically. The results were as follows; 1. Of the patients, 52 patients were male [55.5%] and 45 patients were female [44.5%]. Their age ranged from 7 days to 32 year, and the mean age was 9 year of age and 28.9% of patients were between 4 and 8 year of age. 2. The most common clinical symptoms were frequent U.R.l. and D.O.E.. 3. The most common chest PA findings were cardiomegaly and increased pulmonary vascularity. 4. Associated anomaly was founded in 27 cases and PDA was most common associated anomaly and others were A.S.D., pulmonary stenosis, aortic regurgitation, D.C.R.V.. 5. Pulmonary hypertension was founded in 37 patients and it`s incidence was increased by patient age and shunt amount. 6. On Kirklin`s anatomical classification, type 11 defect was most common [45.5%], and type 1 was 35.5%, and type 111 was 4.4%, and type 1V was 4.4%. 7. Mean E.C.C. time was 69.1 min. and varied by closing method and associated anomaly as in case of simple closure; 47.8 min., in case of patch closure; 77.2 min., in cases with associated anomaly; 92.7 min.. 8. Mean postoperative ventilatory assisted time was 7.3 hour and varied by preoperative pulmonary artery pressure and E.C.C. time, as the group with pulmonary hypertension; 10.5 hour, the group without pulmonary hypertension; 5.5 hour, the group of short E.C.C time [within 1 hour]; 4.4 hour, the group of long E.C.C. time [over 1 hour]; 8.4 hour. 9. Overall operative mortality was 9.3% [9 cases].

• 농업과학연구
• /
• 제14권1호
• /
• pp.191-195
• /
• 1987

충남대학교 부속가축병원에 내원(來院)한 shepherd 견(犬)을 대상으로 임상진단(臨床診斷), 심전도(心電圖) 및 X-ray 검사(檢査)를 실시하여 개방성(開放性) 동맥관(動脈管)으로 진단된 예(例)에 있어서 이를 확인하고 또 치료할 목적(目的)으로 진단적(診斷的) 개흉술(開胸術)을 시도하였다. Pentobarbital sodium을 사용한 마취로 좌측 제(第)4늑간(肋間)에서 개흉(開胸)하여 동맥관(動脈管) 이중결찰법(二重結紮法)으로 시술(施術)하였다. 시술결과(施術結果)는 개방성(開放性) 동맥관(動脈管)의 결찰 3 분준(分俊)에 심실세동(心室細動)이 발생하였기에 defibrillator 로 제세동(除細動)을 실시하였으나 효과(效果)없이 회복하지 못하였다. 합병증이나 cyanosis가 있을 경우에는 수술적합성 여부를 신중히 고려하여야 될 것으로 생각된다. 조직학적(組織學的) 소견(所見)으로는 간(肝)의 만성(慢性) 수동성(受動性) 충혈소견(充血所見)이 인정(認定)되었다.

• Neonatal Medicine
• /
• 제25권3호
• /
• pp.126-130
• /
• 2018

Parkes Weber syndrome is a rare congenital vascular anomaly, related to the RAS p21 protein activator 1 (RASA1) gene. It is characterized by capillary cutaneous malformations, bony and soft tissue hyperplasia, and multiple arteriovenous fistulas throughout the affected upper or lower extremity. These arteriovenous fistulas can be associated with life-threatening complications such as bleeding, thrombosis, and high output heart failure. In this report, we present a neonate who had a disproportionately hypertrophied left upper limb with port-wine stain, dystrophy of the left humerus, and hypertrophy of the left clavicle on X-ray, and arteriovenous malformation and massive dilatation of the left subclavian artery on magnetic resonance angiography. Exome sequencing analysis revealed a novel heterozygous splicing mutation (c.1776+2T>A) in the RASA1 gene. To the best of our knowledge, this report is the first case of RASA1-related Parkes Weber syndrome in Korea.

• Journal of Chest Surgery
• /
• 제9권2호
• /
• pp.276-286
• /
• 1976

Coarctation of the aorta is an important congenital cardiovascular defect,. which occurs in a significant number of persons. The basic anatomic defect is a localized deformity of the media, manifested by two types of strictures in the aorta: "true" coarctation and tubular hypoplasia. The zone of coarctation is characteristically located distal to the origin of left subclavian artery at or just beyond the insertion of the ligamentum arteriosum. It shortens life if untreated, but it can be corrected to render the patient functionally normal. Here we have a 2-year operative experiences with 3 cases of the aortic coarctation, two of hypoplastic type and one of postductal type, at age of 17 to 19 year old Korean, operated in 1965 and l968 at the National Medical Center. The purposes of this report are to describe the immediate and late effect of surgery, histopathologic bases and the rarity of this lesions in Korea.

• Journal of Chest Surgery
• /
• 제20권3호
• /
• pp.588-592
• /
• 1987

A successful repair of traumatic descending thoracic aorta rupture was performed in a 27 year old man. The patient had automobile accident and transferred to our hospital. On admission, a chest film showed mediastinal widening and soon aortography was done. There was a fusiform aneurysm on the descending thoracic aorta just distal to the origin of the left subclavian artery measuring 5cm in diameter and 7cm in length. He underwent thoracotomy and the injured part of the aorta was replaced with a 24mm tightly Woven Dacron graft using femora-femoral bypass. The postoperative course was uneventful.

• Journal of Chest Surgery
• /
• 제15권3호
• /
• pp.361-365
• /
• 1982

Coarctation of the aorta is a congenital constriction of the aorta of varying degree usually located slightly distal to the origin of the left subclavian artery. This congenital malformation is found at 5-9% of the congenital heart disease in Europe & North America, but in our country, it is reported as one of rare malformations. We present a case of coarctation of the aorta, which had double diaphragms as discrete form. This is 9 year-old boy, who has suffered from hypertensive symptoms since 6 years before. Coarctation of the aorta was confirmed by aortography, and there was no combined anomalies, and it was postductal type, and coarctations were consisted of two diaphragmatic webs at the both ends with a central aneurysmized. After resection of the coarctated segment completely, Woven Dacron graft was inserted with 18mm in diameter & 2.5cm in length successfully.