Surgical Management of Critical Pulmonary Stenosis: A case report / 대한흉부외과학회지

Although pulmonary valvular stenosis with intact ventricular septum is a common congenital abnormality, critical pulmonary stenosis of its severe form in the neonate is rare and highly fatal. With the development of percutaneous balloon valvuloplasty, surgical treatment is even more rare. This report is on a 2 day old male neonate with a critical pulmonary stenosis with intact ventricular septum who suffered from severe cyanosis and hypoxemia. Oxygen was inhalated and Prostaglandin E1 was infused initially and then arterial PO2 was increased from 19 mmHg to 54 mmHg. Percutaneous balloon valvuloplasty was attemped; however, the guidewire could not pass through the stenotic pulmonary valve, and during the procedure right ventricular perforation was suspected due to the presence of dye in the pericardial space. Emergency transarterial pulmonary valvotomy was performed using normothermic cardiopulmonary bypass. Postoperatively, the patient was in fair condition in the ICU and presently is in good condition at 6 months postoperative follow up.

A Clinical Evaluation of Esophageal Perforation / 대한흉부외과학회지

BACKGROUND: Esophageal perforation is an extremely lethal injury that requires careful management for survival. MATERIAL AND METHOD: We performed a retrospective clinical review of 14 patients treated for esophageal perforation at the Department of Thoracic and Cardiovascular Surgery hanyang University Hospital between July 1986 and August 1998. Cardiovascular Surgery Hanyang University Hospital between July 1986 and August 1998. RESULT: The ration between male and female patients was 12:2 and their ages ranged from 9 to 68 years( average: 446 years). Iatrogenic perforations were found in 6 patients(42.9%) spontaneous perforations in 3 patients(21.4%) traumatic perforations in 2 patients(14.3%) and caustic perforations foreign body origin and esophagel cancer in 1 patient (7.1%) each. Four of the patients(28.6%) had esophageal ruptures located cancer in 1 patient (7.1%) each. Four of the patients (28.6%) had esophageal ruptures located in the cervical esophagus and 10 patients (71.4%) in the thoracic esophagus, The most frequent location was in the mid third portion of the esophagus (35.7%) there were also 2 patients(14.3%) in the upper third portion and 3 patients(21.4%) in the lower third portion. Complications encountered included mediastinitis empyema or pleural effusion mediastinal or lung abscess sepsis and aspiration pneumonia. The most frequent complication that occurred was mediastinitis in 9 cases (57%) Three patients underwent conservative treatment. Among the patients who underwent surgical treatment 5 patients underwent primary closure 6 patients underwent open drainage and 2 patients underwent reconstrumction (1 patients had an initial primary closure and 1 patient had an initial open drainage procedure). The mortality rates for those with conservative and surgical treatment were 66.7% (2cases) and 9.1% (1 cases) respectively. CONCLUSIONS: Perforation of the esophagus although very rare has a high mortality rate and thus aggressive operative therapy is necessary.

Malignant Fibrous Histocytoma Originating from the Chest Wall / 대한흉부외과학회지

Malignant fibrous histiocytoma(MFH) is a deep-seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, it only rarely occurs in the chest wall. An 85-year-old man had undeergone excision of a small mass on the right posterior chest wall under local anesthesia 14 months age. However, the lesion did not heal and the mass recurred. He was referred to our hospital after the mass had grown to a size of 10.5x8x4cm with a 3x3cm skin defect. Intraoperative frozen biopsy revealed MFH. An en-bloc wide resection and thin-thickness skin graft from his thigh were performed. Although distant metastasis to the lund developed 14 months later and the patient died 2 months later, there was no local recurrence. Thin-thickness skin graft is a simple method for a wide range skin defect, especially in the old age. He recovered in good condition without any physical disabilities.

Surgical Removal of Knotted Pulmonary Artery Catheter: A Case Report / 대한흉부외과학회지

The complications associated with the use of pulmonary artery catheter include dysrhythmias, heart block, pulmonary artery rupture, pulmonary infarction, endocardial damage, balloon rupture, arterial puncture, thromboembolism, air embolism, infection, pneumothorax, and knotting of the catheter. Knotting of the catheter is a rare complication and it should be anticipated if there is an excessive advancement of the pulmonary artery catheter beyond the normally expected distance. We report a successful surgical removal of knotted pulmonary artery catheter by sternotomy and cardiopulmonary bypass.

The Successfully Redoaugmentation of Budd-Chiari Syndrome with Using Gore-Tex Patch of the IVC Obstruction / 대한흉부외과학회지

Budd-Chiari syndrome is a state of hepatic failure caused by impairment of blood flow anywhere from the inferior vena cava to the right atrium. In this case, a 45 year old patient had undergone membranotomy and dilatation with autogenous pericardial graft due to obstruction of the inferior vena cava caused by a congenital membrane in 1987. Ten years after the operation, restenosis occurred. Although a noninvasive method with a Gianturco stent dilatation was performed, a satisfactory result was not obtained. A reoperation was performed. The stenotic segment of inferior vena cava was excised and after augmentation with a prepared pentagon shaped Gore-Tex artificial graft allowing passage of two fingers. The patient's postoperative course was uneventful without signs of rebleeding or any other complications and the patient was discharged at postoperative two weeks without the use of anticoagulants. An excellent result was obtainable after operation using a prepared Gore-Tex graft and such a result. Reoperational case of Budd-Chiari syndrome may require rapid and excellent the operative techenic by prevention of massive bleeding under use of extracorporeal circulation.

Case Analysis of Pulmonary Sequestration / 대한흉부외과학회지

BACKGROUND: Pulmonary sequestration is not common and it's diagnosis needs special care such as an aortogram ar tomography. MATERIAL AND METHOD: We have experienced 13 patients who had pulmonary sequestration from January 1990 to September 1997. RESULT: Six men and seven women were treated and their mean age was 25.8+/-14.3 years. Their chief complaints were coughing, chest pain, and no symptoms in decreasing order. There were nine intralobar (ILS) and three extralobar (ELS) pulmonary sequestrations and one patient had both. There was no preference in location of either left or right. They were mainly diagnosed by aortography and their feeding arteries commonly originated from the lower thoracic aorta. The patients with ILS were treated by lobectomy and those with ELS by sequestrectomy. CONCLUSION: to treat pulmonary sequestration properhy, aortogram or chest CT is warranted to iidenty the abnormal origin of feeding artery.