Perioperative ECMO for Postpartum Cardiogemic Shock with Severe Pulmonary Cdema / 대한흉부외과학회지

Temporary and short-term cardiac assists have been used for management of cardiac failure in a wide variety of application. Among these, extra-corporeal membrane oxygenation (ECMO) can be used if conventional therapies have been unsuccessful. Although ECMO has been utilized often in infants, the indications for ECMO in the adult population are not well delineated and the results have been less encouraging. This is a case of a 32 year-old female who has had underlying mitral stenosis. When admitted, she was in shock and presented with severe post-partum pulmonary edema unresponsive to inotropics, pulmonary vasodilator , and diuretics. She was put on ECMO for 14 hours by right femoral venoarterial cannulation and improved immediately after the application of ECMO. Afterwards, double valve replacement was done, and ECMO was continued post-operatively. The total application of ECMO was 62 hours including valve operation, and the weaning of ECMO was accomplished successfully under stable hemodynamics, improved pulmonary edema, and correction of underlying pathophysiology. She was discharged on post-operative day 30 without specific complications.

Descending Necrotizing Mediastinitis with Dental Caries: One case report / 대한흉부외과학회지

Descending Necrotizing Mediastinitis (DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.

Clinical Evaluation of Traumatic Diaphragmatic Injuries / 대한흉부외과학회지

Diaphragm injuries are very important because, if both thoracic and abdominal viscera are damaged, a combination of shock and acute respiratory distress may develop. It can be highly lethal. This evaluation was based on the reviews of 17 cases of traumatic diaphragm injuries treated at the Department of Cardiovascular Surgery, Seoul Adventist Hospital during 5 years from March 1993 to February 1997. The mean age of the patients was 37.2 years and sex ratio was 3.2:1 with male dominance. Blunt trauma(N=5, Rt.=4, Lt.=1) was 29.5%, penetrating trauma(N=12, Rt.=5, Lt.=7) was 70.5%. Dyspnea(76%) was the most common symptom. Blunt trauma(9.8 3.7 Cm) was larger than the penetrating trauma(3.2 1.3 Cm)(P<0.05) in the size(mean SD) of the injury. All of the patients had associated injuries and repaired immediatley with thoracic approach 11 cases(64%), abdominal approach 3 cases(18%) and thoracoabdominal approach 3 cases(18%). 5 cases of penetrating diaphragmatic trauma was diagnosed on the operation of other organ injury. Now we suggest that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen to protect the patient from its late complications.