Surgical analysis of pulmonary aspergilloma / 대한흉부외과학회지

BACKGROUND: Pulmonary aspergilloma is a potential life-threatening disease resulting from massive hemoptysis. Pulmonary aspergilloma has been treated surgically for many years, however, it has also had higher risk of mortality and complication rate. The purpose of this study is to analyze the operative methods and the types of complications. MATERIAL AND METHOD: Sixty patients who underwent surgical resection for pulmonary their medical reconrds. RESULT: The mean age was 46.3+/-13.4 years(range 20 to 76 years). The most common clinical presentation was hemoptysis which occurred in 48 patients(80%). Pulmonary tuberculosis was the most common pre-existing disease, occurri9ng in 28 patients(46.7%). The other associated lung diseases were bronchiectasis(n=11), silicosis(n=2), and chronic pnumonia(n=1). Operative proceudres wer lobectomy in 35 patients, pneumonectomy in 6, segmentectomy in 5, lobectomy and thoracoplasty in 3, segmentectomy and thoracopasty in 1, and cavernostomy in 10. The operative mortality was 6%(n=3) in lung resection patients but 0% in cavernostomy patients. The most common complications were prolonged air leakage, wound infection and postoperative bleeding. CONCLUSIONS: In most cases of pulmonary aspergilloma surgical resectin remains the only effective therapy. However, cavernostomy may be more effective for pulmonary aspergilloma patients with decreased pulmonary functions and for patients with high risk for lung resection.

Pulmonary Artery Aneurysm in Behcet's Disease / 대한흉부외과학회지

Behcet's disease is classically described as featuring recurrent aphthous ulcers in the mouth and genital organs and as having relapsing iritis. Now it is being recognized as a mul tisystem disorder that involves of the skin, gastrointestinal system, cardiovascular system, lung and the central nervous system as well as the joints, blood vessels and urologic systems. Large vessel diseases are unusual but aneurysm may occur in which the pulmonary circulation may give rise to the massive and often fatal hemoptysis. A 29 year-old man who complained of having dyspnea and hemoptysis during six months visited our hospital. He received right bilobectomy for a mass located in the right lower lobe. He underwent right bilobectomy. The final pathologic diagnosis was a pulmonary artery aneurysm which origina ted from the pulmonary artery.

Clinical Experiences of Continuous Tepid Blood Cardioplegia; Valvular Heart Surgery / 대한흉부외과학회지

BACKGROUND: In cardiac surgery, hypothermia is associated with a number of major disadvantage, including its detrimental effects on enzymatic function, energy generation and cellular integrity. Warm cardioplegia with normothermic cardiopulmonary bypass cause three times more incidence of permanent neurologic deficits than the cold crystalloid cardioplegia with hypothermic cardiopulmonary bypass. Interruptions or inadequate distribution of warm cardioplegia may induce anaerobic metabolism and warm ischemic injury. To avoid these problems, tepid blood cardioplegia was recently introduced. MATERIAL AND METHOD: To evaluate whether continuous tepid blood cardioplegia is beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Warm group(37degree C) consisted of 18 patients who underwent valvular surgery with continuous warm blood cardioplegia. Tepid group(32degree C) consisted of 17 patients who underwent valvular surgery with continuous tepid blood cardioplegia. RESULT: Heartbeat in 100% of the patients receiving continuous warm blood cardioplegia and 88.2% of the patients receiving continuous tepid blood cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic cross clamp. There were no differences between these two groups in CPB time, ACC time, the amount of crystalloid cardioplegia used and peak level of potassium. During the operation, the total amount of urine output was more in the warm group than the tepid group(2372+/-243 ml versus 1535+/-130 ml, p<0.01). There were no differences between the two groups in troponin T level measured 1hr and 12hrs after the operation. CONCLUSION: Continuous tepid blood cardioplegia is as safe and effective as continuous warm blood cardioplegia undergoing cardiac valve surgery in myocardial protection.

Iatrogenic Subclavian Artery Aneurysm: Report of a Case / 대한흉부외과학회지

Iatrogenic suclavian artery aneurysm is a rare disease which requires surgery because of the dangers of a rupture. We report a case of an aneurysm of the right subclavian artery developed by an iatrogenic trauma in a 43-year-old male. The preoperative diagnosis was made by an angiography and Doppler ultrasonogram. After the resection of a 6x7 cm sized aneurysm, an end to end anastomosis was done with a 6 mm Gore-Tex vascular graft. The post-operative course was uneventful and has been followed up from 3 months after discharge.

Tracheal Rupture Following Double-lumen Endotracheal Tube Intubation: One Case Report / 대한흉부외과학회지

Tracheobronchial rupture following tracheal intubation is a rare complication. We experienced a case of tracheal rupture following double-lumen endotracheal tube intubation. A 76 year old female was admitted due to coughing and chest discomfort. The operation was performed with the diagnosis of congenital broncho esophageal fistula. During the operation, accidently the main trachea was ruptured longitudinally. There was no history of surgical trauma. The ruptured trachea was repaired with prolene and monofilament absorbable sutures. The cause of tracheal rupture was suspected overinflation of the cuff. The patient was discharged from the hospital without any significant complications.

Recovery Trajectory in Tachycardia Induced Heart Failure Model / 대한흉부외과학회지

BACKGROUND: Tachycardia induced heart failure model would be the model of choice for the dilated cardiomyopathy. This more closely resembles the clinical syndrome and does not require major surgical trauma, myocardial ischemia and pharmacological or toxic depression of cardiac function. When heart failure is progressive, application of new surgical procedures to the faling heart is highly risky. It has been shown that recovery trajectory from heart failure is a new method in decreasing animal mortality. The purpose is to establish the control datas for recovery trajectory in the canine heart failure model. MATERIAL AND METHOD: 21 mongrel dogs were studied at 4 stages(baseline, at the heart failure, 4 and 8 weeks after recovery). Heart failure was induced during 4 weeks of continuous rapid pacing using a pacemaker. Eight weeks of trajectory of recovery period was allowed. Indices of left ventricular function and dimension were measured every 2 weeks and the hemodynamics were measured by use of Swan-Ganz catheterization and thermodilution method every 4 weeks. Values were expressed as mean+/-standard deviation. RESULT: 4(20%) dogs died due to heart failure. Left ventricular end-diastolic volume at the 4 stages were 40.8+/-7.4, 82.1+/-21.1, 59.9+/-7.7 and 46.5+/-6.5ml. Left ventricular end-systolic volume showed the same trend. Ejection fractions were 50.6+/-4.1, 17.5+/-5.8, 36.3+/-7.3, and 41.5+/-2.4%. Blood pressure and heart rate showed no significant changes. Pressures of central vein, right ventricle, pulmonary artery, and pulmonary capillary wedge showed significant increase during the heart failure period, normalizing at the end of recovery period. Stroke volumes were 21.5+/-8.2, 12.3+/-3.5, 17.9+/-4.6, and 15.5+/-3.4ml. Blood norepinephrine level was 133.3+/-60.0pg/dL at the baseline and 479.4+/-327.3pg/dL at the heart failure stage(p=0.008). CONCLUSION: Development of tachycardia induced heart failure model is of high priority due to ready availability and reasonable amenability to measurements. Recovery trajectory after cessation of tachycardia showed reduction of cardiac dilatation and heart function. Application of new surgical procedures during the recovery period could decrease animal mortality.

Clinical Experiences of Continuous Warm Blood Cardioplegia: Valvular Heart Surgery / 대한흉부외과학회지

Hypothermia is widely acknowledged as fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. The ideal way to rotect the heart is to electromechanically arrest it and perfus it with blood that is aerobic arrest. However alternative technique has been developed, based on the principles of electromechanical arrest and normothermic aerobic perfusion using continuous warm blood cardioplegia. To determine if continuous warm blood cardioplegia was beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Group included is 31 patients undergoing valvular surgery who received intermittent cold crystalloid cardioplegia. Group II included 30 patients undergoing valvular surgery who received continuous warm blood cardioplegia. Our results suggest that the heartbeat in 100% of patients treated with continuous warm blood cardioplegia converted to normal sinus rhythm spontaneously after the removal of the aortic cross-clamp, compared to only 31% of the cold cardioplegia group. After operation, pericardial closure rate was 90% area in the warm group, compared to 35% area in the cold group. 12 hours after the operation, the total amount of urine output in the warm group was greater than that in the cold group (2863+/-127 ml versus 2257+/-127 ml; p<0.05). After the operation, left diaphragmatic elevation developed in 55% of the cold group but in 0% of the warm group. CK-MB level in the warm group was significantly lower than cold group (2.28+/-0.62 versus 9.96+/-2.12; p<0.01) 1 hour after operation and CK-MB level in the warm group was significantly lower than cold group (1.80+/-1.01 versus 6.00+/-1.74; p<0.05) 12hours after operation. Continuous warm blood cardioplegia is at least as safe and effective as hypothermic technique in patients undergoing cardiac valvular surgery. Conceptually, this represents a new approach to the problem of maintaining myocardial preservation during cardiac operations.