PDA Clipping by Using 2mm Thoracoscope / 대한흉부외과학회지

Patent ductus arteriosus(PDA) is a common congenital heart disease encountered in premature neonates infants and children. Patent ductus arteriosus was the first surgically managed congenital heart disease,. Classic surgical interruption of patent ducturs arteriosus was partially replaced by a transcatheter endovascular closure, After a 5-7 mm video-assisted thoracoscopic interruption of the patent ductus arteriosus first applied in 1991, this minimally invasive technique came to be used in many centers, Video-assisted thoracoscopic interruption of the patent ductus arteriosus is feasible in low-weight infants whereas transcatheter endovascular closure of the ductus is usually not possible. We experienced successful outcome for the treatment of patent ductus arteriosus with 2 mm video-assisted thoracoscopic titanium clipping, We believed that this technique is a simple safe and rapid method for closure of the patent arteriosus.

Thymolipoma one case report / 대한흉부외과학회지

We experienced a case of thymolipoma that is a rare benign mediastinal tumor, composed of normal thymic tissue and matured adipose tissue. A 46-years-old woman was admitted to the department of medicine due to lower abdominal pain. Simple chest PA showed a large mass shadow at right cardiac border. Chest CT scanning showed well defined large fatty mass at right cardiac border which was suggested thymolipoma. The mass was resected and confirmed as thymolipoma histopathologically.

Change of both Palmar Temperature During Thoracoscopic Sympathicotomy for Palmar Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Thoracoscopic T2 sympathicotomy is an effective method for the treatment of palmar hyperhidrosis. Not only are the symptoms of hyperhidrosis abolished but also the temperature of the ipsilateral palm is elevated due to the sympatholytic vasodilation after the completion of the sympathicotomy on the first side. However little is known about the temperature changes in the contralateral palm. This study was performed to evaluate the changes in both palmar temperatures during the thoracoscopic T2 sympathicotomy for palmar hyperhidrosis. MATERIAL AND METHOD: Thoracoscopic T2 sympathicotomy was performed in 15 patients with primary palmar hyperhidrosis. Surface temperatures of both palms were monitored continuously and were recorded simultaneously during the 7 different stages of the operation. RESULT: When T2 sympathicotomy was performed on the first(left) side, an ipsilateral increase with a contralateral decrease of temperature was observed. The difference in the temperature of both palms was greatest just before the sympathicotomy on the contralateral(right) side(Lt. 34.6+/-0.9degree C vs. Rt. 31.6+/-1.3degree C, p<0.0001). After the sympathicotomy on the second(right) side, temperature of the right palm was elevated. The difference in the temperature of both palms was abolished at the end of the operation(Lt.34.7+/-0.9degree C vs. Rt.34.4+/-1.0degree C, P=0.415). CONCLUSION: When T2 sympathicotomy was performed on the first side, an ipsilateral palmar temperature increased due to the sympatholytic vasodilation. However contralateral palmar temperature decreased due to a vasoconstriction. Although the mechanism of vasoconstriction is still unknown, it is postulated that there may be a cross- inhibitory effect by the post-ganglionic neurons innervating blood vessels of the palm.

Warfarin-induced Skin Necrosis After Valve Surgery / 대한흉부외과학회지

Warfarin-induced skin necrosis is a rare complication caused by transient hypercoagulable state. This state is a result of rapid decline of the protein C activity relative to that of coagulation factor II, IX, and X during initiation of oral anticoagulant therapy. We experienced a case of warfarin-induced skin necrosis involving both breasts in a patient who underwent double valve replacement 1 month before. Warfarin was replaced to a low- molecular weight heparin and the necrotic breast lesion was healed spontaneously. Low-dose warfarin was restarted and gradually increased, after which a low molecular weight heparin discontinued.

Short and Intermediate Term Results of the ATS Heart Valve Replacement / 대한흉부외과학회지

BACKGROUND: ATS mechanical valve is a recently introduced pyrolytic carbon bileaflet prosthesis. This report is to evaluate the results of hemodynamic and anticoagulant therapy after ATS valve replacement. MATERIAL AND METHOD: From May 1995 to October 1998, 53 patients received 65 ATS prosthesis; 38 Mitral(27-33 mm), 27 Aortic(19-25 mm). 2 CABGs and 5 Tricuspid annuloplasty were taken concomitantly. The follow up period was 769 patient-months(mean 16.2+/-10.0), varied from 1 month to 39 months with 92.5% follow up rate. All patients were evaluated with Doppler echocardiography, 7-14 days after operation. RESULT: NYHA functional class was improved significantly, from 2.6+/-0.8 preoperatively to 1.3+/-0.4 postoperatively. The average value of peak and mean transvalvular pressure gradients were 25.7+/-13.5 mmHg, 12.7+/-8.3 mmHg in aortic position. In the mitral position, the average values of peak and mean transvalvular pressure gradient and valve area were 5.9+/-2.5 mmHg, 3.1+/-0.8 mmHg and 2.9+/-0.5 cm2, respectively. In the anticoagulant therapy, mean INR was 2.5+/-0.6 in mitral valve replacement and 1.9+/-0.5 in aortic valve replacement. There was no anticoagulant related complication. During that period, there were 3 hospital death(5.9%) and 1 late death(1.9%). CONCLUSION: The early clinical results of the ATS heart valve replacement is quite satisfactory, and low target INR reginmen is safe. And long term follow of hemodynamic characteristics is also necessary.

Analysis of Age-related Distribution of the Tracheal Diameter and Cross-sectional Area Among Koreans: Compuerized Tomographic Measurement / 대한흉부외과학회지

INTRODUCTION: Understanding the normal distribution of the tracheal diameter and crross- sectional area is one of the key elements in the management of various tracheal pathologies or tracheal reconstruction for the patients in growing age. However, data for Korean standard has been lacking. This study was designed to analyze retrospectively the distribution of tracheal diameter and cross-sectional area in young Koreans, which can afford fundamental data for the management of tracheal diseases. MATERIAL AND METHOD: Of the patients who underwent computerized tomogram of the chest between May 1996 and August 1998, one hundred six young patients(age range: 0-20 years) were included. Patients with any conditions which might affect the tracheal cross-sectional area or diameter, such as tracheal disease, previous operation, mediastinal tumor, or obstructive lung disease were excluded from the study. Gender distribution was 69 males and 37 females. Tracheal diameters, anterior-posterior and transverse, were measured at the level of the thoracic inlet(level I) and the aortic arch(level II). Types of the trachea were divided into round, oval, or horseshoe shaped on cross-sectional view, and the dimension was calculated by using the equation of A=1/4(pi)ab(A; area, (pi); 3.14, a; anterior-posterior diameter, b; transverse diameter). We analyzed the distribution of the diameter at each level and compared the cross-sectional area with respect to age and gender. A p-value lower than 0.05 wa considered significant. RESULT: The trachea of patients less than 5 years old were round in shape at both of level I and II, and no differences in cross-sectional area was observed between the levels(p=NS). As the age increased, the trachea become oval in shape at level I while it remained round in shape at level II(p=0.020). The tracheal diameter and cross-sectional area increased as the age increased with a linear correlation(r>0.9). In patients less than 5 years of age, female patients showed larger cross-sectional area than male patients (p=0.020), and it was reversed in patients older than 15 years of age(p=0.002). CONCLUSION: From the above results, we suggest chest computerized tomogram as a safe and reliable tool in measuring the tracheal diameter and cross-sectional area. We also provide the data as a standard for distribution of the tracheal diameter and cross-sectional area in young Korean population.

Clinical Analysis to the Early Results of the CABG / 대한흉부외과학회지

BACKGROUND: As coronary arterial disease is increasing, we evaluated the patients who underwent CABG (Coronary Artery Bypass Grafting) and thus report the early results and risk factors related to mortality and morbidity. MATERIALS AND METHODS: Between July 1996 and February 1998, 42 patients underwent CABG. We analyzed age, sex, preoperative ejection fraction, Canadian heart classification, prevalence factors of CAD (Coronary Artery Disease), angiographic findings, graft vessel numbers, IMA (Internal Mallary Artery) use, ECC* (extracorporeal circulation) time and morbidity. We also evaluated the mortality rate and the causes of death. RESULTS: Complication was developed at 17cases. The average age of the complication group was 61+/-11.9 years and that of the noncomplication group was 51+/-10.5 years (p=0.004). ECC time was 198+/-42.5 (min) in the complication group and 158+/-47.4 (min) in the noncomplication group (p=0.008). The other factors had no correlation to the morbidity, statistically. The average follow up duration was 12.5 months and all the patients were alive except for the 2 expired cases. The mortality rate was 4.7%, among which one patient who underwent CABG with aortic valve replacement died due to multiorgan failure and the other died due to sepsis with pneumonia and wound infection. CONCLUSIONS: We conclude that the risk factors related to morbidity were age and ECC time, and that there were no correlations between other factors and morbidity.

Clinical Evaluation of Traumatic Sternal Fracture / 대한흉부외과학회지

Sternal fractures, once thought of as an uncommon phenomenon, have occurred with an increasing frequency, paralleling the incidence of motor vehicle accidents. The tremendous force necessary to cause sternal fracture and this bone's prominent position overlying major intrathoracic and mediastinal structures, have important implications in the assessment and treatment of patients. This evaluation is based on the review of 72 patients of traumatic sternal fracture treated at the Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital during the last 4 years from March 1993 to February 1997. The frequency was 12.2% of nonpenetrating chest trauma and average age was 43.2 years old. Automobile accidents (84%) and sternal body fractures (95.8%) with anterior displacements (19.4%) was the most common cause and fracture site. Increase of cardiac isoenzymes was more frequent and higher in sternal fracture than chest contusion but there was no relationship between the time to take normalization of them and the mode of trauma.

Hypothermia for the Junctional Ectopic Tachycardia after VSD Closure: one case report / 대한흉부외과학회지

50 days old, 4.5kg male patient was admitted at department of pediatrics due to congenital heart disease with congestive heart failure. The echocardiographic finding was perimembranous type ventricular septal defect. The patient underwent open heart surgery for patch closure of VSD. Immediately postoperatively, junctional ectopic tachycardia developed and the patient was in hemodynamically unstable state with decreased urine output. We used inotropics, digitalis and diuretics, however these treatments were not effective in recovering the unstable state. Therefore, we tried a mild hypothermic treatment (34degree C). During the POD #2, mild hypothermia method was repeated four times. The junctional ectopic tachycardia was converted to normal sinus rhythm, hemodynamic state was stable, and urine output was increased. The patient was discharged at POD #8.