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최대융 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.5
The effect of cardiopulmonary bypass on platelet count and function was studied in 20 patients who underwent cardiac operation from April 1991 to August 1991 at the Department of thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. Ten patients were perfused with a bubble oxygenator, 10 with a membrane oxygenator. During and after bypass, platelet counts decreased in both groups and significantly reduced in those perfused with a bubble oxygenator. All 20 patients studied for platelet functions had an abnormal postoperative aggregation response to collagen and epinephrine, but no significant difference in both groups. One hour after bypass, bleeding times increased in both groups but did not differ significantly between groups. Postoperative 24 hour blood losses were significantly higher in patients perfused with a membrane oxygenator. Platelet damage and postoperative blood loss are less severe after cardiopulmonary bypass performed with a membrane oxygenator than with a bubble oxygenator.
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최대융 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.7
We experienced a case of acquired benign bronchoesophageal fistula associated esophageal diverticulum which was treated successfully by division of ~stulous tract and esophageal diverticulectomy.Benign bronchoesophageal fistulas associated with esophageal diverticulum are very rare. This presentation is characterized by paroxysmal cough especially after drinking liquids and is easily diagnosed by esophagogram. We report a case with review of literatures.
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심방심실착위를 동반한 양대혈관 우심실기시증의 수술치험 1례
최대융 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.12
Within the group of congenital cardiac anomalies manifesting atrioventricular discordance, there exists a subset of hearts characterized by the additional presence of double outlet of the morphological right ventricle. Most of these hearts have associated pulmonary stenosis and abnormal direction of the cardiac apex, and all have a ventricular septal defect. Recently, a 10-year old boy underwent successful surgical correction of double outlet right ventricle with atrioventricular discordance. Diagnostic confirmation was made by 2-D echocardiography, cardiac catheterization and cineangiocardiography. The operation consisted of patch closure of ventricular septal defect so as to leave both great arteries draining the systemic[morphologically right] ventricle, and insertion of an extracardiac valved conduit between the morphological left ventricle and the distal end of the proximally oversewn pulmonary artery. Postoperative course was uneventful.
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최세영,유영선,박기성,최대융,박창권,이광숙 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.3
계명대학교 의과대학 흉부외과학교실에서는 1996년 2월부터 1997년 5월까지 승모판막폐쇄부전이 있는 18명의 환자에 대하여 승모판막재건술을 시행하였다. 환자의 남여비는 9:9였고, 연령분포는 19세에서 68세까지로 평균연령은 53세였다. 수술당시 환자의 임상소견은 NYHA 기능적 분류상 3 또는 4등급이 13례(81%)였다. 판막병변의 원인은 퇴행성이 12례, 류마치스성이 5례, 심내막염이 1례였다. Carpentier의 기능적 분류상 II형이 15례, III형이 2례, I형이 1례였다. 수술수기는 인조링을 사용한 경우가 16례, 후첨부의 사각절제가 15례, 건삭의 단축술이 5례, 전첨부의 삼각절제가 2례, 교련절개술이 2례, 후첨의 일부를 절제하여 전첨에 이전시킨례가 1례있었다. 수술수기는 대부분의 경우에서 위의 방법을 복합적으로 시술하였다. 수술사망례는 없었다. 술후 평균 외래추적관찰기간은 6.7개월(1-15개월)이었다. 외래 추적관찰중 1례가 사망하여 사망율은 5.6%였으며 사망원인은 저심박출증이었다. 사망한 환자는 술후 3개월째 발생된 심내막염으로 승모판막치환술을 받았던 례였다. 승모판막재건술후 환자의 NYHA 기능적 분류, 흉부X-선상 심흉곽 비, 심초음파검사상 전반적으로 호전된 소견을 보였다. 이상의 결과에서 승모판막재건술은 승모판막폐쇄부전이 있는 환자에게 적용할 수 있는 비교적 안전한 수술방법으로 사료되어진다. From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years(mean, 53). Thirteen patients were in New York Heart Association(NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty(16 cases), rectangular resection of posterior leaflet(15 cases), chordal shortening(5 cases), triangular resection of anterior leaflet(2 cases), commissurotomy(2 cases), partial transposition of posterior leaflet(1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.
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소아 개심술시 변형 초여과법(Modified Ultrafiltration)의 효과
윤경찬,이광숙,유영선,박창권,최세영,최대융 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.1
체외순환을 이용한 개심술후 과도한 체내 수분 축적은 중요 장기의 기능 이상을 초래한다. 본 논문에서는 소아 개심술시 변형 초여과법을 적용하여 적절한 수분제거와 심폐기능에 미치는 효과를 관찰하기위하여 개심술을 받은 17례의 환자를 대상으로 변형 초여과를 시행한 초여과군 10례와 대조군 7례로 나누어 그 효과를 비교 분석하였다. 초여과군에서 초여과의 시행은 체외순환 완료직후부터 평균 9.8분 시행하여 매 환아당 평균 42ml/kg의 수액을 여과시켜 초여과 실시후 평균 헤마토크리트가 41.7%로 증가함을 관찰할 수 있었다. 초여과군에서는 변형 초여과를 시행하기전에 비해 수축기 및 이완기혈압의 증가가 대조군에 비해 유의하게 높았다. 또한, 대조군에 비해 초여과군에서 혈소판등의 혈액응고인자의 보존효과도 높았으며 변형 초여과법 시행에 따른 합병증은 없었다. 이상의 결과에서 소아 개심술시 변형 초여과법의 적용은 혈역학적 및 혈액학적 이득을 보여 심폐기능의 향상과 환자의 회복에 기여하는 방법이라 사료되어진다. Total body water is increased after cardiopulmonary bypass resulting in tissue edema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water. We have carried out a prospective randomized study in 17 children undergoing open heart surgery, comparing modified ultrafiltration(MUF) with nonfiltered controls. MUF was carried out for about 10 minutes after completion of cardiopulmonary bypass to a hematocrit 36∼42%. Blood loss, blood transfused, hemodynamics, and laboratory data were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls(n=7) to ultrafiltered(n=10). There was no death in each group. The mean filtrate volume(ml/kg) was 42(30∼68). Blood loss(ml/kg/24hr) was 14.5 mean(4.0∼26.6) in controls versus 12.1 mean(6.0∼21.5) in MUF(P>0.05) ; blood transfused(ml/kg/24hr) was 9.4 mean (6.0∼36.3) in controls versus 3.4 mean(0∼11.4) in MUF(P<0.05). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 4.2(0∼11.7) in controls versus 19.8(7.0∼36.9) in MUF(P=0.001). Percent rise of diastolic blood pressure was 10.0(1.6∼20.8) in controls versus 30.6(5.8∼73.3) in MUF(P<0.05). Platelet count, fibrinogen, and oncotic pressure rose after MUF. No complications directly attributable to the ultrafiltration were observed. Conclusively, MUF is safe, effective means of removing body water and beneficial to hemodynamics.
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