Multiple Time Aortic Valve Replacement

정태은,이동협 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.4

심실중격결손 봉합이 우심실 수축기 시간 간격에 미치는 영향

정태은,이영환 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.2

배경: 심실 중격 결손으로 인한 좌우 단락은 폐정맥 환류의 증가로 인한 좌심방 및 좌심실의 비대를 유발할 뿐만 아니라, 폐동맥압이나 폐혈관 저항을 증가 시키므로 우심실의 후부하에 간접적인 영향을 미친다. 따라서 폐동맥 고혈압을 추정하는 하나의 지표로 사용되고 있는 우심실 수축기 시간 간격의 변화를 추적하여 우심실 부하의 변화 정도를 확인하고, 이를 심실 중격 결손 환아의 술 후 관리 지침에 반영하고자 본 연구를 시도하였다. 대상 및 방법: 1995년 1월부터 1996년 12월까지 영남대학교 의과대학 부속병원에서 다른 심기형이나 증후군을 동반하지 않은 단순형 심실중격결손으로 진단받고, 봉합술을 전후하여 어떠한 전신 질환이나 합병증을 동반하지 않은 12명을 대상으로, M-mode 및Doppler 심초음파도를 이용하여 봉합술 전, 술후 3개월 그리고 술후 6개월에서 1년 사이(평균9.5$\pm$1.8개월)의 심박수, 좌심방/대동맥 내경비(LA/Ao), 우심실 박출 전기(right ventricular pre-ejection period : RVPEP)와 우심실 박출 기간(right ventricular ejection time : RVET)을 구하여 그 비(RVPEP/RVET)의 변화를 알아 보았다. 결과:심박수는 술후 실시한 두 차례의 검사에서 유의한 감소를 보였다(137.1$\pm$13.7 vs 114.4$\pm$21.1 and 104.1$\pm$10.2, p<0.01). 좌심방/대동맥 내경비는 술후 실시한 두 차례의 검사에서 유의한 감소를 보였다(1.71$\pm$0.32 vs 1.47$\pm$0.33 and 1.390.23, p<0.05). RVPEP/RVET는 술후 두 차례의 검사에서 유의한 감소를 보였으며(0.38$\pm$0.09 vs 0.32$\pm$0.08 and 0.29$\pm$0.09, p<0.01) 각각을 심박수로 교정한 RVPEP/RVET는 술후 3개월에는 유의한 감소를 보이지 않았으나 술후 6개월에서 1년 사이에는 유의한 감소를 보였다(0.32$\pm$0.03 vs 0.30$\pm$0.05 and 0.28$\pm$0.06, p<0.05). 결론: 심실중격결손으로 인한 좌우 단락은 폐동맥압의 증가를 유발하여 우심실의 후부하에 영향을 미친다는 사실을 우심실 수축기 시간 간격의 변화를 통하여 간접적으로 확인할 수 있었으며, 우심실의 과부하 상태가 수술적 교정 직후부터 정상으로 회복되기 시작하나, 단순형 심실중격결손이라 할지라도 술후 6개월 이상까지 지속되는 것을 확인할 수 있었다. Background: Ventricular septal defect(VSD) that causes pulmonary hypertension increase right ventricular workload. Echocardiographic assessment of right ventricular systolic time interval (RVSTI) has been used to predict pulmonary artery pressure in various cardiopulmonary diseases. This study was undertaken in infants with simple VSD to observe the alteration of the right ventricular workload through the changes of RVSTI after repair of VSD. Material and Method: We evaluated heart rate, the ratio of the left atrium/aortic root diameter (LA/Ao), right ventricular pre-ejection period(RVPEP), right ventricular ejection time(RVET), and its ratio(RVPEP/RVET) as a predictor of right ventricular workload in 12 children with simple VSD. These were measured three times at the preoperative period, at the 3 month and between 6 month and 1 year(average 9.5${\pm}$1.8month) after repair of VSD by M-mode & Doppler echocardiograph from the pulmonic valve echogram. Result: Heart rate was decreased significantly after repair(137.1${\pm}$13.7 vs 114.4${\pm}$21.1 and 104.1${\pm}$10.2, p<0.01). LA/Ao ratio was decreased significantly after repair(1.71${\pm}$0.32 vs 1.47${\pm}$0.33 and 1.39${\pm}$0.23, p<0.05). RVPEP/RVET were decreased after repair (0.38${\pm}$0.09 vs 0.32${\pm}$0.08 and 0.29${\pm}$0.09, p<0.01). Heart rate corrected RVPEP/RVET were significantly decreased only after 6 months(0.32${\pm}$0.03 vs 0.30${\pm}$0.05 and 0.28${\pm}$0.06, p<0.05). Conclusion: We found elevated right ventricular workload was progressively decreased until more than 6 months after repair and the RVSTI may serve a useful guide in postoperative care for children with VSD.

충격후 잔류압축강도시험에 의한 복합재료 적층판의 설계

정태은,박경하,류정주 대한기계학회 1995 대한기계학회논문집 Vol.19 No.9

The compressive tests under impact conditions were performed to establish a design guide for impact damage tolerance. The composition of layup was selected for the real cases of composite aircraft structure. The energy level of visible of visible damage threshold was determined as 7 Joules. It was found that the normalized bending stiffnesses in the direction of closely fixed boundary affected the area of damage. Graphite/epoxy used in the tests exhibited 60% reduction in compression strength at the energy level of visible damage threshold. Wet-conditioned specimens represented 9% reduction in residual compressive strength in comparison with room temperature ambient specimens. In this study, a design factor of 2.1 was proposed for the low velocity impact damage.

영아기 심실중격결손 봉합술의 임상적 고찰

정태은,이장훈,이동협,이정철,한승세,김세연,지대림 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.2

Background: Simple ventricular septal defect(VSD) is the most common congenital heart disease. Although closure of VSD is currently associated with a relatively low risk, experience with younger and smaller infants has been variably less satisfactory. We assessed the results of surgical closure of VSD in infant. Materials and Methods: Between 1996 and 2000, 45 non-restrictive VSD patients underwent patch repair and retrospective analysis was done. Patients were divided into two groups based on weight: group I infants weighed 5kg or less(n=16), and group II infants weighed more than 5kg(n=29). Both groups had similar variation in sex, VSD location, aortic cross clamp time and total bypass time. But combined diseases (ASD, PDA, MR) were more in group I. We closed VSD with patch and used simple continuous suture method in all patients. Results: There were no operative mortality, no reoperation for hemodynamically significant residual shunt and no surgically induced complete heart block. As a complication, pneumonia(group I: 2 cases, group II: 2 cases), transient seizure(group II: 2), wound infection(group I:, group II:1), urinary tract infection(group I: 1) and chylopericardium(group I: 1) developed, and there was no significant difference between two groups(p>0.05). Conclusion: Early primary closure with simple continuous suture method was applicable in all patients with non-restrictive VSD without any serious complications.

허혈성 심질환의 치료에서 관동맥우회술의 임상적 고찰

정태은 영남대학교 의과대학 1996 Yeungnam University Journal of Medicine Vol.13 No.2

허혈성 심질환의 치료로서 시행되는 관동맥 우회술은 최근 국내에서도 보편적으로 시행되고 있는데 1992년부터 1996까지의 영남대학교 의과대학 흉부외과학교실에서 시행한 63례의 관동맥 우회술을 대상으로 수술성적 및 술전 위험인자들이 술 후 합병증에 미치는 영향을 조사하여 다음과 같은 결론을 얻었다. 환자의 성별 및 연령을 보면 총63례의 환자 중 남자가 44례, 여자가 19례였으며 연령분포는 36세에서 71세까지 평균 58.3±8.6세 였으며 50대와 60대에서 대부분을 차지하였다 원위문합수는 환자당 평균 3.5개의 원위부 문합을 하였으며 수술사망은 6례였으며 술후 합병증으로 부정맥이 7례, 창상감염이 5례, 술후 출혈이 4례, 술중 및 술후 심근경색이 4례, 뇌졸증이 4례, 그리고 위장관 및 신장 합병증이 5례에서 발생하였다. 술후 합병증 발생의 요소를 분석 해 본 결과 술전 관동맥 질환 발생의 위험인자 중 흡연환자에서 합병증의 발생빈도가 유의하게 증가하였으며(p<0.05) 술전 위험인자로 정맥으로 Nitroglycerin의 투여가 필요했던 경우와 대동맥 차단시간이 2시간 이상인 경우에 경우 합병증의 발생빈도가 유의하게 증가하였으며(p<0.05) 특히 65세 이상의 고령환자의 경우 수술사망율이 유의하게 증가하였다(p<0.05). 이상의 결과로 흡연, 65세 이상의 고령, 술전 정맥으로 Nitrogloycerin의 투여가 필요했던 경우 그리고 이식혈관의 수가 많아 대동맥 차단시간이 긴 경우 술중 및 술후 관리에 더욱 섬세한 주의가 필요함을 알 수 있었다. From August 1992 to July 1996, 63 consecutive patients underwent coronary artery bypass surgery. The mean age of these patient was 57 years(range form 30 to 71years). There were 44 men and 19 women. Preoperative 12 patients had stable angina pectoris and 23 patients were unstable angina pectoris. 8 patients had previous myocardial infarctation history and emergency or urgent myocardial revascularization were performed in 9 cases. In the risk factors of coronary atherosclerosis, 25 patients(40%) were hypercholesterolemia, 38 patients(60%) have smoking history and 19 patients(30%) have hypertension history. In the patterns of disease, 9 patients were single vessel disease, 18 patients were two vessele disease and 33 patients were three vessel disease. We performed total 284 distal anastomosis(mean 3.5 anastomosis per patient) and performed one case of ascending aorta graft interposition, two cases of mitral valve replacement, one case of aortic valve replacement, one case of ventricular septal defect repair and one case of atrial septal defect repair and the mean aortic cross clamp time was 115.3 minutes. The common complications were arrhythmia(7cases), wound infection(5cases), perioperative myocardial infarction(4cases), reoperation for bleeding control(4cases) and stroke(4cases). There were six hospital deaths due to low cardiac output syndrome, ventricular arrhythmia and respiratory failure. In the evaluation of operative risk factors, preoperative intravenous nitroglycerin requirement and prolonged aortic cross clamp time(>2hours) were found to be predective factor of morbidity and old age(>65years) was found to be predective factor of mortality.

배양중 심장내피세포에 미치는 Hydrocortisone 의 영향

정태은 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.1

To investigate the effects of hydrocortisone on new-born rat cardiac endothelial cells in culture, the endothelial cells were isolated by means of enzyme-cocktail method. The cells were cultivated in Lees modified Dulbeco\ulcorner medium and 10[M or 10[M of hydrocortisone was added to the medium. The cells were harvested or coverglass and processed for thiamin pyrophosphatase reaction and Feulgen reaction. The enzymatic activities of Golgi complex, number of cells and number of large nucleated[more than tetraploid] cells were counted and discussed for their significance. The results were summarized as follows; 1. Hydrocortisone seemed to accelerate the rate of recovery of cardiac endothelial cells from isolation damage. 2. Endothelial cells treated with hydrocortisone revealed strong positive reaction to thiamine pyrophosphatase in early culture and 10 M group had stronger reaction than that of 10 AM group 3. Hydrocortisone had inhibiting effects on endothelial proliferation and the higher the concentration of the reagent was the stronger effects. 4. Hydrocortisone inhibited the appearance of large nucleate cells in endothelial cell population. 5. Hydrocortisone seemed to suppress the nuclear DNA synthesis.

폐동맥에서의 좌관동맥 이상기시증 -성인형 1례 보고-

정태은 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.5

Anomalous origin of the coronary artery from the pulmonary artery is a rare congenital coronary artery disease and the origin of the left coronary artery from the pulmonary artery represents the commonest form of these unusual lesions. Because of differences in symptomatology, clinical course and prognosis, this malformation has been divided into infant type[Bl-and-White-Garland syndrome] and adult type on the basis of the absence or presence of collateral circulation between the right and left coronary artery. The latter type has been reported relatively few cases. A 21-year-old male was admitted to the Yeungnam University Hospital, due to study of incidentally noticed heart murmur. At that time he was asymptomatic and past medical history was noncontributory. Chest roentgenogram was within normal limit and electrocardiogram was consistent with hypertrophy of left ventricle. Echocardiogram and aortogram demonstrated markedly dilated and tortuous right coronary artery and anomalous origin of the left coronary artery from the pulmonary artery. To prevent arteriosclerosis, progressive myocardial infarction, infection and aneurysmal rupture, Takeuchi operation which establish a two coronary system by transpulmonary arterial reconnection of the anomalous left coronary artery was done. Postoperative course was uneventful.

격자 구조를 가진 FRP 축전지 트레이의 제작

정태은 한국기계기술학회 2001 한국기계기술학회지 Vol.3 No.1

難治性인 尿路感染症에 대한 Bactrim의 臨床成績

鄭太銀 우석대학교 의과대학 1971 우석의대잡지 Vol.8 No.1

Simultaneous Aortic and Tricuspid Valve Endocarditis due to Complication of Sinus of Valsalva Rupture

정태은,김정희,두형동,이동협 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.3

We experienced a case of ruptured aneurysm of the sinus of Valsalva, and this resulted in simultaneous aortic and tricuspid valve endocarditis through a shunt. The echocardiography showed a ruptured sinus of Valsalva aneurysm to the right atrium with a shunt. The aortic non-coronary cusp was fibro-thickened with vegetation. Vegetations of the septal leaflet and the anterior leaflet of the tricuspid valve were also found. The blood culture grew Enterococcus garllinarum. We replaced both tricuspid and aortic valve with successful surgical result.