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다빈치 수술로봇을 이용한 심장수술 20예 보고 - 단일 기관 보고
제형곤,정재승,강필제,주석중,이용직,정성호,이재원,송현,정철현 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.4
Background: The interest in robotic cardiac surgery has recently grown but there has not been much clinical research reported on this. The aim of this study is to examine our initial experience, since August 2007, with robotic cardiac surgery using the da VinceTM surgical system and to evaluate the feasibility and safety of it. Material and Method: Between August and December 2007, a total of 20 patients underwent robotic cardiac surgery using the da Vinci surgical system. For mitral valve repair (n=11), tricuspid valve repair (n=1), and ASD repair (n=1), cannulation, antegrade cardioplegia and transthoracic aortic cross-clamping were conducted for the right femoral vessels and the right internal jugular vein. For minimally invasive direct CABG (MIDCAB) (n=7), the internal thoracic artery (ITA) was harvested with the da Vinci surgical system. Result: The mean age of the patients was 50.1 (range: 26∼78) years. Three concomitant Maze procedures and one tricuspid annuloplasty were combined with mitral valve repair. The mean cardiopulmonary bypass time was 208.0±61.3 minutes and the aortic cross clamp time was 158.8±40.6 minutes. No patients showed more than mild mitral regurgitation after repair and the median hospital stay was 4 days. The robotic-harvested ITA was used for either left ITA (n=6) or bilateral ITA (n=1). The mean harvest time was 43.2±12.0 minutes. The harvested ITA showed good flow and it was anastomosed under direct vision after left anterolateral thoracotomy. The patency of all the grafts was 100% (18/18) in MIDCAB. Conclusion: Robotic cardiac surgery using the da Vinci surgical system was variously adapted to areas such as mitral and tricuspid valve repair, ASD repair and ITA harvest for MIDCAB. The early results of the robotic cardiac surgery showed its safety and feasibility. With this primary report, we anticipate that clinical applications and further studies on robotic cardiac surgery using the da Vinci surgical system will be actively conducted in Korea.
말판 증후군 환자에서 승모판막 역류의 교정을 위해 시행된 슬라이드 판막륜 성형술 및 판막륜 주름 성형술
제형곤,이재원 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.6
슬라이드 판막륜 성형술은 승모판막 폐쇄 부전증 환자에서 승모판막 성형술 후 드물게 발생하는 승모판막 전엽의 전방 운동의 발생을 막는 효과가 있다. 저자들은 과도한 판막륜 조직과 심각한 판막륜 이완으로 인해 발생한 승모판막 역류를 보이는 말판 증후군 환자에서 벽측 판막륜 주름을 잡아 광범위한 사각절제술과 슬라이드 판막륜 성형술을 용이하게 하여 성공적인 판막 성형술을 시행하였기에 보고하는 바이다.
제형곤,송두열,장철훈 대한임상미생물학회 2019 Annals of clinical microbiology Vol.22 No.1
Infective endocarditis caused by Abiotrophia defectiva is rarely encountered. A 67-year-old male transferred from a local hospital presented with severe dyspnea and pulmonary edema. Preoperative transthoracic echocardiography revealed severe mitral regurgitation with large vegetation. Blood cultures grew A. defectiva, a gram positive, nutritionally deficient streptococcus variant. Emergent mitral valve replacement through right thoracotomy was performed, and after completing six weeks of antibiotic combination therapy (vancomycin, ampicillin, and gentamicin), the patient recovered fully. Because of the need for prompt surgical treatment and long-term antibiotic therapy and lack of laboratory experience with the organism, physicians and laboratory workers should pay close attention to the possibility of A. defectiva infective endocarditis when gram positive cocci are detected in blood cultures. (Ann Clin Microbiol 2019;22:-27)
제형곤,이상곤 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.2
Extracorporeal Membrane Oxygenation (ECMO) is a variation of cardiopulmonary bypass that temporarily supports tissue oxygenation in patients with life threatening respiratory or cardiac failure. As the ECLS technique becomes safer and simpler following technology advances, and as complications and survival have improved, indication of ECLS has widened. In 2009, a multicentre randomized controlled trial of conventional ventilator support versus extracorporeal life support for severe adult respiratory failure in 180 patients was published (the conventional ventilation or ECMO for severe adult respiratory failure (CESAR) trial). Of patients allocated to ECMO support, 63% survived for six months without disability compared to 47% allocated to conventional ventilation care. This represented the first positive randomized clinical trial on adult ECMO application in acute respiratory distress syndrome patients. In this review, we report on the common terminologies used with ECMO, the practical running mode of ECMO, indications of ECMO application in intensive care unit settings and results of recent clinical trials. In addition, management during ECMO support and common complications of ECMO is outlined. Finally, evolving technologies involved with the progress of ECMO are summarized.
제형곤,주석중,송명근 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.5
흉부 대동맥의 비 외상성 자연 파열은 매우 드물지만, 발생시 응급수술이 요하는 위중한 질환이다. 본원에서는 전산화 단층 촬영과 경식도 초음파로 진단하고 부분 대동맥궁 치환술로 성공적으로 치료된 후 흉부 대동맥의 비 외상성 지연 파열 1례를 체험하였기에 문헌고찰과 더불어 보고하는 바이다.
심실중격결손과 동반한 다중판막 감염성 심내막염의 수술적 치료 −1예 보고−
김선희,제형곤,이상권,김상필 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.4
As higher mortality rate and frequent incidence of morbidity, early surgical treatment is generally recommended for the multivalvular endocarditis. A 46-year-old female presented with high fever. Echocardiography showed the vegetation on pulmonic valve, tricuspid valve and mitral valve with a ventricular septal defect. Emergency operation was conducted due to uncontrolled infection. We present a clinical success of this rare case with review of the medical literature. 다중판막을 침범한 감염성 심내막염은 단일 심내막염에 비해 사망률이 높고 합병증의 발생이 빈번하여 일반적으로 조기수술이 권장된다. 저자들은 고열을 주소로 입원한 46세 환자에서 심초음파 검사로 폐동맥판막, 삼첨판막, 승모판막을 침범한 급성 심내막염 및 심실중격결손을 진단하였고, 항생제 치료에도 감염증이 악화되어 응급수술을 시행하였다. 비교적 드문 증례를 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다.
Technical Aspects of Combined Heart-Lung Transplantation
주민호,제형곤 대한흉부외과학회 2022 Journal of Chest Surgery (J Chest Surg) Vol.55 No.4
Although organ transplants have become quite common, combined heart-lung transplantation (CHLTx) is unfamiliar at most institutions. While the remarkable rate of development in treatment options, such as drugs and mechanical circulatory support, have reduced the need for CHLTx, it remains the sole treatment option for a subset of patients with end-stage cardiopulmonary failure. For many cardiothoracic surgeons, CHLTx is not technically new or difficult, but it does pose challenges due to its low frequency and relative complexity. Thus, this review aims to describe the CHLTx technique in technical detail using the existing literature.