흉부둔상에 의한 기관 식도루

김응중 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery Vol.26 No.7

A tracheoesophageal fistula following blunt chest trauma is rare, with only slightly more than 40 cases having been reported since 1936. With the increased incidence of blunt chest trauma from traffic accidents, it may be anticipated that this complication will be seen more frequently in the future. This report describes successfully managed two cases with such lesion. The pathophysiology and management of such lesion are discussed with a review of the literatures.

만성 신부전증 환자에서 동정맥루형성술의 조기 성적

김응중,황석하,임승평,이영 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

The surgically created arteriovenous fistula has become the method of choice in achieving vascular access for maintenance hemodialysis. The authors performed 70 arteriovenous fistulas for angioaccess in 65 patients with CRF at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period form August 1990 to November 1991. There were 4 cases of early obstructions due to inadequate vein in 2 cases, inadequate artery in 1 case and technical failure in 1 case. In 3 cases except 1 case who was transferred to other hospital, re-AVF were tried with successful outcomes. There were 2 cases of minor complications (wound infection and arm swelling due to venous hypertension) which were managed conservatively with successful outcomes. During the mean follow up of 8 months in 59 patients whore are not expired or lost during follow up, 3 cases of late thrombosis were occured with fistula patency rate of 94.9%. The authors consider the 'anatomical snuffbox' arteriovenous fistula as a primary choice and consider another method if it is not possible.

하행 결장을 이용한 식도 재건술에 관한 임상적 고찰

김응중 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

Isoperistaltic left colon interposition is rapidly becoming the reconstructive technique of choice in the correction of benign esophageal stricture and some cases of malignant esophageal stricture. The author performed five isoperistaltic left colon interposition at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from June 1990 to August 1991. Two cases were benign esophageal strictures and three caes were malignant esophageal strictures. There was one anastomotic leakage at esophagocolostomy site and one case of hoarseness due to recurrent laryngeal nerve injury. All of these five patients are being followed up wihtout specific problems. Left colon has many advantages in esophageal reconstruction comparing with right or transverse colon and is becoming the reconstructive organ of choice in many cases of benign and malignat strictures.

성인에서의 심폐보조를 위한 체외막산소화장치의 적용

김응중,최재성 동국대학교 의학연구소 2009 東國醫學 Vol.15 No.2

Extracorporeal membrane oxygenation (ECMO) is for the temporary mechanical circulatory support that uses a modified heart-lung machine to provide circulatory assistance and oxygenation and carbon dioxide removal from blood for days to weeks to permit recovery from severe cardiac or respiratory failure. ECMO can be deployed in a veno-arterial or veno-venous configuration. Veno-arterial mode is used for the treatment of cardiogenic shock which could be seen post-cardiotomy and in severe cardiac failure due to myocarditis, cardiomyopathy, acute coronary syndrome. Veno-venous mode is used for the treatment of respiratory failure, most commonly due to adult respiratory distress syndrome (ARDS), pneumonia, and trauma. We experienced 3 cases of ECMO in patients with post-cardiotomy cardiac failure, cardiac failure due to myocarditis, and respiratory failure due to ARDS associated with pneumonia. Two patients died and one patient survived. 체외막산소화장치 (Extracorporeal membrane oxygenation, ECMO)는 통상적인 방법으로 치료되지 않는 호흡부전이나 순환부전 환자에게 폐나 심장의 기능이 돌아올 때까지 일시적으로 기계적인 보조를 하는 장치로 통상 사용하는 인공심폐기를 조금 변형하여 사용한다. ECMO의 적용은 상황에 따라 정동맥, 혹은 정정맥 순환으로 사용할 수 있다. 정동맥 순환은 주로 심인성 쇼크에 사용되며, 심인성쇼크의 원인은 심장절개 후나 수술과 관련 없이 심근염, 심근병증, 급성 관동맥증후근 등에 발생하는 순환부전이다. 정정맥 순환은 주로 성인성 호흡곤란증후군(adult respiratory distress syndrome, ARDS), 폐렴, 혹은 외상 후에 나타나는 호흡부전 환자에 적용된다. 저자들은 최근 심장절개 후 순환부전, 심근염으로 인한 순환부전, 그리고 폐렴으로 인한 ARDS환자 3례에서 ECMO를 적용하여 2례는 사망하였으나 1례는 생존한 경힘을 하였기에 문헌고찰과 더불어 이를 보고하는 바이다.

16세 미만에서의 심장판막치환술

김응중,서경필,이영균,Kim, Eung-Jung,Seo, Gyeong-Pil,Lee, Yeong-Gyun 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.1

During 12 years period from 1974 to 1985, 76 valve replacement procedures were performed at Seoul National University Hospital in 67 pediatric patients aging up to 15 years [mean 12.3 years] and it was 7.3% of total valve replacement procedures in same period. Sixty seven patients were composed of 44 males and 23 females. Of the 67 patients, 43 patients had acquired valve lesions and 24 patients congenital valve lesions. Sixty cases received single valve replacement, 7 cases double or triple valve replacement and 9 cases redo-valve replacement. Sixty seven patients received 84 valves [65 bioprosthetic valves and 19 prosthetic valves by] 76 operations, Sixty three of 65 bioprosthetic valves had been replaced before 1983 and 15 of 19 prosthetic valves in recent 2 years. Eleven patients [14.6%] died within one month post-operatively and 8 patients [10.5%] during the follow-up period with the overall mortality rate of 25.1%. There were early post-operative complication of 23 cases [30.3%] and late post-operative complication of 27 cases [35.3%] with the total complication rate of 65.8%. In 58 patients received bioprosthetic valves, there were 14 cases of restenosis of replaced valves. Of the 14 cases of bioprosthetic valve restenosis, 8 cases received redo-valve replacement procedures without mortality in 1 5/12-5 years after initial operation but 4 cases died without reoperation and 2 cases lost during follow-up. The overall mortality and complication rate were still high but they markedly decreased during recent 2 years. So, in spite of its containing many problems, valve replacement in children is becoming safe and useful procedure in whom valve reconstructive procedures are impossible.

대동맥판막에 발생한 유두상 섬유탄력종 1례

김응중,최재성,이명묵,김어진 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

유두상 섬유탄력종은 주로 심장판막에 발생하는 원발성 종양으로 심장종양 중 두 번째로 많은 양성종양이나 전체적으로 그 빈도는 매우 드물다. 78세 여자 환자가 흉부 불편감을 주소로 내원해서 대동맥판막에 위치한 유두상 섬유탄력종이 발견되어 개심술 하에 대동맥판막의 손상 없이 종양을 제거하였기에 문헌고찰과 더불어 이를 보고하는 바이다. Cardiac papillary fibroelastoma is the rare primary cardiac tumor, though it is the second most common benign cardiac tumor. It usually involves the cardiac valve. Papillary fibroelastoma of the aortic valve was found in a 78-year-old woman with chest discomfort and it was excised without valvular injury under cardiopulmonary bypass. Thus we report the present case with relevant review of the literatures.

관상동맥우회술시 심근허혈후 재관류에 의한 활성산소 방어효소계의 변화

김응중,김기봉 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery Vol.29 No.8

Oxygen free radicals and their metabolites have been implicated as possible causes of reperrusion injury In animal models. Their role in the clinical setting is still controversial. The aim of this study was to evaluate the degree of tissue damage, oxidative stress. and changes in the antioxidant enzyme system in patients undergoing cor nary artery bypass graft operations(CABG) with myocardial protection by cold blood cardioplegia. In patients undergoing CABG(n:10). the levels of lactate dehydrogenate(LDH), creatine phosphokinase MB fraction(CK-MB), and malondialdehyde(M DA) were measured In the coronary sinus effluent before aortic cross clamping and 20 minutes after reperfusion. At the same time, the myocardial tissue activities of superoxide dismutase(SOD). catalase(CAT), glutathione peroxiddse(GSHPX), glutathione reductase (GSSGRd), and glucose 6-phosphate dehydrogenate(GfPDH ) were determined in the right atrial auricle excised before aortic cross clamping and in the left atrial auricle excised 20 minutes after reperfuslon. The levels of increased significantly after reperrusion(p< U.05). There were no significant changes in CAT and CfPDH levels. Western blot analysis was performed to study the induction of antioxidant enzyme and demonstrated increased amount of Cu,Zn-SOD.

발살바동 동맥류 파열의 외과적 치료

김응중,황석하,박진석,Kim, Eung-Jung,Hwang, Seok-Ha,Park, Jin-Seok 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery Vol.26 No.6

Over the past 8 years, from 1985 to 1992, 6 patients with ruptured aneurysm of the sinus of Valsalva underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. Five aneurysms originated from the right coronary sinus and ruptured into right ventricle and one from noncoronary sinus into RA. Ventricular septal defects were associated with 5 cases and one had no associated cardiac anomalies. The ruptured aneurysms were repaired through double incisions in 3 cases, through aortotomy in 2 cases and through right atriotomy in 1 case. There were no early and late complications and follow up results are excellent in all patients.

심인성 쇼크에 대한 응급 관상동맥 우회술

김응중,이원용 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery Vol.30 No.10

Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ve'ntricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Pive out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical sten sis limited to left main coronary artery, left main coronary angioplasty was performed. Pive patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.

만성 신부전증 환자에서의 동정맥루조성술

김응중,이영,박진석,Kim, Eung-Joong,Lee, Young,Park, Jin-Seok 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery Vol.27 No.8

Because the number of patients who require maintenance hemodialysis is increasing in number recently, angioaccess has become important to many vascular surgeons participating in the management of such patients.The authors created 269 arteriovenous fistulas[AVF] for angioaccess in 229 patients with chronic renal failure[CRF] at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from August 1990 to March 1993. We analyzed the results of 260 operations for 220 patients except 9 patients who were lost during the follow up period. We performed snuffbox AVF in 171 cases, classic radiocephalic AVF in 46 cases, direct AVF at other site in 5 cases, forearm Gore-Tex AVF in 29 cases, and upper arm Gore-Tex AVF in 9 cases. We experienced 13 cases of operative failures, 11 cases of early complications, and 60 cases of late complications including obstructions during follow-up period. The 1 year, 2 year and 3 year patency rates of snuffbox AVF[Group 1], classic radiocephalic AVF[Group 2], and Gore-Tex AVF[Group 3] are like followings; 89, 84, 76% in group 1, 84, 75, 68% in group 2, and 79, 66, 55% in group 3. It showed a statistically significant difference between group 1, 2 and group 3.