Senning 및 Mustard 수술후 장기 성적

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

We scrutinized the 64 cases of TGA and Taussig-Bing anomaly who underwent Senning and Mustard operations from Jan. 1981 to May 1988. The ratio of male to female was 45; 19, and the age at operation varied from 2 months to 18 years [mean 18.9*32.9 months]. The in-hospital mortality was in 24 cases [37.5%] and the major causes were myocardial failure and congestive heart failure associated with arrhythmias. The risk factors for hospital mortality were complex TGA, prolonged bypass time and high postoperative CVP. In addition, mortality increased during the first year the procedure was used. Late mortality occurred in 6 cases and the major causes was congestive heart failure, and there was not any significant risk factor noted in late mortality. Early arrhythmia developed in 37.5%, all of which were transient and self limited and 7 cases of early mortality were related to the arrhythmias. Late arrhythmias developed in 8 cases, but 7 cases were transient. One case died with junctional tachycardia. Of significance the one case that died late by arrhythmia had a similar junctional tachycardia in the early postoperative period. The survival rate in all cases disregarding initial in-hospital mortality 1YSR 89.8% and 5YSR 84.3%, but because of short duration of follow up this is not significant. We concluded that early hospital mortality could be decreased by operating at an earlier age and by adjusting the appropriate operation method.

Fallot 사징증(四徵症) 외과적(外科的) 완전교정(完全矯正)에 대한 임상적(臨床的) 고찰(考察)

서경필,Suh, Kyung Phill 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

A Total of Forty eight patients underwent open-heart surgery for correction of tetralogy of Fallot at the Seoul National University Hospital from January 1974 to October 1976, with an overall survival rate of 77 per cent. Operative mortality varied according to severity of the lesion, age of the patient, nature of previous surgical treatment and presence or absence of an outflow tract patch across the pulmonary valve ring. Eleven patients died in the early postoperative period and thirty seven patients were discharged from the hospital alive. A patch of the right ventricular outflow tract and pulmonary annulus was required to relieve pulmonic stenosis in 24 patients. There were 10 deaths in this group (42%) as compared to 1 death in the group of 24 patients who were corrected without a patch. Operative mortality was especially higher when an inlay patch was placed across the pulmonary valve ring. This may be related to the possibly greater anatomic severity of these cases and to the longer operating time when a patch was used. The electrocardiogram showed right ventricular hypertrophy in 35 cyanotic patients. Intraventricular conduction was normal in 34 patients before operation. It was normal postoperatively in only 5 of 34 patients in this group who survived surgery. Complete right bundle branch block appeared at operation in 21 patients, and 8 patients developed incomplete right bundle branch block. Major causes of death were progressive cardiac failure (4), Complete atrioventricular dissociation (3), bleeding (2), cardiac tamponade (1), and sudden cardiac arrest (1)

송아지를 이용한 한국형 인공심장의 동물실험에 관한 보고

서경필 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.2

We experienced a series of animal experimental studies of the total artificial heart in 1988. So called, "Korean Heart* was used in this study, which is developed and fabricated in the Department of Biomedical Engineering, College of Med., S.N.U.. "Korean Heart" is a Rolling-Cylinder Motor-Driven type which is a newly developed electromechanical heart over the shortcomes of the previous artificial hearts, especially pneumatic type. The advantages of the "Korean Heart" are total implantability, quiet and smooth movement, small size fittable in oriental people, etc. The animal experiments were performed two times, as an assist device in sheep and total artificial heart implant experiment in calf weighing 100 kg. After total implantation, the artificial heart was well functioned in movement and hemodynamic control. So that, the calf was recovered excellently, which was able to stand up by herself and take an oral intake. Total survival time was 100 hours and the cause of death was a sudden pumping failure [electrical connection problem]. Several postoperative laboratory results almost within normal limits and no hemolysis, but in autopsy, the multiple thromboembolic findings were seen at the lung and kidney.n at the lung and kidney.

pH 體液平衡에 關하여

徐景弼,李寧均 최신의학사 1969 最新醫學 Vol.12 No.4

신생 염소에서 실험적 좌폐동맥 결찰술로 유발시킨 폐혈류량 증가가 폐혈관상에 미치는 영향

서경필 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.6

The possible relationship between pulmonary vascular pathologic changes and an increased pulmonary blood flow and pulmonary blood pressure has been the subject of investigation for many years. In an attempts to study the effects of increased pulmonary blood flow. long-term observations have been made in neonatal goats in which the total pulmonary vascular bed was restricted by means of ligation of left pulmonary artery, thereby diverting the total right ventricular output through the right lung. The left pulmonary artery and patent ductus arteriosus were ligated in 6 neonatal goats of under 3 weeks of age, and the goats were put to death at interval between 1 and 7 months of age. Pulmonary arterial development in both right and left lungs was studied by applying quantitative morphometric techniques, and compared with control group of goats between 1 and 6 months of age. The axial pulmonary artery and its branches were larger in the right lung than in the control group in all animals, and they were abnormally small in the left lung. In the right lung, arteries smaller than 50\ulcornerm showed abnormal increase in `% wall thickness’ in postoperative 2,3,5 and 6th months[p<0.05]. The proportion of non-muscular arteries was over 50% at postoperative 1st month in both right and left lungs, but an increase in proportion of partially muscular and wholly muscular arteries occurred thereafter. The ratio of alveoli/arteries was lower than normal in the right lung of postoperative 1st month[p<0.05], but was elevated thereafter. The failure to perfuse one pulmonary artery in neonatal goats changed growth and development of both lungs.

기관지성 낭종: 1례 보고

서경필 대한흉부심장혈관외과학회 1970 Journal of Chest Surgery (J Chest Surg) Vol.3 No.1

A case of bronchogenic cyst of the posterior mediastinum in a boy of 5 years of age was encountered at Seoul University Hospital. Scarcity of case reports in Korea and Japan suggests that bronchogenic cyst is a relatively rare entity in the Far East.

중복심장판막이식의 임상적 고찰 63예 보고

서경필,양기민,Suh, Kyung-Pill,Yang, Gi-Min 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

A total of 63 patients [42 males and 21 females] underwent multiple valve replacement with artificial valves between January 1975 and August 1980 at Seoul National University Hospital. There were 38 patients with aortic and mitral valve replacement, 22 with mitral and tricuspid, and 3 with aortic, mitral and tricuspid valve replacement. The valve lesions varied from trivial to severe and most aortic and mitral valves had mixed stenosis and insufficiency, while tricuspid valves had only insufficiency. The patients were severely symptomatic in majority of the cases, and belonged to the Classes III and IV [III:45, IV:16] of the NYHA functional criteria. Hemodynamic studies were performed on all the patients. The mean pulmonary wedge pressure was remarkably increased to 19.8 mmHg in aortic and mitral valve lesions and 18.0 mmHg in mitral and tricuspid valve lesions. The mean pulmonary arterial pressure was also increased, while the cardiac index was reduced. In 1977, the average perfusion time was 245.5 minutes for aortic and mitral valve replacement and 181.6 minutes for mitral and tricuspid valve replacement. It has progressively declined to 169.2 minutes for aortic and mitral valve replacement and 123 minutes for mitral and tricuspid valve replacement in 1980. The average period of aortic occlusion also declined after the use of cardioplegic solution. Twenty deaths occurred among the 63 patients operated upon, an overall mortality rate of 30.8%. The operative mortality has declined with successive year from a level of 66.7% before 1977 to 21.1% in 1980. Fourteen patients suffered from a list of postoperative complications, which eventually resolved with adequate treatment. All the survivors were enjoying the levels of daily life activities greater than those existing before the operation.

심장판막 대치술의 장기성적 분석(1968-1994)

서경필,조준량,안 혁,원태희,채 헌 대한순환기학회 1996 Korean Circulation Journal Vol.26 No.4

Fonatan 수술성적에 대한 평가

서경필,성숙환,Seo, Gyeong-Pil,Seong, Suk-Hwan 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.1

From Sep. 1978 to Aug. 1986, 44 cases of Fontan operation were performed at Seoul National University Hospital. 1] The diagnoses were TA in 13 [38.6%], UVH in 21 [47.79`], DORV in 3 [6.8%], TGA in 2 [4.5%] and C-ECD with DORY in 1[2.3%]. 2] There were 20 operative deaths [44.5%]. 3] The operative risk factors were early date of operation between 1978 and 1983, young age below 3 years old, direct atriopulmonary anastomosis without roofing, and postoperative high CVP above 25cmH,O. But the relation between operative mortality and various cardiac diseases was absent. 4] survived patients were followed from 1 to 54 months except 3 patients who were lost to follow up. 16 patients were in functional class I and 1 in class II, 2 of the above 17 patients were reoperated due to residual right to left shunt. In remained 4 patients, 3 patients persisted cyanosis after operation and 1 patients died 1 month postoperatively due to pulmonary embolism. 5] As 4 result, the Fontan procedure can be done with a good result for tricuspid atresia and other complex lesions. The operative mortality can be reduced further with a correct anatomical diagnosis preoperatively, rigid operative criteria to pulmonary vascular resistance, direct atriopulmonary anastomosis with roofing, and use of `Venous Assist Device` postoperatively in low cardiac output patients.

特發性 食道破裂(2例 報告)

徐景弼,池英煥,金源弼,李寧均 醫藥係社 1955 綜合 醫學 Vol.12 No.11