개심술 1000 례에 대한 임상적 고찰

박표원,서동만,송명근,김삼현,박영관,이영균,염명길,김남수,이홍재 대한순환기학회 1987 Korean Circulation Journal Vol.17 No.1

형제에서 발생한 선천성 심장질환

박표원,홍장수,서경필,Park, Pyowon,Hong, Jang-Su,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.1

Genetic and environmental factors are the two areas which have received attention in the etiology of congenital cardiac malformation. Genetic factor in many types of congenital heart disease have not been clearly delineated. Congenital heart diseases are a heterogenous category of developmental anomalies, representing in most cases the multifactorial inheritance of threshold characters, the expression of which is the product of a genetic - environmental interaction. Recently we experienced three pairs of congenital heart disease in siblings including ventricular septal defects in twin.

삼판막 이식수술 (2례 보고)

박표원 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.2

Simultaneous triple valve replacements were performed in two patients on January and April 1980 at Seoul National University Hospital. The first case was 17 years old male patient with a history of exertional dyspnea for 7 years. He was in class III by the NYHA functional classification and diagnosed as aortic insufficiency, mitral steno-insufficiency and tricuspid insufficiency. The second case was 46 years old male patient suffered from exertional dyspnea for 5 years, He was in class IV and diagnosed as aortic stenoinsufficiency, mitral stenoinsufficiency and tricuspid insufficiency. Triple valve replacements were performed under the deep hypothermia and pharmacologic cardiac arrest with aortic cross clamping for 80 minutes to 159 minutes. Total extracorporeal circulation time were 197 and 176 minutes respectively. The postoperative courses were uneventful.

대동맥류의 수술요법

박표원,노준량,Park, Pyo-Won,No, Jun-Ryang 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.3

Twenty-three patients with aneurysm were operated between Jan. 1956 to July 1983 at the Department of Thoracic surgery, Seoul National University Hospital. There were 18 males and 5 females in this series. The age ranged from 14 to 68 years with the mean age of 41 years. The etiology of aortic aneurysms was atherosclerosis in 10, trauma in 2, annuloaortic ectasia in 4, syphilis in 1, and unknown etiology in six cases. Among the 4 patients with ascending aortic aneurysm, aortic valve replacement with aneurysmorrhaphy in three patients and Bentall operation in one patient were performed successfully. One patient with entire aortic arch aneurysm was received Dacron graft replacement with anastomosis of brachiocephalic arteries separately under cardiopulmonary bypass. There was no complication. Among 6 patients involving the descending thoracic aorta, three patients were managed by prosthetic bypass graft and aneurysm resection, and another three patients were also managed by prosthetic graft replacement. There were three hospital deaths. There were two thoracoabdominal aortic aneurysm. One patient in shock state due to preoperative rupture died from cardiac arrest during operative procedure. In another patient who had extensive involvement from the midportion of descending thoracic aorta to the terminal abdominal aorta, the aneurysm was successfully repaired with Dacron graft. In this instance celiac axis, superior and inferior mesenteric arteries and right renal artery were anastomosed separately. Eight of the 10 abdominal aortic aneurysms was replaced with prosthetic graft. One saccular aneurysm was treated by resection and primary closure. In another patient, cardiac arrest occurred during operation before definitive procedure. There was one another hospital death in the patient with preoperative rupture.

체-폐동맥 단락술의 임상적 고찰

박표원,서동만,송명근,김삼현,박영관,이영균,문현수 世宗醫學硏究所 1986 世宗醫學 Vol.3 No.2

개방성 승모판막 교련부절개술의 결과

박표원,서경필,Park, Pyo-Won,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.4

A total of 18 open mitral commissurotomy were performed at Seoul National University Hospital between January 1975 and August 19. Thirteen patients had open mitral commissurotomy alone and five had additional cardiac procedure. Six patients were men and twelve were women. The mean age was 33 years. According to the NYHA classification, the distribution of patients preoperatively was as follows; Glass II, 2 patients; class III, 14 patients; class IV, 2 patients. Three patients had emboli preoperatively, all of whom were in atrlal fibrillation. There was no operative death. The patients were followed from 2 to 86 months [mean 26 months]. There was no late death and no embolic episode. Mitral valve replacement was required in one patient due to mitral restenosis after 4 years.

Verapamil 심정지액의 심근보호효과에 관한 실험적 연구

박표원 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.2

Using an isolated rat heart preparation under both aerobic and ischemic condition, we observed the myocardial protective effect of verapamil cardioplegia. Isolated working hearts were subjected to global ischemia at 25oC. Before ischemic arrest, rat hearts were treated with cold potassium cardioplegic solution [K=30 mEq/L] in control group and cold potassium cardioplegic solution added with verapamil [1 mg/L] in other group. After 30 min. of ischemia, hemodynamic parameters and creatine kinase leakage in coronary effluent were observed. Verapamil group exhibited greater percent of recovery in aortic pressure [p<0.01], aortic flow [p<0.01], and stroke volume [p<0.05]. Although there were no significant difference in creatine kinase leakage and the percent recovery of cardiac output between verapamil and control group, verapamil group showed better myocardial function. But the time to recover regular sinus rhythm was significantly [p<0.001] prolonged in verapamil group.

1986 년 개심술 622례에 대한 임상적 고찰

박표원 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.3

Six hundred and twenty two cases of open heart surgery were performed at Sejong General Hospital in 1986. And also, 117 cases of non open heart cardiac surgery had been performed during same period. Among the 622 open heart cases, 548 were congenital cardiac diseases and 74 were acquired heart diseases. In congenital heart patients, 422 were acyanotic and 126 were cyanotic. There were 52 cases of infant open heart Surgery below 12 months. Acyanotic group were consisted of 314 VSD, 66 ASD, 13 AVSD, 9 PDA, 8 ASD + PS, 4 AS, and 8 other rare cardiac cases. And cyanotic group were consisted of 84 TOF, 15 DORV, 5 Trilogy, 4 Ebstein`s anomaly, 3 PS + TR, 3 TGA, 3 TAPVR, 3 Pulmonary atresia and 6 other rare cardiac diseases. Majority of the acquired heart cases were valvular heart diseases. And there were also 4 cardiac myxoma and one endomyocardial fibrosis in acquired heart disease group. The operative results were as follows: Overall operative mortality, 5.3%: acyanotic 2.4%: cyanotic 15.8% and acquired heart disease, 8.5%.

송아지에 이식한 공기구동형 인공심장의 혈역학적 연구

박표원 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.3

Pneumatic total artificial heart[TAH] has been clinically applied for the purpose of permanent or temporary use followed by cardiac transplantation in the patients with end stage heart diseases. In spite of the good durability of the pneumatic TAH, thrombus formation, bleeding and infection resulted in death. The Tomasu heart, which is a type of pneumatic TAH, was used in this study. This model is a modified Jarvik heart and consists of atrial cuffs, outflow vascular grafts and thin-layer seamless diaphragm type of ventricles. Cardiac outputs of the left artificial heart were measured by Donovan`s mock circulation under variable conditions of driving parameters, and an experimental artificial heart implantation was performed in 4 calves to observe the changes of hemodynamic parameters in early postoperative period and hematologic and bio-chemical changes in a long-term survival case. In the mock circulation test, cardiac output of the heart was increased with the increase of the left atrial pressure and left driving pressure. Maximum cardiac output was obtained at the heart rate of 120 to 130/min and percent systole of 40 to 45Zo under the condition of a constant left driving pressure of 180mmHg and left atrial pressure of 10mmHg. During the first 24 hours of TAH pumping, driving pressure ranged from 178$\pm$5mmHg to 187$\pm$8mmHg for the left heart and from 58$\pm$6mmHg to 78$\pm$28mmHg for the right heart. The Mean arterial pressure significantly increased between 2 and 8 hours after the start of pumping. The survival time ranged from 27 hours to 46 days. The causes of death were respiratory failure in 2 cases, mechanical valve failure in one, and left ventricular outflow obstruction due to thrombus in a 46-day survival case. This study demonstrated that Tomasu artificial heart operated effectively during the first 24 hours of artificial heart pumping, but thrombus formation around the valve holding area was the main problem in long-term survival case.

승모판막질환 환자의 수술전후 심에코상의 좌심실기능 변화에 관한 고찰

박표원,이영균,Park, Pyo-Won,Lee, Yung-Kyoon 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.1

M-mode echocardiographic studies of left ventricular function in mitral valve disease were evaluated in 19 surgically treated patients before and one year after operation (mean 12.7 months). Twelve patients had mitral stenosis (MS) and seven patients had mitral regurgitation (MR). Before surgery, average end-diastolic and end systolic dimensions (EDD, and ESD) and left atrial dimension were significantly greater than normal in subject with MR. After surgery, EDD fell significantly from $66.5{\pm}8.4$ (SD)mm to $52.7{\pm}6.3$mm (P 0.01) at the time of late follow up study; ESD fell significantly from $46.5{\pm}9.7$mm to $36.4{\pm}8.6$ (P 0.05) on early follow up study; left atrial dimension fell significantly from $60.5{\pm}6.8$mm to $48.1{\pm}7.2$mm (P 0.01) at the time of the late follow up study. In patients with MS, EDD and ESD were normal and did not change significantly at any time after surgery. The left ventricular ejection fraction (E.F.) was normal in both groups. preoperatively([MR: $64.2{\pm}15.1$, MS: $65.7{\pm}12.3$). After surgery, E.F. did not change significantly at any time after surgery in both groups, but de-creased from $64.2{\pm}15.1$% to $59.5{\pm}11.2$% in MR patients at the time of early follow up study.