심실중격결손을 동반한 대동맥교약증의 수술성적

서동만,박영관,서경필,Seo, Dong-Man,Park, Yeong-Gwan,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

The optimal surgical management of the coarctation of the aorta associated with ventricular septal defect is still debated. Sixteen patients with the coarctation of the aorta and VSD were operated upon between November, 1980 and September 1984 at Seoul National University Hospital. They were 11 males and 5 females. All presented between 5 months and 11.5 years of age [mean= 5.5 years]. Presenting symptoms were congestive heart failure in 11 [69%], cyanosis on crying in 3 [19%], and frequent upper respiratory infection in 2 [13%]. In all cases two-stage operation was applied except one in which one stage procedure was taken. Resection and end-to-end anastomosis was used in 3, Dacron graft in 5, Gortex graft in 1, and left subclavian flap angioplasty in 4. Remaining two were missed on the operating table before correction of the coarctation of the aorta. Overall operative death in repair of the coarctation of the aorta were 3[20%]. Among the 12 survivors after repair of the coarctation of the aorta, 4 required patch closure of VSD, 2 required primary closure, 2 showed spontaneous closure [17%], one [8%] showed decrease in its size, 3 were under observation. It might be safe to approach the coarctation of aorta plus VSD with initial repair of the coarctation of the aorta without banding of main pulmonary artery and later management of VSD as usual manner in simple VSD.

총폐정맥 환류이상의 수술적 교정및 후발성 폐정맥 협착

서동만,송명근,Seo, Dong-Man,Song, Myeong-Geun 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.4

Twelve patients underwent surgical correction of total anomalous pulmonary venous connection[TAPVC] between Sep. 1989 and May 1993. There were 9 boys and 3 girls whose ages ranged from 10 days to 17 month [median 1.2 month]. Six patients were less than 1 month of age at operation. The anomalous drainage was supracardiac in 6, cardiac in 2, infracardiac in 2, and mixed in 2. There were 3 early death, and its mortality rate was 25%. There were no operative mortality after Sep. 1991. Age at operation, presence of preoperative pulmonary venous obstruction, preoperative assisted ventilation and type of anomaly did not affect early mortality. Late pulmonary venous obstruction was developed in 4 patients between 1 month to 4 month after operation. Among these patients, 2 were died and one was reoperated and well, and the other one was not operated because of patient`s refusal. We conclude that late pulmonary venous obstruction is fatal and its early detection and correction is important for improving late survival.

관상동맥 우회술;심마비액을 사용하지 않은 수술방법

서동만,송명근,Seo, Dong-Man,Song, Myeong-Geun 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.4

During the 3 years through December 1992, 118 cases of coronary bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. They consisted of 80 males and 38 females with the mean age of 59. History of myocardial infarction was noted in 23 cases[20%], congestive heart failure in 11[10%], left ventricular aneurysm in 6, postinfarct VSD in 2, and mitral regurgitation in 1. The angina was stable in 13 cases, and unstable in 104 cases[89%]. Left main stem disease were 41 cases[35%], triple vessel 36[31%], double vessel 30[26%] and single vessel involvement[LAD] in 10. We performed 335 distal bypasses out of 117 cases, with single bypass in 9, double 29, triple 52, quadruple 23, and quintuple 4. Myocardial protections were cardioplegia in 29 and intermittent aortic occlusion 79 and continuous aortic perfusion 7. The ischemic time per graft was 13 minutes[intermittent aortic occlusion group] and 20 minutes [cardioplegia group] respectively, and the mean number of graft per patient is 2.85. Early mortality was 6.8% [8/117]. If we exclude the patients with LV aneurysm, the surgical mortality could be downed to 4.5% [5/111]. The causes of deaths were cardiogenic shock[6], aortic dissection[1], and neurologic complication[1]. We conclude that noncardioplegic myocardial protection may be equally beneficial or sometimes advantageous to cardioplegic technique in aortocoronary bypass graft surgery.

원발성 폐암의 외과적 치료 및 장기 성적

서동만,김용진,김주현,Seo, Dong-Man,Kim, Yong-Jin,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.3

We have experienced 120 non-small cell primary carcinomas of the lung between June, 1974 and December, 1984, at Seoul National University Hospital. They were 107 males and 13 females. 95% of all were ranged from 40 years to 69 years of age with 56 years of mean age. They were composed of 70 [66.7%] squamous cell ca., 20 [19%] adenoca., 6 [5.7%] undifferentiated large cell ca., 4 [3.8%] undifferentiated small cell ca., and 5 [4.8%] mixed adenosquamous cell ca. 41 [36%] and 35 [30.7%] patients have received pneumonectomies and lobectomies with a 66.7% resectability rate. Of the 36 stage I and 21 stage II patients, 56 were resectable but only 20 [31.7%] of the 63 stage III patients were resectable. This informed us the significance of the stage of the disease at the time of operation. The actuarial survival rate in 70 patients was as follow: 1, 3, 5 year survival rate of the patients in stage I were 80%, 80%, and 60% respectively. Both 1, 3 year survival rate of patients in stage II were 84%. But 1, 2, 3 year survival rate of patients in stage III were 40%, 11%, and 5% respectively. By dividing the patients in stage III into resectable group and nonresectable one, both 1, 2 year survival rate of the former were 37% and those of the latter were 42% and 7%. According to the cell type of the cancer, 1, 3, 5 year survival rate of the squamous cell ca. were 63%, 40%, and 26% respectively. 1, 3 year survival rate of the adenoca. were 43% and 34%. Hospital death were only 2 cases with a 1.7% operative mortality rate. We had acceptable long-term survival rate and have convinced the necessity and hope of the early detection and resection of the lung carcinoma.

심맥관계 활동과 관련있는 연수 척수로 세포에 작용하는 신경흥분전달물질에 대한 연구

서동만,김상정,임원일,김전,김종환,Seo, Dong-Man,Kim, Sang-Jeong,Lim, Won-il,Kim, Jun,Kim, Chong-Whan 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.5

본 연구는 동맥혈압의 조절에 결정적 역할을 하는 상부연수 복외측부에 존재하는 심맥관계 활동과 관련 있는 신경세포들에 대해 iontophoresis 법으로 투여한 신경흥분전달물질의 작용기전을 규명하고자 하였다. 이를 위해서 $\alpha$-chloralose로 마취한 고양이를 실험동물로 하여 연수의 복외측부에 multibarrel 전극을 삽입하여 심맥관계 활동과 관련 있는 신경세포의 활동을 세포외기록법으로 확인한 후 세포에 iontophoresis법으로 투여한 glutamate, GABA(\ulcorner-aminobutyric acid) 및 bicuculline의 효과를 관찰하여 다음과 같은 결과를 얻었다. 1) 자발적으로 활동전압을 보이지 않는 세포에서 glutamate를 10초 주기로 5초간 iontophoresis할 때 주기적인 세포활동을 기록할 수 있었고 이 활동은 동시에 가한 GABA에 의하여 억제되었다. 2) 자발적으로 활동하고 있는 세포들에 대하여 glutamate를 투여하였을 때 활동전압의 빈도가 증가하였고 GABA에 의해서 억제되었다. 3) GABA억제제인 bicuculline을 단독으로 투여시 활동전압 빈도의 증가는 뚜렷하지 않았으나 GABA와 동시 투여시에는 GABA의 억제작용을 차단하였다. 4) GABA의 작용은 RVLM(rostral ventrolateral medulla) 세포의 주기적 활동과 basal discharge 모두를 감소시켰으나 주기적 양상이 없어진 세포는 드물었다. 5) 말초에 가한 유해자극에 의하여 유발된 신경세포 활동이 GABA에 의하여 억제되었다. 이상의 결과로부터 $\alpha$-chloralose로 마취한 고양이에서 GABA는 RVLM에 존재하는 심맥관계 신경세포들에 대하여 억제적으로 작용하나 bicuculline의 투여후에도 이들 세포들의 주기적 활동이 유지되는 점으로 보아 RVLM세포의 자발적 흥분에 대하여 감압반사의 흥분이 기여하는 바가 크지는 않을 것으로 사료된다. The medullospinal tract cells are known to play an important role in the control of the cardiovascular activities. To clarify the modes of action of the neurotransmitters on these cells, glutamate, GABA(${\gamma}$-aminobutyric acid) and bicuculline were applicated iontophoretically into the rostral ventrolateral medulla in adult cats anesthetised with ${\alpha}$-chloralose. Followings are the results obtained : 1. The spontaneous activities of the cardiac-related neurons in rostral ventrolateral medulla (RVLM) were increased by the glutamate and decreased by the GABA. 2. Bicuculline, an antagonist of GABA, alone didn't increase the frequency of the action potentials, but could reverse the cellular response to the GABA, simultaneously applicated. 3. GABA seemed to decrease the peak as well as the basal discharge of the neurons in RVLM, but hardly changed their periodicities. 4. The cellular responses of RVLM evoked by the peripheral nerve stimulation could be inhibited by the iontophoretically released GABA. In conclusion, GABA seemed to act as an inhibitory neurotransmitter on the cardiac- related neurons in RVLM of the cats anesthetized with ${\alpha}$-chloralose. But the maintenance of the periodicities of these cells after the application of bicuculline suggested that the afferent activity of the baroreceptor didn't play a key role in the spontaneous activities of the RVLM neurons.

기관지선종의 수술요법

서동만,김주현,Seo, Dong-Man,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

Bronchial Adenomas are rare entity among the primary bronchopulmonary neoplasms. But they have received attention because of debate on their malignant nature, prognosis, and mode of therapy. We have four carcinoids and two cylindromas from Jan. 1972 to Jun. 1983. Operations include two pneumonectomies two lobectomies and one bilobectomy. In one cylindroma, resection was impossible due to its invasion into mediastinum and pericardium. There were no hospital deaths.

체외순환시 혈청 이온화칼슘 측정치의 변동에 관한 연구

서동만,김종환,Seo, Dong-Man,Kim, Jong-Hwan 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

It is well documented that calcium is essential to cardiac contraction and the amplitude of contractility is proportional to the ionized calcium not to total calcium. Changes of serum ionic calcium before and after extracorporeal circulation were observed in fifty two patients operated on at Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, from May 21st, 1984, to July 6th, 1984. They were 28 males and 24 females including 21 acyanotic congenital heart diseases, 21 cyanotic congenital heart diseases, and 10 acquired valvular heart diseases. In general, preoperative serum ionic calcium was around the normal level, but those of immediate postoperative day and postop-first day were decreased subnormally with significance [P<0.05 vs. preop.]. From postop-third day, serum ionic calcium was returned to normal range. No significant difference was noticed in subgroups divided by 10 Kg of body weight and by the methods of myocardial protection. But the change of serum ionic calcium in the patients with prolonged pump time over 90 minutes was remarkable and the values were as follow; on immediate postop-day 1.780.18 mEq/L vs. 1.970.20 mEq/L [P<0.005],on postop-first day, 1.940.20mEq/L vs. 2.060.12 mEq/L [P<0.025], on postop-third day, 2.030.11mEq/L vs. 2.150.13mEq/L [P<0.01], and on postop-seventh day, 2.030.09mEq/L vs. 2.190.11mEq/L [P<0.005]. In summary, the serum ionic calcium was lowered after extracorporeal circulation and even severer degree according to the prolongation of bypass time. So, after extracorporeal circulation esp. in the cases with prolonged bypass time, early correction of lowered serum ionic calcium would be helpful to the postoperative hemodynamics.

이 달의 책, 이 달의 저자 깊이 읽기

서동만,Seo, Dong-Man 대한출판문화협회 2006 출판저널 Vol.367 No.-

Outcome of Neonatal Cardiac Surgery

서동만 ( Dong Man Seo ),박정준 ( Jeong Jun Park ) 대한주산의학회 2003 大韓周産醫學會雜誌 Vol.14 No.3

심내막염 환자에서의 Aorto-mitral fibrous skeleton의 재건술 -치험 1례-

민경석,서동만,Min, Gyeong-Seok,Seo, Dong-Man 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.2

This is a report of successful management of a patient with complicated native valvular endocarditis. Initially stable patient showed sudden collapse at the end of 4th week of antibiotics coverage. Echocardiography revealed that previous vegetation at the Aorto-mitral Fibrous Skeleton[AMFS developed into a false aneurysm, perforated to left atrium and caused fistulous communication between left ventricle and left atrium. Extensive debridement was performed including part of the ascending aorta, aortic cusps, the AMFS, anterior mitral cusp and roof of the left atrium. Reconstruction of the AMFS with tailored single piece of autologous pericardium enabled the implantation of mechanical valves at the aortic and the mitral position. Ascending aorta and roof of the left atrium were repaired with autologous pulmonary artery patch graft and another autologous pericardial patch. The patient was discharged on postoperative 16th day and followed - up till now without any residuae or sequelae.