기획논문 : 뇌사와 장기이식 ; 장기이식과 의료윤리

박국양 ( Kook Yang Park ) 한국의료윤리학회 2000 한국의료윤리학회지 Vol.3 No.1

심장 관통상 후 잔류한 심장 내 이물질의 수술적 제거

박국양 ( Kook Yang Park ),박철현 ( Chul Hyun Park ),최창휴 ( Chang Hyu Choi ),이재익 ( Jae Ik Lee ),전양빈 ( Yang Bin Jeon ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

A 27 year-old man, who had a penetrating cardiac injury due to a metal fragment was transferred to our hospital. At admission, his vital signs were stable, and his chest film showed a foreign-body-like finding in the heart silhouette. We evaluated the patient with chest computed tomography and echocardiography for further information. Finally, we removed the metal fragment from the left ventricle by using a cardiopulmonary bypass. (J Trauma Inj 2012;25:267-270)

심장 스텐트 시술과 의료사고 예방

김경례,박국양,Kim, Kyoung Reay,Park, Kook Yang 대한의료법학회 2017 의료법학 Vol.18 No.2

Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials. 관상동맥 질환은 2017년 고령사회로 진입한 우리나라에서 앞으로 더 많은 관심을 가질 것이다. 고령화가 될수록 고혈압, 당뇨 등 복합적인 질환이 합병되어 혈관상태도 상대적으로 더 나빠져 관상동맥 질환에 걸릴 가능성이 높기 때문이다. 심혈관 질병은 심장외과와 심장내과와의 긴밀한 협진이 필요하다. 따라서 협심증이나 심근경색증환자를 먼저 진료하게 되어 있는 우리나라의 임상현장에서 객관적인 심장내과 의사의 치료방침에 대한 판단은 매우 중요하다. 최근 심장내과의 비수술적 중재술이 발전하고 있지만 무리한 스텐트 시술로 의료사고도 발생하고 있다. 특히 관상동맥 3개혈관이 모두 막힌 삼중혈관이거나 석회화가 심해 혈관 상태가 좋지 않은 경우가 문제이다. 또한 심장외과 의사가 없는 병원에서 무리하게 경피적관상동맥중재술을 실시하다가 응급상황이 발생할 경우 관상동맥이식술 등 외과적 대처가 어려운 경우가 종종 발생한다. 최근 2년간 한국소비자원(소비자분쟁조정위원회) 의료분쟁 조정결정 8사례를 분석한 결과, 심장 중재술을 시행한 병원 중 심장외과 의사가 상주한 곳은 2곳으로 확인됐다. 8사례 모두 심장내과 진료 후 풍선확장술 및 스텐트 삽입한 경우로 7명이 사망했고 이중 5명은 시술 당일에 사망했다. 8사례 중에 3중혈관 환자는 5건이고, 나머지도 석회화가 심하거나 완전폐쇄로 혈관상태가 좋지 않은 상태였다. 2017년 심장내과 스텐트 시술 건수 조사 보고에 의하면 3개 이하 약물 방출 스텐트 시술이 98%로 보고됐다. 2015년 스텐트 시술 건수가 38,922건으로 약800건(2%)은 스텐트가 4개 이상 사용된 것으로 추정된다. 무리한 스텐트 시술로 마지막 여명에 급사함으로써 신변정리 기회상실은 물론 여명단축에 따른 손해로서 '지도 설명의무' 책임을 물어 전 손해에 대한 배상을 신중하게 고려할 필요가 있다. 최근 심평원 보험적용 스텐트 시술 개수 제한규제가 없어지면서 무리한 시술과 심장외과 의사 확충에 대한 문제가 있다. '다학제통합진료' 같은 병원차원의 해결방안은 물론 필수요원에 해당하는 심장외과를 공무원으로 확충하는 등 국가차원의 해결방안이 요구된다.

소아심장판막치환술

김혁,유재현,서필원,이원용,백완기,박국양,이영탁,박영관,홍승록,이영균,Kim, Hyuk,Yu, Jae-Hyeon,Seo, Pil-Won,Lee, Won-Yong,Baek, Wan-Ki,Park, Kook-Yang,Lee, Young-Tak,Park, Young-Kwan,Hong, Sung-Nok,Lee, Yung-Kyoon 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.4

Between 1985 and 1993, 29 children from 1 to 15 years of age have undergone cardiac valve replacements at Buchon Sejong Hospital. The patients were composed of 20 males and 9 females and 17 patient had congenital heart disease and 12 patients had acquired heart disease. Two of these patients have had second valve replacements due to paravalvular leakage and valve thrombosis. Single valve replacements were 29 and double valve replacements were 2. All the patients had received prosthetic valves except one. Among the 25 patients who had definite post-operative records, the overall mortality was 12%[4% was early mortality and 8% was late mortality].25 patients were followed up with coumadin anticoagulation for total 633 patient-months[minimum 2 months to maximum 93 months, mean 25.3 months] and actuarial survival rate was 88.5 $\pm$ 6.3% at 7 years and event free rate was 70.3 $\pm$ 11.7% at 7 years. These results suggest that pediatric valve replacements can now be performed at a low operative risk although various problems are still remained and the choice of valve is prosthetic valve mainly due to its durability at the present time.

한국의 심장이식 성적

오세일(Se Il Oh),오병희(Byung Hee Oh),노준량(Joon Ryang Rho),김기봉(Ki Bong Kim),김재중(Jae Joong Kim),송명근(Meung Gun Song),진동규(Dong Gyu Jin),박국양(Kook Yang Park),홍석근(Suk Keun Hong),정윤섭(Yoon Seop Jeong),이상훈(Sang Hoon 대한내과학회 2001 대한내과학회지 Vol.60 No.3

N/A Background : Heart transplantation is a definite treatment modality of the patients with end-stage heart failure. Heart transplantation has been performed in Korea since 1992, and currently it is an established procedure for the management of terminal heart failure. The purpose of this study is to clarify the Korean status of heart transplantation. Methods : Six major heart transplantation centers' 137 cases during the period November 1992 through May 1999 are analyzed to evaluate the general demographics, underlying heart diseases, postoperative management, complications, and survival. Results : The mean age of the patients is 37 years old, and the mean follow-up period is 25 months (1 day - 80 months, median 20 months). Most common underlying disease related to heart failure is cardiomyopathy (86%). Total 16% of patients underwent cellular rejection of ISHLT (International Society of Heart and Lung Transplantation) grade 3A or more within 1 year after transplantation. The most common type of clinical infection is bacterial (18%), and the most common organism is Herpes zoster virus (6.4%). Graft coronary artery disease examined by coronary angiography detected in 3.7% of recipients within 12 months after transplantation. One, 2, 3, and 5-year overall survival rates of recipients are 81% , 72%, 71%, and 62%, respectively. Conclusion : Distribution of underlying heart diseases and the frequency of graft coronary artery disease of Korean heart transplantation recipients were different from those of the western patients. Although the history of heart transplantation in Korea is relatively short, the early and long-term results are comparable with well-established centers.(Korean J Med 60:228-233, 2001)

풍선 카테터에 의한 폐동맥 판막 성형술

박국양,김창호 大韓胸部外科學會 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.6

심장이식 후 재활

박국양 世宗醫學硏究所 1993 世宗醫學 Vol.10 No.1

선천성 심기형 수술 후 흉입 산화질소 중단시 발생한 반동성 폐동맥 고혈압

박희권,장영진,김지희,조영례,박정출,이현우,이경천,임유택,박국양 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.3

Background : Inhaled nitric oxide (NO) therapy causes selective pulmonary vasodilation in patients with pulmonary hypertension. However, attempts to discontinue inhaled NO may be complicated by abrupt life-threatening rebound pulmonary hypertension (RPH). The purpose of this study was to deter- mine the risk factors to develop RPH and to present the adequate weaning methods. Methods : We studied 19 consecutive children who were treated with inhaled NO because of pulmo- nary hypertension after surgery for congenital heart disease. We compared the dose of NO at the time of start and withdrawal, the duration of weaning and treatment, hemodynamic data, and blood gas analysis before inhaled nitric oxide withdrawal, between patients without (group I, n =13) and with RPH (group II, n =6). Results : Compared with group I, group II patients were older in age (1204 ± 1688 versus 546 ± 1654 days, P $lt; 0.05), had a lower NO concentration just befote withdrawal (3 ± 1.6 versus 5 ± 2.6 ppm, P $lt; 0.05), a shorter dura of NO weaning period (4 + 3.3 versus 15 + 13.4 hours, P $lt; 0.05) and received NO therapy for a shorter duration (26 ± 11.6 versus 57 ± 46.0 hours, P $lt; 0.05). Conclusions: We recommend a progressive withdrawal of inhaled nitric oxide to avoid life-threatening RPH observed in the sudden discontinuation. (Korean J Anesthesiol 2000; 38: 457~462)

The Expression of Class Ⅱ MHC Antigens Consequent to Ischemic Injury : A comparative study between kindney and heart 신장과 심장의 비교 연구

Park, Kook-Yang,Larson, Douglas F.,Copeland, Jack G. 大韓移植學會 1994 Korean Journal of Transplantation Vol.8 No.1

좌심방 점액종 치험 1례보고

이윤우,박영우,최석구,유원상,구본일,박국양,이홍섭,김창호,윤귀옥,고일향 인제대학교 1987 仁濟醫學 Vol.8 No.3

A 56 year-old woman admitted to our hospital because of progressive exertional dyspnea for 2 months. Preoperative clinical diagnosis of left atrial myxoma was made from M-mode and 2-dimensional echocardiography, and the tumor was removed successfully with the aid of extracorporeal circulation on October 23,1986, which was the first open heart surgery in Paik Hospital, Seoul. We report a case of left atrial myxoma with a review of literatue.