승모판 치환술후 발생한 좌심실 후벽 파열

강면식 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.11

Rupture of the posterior left ventricular wall following mitral valve replacement is a rare but fatal complication. Over a 10 year period from August 25 1980 to November 27 1990, we have experienced 6 such patients among 884 cases of mitral valve replacement with 4 deaths and 2 survivors. One patient had a type I rupture and another a type II rapture with the remaining four patients having suffered type III ruptures. All of the ruptures were dis covered intraoperatively enabling prompt reinstitution of the cardiopulmonary bypass and subsequent cardioplegic arrest prior to repair. Overzealous removal of calcified valve leaflets seemed to be responsible for the single type I rupture, and untethering of the so called ventricular loop appeared to be the main mechanism responsible for the type III ruptures. The single type II rupture that had occurred seemed to have been caused by inadvertent laceration of the papillary muscle with resultant rupture of the posterior LV wall at the base of the papillary muscle. Among the type III ruptures, 2 patients required intraaortic balloon pump[IABP] support only for mechanical assistance and 1 patient required both the IABP and the Biomedicus LV assist device for successfull weaning following repair of the LV rupture Another patient with a type II rupture also required the circulatory assistance of both the IABP and the bio-medicus LV assist device for weaning from the bypass. Attention to meticulous technical considerations such as avoiding over aggressive removal of heavily calcified valvular tissue, preservation of as much mural leaflet tissue and chordal stuctures as possible seemed helpful in preventing this catastrophic complication from occurring. Fusion and fibrous stricture of the chordal structures appeared particularly conducive to the type II ruptures as a result of the increased susceptibility to papillary injury during operation.

심정지액의 oxygenation이 심근보호에 미치는 영향

강면식 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.11

Current methods of myocardial protection has been improved with cardioplegia and hypothermia. We compared St. Thomas hospital cardiopleic solution without oxygenation[Group I], with oxygenation[Group II] and with oxygenation with filter[Group III] under isolated working heart model. Heart rate recovery was more significantly improved in Group II than Group I after 15 minutes of recovery time [p<0.05]. Maximal systolic pressure shows no difference as it increases with time. Cardiac ouputs were not diffrent between groups. Recovery time was shorter significantly in group II and group III than group I [p<0.05] Use of filter showed no difference. As a conclusion, oxygenated cardioplegic solutions improves ability to protect the heart against ischemia and it is manifested by improved recovery time and heart rate.

폐암의 진단과 STAGING

강면식 연세대학교 의과대학 1983 연세의대논문집 Vol.16 No.1

대혈관전위증 (S.D.D.) 치험 1례

강면식 대한흉부심장혈관외과학회 1979 Journal of Chest Surgery (J Chest Surg) Vol.12 No.3

This 3-year-old girl was observed frequent exertional dyspnea and cyanosis at crying since birth. She was not premature baby and delivered at full term normally. On physical examination, she was underdeveloped-body weight 13.5 kg, height 99 cm.- and cyanotic. There was severe clubbing on fingers. There was grade II/VI ejection systolic murmur on left lateral border of the sternum. The preoperative examinations [EKG, echocardiogram, cardiac catheterization and biventriculogram] showed that complicated T.G.A. combined vena cava[S.D.D.]. Preoperatively, we decided the corrective surgery of Rastelli operation using a. pulmonary valved conduit. The operation was performed under total circulatory arrest using deep profound hypothermia combining with extracorporeal circulation. On operation, the anatomy of the heart showed that, 1. The subaortic conus was seen and subaortic muscles were hypertrophied. 2. The VSD[type II], behind the subaortic conus-about 1 cm. in diameter, was visible only through LV cavity and, 3. The pulmonary valve ring was hypoplastic and pulmonary valvular stenosis was seen also. The subpulmonic area [LV outflow tract] was obstructed with hypertrophied muscle and mitral valve. 4. Left superior vena cava was drained to RA via coronary sinus. 5. LAD coronary artery was originated from right coronary artery and ran anterior to the pulmonary artery. According to above anatomy, we performed the VSD closure with Teflon patch, and Mustard operation combined with LV-to-pulmonary artery bypass graft using the valve contained [Hancock 16 mm] conduit. Postoperatively, adequate blood pressure could be maintained under the state of using inotropic agent [epinephrine]. On the second postoperative day, the patient died of cardiac arrest due to low cardiac output syndrome, acute renal failure and pulmonary edema.

우심증 [S.D.L.] 및 우심실 복형출구증 [DORV] 이 동반된 선천성 심기형의 수술치험 1예

강면식,조범구,홍필훈,Kang, Myung-Sik,Cho, Bum-Koo,Hong, Pil-Hun 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.2

Within the group of congenital cardiac anomalies manifesting dextrocardia and double-outlet right ventricle, ventricular non-inversion [S.D.L] is extremely rare. Recently, a 5 year-old boy underwent a successful surgical correction of dextrocardia associated with double-outlet right ventricle, ventricular non-inversion [S.D], ventricular septal defect, pulmonary stenosis, and patent foramen ovale. The operation consisted of construction of an internal baffle connecting the left ventricle to the aorta through the large ventricular septal defect [subaortic]. The pulmonary stenosis was managed by infundibulectomy and patch enlargement of the right ventricular wall. The patient`s postoperative recovery has been uneventful, and 2 months after the operation, he is doing well.

Rastelli씨 수술법을 이용한 완전 대혈관전위증(S. D. D.) -치험 1예-

강면식,조범구,Kang, Myung-Sik,Cho, Bum-Koo 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

A 8-year-old boy underwent surgical correction of complete transposition S.D.D. of great arteries combined with subaortic ventricular septal defect and pulmonary stenosis [infundibular and valvular]. The operation consisted of an internal baffling connecting the left ventricle to the aorta through the ventricular septal defect. The pulmonary stenosis was corrected with the method of external connection, the right ventricle to the pulmonary artery using the conduit valve [20 mm] contained Hancock due to abnormal distribution of left coronary artery of which conduit due to abnormal distribution of left coronary artery of which the circumflex branch crossed the portion of right ventricular outflow tract. This case was suitable for corrective surgery-Rastelli operation-and the patient`s condition in very good until present [post-operative 5 months].

개심술후의 정신병리적 변화

강면식 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

Preoperative and postoperative psychiatric evaluation were done for 51 patients who were undergoing open-heart surgery. The incidence of postoperative psychopathological complications following open-heart surgery was 27.5%. This rate is comparable to that of previous studies. Neurotic reactions occurred in eight patients, delirium in five, and acute psychotic reaction in one. Of those variables which were previously suggested to influence the high incidence, the demographic factors and the severity of preoperative illness were correlated with postoperative psychopathologic dysfunctions. No somatic variable associated with intraoperative or postoperative procedures has been proven to correlate. By preoperative psychiatric evaluations, the patients could be divided into three groups: the Anxiety group, the Denial group, and the Adjusted group. The most important psychological finding was that in patients who demonstrated a high degree of preoperative anxiety or who could not express preoperative anxiety, postoperative psychological complications developed more frequently. With these findings, the preoperative psychiatric interview was recommended for prevention and reduction of postoperative psychiatric complications.

협소한 대동맥판윤의 첨포확대후 대동맥 및 승모판막 대치술 치험 1예

강면식 대한흉부심장혈관외과학회 1979 Journal of Chest Surgery (J Chest Surg) Vol.12 No.1

Replacement of the aortic valve in a normal or large aortic root can be accomplished with ease and safety in most instances. The presence of a narrowed aortic annulus remains a problem in that the replaced smaller prosthetic valve has a significant resting pressure gradient across the orifice. This narrowing causes not only technical difficulties, but also increased mortality and post-op. complication. Therefore this problem deserves special attention. This report presents our experience with a case of a small aortic root caused by rheumatic heart disease [AI and MS]. This is the method of enlargement of the aortic annulus with a woven Dacron patch and replacement of a larger prosthetic aortic valve combined with mitral valve replacement.

원발성 심장 종양의 수술적 치료

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

During 22-year period ending in June 1988, operation was performed on 22 patients with primary heart tumor at Yonsei University College of Medicine. Mean age was 38.8*3.03[mean \ulcornerEM] ranging from 14 to 63 years old. Twenty cases were myxomas. Others were fibromyxoma and rhabdomyosarcoma. All patients complained of dyspnea on exertion. Nine cases had palpitation. Other constitutional symptoms were weight loss [7 cases], headache [4 cases], generalized edema [3 cases] and cough [3 cases]. Five cases had neurological symptoms and signs preoperatively. Preoperative NYHA Class was poor [Class II; 8 cases, III; 9 cases and IV; 5 cases]. The most common site of tumor origin was fossa ovalis limbus [16 cases; 72.8%]. Because of severe mitral regurgitation and of recurrent myxoma, 2 cases were reoperated for mitral valve replacement. Postoperative complications were postoperative mitral regurgitation [5 cases; 22.8%] and arrhythmia [4 cases; 18.2%], one of which was supra-His bundle block. All patient survived operation. Follow-up of 15 patients [mean 28.95*8.3 months] was good as functional class 1[8 cases] or II [7 cases]. More effective adjuvant therapy will be necessary to improve long-term prognosis for malignant primary heart tumor.

심실중격결손증을 동반한 폐동맥 폐쇄증 [Pulmonary Atresia] 의 외과적 치료-2예 보고-

강면식 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

Pulmonary atresia with VSD is uncommon congenital anomaly with high mortality in neonatal period. Recently we experienced surgical correction of 2 cases of pulmonary atresia with VSD. The first case was 7-year old female patient and diagnosed as pulmonary atresia with VSD combined PDA. So, total correction was undertaken which consisted of PDA ligation, patch repair of VSD, transannular enlargement of RVOT with woven Dacron vascular graft, and closure of PFO. Postoperative systemic Rt. ventricular and radial artery pressure ratio was 0.44 and her postoperative course was uneventful. The second case was 6-year old male patient diagnosed as pulmonary atresia with VSD and large systemic-pulmonary collateral arteries. There were two large systemic-pulmonary collaterals, one was simply controlled by ligation, but the other was considered to supply Rt. upper lung. So end to side anastomosis was performed to the RVOT patch. Postoperative systolic Rt. ventricular and radial artery pressure ratio was 0.54. During the follow up period he showed clinical picture of Rt. heart failure, which is relatively well controlled with anticongestive therapy.