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이만복,김우종,강창희,이길노,Lee, Man-Bok,Kim, U-Jong,Gang, Chang-Hui,Lee, Gil-No 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.3
Hypothermia during lung preservation decreases metabolic processes. After the rabbit lung was flushed with modified Euro-Collins solution, heart-lung block was harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. Heart-lung block was immersed in the same solution for 6 hours. The modified Euro-Collins solution and storage temperature of group 1(10 cases) was 4t, roup 2(10 cases) was l$0^{\circ}C$. On completion of the storage period, the left lung was ventilated and reperfused with blood u:high used a cross-circulating paracorporeal rabbit as a "biologic deoxygenator" for 60 minutes. Pulmonary artery pressure, airway pressure, difference in oxygen tension between mow and outflow perfusate and degree of pulmonary edema were assessed at 10-minute intervals while the left lung was ventilated at 0.8 of the inspired oxygen fraction. The mean pulmonary venous oxygen tensions at 10 and 60 minutes after reperfusion were 209.52$\pm$42.46 and 103.48$\pm$ 15.96 mmHg in group I versus 247.78$\pm$36.19 and 147.91 $\pm$ 11.07 mmHg in group II(p=0.049, (0.0001). The mean alveolar-arterial oxygen differences at 20 and 60 minutes after reperfusion were 357. 95$\pm$ 12.84 and 437.31 14.26 mmHg in group I versus 310.88$\pm$3).47 and )90.93$\pm$ 15.86 mmHg in group II (p=0.0092, (0.0001). The mean pulmonary arterial pressures at 10 and 60 minutes after reperfusion were 40.56$\pm$ 18.66 and 87. 2$\pm$ 17.22 mmHg in group I versus 31.22$\pm$6.84 and 65.78$\pm$ 11.02 mmHg in group rl (p : 0.048, 0.0062). The mean pulmonary vascular resistances at 10 and 60 minutes after reperfusion were 2.69$\pm$0.85 and 4.36$\pm$0.86 mmHg/ml/min in group I versus 1.99$\pm$0.39 and 3.29$\pm$0.55 mmHg/ml/min in group II(p : 0.0323, 0.0062). There were no difference between groups in peak airway pressure, lung compliance and degree of pulmonary edema. In conclusion that preservation of lung at l$0^{\circ}C$ was superior to preservation at 4$^{\circ}C$.}C$. 가토의 적출폐장보고시험의 모델을 이용하여 폐세척웅액과 폐장보존용액의 온도를 제 1군은 4$^{\circ}C$로 제 2군은 1$0^{\circ}C$로 하여 6시간동안 적출폐장보존후에 재관류시켜 각각의 온도차이에 따른 폐기보존효과를 비교 실험하였으며 각 군은 10례씩으로 하였다. 폐정맥혈액산소분압, 폐포-동맥간 산소분압 차, 폐동 맥압 및 폐혈관저항은제 1군보다제 2군이 재관류동안에 성적이 우수하였으며 기도내압, 폐탄성도및 폐부종의 정도는 두 군간에 통계학적 유의성은 없었다. 결론적으로 가토의 적출폐기 보존온도에 따른 실험에서 1$0^{\circ}C$의 폐수*용액과 폐기보존온도가 4$^{\circ}C$보다 재순환시 폐기능의 회복이 우수하였다.
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이만복 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.3
We experienced an intraatrial baffle repair for unroofed coronary sinus syndrome in TOF. The patient was a 32-month old female, with complaints of cyanosis, exertional dyspnea and growth retardation. Physical examination showed cyanosis of lip, clubbing of finger, growth retardation and systolic murmur[0 /Gr VI] on left sternal border. With an aid of noninvasive and invasive diagnostic procedure, the patient was diagnosed as TOF combined with unroofed coronary sinus syndrome and LSVC connecting to left atrium. After patch closure of VSD, infundibulectomy and pulmonary valvotomy, the intraatrial baffle redirection of anomalous LSVC to right atrium was undertaken. The Dacron baffle was constructed along the roof of the left atrium to the plane of the atrial septum. The intraatrial septum was then reconstructed with Dacron which was sutured to residual septal tissue. After surgery, the systemic oxygen saturation was elevated to 95.5%, as compared with preoperative value 61%. The postoperative course was uneventful.
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심낭압진이 동반된 관통성 및 비관통성 심장외상 - 7례 보고 및 임상분-
이만복 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4
We experienced the seven cases of penetrating and non-penetrating cardiac injuries combined with cardiac tamponade from June 1986 to June 1989 at Seoul and Chun-An Hospital of SOONCHUNHYANG medical college. The results were as follows. l. In sex distribution, 7 cases were male. In age distribution, The fourth decades occupied about 58 % of all cases. 2. In mode of injury, 4 cases were stab wounds, 1 case penetration by metallic fragment, 2 cases blunt chest trauma. 3. We routinely checked the CVP with subclavian vein catheterization in case of suspicious cardiac tamponade. Significant increments were showed in 4 cases. 4. Becks triad [low blood pressure, raised central venous pressure, distant heart sound] were recorded in 43 % of the cases with proven tamponades. 5. The sites of injury included RV in 4 cases, LV in 1 case, RA in 1 case and branch of RCA in 1 case. The RV injuries were the most common. 6. Coronary artery damage occurred in 2 cases. LADA was severed in 1 case combined with RV rupture and branch of RCA was torn 1 case. 7. Pericardiocentesis was performed 1 case at another hospital before referring to our hospital. We have never used the procedure because we think that it is potentially dangerous with no clear benefit. 8. Subxyphoid pericardial window was performed in 2 cases of severe cardiac tamponade. We have employed this method to stabilize the patients who had systolic hypotension. 9. Surgical approaches were performed with median sternotomy in 3 cases, thoracotomy in 4 cases. 10. We undertook the simple closure in 6 penetrating cardiac wounds. The removal of impacted metallic fragment was performed under the cardiopulmonary bypass. Simple ligation was performed in 2 cases of coronary artery severance 11. One patient with no sign of life was urgently intubated and undertaken an emergency room thoracotomy on the stretch car without antiseptic preparation. The cardiorrhaphy in 6 cases were performed in the operating theater 12. One patient undertaken emergency room thoracotomy did not survive due to refractory hypovolemic shock. But the remaining 6 patients recovered.
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이만복 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.1
A 37-year old man was admitted due to the left subauricular mass of 6 month duration which was 3 x 4cm sized, pulsatile and slowly growing He was suffered from the intermittent left facial and auricular pain radiating to the occipital area. The carotid angiography revealed 3x4cm sized saccular aneurysm of the left internal carotid artery just above the carotid bifurcation, extending to the mandibular angle level. He was planned to be operated under the direct clamp of internal carotid artery or shunting procedure. But, the back pressure of the internal carotid was 35mmHg, which suggested adequate cerebral collateral. Thereby, aneurysmectomy and restoration of cerebral blood flow with saphenous vein graft was done under the direct clamp of internal carotid artery for 25 minutes. Although mild transient neurologic sequelae such as mydriasis, tongue deviation for 10 days, he recovered completely without any complication. The aneurysmal sac had no thrombus and pathologic finding was compatible with congenital origin.
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