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양대동맥 우심실 기시증 [Double Outlet Right Ventricle] 의 전교정술 -27례 분석-
조재일 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.3
Twenty-seven patients with double-outlet right ventricle underwent complete intracardiac repair between 1978 and 1983, June, at Seoul National University Hospital . Although definite aorto-mitral discontinuity was discovered in 20 patients, both great arteries arose wholly or mostly from the right ventricle in all cases. There were 17 cases with subaortic VSD, 6 with subpulmonic, 2 with doubly-committed, and 2 with non-committed VSD. Pulmonary stenosis was present in 21 patients. Intraventricular baffle repair was applied in 23 patients. Three patients required extracardiac conduit to establish continuity between right ventricle and pulmonary artery, and modified Fontan operation was performed in one patient. Over-all mortality rate was 37.0%, but recently 4 of 15 died [26.7%]. One late death occurred from infective endocarditis. Incremental risk factors were small patient size, subpulmonic or non-committed VSD, presence of PS, coronary artery anomalies, associated valvular lesion and other complicated anomalies. However, great artery relationship, restrictive VSD and transannular patch were not risk factors. No instances of complete heart block occurred. Of the survivors, all showed complete or in complete right bundle branch block and in one patient intermittent ventricular tachycardia had developed. The important cause of death was low cardiac output syndrome.
조재일,최성영,최세근,이상하 한국방위산업학회 2022 韓國防衛産業學會誌 Vol.29 No.1
도전적이고 혁신적인 국방과학기술 R&D를 위해 다양한 제도개선이 이루어지고 있으나, 실제 체계를 개발하는 마지막 단계인 무기체계 연구개발에 대해서는 국가계약법령 등에 따른 제약으로 아직까지 혁신적인 제도가 부재한 실정이다. 국방과학기술 혁신 촉진법에 따라 기술적 목표 미달시 성실수행 인정이 가능한 협약방식이 가능해졌으나, 일부 사업만 해당하고 여전히 목표 미달에 대한 규제만 존재하고, 도전적으로 기술적 목표를 넘어서는 유인과 보상제도는 부재하다. 또한, 기존 유인부계약제도는 연구개발 주관업체와 정부에 모두 부담이 되는 원가 절감만을 목적으로 하고 있어 활성화 되지 못해 오고 있는실정이다. 따라서, 본 연구에서는 무기체계 연구개발 단계에서 주관 업체로 하여금 기술적 성능 목표를 넘어서는 도전적인 노력을 유인하고 이에 대한 보상을 위한 유인성능 개념을 제안하고, 이를 토대로 제안서 평가 및 업체 선정, 계약방법 및 인센티브 지급 등 연구개발 사업 전 단계별로 구체적인 적용방안을 연구, 제시하였다. 그 동안 국방과학기술의 최종 단계로써 R&D 혁신의 중요한 대상임에도 무기체계 연구개발은 조달영역으로써의 한계가존재하였는데, 본 연구를 통해 최초로 국가 조달관점에서 도전적인 국방과학기술진흥을 도모할 수 있는 제도를 최초로 구체화 연구, 제시한데 큰 의의가 있다.
조재일,이영균,Jo, Jae-Il,Lee, Yeong-Gyun 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4
Of the valve replacement patients operated between 1983 and June, 1984, 75 patients need more than 60 minutes of aortic cross-clamping time. 42 patients performed single valve replacement [35 MVR, 7 AVR with or without TAP] and remainder needs double valve replacement with or without TAP. The average aortic clamping time was 95.1 minutes. They need 30 minutes more extra-corporeal circulation time than aortic clamping time. The patients were divided into two groups by usage of cardioplegic solution. Group I [n=31] with Bretschneider solution and group II with potassium cardioplegic solution [M.G.H. modification] were analyzed by extra-corporeal circulation data,/CG and Echocardiography findings, and clinical data. There was no difference between two groups in Bivon addition amounts [cc/kg] and E.F. and S.F. by echocardiography, group I need 1 more electrocardioversion to convert sinus rhythm postoperatively. Also no difference could be found in patients whose preoperative C.I. was above 2.0 between two group. But significant postoperative decrease in E.F. was found in group I whose preoperative C.I. was below 2.0. Relatively longer ECC time was also needed in same group. Ischemic changes in ECG and low cardiac output syndrome was, however more prevalent in groupII. As a whole, the clinical data was satisfactory with both cardioplegic solution in clinical practice.
조재일,서경필,Jo, Jae-Il,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4
Thirty-seven patients had undergone repair of a endocardial cushion defect between 1977 and Aug. 1983 in Seoul National University Hospital. Twenty eight had a partial defect, one intermediate defect and eight complete endocardial cushion defect. Tricuspid cleft was found in 4 cases and mitral cleft was in all p-ECD. Seven patients were of type C anatomy in c-ECD. Four patients had associated major anomalies, including three TOF in c-ECD, one coarctation in p- ECD. In p-ECD patients, the septal defect was closed with patch in all cases and the atrioventricular valvular insufficiency was corrected with MVR in 4 cases, TVR in 1 case and simple interrupted sutures in remainders. In c-ECD patients the septal defect was closed with single patch except one case. The atrioventricular valve was repaired with simple interrupted sutures except one MVR and TVR case. The operative mortality was 14.2% in p-ECD, 44.4% in c-ECD, but recent 3 years [1980-1983] mortality was 8.7% in p-ECD, 20% in c-ECD. More than grade III systolic regurgitant murmur was oted postoperatively in 4 cases of c-ECD and 3 cases of p-ECD. The operative risk factors were preoperative NYHA classification, cyanosis, Rp/Rs, systolic pressure of main pulmonary artery and the degree of regurgitation of atrioventricular valves. The causes of death were low cardiac output syndromes, pulmonary complications and arrhythmias.