혼성 관상동맥 혈관재생술

한승세 ( Sung Sae Han ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Hybrid coronary revascularization combines left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting integrated with percutaneous coronary intervention (PCI) on stenoses in the non-LAD territories. Hybrid coronary revascularization offers multivessel revascularization with minimal morbidity in high risk patients. Usually hybrid coronary revascularization performs minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. The concept is now 10 year old. This procedure has been developed from MIDCAB plus percutaneous transluminal coronary angioplasty (PTCA) to totally endoscopic coronary artery bypass grafting (TECAB) procedures plus PTCA and drug-eluting stenting (DES). The hybrid coronary revascularization procedure may be especially useful in complex LAD lesions, restenotic lesions in LAD, acute myocardial infarction in “non-LAD” territory, high-risk elderly patients with multiple comorbidities and patients with severe left ventricular systolic dysfunction who are not ideal candidates for conventional bypass surgery. Hybrid coronary revascularization results according to the literature are very attractive. LIMA patency rates were found to be in the 98% range and restenosis rates in the PCI part of the procedure are in a 12% range.16) The wider introduction of hybrid revascularization is limited chiefly by the high number of repeat interventions compared with off-pump coronary artery bypass grafting, which occurs because of the target vessel failure rate of percutaneous coronary intervention. Drug-eluting stents substantially decrease the reintervention rate. However, the future role of hybrid coronary revascularization is unclear in patients with multivessel coronary artery disease involving the LAD if comparable results may be attained with multivessel PCI.

개심술후의 Ventilator Weaning 에 관한 임상적 고찰

김규태,한승세,이종태,Kim, Kyou-Tae,Han, Sung-Sae,Lee, Chong-Tae 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.3

Cardiac surgery is generally followed by a period of routine ventilator support. When the patient seems hemodynamically stable and relatively alert following surgery, respiratory adequacy is tested by the weaning trial. In this study, physiological and clinical prediction of postoperative respiratory adequacy, including values of pulmonary function tests, were examined in an attempt to identity those few variables which predicted the outcome of the ventilator weaning trial following surgery. Our series comprised 27 patients who underwent elective open intracardiac operations at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, from October 1979 to July, 1980. The pulmonary function tests performed on all patients included the following; forced vital capacity [FVC], forced expiratory volume [FEV1.0], forced expiratory flow [FEF 25--75~], residual volume [RV], and functional residual capacity [FRC], measured with a helium dilution technique. Of our 27 patients, 8 were successfully weaned within 20 hours of operation. All patients with cyanotic heart diseases or acquired heart diseases were unsuccessfully weaned. The bypass time in the successful weaning group was shorter in the mean value [82.8 minutes]than in the unsuccessful weaning group [120.5 minutes]. There was a relatively significant difference in the mean values for the two groups in arterial pressure, bleeding amounts and FiO2 among the postoperative monitoring variables, and in forced vital capacity [FVC]. The postoperative clinical assessments appeared vague but corresponded reasonably well to appraisal of success in weaning, especially in variables of cough and self-respiration efforts.

기관지성 낭종[3례 보고]

이종태,한승세,이성행,Lee, Chong-Tae,Han, Sung-Sae,Lee, Sung-Haing 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.3

The bronchogenic cysts result from an abnormal budding or branching of the tracheo-bronchial tree from the primitive foregut. Bronchogenic cysts may be pulmonary or mediastinal. The most common location for a mediastinal bronchogenic cyst is in relation to the carina. They are usually solitary. They usually are thin walled and contain fluid that is most often clear. The cyst is lined by ciliated columnar epithelium. The bronchogenic cyst i~ usually asymptomatic. They can cause pressure symptoms. When they become infected, symptoms do occur. We report 3 cases of bronchogenic cysts experienced at the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital. Case I, a man of 20 year-old, had a cyst at the site between aortic arch and left pulmonary artery. He complained cough and dyspnea. The cyst wasn`t communicated with tracheobronchial tree. Case II was 55-year-old male who had had hemoptysis. A huge cyst was located within the lower lobe of left lung and removed by pulmonary lobectomy. There were not any symptoms in Case III that was 6-year old girl. That cyst was located just next to the right main bronchus.

Subclavian artery 의 동맥류 -1예 수술 경험-

이성행,이성구,한승세,이길노,김송명,Lee, Sung Haing,Lee, Sung Koo,Han, Sung Sae,Lee, Khil Rho,Kim, Song Myung 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

환자는 남자 33세이며 외상으로 인하여 좌측쇄골하동맥에 낭형의 가성동맥류가 발생했고 수술은 동맥류낭을 부분절제하고 Dacron 인조혈관을 이식하였다. 술후경과는 비교적 양호하였으며 관계된 문헌의 고찰과 함께 보고 하였다. A 33 year-old man was admitted with chief complaints of severe sharp pain on left upper interscapular region and motor weakness of left arm for 9 days. He had a history of blunt trauma over left shoulder about 3 years ago. Physical examination showed a ping pong ball sized mass which was located at the left supraclavicular area and was firm, fixed, and nonpulsatile. No bruit or murmur was obtained over the mass. Ipsilaterally, radial, ulnar, and brachial pulse were very weak and ptosis and anhidrosis were noticed. Neurologic examination revealed moderate or severe weakness of flexion and extension of left elbow, wrist and fingers, and anesthesia of the skin in left C8-T1 dermatome and hypalgesia in left C6-C7 dermatome. Retrograde aortography demonstrated complete obstruction of left subclavian artery. An exploratory operation was performed through the left 4th intercostal space. It was found that the mass was a left subclavian aneurysm of traumatic false type. Proximal and distal ligation of the aneurysm were applied and the sac was partially removed. The continuity of the subclavain artery was established by the use of a 6mm. Dacron graft from the root of the subclavian to the axillary artery. Postoperatively the patient was improved from the circulatory and neurologic disturbances.

선천성(先天性) 심장병(心臟病)의 개심술(開心術) -6례(例) 수술경험(手術經驗) -

이성행,이성구,한승세,이길노,김송명,이광숙,이종국,Lee, Sung Haing,Lee, Sung Koo,Han, Sung Sae,Lee, Kihl Rho,Kim, Song Myung,Lee, Kwang Sook,Lee, Chong Kook 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

Six cases of congenital heart disease were operated on by means of cardiopulmonary bypass between December, 1975 and April, 1976. Two cases of ventricular septal defects (VSD), two cases of VSD, associated with ruptured aneurysm of sinus Valsalva, two cases of atrial septal defects (ASD) and one case of pulmonic stenosis with patent ductus arteriosus were operated. Sarns roller pumps and Bentley Temptrol oxygenators were used for extracorporeal circulation. Pump oxygenator was primed with Ringer's lactate solution, 5% dextrose in water, mannitol, and ACD blood. Flow rate ranged from 2.0 to $2.4L/M^2/min$. Bicarbonate was added to the oxygenator with estimated amount as 15 mEq/L/hr. Venous catheters were introduced into superior and inferior vena cava, and oxygenated blood was returned to the body through aortic cannula inserted into ascending aorta. Moderate hypothermia ($30^{\circ}C$) was induced by core cooling. Aorta was cross clamped for 15 minutes and released for 3 minutes, and repeated clamping when necessary. Atrial and ventricular septal efects were closed by direct sutures. Aneurysms of sinus Valsalva ruptured into the right ventricle were repaired through right ventriculotomy by d:rect closure with Dacron patch reinforcement. Cardiopulmonary bypass time varied from 66 to 209 minutes, and aorta cross clamping time ranged from 13 to 56 minutes. Postoperative bleeding was minimal except one case who needed for evacuation of substernal hematoma. Intra- and postoperative urinary output was satisfactory. Acid-base balance, partial pressure of $O_2$, electrolytes, and hematological changes during intra- and post-perfusion period remained at the acceptable ranges. No mortality was experienced.

종격동내 혼합 생식 세포종과 폐전이를 동반한 혈관육종이 동시에 존재한 중복암

류헌모 ( Hon Mo Ryu ),최희진 ( Hee Jin Choi ),신경철 ( Ghung Cheul Shin ),정진홍 ( Jin Hong Chung ),이관호 ( Kuan Ho Lee ),이현우 ( Hyen Woo Lee ),이동혁 ( Dong Hyunp Lee ),이정철 ( Jung Cheul Lee ),한승세 ( Sung Sae Han ),심영란 대한결핵 및 호흡기학회 1994 Tuberculosis and Respiratory Diseases Vol.41 No.4

氣管支擴張症의 外科的 治療

한승세,이정철,이재성,송원영,이성행 慶北大學校 醫科大學 1983 慶北醫大誌 Vol.24 No.2

경북의대 흉부외과학 교실에서 1973년 1월부터 1982년 12월까지 기관지확장증으로 수술했던 환자중에서 65예를 선택하여 임상적인 분석을 하고 외과적요법의 결과를 관찰해 보았다. 전체 65예 중 남자는 49예였으며 여자는 16예였는데. 3:1비율로 남자가 많았다. 환자의 연령은 8세에서 51세까지 분포하였으며 10세에서 39세사이가 59명으로 91%를 차지하였다. 환자의 임상증상은 기침 88%, 객담 78%, 상기도 감염 51%, 및 혈담 37% 순으로 많았다. 환자의 과거력을 보면 홍역 29%, 백일해 14%, 및 폐결핵과 기관지염이 각각 12%였다. 기관조영술상 cylindrical형이 43%를 차지하여 가장 많았다. 폐기능검사상 폐활량 87.8%, 강제호기량 1초치 82.7%, 및 최대자발적환기량 73.9%로 다소 감소하여 있었다. 이환폐는 좌측이 52예로서 80%였고 우측은 13예였다. 좌하엽절제술과 설상구역절제술을 동시에 시행한 경우가 22예로서 34%였는데 가장 많았고 좌하엽절제술이 단독으로 시행된 경우는 그 다음순으로 14예로 22%였다. 일부절제술을 시행한 12예에서는 7예에서 만족한 결과를 보였다. 양측절제술은 4예에서 시행하였는데 2예는 술후합병증이 없이 완쾌되었고 나머지 2예는 각기 술후에 candida 폐염과 무기폐를 가졌었다. 수술후합병증으로는 무기폐가 11%, 농흉 9%, 그외에 술후출혈, 창상감염 늑막삼출액 등이 각각 6%씩이었으며 수술사망율은 1.5% 였다. 퇴원후 장기관찰에서 증상이 완전히 없어진 경우는 53%였고 증상이 호전된 경우는 34%였으며 13%에서는 증상이 잔존하였었다. Since the advent of potent chemotherapy, the incidence and severity of bronchiectasis have been on the decrease. Up to date, however, the medical treatment of bronchiectasis has not given us much satisfaction. Our purpose here is to show our experiences with pulmonary resections of bronchiectasis to clarify its surgical results and define its surgical indications. Sixty-five patients with bronchiectasis, treated surgically from January, 1973 to December, 1982 at the Department of Thoracic and Cardiovascular Surgeory, Kyungpook National University Hospital, were given clinical assessment. Of the 65 patients involved in the series, 49 were male and 16, female. The patients ranged from 8 to 51 in ages, with 59 cases(91%) between 10 and 39 years old. The prominant clinical features were as follows: cough(88%), sputum production(78%), recurrent upper respiratory infection (51%), and frequent hemoptysis(32%). The past history of the patients included measles 29%, whooping cough 14%, pulmonary tuberculosis 12%, and pneumonia or bronchitis 12%. The cylindrical type of the bronchiectasis was found to be most common, accounting for 43% of the cases. The operations were performed on the left lung in 52 cases and the right lung in 13 cases. The most common operative procedure was the left lower lobectomy and lingular segmentectomy, which showed 34%. The second most frequent procedure was the simple left lower lobectomy which was 22%. Imcomplete resections of the multisegmental bronchiectasis were carried out in 12 cases, of which 7 cases were satisfactory Four patients underwent bilateral pulmonary resections for the severe multisegmental bilateral bronchiectasis. during the first and second operations. Improvement in pulmonary sysmptoms was generally obtained in all four cases. The follow-up ranged from 1 week to 7 years, with an average of 18.8 months. The overall results revealed that 87% of these had excellent or good conditions, but 13% had persistent symptoms. There was one operative death, which is a 1.5% mortality.

성인의 심방중격 결손의 외과적 치료

이동협,이정철,한승세 영남대학교 의과대학 1992 Yeungnam University Journal of Medicine Vol.9 No.2

영남대학교 의과대학 흉부외과학 교실에서는 1985년 6월부터 1992년 8월까지 35세 이상의 성인 심방중격환자를 수술로 치험한 15례에서 다음과 같은 결과를 얻었다. 1. 수술은 11례(73%)에서 인조포편 및 자가심막을 사용하여 봉합하였다. 2. 단락정도와 수축기 폐동맥압과의 관계에서 특이한 상관관계가 없었다. 3. 술전의 뉴욕심장협회 기능분류 Ⅱ가 6명 Ⅲ이 8명이었는데 술 후 Ⅰ이 8명, Ⅱ가 6명으로 증상의 호전 있었다. 4. 심방세동 4례중 술후 3례에서 지속적으로 나타났고 1례에서는 정상리듬으로 돌아왔다. 5. 수술사망율은 없었고 수술결과는 만족하였다. The study consisted of all patients over 35years old undergoing surgical repair of atrial septal defect for the period from June 1985, to August 1992. The following results were observed. 1. ASD was closed with patch in 11(73%) patients. 2. The relationship of pulmonary artery systolic pressure to Qp/Qs ratio was not significant. 3. Before operation 6 patients were in NYHA functional class Ⅱ, 8 were in class Ⅲ, After operation 8 patients were in class Ⅰ, 6 were in class Ⅱ. 4. Atrial fibrillation has persisted in 3 patients and returned regular rhythm in 1 patient after surgery. 5. There was no operative mortality and we had good surgical results regardless of patient's age.

폐동맥 교약술

한승세 慶北大學校 醫科大學 1986 慶北醫大誌 Vol.27 No.4

경북의대 흉부외과에서 1986년 1년간 5예의 폐동맥교약술을 치험하여 좋은 성적을 얻었기에 이를 보고하면서 문헌 고찰을 하였다. 1) 증예는 남 1예 여 4예였고 연령은 3개월에서 14개월사이였으며 체중은 4㎏에서 6㎏사이로서 매우 낮은 성장측도를 보였다. 2) 5예 모두 심한 심부전, 호흡기증상 및 발육부전을 호소하였다. 3) 단순심실중격결손은 2예였고 복합심실중격결손은 3예였는데 각각 개존동맥관, 심방중격결손, 또는 개존난원공을 합병하였다. 전예에서 폐고혈압을 동반하였다. 4) 4예에서 심도자법을 시행하였다. Qp/Qs는 1.2와 4.0 사이였고 Rp/Rs는 0.22와 0.67사이 이었다. 이 중 3예는 반응성폐고혈압이 인지되었다. Qp/Qs 1.2의 1예는 높은 Rp/Rs(0.67)에 의한 상대적인 저하로 생각되었다. Pp/Ps는 0.78과 0.98로 상승하여 있었다. 5) 수술은 좌전흉부절개로 개흉하였다. 폭 4-5㎜의 Dacron band를 교약띠로 하였다. band의 둘레는 21와 25㎜ 사이였다. 폐동맥교약술후에 수축기동맥압은 수축기동맥압의 약 반으로 하강하였다. 6) 술후 경과중 호흡기증상이 3예에서 발생하였으며 이 중 2예는 보조호흡치료를 필요로 하였다. 1예는 질식으로 심정지를 일으켰으나 소생술로 회복하였다. 1예는 별다른 합병증없이 양호한 경과를 보였다. 사망예는 없었다. 퇴원후 관찰기간은 최소 18일에서 최고 7개월까지 였으며 전예 모두 전신상태가 양호하였고 디곡신 및 이뇨제를 복용중이었다. 결론적으로 단순 또는 복합심실중격결손에서 폐동맥교약술은 선별된 환자에 적용될 때 좋은 성적을 얻을 수 있을 것으로 사료되었다. Five patients with ventriclar septal defect underwent pulmonary artery banding at the Thoracic and Cardiovascular Surgtery, Kyungpook National University Hospital in 1986. There were one male and four female. The ages of the patients ranged between 3 months and 14 months. Their body weight ranged from 4 ㎏ to 6 ㎏ which were below the third percentile level. All patients had suffered from severe congestive heart failure, respiratory symptoms, and failure to thrive. In two patients ventricular septal defect was present as simple wheras in the remaining three, it was associated with patent ductus arteriosus, atrial septal defect, or patent foramen ovale, respectively. All patients were complicated with pulmonary hypertension. Cardiac catheterization was performed in four patients. Qp/Qs ranged from 1.2 to 4.0. Rp/Rs from 0.22 to 0.67, and Pp/Ps from 0.78 to 0.98. Three of them were confirmed to have a reactive pulmonary hypertension. One patient showed low Qp/Ps(1.2) and significantly high Rp/Rs(0.67) which was suggested to be a pulmonary vascular disease. However, her postoperative course was uneventful. Left anterior thoracotomy were done in all patients. Dacron tape 4-5㎜ wide was used for all bandings. The circumference of band appeared to range between 21 and 25 ㎜. An average rise in systemic systolic pressure of 15 mmHg occurred following the pulmonary artery banding. Postband pulmonary artery pressure dropped to approximately half of the systemic pressure. Postoperative course were complicated with respiratory symptoms in three patients, two of whom needed an assisted ventilation. One patient had an asphyxia and subsequent cardiac arrest and then was resuscitated. There was no operative mortality. Follow-up ranged from 18 days to 7 months. All patients did well with normal growth rate at their last follow-up. They were all taking digoxin and diuretic. It is concluded that pulmonary artery banding in simple and complex ventricular septal defect might prove to be beneficial in the selected patients.

상행 대동맥 동맥류를 동반한 Marfan씨증후군 환자에서 생긴 대동맥 박리(Aortic Dissection) 1례

윤봉영,양창헌,김영조,심봉섭,이현우,류한영,정태은,박이태,한승세 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.1

본원에서는 Marfan씨증후군과 대동맥류, 대동맥판 역류로 진단받은 환자가 1년후 흉통을 주소로 내원하여 대동맥 박리로 이행한 것으로 밝혀져 응급수술을 성공적으로 치룬 1례를 경험하였기에 보고하는 바이다. The Marfans syndrome is a generalized connective tissue disease involving eye, musculoskeletal system, cardiovascular system, and inherited autosomal dominant with various expression type. The cardiovascular complications such as aortic aneurysm, aortic dissection, aortic regurgitation, mitral regurgitation and aortic dissection which usually occurs in previously normal sized aorta are poor prognostic factors. However, the aortic dissection which developed in patient with Marfan syndrome and aortic aneurysm was rare. We experienced one case of dissecting aneurysm in patient diagnosed as previous aortic aneurysm, aortic regurgitation, and Marfan syndrome, receiving successful operation.