관상동맥우회술 후 1년 개존성에 관한 연구

김기봉,김현조,성기익,Kim, Gi-Bong,Kim, Hyeon-Jo,Seong, Gi-Ik 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.12

1994년 7월부터 1995년 8월까지 서울대학교병원 흉부외과에서 시행한 관상동맥 우회술 78례 중 49례 (62,8%)에서 수술 1년 후 관상동맥 조영술을 시행하여 이식 혈관의 개존성을 조사하였으며, 수술 전,후 및 수술과 관련된 여러 위험 요소들이 개존성에 미치는 영향에 대하여 분석하였다. 관상동맥 우회술 후 평균 13.4$\pm$2.1개월 째에 관상동맥 조영술을 시행하였다. 내유동맥으로 문함을 시행한 60개소 중 3개소에서 string sign을 보였으나, 폐쇄 없이 전례에서 개존성이 유지되었으며, 요골동맥으로 문합을 시행한 4개소는 모두 개존성이 유지되었다. 복제정맥으로 문합을 시행한 81개소 중 69개소(85.2%)에서 개존성이 유지되었으며, 12개 소(14.8%)에서 폐쇄되었다. 개존성에 미치는 위험요소로 수술 전,수술 중 그리고 합병증 등의 수술 후 요소로 나누어 일원적 및 다원적으로 분석하였으며, 내유동맥의 협착 과 복재정맥의 개존성, 폐쇄에 미치는 요소들을 분석하였다. 내유동맥은 환자의 연령(60세 이상),수술 후 대동맥 내 풍선펌프의 삽입,수술 후 출혈, 및 급성신부전 등 합병증이 이식 혈관의 협착과 관련된 위험 인자였으며, 복제정맥은 우회술을 시\ulcorner 받은 관상동맥의 직경이 1.5mm 이하인 경우가 이식 혈관의 폐쇄 위험성과 관련된 위험 인자로 분석되었다(p<0.05). 관상동맥 우회술 1년 후 이식 혈관의 개존성은 내유동맥이 복재정맥보다 우수함을 보였으며 환자 연령 수술 후 대동맥 내 풍선펌프의 삽입여부, 출혈, 급성 신부전 등의 합병증 및 문합된 관상 동맥의 직경 등이 개존에 관련된 요소로 분석되었다. 이러한 결과를 토대로 수술 후 이식혈관의 폐쇄 여부에 대한 11측과 수술 방법이나 수술 후 환자의 추적 관찰에 도움을 줄 수 있으리라 생각된다. Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

전소엽의 열구에 의한 승모판막부전치험 1례

김기봉,조대윤,서경필,Kim, Gi-Bong,Jo, Dae-Yun,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.1

A cleft in the anterior mitral valve leaflet is commonly associated with atrioventricular septal defects, but may occur as an isolated phenomenon. The cleft mitral valve can cause regurgitation, and surgical treatment of the cleft leaflet should conserve the existing valve if possible. But if satisfactory hemodynamic security cannot be obtained with a reconstructive procedure, the valve should be replaced. We present one case of an isolated cleft in the anterior mitral valve leaflet. The patient showed marked mitral regurgitation in the preoperative left ventriculogram. We managed him successfully by interrupted suture repair of the cleft, and he was discharged uneventfully.

대혈관전위증의 Senning 수술요법

김기봉,노준량,Kim, Gi-Bong,No, Jun-Ryang 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.5

Recently, the arterial switch operation has received more interest and increased application for many patients with TGA [Transposition of the Great Arteries]. Not all patients, however, are suitable candidates for this approach, and its success will be measured against the Senning procedure. From June 1982 through June 1989, 48 consecutive patients underwent correction of TGA by a modification of the Senning procedure in our hospital. 34 were males and 14 females, with ages ranging from 3 months to 99 months [mean age 14 months]. The patients were divided into two groups, group I [TGA with intact ventricular septum or without significant pulmonary hypertension] and group II [TGA with significant pulmonary hypertension]. The hospital mortality was 9.5 % in group I and 55.6 % in group lI. 31 patients were discharged from the hospital after a Senning operation and have been followed a mean of 31.2 months. There were 5 late deaths, 3 in group I and 2 in group II. All patients were followed up with EKG, echocardiogram, and in several cases, Holter monitor and cardiac catheterization and angiography were also performed. There have been arrhythmias in 7, superior vena caval obstruction in 5, pulmonary venous obstruction in 2 and tricuspid insufficiency and/or right ventricular dysfunction in 16 patients. The Senning operation for Simple TGA can be performed with a low operative mortality and morbidity, but tricuspid insufficiency and/or depressed right ventricular function can be a problem with prolonged follow up.

외부 후긴장으로 보강한 합성보에 대한 실험적 연구

김기봉,정영수,최혁주,강보순,Kim, Gi Bong,Chung, Young Soo,Choi, Hyok Chu,Kang, Bo Soon 한국강구조학회 1998 韓國鋼構造學會 論文集 Vol.10 No.4

최근 2등급(DB18)으로 설계된 국도상의 일부 교량들은 교통량 수송능력 향상을 위해 외부후긴장 방법을 적용하여 보강하는 방법이 사용되고 있으나, 그러한 보강 작업의 대부분은 실험 및 해석적 검증없이 사용되고 있다. 본 논문에서는 DB18로 설계된 단순 합성보에 외부 후긴장을 적용하여 보강효과 및 거동을 실험적으로 연구하였으며 실험 결과로부터 외부 후긴장은 극한 및 항복에 대한 강성을 증가시키며 인장파괴 모드로 설계된 구조물의 인장보강에 특히 효과적임을 알 수 있었다. The application of additional post-tensioning tendons has recently been widely considered and requires very little interference with the existing structure. Several bridges on the national roadway designed as the second class were strengthened by external post-tensioning for the capacity enhancement purpose, but much of that strengthening work was not verified analytically as well as experimentally. This paper examines experimentally the behavior of simple composite steel-concrete beams designed as the second class(DB-18) When they are strengthened with external post-tensioning tendon. Test results show that external post-tensioning increases the ultimate load and the magnitude of tendon force increases the yield load but not the ultimate load.

선천성 Valsalva 동 동맥류의 수술요법

김기봉,서경필,Kim, Gi-Bong,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

Congenital aneurysm of sinus of Valsalva is one of the rare congenital heart disease, which is usually asymptomatic until rupture. The aneurysm usually ruptures into a cardiac chamber and produces an aorto-intracardiac fistula. Ruptured aneurysm is a grave lesion in that it causes heart failure and subsequent death. If, however, it is discovered in its early stages and operated on properly, it can be corrected with considerable success. Form January 1975 through December 1984, 18 consecutive patients with congenital aneurysm of sinus of Valsalva underwent corrective surgery using total cardiopulmonary bypass in our department of Thoracic Surgery. 1. The incidence was about 0.9% of surgical cases of congenital heart disease during that period. 2. 13 were males and 5 females, with ages ranging 12 years to 52 years. 3. Associated anomalies were VSD in 14, infundibular PS in 1, aberrant muscle band in RVOT in 1, and secondary aortic insufficiency in 9. 4. 17 were suggested to arise from right coronary sinus and 1 from noncoronary sinus; Among 17, 12 ruptured into right ventricle, and one from noncoronary sinus into right atrium. 5. Surgical correction was performed by means of direct suture closure with combined pledget or patch graft after aneurysm resection, and associated lesions were also corrected simultaneously. 6. There was only one case of operative mortality, and all the other patients were relatively uneventful in their follow-up studies.

Senning씨 술식에 의해 교정한 완전 대혈관전위증에서의 심전도 변화에 관한 연구

김기봉,노준량,Kim, Gi-Bong,No, Jun-Ryang 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.4

One of the most widely recognized problems in patients with TGA [transposition of the great arteries] after the Senning operation is the occurrence of arrhythmias. From June 1982 through October 1984, 22 patients, 11 with "simple" and 11 with "complex" TGA, underwent correction of TGA by a modification of the Senning operation designed to avoid dysrhythmias. 16 were males and 6 females, with ages ranging from 3 months to 27 months. [mean age 10.8 months] 7 patients [31.8%], 1 with simple TCA and 6 with complex TGA, died in the early post-operative period. The operative mortality was 9.1% in "simple" TGA, and 54.9% in "complex" TGA. There were 4 late deaths but only one of these patients died of a dysrhythmia as a possible factor. The standard ECG [Electrocardiography] checked preoperatively showed sinus rhythm in 17 [77.3%], 1 AV block in 5 [22.7%]. In 22 patients studied postoperative 1st day, the incidence of arrhythmias was 63.6%, with significant incidence compared with preoperative study. [P<0.05]. But, in 15 patients studied postoperatively at intervals from 1 month to 26 months, the incidence of arrhythmias was 26.7%, with no significant incidence compared with preoperative study [P>0.1]. Our results indicate that a modified Senning operation may reduce the frequency of surgically induced arrhythmias. The mean frontal plane P-wave axis also revealed significant deviation to the right side [P<0.05], compared with preoperative study. These findings raise the possibility that what has been called sinus rhythm postoperatively may have a different origin and conduction sequence from normal. But the rhythm seems to be functionally similar.rhythm seems to be functionally similar.

Valsalva형 동뇌류파열의 외과적 치료

김기봉,이영균,Kim, Gi-Bong,Lee, Yeong-Gyun 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.1

Over the past 11 years, from Jan. 1975 through Nov. 1985, 27 consecutive patients with congenital aneurysms of sinus of Valsalva underwent corrective surgery in our department of Thoracic Surgery. 26 were suggested to arise from right coronary sinus and 1 from noncoronary sinus: among 26, 18 ruptured into right ventricle, 1 into right atrium, 1 into pulmonary artery. And 1 from noncoronary sinus into right atrium. Among 18 cases of preoperatively diagnosed as ruptured aneurysm, the fistula was repaired through the aorta in 12, although the chamber of termination was also opened in some. Recurrent fistula occurred in 2 cases in which the ruptured aneurysm was repaired through right ventricle. It appears that repair of the fistula itself is best carried out through an aortotomy, after cross-clamping.

심막 낭종의 외과적 수술3례 보고

김기봉,김주현,Kim, Gi-Bong,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.1

Pericardial cysts are infrequent benign intrathoracic lesions. They rarely cause symptoms, and they are usually discovered on routine X-ray by chance. Over 70% of the cases occur at the right anterior cardiophrenic angle. Surgery is generally not indicated if the diagnosis of pericardial cyst can be made with certainty, and then an operation is performed to rule out other lesions. The authors present 3 cases of pericardial cyst confirmed by surgery. In two Gases Of the three, the pericardial cysts were located at the right anterior cardiophrenic angle, and in one case, at the left superior area of the posterior mediastinum. We managed them successfully by surgery, and they were discharged uneventfully.

흉곽내로 전위시킨 골격근을 이용한 농흉의 외과적 치료

김기봉,박종호,Kim, Gi-Bong,Park, Jong-Ho 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.6

From August 1990 through December 1991, 14 patients[all males] underwent int-rathoracic muscle transposition of extrathoracic skeletal muscles to treat empyemas, 6 patients had tuberculous empyemas, 4 had chronic empyemas of unknown etiology, 3 had pos-tpneumonectomy empyemas, and 1 had postlobectomy empyema. 9 patients had associated bronchopleural fistulas, Their ages ranged from 22 to 67 years, with mean age of 45.1$\pm$17. 6[$\pm$S.D] years. The serratus anterior was transposed in 13 patients, the latissimus dorsi in 12. In 11 patients, both the serratus anterior and the latissimus dorsi were transposed. The omental flap also transposed in 3 patients. To reduce the dead space in the thoracic cavity, thr-oacoplasty was also carried out in 10 patients. The number of the partially resected ribs was 3.0$\pm$0.8[$\pm$S.D.]. All operations were single stage procedures, and all wounds were closed primarily, with no permanent tubes or chest wall openings. There was no hospital mortality, and so no subsequent operation has been required. Follow-up of the patients ranged from 5 to 16 months with a mean of 9.2$\pm$3.1[$\pm$S.D] months, All the patints had no further signs or symptoms of the original infection after discharge. We conclude that intrathoracic transposition of extrathoracic skeletal muscle is an excellent method of treatment for persistent, life-threatening intrathoracic infections.

심장세동의 수술요법

김기봉,이창하,손대원,Kim, Gi-Bong,Lee, Chang-Ha,Son, Dae-Won 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.3

심방세동은 가장 흔한 부정맥 질환으로서,특히 승모판막 질환이 있는 경우에는 60%에 이르는높은 빈도의 유병율을 보이는데,심방세동 환자의 약 113에서 혈전 색전증을 일으키고,혈전 색전증이 생긴 환자의 약 60%에서는 사망에 이르거나 심각한 합병증이 초래되므로 심장질환에 대한 수술시,동반 심 방세동에 대한 적극적 인 치료가 고려되어야 한다. 서울대학교병원 흉부외과학교실에서는 1994년 4월부터 1995년 6월까지 심방세동을 동반한 심장질환 을 가진 20명의 환자에서 Maze 술식을 포함한 개심술을 시행하였다 대상환자들의 남녀 성비는 남 '녀 : 6 : 14 이 었으며, 평균연령은 48$\pm$11세 (31 ~66세) 였다. 1년이상 지 속된 만성 심방세동이 14례(70%)였고, 1년미만인 경우가 6례(30%)였으며,심방세동의 과거력은 평균 36$\pm$42개월(1~132개월)이었다. 수술전 혈전전색증의 과거력이 있었던 경우가 7례(35%), 좌심방내에 혈전이 있었던 경우가 9례(45%)였다. 동반 심장질환으로는 판막질환이 19례,심실중격결손증이 1례였 으며, Maze술식과 더불어 승모판막 및 대동맥판막 치환술이 5례, 승모판막 치환술을 시행한 경우가 4 fl, 승모판막 치환술 및 삼첨판\ulcorner 성형술 4례, 승모판막 성형술 3례, 승모판막 성형술 및 삼첨판막 성형 술이 1례, 승모판막 치환술 및 관상동맥 우회술이 1례, 대동맥판막 치환술 1례, 심실중격결손봉합술이 1례 였다. 대동맥차단시간은 평균 175 :41분(116~270분)이었다. 수술과 관련된 사망은 없었으며, 수술 후 심방세동의 재발이 16명(80%)에서 있었으나, 수술후 평균 41일째 규칙적인 심박동 소견을 보였다. 수술후 합병증으로서는 저심박출증을 보였던 경우가 3례 (15%), 술전 존재하였던 반신불수의 악화가 1 례, 그리고 급성 신부전이 1례씩 관찰되었다. 20명의 외래추적 관찰기간은 평균 16.5개월(10.5~24개월) 이었는데, 외래 추적기간 중 모든 환자에서 규칙적인 심박동의 소견을 보였으며, 정상 동방결절리듬을 보인 경우 17례 (85%)중에서 항부정맥제의 투여가 필요 없는 경우가 13례 (76%)이고 나머지 4례에서는 항부정맥제를 투여중이며, 접합부 율동을 보이는 3례 (15%) 중 2례에서는 항부정맥제를 투.i중이고, 1 례는 접합부 서맥으로 인공심박동기 (DDD-R type : AAI mode)의 삽입이 필요했다. 추적기간 중에 심에 코검사는 19명에서 시행하였는데, 우심방 수축력이 보이는 경우가 1 례 (95%) 이었고, 좌심방 수축력은 12례 (63%)에서 명백히 관찰되 었다. 심장질환에 대한 개심술시 Maze술식을 동반시행할 경우심장허혈시간이 길어지는 단점이 있으나, 최근의 발달된 심근보호법의 적용으로 수술에 따른 위험을 최소화할 수 있으므로 심방세동의 적극적 인 치료를 고려하여야 할 것으로 사료된다. .Itrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze 111 procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defEct (VSD). Mean duration of atrial fibrillation was 36 months (:42 months) (range, 1 to 132 months). T e past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombus was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVd and tricuspid annuloplasty(TAP) in 4, mitral valvuloplasty(Mln) in 3, Mln and Tln in 1, MIW and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, but, recurrent atrial fibrillation was converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegic in 1, and acute renal failure in 1. Mean follow-up interval of patient was 16.5 months (range, 10.5 to 24 months) and all patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.