Ebstein 심기형의 개심술 1례

박국양,이정호,유회성,Park, Guk-Yang,Lee, Jeong-Ho,Yu, Hoe-Seong 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.3

A patient of Ebstein`s anomaly underwent surgical repair on Oct. 24th, 1984. Tricuspid valve was replaced by 31mm St. Jude mechanical valve without plication of atrialized right ventricle. The annulus has been placed below the coronary sinus, with care not to damage the conduction system. But postoperatively complete heart block developed. Permanent pacemaker was implanted on his 12th POD. Now he has been followed up for 9 months. There was no hemodynamic problems yet.

고양이 연수 복외측부 세포의 동맥혈압 조절에 관한 연구

박국양,구용숙,김종환,Park, Guk-Yang,Gu, Yong-Suk,Kim, Jong-Hwan 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.5

Vasomotor areas were identified by stimulating various sites of the medulla electrically in adult cats anesthetized with a-chloralose and their correlation with somatosympathetic pressor or depressor responses was investigated. Followings are the results obtained: 1. Pressor areas were found in the rostral ventrolateral, the caudal ventrolateral and the rostral dorsolateral medulla. 2. Separate depressor areas were found dorsal and ventral to the rostral ventrolateral pressor area. 3. Some areas showed biphasic responses: depressor responses to low frequency[1 \ulcorner2 Hz] and pressor responses to high frequency[20 \ulcorner100 Hz] stimulation 4. Lesions on the rostral ventrolateral pressor areas abolished the somatosympathetic pressor responses to the stimulation of peripheral afferent nerves, while the depressor responses remained. Lesions on the caudal ventrolateral pressor area affected neither the pressor nor depressor responses to the peripheral nerve stimulation. 5. Lesions on the depressor areas resulted in decreased depressor responses to the peripheral nerve stimulation, but to a lesser degree than that resulted from lesions on the pressor areas. 6. A microinjection of glutamate solution to the pressor area resulted in a prolonged pressor response, while glutamate injection to the depressor areas did not elicit depressor responses. From the above results, it is concluded that there are separate pressor and depressor areas in the rostral medulla of cats and each area plays a role in somatosympathetic pressor and depressor responses, respectively.

폐관류스캔에 의한 폐절제술후 폐기능 예측

박국양,유회성,김주현,Park, Guk-Yang,Yu, Hoe-Seong,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.2

The purpose of this study is to predict postoperative lung function by perfusion lung scanning method. 40 patients who underwent lobectomy or pneumonectomy between 1983-1985 were analyzed. Mean preoperative FEV1 was 2.36 L in lobectomy cases and 1.73 L in pneumonectomy cases. Preoperative and postoperative lung function were measured by routine spirometry in sitting position. Perfusion lung scanning was performed by 99mTc-MAA radioisotope. Postoperative FEV1 and VC were predicted by the formula; Postoperative FEV1 [VC]=Preoperative FEV1 [VC] x percent function of regions of lung not to be resected. In this study, I concluded that perfusion lung scanning is a simple and useful method to predict postoperative ventilatory function after pneumonectomy of lobectomy.

수직추락후 발생한 복부대동맥 협착 1례 보

박국양,이홍섭,김창호,Park, Guk-Yang,Lee, Hong-Seop,Kim, Chang-Ho 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.1

We have recently experienced a rare case of abdominal aortic injury caused by deceleration force during fall in upright position. The patient was 43-year-old brick-layer fell from 12 meter height and sustained compression fracture of the spine and both legs. The aortic injury was unnoticed at that time. About 2 years later, marked stenosis of the distal abdominal aorta was found together with clinical manifestations of ischemia of both legs. Aorto-femoral bypass on both sides has completely relieved the symptoms, Similar type of abdominal aortic injuries could not be found in the literatures.

4첨 대동맥판막 환자에서 발생한 대동맥 판막폐쇄부전 -1례 보고-

박국양,김성철,김창호,Park, Guk-Yang,Kim, Seong-Cheol,Kim, Chang-Ho 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.3

A 11 year-old girl with quadricuspid aortic avlve associated with regurgitation left superior vena cava and chromosomal anomaly is presented. The quadricuspid valve was unexpectedly found during operation for aortic valve replacement. The aortic valve consisted of 4 equal-sized cusps and retrospective review of the aortogram revealed the aortic valve to have 4 cusps also. To the best of our knowledge, this combination of anomalies has not been reported in Korea previously.

심장 관통상 후 잔류한 심장 내 이물질의 수술적 제거

박국양 ( Kook Yang Park ),박철현 ( Chul Hyun Park ),최창휴 ( Chang Hyu Choi ),이재익 ( Jae Ik Lee ),전양빈 ( Yang Bin Jeon ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

A 27 year-old man, who had a penetrating cardiac injury due to a metal fragment was transferred to our hospital. At admission, his vital signs were stable, and his chest film showed a foreign-body-like finding in the heart silhouette. We evaluated the patient with chest computed tomography and echocardiography for further information. Finally, we removed the metal fragment from the left ventricle by using a cardiopulmonary bypass. (J Trauma Inj 2012;25:267-270)

기획논문 : 뇌사와 장기이식 ; 장기이식과 의료윤리

박국양 ( Kook Yang Park ) 한국의료윤리학회 2000 한국의료윤리학회지 Vol.3 No.1

심장 스텐트 시술과 의료사고 예방

김경례,박국양,Kim, Kyoung Reay,Park, Kook Yang 대한의료법학회 2017 의료법학 Vol.18 No.2

Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials. 관상동맥 질환은 2017년 고령사회로 진입한 우리나라에서 앞으로 더 많은 관심을 가질 것이다. 고령화가 될수록 고혈압, 당뇨 등 복합적인 질환이 합병되어 혈관상태도 상대적으로 더 나빠져 관상동맥 질환에 걸릴 가능성이 높기 때문이다. 심혈관 질병은 심장외과와 심장내과와의 긴밀한 협진이 필요하다. 따라서 협심증이나 심근경색증환자를 먼저 진료하게 되어 있는 우리나라의 임상현장에서 객관적인 심장내과 의사의 치료방침에 대한 판단은 매우 중요하다. 최근 심장내과의 비수술적 중재술이 발전하고 있지만 무리한 스텐트 시술로 의료사고도 발생하고 있다. 특히 관상동맥 3개혈관이 모두 막힌 삼중혈관이거나 석회화가 심해 혈관 상태가 좋지 않은 경우가 문제이다. 또한 심장외과 의사가 없는 병원에서 무리하게 경피적관상동맥중재술을 실시하다가 응급상황이 발생할 경우 관상동맥이식술 등 외과적 대처가 어려운 경우가 종종 발생한다. 최근 2년간 한국소비자원(소비자분쟁조정위원회) 의료분쟁 조정결정 8사례를 분석한 결과, 심장 중재술을 시행한 병원 중 심장외과 의사가 상주한 곳은 2곳으로 확인됐다. 8사례 모두 심장내과 진료 후 풍선확장술 및 스텐트 삽입한 경우로 7명이 사망했고 이중 5명은 시술 당일에 사망했다. 8사례 중에 3중혈관 환자는 5건이고, 나머지도 석회화가 심하거나 완전폐쇄로 혈관상태가 좋지 않은 상태였다. 2017년 심장내과 스텐트 시술 건수 조사 보고에 의하면 3개 이하 약물 방출 스텐트 시술이 98%로 보고됐다. 2015년 스텐트 시술 건수가 38,922건으로 약800건(2%)은 스텐트가 4개 이상 사용된 것으로 추정된다. 무리한 스텐트 시술로 마지막 여명에 급사함으로써 신변정리 기회상실은 물론 여명단축에 따른 손해로서 '지도 설명의무' 책임을 물어 전 손해에 대한 배상을 신중하게 고려할 필요가 있다. 최근 심평원 보험적용 스텐트 시술 개수 제한규제가 없어지면서 무리한 시술과 심장외과 의사 확충에 대한 문제가 있다. '다학제통합진료' 같은 병원차원의 해결방안은 물론 필수요원에 해당하는 심장외과를 공무원으로 확충하는 등 국가차원의 해결방안이 요구된다.

흉골 출혈에 대한 fibrin glue의 지혈 효과

이홍섭,박국양,김창호,Lee, Hong-Seop,Park, Guk-Yang,Kim, Chang-Ho 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

Bleeding from bone marrow after sternotomy for open cardiac surgery can be sometimes difficult to control and even lead to reoperation for hemostasis. A clinical comparative study was carried out to demonstrate the hemostatic effect of fibrin glue [Beriplast] for sternal marrow bleeding after sternotomy for open heart surgery. Postoperative blood loss was measured in two patient groups, group A included 19 patients operated upon from June to October 1987 and the fibrin glue was applied to the sternal marrow together with collagen fleece and group B consisted of 22 patients from January to May 1987 and only collagen fleece was applied without fibrin glue. There was no difference between two groups in age and sex distributions, coagulation state, method of extracorporeal circulation and operative management. The blood loss one hour after operation was 2.04 ml/hr/kg in group A and 3.55 ml/hr/kg in group B [P<0.001]. The most significant difference was observed during the first 4 hours after surgery with 1.34 ml/hr/kg versus 2.05 ml/hr/kg. over the following 20 hours the amount of drainage from the chest tubes was identical in both groups. Fibrin glue reduces blood loss after open heart surgery by local hemostasis at sternum. Our study has shown that local application of fibrin glue to sternal marrow is an effective method of controlling the sternal bleedings. No side effect or complication of fibrin glue was noted.

자연위치의 복재정맥을 이용한 하지동맥 우회술 1례 보

이홍섭,박국양,김창호,Lee, Hong-Seop,Park, Guk-Yang,Kim, Chang-Ho 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.1

The Saphenous vein is still the graft of choice for bypass of small calibered peripheral arteries, and many recent studies revealed that the "In Situ" technique had higher rate of long term patency than the conventional "reversed" one. A 71-year-old male who had atherosclerotic obstruction in the superficial femoral and popliteal trifurcation underwent In Situ saphenous vein arterial bypass. The saphenous vein is exposed by a long medial skin incision over the course of the vein. All branches of vein are ligated. A olive-tipped metal needle is introduced into the vein from above and everts the valves. The patient has been followed for 2 months after operation. The graft remained pulsatile and the gangrenous areas on the toe proceeded to heal. We think In situ vein bypass offers an excellent and safe method of revascularization of the arterial occlusion below the knee although it is technically demanding and the time consuming. time consuming.