중복심장판막이식의 임상적 고찰 63예 보고

서경필,양기민,Suh, Kyung-Pill,Yang, Gi-Min 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

A total of 63 patients [42 males and 21 females] underwent multiple valve replacement with artificial valves between January 1975 and August 1980 at Seoul National University Hospital. There were 38 patients with aortic and mitral valve replacement, 22 with mitral and tricuspid, and 3 with aortic, mitral and tricuspid valve replacement. The valve lesions varied from trivial to severe and most aortic and mitral valves had mixed stenosis and insufficiency, while tricuspid valves had only insufficiency. The patients were severely symptomatic in majority of the cases, and belonged to the Classes III and IV [III:45, IV:16] of the NYHA functional criteria. Hemodynamic studies were performed on all the patients. The mean pulmonary wedge pressure was remarkably increased to 19.8 mmHg in aortic and mitral valve lesions and 18.0 mmHg in mitral and tricuspid valve lesions. The mean pulmonary arterial pressure was also increased, while the cardiac index was reduced. In 1977, the average perfusion time was 245.5 minutes for aortic and mitral valve replacement and 181.6 minutes for mitral and tricuspid valve replacement. It has progressively declined to 169.2 minutes for aortic and mitral valve replacement and 123 minutes for mitral and tricuspid valve replacement in 1980. The average period of aortic occlusion also declined after the use of cardioplegic solution. Twenty deaths occurred among the 63 patients operated upon, an overall mortality rate of 30.8%. The operative mortality has declined with successive year from a level of 66.7% before 1977 to 21.1% in 1980. Fourteen patients suffered from a list of postoperative complications, which eventually resolved with adequate treatment. All the survivors were enjoying the levels of daily life activities greater than those existing before the operation.

심실중격결손증의 외과적 고찰

성숙환,서경필,Seong, Suk-Hwan,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.1

Two hundred one patients of ventricular septal defect, which were operated at Seoul National University Hospital, were analysed on clinical background during the period from January, 1975 to December, 1980. The results were as follows: 1. Of the 201 patients, 118 patients were male [58.7%] and 83 patients were female [41.3%]. Their age ranged from 15 months to 40 years, and the mean age was 8.7 years. 40% of the patients were between 4 and 8 years. 2. The most common symptoms showed frequent U RI and exertional dyspnea. 3. On Kirklin`s anatomical classification, type I constituted 26.9%, type II 58.2%, type III 12.4%, and type IV 1.0%. We showed marked increased incidence of type I VSD as compared to Caucasians* 4. 46 cases were associated with other congenital cardiac diseases. They were PDA [13 cases], AI[11 ], ASD[6], PS[10], MI[4], and Double aortic arch [1]. 5. In 128 patients, who had complete hemodynamic data and were not associated with other congenital cardiac diseases, an attempt was made to correlate the EKG findings with the hemodynamic data, and defect size with the hemodynamic data. The children had variable distribution of PA syst. pr. and Rp/Rs. But most of adults had $R_P$/$R_S$of 0.15 or less. As $P_P$/$P_S$increased, the rate of operative complication increased also. 6. When a normal EKG pattern was present, $Q_P$/$Q_S$and $R_P$/$R_S$and $P_P$/$P_S$were relatively low. When EKG findings were LVH pattern, there was diastolic volume overload to left ventricle. As RVH, there was systolic pressure overload to right ventricle. And as BVH, there was mixed pattern of diastolic volume overload to left ventricle and systolic pressure overload to right ventricle. 7. Among patients in defect was less than 1 $cm^2$ per $M^2$ of BSA, $Q_P$/$Q_S$was less than 2:1, and $R_P$/$R_S$less than 0.25, and PAsyst. pr. less than 50 mmHg, and $P_P$/$P_S$was less than 0.5. But patients with the defect greater than 1 $cm^2$ per $M^2$ of BSA had no correlationship between $Q_P$/$Q_S$, $R_P$/$R_S$, PAsyst. pr. and defect size in each other. Most of patients with the defect greater than 2 $cm^2$/$M^2$ BSA, $R_P$/$R_S$was greater than 0.5. 8. Operative mortality rate was 9.5% [19 cases] among 201 patients. And complication rate including mortality rate was 22.9% [46 cases].

휴벽에 발생한 원발성 연골육종

임승평,서경필,Im, Seung-pyeong,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.2

A 36 years old male patient underwent en bloc excision of the primary chondrosarcoma arising from 8th, 9th and 10th ribs of the chest wall. The tumor was 11.5 x 7.5 x 6.5 cm in size and was 320 gram in weight. After en bloc excision of the tumor, the defect of the chest wall was reconstructed with pedicle muscle flap and using compression dressing for 2 weeks, there happened no respiratory problem. And so we made a case report and review of literature.

폴란드 증후군 :1례 보고

박이태,홍장수,서경필,Park, I-Tae,Hong, Jang-Su,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.1

The Poland`s syndrome is very rare anomaly, which consists of congenital unilateral absence of the sternocostal pert of the pectoralis major muscle, with ipsilateral hand deformities. The clinical features are variable but all patients have absence of at least the sternal head of the pectoralis major muscle. The syndrome is not hereditary and is of unknown origin. Early recognition of Poland`s syndrome may give the provision of psychological and genetic counseling for anxious parents. We have encountered a patient with this entity, who showed striking paradoxical movement of the left anterior Ghest wall and recurrent pneumonia, and underwent successful surgical correction.

형제에서 발생한 선천성 심장질환

박표원,홍장수,서경필,Park, Pyowon,Hong, Jang-Su,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.1

Genetic and environmental factors are the two areas which have received attention in the etiology of congenital cardiac malformation. Genetic factor in many types of congenital heart disease have not been clearly delineated. Congenital heart diseases are a heterogenous category of developmental anomalies, representing in most cases the multifactorial inheritance of threshold characters, the expression of which is the product of a genetic - environmental interaction. Recently we experienced three pairs of congenital heart disease in siblings including ventricular septal defects in twin.

관상동맥정맥루의 외과적 수술 1례

심영목,홍장수,서경필,Sim, Yeong-Mok,Hong, Jang-Su,Suh, Kyung-Pill 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.1

Coronary arterial fistula was first described by Krause in 1865. Since then more than 200 examples of this lesion have been reported In the literature. It is relatively rare disease and it more commonly originate in the right than in the left coronary artery. A 9-year old male was admitted with the chief complaint of cardiac murmur and diagnosed as coronary A-V fistula at middle segment of the right coronary artery by cardiac catheterization and aortography. On the operation field, the right coronary artery was markedly dilated as one cm. in diameter from the aorta to the middle segment at acute angle of the right ventricle. Fistula opening was obliterated by one stitch horizontal mattress suture with pledget. Postoperative course was uneventful and discharged without problem.

外傷性 橫隔膜 헤르니아 : A Report of Two Caess

朴永寬,李榮根,徐景弼,李寧均 現代醫學社 1968 現代醫學 Vol.9 No.4

Two cases of traumatic diaphragmatic hernia were operated on in this department during the past 12 months period. The. first case, a 14 years old girl, had laparotomy for intestinal perforation inflicted by traffic accident at another hospital. After suturing the perforated jejunum, she was transferd to this hospital due to coincidental rupture of the left leaf of the diaphragm. Prompt reposition and repair of the diaphragm was done utilizing transthoracic approach. The second case was a 26 years old man, who was admitted with severe abdominal pain and vomiting. Two years ago he was stabbed with a knife in the left lower lateral chest wall. By chest P-A and barium enema study stomach and colon were noted in the left bemithorax. A round defect, 3.5 cm in diameter, was found in the muscular portion of the left diaphragm, which was repaired after reposition of the herniated abdominal viscera. Transthoracic approach was used in this case, too. Both cases were discharged after uneventful recovery.