체외 순환을 이용한 감염된 영구 심박동기 도선의 제거 −2예 보고−

오탁혁,김근직,이종태 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.1

Implanting a pacemaker is the most often used intervention for treating bradycardia. The most commonly used pacemaker is the intracardiac pacemaker, yet it can have many complications. An infected pacemaker can spread to systemic infection and the condition of the patient can quickly get worse, so if an infected pacemaker is suspected, then the pacemaker must be removed. Apart from the use of interventional methods such as a loop or a weight, we can take a more aggressive approach by using extracorporeal circulation for removal of the pacemaker. We report here on two cases in which extracorporeal circulation was used to remove the infected pacemakers. 심박동기는 동기능 부전 증후군에서부터 완전 방실차단까지 서맥의 치료에 가장 보편적으로 사용되는 중재적 치료다. 일반적으로 경정맥을 통한 심내 심박동기를 많이 사용하고 있으나 감염 및 혈전증, 박동기의 기능부전, 부정맥, 심근천공, 삼첨판 폐쇄부전증 등의 합병증이 발생할 수 있다. 심박동기의 감염은 전신감염으로 이행되어 환자 상태가 빠르게 악화될 수 있으므로 감염으로 의심되면 제거하는 것이 원칙이다. 추나 올가미 등을 이용한 방법등 비수술적인 방법외에도 체외순환을 이용한 적극적인 제거도 환자 상태에 따라 고려해야 할 것이다. 감염된 심박동기를 체외순환을 이용하여 제거한 두 개의 증례를 보고하는 바이다.

Edwards MC3 Annuloplasty System을 이용한 삼첨판 성형술의 조기 성적

오탁혁,조준용,이종태,김근직,김대현 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.1

Background: Functional tricuspid regurgitation (TR) greater than or equal to a mild grade requires tricuspid valvuloplasty, and tricuspid valvuloplasty with ring annuloplasty has shown good outcomes. We report here on our early experience with the Edwards MC3 annuloplasty system (Edwards LifeSciences, Irvine, CA). Material and Method: From November 2004 to July 2006, 72 patients with tricuspid annular dilatation and TR underwent tricuspid valvuloplasty with using the Edwards MC3 annuloplasty ring. Sixty-eight patients were operated on via median sternotomy and four patients were operated on using robotic assisted minimal invasive thoracotomy. The patient population included 21 males and 51 females and their mean age was 53.9±12.3. The mean grade of TR, as assessed by the preoperative echocardiography, was 2.2±1.0. The mean NYHA functional class was 3.1±0.8. The mean left ventricular ejection fraction was 57.0±9.9%. Result: The TR and NYHA functional class, as assessed by postoperative echocardiography, was significantly reduced (mean=0.4±0.6 and 2.0±0.7, respectively p<0.001). There was one case of hospital mortality. One patient required permanent pacemaker insertion for third degree atrioventricular block. Conclusion: Our study shows that the Edwards MC3 remodeling ring is easy to implant and it effectively corrects functional TR with excellent clinical and echocardiographic outcomes. Further follow-up and a larger clinical series are required to establish the long-term stability of this repair technique. 배경: 경도이상의 기능성 삼첨판막 폐쇄부전이 있는 경우 삼첨판 성형술이 널리 시행되고 있으며, 판륜링을 이용한 성형술이 우수한 성적을 나타내고 있다. 우리는 새로운 삼차원적 모양의 삼첨판륜링(Edwards MC3 annuloplasty system [Edward LifeSciences, Irvine, CA])을 이용한 삼첨판 성형술의 조기성적을 보고하고자 한다. 대상 및 방법: 2004년 11월부터 2006년 7월까지 삼첨판륜의 확장 및 경도이상의 삼첨판막 폐쇄부전이 있는 72명의 환자에서 Edwards MC3 annuloplasty ring을 이용한 삼첨판 성형술을 시행하였다. 72명의 환자 중, 68명에서 정중흉골절개술을 하였고 4명에서 로봇팔을 이용한 최소절개 개흉술을 시행하였다. 남녀비는 21 : 51이었고 평균 나이는 53.9±12.3세였다. 수술 전 삼첨판막 폐쇄부전은 평균 2.2±1.0도였으며 평균 NYHA functional class는 3.1±0.8, 평균 좌심실박출계수는 57.0±9.9%였다. 결과: 삼첨판막 폐쇄부전과 NYHA functional class는 각각 0.4±0.6, 2.0±0.7으로 의미있게 감소하였고 삼첨판막 협착은 없었다(p<0.001). 병원 사망은 1명이 있었으며 술 후 합병증은 3도 블록이 발생하여 영구적 인공심박동기 삽입을 한 경우가 1명이 있었다. 결론: 3차원적 모양의 삼첨판륜링은 장착하기 용이하며 임상적, 심초음파 검사상 단기성적은 우수한 것으로 판단된다. 그러나 이 판막륜링의 장기 성적에 대하여는 연구 대상환자에 대한 정기적인 추적관찰 및 검사가 필요하고 더 많은 임상 적용 및 경험이 필요할 것으로 판단된다.

신생아기 개심술의 조기 성적

오탁혁,김규태,김근직,이종태,조준용 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.4

Background: Remarkable progress has recently been made in achieving successful early repair of congenital heart disease with using cardiopulmonary bypass in the neonatal period. The aim of this study is to evaluate our short-term outcomes for performing neonatal cardiac surgery under extracorporeal circulation. Material and Method: Fifty five neonates underwent open heart surgery from February 2002 to December 2007. The mean ages and body weight was 13.5 days and 3.2 kg, respectively. The diagnoses of the patients were transposition of the great arteries (14), total anomalous pulmonary venous connection (7), large ventricular septal defect (VSD) (7), coarctation of the aorta with VSD (6), interrupted aortic arch (5) and others (16). Result: Six patients had difficulties being weaned from extracorporeal circulation. Four patients left the operating room with an open sternum. Low cardiac output syndrome and acute renal insufficiency were observed in 3 patients each, respectively. Post-operative complications were observed in 27 patients (49.1%). The postoperative mortality was 12.7% (7 patients); 5 patients experienced early hospital death and 2 experienced late death (2). Conclusion: In our hospital, early surgical repair with extracorporeal circulation in neonates was feasible with tolerable mortality. Further follow-up is required to establish the long-term survival and complications. 배경: 최근 신생아기에 선천성 심질환을 심폐우회술을 이용해서 성공적인 조기 교정을 하는데 있어서 상당한 진전이 이루어졌다. 이 연구의 목적은 체외순환 하에서의 신생아 개심술의 조기 성적을 알아보는 것이다. 대상 및 방법: 2002년 2월부터 2007년 12월까지 55명의 신생아에서 개심술을 시행하였다. 술전 상태, 수술 방법, 술후 이병률과 사망률을 알아보기 위해서 후향적인 조사를 하였다. 평균 연령과 체중은 각각 13.5일, 3.2 kg이었다. 진단은 대혈관전위 14예, 전폐정맥연결이상 7예, 큰 심실중격결손 7예, 심실중격결손이 동반된 대동맥축착 6예, 대동맥궁단절 5예 및 기타 16예로 분포되어 있었다. 결과: 평균 대동맥차단시간은 62.2분이었다. 심도 저체온하 완전순환정지(평균 기간 22.5분)는 6예에서 적용되었다. 술후 체외순환의 이탈이 어려웠던 경우가 6예 있었다. 흉골을 봉합하지 못하고 수술실을 나왔던 환아가 4명 있었다. 저심박출증과 급성 신부전이 각각 3예씩 있었다. 평균 인공호흡기 사용기간은 70.5시간, 평균 집중치료실 재원기간은 14.9일이었다. 술후 합병증은 27명(49.1%)에서 나타났다. 술후 평균 추적관찰 기간은 23.8개월이었다. 술후 사망률은 12.7% (7예)였는데, 조기 병원사망예가 5예, 만기 사망예가 2예였다. 결론: 최근 본원에서의 체외순환을 이용한 신생아기 개심술의 조기 성적은 비교적 양호하였다. 향후 장기 생존과 만기 합병증을 알아보기 위해서 더 긴 추적관찰을 요한다.

피하기종의 Vacuum-assisted Closure Therapy

오탁혁 ( Tak Hyuk Oh ),이상철 ( Sang Cjeol Lee ),이덕헌 ( Deok Heon Lee ),조준용 ( Joon Yong Cho ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

Subcutaneous emphysema is a benign condition following trauma (pneumothorax and oropharyngeal), cervical or thoracic procedures, and mediastinal infection. However, severe subcutaneous emphysema may be related to serious complications such as respiratory failure, airway compromise, and tension- related phenomena. Many alternative therapies have been tried to treat patients with this condition. We report our experience with vacuum-assisted closure therapy for treating patients with severe subcutaneous emphysema. [ J Trauma Inj 2015; 28: 276-279 ]

흉부 둔상으로 골절된 늑골로 인해 발생한 좌심실 천공

오탁혁 ( Tak Hyuk Oh ),이상철 ( Sang Cjeol Lee ),이덕헌 ( Deok Heon Lee ),조준용 ( Joon Yong Cho ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

The perforation of a cardiac chamber by a fractured rib after blunt trauma is a rare event. Here, we report the case of patient who was referred for multiple rib fractures after a fall from a height. The patient was found to have a penetrating cardiac injury which was detected on a computed tomography chest scan. Computed tomography is a useful screening tool for victims of blunt chest trauma. Once cardiac perforation has been confirmed or is highly suspected, it is important to preserve the patient’s vital signs until reaching the operating room by minimally manuplating the chest wall and permitting hypotension, which also prevents exsanguinating hemorrhage. For the same reasons, early cardiac tamponade may also improve the patient’s survival. [ J Trauma Inj 2014; 27: 192-5 ]

Mid-Term Outcomes of Single-Port versus Conventional Three-Port Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax

정한나,오탁혁,조준용,이덕헌 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.3

Background: The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. Methods: Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. Results: The mean follow-up duration was 13.4±6.5 months in the s-VATS group and 28.7±3.9 months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence- free survival rate between the s-VATS and t-VATS groups. Conclusion: No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore

Cardiac Perforation Caused by Bone Cements as a Complication of Cement Augmented Pedicle Screw Fixation Using the Fenestrated Pedicle Screw: A Case Report

홍성욱,오탁혁,전재민,이영석,김경태 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

Cement-augmented fenestrated pedicle screw fxation is becoming more popular forosteoporotic patients. Although several reports have been published on leakage-relatedproblems with bone cement, no cases of cardiac perforation afer cement-augmentedpedicle screw fxation have been reported. We present a case of cardiac perforation afercement-augmented fenestrated pedicle screw fxation. A 67-year-old female was admitted toour hospital with complaints of dyspnea and chest pain afer lumbar surgery. She had beentreated with L4–5 lumbar interbody fusion and percutaneous pedicle screw fxation withbone cement augmentation seven days earlier for degenerative spondylolisthesis. The rightchest pain was observed a day afer the surgery; she was treated conservatively but it did notimprove for 7 days afer surgery. Chest computed tomography (CT) revealed a hemothoraxand a large sharp bone cement fragment that perforated the right atrium. Bone cement canbe removed with thoracotomy surgery. We have to be aware of cement leakage through thenormal venous drain system around the vertebral body. We also have to consider a detailedcardiac workup, which may include chest CT or echocardiography, if a patient complains ofchest pain or dyspnea afer cement augmentation

Staged Management of a Ruptured Internal Mammary Artery Aneurysm

권오영,김근직,오탁혁,이영옥,이상철,조준용 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.2

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.

Traumatic Right Pulmonary Artery Rupture after Accidentally Being Stepped on the Chest

손신아,배재민,오탁혁,도영우,석양기,조준용 대한흉부외과학회 2019 Journal of Chest Surgery (J Chest Surg) Vol.52 No.5

Traumatic pulmonary artery rupture is a rare, life-threatening injury. Currently, no strict guidelines for its management exist. Herein, we report a successful surgical repair of a right pulmonary artery rupture caused by being stepped on.

Outcomes of Nonpledgeted Horizontal Mattress Suture Technique for Mitral Valve Replacement

김근직,이영옥,조준용,오탁혁,이종태 대한흉부외과학회 2014 Journal of Chest Surgery (J Chest Surg) Vol.47 No.6

Background: Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. Methods: We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. Results: In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. Conclusion: We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.