From July 1988, open heart surgery was performed on fifty adults utilizing the pulmonary artery vent instead of conventional venting methods. The open heart procedures included were twenty coronary artery bypass grafitings(CABG), ten mitral valve replacements(MVR), ten aortic aneurysms(DA), and three ventricular septal defects(VSD). To determine the effectiveness of the pulmonary artery venting, non-cardiotomy procedures(CABGs') were classified into satisfactory, ordinary and poor group in terms of the degree of chamber dilatation throughtout the entire period of the operation. Again, cardiotomy procedures were categorized as degree 0, I, II, III and IV according to the clearness of the operative fields. Out of the twenty non-cardiotomy procedures, 17 cases(85%) were fallen into the satisfactory group, while the remained three cases into ordinary group. The degree of satisfaction, in cardiotomy procedures, was III or IV in patients having mitral valve replacement, aortic valve replacement, double valve replacement or dissecting aneurysm repair, and it was I or II in patients having ventricular septal defect repair, on the other hand. There was neither bleeding complication nor stenosis on the vent site. There was only one suspicious perfusion defect on routine postoperative perfusion lung scan. The study demonstrated that venting the pulmonary artery was very helpful in most of the procedures, because it was easy to reach, removal of the vent cannula was safe and simple and complications were trivial.
Adult ; Aneurysm, Dissecting ; Aortic Valve ; Catheters ; Constriction, Pathologic ; Coronary Artery Bypass ; Dilatation ; Hand ; Heart ; Heart Septal Defects, Ventricular ; Hemorrhage ; Humans ; Lung ; Mitral Valve ; Perfusion ; Pulmonary Artery* ; Thoracic Surgery

No abstract available.
Aorta* ; Endothelium-Dependent Relaxing Factors*

No abstract available.
Heart, Artificial*

No abstract available.
Paralysis* ; Phrenic Nerve*

Purpose: The safety and efficacy of minimally invasive techniques in congenital heart surgery were tested in this study. Materal and method: Between July 1997 and November 1997, a total of 46 children were underwent minimally invasive cardiac operations at Seoul National University Children's Hospital. Age and body weight of the patients averaged 34.6+/-41.8 (Range: 1~148) months and 14.5+/-9.9 (Range: 3.0~40.0) kg, respectively. Twenty eight patients were male. Preoperative surgical indications included 15 atrial septal defects, 25 ventricular septal defects, 1 foreign body in aorta, 3 partial atrioventricular septal defects, 1 total anomalous pulmonary venous connection (cardiac type), and 1 tetralogy of Fallot. After creating a small lower midline skin incision starting as down as possible from the sternal notch, a vertical midline sternotomy extended from xyphoid process to the level of the second intercostal space, where one of the T-, J-, I-or inverted C-shaped lower lying mini-sternotomy was completed with a creation of unilateral right or bilateral trap door sternal opening. A conventional direct aortic and bicaval cannulation was routine. RESULT: A mean length of skin incision was 6.1+/-1.0 (range: 4.0~9.0) cm. A mean distance between the suprasternal notch and the upper most point of the skin incision was 4.0+/-1.1 (range: 2.0~7.0) cm. Mean cardiopulmonary bypass time, aortic cross-clamp time, and the operation time were 62.9+/-20.0 (range: 28~147), 29.8+/-12.8 (range: 11~79), and 161.1+/-34.5 (range: 100-250) minutes. A mean total amount of postoperative blood transfusion was 71.0+/-68.1 (range: 0~267) cc. All patients were extubated mean 11.3+/-13.8 (range: 1~73) hours after operation. A mean total amount of analgesics used was 0.8+/-1.8 (range: 0~9) mg of morphine. The mean duration of stay in intensive care unit and hospital stay were 35.0+/-32.2 (range: 10~194) hours and 6.2+/-2.0 (range: 3~11) days. There were no wound complications and hospital deaths. CONCLUSION: This short-term experience disclosed that the minimally invasive technique can be feasibly applied in a selected group of congenital heart disease as well as is cosmetically more attractive approach.
Analgesics ; Aorta ; Blood Transfusion ; Body Weight ; Cardiopulmonary Bypass ; Catheterization ; Child* ; Deception ; Foreign Bodies ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Morphine ; Seoul ; Skin ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Tetralogy of Fallot ; Thoracic Surgery* ; Wounds and Injuries

It is very important to tallow that pelvic lymphadenectomy associated with proctectomy must be based on the principle of oncologic surgery and encompass all predictable pathways of extension of rectal cancer for curative surgical resection. We investigated the characteristis of lymph node metastasis in patients with rectal cancer prospectively. 108 consecutive patients with rectal cancer underwent curative surgical resection were enrolled in this study. Rectal cancers were divided into two groups, upper and mid-lower. Upper rectal cancer was defined as the tumor above the peritoneal reflexion. Lymph nodes were stratified as mesorectum, distal mesorectum (defined as distal part more than 2 cm from the lower margin of the tumor), intemal iliac, common iliac, presacral, superior rectal artery, inferior mesenteric artery, paraaortic lymph node. Average number of sampled nodes in these groups 18.5+/-10.7, 3.6+/-3, 2.3+/-3, 1.8+/-1.3, 4 +/-4.1, 1.6+/-2, 3.1+/-3.2, 5.4+/-4.7 respectively. 60 of all patients showed positive lymph node. The over all percentages of patients with positive lymph node was 53% in mesorectum, 12% in distal mesorectum, 8% in intemal iliac, 4.5% in common iliac, 4.5% in presacral, 10% in superior rectal artery, 6.5% in inferior mesenteric artery, 4% in paraaortic lymph node. The over all percentages of patients with positive lymph nodes in each group were 60% (27/45), 9% (4/45), 6.5% (3/45),2% (1/45), 2% (1/45), 13% (6/45), 11% (5/45), 1% (1/45) respectively in upper rectal cancer, 49% (31/63), 14% (9/63), 9.5% (6/63), 6% (4/63), 6% (4/63), 8% (5/63),3% (2/63),5% (3/63) respectively in mid-lower rectal cancer. There were skip metastasis in 3 patients with upper rectal cancer, 2 patients with mid-lower rectal cancer. Age, depth of invasion, tumor size, tumor differentiation among clinicopathologic factors were predictive factors of lymph node metastasis to mesorectum. Risk factors of metastasis to extra-mesorectal lymph node were younger age (<40), poorly differentiation, larger tumor size (>5.0 cm), involved circimferential (>50%), and positive CA 19-9 (>37 U/ml). These results suggest that more careful upward lymphadenectomy must be carried out especially in upper rectal cancer and also careful lateral dissection in selected patients and more generous excision of distal mesorectum especially in mid-lower rectal cancer is needed for curative resection according to clinicopathologic factors.
Arteries ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mesenteric Artery, Inferior ; Neoplasm Metastasis* ; Prospective Studies* ; Rectal Neoplasms* ; Risk Factors

No abstract available.
Animals ; Dogs* ; Heart* ; Heart-Lung Transplantation*

Marfan syndrome may be associated with various cardiovascular complications, but expanding abdominal aneurysm is a relatively rare complication. A 32 year old male patient was admitted to S.N.U.H. because of pulsating abdominal mass and back pain. The patient was diagnosed as a case of expanding abdominal aortic aneurysm and annuloectasia of aorta due to Marfan syndrome. Abdominal aneurysm was located from 3 cm below the origin of left renal artery to left common iliac artery. Abdominal aneurysm was operated successfuly. The size of abdominal aneurysm was about 2815cm. The pathological findings of surgically removed abdominal aortic wall showed loss of elastic fibers and fragmentation of fibers in media. A case of expanding abdominal aortic aneurysm due to Marfan's syndrome was reported with a review of literatures.
Adult ; Aneurysm* ; Aorta ; Aortic Aneurysm, Abdominal ; Back Pain ; Elastic Tissue ; Humans ; Iliac Artery ; Male ; Marfan Syndrome* ; Renal Artery

We experienced a case of unusual complication following esophageal reconstruction. In 1969, accidentally the patient swallowed lye and was developed benign esophageal stricture one year later. In 1972, esophageal reconstruction with right colon was done but pus was drained out of the abdominal wound. After then wound disruption and healing were repeated. In 1996, stenosis of colonic graft was found and resection of stenotic area and end to end anastomosis was done. We concluded that it was developed inflammatory change of graft by intraoperative infection.
Abscess* ; Colon ; Constriction, Pathologic* ; Esophageal Stenosis ; Humans ; Lye ; Postoperative Complications ; Suppuration ; Transplants ; Wounds and Injuries

Tetrasomy 18p, one of the most commonly observed isochromosomes, consists of two copies of the p arms on chromosome 18[i(18p)]. It is known as a de novo occurrence of non-disjunction or centromeric mis-division during meiosis II in the vast majority of cases. It has a prevalence of 1/140,000-180,000 live births and affects both genders equally. A 28-year-old woman was referred at 33+2 weeks gestation to rule out fetal congenital heart disease. Her prenatal ultrasonography showed intrauterine growth retardation, cardiomegaly, and imperforate anus. Doppler ultrasonographic finding showed fetal anemia. Tetrasomy 18p was confirmed by conventional karyotyping and fluorescence in situ hybridization. Because of its very low prevalence rate, only several cases of tetrasomy 18p has been reported worldwide and it has not yet been reported in Korea before. Therefore, we report a case of prenatally diagnosed tetrasomy 18p.
Anemia ; Aneuploidy ; Anus, Imperforate ; Arm ; Cardiomegaly ; Chromosomes, Human, Pair 18 ; Coat Protein Complex I ; Female ; Fetal Growth Retardation ; Fluorescence ; Heart Diseases ; Humans ; In Situ Hybridization ; Isochromosomes ; Karyotyping ; Korea ; Live Birth ; Meiosis ; Pregnancy ; Prenatal Diagnosis ; Prevalence ; Tetrasomy ; Ultrasonography, Prenatal