• Vascular Specialist International
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• 제34권4호
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• pp.117-120
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• 2018

The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.

• Journal of Chest Surgery
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• 제18권1호
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• pp.128-139
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• 1985

Seven patients [six women and one man] with obstruction of hepatic portion of inferior vena cava was operated on, from May, 1969 to January, 1985. Of seven patients, six were undergone corrective operation for IVC obstruction and another one was not operated because of far advanced liver cirrhosis. The occlusions were found at or close to the level of diaphragm and they were membranous or diffuse with or without thrombi. Most of their symptoms were referable to either inferior vena caval or hepatic venous obstruction and onset of the symptoms was usually gradual, beginning between the age of their thirties and forties. Most of the patients showed marked elevation of peripheral venous pressure of lower extremity [29-40 cm H2O] preoperatively, which decreased significantly after corrective operation [17-30 cm H2O]. Venous catheterization for pressure study and venography were essential for confirming the diagnosis. Of six cases, in which corrective operations were done, Transatrial membranotomy with or without IVC dilatation were performed in five cases [case 1, 2, 3, 5, 6], using cardiopulmonary bypass and in another one case, bypass operation between IVC, distal to obstruction, and RA was done using Dacron tube graft under the thoracoabdominal incision. All survived and their conditions were improved.

• Journal of Chest Surgery
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• 제27권1호
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• pp.52-56
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• 1994

This is case report of total anomalous pulmonary venous return with atrial septal defect which were corrected surgically by intracardiac procedure under total cardiopulmonary bypass.Two patients were supracardiac type,cardiac and mixed type was each one.The mixed type was three years old female patient.She was diagnosed as atrial septal defect with partial anomalous pulmonary venous return[right pulmonary vein drains into superior vena cava and right atrium] and corrected as usual.After operation,she underwent exertional dyspnea and frequent tachycardia.Chest x-ray film showed pulmonary congestion.Follow up cardiac cineangiogram revealed that left pulmonary vein also anomalously drained into left innominate vein through vertical vein.Through left thoracotomy,anastomosis was successfully carried between left atrium and vertical vein without cardiopulmonary bypass and there was no sign of pulmonary artery obstruction for two years follow up.The other three patient were corrected successfully without complication and got good result.

• Journal of Chest Surgery
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• 제36권11호
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• pp.834-838
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• 2003

배경: 개심술 후 공기 제거는 매우 중요한 시술이다. 그러나, 심장 내의 공기 분포, 시술로 인한 합병증, 심폐바이패스의 시간 연장으로 여전히 제한적이다. 인위적으로 동정맥루를 만들어 공기를 제거하고 그 효과를 경식도초음파로 확인하였다. 대상 및 방법: 심폐바이패스 완료 직전에 압력표준변환선을 동맥과 정맥회로에 설치해둔 마개에 연결하면 동맥과 정맥사이에 작은 동정맥루가 형성된다. 심장 내의 공기정도와 공기제거시간은 경식도 초음파와 압력표준변환선으로 확인하였다. 결과: 간단한 방법으로 심폐바이패스의 시간단축, 수분 내에 공기가 제거되는 것을 경식도초음파로 확인하였다. 결론: 동맥과 정맥 사이에 작은 연결관으로 동정 맥루를 만드는 것은 매우 간단하며 개심술 후 공기 제거와 공기색전증 예방에 효과적인 방법이다.

• Journal of Chest Surgery
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• 제39권1호
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• pp.68-71
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• 2006

종격동 섬유화로 인한 상대정맥증후군을 가진 41세의 남자 환자를 정맥 우회단락을 사용하여 상대정맥 재건술을 시행하였다. 환자는 수술 전 상당히 높은 중심 정맥압을 보였으며, 수술 시 측행혈관이 차단될 수밖에 없어, 수술에 따른 신경학적 합병증의 위험성이 높았다. 수술은 막힌 상대정맥과 무명정맥을 제거한 후에 자가 심낭을 튜브 모양으로 만들어 재건술을 시행하였으며, 수술 중에 정맥 우회 단락을 이용하여 두경부 및 상지의 정맥환류를 유지하였다. 우회단락의 사용은 상대정맥증후군의 수술 시 정맥압을 즉시 감소시키고, 수술시간에 따른 부담이 없었으며, 수술 후 합병증 발생을 예방하는데 효과적이었다.

• Journal of Chest Surgery
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• 제43권5호
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• pp.534-537
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• 2010

5세 때에 교통사고 후 지혈목적으로 대퇴정맥 결찰을 받은 26세 남자 환자가 입원 5일 전 축구하다 생긴 좌측 하지의 정맥궤양에서 나타난 출혈을 주소로 입원하였다. 환자는 좌측 하지에 하지 정맥류의 발생과 정체성 피부염과 정맥 궤양이 있었다. 좌측 대퇴정맥 혈류를 우측 대퇴정맥으로 환류시키려고 우측 대복재정맥을 이용하여 동정맥루가 있는 우회로 조성술을 시행하였다. 우회로의 원활한 개통을 위해 만든 동정맥루는 처음 수술 6주 후에 폐쇄하였다. 환자는 수술 후 6개월 간 좌측 하지 둘레가 비교적 일정하게 유지되고 있다. 이와 같이 만성 대퇴정맥 결찰 환자에 대한 정맥 crossover 우회로 조성술 1예를 치험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권9호
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• pp.801-803
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• 1994

We report a case of a 45-year-old woman with Budd-Chiari syndrome caused by the obstruction of the inferior vena cava just below the diaphragm. Transatrial dilatation or membranotomy was not possible due to the severe fibrotic obliteration of the inferior vena cava. Instead, cavoatrial bypass with a Dacron graft[20 mm-Vascutek] was performed under the median sternotomy and median abdominal incision.The postoperative course was uneventful and generalized symptoms were much improved. During the following period[6 month] the graft patency was maintained with no recurrence of symptoms.

• Journal of Chest Surgery
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• 제13권2호
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• pp.110-117
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• 1980

This is a case report of total anomalous pulmonary venous drainage with Atrial septal defect, which was corrected surgically by intracardiac procedure under total cardiopulmonary bypass. This 9 years old girl, she complained mild cyanosis, exertional dyspnea, and frequent upper respiratory infection from 3 months age. The chest X-ray showed cardiomegaly and a "snow man appearance", she has systolic murmur with splitting of S2. The diagnosis was confirmed with right heart catheterization, the catheter was reached to right pulmonic vein passed through right atrium, right superior vena cava, innominate vein, left superior vena cava, and common venous trunk. On 28th, Dec. 1979, an anastomosis between common pulmonary venous trunk and left atrium, Pericardial patch closure of ASD, and ligation of left superior vena cava were performed with Extra-corporeal circulation. The postoperative course was uneventful and discharged with excellent general condition.Total Anomalous Pulmonary Venous Drainage with A.S.D. with A.S.D.

• Journal of Chest Surgery
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• 제28권1호
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• pp.7-10
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• 1995

Mixed Venous oxygenation saturation[SvO2 is a variable determined in part by the externally controlled factors and in part by the patient during CPB. I monitored the SvO2 and tested it as a parameter for the regulation of pump output and as a criteria for the need of inotropics after CPB. With the help of SvO2, I increased the pump flow especially during rewarming for more optimal oxygenation of cells. After CPB, the calculated cardiac index was used as an indicator for the need of inotropic support with greater accuracy and without any clinical problems. I conclude that the SvO2 is an easily checkable variable and a good indicator for optimal oxygenation at cell level, and can be used as an objective criteria for the need of postoperative inotropic support.

• Journal of Chest Surgery
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• 제46권5호
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• pp.319-327
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• 2013

Strategic planning is integral to any operation but complexity varies immensely and therefore the effort necessary to create the optimal plan. The previous three reports have discussed individual conduits and herein is an attempt to present approaches to common situations which the author favors. Although much has been learned over 45 years about use and subsequent behavior of venous and arterial grafts we continue to learn and, as a result, evolve new strategies or modify those now popular. Thus the reader must recognize that in spite of trying to be balanced and inclusive all surgeons have personal opinions and also prejudices which influence the approach taken and which may not be the optimal one for others or for the patient.