Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4±43.6 months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

Early postoperative complications after heart transplantation in adult recipients: asan medical center experience.

/pdf/morphometric-study-of-the-trachea-in-korean-den2c14vrn.pdf

Morphometric Study of the Trachea in Korean

Morphometric Study of Cricoid Cartilage in Korean

This morphometric study of main bronchus was performed to provide the basic data necessary for anatomists, anesthetists and emergency medical technicians. A total of 48 cadavers, 33 men and 15 women, were used in this study. When it comes to their average age, men were 70 years old (50 to 91 years old), and women were 74 years old (47 to 92 years old). For this study, the length of the left and right main bronchi and the angle between them, and the first bronchial cartilage’s each anteroposterior diameter, transverse diameter, vertical height, and distance between posterior ends of cartilage were measured. As for the length, left length was longer than right length regardless of gender, and there was no significant difference between men and women. When it comes to anterorposterior diameter, transverse diameter, and distance between posterior ends of the first bronchial cartilage in main bronchi, the right side was longer and wider than left side regardless of gender, but statistical significance was shown only in the distance between posterior ends of cartilage. Vertical height of the first bronchial cartilage in main bronchi did not show any difference between the left and right and between men and women, and men cadavers had a very large individual difference from 2.35 mm to 9.22 mm. As for the angle of the main bronchi’s separation from trachea’s major axis, the left side was larger than the right side in both men and women cadavers and it was larger in men than women, but there was no significant statistical difference. Lastly, as for the length of the main bronchi, the right and left lengths in men were 16.83±1.36 and 37.26±1.42 mm respectively; and the right and left lengths in women were 16.90±2.26 and 36.08±3.39 mm respectively. These results are expected to be used as the basic clinical data useful for medical procedures of emergency care practitioners, anesthetists and emergency medical technicians.

/pdf/the-morphometric-study-of-main-bronchus-in-korean-cadaver-346eypw2fw.pdf

The Morphometric Study of Main Bronchus in Korean Cadaver

Background and Objectives:Recently, in mitral valve surgery, valvuloplasty or valve repair was successfully introduced to improve postoperative left ventricular function and to decrease operative mortality. However, the real impact of this technique on daily practice in Korea was not systematically assessed. Materials and Method:The operative methods, postoperative death, follow-up results and their contributing factors were analysed among patients who underwent mitral valve surgery at our institution. Results:1) From June 1989 to December 1996, 416 patients (186 males, mean age 48±13 years) underwent mitral valve surgery. Dominant mitral stenosis (MS) was the main pathology in 167 patients;dominant mitral regurgitation (MR) and balanced mitral stenoinsufficiency (MSR) in 197 and 52 respectively. 2) In MS, valve replacement was performed in 91% whereas commissurotomy in 9%. However, in MR, the rates of valve repair surgery has increased up to 60% of the total surgical procedures for the past three years. 3) The overall operative mortality was 4% (18/416). It was significantly lower in valve repair compaired with valve replacement (0% vs. 6%;p=0.003). In MS, factors associated with high mortality were longer cardiopulmonary bypass and aortic cross clamp time. In MR, high mortality was associated with diabetes, endocarditis, valve replacement and longer cardiopulmonary bypass time. 4) The 7-year late survival among operative survivors was 95±2% in MS, which was singnificantly higher than that in MR (80±6%, p=0.04). 5) In MR, the 4-year cardiac event-free survival among operative survivors (absence of cardiac death, reoperation, bleeding, endocarditis, thromboembolism, or development of heart failure) was significantly higher in valve repair group than in valve replacement (84±7 vs. 76±5%;p=0.03). Conclusion:The overall outcomes of recent mitral valve surgery were satisfactory. In MR, valve repair surgery seemed to be an established method to decrease operative mortality and long-term complications. (Korean Circulation J 1998;28(7):1059-1068)

https://e-kcj.org/Synapse/Data/PDFData/1054KCJ/kcj-28-1059.pdf

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Papers

한국 성인의 기관 길이 측정에 관한 연구

심장이식 환자의 임상적 고찰

승모판막질환에 있어서 인공판륜을 이용한 승모판막재건술의 임상적 고찰

개방성 승모판 교련 절개술의 장기성적

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