한국에 있어서의 개심술 - 서울대학교 의과대학 흉부외과학교실 개심술 1,701예의 분석 -

Abstract

Open heart surgery utilizing cardiopulmonary bypass is a rather difficult clinical enterprise among clinical fields especially in a developing country. It is due to the facts that require a large sum of investment in cquipments and facilities, organization of a specialists team , costly medical expenses, and that high risk with technical difficulties are unavoidable. Since the first open heart surgery was performed on ventricular septal defect in this department on August 6, 1959, 1,701 cases were done up to the end of september 1981. Few cases and high operative mortality at the incipient stage progressed to larger number of cases and decreased mortality. Since 1977 when 100 open heart surgery cases a year were marked in this institution for the first time in Korea , annual increase and improvement of operative results were remarkable. In 1980 annual 116 open heart surgery cases were performed and it will reach GOO cases this year with oYer all mortality rate of less than 10% Among 1701 open heart surgery cases 1, 155 were congenital consisting of 674 acyanotic and 181 cyanotic cases with operative mortality of 4.8% and 22.9% respectively. Main anomalies were ventricular septal defect (393 cases) , tetralogy of Fallot (391 cases) and atrial septal defect(174 cases). In acquired diseases valvular heart lesions were found in 523 cases out of total 539 patients. There were 16 cardiac myxomas, consisting of 13 left atrial, one right atrial, one right ventricular, and one left ventricular cases. All of 16 cascs survived operation and operative results were satisfactory. 59G valves were replaced in 495 patients. There werc 399 single valve , 91 double valve , and 5 triple valve rcplacement cases with over all mortality of 10.7%, 15.4%, and 20% respectively. Due to the difficulties of postoperative anticoagula tion in Korea, bioprosthetic valves (Ionescu-Shiley bovine pericardial xenograft) were mainly utilized recently. In valve replacement cases decrease in operative mortality was remarkable recently. In 9 months period this year over alI mortality was 3.3% for 121 valve replacemennt cases, consis ting of 99 single, 20 double and 2 triple valve replacements.