• Journal of Chest Surgery
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• v.31 no.4
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• pp.398-401
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• 1998

A 56-year-old female with a permanent unipolar pacing(VVI) system underwent elective coronary bypass surgery and mitral valve replacement. Because the unipolar sensing is subject to considerable nonmyocardial electrical noise, the pacing function may be disturbed by the use of electrocautery. Temporary atrial and ventricular bipolar epicardial leads and external generator were used for maintaining A-V sequential pacing during the use of electrocautery. Before aortic cross-clamp was released after cardiac operation, regular cardiac rhythm could spontaneously be resumed with an integrated cardioplegic strategy, avoiding the use of defibrillator

• Journal of Chest Surgery
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• v.31 no.2
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• pp.125-133
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• 1998

This study was designed to identify the efficiency of serum troponin-T(s-TnT) level as a diagnostic indicator for the perioperative myocardial damage with open heart surgery(OHS) and to compare with the conventional myocardial enzyme tests such as isoenzyme fraction of creatine kinase(% CK-MB) and isoenzyme ratio of lactate dehydrogenase(LDH1/LDH2 ratio). The study was performed on 30 adult patients who underwent OHS from Jan. 1996 to June 1996 at Inje University Pusan Paik Hospital, and they were divided into two groups accor- ding to aortic clamping time(ACT) duration : group I(ACT＜60 minutes, n=15); group II (ACT＞60 minutes, n=15). S-TnT, % CK-MB, and LDH1/LDH2 ratio were measured in serial blood samples from all subjected patients. The results were obtained as follows. 1. In both groups, s-TnT concentrations increased gradually during OHS and elevated significantly at CPB-10(p＜0.001). The peak level was noticed at POD 1 in group I(1.10 $\pm$0.19 ng/ml), whereas, at CPB-off in group II(1.88$\pm$0.42 ng/ml). The elevated levels remained until POD 7 in both groups. 2. %CK-MB was risen significantly with the initiation of operations(p＜0.001) and the peak levels were noticed at CPB-off in both groups(7.14$\pm$0.86% in group I, 10.69$\pm$1.27% in group II). Thereafter, these levels returned to normal values at POD 3. 3. There were no significant changes in the values of LDH1/LDH2 ratio during and after OHS compared with the control levels(p＞0.05). 4. The serial changes of s-TnT were relatively well correlated with those of changes of % CK-MB(r=0.64, p＜0.05). 5. The serial s-TnT levels were significantly higher in group II than group I from B-ACR to POD 1(p＜0.05), suggesting that duration of aortic clamping time was a major factor concerned with perioperative myocardial injury. In conclusion, measurement of s-TnT is a very useful indicator in assessing the myocardial cell damage and therefore it is expected that serial checking and evaluation of the s-TnT is very available for identification of the perioperative myocardial damage and for postoperative cares in patients with OHS.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.604-609
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• 2009

Background: Recently, percutaneous cardiopulmonary support (PCPS) has been widely used to rescue patients in cardiogenic shock or cardiac arrest. However, patients with cardiopulmonary bypass (CPB) weaning failure during open heart surgery still have very poor outcomes after PCPS. We investigated clinical results and prognostic factors for patients who underwent PCPS during open heart surgery. Material and Method: From January 2005 to December 2008, 10 patients with CPB weaning failure during open heart surgery underwent PCPS using the CAPIOX emergency bypass system ($EBS^{(R)}$, Terumo Inc, Tokyo, Japan). We retrospectively reviewed the medical records of those 10 patients. Result: The average age of the patients was $60.2{\pm}16.5$ years (range, $19{\sim}77$ years). The mean supporting time was $48.7{\pm}64.7$ hours (range, $4{\sim}210$ hours). Of the 10 patients, 6(60%) were successfully weaned from the PCPS While 5 (50%) were able to be discharged from the hospital. Complications were noted in 5 patients (50%). In univariate analysis, long aortic cross clamp time during surgery, mediastinal bleeding during PCPS and high level of Troponin-I before PCPS were significant risk factors. All of the discharged patients are still surviving $34{\pm}8.6$ months (range, $23{\sim}48$ months) post-operatively. Conclusion: The use of PCPS for CPB weaning failure during open heart surgery can improve the prognosis. More experience and additional clinical studies are necessary to improve survival and decrease complications.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.213-218
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• 1997

Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four cases of thoracic aortic pseudoaneurysm who underwent surgical repair, The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.

• Journal of Yeungnam Medical Science
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• v.5 no.2
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• pp.101-110
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• 1988

Between April, 1984 and September, 1988, 459 patients underwent cardiovascular surgery at the Yeungnam University Hospital. Of these, 355 cases were open heart surgeries and 104 cases were non-open heart surgeries. There were 237 patients of acyanotic congenital cardiac anomalies, 40 patients of cyanotic congenital cardiac anomalies, and 85 patients of acquired heart diseases. The sex ratio of cardiovascular diseases was represented as 1:1.3 in male and female. The age distribution was ranged from 1 day to 65 years old. The common congenital cardiovascular anomalies were ventricular septal defect(38.7%), patent ductus arteriosus(25.5%), atrial septal defect(20.7%), Tetralogy of Fallot(8.3%), and pulmonary stenosis(2.4%) in order of frequency. Among 87 acquired cardiovascular diseases, 81 patients underwent operation for cardiac valvular lesions. 51 patients had mitral valve replacement and 13 patients had aortic valve replacement and 17 patients had double valve replacement. The overall mortality of cardiovascular surgery was 3.3% and mortality of open heart surgery was 3.9%.

• Journal of Korean Academy of Nursing
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• v.21 no.3
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• pp.257-267
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• 1991

This study investigated the effects of nursing in formation given verbally and a booklet on the knowledge, Physical symptoms, anxiety and daily activities of patients recovering from open heart surgery from just before discharge to six weeks after discharge. The convenience sample was of patients who had undergone open heart surgery in Seoul National University Hospital. The first 25 patients who agreed to participate in the study became the control group. They did not receive the intentional information but the usual nursing care. The next 28 patients became the experimental group who received a booklet about their post-discharge care which was discussed with them by the researcher before discharge. This study used a non equivalent control group non - synchronized quasiexperimental design. The tools included a 30 item knowledge scale, a 9 item physical symptom scale, Spielberger's state anxiety scale, and a 28 item daily activity scale. The instruments were applied before discharge and at two and six weeks after discharge. For data analysis, frequency, t-test, Pearson's Correlational Coefficient and Cronbach's $\alpha$ were used. The results were as follows : 1. Information given through the booklet was effective in increasing the knowledge of patients recovering from open heart surgery. The experimental group's knowledge was higher at 2 weeks after discharge than prior to discharge (P＜0.05). 2. There was no significant difference in physical symptoms between the two groups at two and six weeks after discharge. 3. Information given through the booklet was effective in decreasing the State Anxiety two weeks after discharge (P＜0.001) but at six weeks after discharge, there was no significant difference in anxiety between the control and the experimental groups. 4. There was no significant difference in daily activity between the two groups at two and six weeks after discharge. 5. There was a negative correlation between knowledge at discharge and at 2 weeks and anxiety at 2 weeks after discharge. There was a positive correlation between knowledge at discharge and daily activity at 2 weeks after discharge. There was a negative correlation between knowledge at 2 weeks and Physical symptom at 6 weeks after discharge.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.305-307
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• 1989

Cold agglutinins are a potential danger to patients who must be subjected to hypothermia. A patient with a cold agglutinin of moderate titer but broad thermal amplitude was to undergo hypothermia during double valve replacement. She was managed preoperatively with plasmapheresis 5 times. There was no complication during and after operation.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.256-258
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• 2009

A 63-year-old man who had a permanent pacemaker placed 17 years ago presented to us with local inflammatory signs on his chest. The skin was opened to remove the permanent pacemaker. However, the pacing wire was not easily removed. So, the permanent pacemaker was removed from the chest with leaving the remnant wire inside. However, the local infection recurred because of the remnant wire. Right thoracotomy was performed and cardiopulmonary bypass was started. After total circulatory arrest, the right atrium was opened and the wire was completely removed.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.448-451
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• 2004

Report of right atrial thrombus complicating pulmonary embolism after cardiac surgery is rare. A 54-year-old woman operated on the atrial septal defect 10 months ago was admitted for left pleuritic pain and dyspnea. Multiple segmental perfusion defects were detected in lung perfusion scan. Transesophageal echocardiography showed a large mobile right atrial mass attached to the free wall of the right atrium with a stalk. Despite the intravenous heparinization for 13 days, follow-up echocardiography revealed the right atrial mass had not diminished in size. The mass which was confirmed as an organizing thrombus was excised under cardiopulmonary bypass. The patient recovered uneventfully and was discharged on warfarin therapy.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.576-580
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• 1998

This study is to clarify the results of atrial septal defect(ASD) repair and mitral valve surgery through right anterolateral thoracotomy since 1989, and those of more generalized application of minimal invasive cardiac surgery since August 1997. We retrospectively analyzed the results of open heart surgery(OHS) through other than full sternotomy carried out until October 1997. There were 28 cases of OHS done through right anterolateral thoracotomy(17 cases of ASD, 4 cases of mitral valve repair, 6 cases of mitral valve replacement, and 1 redo mitral and tricuspid valve repalcement) which has demonstrated no surgical mortality or morbidity except only 1 case of reoperation for bleeding. During the period between August and October 1997, we performed near routine application of upper sternotomy or transverse sternotomy in aortic valve cases and routine application of minimal incision in cases with ASD and there was no evidence of early and late complications associated with this approach. We conclude that OHS with the use of minimal incisions is very safe, cosmetically excellent, and superior in terms of the amount of bleeding. The indication for minimal incision, therefore, should be extended afterwards.