• The Korean Journal of Nuclear Medicine
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• v.31 no.1
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• pp.36-42
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• 1997

Though myocardial perfusion was usually expected to improve after coronary artery bypass graft(CABG) surgery, some myocardial segments were aggravated after operation, as we compared perfusion changes on postoperative SPECT with preoperative ones. In this study, we evaluated perfusion changes after operation in rest and stress myocardial SPECT in 44 patients (M:F=25:19, age 57.1 $year{\pm}8.2$) who had CABG before and 3 months after operation. We tried to find out possible causes for perfusion aggravation with multivariate logistic regression analysis regarding whether bypass graft was artery or vein and which coronary artery territory was operated. Among 616 myocardial segments which were operated, 89(14.4%) aggravated after operation. In the univariate analysis, myocardial segments in the left circumflex arteries(LCx) aggravated more often(p<0.01) than others and segments having operative angioplasty did less often(p<0.01). Multivariate logistic regression revealed that LCx was risk factor for perfusion aggravation [odds ratio=2.54 (95% confidence interval : 1.53-4.22, p<0.01)]. However, this was not the case when we analysed in terms of arterial territories. Among 106 coronary arterial territories which were operated, 27(25.5%) aggravated. The territories having aggravated had similar characteristics regarding whether they received arterial or venous grafts, angioplasty and whether the operated territories were left anterior descending, right coronary or left circumflex arteries. In conclusion, myocardial segments in the left circumflex artery tended to aggravate more often after bypass surgery than the others. In short-term comparison of perfusion after surgery, we could not find any tendency that arterial or venous graft was associated with more frequency of the aggravation of perfusion after operation.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1056-1062
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• 1998

Background: We prospectively investigated types, incidences, and risk factors for arrhythmias after open heart surgery in adults. Materials and methods: From June 1994 to May 1995, we performed 302 cases of adult cardiac surgery at our department. This study group consisted of 150 men and 152 women, with a mean age of 43.9±28.0(range 16 to 75)years. We included all the patients irrespective of their operative types or disease entities. Results: The overall incidence of arrhythmias after open heart surgery in adults was 58.3%. The incidence of postoperative arrhythmias for redo-valvular heart surgery was 77.8%, and those for simple valvular procedure, coronary artery bypass surgery, aortic surgery, and congenital heart disease were 70.8%, 45.3%, 40.0%, and 29.5%, respectively. Eight out of twelve risk factors showed statistical significance for the development of postoperative arrhythmias. They were preoperative history of arrhythmias, antiarrhythmic drug medication, previous cardiac surgery, larger left ventricular end-diastolic, end-systolic dimension, left atrial dimension on preoperative echocardiogram, longer cardiopulmonary bypass time and aortic cross clamping time. Univariated analyses for age and types of cardioplegic solution did not show statistical significance. Conclusions: Prospective study on postoperative arrhythmias occurrence, treatment and prevention of is warrauted to draw more clear conclusion.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.534-543
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• 2006

Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1183-1194
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• 1998

Background: From Sept. 1985 to Sept. 1997, 2,000 cases of open heart surgery(OHS) were performed in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. Material and Method: Among the total of 2,000 cases of OHS, 1532 cases were congenital heart disease(CHD) and 468 cases were acquired heart disease(AHD). The age distribution was 9 days(4.0kg) to 68 years in CHD and 11 to 66 years in AHD. In 1532 cases of CHD, there were 1403 acyanotic cases and 129 cyanotic cases. Result: The CHD cases consisted of 940 ventricular septal defects(61.4%), 324 atrial septal defects(21.1%), 112 tetralogy of Fallot(7.3%), 46 pulmonary stenosis(3%), 38 endocardial cushion defects(2.5%), 15 valsalva sinus ruptures(1%), 4 transposition of great arteries (0.3%), 4 double outlet right ventricles(0.3%), and etc. Corrective operations were applied for congenital heart disease with a result of 3.1% hospital mortality. Of 468 AHD, 381 cases were valvular heart diseases, 48 ischemic heart diseases, 12 cardiac tumors, 8 annuloaortic ectasias, 16 dissecting aortic aneurysms and etc. In the 381 valvular heart diseases, there were 226 single valve replacements(36 aortic valve replacements(AVR), 188 mitral valve replacements(MVR), and 2 tricuspid valve replacements(TVR), among these were 71 cases of double valve replacements(AVR & MVR), 54 cases of MVR with tricuspid valve annuloplasty(TVA), and 18 cases of AVR, MVR with TVA. The total implanted prosthetic valves were 466. In MVR, 123 St. Jude Medical valves, 90 Carpentier-Edwards valves, 65 CarboMedics valves, 42 Sorin valves and 16 other valves were used. In AVR, 68 St. Jude Medical valves, 36 CarboMedics valves, 14 Carpentier-Edwards valves and 9 other valves were used. Coronary Artery Bypass Surgery(CABG) were performed in 48 cases. The patterns of bypass graft were 14 patients of single vessel graft, 21 patients of two vessels graft, 10 patients of three vessels graft and 3 patients of four vessels graft. Conclusion: The hospital operation mortality rate of congenital acyanotic, cyanotic and acquired heart diseases were 2.0%, 15.5%, and 5.1% respectively. The overall mortality rate was 3.6%(72/2,000).

• Reproductive and Developmental Biology
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• v.29 no.3
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• pp.163-168
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• 2005

The aim of this study was to investigate the changes in insulin-like growth factor-I (IGF-I) and growth hormone (GH) in serum, the quantitation of spermato-genesis and the comparable relationships among these measurements during pubertal period in New Zealand White male rabbits. To investigate the age-related testicular changes in DNA contents of spermatogenic cells, the fine-needle testicular biopsies from males aged 10 to 28 wks were evaluated by flow cytometry(FCM). Body weight increased significantly between the ages of 12 and 20 wks (P<0.05) and reached 3.4 kg at 28 wks of age. The highest serum IGF-I level (451.3ng/mL) was observed at 20wks of age (P<0.05) and thereafter remained stable at low levels. Serum GH level at 18 wks of age was 183.3 pg/mL which was significantly higher compared to the other ages (P<0.05), and the rising time in serum GH tend to be somewhat earlier than that of IGF-I. The relative percentage of It-cells in testicular cell compartments was $48.2\%$ at the age of 18 wks which significantly increased than those of 16-wk-old (P<0.05) and thereafter increased with the advance of age to $68\%$. The percentage of 2C-cells in testis was $26.8\%$ at 18 wks of age which was significantly lower than $54.3\%$ at 16 wks old (P<0.05). The percentage of 4C-cells was constantly maintained $2\~6\%$ except the $9.9\%$ at 18 wks of age. In conclusion, the results suggest that the puberty onset occurred at about the 18 wks of age and that the IGF-I and GH in serum during the pubertal period showed the age/growth-specific changes and these changes might be related to the spermatogenesis. The DNA FCM combined with fine-needle testicular biopsy could offer a very sensitive method to monitor the quantitative spermatogenic events related to the puberty onset.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.287-292
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• 1997

.Itrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze 111 procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defEct (VSD). Mean duration of atrial fibrillation was 36 months (:42 months) (range, 1 to 132 months). T e past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombus was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVd and tricuspid annuloplasty(TAP) in 4, mitral valvuloplasty(Mln) in 3, Mln and Tln in 1, MIW and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, but, recurrent atrial fibrillation was converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegic in 1, and acute renal failure in 1. Mean follow-up interval of patient was 16.5 months (range, 10.5 to 24 months) and all patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.881-889
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• 1991

The ideal goal of the coronary artery bypass surgery is complete revascularization. To estimate the numerical degree of completeness of revascularization, the following formula was used in 50 patients having aorta-coronary bypass grafting for the treatment of unstable angina. myocardial perfusion score of revascularized area Degree of Completeness = ----------------------------------------------------------------------------- x100[%] preoperative myocardial perfusion score Randomized patients who underwent revascularization procedures in 19Hb were compared with the patients who received similar elective operation each year from 1988 through 1991. To obtain these data, the patients aged 38 ~ 75[mean 54$\pm$9.1years], composed of 31 males and 19 females were randomly sampled. The number of grafts per patient increased from 2.30 in 1986, to 3.07 in 1988 - 89, to 3.21 in 1990, and to 3.50 in 1991. [0.05 The degree of completeness improved from 75.4% to 81.4%, 91.6% and 88.6% respectively. It improved significantly in the last two years, [P<0.05, Mann-Whitney U test] At a follow-up of three months, 90 percent[45/50] of patients remained angina, free, 6 percent[3/50] had residual angina, and 4 percent[2/50] died. The last two patients degree of completeness corresponded to 43% and 30% respectively As a conclusion, the degree of completeness seems to improve year by year, and to have close relationship with the clinical results.

• Journal of Yeungnam Medical Science
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• v.28 no.2
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• pp.124-132
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• 2011

Background: Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). Methods: From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups' perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. Results: The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. Conclusion: The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.214-220
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• 2005

Extended transseptal approach can provide an excellent view of the mitral valve but the safety of this approach is controversial because this incision requires transaction of the sinus node artery, which in most cases and can result postoperative arrhythmia. The purpose of this study was to evaluate perioperative and longterm conduction disturbances and the cardiac rhythms of patients who underwent an extended transseptal approach for mitral valve surgery. Material and Method: Postoperative cardiac rhythms were analyzed in the 164 consecutive patients who received mitral valve replacements with a extended transseptal approach between March 1992 and July 2003. Result: Of the 84 patients in normal sinus rhythm, 34 ($39\%$) had developed transient junctional rhythm and atrial fibrillation after operation, lasting less than 72 hours in most of cases. No intractable arrhythmias occurred. Most of these arrhythmia were not detected at the time of discharge and only 8 patients ($9\%$) had atrial fibrillation at discharge. Postoperative PR intervals increased for 1 week, then decreased within 2 weeks postoperatively, and returned to normal range by 6 months postoperatively. During the postoperative period, 4 of the 78 patients with preoperative atrial fibrillation developed normal sinus thythm. Conclusion: The post-operative arrhythmias were temporary and showed no significant complications after extended transseptal approach for the mitral valve surgery.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.627-634
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• 2010

Background: The durability of the tissue valve is important in choice between a mechanical valve and a tissue valve in cardiac surgery. We studied the mid-term results of tissue valve in the aortic position. Material and Method: The subjects were 380 patients who had undergone aortic prosthesis replacement between May 1990 and March 2009. We retrospectively analyzed hospital and outpatient records: the mean age was $69{\pm}9$ years; the male to female ratio was 227 : 162; and the mean follow-up duration was $46.7{\pm}40.8$ months (range 0~196 months). Result: 389 surgical cases in total had been taken with 380 patients. Early death occurred in 15 patients (3.9%). Overall survival rate at 1, 5 and 10 years were 92.3%, 78.1% and 54.2% respectively. Freedom from reoperation at 1, 5 and 10 years were 98.4%, 97.1% and 91.7% respectively. Freedom from structural valvular deterioration at 1, 5 and 10 years were 96.1%, 92.3% and 88.0% respectively. In the multivariate analysis of preoperative risk factors, young age (p<0.001) was significant risk factor for reoperation. High peak velocity in the postoperative period (p=0.034) and young age (p=0.029) were significant risk factors for structural valvular deterioration. Old age (p=0.001), long bypass time (p=0.035), concomitant coronary artery bypass graft surgery (p=0.003) and preoperative low left ventricular ejection fraction (p=0.003) were significant factors for early mortality. Preoperative estimated glomerular filtration rate (< 60 mL/min) (p=0.025) and persistent left ventricular hypertrophy (p=0.032) were the risk factors for late mortality. Conclusion: This study showed that the freedom from reoperation and the freedom from structural valvular deterioration in aortic tissue valve replacement were acceptable. It will be necessary to conduct further studies with long-term follow-up and more patients.