• Journal of Chest Surgery
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• v.29 no.8
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• pp.828-835
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• 1996

From January 1993 to April 1995, 27 neonates (under age of 30 days underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Center. Mean age and weight were 12.1 days(2days∼306ays) and 3.29 kg(2.6kg∼4.1 kg) respectively. Cardiac anomalies were simple complete transposition of great arteries(TGA) in 11 neonates, TGA with coarctation of aorta(COA) in 1 , total anomalous pulmonary venous connection(TAPVC) in 5, double inlet right ventricle with TAPVC in 1, interrupted aortic arch(IAA) with ventricular septal defect(VSD) in 3, pulmonary atresia(PA) with intact ventricular septum(IVS) in 3, pulmonary stenosis with IVS in 1, Taussig-Bing anomaly with IAA in 1, and hypoplastic left heart syndrome(HLHS) in 1 . Postoperative complications were myocardial and/or pulmonary edema which caused open sternum in 13 patients(54.2%), acute renal failure( RF) in 10(37.0%), Intractable low cardiac output syndrome (LCOS) including weaning failure from cardiopulmonary bypass in 7(25.9%), bronchopulmonary dysplasia in 1, wound infection in 1, and paroxysmal supraventricular tachycardia in 1. Nine of 13 patients with postoperative open sternum were recovered with delayed sternal closure, and seven of 10 patients survived postoperative ARF with peritoneal dialysis. There were 8 operative deaths(29.6%): 3 in the patients with simple complete TGA, 1 In TCA with COA, 1 in PA with IVS, 1 in Taussig-Bing anomaly with IAA, 1 in DIRV with TAPVC, and 1 in HLHS. One late death occurred after arterial switch operation in simple TGA. The mosts common cause of death was low cardiac output syndrome. Our initial experience of open heart surgery in neonates showed high operative mortality and morbidity, especially in complex anomalies.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.466-471
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• 1998

Purpose: The safety and efficacy of minimally invasive techniques in congenital heart surgery were tested in this study. Materal and method: Between July 1997 and November 1997, a total of 46 children were underwent minimally invasive cardiac operations at Seoul National University Children's Hospital. Age and body weight of the patients averaged 34.6${\pm}$41.8 (Range: 1∼148) months and 14.5${\pm}$9.9(Range: 3.0∼40.0) kg, respectively. Twenty eight patients were male. Preoperative surgical indications included 15 atrial septal defects, 25 ventricular septal defects, 1 foreign body in aorta, 3 partial atrioventricular septal defects, 1 total anomalous pulmonary venous connection(cardiac type), and 1 tetralogy of Fallot. After creating a small lower midline skin incision starting as down as possible from the sternal notch, a vertical midline sternotomy extended from xyphoid process to the level of the second intercostal space, where one of the T-, J-, I- or inverted C-shaped lower lying mini-sternotomy was completed with a creation of unilateral right or bilateral trap door sternal opening. A conventional direct aortic and bicaval cannulation was routine. Result: A mean length of skin incision was 6.1${\pm}$1.0(range: 4.0∼9.0) cm. A mean distance between the suprasternal notch and the upper most point of the skin incision was 4.0${\pm}$1.1 (range: 2.0∼7.0) cm. Mean cardiopulmonary bypass time, aortic cross-clamp time, and the operation time were 62.9${\pm}$20.0(range: 28∼147), 29.8${\pm}$12.8(range: 11∼79), and 161.1${\pm}$34.5 (range: 100-250) minutes. A mean total amount of postoperative blood transfusion was 71.0${\pm}$68.1 (range: 0∼267) cc. All patients were extubated mean 11.3${\pm}$13.8(range: 1∼73) hours after operation. A mean total amount of analgesics used was 0.8${\pm}$1.8(range: 0∼9) mg of morphine. The mean duration of stay in intensive care unit and hospital stay were 35.0${\pm}$32.2 (range: 10∼194) hours and 6.2${\pm}$2.0(range: 3∼11) days. There were no wound complications and hospital deaths. Conclusion: This short-term experience disclosed that the minimally invasive technique can be feasibly applied in a selected group of congenital heart disease as well as is cosmetically more attractive approach.

• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.532-537
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• 2010

Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.23-28
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• 2005

Ross procedure is ideal aortic valve replacement method with several merits of hemodynamic superiority and durability without the need of anticoagulation. Based upon this presumption, we studied its procedure performed in our hospital and tried to get the mid-term results Material and Method: From Jan 1999 to Oct 2001, 22 patients underwent the Ross procedure. The mean age of experimented (including 17 men and 5 women) was $30.9{\pm}8.1(17\~44)$. The diagnosis before the surgery had shown 20 as accompanied with AR and the rest 2 as with ASR. The follow-up period ranged from 0.6 to 40.6 months, mean of $38.9{\pm}1.6\;months,\;and\;follow-up\;rate\;was\;100{\%}$. Result. There was no operative death and two late deaths, one of whom was cardiac originated and the other, non-cardiac relate The survival rate was $94.1{\pm}5.7{\%}$(40.6 months). Postoperatively there were 2 exploration for bleeding, 3 low cardiac output patients. The pulmonary autograft technique was root replacement in 14 and inclusion technique in 8. Pulmonary homografts were used at the pulmonary position in all cases. There was no patient with significant aortic regurgitation. Conclusion: These showed that the mortality and morbidity of the Ross procedure were acceptable and postoperative AR was not significant. However, further long-term follow-up will be necessary for the improvement of the function of pulmonary autograft and homograft.

• Journal of Veterinary Clinics
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• v.25 no.1
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• pp.23-26
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• 2008

A 2-year-old, female, Turkish Angora cat was presented due to hindlimb paralysis with 2-day history of vomiting and depression. Physical examination revealed weak femoral pulse and cyanotic footpads of hind limbs. Chest auscultation, thoracic radiography, and electrocardiogram were no remarkable. Abdominal ultrasonography showed suspected hyperechoic thrombus in abdominal aorta. Underlying causes of the arterial thromboembolism were not found on multiple diagnostic examinations and the cat was diagnosed as idiopathic saddle thromboembolism. Despite 4-week regimen with heparin sodium, aspirin, and diltiazem, the hind limbs were progressively and irreversibly necrotized. Therefore, coxofemoral amputation was performed. After surgery, the clinical condition of this cat returned to normal without further complications.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.785-791
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• 2002

The results of reoperative valve replacement can be improved if appropriate analysis for the risk of reoperation was achieved. The purpose of our study was to analyze the results of reoperations for failure of bioprosthesis, and to define the risk factors in high-risk populations for reoperative procedures. Material and Method The series of 46 consecutive patients who had undergone first reoperative replacement for failed bioprosthesis between 1993 and 2001 were reviewed retrospectively. Mean age was 42 $\pm$ 12 years, mean body surface area was 1.52 $\pm$0.15 $m^2$. The reoperative procedure comprised of 36 MVR, 8 DVR, and 2 AVR. The first operation comprised of 2 DVR, 1 AVR, and 43 MVR. Factors which were choose to assess a predictor of results in reoperative valve replacement were sex, old age(＞60 years), early age at first operation(＜30 years), long interval between first and redo operation(.15years), poor NYHA functional class(＞3), LV dysfunction(LVEF＜45%), long operation time(＞8hours), endocarditis, combined procedures, and renal insufficiency, Result : Overall mortality was 4.3%(2 cases). The risk factors that influenced postoperative complications and unexpected postoperative results were lower ejection fraction(p＝0.012), older age(p＝0.045), endocarditis(p＝0.023), long operation time above 8 hours(p＝0.027). There was no statistically significant factor influencing hospital mortality. Conclusion : No factor influenced the mortality. Better results could be achieved if reoferation was performed carefully in poor left ventricular function, old aged patient, and with endocarditis. Effort to shorten the operation time would be helpful on postoperative results.

• Journal of the Korean Society of Food Science and Nutrition
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• v.31 no.1
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• pp.104-108
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• 2002

Numerous studies have suggested the involvement of oxidative processes in the pathogenesis of atherosclerosis and especially of oxidized low density lipoproteins (LDL). We studied the effect of Korean wheat on the oxidizability of LDL and the development of experimental atherosclerosis in rabbits on cholesterol diet. For the approach of the aim, antioxidative activity of wheat extracts against oxidation of LDL was investigated. The antiatherogenic effect of wheat was studied against Newzealand whithe (NZW) rabbits fed containing the wheat powder for 12 weeks. PBS extracts of Korean and imported wheats decreased LDL oxidation induced by copper ion by 62.3%, 52.6% respectively in comparison with control. Liver thiobarbituric acid reactive substance (TBARS ) levels of rabbits were significantly lowered in Korean wheat fed group (0.397$\pm$ 0.029 nmol MDA/mg protein, p<0.05) compared to control (0.496$\pm$0.021 nmol MDA/mg protein) and imported wheat group (0.478$\pm$0.019 nmol MDA/mg protein). TBARS levels of kidney showed no significant difference among treatment groups. The aorta of cholesterol-fed rabbits showed typical atherosclerotic lesions when compared with the controls, but the microscopic differences between groups was not clear. The present study suggests that Korean wheat may have higher antioxidative capacity than imported wheat and have more beneficial effects for the treatment of disease by inhibiting the oxidation of LDL.

• Korean Journal of Environmental Biology
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• v.21 no.3
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• pp.313-318
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• 2003

Environmental stresses, such as heat shock, alcohol and physiological salt have been shown to induce a group of protein called heat shock protein (HSPs) in various tissues. In this investigation, we studied that arsenic stress would alter contraction of isolated rat aorta and expression of heat shock protein 70 and investigated the relation between expression of HSP 70 and vascular contractility of isolated rat aorta. Rat aorta strips, mounted in organ baths were exposed to 0, 0.5, 1,2 and 4 mM arsonic for 60 min. and 1,3 and 8 hours later tested for contractile response and expression of heat shock protein 70. Contractility of rat aorta were determined by isometric transducer connected to computerized physiograph and expression of HSP 70 was characterized by western blotting, respectively. Potassium chloride (55 mM) significantly augmented vascular contractility of yat aorta by 39％ compared with the control at 8 hours but not one or three hours after treatment of 4 mM arsenic. Arsonic stress (4 mM) also increased the expression of HSP 70 in rat aorta at 8 hours but one or three hours compared with the control and HSP expressed in vascular smooth muscle cells and some expressed in endothelium cells. These results suggest that arsenic stress not only did alter the magnitude of the contractile response to high potassium chloride but also increased the expression of HSP 70 in the rat aorta.

• The Korean Journal of Pharmacology
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• v.27 no.2
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• pp.125-133
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• 1991

In the isolated rabbit mesenteric artery denuded of endothelium, we characterized the identity of the A23187-induced endothelium-dependent relaxing factor (EDRF) released from the endothelium of rabbit aorta, which is distinct from that of acetylcholine-induced relaxing factor. In the normal physiological salt solution (PSS), the dose-response curves to A23187 and acetylcholine were overlapped together. Their effects were also inhibited by methylene blue. Upon application of hypoxanthine and xanthine oxidase into the bath, the phenylephrine-induced precontraction was transiently increased followed by the sustained relaxation. During the burst of hypoxanthine-xanthine oxidase reaction, the $Ca^{++}$ ionophore, A23187 but not acetylcholine was able to cause an immediate relaxation. However, A23187-induced relaxation was not manifested when precontracted by 50 mM $K^+-PSS$. Nevertheless, in the presence of superoxide dismutase, A23187 could produce an immediate relaxation without accompanying the transient contraction as acetylcholine did during the hypoxanthine-xanthine oxidase reaction. On the other hand, acetylcholine-induced relaxation was more sensitively inhibited by phorbol 12-myristate 13-acetate (PMA) than A23187-induced relaxation. Endothelium-independent relaxation to sodium nitroprusside was not affected by PMA. Based on these results it is suggested that both A23187 and acetylcholine cause the methylene blue-inhibitable endothelium-dependent relaxation, and in addition, A23187 may release a stable EDRF which is resistant to superoxide anion and PMA.

• The Korean Journal of Pharmacology
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• v.30 no.3
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• pp.337-342
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• 1994

It is well known that angiotensin converting enzyme inhibitors(ACEIs) increase endothelium-dependent relaxation in aortic strips of spontaneously hypertensive rats(SHR) and this increase in relaxation may be due to altered endothelial nitric oxide breakdown. But there are few studies on the effect of the angiotensin II receptor blocker on the nitric oxide-mediated relaxation. So we attempted to investigate the effect of angiotensin II receptor blocker on the nitric oxide-dependent relaxation in isolated aorta of SHR. Two week-treatment of losartan (30 mg/kg/day) increased the acetylcholine$(10^{-9}\;to\;10^{-5}\;M)$-and histamine$(10^{-8}\;to\;10^{-4}\;M)$-induced relaxation in endothelium intact strips but 90 minutes-treatment of losartan $(10^{-4}\;M)$ showed no increase in relaxation. The phenylephrine $(10^{-7}\;M)$-induced contraction, repeated every 2 hours, was diminished gradually following lipopolysaccharide (LPS)-treatment $(100\;{\mu}g/ml)$ but there was no significant difference in enalapril- and losartan-treated group compared with control group. These results suggest that activity of the endothelial constitutive NO synthase may be changed by chronic treatment of angiotensin II receptor blockers and ACEIs but angiotensin II antagonist and ACEI have no effect on the inducible NO synthase activity in the isolated aorta of SHR