• Journal of Chest Surgery
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• v.37 no.7
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• pp.553-558
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• 2004

Avoiding cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CAB G) has been known to reduce early mortality and morbidity. Diabetes Mellitus is a significant risk factor for adverse early and late outcomes after CABG. We compared the clinical results of off-pump CABG versus on-pump CABG in diabetes patients. Material and Method: 682 patients (424 off-pump CABG and 258 on-pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Data were collected 242 patient who had diabetes. Among them, 154 patients underwent off-pump CABG and 90 patients underwent on-pump CABG. We analyzed the preoperative risk factors and postoperative results between 2 groups. Result: Two groups did not show statistical differences in age, sex, coronary and operative risk factors. Operative time was significantly shorter in off-pump CABG, however, number of grafts was fewer in off-pump CABG. Postoperative inotropic usage was lower in off-pump CABG. Postoperative CK-MB level was lower in off-pump CABG, and ICU stay and ventilation time was significantly shorter in off-pump CABG. However, there was no statistical difference between 2 groups in operative mortality, reoperation rate, perioperative myocardial infarction, wound infection, renal failure, neurological complications and hospital stay. Conclusion: Off-pump CABG group showed less myocardial damage and early recovery. We concluded that off-pump CABG is the more reasonable technique in diabetes patients although two techniques showed good results. The long-term follow up and prospective study may be warranted.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.197-203
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• 2012

Purpose: In this study, we considerate our radiation therapy process for the breast cancer patient implanted a pacemaker applying the machine movement surgery, shielding, beam selection. Materials and Methods: We perform radiation therapy to a 54 years old, breast cancer patient implanted a pacemaker. The patient underwent a surgery to move the position of a pacemaker to right side breast after consultation with cardiology department. Prescribed dose was 5,040 cGy and daily dose 180 cGy for 28 fractions. The 10 MV photon energy, field size 0/$9.5{\times}20$ cm, half beam and opposing portal irradiation are used. To find out appropriate thickness of shielding board, we carried out an experiment using a solid water phantom ($30{\times}30{\times}7$ cm), a Farmer-type chamber (TN30013, PTW, Germany) and a shielding board (Pb $28{\times}27{\times}0.1$ cm). We calculated expected absorbed dose to te pacemaker with absorb ratio and shielding ratio. In the PTP system (Eclipse, Varian, USA), we figured out how much radiation would be absorbed to the machine with and without shielding. First day of the radiation therapy, we measured head scatter to the pacemaker with MOSFET Dose Verification System (TN-RD-70-W, Medical Canada Ltd., Canada). Results: In the phantom measurement, we found out appropriate thickness was 2 mm of shielding board. In the RTP, when using 2 mm shielding the pacemaker will be absorbed 11.5~38.2 cGy and DVH is 77.3 cGy. In the first day of the therapy, 4.3 cGy was measured so 120.4 cGy was calculated during total therapy. The patient was free from any side effects, and the machine also normally functioned. Conclusion: As the report of association which have public confidence became superannuated, there is lack of data about new machine. We believe that radiation therapy to thiese kind of patients could be done successfully with co-operation, patient-suitable planning, accurate QA, frequent in-vivo dosimetry and monitoring.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1127-1133
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• 1998

Background: There are no ideal substitutes for tracheal replacement. Therefore we investigated the possibility of clinical use of cryopreserved tracheal homograft with special interest in the viability and rejection of the epithelial cell and cartilage. Material and Method: Rabbit's trachea was sected and stored in liquid nitrogen tank for 1 month. Tracheal replacement was done in 45 rabbits with autograft(n=15, Group 1), fresh allograft(n=15, Group 2) and cryopreserved homograft(n=15, Group 3). After 7, 14, and 30 days, 5 rabbits in each group were sacrificed and the regeneration of epithelium and cartilage and the degree of rejection were assessed by counting the monocellular infiltration. Result: Investigation at day 7, showed no difference in epithelial regeneration, however, at days 14 and 30, Group 1 showed better regeneration of epithelium than groups 2 and 3. There was no difference of epithelial regeneration between group 2 and 3. There was little rejection at day 7, but at days 14 and 30, there was significant rejection in group 2 and group 3.(P<0.05). Group 3 showed lesser rejection than group 2 at days 14 and 30, but it was not statistically significant. Cartilage showed no rejection and maintained its viability in groups 2 and 3. Conclusion: Cryopreserved tracheal homograft can maintain its viability, therefore it may represent a possibility of clinical application for tracheal replacement. However, cryopreservation can not eliminate the antigenicity of the trachea completely. Furthere studies for lowering the antigenicity and rejection should be performed for an ideal substitute for tracheal replacement.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.364-368
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• 2004

Congenital pulmonary vein stenosis is a rare anomaly and related to high mortality due to progressive pulmonary hypertension and heart failure in infancy. Aggressive anti-failure medication and surgical treatment is recommended. Surgical options are balloon dilatation, endovascular stent, pneumonectomy, lung transplantation, patch grafting, and sutureless repair. We report a case of congenital pulmonary vein stenosis with normal anatomical connection successfully treated with sutureless technique and using pulmonary vasodilators, such as Sildenafil, lloprost and iNO postoperatively.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.393-397
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• 1998

A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction(LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle(LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator(EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.733-738
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• 1997

Sequential bilateral lung transplantation may result in a variety of perioperative and postoperative complications, showing high perioperative morbidity and mortality rates. This research was performed to investigate the hemodynamic changes in adult mongrel dogs after bilateral reimplantation, two methods preferred for avoiding or minimizing graft rejection. The anterior portion of the pulmonary artery and the left atrium proximal to the superior and the inferior pulmonary veins were resected out and then re-anastomosed one hour later to prevent torsion or stenosis of the anastomotic site and the formation of a thrombosis in the left atrium. An everted suture technique was employed for the left atrium; An hour after the division, however, the main bronchus was tightly anastomose by interrupted sutures of No. 4-0 prolene in a telescope method. A modified I-C solution mixed with PGEI was infused into the cut portion of the pulmonary artery at the rate of 15 mllkglmin and at a pressure of 40 cmH20 for a total dosage of 70 mlfkg in order to preserve the transected lung. Topical cooling using wet gauzes soaked with cold I-C solution was performed for one hour to prevent ischemic lung injury. The above procedures are considered to be beneficial for achieving a satisfactory outcome for bilateral lung reimplantation.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1055-1061
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• 1997

In the field of the experimental lung transplantation, we analyzed the CT findings of acute rejection, infection in the left single allotransplanted lung of adult mongrel dogs, and the CT findings were compared with the histological findings obtained by the lung biopsy Twenty two adult mongrel dogs were divided into two groups(Donor and recipient group). Donor lungs were flushed with LPDG(low pota,ilium dextral glucose) solution(n=4) or modified Euro-collins solution(n=7) and preserved over 20 hours with $10^{\circ}C(1$ case preservation for 4hours). After left single lung transplantation, the chest X-ray and sequential computed tomogram were performed with concomitant hemodynamic study and arterial blood gas analysis on immediate postoperative period, postoperative 3rd day and postoperative 7th day. Two of eleven transplanted lungs had acute rejection which was represented as moderate infiltration at immediate or 1st postoperative d y but became extensive infiltration at postoperative 3rd day on CT. There were showed one case of bronchopleural fistula, six cases of pneumonia and two cases of pulmonary infarction. In one rejection cases, the opacity of transplanted lung was improved by injection of methylprednisolone 500mg daily during 3 days. We concluded that CT was a useful noninvasive evaluation parameter after lung transplantation and the serial CT scan enabled early detection of acute rejection.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.270-274
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• 1997

In recent years, the use of allograft conduits in repair of congenital cardiac disease is widely accepted. However, the supply of homograft. is currently limiting their increased clinical application, especially small cryopreserved homografts for use in neonates and inf'ants. We used a technique to surgically reduce the size of the more readily available large-diameter allografts, making them suitable for right ventricular outflow tract reconstruction in small infants and children. From December 1994 to March 1996, a total of 11 patients ranging in age from 10 months to 6 years (mean age, 27.3 months) and ranging in weight from 5.6 to 18.5 kg (mean 11.5 kg) underwent reconstruction of the right ventricular outflow tract using this surgical technique (pulmo ary atresia with ventricular septal defect, 9 cases ; tetralogy of Falloff, 2 cases). The diameter after downsizing ranged from 14 to 19 mm with a mean of 16.8 mm. There was one operative death due to rupture of the infected homograft. Evaluation of these patients between 2 and 15 months (mean 6.9 months) after homograft implantation reveals excellent clinical and echocardiographic results. There were no significant homograft insufficiency and RVOT obstructions. Although a longer follow-up is certainly required to evaluate the long term fate of the surgically modified bicuspid homografts, we believe that this technique may represent a valuable therapeutic alternative, at least in the short term, to the use of synthetic grafts when an appropriately sized homograft is not available.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.297-306
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• 2004

Current artificial heart valves have several disadvantages, such as thromboembolism, limited durability, infection, and inability to grow. The solution to these problems would be to develop a tissue-engineered heart valves containing autologous cells. The aim of this study was to optimize the protocol to obtain a porcine acellular matrix and seed goat autologous endothelial cells on it, and to evaluate the biological responses of xenograft and xeno-autograft heart valves in goats. Material and Method: Fresh porcine pulmonic valves were treated with one method among 3 representative decellularization protocols (Triton-X, freeze-thawing, and NaCl-SDS). Goat venous endothelial cells were isolated and seeded onto the acellularized xenograft leaflets. Microscopic examinations were done to select the most effective method of decellularizing xenogeneic cells and seeding autologous endothelial cells. Two pulmonic valve leaflets of. 6 goats were replaced by acellularized porcine leaflets with or without seeding autologous endothelial cells while on cardiopulmonary bypass. Goats were sacrificed electively at 6 hours, 1 day, 1 week, 1 month, 3 months, and 6. months after operation. Morphologic examinations were done to see the biological responses of replaced valve leaflets. Result: The microscopic examinations showed that porcine cells were almost completely removed in the leaflets treated with NaCl-SDS. The seeded endothelial cells were more evenly preserved in NaCl-SDS treatment. All 6 goats survived the operation without complications. The xeno- autografts and xenografts showed the appearance, the remodeling process, and the cellular functions of myofibroblasts, 1 day, 1 month, and 3 months after operation, respectively. They were compatible with the native pulmonary leaflet (control group) except for the increased cellularity at 6 months. The xenografts revealed the new endothelial cell lining at that time. Conclusion: Treatment with NaCl-SDS was most effective in obtaining decellularized xenografts and facilitate seeding autologous endothelial cells. The xenografts and xeno-autografts were repopulated with myofibroblasts and endothelial cells in situ serially. Both of grafts served as a matrix for a tissue engineered heart valve and developed into autologous tissue for 6 months.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.639-645
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• 1996

A 14-year-old male patient with previous surgical repair of tetralogy of Fallot was admitted with hemodynamically significant ventricular tachycardia (VT). On preoperative electrophysiologic study (EPS), the morphology of documented VT was RBBB of vertical axis with 320 msec cycle length. The endocardial mapping during VT delineated the origin of VT at right ventricular outflow tract (RVOT), where the patch was attached. The clinical VT had a clockwise reentry circuit around the patch with the earliest activation at the same site seen during the preoperative EPS. The previously placed right ventricular outflow patch and fibrous tissue were removed. During a postoperative EPS, it was no longer possible to induce the VT. Ventricular tachycardia following repair of tetralogy of Fallot seen in this patient was caused by a macro-reentry around the right ventricular outflow patch. We were able to ablate the VT with the aid of a detailed mapping of its epicardial activation sequence.