• Journal of Chest Surgery
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• v.37 no.12
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• pp.1003-1009
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• 2004

Mechanical circulatory support (MCS) has been used for myocardium failure, but moreover, it may be essential for the life support in cardiac arrest or cardiogenic shock. Many commercial devices can be used effectively for the long-term support. However, there are some limitations in the aspects of the cost and technical support by production company. Short-term support with centrifugal type has been reported numerously with the purpose of bridging to heart transplantation or recovery. We successfully treated 5 patitents who were in the status of cardiogenic shock (n=3) or arrest (n=2) with the technique of extracorporeal life support system (ECLS) or left ventricular assist device (LVAD) using the centrifugal type pump. The MCS were performed emergently (n=2) under cardiac arrest caused by ischemic heart disease, and urgently (n=3) under cardiogenic shock with ischemic heart disease (n=1) or acute fulminant viral myocarditis (n=2). All patients were weaned from MCS. Complications related to the use of MCS were bleeding and acute renal failure, but there were no major complications related to femoral cannulations. Mechanical circulatory support may be essential for the life support and rescue in cardiac arrest or cardiogenic shock.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.717-720
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• 2005

Here we report a case of posterior left ventricular (LV) free wall rupture following postinfarct ventricular septal rupture (VSR). A 58-year-old man was transferred to the hospital under the impression of acute myocardial infarction. Posterior VSR was seen on echocardiographic examination. The intraaortic balloon pump catheter was introduced percutaneously and the emergent operation was proposed. Sudden circulatory collapse was developed shortly after the anesthetic induction and the patient's chest was hurriedly opened while on cardiopulmonary resuscitation. The acute cardiac tamponade was seen and the blood was seen pumping from the longitudinal tear at the mid-level of LV posterior wall, measuring 2 cm in length. The cardiopulmonary bypass was set and LV reconstruction was done. The postoperative recovery was delayed due to the brain injury presumably caused by preoperative cardiac arrest.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.38-44
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• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• Journal of Life Science
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• v.20 no.9
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• pp.1299-1305
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• 2010

Cardiac troponin-I (cTnI), creatine kinase-MB (CK-MB), and C-reactive protein (CRP) are routine cardiac markers for the diagnosis of cardiovascular disease. Recently, brain natriuretic peptide (BNP) has garnered attention as a marker of heart failure. This study was retrospectively designed to investigate the relationships between preoperative BNP, other cardiac markers levels and perioperative parameters in seventy-four adult patients that underwent off-pump coronary artery bypass grafting (OPCAB) and to assess its usefulness for predicting postoperative outcomes. Preoperative levels of BNP, cTnI, CK-MB, and CRP had significantly positive or negative correlations with echocadiographic parameters. There were significantly positive relationships between BNP, cTnI, CK-MB, and CRP concentration. Postoperative mechanical ventilation time had a positive correlation to preoperative levels of cTnI, CK-MB, and CRP, while ICU-staying period had a positive correlation with BNP, cTnI and CK-MB. These results reveal that a preoperative level of BNP is a good predictor and that its combination with cTnI, CK-MB, and CRP might be useful for diagnosis and comprehensive risk stratification of patients with coronary heart diseases, as well as prognosis of perioperative outcomes in OPCAB patients.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.345-350
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• 2001

배경: 항부정맥 술식으로서의 메이스 술식은 우수한 동율동 전환율을 보고 있으나, 술식의 복잡성과 상대적으로 긴 수술 시간 등으로 모든 환자들에게 적용할 수는 없기에, 일부 환자군에서 보다 간단한 항부정맥술인 폐정맥 분리술을 시행 받은 환자들을 대상으로 동율동 전환율 등의 수술 성적과 위험 인자 등에 대해 알아보고자한다. 대상 및 방법: 1995년 10월부터 1999년 2월까지, 폐정맥 분리술을 시행받은 96명의 환자들을 대상으로 후향적 연구를 시행하였다. 남자가 37명(38.5%), 여자가 59명(61.5%) 이었고, 평균 연령은 46.9$\pm$11.6세 이었다. 승모판 협착 환자가 50명(52.1%), 폐쇄 부전이 24명(25%), 협착과 폐쇄부전이 같이 있었던 경우가 22명(22.9%)이었다. 판막 술식과 폐정맥 분리술을 시행하고 좌심방이 제거술을 시행하였다. 모든 환자들은 술 후 6개월 내지 1년 이내에 외래에서 심전도와 심초음파를 시행받았다. 평균 추적 관찰 기간은 25.9$\pm$11.5개월 이었다. 술 후 최근 추적일까지 동율동으로 전환된 군과 안된 군으로 나누어 분석을 하였다. 결과: 조기 성적으로는 사망이 3명(3.1%), 술 후 6개월 이내의 추적관찰 유실이 2명(2.1%) 이었다. 조기 합병증으로 재수술이 필요 했던 출혈이 4례, 심폐바이패스 이탈 실패오 심실보조장치 등의 삽입이필요했던 경우가 1례, 뇌혈관질환 1례, 심근경색이 1례 등이 있었다. 만기 합병증으로는 동기능 부전 증후군으로 영구 심박동기를 삽입한 경우가 1례, 일시적인 뇌경색 1례 있었고 다른 판막과 연관된 합병증은 없었다. 동율동 전환 환자 수는 75명(82%)이었다. 동율동으로의 전환이 어려운 위험인자로 50세로 이상의 연령(p=0.03), 65mm 이상의 좌심방 크기(p=0.03), 동반 우심 술식 시행(p=0.02)등이 있었다 결론: 승모판 질환을 동반한 심방 세동 환자에서 폐정맥 분리술을 시행하여 만족할 만한 동율동 전환율을 얻을 수 있었다.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.440-448
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• 2006

Background: Surgery of descending thoracic or thoracoabdominal aorta has the potential risk of causing neurological injury including spinal cord damage. This study was designed to find out the risk factors leading to spinal cord and brain damage after surgery of descending thoracic and thoracoabdominal aorta. Material and Method: Between October 1995 and July 2005, thirty three patients with descending thoracic or thoracoabdominal aortic disease underwent resection and graft replacement of the involved aortic segments. We reviewed these patients retrospectively. There were 23 descending thoracic aortic diseases and 10 thoracoabdominal aortic diseases. As an etiology, there were 23 aortic dissections and 10 aortic aneurysms. Preoperative and perioperative variables were analyzed univariately and multivariately to identify risk factors of neurological injury. Result: Paraplegia occurred in 2 (6.1%) patients and permanent in one. There were 7 brain damages (21%), among them, 4 were permanent damages. As risk factors of spinal cord damage, Crawford type II III(p=0.011) and intercostal artery anastomosis (p=0.040) were statistically significant. Cardiopulmonary bypass time more than 200 minutes (p=0.023), left atrial vent catheter insertion (p=0.005) were statistically significant as risk factors of brain damage. Left heart partial bypass (LHPB) was statistically significant as a protecting factor of brain (p=0.032). Conclusion: The incidence of brain damage was higher than that of spinal cord damage after surgery of descending thoracic and thoracoabdominal aorta. There was no brain damage in LHPB group. LHPB was advantageous in protecting brain from postoperative brain injury. Adjunctive procedures to protect spinal cord is needed and vigilant attention should be paid in patients with Crawford type II III and patients who have patent intercostal arteries.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.680-684
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• 2005

Background: With the increasing age of the population, coronary artery bypass grafting in the elderly patients is becoming common. Off-pump coronary artery bypass grafting (OPCAB) has been proven to be less morbidity and to facilitate early recovery. The elderly patients may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The purpose of this study is to evaluate our results of OPCAB in elderly patients. Material and Method: A retrospective chart review was carried out for 12 patients aged over 80 years who underwent isolated OPCAB from January 2001 and March 2004. Data were collected risk factors for disease, extent of coronary disease, and in-hospital outcomes. Postoperative graft patiency was evaluated in 9 patients by multi-slice computed tomography. Result: Eleven patients had triple vessel disease or left main disease. Four patients were suffered from preoperative CVA, and 4 patients had chronic obstructive pulmonary disease. Two patients had myocardial infarction (MI), among them 1 patient was suffered from pulmonary edema after preoperative MI. There was no perioperative death, perioperative MI, and no ventricular arrhythmia. Also there was no perioperative stroke and renal failure. But there was one deep sternal infection who recovered by treating of muscle flap. Atrial fibrillation was newly developed in 1 patient, but was well controlled by medication. Mean intubation time was $15.9\pm4.4(8\~20hrs)$ hrs and mean ICU stay was $2.9\pm0.8(2\~4 days)$ days. Mean hospital day was $21.6\pm14.3(13\~56 days)$ days. Postoperative mean CK-MS was $11.3\pm14.1\;ng/mL$. Early postoperative graft patency rate was $100\%(24/24)$. Follow-up was completed in all patients. In this time, there was no patients with angina or death. Conclusion: The results of this study suggest that OPCAB reduces morbidity and favors hospital outcomes. Therefore, OPCAB is safe, reasonable and might be preferable operative strategy in elderly patients.

• Economic and Environmental Geology
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• v.38 no.6 s.175
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• pp.675-687
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• 2005

The rocks of the five storied stone pagoda in the Jeongrimsaji temple site are 149 materials in total with porphyritic biotite granodiorite. They include pegmatite veinlet, basic xenolith and evenly developed plagioclase porphyry. This stone pagoda has comparably small fracture and cracks which are farmed in the times of rock properties, but surface exfoliation and granular decomposition are in process actively since the rocks are generally weakened from the influence of air contaminants and acid rain. Structural instability of constituting rocks in the 4th roof materials are observed to occur from distortion and tilt. Such instability is judged to threat stability of the upper part of the stone pagoda. Also, chemical weathering is operating even more as the contaminants, ferro-manganese hydroxides eluted from water-rock interaction on the rock surface. Most of the rock surface is covered with yellowish brown, dark black and light gray contaminants, and especially occur in the lower part of the roof rocks on each floor. The roof underpinning rocks are severe in surface pigmentation from manganese hydroxides and light gray contaminants. The surface of rocks lives bacteria. algae, lichen, or moss and diverse productions in colors of light gray, dark Bray and dark green. Grayish white crustose lichen grows thick on the surface with darkly discolored by fungi and algae in the first stage on basement rocks, and weeds grows wild on the upper part of each roof rocks. This stone pagoda must closely observe the movements of the upper part rock materials through minute safety diagnosis and long term monitoring for structural stability. Especially since the surface discoloration of rocks and pigmentation of secondary contaminants are severe, establishment of general restoration and scientific conservation treatment are necessary through more detailed study for this stone pagoda.

• Economic and Environmental Geology
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• v.38 no.6 s.175
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• pp.643-656
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• 2005

The East Sea, a marginal sea or back-arc basin, consists of Japan Basin, Yamato Basin, and Ulleung Basin and is surrounded by the Pacific Plate and Philippine Sea Plate. Ulleung Basin locates in the southwestern part of the East Sea and shows the depth of 1,500 m in average and 2,500 m in maximum, connecting to the Japan Basin along 2,000 m contour. The slope of the seafloor is greater in the western side of the basin than in the southern and the eastern side. The crustal thickness of the Ulleung Basin from the OBS tends to get thicker toward the north and the west side and the sediment thickness of the Ulleung Basin is getting thicker toward the southeast side and reaches up to 12 km. The crustal type of the Ulleung Basin was variously suggested as like as a rifted continental crust, an extended continental crust, and an incipient oceanic trust. The origin of the crustal formation and the Ulleung Basin, however, is still controversial. Based on the bathymetry and gravtiy anomaly data for this study, the axis of the Ulleung Basin shows that the basin develops along the axis trending NW-SE direction and reveals a general symmetry of the bathymetry. And also the free-air gravity anomalies show a very similar pattern to the bathymetry of the basin. The sediment thickness is relatively thicker in the southeastern side of the basin than in the northwestern side. Although the crustal age of the Ulleung Basin is supposed to be younger than them of the Japan Basin and the Yamato Basin, the free-air gravity anomalies of the Ulleung Basin ranging -40 to 50 mGals are lower than the other basins, which suggests that the densities of crust and sediment of the Ulleng Basin are lower than the Japan Basin and the Yamato Basin.

• Economic and Environmental Geology
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• v.38 no.6 s.175
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• pp.717-729
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• 2005

Peak cooling load of large buildings is generally greater than their peak heating load. Internal and solar heat gains are used fur selection of adquate equipment in large building in cold winter climate like Canada and even Korea. The cost of geothermal heat exchanger to meet the cooling loads can increase the initial cost of ground source heat pump system to the extend less costly conventional system often chosen. Thermal ice storage system has been used for many years in Korea to reduce chiller capacity and shift Peak electrical time and demand. A distribution system designed to take advantage of heat extracted from the ice, and use of geothermal loop (geothermal heat exchanger) to heat as an alternate heat source and sink is well known to provide many benifits. The use of thermal energy storage (TES) reduces the heat pump capacity and peak cooling load needed in large building by as much as 40 to $60\%$ with less mechanical equipment and less space for mechanical room. Additionally TES can reduce the size and cost of the geothermal loop by 1/3 to 1/4 compared to ground coupled heat pump system that is designed to meet the peak heating and cooling load and also can eliminate difficuties of geothermal loop installation such as space requirements and thermal conditions of soil and rock at the urban area.