• Journal of Chest Surgery
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• v.36 no.7
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• pp.472-482
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• 2003

Recent studies have demonstrated that cerebral desaturation during rewarming period of CPB was associated with postoperative neurologic dysfunction. The prevention of cerebral desaturation during CPB may reduce the incidences of neurologic and neuropsychological complications. The present study was prospectively undertaken to compare the clinical effects between two strategies (hypercapnic CPB and high flow CPB) to prevent cerebral desaturation for establishing a proper CPB technique. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized into either hypercapnic (Pa$CO_2$ 45~50mmHg, n＝18) or high flow group (flow rate 2.75 L/ $m^2$/min and Pa$CO_2$ 35~40mmHg, n＝18) during rewarming period of CPB. In each patient, middle cerebral artery blood flow velocity ( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), modified cerebral metabolic rate for oxygen (MCMR $O_2$), cerebral oxygen transport rate ( $T_{E}$ $O_2$), incidence of cerebral desaturation (internal jugular bulb blood oxygen saturation $\leq$ 50%), increased rate of S-100 $\beta$ concentration, and arterial and internal jugular bulb blood gas were measured during the five phases of the operation; Pre-CPB, CPB-10 min (steady-state CPB, nasopharyngeal temperature 29~3$0^{\circ}C$), Rewarm-1 (rewarming phase, nasopharyngeal temperature 33$^{\circ}C$), Rewarm-2 (nasopharyngeal temperature 37$^{\circ}C$), and CPB-off. Incidence of postoperative delirium and duration were assessed in all patients. All variables were compared between the two groups. Result: $V_{MCA}$ (157.88$\pm$10.87 vs 120.00$\pm$6.18%, p＝0.006), internal jugular bulb $O_2$ saturation (68.01$\pm$2.75 vs 61.28$\pm$2.87%, p＝0.03) and $O_2$ tension (41.01$\pm$2.25 vs 32.02$\pm$ 1,67 mmHg, p＝0.03), and $T_{E}$ $O_2$(110.84$\pm$7.41 vs 81.15$\pm$8.11%, p＝0.003) at rewarming periods were higher in the hypercapnic group than in the high flow group. C(a-v) $O_2$ (4.0$\pm$0.30 vs 4.84$\pm$0.38 mg/dL, p＝0.04), COE (0.36$\pm$0.03 vs 0.42$\pm$0.03, p＝0.04), increased rate of S- 100$\beta$ (391.67$\pm$23.40 vs 940.0$\pm$17.02%, p＝0.003), and incidence of cerebral desaturation (2 vs 4 patients, p＝0.04) at rewarming periods, and duration of postoperative delirium (18 vs 34 hr, p＝0.02) were low in the hypercapnic group compared to the high flow group. Conclusion: These results indicate that hypercapnic CPB may provide relatively diminished cerebral injury and beneficial effects for cerebral metabolism relatively compared to high flow CPB.low CPB.

• The Korean Journal of Nuclear Medicine
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• v.37 no.4
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• pp.219-228
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• 2003

Purpose: The amount of salvaged myocardium is an important prognostic factor in patients with acute myocardial infarction (MI). We investigated if early Tl-201 SPECT imaging could be used to predict the salvaged myocardium and functional recovery in acute MI after primary PTCA. Materials and Methods: In 36 patients with first acute MI treated with primary PTCA, serial echocardiography and Tl-201 SPECT imaging ($5.8{\pm}2.1$ days after PTDA) were performed. Regional wall motion and perfusion were quantified with on 16-segment myocardial model with 5-point and 4-point scaling system, respectively. Results: Wall motion was improved in 78 of the 212 dyssynergic segments on 1 month follow-up echocardiography and 97 on 7 months follow-up echocardiography, which were proved to be salvaged myocardium. The areas under receiver operating characteristic curves of Tl-201 perfusion score for detecting salvaged myocardial segments were 0.79 for 1 month follow-up and 0.83 for 7 months follow-up. The sensitivity and specificity of Tl-201 redistribution images with optimum cutoff of 40% of peak thallium activity for detecting salvaged myocardium were 84.6% and 55.2% for 1 month follow-up, and 87.6% and 64.3% for 7 months follow-up, respectively. There was a linear relationship between the percentage of peak thallium activity on early redistribution imaging and the likelihood of segmental functional improvement 7 months after reperfusion. Conclusion: Tl-201 myocardial perfusion SPECT imaging performed early within 10 days after reperfusion can be used to predict the salvaged myocardium and functional recovery with high sensitivity during the 7 months following primary PTCA in patients with acute MI.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.118-124
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• 1998

Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending(LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours(mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.

• The Korean Journal of Nuclear Medicine
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• v.38 no.4
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• pp.288-293
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• 2004

Purpose: increased uptake of wrist and hand joints in three phase bone scintigraphy (TPBS) have been used in the detection of reflex sympathetic dystrophy syndrome (RSDS). TPBS frequently shows increased shoulder uptake in the hemiplegic RSDS patients. We investigated the significance of the shoulder uptake in the detection of these patients. Materials and Methods: Twenty three patients who had hemiplegia due to brain stroke and diagnosed as RSD were enrolled in this study (M:F=16:7, R:L=11:12). The mean age was $63{\pm}10$ yrs. Ter normal volunteer (mean age: $60{\pm}5$, M:F=1:9) data was used as control group. TPBS was performed $59{\pm}32$ days after stoke (acute stage). We obtained the count ratios of bilateral hands by drawing a region of interest (ROI) in three phase images and compared to the count ratios of shoulders in the delayed image. Hand ROI included an ipsilateral wrist. Sensitivity of detecting the affected limb was defined using the right/left count ratio of normal control. Results: Sensitivities using count ratios of hand blood flow, blood pool and delayed image were 45%, 76% and 78%, respectively. Sensitivity of shoulder count ratio was 74%. Log of right/left counts of hand delayed image and that of shoulder delayed image were correlated well with statistical significance (Spearman's R=0.824, p<0.001). Conclusion: Shoulder uptake showed good correlation with hand uptake in the delayed image of TPBS. Shoulder uptake maybe helpful in the diagnosis of reflex sympathetic dystrophy syndrome in patients with hemiplegia.

• Journal of Chest Surgery
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• v.39 no.3 s.260
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• pp.201-207
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• 2006

Background: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of bleeding and need for chest re~ exploration. We summarized a single center's experiences with PCPS in patients with cardiogenic shock or cardiac arrest due to the ischemic heart disease. Material and Method: Among the 20 consecutive patients with cardiogenic shock or cardiac arrest from May 1999 to June 2005, Biopump (Medtronic, Inc, Minneapolis, MN) was used in 7 patients and the self-priming, heparin-coated circuit of EBS (Terumo, Japan) was applied to remaining 13 patients. Most of cannulations were performed percutaneously via femoral arteries and veins. The long venous cannulas of DLP (Medtronic inc. Minneapolis, MN) or the RMI (Edwards's lifescience LLC, Irvine, CA) were used with the arterial cannulae from 17 Fr to 21 Fr and the venous cannula from 21 Fr to 28 Fr. Result: The 20 consecutive patients who were severely compromised and received PCPS for the purpose of resuscitation were comprised of 13 cardiac arrests and 7 cardiogenic shocks in which by-pass surgery was performed in 11 patients and 9 ongoing PCls under the cardiopulmonary support. The mean support time on the PCPS was 38$\pm$42 hours. Of the 20 patients implanted with PCPS, 11 patients ($55\%$) have had the PCPS removed successfully; overall, 8 of these patients ($40\%$) were discharged from the hospital in an average surviving time for 27$\pm$17 days after removing the PCPS and survived well with 31$\pm$30 months of follow-up after the procedure. Conclusion: The use of PCPS appears to provide the hemodynamic restoration, allowing the survival of patients in cardiac arrest or cardiogenic shock who would otherwise not survive, and patients receiving PCPS had a relatively long-term survival.