• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.354-358
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• 2006

Background: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of $T-PLS^{TM}$ through the comparison of clinical effects of $T-PLS^{TM}$ (pulsatile pump) and $Bio-pump^{TM}$ (non-pulsatile pump) used for coronary bypass surgery. Material and Method: The comparison was made on 40 patients who had coronary bypass using $T-PLS^{TM}\;and\;Bio-pump^{TM}$ (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. Result: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with $T-PLS^{TM}\;(46{\pm}15\;mmHg\;in\;T-PLS^{TM}\;vs\;35{\pm}13\;mmHg\;in\;Bio-pump^{TM},\;p<0.05)$. The $T-PLS^{TM}$-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant $(9.7{\pm}3.9\;cc/min\;in\;T-PLS^{TM}\;vs\;8.9{\pm}3.6\;cc/min\;in\;Bio-pump^{TM},\;p=0.20)$. There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with $T-PLS^{TM}\;(24.5{\pm}21.7\;mg/dL\;in\;T-PLS^{TM}\;versus\;46.8{\pm}23.0mg/dL\;in\;Bio-pump^{TM},\;p<0.05)$. There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with $T-PLS^{TM}$, but the death rate was not statistically significant. Conclusion: Coronary bypass was operated with $T-PLS^{TM}$ (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which $Bio-pump^{TM}$ was used. In addition, $T-PLS^{TM}$ used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of $T-PLS^{TM}$.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.373-378
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• 1999

Background: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. Material and Method: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. Result: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. Conclusion: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.897-902
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• 2004

Background: Although great concerns have been raised regarding the suitability of the use of the radial artery as a bypass conduit after transradial catheterization, there has been no studies that examined this issue in Korea. The purpose of this study was to compare clinical and angiographic results of radial artery grafting between patients with and without previous transradial catheterization. Material and Method: From January 2000 to February 2004, a total of 93 patients underwent coronary artery bypass grafting using the radial artery: 49 patients received preoperative transradial catheterization for coronary angiography (group I) and 44 patients did not (group II). These patients were retrospectively reviewed. Result: There was no significant difference in sex ratio, age, clinical diagnosis, risk factors, ejection fraction and early clinical outcomes between two groups. The graft patency rates in groups I and II were both 100% in the internal thoracic artery and in the radial artery, and 85% and 86% in the saphenous vein. respectively. The stenosis-free graft patency in groups I and II were 93% and 81% in the radial artery respectively but no statistical significance was shown. Conclusion: There was no significant difference in graft patency at postoperative coronary angiography between two groups. Radial artery graft after transradial catherization seems to be suitable for bypass conduit in short-term analysis.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1169-1179
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• 1992

To determine the period and degree of full recovery of postoperative pulmonary function, the author performed seiral pulmonry function test with spirometry at preoperative period and 1st, 2nd, 3rd, 4th, 6th and 8th postoperative week in 64 patients who underwent chest surgery form 1990. 1. to 1990. 8. at Dep. of Thoracic & Cardiovascular surgery, Pusan National University Hospitcal, Pusan, Korea 28 patients underwent lung resection[Group A], 14 patients mediastinal and other thoracic surgery[Group B], and 22 patients heart surgery with cardiopulmonary bypass[Group C]. Al of them recovered normally and discharged without any complications. Their serial changes of pulmonary function test were compaired and its results was as follows; l. Over all mean recovery time of restrictive ventilatory function tests[ie, VC, ERV, IC, FEF1, FVC, FEF200-1200, MVV] were 4th & 6th postoperative week, and that of obstructive ventilatory function tests[ie., EFE25-75%, Vmax50] were 2nd postoperative week. 2. In patient who underwent lung resection surgery[Group A], FEF1 recovered in 4th~6th postoperative week and its ratio to preoperative value was 70% in pneumonectomy, and 75% in lobectomy. FVC recovered in 4th~6th postoperative week and its ratio to preoperative value was 65% in pneumonectomy, and 80% in lobectomy. MVV was recovered in 4th~8th postoperative week and recovery ratio was 80%, FEF200-1200 was recovered at 4th~6th postoperative week and its recovery ratio was 70%, FEF25-75% and Vmax50 was recovered in 2nd~4th postoperative week and recovered nearly to preoperative level. 3. In patient who underwent mediastinal and other thoracic surgery[Group B], FEV1 and FVC and recovered in 4th~6th postoperative week and the recovery ratio of FVC in blebectomy was 90%. MVV reached preoperative level in 4th~8th postoperative week. FEF200-1200, FEF25-75% and Vmax50 were recovered in 2nd~4th postoperative week and the recovery of FEF25-75% and Vmax50 in blebectomy was prominant. 4. In patient who underwent heart surgery[Group C], FEV1 and FVC were recovered in 4th~6th postoperative week. The recover ratio of FEF25-75% and Vmax50 was delaied to 6th~8th postoperative week From the above results we concluded that the recovery time of posoperative restrictive ventilatory disorder was 4th postoperative week and pulmonary complication would possibly occure during that period. So more intensive observations will be needed.

• Radiation Oncology Journal
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• v.14 no.2
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• pp.129-136
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• 1996

Purpose : To evaluate the effectiveness and tolerance of patients of external beam radiotherapy for carcinoma of the extrahepatic biliary system (EHBS) including gall bladder (GB) and extrahepatic bile ducts (EHBD) and to define the role of radiotherapy for these tumors. Methods and Materials : We retrospectively analyzed the records of 43 patients with carcinoma of the EHBS treated with external beam radiotherapy at our institution between April, 1986 and Julr, 1994. Twenty three patients had GB cancers and remaining 20 patients did EHBD cancers. Of those 23 GB cancers, 2 had Stage II, 12 did Stage III and 9 did Stage IV disease, respectively. Male to female ratio was 11 to 12. Fifteen patients underwent radical surgery with curative intent and 8 patients did biopsy and bypass surgery alone All of the patients except for 3 patients were treated with 4500 cGy or higher doses postoperatively Follow up periods ranged from 11 to 82 months. Of those 20 EHBD cancers, one had Stage I, 2 did Stage II, 10 did Stage III and 7 did Stage IV disease, respectively. Male to female ratio was 16 to 4 Sixteen patients underwent Whipple's procedure or resection and drainage with curative aim and remaining 4 patients did bypass surgery alone Postoperatively 16 patients were irradiated with 4500 cGy or higher doses and 4 patients with 3180 to 4140 cGy Follow up periods ranged from 8 to 34 months. Results : Overall median survival time of patients with GB cancer was 11 months. Median survival time for Patients with Stage III and IV disease were 14 months and 5 months, respectively. Corresponding two rear survival rates were $36\%$(4/11) and $13\%$(1/8), respectively Those who underwent surgery with curative intent showed significantly better survival at 12 months than those who underwent bypass surgery alone($67\%$ vs $13\%$). None of the patients died of treatment related complications Median survival time for entire group of 20 EHBD patients was 10 months Median survivals of 10 Stage III and 7 Stage IV disease were 10 and 8 months, respectively. Two patients who underwent Whipple's procedure had 11 and 14 month survival and those treated with resection and drainage showed median survival of 10 month. Conclusion : Postoperative external beam radiotherapy for carcinoma of the extrahepatic biliary system is well tolerated and might improve survival of patients, especially those with resectable lesions with microscopic or gross residual disease after surgery.

• Transactions of the Korean Society of Automotive Engineers
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• v.9 no.1
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• pp.102-111
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• 2001

To describe the air flow characteristics within an air cleaner cover and mass air flow sensor (MAFS) entry region installed in a 3.0L engine air induction system, flow visualization, velocity and turbulence intensity measurements were taken in several view planes. A detailed knowledge of the interaction between the design parameters and the flow structures will enhance our understanding of the motions within the flow field and enable engineers to optimize the induction system and reduce the signal-to-noise ratio in the MAFS output. Emphasis is placed on the analysis of coherent motions and the controlling parameters which affect the air flow in the MAFS entrance region over a flow rate of 13-240 kg/hr. The high speed motion pictures illustrated that the air flow generated within the air cleaner cover under steady state condition is quite complex. In both axial and radial planes of the main passage it was found that the flow pattern is remarkably influenced by the air cleaner cover and main passage configuration. A comparison of the flow patterns and measurements in the original and modified air cleaner cover is presented. Measurements from the MAFS indicated an significant reduction in pressure drop and signal noise for the modified cover as compared with the original cover, over an air flow rate of 13-240 kg/hr.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.233-236
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• 1995

Subepicardial space is one of the regions in which fat in moderate amount is normally deposited. When excess deposits of epicardial fat occur, penetration or infiltration of fat into the connective tissues between muscle bundles is observed. In some cases with very extensive involvement of epicardial fat,myocardial insufficiency and conduction system defect such as heart block have been implicated. More fat is deposited over the right ventricle than over left and the anterior surface contains more fat than dose the posterior surface. We studied 40 patients who underwent open heart surgery under the cardiopulmonary bypass. This study was designed to evaluate the percentage of the area of epicardial fat of the right ventricular anterior surface, which is more accessible area during the operative procedure. Other variables included thickness of subcutanous tissue of anterior chest wall, the ratio of waist to hip circumference, body weight and age. In conclusion, the amount of the epicardial fat correlates with thickness of the subcutaneous fat of the anterior chest wall and simple linear regression analysis indicates good correlation with body weight. Increased age results in large amount of epicardial fat.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.71-80
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• 1987

Twenty six patients were operated a total correction of tetralogy of Fallot between Jan., 1984 and July, 1985 at the Dept. of thoracic and cardiovascular surgery, Chonnam University Medical School, and a comparison between the survived group [n = 18] and the dead group [n = B was performed to detect factors influencing laboratory data, cineangiographic findings, operative findings and methods, and pump time. Following results were obtained, 1. There was no significant difference between two groups in the preoperative P.O2 and hematocrit level. 2. The size of the interventricular defect was not related to the operative mortality. 3. There was a significant difference in mortality rate between combined type of stenosis of pulmonary artery, valve and infundibulum and other types of right ventricular outflow tract stenosis. 4. There was a significant difference in mortality rate between the transannular patch reconstruction and other types of operative procedure. 5. There was no significant difference between two groups in total bypass time and aortic time. 6. There was no significant difference between two groups in left ventricular end diastolic volume and right ventricular end diastolic volume. 7. The operative mortality was related to the ratio of the diameter of the pulmonary valve annulus or each pulmonary artery to the ascending or descending aorta in cineangiographic findings, but there was no statistical significance of which probably is due to the lack of the total number of patients.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.528-535
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• 1987

A clinical study was performed on 164 cases of PDA experienced at the Dept. of Thoracic and Cardiovascular Surgery of Pusan National University Hospital during 6 years from Jan. 1981 to Dec. 1986. It was shown that the PDA was a female-dominant heart disease [male to female ratio, 1:2.8] and two most common symptoms were frequent URI [45.6%] and exertional dyspnea [36.7%]. Continuous machinery murmurs were detected in 143 cases [87.2%], increased pulmonary vascularities [89.0%] and cardiomegalies [63.4%] by chest X-ray. The signs of LVH [43.9%], RVH [3.7%] and BVH [4.9%] were noted on the EKG. Cardiac catheterizations were performed on 67 out of 164 patients and the mean systolic pulmonary artery pressure was 48mmHg [range: 18-131mmHg] and the mean Qp/Qs was 3.1 [range:1.2-8.5] and Rp/Rs below 0.25 was 83.6%. Associated cardiac anomalies were VSD [7.9%], ASD [3.0%], pulmonary valvular stenosis [2.4%] and left persistent SVC [2.4%]. Operative methods were as follows; ligations [145; 88.4%] and divisions [6;3.7%] were performed through the left posterolateral thoracotomies without mortality and the remained cases [13;8.0%] were managed under the cardiopulmonary bypass because of the associated cardiac anomalies. Atelectasis [4.9%] and pneumonia [4.3%] were most frequent postoperative complications and the overall mortality rate was 2.4% [4 out of 164 cases].

• Journal of Chest Surgery
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• v.20 no.3
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• pp.520-527
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• 1987

Clinical analysis was performed of 89 secundum type atrial septal defect patients operated on during the period from July, 15th, 1981 to March, 1987 in the Thoracic and Cardiovascular Surgery Department of Pusan National University Hospital. Secundum type ASD was 2`I.0% among all of congenital heart diseases operated in the same period. The age distribution of patients ranged from 3 to 41 years and sex ratio, male to female was 1.23 to 1.0. Common symptoms were exertional dyspnea 64.0%, frequent upper respiratory infection 43.8%, cyanosis 10.1% and fatigue 7.9%. The mean value of cardiac catheterization data of the group of ASD combined with another cardiovascular anomalies was compared with that of only ASD group. The amount of shunt showed not statistically significant difference between two groups [P>0.05] but pulmonary arterial pressure and pulmonary vascular resistance of combined group was significantly higher than that of only ASD group [P<0.02, P<0.01]. The difference of mean hemodynamic data between the age group below 20 years and above 21 years was not statistically significant [P>0.05]. All cases were operated under cardiopulmonary bypass. Among these 51 were closed directly and 38 were applied Dacron patch. Two most common associated cardiac anomalies were pulmonary stenosis [8 cases, 9.0%] and VSD [8 cases, 9.0%]. The most frequent postoperative complication was wound infection, One patient died of low cardiac output on 10th postoperative day and the overall operative mortality was 1.1%