• Journal of Chest Surgery
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• 제42권2호
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• pp.256-258
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• 2009

17년 전에 관상동맥 우회술을 시술 받은 63세 환자가 인공 심박동기 삽입 후 발생한 국소 감염으로 입원하였다. 피부 절개 후 심박동기를 견인하여 제거하려 하였으나 와이어가 뽑히지 않았고, 와이어는 절단하여 체내에 남겨둔 채로 치료를 종료하였다. 그러나 반복적으로 국소 감염이 재발하였고, 이에 우측 개흉술로 접근하여 인공 심폐 순환 후, 순환 정지 하에 우심방을 열고 와이어를 제거하였다.

• International Journal of Vascular Biomedical Engineering
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• 제3권1호
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• pp.1-5
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• 2005

Background: Coronary atherosclerosis artery disease is the leading cause of morbidity and mortality. Coronary artery bypass grafting (CABG) which utilizes the saphenous vein graft, has helped in alleviating the suffering of these patients. Newer techniques are being developed to improve upon the techniques. Still there is significant number of failures, leading to re-grafting or re-vascularization. Some studies have helped in identifying the high and low shear stress regions. Further studies based on their realistic models are required. Material, methods and results: we developed the realistic model of fully blocked right coronary with bypass graft placed at angle of $5^0$ with curvature similar to that of artery. Pulsatile flow of birefringent solution through this model by polarized light was visualized. The images of complete flow field in the model were recorded and analyzed. Regions of high flow disturbances which are prone to further changes are identified. Existence of recirculation in the blocked coronary may initiate new blood-tissue interactions deleterious to bypass graft. Conclusion: Our study shows that by selecting the procedure to place bypass graft at minimum angle with curvature similar to that of artery and smooth sutures may improve the life span of the graft. This study also identified that coronary blocked regions contributing by recirculation flow at the proximal and distal regions of bypass which may require further studies.

• Journal of Chest Surgery
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• 제33권6호
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• pp.487-493
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• 2000

Background: Early patency of the coronary artery bypass grafting is determined mainly by surgical technique and status of coronary artery. We analyzed the early result, focusing on the relationship between postoperative angiographic findings and the patency rate. Material and method: During the period of July 1997- August 1999, 86 cases of CABG were performed and the postoperative coronary artery angiography was done in 76 cases on postoperative day 7 to assess the graft patency. Result: Overall graft patency was 90.2% on the angiographic finding. Factors influencing the early graft occlusion were the surgeon's experience, small coronary artery size less than 1.5mm in diameter, coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site(p<0.001). Operative mortailty was 2.3%. Early recurrence of the symptom was 19.8% during the follow up period. Conclusion: We examined the postoperative coronary angiography and found that the surgeon's experience, small coronary artery size less than 1.5mm in diameter, bypass surgery on the coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site were the factors for the graft occlusion.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1369-1375
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• 1992

During a 17-month period 32 consecutive patients underwent coronary artery bypass graft. The mean age of these patients was 45.3 years [range 39 to 71 years]. There were 18 men and 14 women. Preoperatively 11 patients had stable angina pectoris and 12 patients of unstable angina pectoris. 28% [9 patients] had of myocardial infarction history. The patterns of disease were single vessel involvement [4 casis], double vessel involvement [11 cases], triple vessel involvement [12 caese] and 5 cases of left main coronary artery disease. Thirty-seven percent [12/32] were in New York Heart Association class IV. Myocardial revascularization was performed under emergency conditions in 3 patients. We performed 13 case of double anastomosis, 12 case of triple anastomosis and 4 case of 4 anstomosis [mean 2.59 anastomosis per patient]. The left internal mammary artery was used in 68.7%. 90% of the patients receieved two or more grafts. Complications occurred in 8 patients [25%]. All patients were followed up for a mean of 8.6 months [2 to 17 months]. There was no hospital and late death. Postoperatively 87% were in New York Heart Association class I or II and 96% of the patient were free from angina.

• 기본간호학회지
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• 제15권2호
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• pp.171-177
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• 2008

Purpose: The aim of study was to identify the effects of exercise on the relief of low back pain in patients on absolute bed rest after TAE. Method: A nonequivalent control group pretest-posttest design research design was used. The participants were 43 patients who had received TAE in a university hospital; patients in the experimental group (21) received both exercise therapy and general post-op nursing care and in the control group (22) only the latter. The exercise program used in this study was modified from exercise for post CABG to exercise for post TAE, which deflect the movement of thigh in which the catheter was inserted, the lumbar region of the back and pelvis. Results: First, Low back pain scores in the experimental group were lower than the control group. Second, The first dose of analgesics in the experimental group was delayed compared to the control group. Third, There was no significant difference in bleeding complications between the experimental group control groups. Conclusion: The results suggest that the exercise program used in this study is effective for relief of low back pain in patients on absolute bed rest after TAE.

• Journal of Chest Surgery
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• 제26권11호
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• pp.833-837
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• 1993

In an effort to reduce the stroke rate of patients after coronary artery bypass, many authors have studied the prevalence of the extracranial carotid disease and its role in determining neurologic morbidity and mortality rates. From April 1992 to August 1993, Seventy-five patients undergoing coronary artery bypass were preoperatively evaluated for presence of carotid and femoral stenosis by Duplex sono. Among them, fourteen patients was positive by Duplex sono and overall prevalence of carotid or femoral stenosis was 18.7%. And significant carotid stenosis [ > 60% ] had proved to be in 3 patients [ 4.0% ].Prophylatic bilateral carotid endarterectomy was performed in one patient, at 5 months prior to and , 1 week prior to coronary artery bypass respectively. Their mean age was 57.6 years [ ranged from 40 to 70 years] and were composed of 10 males and 4 females. There was no postoperative morbidiry and mortality related to neurologic complications. Our data, although small, suggest that preoperative carotid screening is helpful to determine patients at high risk of stroke, and significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible.

• Journal of Chest Surgery
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• 제26권7호
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• pp.526-531
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• 1993

Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

• Journal of Chest Surgery
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• 제27권3호
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• pp.187-190
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• 1994

Between March, 1989, and August, 1993, 10 patients underwent aortocoronary bypass surgery concomittant with cardiac valve replacement. They were 6 men and 4 women, the age ranging from 47 to 64. 7 patients underwent single valve replacement and 2 patients underwent double valve replacement, Another one patient underwent only CABG one year after valve replacement and he had no evidence of prosthetic valve failure. Total number of graft vessels were.15,14 were saphenous venous grafts and 1 was internal mammary artery graft. Dyspnea on exertion was frequent symptom and was found in all patients. 8 patients presented stable angina, only 1 patient presented postinfarct angina and another 1 patient presented no angina symptom. The graft was placed prior to valve replacement and periods of myocardial ischemia were kept at a minimum by maintaining coronary perfusion throughout operation. Postoperative course was uneventful and there was no hospital mortality, as was supported by many reports, it is our opinion that simultaneous valve replacement and aortotomy bypass graft does not increase the risk of cardiac valve replacement substantially.

• 보건행정학회지
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• 제21권4호
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• pp.541-564
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• 2011

This study aimed to investigate health outcome of acute myocardial infarction (AMI) patients such as mortality and length of stay in hospital and to identify factors associated with the health outcome according to the comorbidity index. Nation-wide representative samples of 3,748 adult inpatients aged between 20-85 years with acute myocardial infarction were derived from the Korea National Hospital Discharge Injury Survey, 2005-2008. Comorbidity index was measured using the Charlson Comorbidity Index (CCI). The data were analyzed using t-test, ANOVA, multiple regression, logistic regression analysis in order to investigate the effect of comorbidity on health outcome. According to the study results, the factors associated with length of hospital stay of acute myocardial infarction patients were gender, insurance type, residential area scale, admission route, PCI perform, CABG perform, and CCI. The factors associated with mortality of acute myocardial infarction patients were age, admission route, PCI perform, and CCI. CCI with a higher length of hospital stay and mortality also increased significantly. This study demonstrated comorbidity risk adjustment for health outcome and presented important data for health care policy. In the future study, more detailed and adequate comorbidity measurement tool should be developed, so patients' severity can be adjusted accurately.

• 임상간호연구
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• 제14권1호
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• pp.25-32
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• 2008

Purpose: The purpose of this study was to examine quality of life with patients in 12 months after coronary artery bypass graft surgery, compared with general population. Method: A cross-sectional comparative study was designed. Study participants were 90 adults who had undergone CABG surgery (n=45) in experimental group and general population (n=45) in control group. The subjects were asked the questionnaire (SF-36, Short Form-36) regarding the quality of life. The data were analyzed by the SPSS 13.0 program including frequency, percentage, $x^2$ test, t-test and One-Way ANOVA. Results: There were no significant differences in the quality of life between two groups including physical functioning (t=-.938, p=.351), role-physical limitation (t=-.322, p=.748), bodily pain (t=-.938, p=.351), general health (t=-.1418, p=.888), vitality (t=-.816, p=.417), social functioning (t=.720, p=.474), role-emotional limitation (t=-.710, p=.479), mental health (t=-.431, p=.667). Conclusion: Even though patients in experimental group had operation experience, the quality of life examined on the time of 1 year after bypass surgery is similar in that of general population. We suggest the study change the design as examination of quality of life before and after coronary artery bypass graft surgery.