• Journal of Chest Surgery
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• v.25 no.7
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• pp.750-755
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• 1992

We report a case of leaflet embolization of central leaflet fracture a 31mm mitral Edw-ards-Duromedics prosthesis. A leaflet was fractured to two segments, a larger one embolized to right common iliac artery and a smaller one to left femoral artery, respectively. Patient was reoperated with 29mm mitral Carbomedics prosthesis and incidentally found of smaller segment in left femoral artery at cannulation site. The embolectomy was done 15 days after cardiac operation through midline abdominal incision, Leaflet escape of a mitral Edward-Duromedics prosthesis is a rare, potentially curable mode of valve failure. After mechanical valve replacement, unexplained heart failure and acute pulmonary edema, mechanical valve failure should be suspected. Correct interpretation of clinical signs, symptoms and fluroscopy should allow early diagnosis of leaflet escape and prompt surgical therapy.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.455-459
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• 1994

We experienced 20 cases of acquired aortic diseases during last 1 year [Sep. 1992-Aug. 1993] with newly developed surgical strategies. There were 13 cases[65%] of aortic dissections, 5 cases[25%] of aortic aneurysms and 2 cases of Takayasu arteritis with mean age of 56 + 16 years[range:5-78].In ten cases of patients requiring ascending aortic replacement, femoral artery and femoral vein &/or RA auricle were used as cannulation site. With deep hypothermic circulatory arrest and retrograde cerebral perfusion of cold oxygenated blood via SVC, we can replace the ascending aorta and part of arch if necessary. The mean duration of circulatory arrest was 30 minutes[17-45 min]. In 5 cases of patients who requiring descending and thoracoabdominal aorta replacement, we used simple aortic crossclamping under normothermia with no heparin. The mean duration of aortic crossclamping was 37 minutes[25-50 min].The results of operation were as follow:Operative mortality[2 cases, 10%], delayed cerebral infarct[1], low extremity weakness[1] and intraoperative myocardial infarct[1]. There are no delayed complication or mortality as yet.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.147-150
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• 2023

A child being supported with an extracorporeal ventricular assist device, such as the Berlin Heart EXCOR (Berlin Heart GmbH, Berlin, Germany), must have at least 2 large cannulae for a long period. Management of cannula wounds is crucial since a cannula forms a track of prosthetic material passing the mediastinum to the heart. Deep wound complications, if they occur, can be troublesome and difficult to control with conventional methods. We applied vacuum-assisted closure to a patient who had Berlin-Heart EXCOR and a gap at the cannulation site. Herein, we describe the technical aspects of management in detail.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.6
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• pp.437-442
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• 2022

Background: Propofol is a short-acting intravenous sedative widely used for procedural sedation and general anesthesia. However, pain during propofol injection is a distressing adverse effect. This study was designed to investigate whether transcutaneous electrical nerve stimulation (TENS) could reduce pain during propofol injection compared to sham TENS. Methods: In a randomized controlled trial, 80 patients were allocated to two groups: the active TENS group received electrical stimulation via two electrodes on the venous cannulation site, whereas the sham TENS group received no stimulus. After 20 min following TENS, propofol 0.5 mg/kg pain was injected intravenously and pain was evaluated using a four-point score (0 = none, 1 = mild, 2 = moderate, 3 = severe). Adverse effects associated with TENS were also recorded. Results: The overall incidence of pain during propofol injection was 47.5% in the TENS group and 87.5% in the sham group (P < 0.001). The incidence of moderate pain was significantly lower in the TENS group (7.5%) than in the sham TENS group (42.5%) (P < 0.001). There were no complications associated with TENS. Conclusion: Pre-treatment with TENS significantly reduced the incidence and intensity of pain during propofol injection.

• The Korean Journal of Pain
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• v.31 no.1
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• pp.39-42
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• 2018

Background: Venipuncture pain is an uncomfortable suffering to the patient. It creates anxiety, fear and dissatisfaction. The ketoprofen transdermal patch is a proven treatment for musculoskeletal and arthritic pain. We planned this study to evaluate the efficacy of the ketoprofen patch to reduce venipuncture pain. Methods: Two hundred adult patients, aged 18-60 years, of either sex, ASA grade I or II, were enrolled. Presuming that therapy would decrease venipuncture pain by 30%, a power calculation with ${\alpha}=0.05$ and ${\beta}=0.80$ required enrollment of at least 24 patients into each group. However, 100 patients in each group were recruited. Group I (Control) received a placebo patch; Group II (Ketoprofen) received a 20 mg ketoprofen patch. A selected vein on the dorsum of the patient's non-dominant hand was cannulated with 18 g intravenous cannula 1 h after the application of the respective patch. Assessment of pain was done by a 10 cm visual analogue scale (VAS) of 0-10, where 0 depicts "no pain" and 10 is "the worst imaginable pain". The venipuncture site was assessed for the presence of skin erythema, swelling and rashes at 12 h, 24 h and at the time of decannulation. Results: Incidence of pain was 100% (94/94) in the control group as compared to 93% (85/91) in the ketoprofen group. The severity of the venipuncture pain was 6 (2) and 2 (2) for control and ketoprofen groups respectively (P < 0.05). Conclusions: Application of a ketoprofen patch at the proposed site of venipuncture one hour before the attempt is effective and safe for attenuating venipuncture pain.

• The Korean Journal of Physiology
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• v.19 no.1
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• pp.25-33
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• 1985

Renal arterial infusion of renotropic agents has been a very useful technique in the renal function studies. This type of experiments have usually been conducted in the large animals such as dogs and sheep. In these animals a catheter can be placed in the site without much disturbances of renal blood flow. Rabbits as an experimental model, however, caused a disturbances of renal blood flow by a catheterization of renal artery by its properties. Therefore we have developed a new technique that allows a simple and selective access to one side of renal arteries and the other as a control, without any disturbances of renal function. The distance between the both bifurcations of renal arteries on abdominal aorta is about 7 mm. To locate the tip of catheter on one side renal artery, ascending cannulation performed via femoral artery was done. We did an experiment with the technique to clarify the effect of calmodulin inhibitor on the renal function. One of the phenothiazine derivatives, trifluoperazine known as a powerful calmodulin inhibitor. Trifluoperazine, actual dose ranges of $2.76-5.20\;ug\;{\cdot}\;kg^{-1}\;{\cdot}\;min^{-1}$, increased urine volume and glomerular filtration rate significantly. Significant increases in urinary excretion of sodium, chloride and potassium were found. Fractional excretion of sodium and free water clearance increased significantly. These data suggest that this new technique is very useful in field of renal physiology and that striking effect of trifluoperazine on the renal function may be caused by increasing the renal hemodynamics, and by the inhibition of sodium, chloride and potassium reabsorption in the renal tubules.

• Journal of Chest Surgery
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• v.34 no.9
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• pp.724-728
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• 2001

We report a case of an 8 years and 11 month-old male patient who had developed severe tricuspid insufficiency(TI) after correction of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA). Transthoracic echocardiogram and coronary angiography confirmed ALCAPA, ischemic mitral regurgitation and trivial TI. He underwent direct reimplantation of the left coronary artery to the aortic root by using additional cannulation at the main pulmonary artery for arterial inflow and cardioplegia delivery to the left coronary artery. After the correction of ALCAPA, transesophageal echocardiogram(TEE) revealed good antegrade flow at the aortic implantation site of the left coronary artery and severe TI(Gr III-IV/IV). Cardiopulmonary bypass was reestablished and tricuspid valve was repaired with Kay-type annuloplasty, artificial chordae formation and chordal shortening plasty. The postrepair TEE revealed trivial to mild TI.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.25-31
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• 2019

Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.

• 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.29 no.12
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• pp.1360-1365
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• 1996

From September 1992 to May 1996, 38 patients ranging in age from 23 to 78, were operated for aortic dissection at Asan medical center There were 21 men and 17 women. The underlying aortic pathology were acute aortic dissection in 23, chronic aortic dissection in 15. Eight patients had Martian syndrome. In 34 cases of DeBakey type I, II patients, femoral artery and vein and/or right atrial auricle were used as cannulation site. With deep hypothermic c rculatory arrest (esophageal temperature 12 $\pm$ 2.5$^{\circ}C$) and retrograde cerebral perfusion of cold oxygenated blood through SVC, we replaced the ascending aorta and the part of arch if necessary. The mean duration of the total circulatory arrest time was 25 $\pm$ 1.7 mintstuts. In 4 cases of DeBakey type III patients, we replaced descending thoracic aorta or thoracoabdomlnal aorta without shunt or bypass under normothermia with an average 30: 1.5 minutesaortic cross clamp time. One death(2.6%) occurred on the twenty-second postoperative day owing to asphyxia related to ulcer bleeding. Postoperative complications were myocardial infarction with transient left peroneal palsy in 1 case, transient lower extremity weakness in 1 case and prolonged ventilatory support in 1 case. Two patients required reoperation due to retrograde extended dissection and aortic insufuciency. There was no late death with an average 25 months follow-up period.