• Journal of Chest Surgery
• /
• 제19권4호
• /
• pp.618-626
• /
• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• 한국산학기술학회:학술대회논문집
• /
• 한국산학기술학회 2011년도 추계학술논문집 1부
• /
• pp.170-173
• /
• 2011

Therapeutic hypothermia(TH) improves neurological outcomes and reduces mortality among survivors of out-of-hospital cardiac arrest. Animal and human studies have shown that TH results in improved salvage of the myocardium, reduced infarct size, reduced left ventricular remodeling and better long-term left ventricular function in settings of regional myocardial ischemia. This study is to investigate the effect of TH on post-resuscitation myocardial dysfunction and survival time after cardiac arrest and resuscitation in a rat model of myocardial infarction (MI). Thoracotomies were performed in 10 Male Sprague-Dawley rats weighing 450-550 g. MI was induced by ligation of the left anterior descending coronary artery (LAD). Ninety min after LAD ligation, ventricular fibrillation induction and subsequent cardiopulmonary resuscitation was performed before defibrillation attempts. Animals were randomized to two groups: a) Acute MI-Normothermia b) Acute MI-Hypothermia ($32^{\circ}C$ for 4 h). Myocardial functions, including cardiac output, left ventricular ejection fraction, and myocardial performance index were measured echocardiographically together with duration of survival. Ejection fraction, cardiac output and myocardial performance index were $54.74{\pm}9.16$, $89.00{\pm}8.89$, $1.30{\pm}0.09$ respectively and significantly better in the TH group than those of the normothermic group at the first 4 h after resuscitation($32.20{\pm}1.85$,$41.60{\pm}8.62$,$1.77{\pm}0.19$)(p=0.00). The survival time of the hypothermic group ($31.8{\pm}14.8$ h) was greater than that of the normothermic group($12.3{\pm}6.5$ h, p<0.05). This study suggested that TH attenuated post resuscitation myocardial dysfunction in acute MI and would be a potential strategy in post resuscitation care.

• Journal of Chest Surgery
• /
• 제27권10호
• /
• pp.815-823
• /
• 1994

This study was undertaken to hemodynamically determine the differences of myocardial protective effect between crystalloid and blood cardioplegic solution. Twenty nine children undergoing cardiac operations due to cyanotic congenital heart diseases were randomized into two groups receiving crystalloid or blood cardioplegia. Cardiac indices and other hemodynamic datum were examined postoperatively. Although there was no statistical differences between groups, postoperative stroke volume indices and left ventricular stroke work indices were slightly better with blood cardioplegia. We also found that postoperative left atrial pressures[p=0.0003], central venous pressures[p=0.004], and heart rates[p=0.014] were significantly lower with blood cardioplegia. The fact that relatively lower ventricular preloads [left atrial pressure and central venous pressure] were required to provide adequate cardiac output in blood cardioplegia group suggested superior myocardial protective effect of blood cardioplegic solution.

• Journal of Chest Surgery
• /
• 제25권11호
• /
• pp.1192-1202
• /
• 1992

Postoperative cardiac outputs and other hernoaynamic values were serially measured in fifteen patients of cyanotic congenital heart disease, after use of blood cardioplegic solution. Cardiac indices showed no change untill eight postoparative hours, then it began to decline to reach as low as 3.22$\pm$0.7L/min/m2 at 12 hours. After then gradual increse occ-ured to recover upto immediate postoperative value at 20 hours. Sharp decrese of heart rate and increse of systemic vascular resistance during 8~16 hours and steady increase of stroke indices during the whole study periods were observed. These observations suggested that the myocardium recovered gradually after open heart surgery, and that the decrease of cardiac indices during 8~16 hours could be a result of decrease of heart rates and increase of afterload. The changes of cardiac indices correlated with the changes of heart rate, postoperative time and mixed venous oxygen saturation [p<0.05]. No other hemodynamic values found to be in statistically significant correlation with the changes of cardiac indices. Left ventricular dysfunction seemed to occur more frequently during 8~12 hours, but it was not statistically significant. [p=0.73] In conclusion, great care must be taken during 2~3 days after the operation of cyanotic congenital heart disease, not to fall into a low cardiac output state, by maintaing adequate heart rates and reducing afterload especially when the systemic vascular resistance increases.

• Journal of Ginseng Research
• /
• 제33권4호
• /
• pp.283-293
• /
• 2009

Ginsenosides, one of the most well-known traditional herbal medicines, are used frequently in Korea for the treatment of cardiovascular symptoms. The effects of ginseng saponin on ischemia-induced isolated rat heart were investigated through analyses of hemodynamic changes including perfusion pressure, aortic flow, coronary flow, and cardiac output. Isolated rat hearts were perfused and then subjected to 30 min of global ischemia followed by 60 min of reperfusion with modified Kreb's Henseleit solution. Myocardial contractile function was continuously recorded. Ginseng saponin administered before inducing ischemia significantly prevented decreases in perfusion pressure, aortic flow, coronary flow, and cardiac output. The ginseng saponin administered group significantly recovered all of the hemodynamic parameters, except heart rate, after ischemia-reperfusion (I/R) compared with ischemia control. The intracellular calcium ($[Ca^{2+}]_i$) content in rat neonatal cardiomyocytes was quantitatively determined. Administration of ginseng saponin significantly prevented $[Ca^{2+}]_i$ increase that had been induced by simulated I/R in vitro (p<0.01) in a dose-dependent manner, suggesting that the cardioprotection of ginseng saponin is mediated by the inhibition of $[Ca^{2+}]_i$ increase. Overall, we found that the administration of ginseng saponin has cardioprotective effects on the isolated rat heart after I/R injury. These results indicate that ginseng saponin has distinct cardioprotective effects in an I/R-induced rat heart.

• Journal of Chest Surgery
• /
• 제22권4호
• /
• pp.580-588
• /
• 1989

The potential for enhancing myocardial protection by adding high-energy phosphate to cardioplegic solutions [St. Thomas Hospital solution] was investigated in a rat heart model of cardiopulmonary bypass and ischemic arrest. Creatine phosphate was evaluated as an additive to the St. Thomas Hospital cardioplegic solution. Creatine phosphate 10.0 mmol/L as the optimal concentration which improved recovery of aortic flow and cardiac output after a 30 minute period of normothermic [37oC] ischemic arrest. In comparing mechanical function in both groups the mean postischemic recoveries of aortic flow, cardiac output, stroke volume and stroke work [expressed as a percentage of its preischemic control] were significantly greater in STH-CP group than in CP- free control group. In addition to improving function and decreasing CK release, CP reduced reperfusion arrhythmias significantly decreasing the time between cross-clamp removal and return to regular rhythm from 81.8 * 13.9 [sec] in CP-free group to 35.9 * 6.8 [sec] in CP group [P< 0.05] so, exogenous CP exerts potent protective and antiarrhythmic effects when added to the St. Thomas Hospital cardioplegic solution. However, the mechanism of action remains to be elucidated.

• Journal of Chest Surgery
• /
• 제28권2호
• /
• pp.143-149
• /
• 1995

From January, 1983, to August, 1993, 23 cases of pericardiectomy for chronic constrictive pericarditis were carried out. The 15 male and 8 female patients ranged in age from 7 to 68 years[mean 39.1 years . All patients underwent pericardiectomy through a median sternotomy. Postoperative complications were low cardiac output[2 patients , wound infection[2 patients , pneumonia[2 patients , and unilateral phrenic nerve palsy[2 patients . One patient died of low cardiac output 1 day after pericardiectomy due to the associated transposition of great artery and hypoplastic right lung. Clinical and pathological findings showed that the cause of constrictive pericarditis was tuberculous in 8 cases[34.8% , idiopathic in 12 cases[52.2% and pyogenic in 3 cases[13.0% . Central venous pressure fell below 10cmH2O by immediate in 6 cases, fell below 10cmH2O by 24hrs in 5 cases and continued above 10cmH2O after 24hrs in 12 cases. Preoperative NYHA functional class of patients showed class I-1, classII-4, class III-14, and class IV-3. Postoperativly NYHA functional class was improved to class I-15, classII-6, class III-1.

• 대한의용생체공학회:학술대회논문집
• /
• 대한의용생체공학회 1989년도 춘계학술대회
• /
• pp.71-73
• /
• 1989

The origins of the motion artifact resulting from exercise in impedance cardiography wore explained and the ensemble average technique was applied to reduce the motion artifact enabling the measurement of cardiac output during exercise. Algorithm for ensemble average was developed and applied to the actual impedance signals. It was found that the minimum number of sampling was 20, and sampling frequency was 500Hz. Using the ensemble average technique it was possible to measure cardiac output continuously during the treadmill exercise. Therefore it is hoped that this study may contribute in the area of exercise physiology and sport medicine.

• Journal of Chest Surgery
• /
• 제28권1호
• /
• pp.7-10
• /
• 1995

Mixed Venous oxygenation saturation[SvO2 is a variable determined in part by the externally controlled factors and in part by the patient during CPB. I monitored the SvO2 and tested it as a parameter for the regulation of pump output and as a criteria for the need of inotropics after CPB. With the help of SvO2, I increased the pump flow especially during rewarming for more optimal oxygenation of cells. After CPB, the calculated cardiac index was used as an indicator for the need of inotropic support with greater accuracy and without any clinical problems. I conclude that the SvO2 is an easily checkable variable and a good indicator for optimal oxygenation at cell level, and can be used as an objective criteria for the need of postoperative inotropic support.

• 한국수산과학회지
• /
• 제47권6호
• /
• pp.869-873
• /
• 2014

Cardiorespiratory variables were measured in flounder Paralicthys olivaceus exposed to acidified seawater equilibrated with a gas mixture containing 5% $CO_2$ gas for 72 h at $20^{\circ}C$. It was found that $CO_2$ produced a significant increase in arterial $PCO_2$ ($PaCO_2$) and significant decreases in arterial pH (pHa). $CO_2$ transiently increased heart rate within 30 min of exposure. After cardiac output was elevated by the increase in heart rate within 30 min, was then reduced by the decrease in both stroke volume and heart rate. The heart responses of flounder differ from those of yellowtail to high $CO_2$ environment.