• Journal of Chest Surgery
• /
• v.20 no.1
• /
• pp.101-105
• /
• 1987

A clinical evaluation was performed on 17 cases of the cardiac and great vessel injuries above the subclavian vessel at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital from April, 1980 to September, 1986. The results were as follows: 1. Sex distribution were 13 cases in male and 4 cases in female. In age range, second and third decades occupied in about 65% of total cases. 2. Modes of injury were penetrating wound is 14 cases and nonpenetrating wound in 3 cases. The stab wounds by knife were most frequent. 3. Time interval from injury to operation was mean 103 minutes. 4. Surgical approaches were performed with thoracotomy in 9 cases, median sternotomy in 3 cases and direct incision above the wound. 5. Sites of injury were heart in 10 cases and great vessel in 7 cases. The right ventricular injury was most common as 7 cases. 6. Operative procedures were performed with simple closure, vascular graft anastomosis and ligation. There was no postoperative death.

• Journal of Chest Surgery
• /
• v.49 no.5
• /
• pp.366-373
• /
• 2016

Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (${\geq}$3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results: Follow-up was 100% complete (mean $85{\pm}24months$). CWPM was inversely correlated with single lung VC (Spearman R=-0.72, p=0.0003), global VC (R=-0.51, p=0.02) and diaphragm excursion (R=-0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.

• Clinical and Experimental Pediatrics
• /
• v.49 no.9
• /
• pp.917-929
• /
• 2006

Over the last several decades there has been a remarkable change in the therapeutic strategy of congenital heart disease. Development of new tools and devices, accumulations of experience, technical refinement have positively affected the outcome of interventional treatment. Many procedures including atrial septostomy, balloon valvuloplasty, balloon dilation of stenotic vessel with or without stent implantation, transcatheter occlusion of abnormal vascular structure, transcatheter closure of patent arterial duct and atrial septal defect, are now performed as routine interventional procedures in many institutes. In diverse conditions, transcatheter techniques also provide complementary and additive role in combination with surgery. Intraoperative stent implantation on stenotic vessels, perventricular device insertion, and hybrid stage 1 palliative procedure for hypoplastic left heart syndrome have been employed in high risk patients for cardiac surgery with encouraging results. Transcatheter closure of ventricular septal defect has been performed safely showing comparable result with surgery. Investigational procedures such as percutaneous valve insertion and valve repair are expected to replace the role of surgery in certain group of patients in the near future. Continuous evolvement in this field will contribute to reduce the risk and suffering from congenital heart disease, while surgery will be still remained as a gold standard for significant portion of congenital heart disease.

• Biomedical Science Letters
• /
• v.6 no.4
• /
• pp.281-288
• /
• 2000

Leukocyte activation with cardiac surgery procedures produces various iuflammatory substances and involves in postoperative pathophysiology. The present study was carried out to elucidate changes in leukocyte myeloperoxidase level and effect on the heart and lung during cardiac operation. Total leukocyte and differential counts in peripheral blood, myeloperoxidase (MPO) and troponin-T concentratiens (TnT) in coronary sinus blood, and pulmonary vascular resistance (PVR) were measured at preoperative and postoperative period. The parameters were compared between sampling periods, and relationship was investigated between MPO and each variable. At the end of operation, there were leukocytosis with neutrophilia (p＜0.01), and increases of MPO and TnT concentrations (p＜0.05), but decrease in PVR (p＜0.05). MPO had a positive correlation to TnT, total leukocyte, neutrophil, or operative times (p＜0.05), whereas PVR had a negative relationship to total leukocyte or neutrophil counts (p＜0.05). These results indicate that cardiac surgery leads to elevated liberations of myeloperoxidase from neutrophils and may harmfully affect myocardium.

• Journal of Chest Surgery
• /
• v.52 no.2
• /
• pp.70-77
• /
• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

• Journal of Chest Surgery
• /
• v.22 no.6
• /
• pp.1036-1043
• /
• 1989

Seventy eight patients underwent operation for combined multiple valve disease, with an overall early mortality of 14.1 % from January, 1983 to September, 1988 in the department of thoracic and cardiovascular surgery of Pusan National University Hospital. All of the above cases had combined multiple valve procedures. There were 33 mitral valve replacements and tricuspid annuloplasties, 33 aortic and mitral valve replacements, 5 aortic and mitral valve replacements with tricuspid annuloplasties, 3 aortic valve replacements and mitral annuloplasties, 1 open mitral commissurotomy and tricuspid annuloplasty and, 1 mitral valve replacement and primary closure of tricuspid valve cleft, 1 mitral valve replacement and aortic commissurotomy, 1 mitral, aortic and tricuspid valve replacement were done. 44 were male and 34 were female and the age distribution was from 14 to 57 with mean 38 year old. According to NYHA[New York Heart Association] classification, 49 patients were class I, 19 patients were class Il and 10 were class IV. Average perfusion time was 205.3 minutes. The live patients perfusion time was 178.7 minutes while that of dead ones was 272.0 minutes. Early deaths within 30 days from operation were 11 cases, 6 of which were due to low cardiac output, 3 were acute renal failure and 2 were cardiac rupture. The 65 patients were followed up from 2 to 30 months for a total 20.6 patient years. 1 patient committed suicide because of postoperative depression 1 year after operation. All of the survivors were enjoying their daily life and their NYHA class was superior to the preoperative ones.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.20 no.1
• /
• pp.39-44
• /
• 2020

Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder that presents as abnormally elevated levels of low-density lipoprotein cholesterol and premature heart disease, requiring frequent intervention through lipid apheresis for management. The risk of perioperative cardiac events is higher in patients with HoFH because of its pathophysiological manifestations in the vascular system. Careful cardiac precautions and anesthetic assessments are necessary to ensure patient safety. In the following case report, we discuss the clinical course and anesthetic considerations for a 14-year-old girl with HoFH undergoing sedation for dental extractions and mandibular molar uprighting in an outpatient oral surgery clinic. Considerations included the use of heparin in the patient's weekly plasma lipid apheresis treatment. In order to reduce the risks of peri- and postoperative bleeding and perioperative cardiac events, the operation was scheduled for 4 days after apheresis. This allowed for adequate heparin clearance, while also reducing the likelihood of possible cardiac events. A literature review revealed no results for the outpatient management of patients with HoFH undergoing sedation for noncardiac procedures. Our reported case serves as a clinical example for physicians to be utilized in the future.

• Journal of Chest Surgery
• /
• v.56 no.2
• /
• pp.90-98
• /
• 2023

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Totally thoracoscopic ablation (TTA) is a surgical treatment showing a high success rate as a hybrid procedure with radiofrequency catheter ablation to control AF. This study compared the early complications of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) in patients who underwent TTA. Methods: This single-center retrospective cohort study enrolled patients who underwent planned TTA for AF from February 2012 to October 2020. All patients received postoperative anticoagulation, either with warfarin or a NOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). Propensity score matching was performed for both groups. Early complications were assessed at 12 weeks after TTA and were divided into efficacy and safety outcomes. Both efficacy and safety outcomes were compared in the propensity score-matched groups. Results: Early complications involving efficacy outcomes, such as stroke and transient ischemic attack, were seen in 5 patients in the warfarin group and none in the NOAC group. Although the 2 groups differed in the incidence of efficacy outcomes, it was not statistically significant. In safety outcomes, 11 patients in the warfarin group and 24 patients in the NOAC group had complications, but likewise, the between-group difference was not statistically significant. Conclusion: Among patients who underwent TTA, those who received NOACs had a lower incidence of thromboembolic complications than those who received warfarin; however, both groups showed a similar bleeding complication rate. Using a NOAC after TTA does not reduce efficacy and safety when compared to warfarin.

• Journal of Yeungnam Medical Science
• /
• v.22 no.1
• /
• pp.13-26
• /
• 2005

Atrial fibrillation (AF) is the most common cardiac rhythm disturbance, which carries significant cardiovascular morbidity and mortality. The medical treatment for AF is cumbersome and unsatisfactory, which has highlighted the need to develop alternative treatments for AF. The recent discovery that AF is often initiated by atrial ectopic beats has resulted in treatments designed to target the ectopic sources, particularly those within the pulmonary veins. Building on the pioneering work of Cox et al., a recent reported series demonstrated the feasibility of treating patients undergoing cardiac surgery for other structural heart diseases with limited, left-atrial ablation lesion sets using alternative energy sources. As less complex modifications of the Maze procedure have been developed, a number of energy sources have been introduced to create of electrically isolating lesions within the atria. These sources have been used both endocardially in arrest heart procedures as well as epicardially in a beating heart setting. This review summarizes the recent advances in surgery for AF that will aid in the development of an effective, minimally invasive surgical procedure to cure patients with AF.

• Journal of Chest Surgery
• /
• v.21 no.5
• /
• pp.850-855
• /
• 1988

From July 1983 to June 1988, twenty six patients underwent mitral valve repair for pure mitral stenosis[21 patient] or for mitral stenosis with a mild degree of regurgitation[5 patient] at Chonbuk National University Hospital. All patients underwent open mitral commissurotomy and 17 patients required to additional procedures for relief of obstructive subvalvular lesion. There was no operative death. The patients were followed from one to sixty months[mean 24. 1Mo.] One late death occurred due to cardiac and renal failure 10 month postoperatively. Of the 25 surviving patients at the time of follow-up, 17 patients[68%] were in NYHA functional class I and 8 patients[32%] were in class II.