• Journal of Chest Surgery
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• v.24 no.2
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• pp.123-134
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• 1991

Twenty eight patients had undergone repair of an isolated complete atrioventricular septal defect between April 1986 and September 1990 in Seoul National University Children`s Hospital. The group comprised 13 male and 15 female patients. They ranged in age from 2 months to 8 years[mean 18.6months] and in weight from 3. 4kg to 23kg[mean 9.0$\pm$4.6kg]. They were analysed as Rastelli type A in 17 patients, Rastelli type B in 2 patients, and Rastelli type C in 9 patients. Seven patients had concomitant Down`s syndrome. All patients had large left-to-right shunt[mean pulmonary to systemic flow ratio 3.5 $\pm$2.2 ranging from 0.68 to 10.0] and high pulmonary systolic pressure[mean 74$\pm$18.8mmHg, ranging from 35 to 110]. In 11 patients, one patch technique was used to close the atrial and ventricular septal defect and 16 patients were undergone by two patch technique. We urgently managed only one patient by pulmonary artery banding whose anatomy was Rastelli type C and severe mitral regurgitation was identified. Postoperative complete A - V block was noted in 3 patients, two of whom were dead in operating room due to combined LVOTO and myocardial failure, and one patient with Rastelli type C was undergone by VVI type permanent pacemaker insertion 1wk later after two patch technique, but we had to manage him by modified Konno operation and total correction due to LVOTO and VSD leakage and severe mitral regurgitation 3 years later. Another two reoperation cases due to severe mitral regurgitation after two patch technique were undergone, one of whom we managed by mitral annuloplasty 3 months later but aggravated mitral regurgitation made us to control him by MVR 3 months later. Another one case of VSD leakage and tricuspid regurgitation was managed by total correction but she died of respiratory insufficiency 14 days later. We experienced pulmonary hypertensive crisis in 3 patients, who were dead in two cases comparing with one control case. So operative mortality is 9/27[33.6%], in one patch group of 3/11[29.2%] comparing with two patch group of 6/16[37.5%]. In summary, causes of death were pump weaning failure, myocardial failure and low cardiac output syndrome and pulmonary hypertensive crisis, resp. failure, complete AV block. Mean follow up period is 15.8$\pm$10.7 months[ranging from 3months to 37 months]

• Journal of Chest Surgery
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• v.20 no.3
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• pp.451-457
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• 1987

Reoperations following cardiac surgery have an increased risk of the danger of damaging the heart, great vessels or extracardiac grafts because of adhesions to the sternum. We experimentally evaluated 3 different methods for pericardial closure. A standardized procedure for induction of pericardial adhesions was carried out in 30 rabbits. For closure of pericardium, animals were divided into 3 groups, 10 animals respectively: Croup 1 [simple pericardial closure]The pericardium was primarily resuture; Group 2 [Core-Tex surgical membrane as a pericardial substitute]- A Gore-Tex surgical membrane was interposed between the sternum and the heart; and Group 3 [pericardial tension releasing technique]-Three longitudinal overlapping incisions were made on the right side of the pericardium while the midline incison was sutured. Animals were put to death 4 weeks postoperatively and the pericardial space was examined for pericardial adhesions and epicardial reactions. The extent of adhesions and reactions were graded as: I-none; II-minimal; III-moderate; and IV-severe. Histologic studies of the pericardium, the pericardial substitute and the epicardium were also performed. The results were as follows: 1. In group 1 [simple pericardial closure], the degree of pericardial adhesions were grade I in 1 animal, grade II in 2, grade III in 4 and grade IV in 3. Epicardial reactions were grade I in 1 animal, grade II in 3, grade III in 5 and grade IV in 1. Histologic examination revealed thick fibrous tissue that obliterated the pericardial space in 7 animals. 2. In group 2 [Gore-Tex surgical membrane as a pericardial substitute], the degree of pericardial adhesions were grade I in 3 animals, grade II in 3, grade III in 2 and grade IV in 2. The degree of epicardial reactions were grade II in 1 animal, grade III in 5 and grade IV in 4. Histologic studies revealed a thin layer of dense fibrous tissue which covered the Gore-Tex surgical membrane and thick loose fibrous tissue on the epicardium just beneath the substitute. 3. In group 3 [pericardial tension releasing technique], the degree of pericardial adhesions were grade I in 3 animals, grade II in 4, grade III in 2 and grade IV in 1. The degree of epicardial reactions were grade 1 in 4 animals, grade II in 4 and grade III in 2. Severe epicardial reactions were not observed in this group. Histologic examination showed normal epicardium in 4 animals and the epicardium of the other 6 animals only revealed very thin fibrous layer compared to group I and group II. Pericardial adhesions more than grade III were 70% in group 1, 40% in group 2 and 30% in group 3. Pericardial adhesions were reduced in group 2 and group 3 compared to group 1, but statistically not significant. Epicardial reactions more than grade III were 60% in group 1, 90% in group 2 and 20% in group 3. Epicardial reactions were significantly reduced in group 3 compared to group 2. Author`s modified pericardial releasing technique provides marked augment of pericardial surface area and facilitates tension-free pericardial closure. Furthermore, pericardial adhesion and epicardial reaction will be reduced with the pericardial tension releasing technique.

• The Journal of the Korean life insurance medical association
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• v.2 no.1
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• pp.135-142
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• 1985

For the past 10 years, the socioeconomic status of our country was markedly improved. Accordingly, our foodintake patterns and other alt parts are preparing to blance with developed countries. Especially, be westernizing or improving our foodintake patterns, we intake much fat diet(animal food) while our physical activities decrease and alcohol consumtion's population, smoking population gradually increase. For such reasons, the population of obese tendency and cardiovascular diseases are increased. According to recent reports, among all death causes in our country, cardiovascular diseases(hypertension, hypertensive cardiovascular diseases, ischemic heart diseases) occupyd top rank, we know. I(the author) studied the inter-relation between serum cholesterol level which is the important factor of the cardiovascular diseases and essential hypertension liver diseases, hyperglycemia, some cardiac problems which are main decline causes in life insurance's medical assessment, and body weight distribution. Studied samples were selected on 4,313 cases(male; 1,791, female; 2,522) who were tested liver function test from June, 11th, 1980 to Dec., 31st, 1983 on our medical department's laboratory. I selected two groups in those cases: one group was serum cholesterol level 180mg/dl over(11% of whole LFT examed cases: No=502 cases), the other group was serum cholesterol level 120-160mg/dl(No= 502 cases). For convenience, the group of serum cholesterol level 180mg/dl over was "A" the other group was "B", I described. All examed persons of LFT were resident m Tae-Jon city in that time. On the result, 1) Decline rate is 10.5% on the "A" group, 5.9% on the "B" group. "A" group reveals 1.8 times higher than "B" group. 2) On decline causes, Essential hypertension is 4.0 times higher on the "A" group than "B", liver function's abnormalities are 2.0 times higher on "A" group than "B" and other diseases are same on "A" and "B". On the "A" group, essential hypertension is considerably higher than "B" group. 3) On the body weight distribution, the cases of 70kg(B.W.) over is 19.7% on "A", 10.6% on "B" group. Obese tendency is 1.8 folds higher on "A" group than "B" group. Studing the result, we find high serum cholesterol concentration is closely related with essential hypertension, obese tendency and liver function's abnormalities on the life insurance's medical examination part, also. On the future, we will more carefully consider the serum cholesterol concentration on our medical examnination and assessment of life insurance, I think.

• The Korean Journal of Physiology
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• v.2 no.1
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• pp.47-52
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• 1968

Twenty white rabbits anesthetized with nembutal (30 mg/kg) were employed in this experiment. Five of them served as controls; the remaining rabbits as experimental group were subjected to irreversible hemorrhagic shock. Shock was induced by bleeding the animals until mean blood pressure decreased to a level of 50-40 mmHg. This level of pressure was maintained for 3-4 hours, after which the drawn blood was reinfused. The reinfusion of blood caused the elevation of arterial pressure almost the control level for some minutes, after which a gradual and progressive decline of blood pressure became evident. This decline was thought to be the result from irreversible hemorrhagic shock. When mean blood pressure declined to less than 50 mmHg, chest was opened and samples of arterial blood and left ventricular muscle were taken. Left ventricular muscle and blood plasma were analyzed for potassium, sodium, chloride and water content. Blood glucose concentration was determined by Somogyi-Nelson's method. Extracellular and intracellular myocardial water and electrolyte content were calculated on the basis that electrolytes are distributed between plasma water and interstitial water according to Gibbs-Donnan equilibrium. In this calculation extracellular water was substituted for Na space. The findings obtained were as follows: 1. The concentration of blood glucose was 87mg% in the controls and it rose to 222 mg% in shock (P<0.01). 2. Plasma potassium elevated significantly from 3.3 mEq/l in controls to 8.0 mEq/l in shock (P<0.01), while small decreases in sodium (151-146 mEq/l) and chloride (102-96 mEq/l) were observed (P<0.3, P<0.1), 3. The changes of blood water content (83.1-84.3%) and cardiac water content (77.5-78.3 gm/100gm WT) were observed. 4. In control animals myocardial potassium levels which averaged 30.2 mEq/100 gmDT rose significantly to 40.3 mEq/100 gmDT in shock (P<0.01), while moderate decreases in sodium(16.3-14.3 mEq/100 gmDT) were observed in shock. 5. The calculated transmembrane resting potential of left ventricular muscle of control animals averaged 95 mV, while rabbits in shock averaged 77 mV. (P <0.01). The findings of this experiment do not correspond with the conclusions that myocardial depression seems to be the cause of irreversible hemorrhagic shock, because the excitability of heart muscle is elevated. From the point of view that the lowered transmembrane resting potential, the cause of death in terminal stage of irreversible hemorrhagic shock may be ventricular fibrillation. It can't be said, however, that the lowered transmembrane resting potential is responsible for the transition from reversible to irreversible hemorrhagic shock. The marked increase in blood glucose suggested that glycogenolysis in the liver is favorably active in shock.

• Journal of Veterinary Clinics
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• v.26 no.1
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• pp.104-108
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• 2009

Global cerebral ischemia occurs commonly in patients who have a variety of clinical conditions including cardiac arrest and shock. Cerebral ischemia results in a rapid depletion of energy stores that triggers resulting in excitotoxic death. Imaging studies of the brain with computed tomography(CT) or magnetic resonance imaging(MRI) are necessary to confirm the clinical neurolocalization, identify any associated mass effect, and rule out other causes of focal brain disorders. Cardiopulmonary arrest was occurred by propofol anesthesia in a 1 year old, intact female Beagle dog. After successful cardiopulmonary resuscitation was performed within 5 minutes, clinical signs such as vocalization, paddling, opisthotonus and seizure were represented. At the 12th day, CT and MRI examinations of the brain were performed to evaluate the brain. After euthanasia, histopathologic examination was performed. On transverse image of CT, lesions appeared as a hypodense in the right dorsal surface of the frontal lobe and level of optic canal, and dorsomedial surface of occipital lobe of cerebrum. No contrast enhancement was represented following intravenous contrast administration. On MR images of brain, the lesions were seen as a hyperintense on T2-weighted(T2W) images and a isointense or mild hypointense on T1-weighted(T1W) images. Hyperintense lesions both T2W and T1W images were observed at the surrounding cerebral sulcus. There was no significant signal changes on contrast T1WI. Histopathologic examination after euthanasia revealed that the lesion was necrosis of the cerebral cortex caused by cerebral ischemia.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1165-1171
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• 1998

Background: All currently available mechanical and bioprosthetic valves are associated with various types of deterioration leading to dysfunction and/or valvular complications. Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. This review was conducted to determine the factors affecting the risk of reoperation for prosthetic valve replacement. Material and method: From January 1985 to July 1996, 124 patients underwent reoperation on prosthetic heart valves, and 3 patients had a second valve reoperation. The causes of reoperation were prosthetic valve failure(96 cases, 77.4%), prosthetic valve thrombosis(16 cases, 12.9%), prosthetic valve endocarditis(7 cases, 5.6%) and paravalvular leak(5 cases, 4.1%). This article is based on the analysis of the experience with particular emphasis on the preoperative risks affecting the outcome of the reoperation. Result: Overall hospital mortality rate was 8.9%(11/124). Low cardiac output was the most common cause of death(70.6%). Left ventricular systolic dimension(p=0.001), New York Heart Association functional class IV(p=0.003) and serum creatinine level(p=0.007) were the independent risk factors, but age, sex and cardiothoracic ratio did not have any influence on the operative mortality. Follow-up period was ranged from 3 to 141 months (mean, 50.6 months). A late mortality rate was 1.8%. Conclusion: The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, therefore reoperation is recommended before the hemodynamic impairment become severe.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1118-1122
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• 1996

From January 1990 through December 1995, 43 patients underwent diaphragmatic plication for the management of phrenic nerve palsy .complicating various pediatric cardiovascular surgery. Their mean age at plication was 11.1 months and sex ratio was 31 males to 12 females. In order of decreasing incidence, the primary cardiovascular procedures included modified Blalock-Taussig shunt (7), total correction for the Tetralogy of Falloff (7), arterial switch operation (6), unifocalization for the pulmonary atresia with VSD (3), modified Fontan operation (3), VSD patch closure (3) and others. The involved sides of diaphragm were right in 17, left in 2) and bilateral in 3. Extensive pericardial resection with electocauterization of resected margin was thought to be the most common cause of phrenic nerve palsy (20). The interval between primary operation and plication ranged from the day of operation to 98 days (median 11 days). The methods of plication were central pleating technique(plication with phrenic nerve branch preservation) in 41, and other technique In 2. 10 patients died after plication (7: early, 3; late), and the causes of death were thought to be unrelated to plication itself. Among the 36 early survivors, extubation or cessation of positive pressure ventilation could be accomplished between 1 and 24 days postoperatively(mean : 4.5). Cumulative follow-up was 92 patient years without major complications. Postoperative follow-up fluoroscopy was performed in 6 patients, and the location and movement of plicated diaphragms were satisfactory in 5 patients. We concluded that diaphragmatic plication with preservation of phrenic n rve branch could lead to cessation of positive pressure ventilation and complete recovery of diaphragmatic function in the long term, unless the phrenic nerve was irreversibly damaged.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.578-584
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• 2004

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.

• Journal of the Institute of Electronics Engineers of Korea SC
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• v.42 no.3 s.303
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• pp.47-52
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• 2005

Obstructive Sleep Apnea (OSA) is a representative symptom of sleep disorder caused by the obstruction of upper airway. Because OSA causes not only excessive daytime sleepiness and fatigue, hypertension and arrhythmia but also cardiac arrest and sudden death during sleep in the severe case, it is very important to detect the occurrence and the frequency of OSA. OSA is usually diagnosed through the laboratory-based Polysomnography (PSG) which is uncomfortable and expensive. Therefore researches to improve the disadvantages of PSG are needed and studies for the detection of OSA using only one or two parameters are being made as alternatives to PSG. In this paper, we developed an algorithm for the detection of OSA based on Heart Rate Variability (HRV). The proposed method is applied to the ECG data sets provided from PhysioNet which consist of learning set and training set. We extracted features for the detection of OSA such as average and standard deviation of 1 minute R-R interval, power spectrum of R-R interval and S-peak amplitude from data sets. These features are applied to the input of neural network. As a result, we obtained sensitivity of $89.66\%$ and specificity of $95.25\%$. It shows that the features suggested in this study are useful to detect OSA.

• Clinical and Experimental Pediatrics
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• v.46 no.11
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• pp.1080-1084
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• 2003

Purpose : To compare perinatal characteristics, clinical courses, and overall morbidity between respiratory distress syndrome(RDS) with patent ductus arteriosus(PDA) and RDS without PDA in neonates. Methods : Eighty-three neonates who were diagnosed and treated for RDS in the neonatal intensive care unit(NICU) from Jan. 2000 to Dec. 2002 were included in this study. RDS was complicated with PDA(group A) in 17 patients and not complicated in 66(group B). PDA was diagnosed by echocardiogram in neonates with congestive heart failure symptom, cardiac murmur or chest X-ray findings of cardiomegaly or pulmonary edema. A retrospective study was undertaken of the perinatal characteristics and overall morbidity in group A and group B. Results : The birth weight and gestational periods of group A were less compared with group B. There was more perinatal asphyxia in group A. Incidence of overall morbidity such as bronchopulmonary dysplasia, intraventricular hemorrhage and death was higher in group A. Intravenous indomethacin was administered in 17 PDA infants. Conclusion : The perinatal characteristics in the two groups showed a significant difference. Incidence of overall morbidity in the two groups showed significant differences, however, there is no simple conclusion to draw because we didn't do multifactorial analyses to rule out other many risk factors affecting morbidity, such as gestational weeks or birth weight.