• Journal of Chest Surgery
• /
• v.37 no.8
• /
• pp.660-664
• /
• 2004

Background: Dilution of blood cardioplegia is not needed in IAWBC as it is in cold blood cardioplegia because it does not aggregate red blood cells on normal body temperature and does not compromise micro coronary circulation. This study was designed to evaluate the safety and efficacy of undiluted potassium solution in IAWBC. Material and Method: Thirty patients who underwent CABG with IAWBC were grouped into dilutedplegia (n=14) and microplegia (n=16). Potassium was delivered conventionally with 4 : 1 delivery kit in the dilutedplegia group. The undiluted potassium was directly connected on the blood of oxygenator in the microplegia group. Result: There were no differences in sex, age, left ventricular ejection fraction, number of grafts, aortic cross clamping time, and the value of perioperative myocardial enzyme between the two groups. There were no perioperative myocardial infarction and hospital mortality. The amount of crystalloid cardioplegia was 1346$\pm$597 mL in dilutedplegia (mean$\pm$standard deviation, and 28$\pm$9 mL in microplegia (p<0.0001). The hematocrit during cardiopulmonary bypass was 21$\pm$4% in dilutedplegia and 24$\pm$3% in microplegia (p>0.05). 11 patients in dilultedplegia received blood transfusion, but 4 patients in microplegia received blood transfusion (p<0.05). The amount of urine and hemofiltration during the operation were more in dilutedplegia (1250$\pm$810 mL, 1689$\pm$548 mL) than in microplegia (959$\pm$410 mL, 1461$\pm$784 mL; p<0.05). Conclusion: The undiluted potassium of IAWBC in CABG operation is a safe, effective technique for myocardial protection to prevent fluid overload, and blood transfusion. There is no need to use the delivery kit.

• Journal of Chest Surgery
• /
• v.31 no.9
• /
• pp.837-844
• /
• 1998

Background: Adenosine is secreted by myocardial cells during myocardial ischemia or hypoxia. It has many beneficial effects on arrhythmias, myocardial ischemia, and reperfusion ischemia. Although many investigators have demonstrated that cardioplegia that includes adenosine shows protective effects in myocardial ischemia or reperfusion injury, reports of the optimal dose of adenosine in cardioplegic solutions vary. We reported the results of beneficial effects of single dosage(0.75 mg/Kg/min) adenosine by use of self-made Langendorff system. But it is uncertain that dosage was optimal. The objective of this study is to determine the optimal dose of adenosine in cardioplegic solutions. Material and Method: We used a self-made Langendorff system to evaluate the myocardial protective effect. Isolated rat hearts were subjected to 90 minutes of deep hypothermic arrest(15$^{\circ}C$) with modified St. Thomas' Hospital cardioplegia including adenosine. Myocardial adenosine levels were augmented during ischemia by providing exogenous adenosine in the cardioplegia. Three groups of hearts were studied: (1) group 1 (n=10) : adenosine - 0.5 mg/Kg/min, (2) group 2(n=10): adenosine -0.75 mg/Kg/min, (3) group 3 (n=10) : adenosine -1 mg/Kg/min. Result: Group 3 resulted in a significantly rapid arrest time of the heart beat(p<0.05) but significantly slow recovery time of the heart beat after reperfusion(p<0.05) compared to groups 1 and 2. Group 2 showed a better percentage of recovery(p<0.05) in systolic aortic pressure, aortic overflow volume, coronary flow volume, and cardiac output compared to groups 1 and 3. Group 1 showed a a better percentage of recovery(p<0.05) in the heart rate compared to the others. In biochemical study of drained reperfusates, CPK and lactic acid levels did not show significant differences in all of the groups. Conclusion: We concluded that group 2 [adenosine(0.75 mg/Kg/min) added to cardioplegia] has better recovery effects after reperfusion in myocardial ischemia and is the most appropriate dosage compared to group 1 and 3.

• Journal of Chest Surgery
• /
• v.19 no.4
• /
• pp.678-682
• /
• 1986

A case of ventricular septal defect associated with aorticopulmonary septal defect, left superior vena cava, and pulmonary hypertension in 6 years old boy is presented. Teflon patch closure of ventricular septal defect through transtricuspital procedure and division and suture closure of aorticopulmonary window performed under cardiopulmonary bypass with cardioplegia. The postoperative course was uneventful and discharged with good general condition.

• Journal of Chest Surgery
• /
• v.27 no.5
• /
• pp.339-344
• /
• 1994

Sinus node dysfunction is common after orthotopic heart transplantation.Electrophysiologic studies have documented a high incidence [46% to 50%] of impaired sinus node automaticity and sinoatrial conduction in the early posttransplantation period. Sinus node dysfunction persists in over 20 % of patients and leads to prolonged bradyarrythmias, including sinus or nodal bradycardia and sinus arrest.The purpose of this paper was to observe sinus node dysfunction after orthotopic heart transplantation. Ten cardiac recipient dogs were monitored continuously after orthotopic transplantations between unrelated adult mongrel dogs. Crystalloid cardioplegic solution [Choongwoi Cardioplegia

• Journal of Chest Surgery
• /
• v.30 no.10
• /
• pp.961-965
• /
• 1997

From October 1991 to April 1996, 27 patients underwent aortocoronary bypass graft. There were 17 men, 10 women. The mean age was 65 years(range 45 to 76). The preoperative clinical status were chronic stable angina in 11 cases, unstable angina in 13 cases and postinfarction angina in 3 cases. The involved ri k factors were as follows: Hypertension in 7 cases, Diabetes Mellitus in 5 cases and any other diseases in 3 cases We divided these patients into two groups in this survey: The A group was 15 patients who were managed with cardioplegia from 1991 to 1994. The B group of 12 patients was done with intermittent aortic clamping without cardioplegia from 1995 to 1996. The mean numbers of graft per patient was 2.0 in A group and 2.83 in B group. The ischemic time per graft was 27.3 minute in A group and 18.5 minute in B group respectively. The morbidity was occlusion of grafted vessel in one patient and one of postoperative angina in A group. The total mortality was 14.8%(4/27), but mortality of B group was 8.35 (1/12)

• Journal of Chest Surgery
• /
• v.24 no.7
• /
• pp.647-655
• /
• 1991

The efficacy of cold blood potassium cardioplegia during periods of ischemic arrest was assessed in 88 patients undergoing open heart surgical procedures at Chonnam National University Medical School from December, 1987 to January, 1989. The purpose of this study was to determine if the aortic cross clamping time[ACCT] over 120 minutes correlated with operative mortality, incidence of postoperative ventricular tachyarrhythmias, needs of postoperative inotropic support and serum enzyme levels. The patients were divided according to aortic cross clamping time[less than 120 minutes and 120 minutes or greater]. The results were as follows: 1. The operative mortality was 3.2% in ACCT<120min group and 7.7% in ACCT>120 min group. 2. The incidence of postoperative ventricular tachyarrhythmia was 1.6% in ACCT <120min group and 11.5% in ACCT>120min group[p<0.05]. 3. The incidence of postoperative inotropic support in congenital heart disease was 13.0Fo in ACCT<120min group and 45.0%o in ACCT>120min group[p<0.05]. The incidence in acquired heart disease was 26.0% in ACCT<120min group and 40.0% in ACCT> 120min group. 4. After cardiopulmonary bypass, serum GOT, LDH, CPK and CPK - MB were elevated prominently. Children showed higher value of the enzymes examined than adults did before and after cardiopulmonary bypass. In congenital heart diseases, postoperative serum GOT, LDH, CPK and CPK - MB levels of ACCT>120min group were significantly higher than those of ACCT<120min group. Postoperative serum GOT, LDH and CPK - MB levels of ACCT>=120min group were significantly higher than those of ACCT<120min group also in acquired heart diseases. The results suggest that the myocardial protective effect with cold blood potassium cardioplegic solutions was not sufficient when the aortic cross clamping time was over 120 minutes.

• Journal of Chest Surgery
• /
• v.36 no.7
• /
• pp.483-488
• /
• 2003

There are still debates in the literature on the relative benefits of blood cardioplegia and crystalloid cardioplegia in pediatric cardiac surgery. We performed a clinical trial to compare the myocardial protective effect between HTK solution and blood cardioplegic solution in congenital heart surgery. Material and Method: 15 patients who underwent HTK solution cardioplegia (group 1) and 15 patients who underwent blood cardioplegia(group 2) were included in this study. Preoperative and postoperative serial serum cardiac enzyme levels (troponin I, CK-MB, LDH) were measured in all patients. Clinical data were analyzed and compared between the two groups. Result: There were no differences in age and body weight between the two groups. Operative diagnosis included ventricular septal defect (VSD, n＝4), atrial septal defect (ASD, n＝1), tetralogy of Fallot (TOF, n＝4), and other complex heart diseases (n＝6) in group 1, VSD (n＝7), ASD (n＝5), and TOF (n＝3) in group 2. Cardiopulmonary bypass times were 99.1$\pm$48.1 minutes in group 1, and 69.3$\pm$27.3 minutes in group 2 (p＝0,02). Aortic clamping times were 52.1$\pm$23.6 minutes in group 1, and 37.9$\pm$20.5 minutes in group 2 (p＝0.07). There was no mortality and spontaneous defibrillation was possible in all patients. No differences were observed in the serial enzyme levels between the two groups. There were no differences in the duration of inotropic support and ventilator time between the two groups. Conclusion: HTK solution provided comparable myocardial protection compared with blood cardioplegic solution. A single high dose of HTK solution may be safely and conveniently used for an extended periods as well in congenital heart surgery.

• Journal of Chest Surgery
• /
• v.29 no.2
• /
• pp.199-207
• /
• 1996

Ischemic myocardial damage is inevitable to cardiac surgery. Myocardial damage after initiation of reperfusion through the coronary arteries is one of the most important determinants of a successful surgery. Adenosine is a potent vasodilator, and is also known to induce rapid cardioplegic arrest by its property of antagonizing cardiac calcium channels and activating the potassium channel. Thus, we initiated this study with adenosine to improve postischemic recovery in the isolated rat heart. We tested the hypothesis that adenosine could be more effective than potassium in inducing rapid cardiac arrest and enhancing postischemlc hemodynamic recovery. Isolated rat hearts, connected to the Langendorff appratus, were perfused with Krebs-Henseleit buffer and all hearts were subjected to arrest for 60 minutes. Three groups of hearts were studied according to the composition of cardioplegic solutions : Group A (n=10), adenosine 10mmo1/L+potassium free modified St. Thomas cardioplegia : Group B (n=10), adenosine 400mo1/L+S1. Thomas cardioplegia:Group C(control, n=10), St. Thomas cardioplegia. Adenosine-treated groups (group A & B) resulted in more rapid cardiac arrest than control group (C) (p< 0.01). There was greater improvement in recovery of coronary blood flow at 20 and 30 minutes of reperfusion in group A and at 20 minutes in group B when compared with control group(p<0.01). Recovery of systolic blood pressure at 10 minutes after reperfusion in group A and B was significantly superior to that in group C (p<0.01). Recovery of dp/dt at 10 minute after reperfusion in group A was also significantly superior to group C (p<0.05). Group A and B showed better recovery rates than control group in aortic blood flow, cardiac output, and heart rate, but there were no statistical differences. CPK levels of coronary flow in group A were significantly low (p< 0.01). We concluded that adenosine-enriched cardioplegic solutions have better effects on rapid cardiac arrest and postischemic recovery when compared with potassium cardioplegia.

• Journal of Chest Surgery
• /
• v.13 no.4
• /
• pp.394-404
• /
• 1980

During the period of June 1976 October 1980 131 cases of Open heart Surgery was performed at the National Medical Center in Seoul under the extracorpocal circulation. 77 cases were congenital heart disease and 54 were acquired heart disease. The age of the patients ranged between 2$\frac{1}{2}$ and 51 years. For all patients partial hemodilution technique and moderte hypothermia was used during extracorporeal circulation and cardioplegia was done for myocardial protection since April 1978. 41 of congenital cases were non-cyanotic group and 1 case died. 36 of congenital cases were cyanotic group and revealed very high mortiality rate (16 death, 39%). 53 of acquired cases were cases of valvular heart disease, 34 mitral (3 death), 1 aortic, 4 mitral with aortic 12 mitral with tricuspid (3 death), 2 triple valves (2 death), and revealed mortality rate of 15.1% (8 death). 1 of acquired cases were left atrial myxoma. There were 25 cases of operative death and over all motality rate was 19.1%.

• Journal of Chest Surgery
• /
• v.24 no.5
• /
• pp.491-497
• /
• 1991

Coronary arteriovenous fistula is a relatively rare congenital heart disease and it drains into right atrium, right ventricle, pulmonary artery, coronary sinus or superior vena cava. We experienced one case of fistulous communication between right coronary artery and right ventricle which was most common condition. The patient was a 12 year old female and the only sign was continuous cardiac murmur. The cardiac catheterization and coronary angiography showed the fistulous communication between right coronary artery and right ventricle and aneurysmal dilatation of right coronary artery. Under the cardiopulmonary bypass with the hypothermic cardioplegia, fistula opening[7mm] which was located at right ventricle below the tricuspid valve annulus between septal and posterior leaflet was closed with 4 - 0 prolene continuous suture through right ventriculotomy. Her postoperative course was uneventful.