• Journal of Chest Surgery
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• v.30 no.12
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• pp.1251-1253
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• 1997

Gastrointestinal complications, especially duodenal complication after cardiopulmonary bypass are rare, but often fatal. We experienced 1 case of duodenal ulcer bleeding and 2 cases of duodenal ulcer perforation developing after cardiopulmonary bypass from August 1994 to April 1996. In the case of duodenal ulcer bleeding, palpitation, dizziness, tachycardia and melena were the clues leading to diagnosis, and in the cases of perforation, abdominal distension with pain, tachycardia, hypotension, oliguria were the clues. Duodenal perforations were diagnosed by abdominal paracentesis. The patient with duodenal bleeding was treated by H-2 receptor antagonist, antacids and transfusion. And emergency laparotomy was required for the patients with duodenal perforation. In addition to ulcer prophylaxis including H-2 receptor antagonist and antacids, a high index of suspicion and timely surgery are necessary for early diagnosis and appropriate treatment of duodenal complication developing af er cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.630-637
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• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.718-731
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• 1985

Renal dysfunction is a common complication of open-heart surgery: a form of controlled hemorrhagic shock, and successful perioperative management of renal dysfunction depends on recognition of the risk factors and optimal management of factors influencing renal function, including cardiopulmonary bypass, and early detection of renal failure. Changes in renal functional parameters including Ccr, Cosm, CH2O, FENa, and RFI were observed prospectively in forty five patients operated on at Dept. of Thoracic and Cardiovascular Surgery, S.N.U.H., from April to June, 1985. They were 23 males and 22 females with 35 acquired and 10 congenital heart diseases and the mean age and body surface area of them were 38.010.3 years [22-63] and 1.5518 M2[1.151.92] respectively. Followings are the conclusion. 1. The Ccr, representative of renal function, is significantly improved from 90.231.3 ml/min/M2 preoperatively to 101.536.4 ml/min/M2 postoperative and day [P<0.05], and all patients were classified as postoperative renal functional class I of Abel, which representing adequate renal protection during our cardiopulmonary bypass. 2. The Cosm is significantly elevated at immediate postperfusion time and remained high at postoperative one day representing osmotic diuresis at that time, but CH2O shows no significant changes at immediate postperfusion period and is decreased significantly at postoperative one day, representing recovery of renal concentrating ability at that time with decreasing urine flow. 3. The absolute value and changing tendency in FENa and RFI during perioperative period shows no diagnostic reliability on these parameters, but those of CH2O appear to reveal future renal function more accurately than Ccr 4. The depth of hypothermia may be protective upon renal function against the ill effects of prolonged nonpulsatile cardiopulmonary bypass. 5. The depth of the hypothermia, pump time of more than 150 minutes, poor cardiac function, and intraoperative events such as embolism appear to be related with immediate postperfusion renal function. 6. Hemoglobinuria and hemolysis, poor preoperative renal function, history of cardiac surgery, and massive transfusion associated with bleeding appear not to be related with renal dysfunction.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.713-723
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• 1989

In order to assess the correlation of the myocardial damage and the duration of cardiopulmonary bypass, measurement of creatine kinase [CK], lactate dehydrogenase [LDH], asparatate aminotransferase [AST], and MB band of CK [CK-MB] were carried out on the first, third, fifth, seventh, and ninth day in 44 patients following open heart surgery [POD 1,3,5,7,9]. And the patients were divided into three groups according to the duration of aortic cross clamp time [ACT]: Group I [ACT< 60 minutes. n=19], Group II [60 minutes < ACT< 90 minutes, n=7] and Group III[90 minutes > ACT, n=18]. 1. The leakage of CK in total patients increased to the highest level at POD 1, with rapid decrease and recovery at POD 7. The leakage of CK in Group III were greater than in Group I from POD 1 to POD 3 [P < 0.01]. The recovery time of CK level was shorter in Group I [POD 3] than in Group II and III [POD 7]. 2. The serum levels of LDH in total patients increased to the highest level at POD 1, with slow recovery until POD 9. The levels of LDH in Group III were higher than in Group I until POD 9 [P < 0.005]. The levels of LDH in Group I and II recovered but not in Group III. 3. The serum levels of AST in total patients increased to the highest level at POD 1, with rapid decrease and recovery at POD 7. The levels of AST in Group III were greater than in Group I from POD 1 to POD 5 [P < 0.05]. The recovery time of AST level was shorter in Group I and II [POD 5] than in Group III [POD 7]. 4. The positive cases for CK-MB in 36 patients were 22 [61.1 %] as a whole, 5[41.6%] in Group I, 4[57.1 %] in Group II, 13[76.4 %] in Group III at POD 1, and a case in each group at POD 3, and only a case in Group Ill at POD 5. It is concluded that the myocardial injury was closely related with the duration of cardiopulmonary bypass in open heart surgery.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.649-657
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• 1995

From December 1993 to April 1994, to investigate complement activation and pulmonary leukostasis, thirty adult patients were studied during cardiopulmonary bypass[CPB for cardiac surgery in Department of Cardiovascular & Thoracic Surgery, Pusan Paik Hospital, Inje University. Total patients were divided into group I and II according to the purpose of study ; Group I was 15 patients undergoing CPB with bubble oxygenator, Group II was 15 patients undergoing CPB with membrane oxygenator. The results of study were summarized as follows.1. The decrease of C3 and C4 levels were observed within few minutes of beginning of CPB in all patients[P<0.05 , and this decrease was proved to be due to complement activation, not by the influence of hemodilution.2. In the correlation between the change of C3 and C4, group I showed linear correlation each other suggesting complement activation occurred through the classical pathway, group II showed a correlation at only partial sampling times suggesting complement activation via both classical and alternative pathway, however there was no significant statistical difference at the change of C3 and C4 concentrations in two groups[P>0.05 .3. After switching to partial CPB, a few difference between right atrial and left atrial WBC count was observed, but statistically not significant and median cell count difference between group I and II was not significant, too [P>0.05 . With the above result, we concluded that CPB itself contributes to the activation of complement system, but bubble oxygenator does not activate always complement system more than membrane oxygenator.

• Journal of Chest Surgery
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• v.11 no.2
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• pp.117-122
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• 1978

With the increasing performance of open heart surgery during recent years, the occurrence of renal failure associated with cardiopulmonary aypass has received considerable attention. This patient was 33 yaar old woman who undertaken mitral valve replacement under the cardiopulmonary bypass. Acute renal failure developed after 2nd postoperative day. So we report here the course of renal failure as it occur in immediate relation to open heart surgery and examine the role of preoperative, intraoperative and postoderative factors.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.518-524
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• 1999

Background: This study has proven the effect of modified ultrafiltration(MUF) performed after the cessation of cardiopulmonary bypass in pediatric patients who underwent open heart surgery. Material and Method: From Jan. to Dec. 1997, modified ultrafiltration was performed after cardiopulmonary bypass in 50 infants with cyanotic heart disease and the results were compared to the control group of 50 patients with cyanotic heart disease in whom modified ultrafiltration was not used. Changes of hematocrit, central venous pressure, systolic and diastolic pressure, heart rate and body weight were compared. Result: Age and body weight were not different(p=0.38, p=0.46). Disease categories were similar. Average filtering volume was 60.0$\pm$29.2cc/kg for 7.0$\pm$2.4minutes of filtration. Mean hematocrit after filtration(MUF=36.1%, control=26.4%, p=0.001) was higher in the MUF group. Systolic (p=0.0001) and diastolic blood pressure(p=0.0001) were observed to increase more and the central venous pressure(p=0.02) and the heart rate(p=0.02) were lower after filtration in the MUF group. Conclusion: This study demonstrated that modified ultrafiltration after cardiopulmonary bypass was a technically feasible option to improve the post-surgical course through the effective hemoconcentration, hemodynamic improvements, and body water control.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.510-516
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• 1996

Cardiopulmonary bypass cannulas are usually characterized by the French number. However this de- scription provides only the external diameter of the cannula, which gives no information about the press- ure-flow characteristics of the cannula itself. A standardized system to describe the pressure-flow characteristics of a given cannula has recently been proposed and has been termed the M-number It is reported that the pressure-flow characteristics of a particular cannula can be determined from a novo- gram or chart, if the experimentally derived M-number of the cannula is known. In this regard, we conducted an investigation to analyze correlation between experimentally and clinical y derived M-numbers using three different sizes of pediatric aortic cannulas in fifty cardiac patients on cardiopulmonary bypass. The clinical and experimental M-numbers showed a strong correlation. The clinical M-numbers were typically 0.)5 to 0.55 greater than the experimental M-numbers. The clinical M-numbers also showed an inverse relationship to the temperature change of the patient, most probably due to an increase in blood viscosity from hypothermia. This inverse clinical M-numbersltemperature re- lationship was more marked in higher M-number cannulas. The clinical data obtained in this study suggest that the experimentally derived M-numbers correlated strongly with the clinical performance of the cannula with the significant influence of the temperature.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.481-487
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• 1998

The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients(25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.615-622
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• 1985

Supravalvular aortic stenosis was relatively uncommon form of congenital heart disease. This patient had typical "elfin faces" with mental retardation, and supravalvular aortic stenosis. The diagnosis was confirmed by pressure tracing obtained at retrograde left heart catheterization and aortography. The type of supravalvular aortic stenosis was localized hourglass narrowing, which was treated by insertion of prosthetic gusset placed across the area of narrowing under the cardiopulmonary bypass.ry bypass.