• Journal of The Korean Society of Clinical Toxicology
• /
• v.14 no.1
• /
• pp.1-8
• /
• 2016

Purpose: Extracorporeal life support (ECLS) is a term used to describe a number of modalities including extracorporeal membrane oxygenation (ECMO) to support cardiac and/or pulmonary systems. The purpose of this study is to review the available evidence regarding the effect of ECLS in patients with acute poisoning. Methods: Electronic literature searches with PubMed, Embase, Cochrane library, and KoreaMed were conducted for identification of relevant studies addressing ECLS in treatment of acute poisoning. The literature search was conducted by two investigators in March, 2016 with publication language restricted to English and Korean. The toxic substance, technique of ECLS, and final outcome of each case were analyzed. Results: The final analysis included 64 articles including 55 case reports. There were no articles classified according to a high level of evidence such as randomized trial and prospective cohort study. ECLS treatment was used in the management of patients poisoned with 36 unique substances. Venovenous ECMO was performed in 4 cases. Among the reported cases, 10 patients died despite treatment with ECLS. Conclusion: Evidence supporting ECLS for patients with acute poisoning is inadequate. However, many case reports suggest that early consideration of ECLS in poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial.

• Journal of Chest Surgery
• /
• v.34 no.9
• /
• pp.724-728
• /
• 2001

We report a case of an 8 years and 11 month-old male patient who had developed severe tricuspid insufficiency(TI) after correction of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA). Transthoracic echocardiogram and coronary angiography confirmed ALCAPA, ischemic mitral regurgitation and trivial TI. He underwent direct reimplantation of the left coronary artery to the aortic root by using additional cannulation at the main pulmonary artery for arterial inflow and cardioplegia delivery to the left coronary artery. After the correction of ALCAPA, transesophageal echocardiogram(TEE) revealed good antegrade flow at the aortic implantation site of the left coronary artery and severe TI(Gr III-IV/IV). Cardiopulmonary bypass was reestablished and tricuspid valve was repaired with Kay-type annuloplasty, artificial chordae formation and chordal shortening plasty. The postrepair TEE revealed trivial to mild TI.

• Journal of Chest Surgery
• /
• v.28 no.2
• /
• pp.125-130
• /
• 1995

Autotransfusion system is a common method of reducing the need of intraoperative and postoperative homologous blood transfusion in cardiac operation. Between August 1991 and August 1993, a series of 51 adults undergoing open heart surgery was selected. Autotransfusion using Cell Saver [COBE Baylor Rapid Autologous Transfusion System was done with homologous blood transfusion in 15 cases [Group II or without homologous blood transfusion in 17 cases [Group III . The other 19 cases were taken without Cell Saver for control [Group I . The shed blood in the operative field, remained blood in the oxygenator after cardiopulmonary bypass, and blood drained from chest tubes in postoperative care were aspirated by means of a locally heparinized collection system. After the salvaged blood was washed and centrifuged, the processed blood subsequently reinfused. Composition of processed blood by Cell Saver was hemoglobin 16.9gm%, hematocrit 49%, RBC 5,140,000/ml, WBC 670/ml, and platelet 30,000/ml. In three group, hemoglobin, hematocrit, and platelet counts were decreased postoperatively, but no significant differences between three group. Postoperatively, the amounts of drainage from chest tubes was 543$\pm$121ml in Group I, 809$\pm$201ml in Group II, and 631$\pm$147ml in Group III. In Group II, there was large amount of drainage compared with Group I [p<0.05 . The amount of homologous blood transfused was 1116$\pm$219 ml in Group I, 791$\pm$183 ml in Group II [p<0.05 . The homologous blood was not transfused in 17 cases [53% with Cell Saver.Preoperative and postoperative, coagulation parameters showed no significant differences between three group. And there was no complication related to Cell Saver. We conclude that the autotransfusion using Cell Saver is effective for reducing the homologous blood transfusion in cardiac surgery.

• Journal of Chest Surgery
• /
• v.39 no.6 s.263
• /
• pp.490-494
• /
• 2006

Lung transplantation is the choice of treatment for selected patients with end-stage pulmonary disease. However, retransplantation of the lung due to primary graft failure carries a high risk of morbidity and mortality. This is a case of a 52 year old male with emphysema who continuously needed a ventilator care and a tracheostomy. He underwent a left single lung transplantation but were not able to wean from the ventilator due to primary graft failure, and therefore we decided to do a retransplantation. Bilateral sequential single lung transplantation was performed under the cardiopulmonary bypass. The patient recovered quite well and was discharged and fully active with his work. Retransplantation although it carries a high risk, is a very effective treatment in patients with primary graft failure.

• Journal of Chest Surgery
• /
• v.28 no.2
• /
• pp.136-142
• /
• 1995

A clinical study was performed on 69 cases of isolated PDA surgically treated at the Department of Thoracic and Cardiovascular surgery of Kyung-Hee University Hospital from Mar. 1986 to Feb. 1994. Retrospective clinical analysis of these patients were as follows: 1.23 males and 46 females ranged in age from 16 days to 49 years. [mean 8.69yrs.,sex ratio M:F=1:2 2. Chief complaints were frequent URI in 44%, dyspnea on exertion in 16%,palpitation in 8%, easy fatigability in 6%, and no subjective symptoms in 26%. 3. On auscultation, typical continuous machinery murmur heard in 84%, and systolic murmur in 16% on Lt 2nd or 3rd intercostal space. 4. Simple chest x- ray showed increased pulmonary vascularity in 67%, cardiomegaly in 61%,and within normal limit in 16%. 5. EKG findings were LVH in 42%, biventricular hypertrophy in 17%, RVH in 3%, and within normal limit in 38%. 6. Echocardiogram was performed from all patient, and direct visualization of ductus in 93% 7. Cardiac catheterization was performed in 39 patients. The mean value of the results were;Differance SaO2[MPA-RV =11.03$\pm$ 5.26%,Qp/Qs=2.44$\pm$1.35,systolic pulmonary arterial pressure=40.69 $\pm$ 17.69mmHg. 8. 66 patients were operated through the left posterolateral thoracoctomy ; closure of ductus by double ligation in 43 cases, triple ligation in 23 cases.3 patients were operated by simple closure under cardiopulmonary bypass. 9. There was no death associated with the operation. The operative complications were atelectasis in 8 cases, pneumonia in 4 cases recannalization in 2 cases, and hoarseness in one case. 10. Systemic diastolic pressure was increased 8.12$\pm$ 0.13mmHg, and pulse pressure was decreased about 9.52 $\pm$ 1.87mmHg.

• Journal of Chest Surgery
• /
• v.43 no.2
• /
• pp.164-167
• /
• 2010

Extracorporeal membrane oxygenation (ECMO) during acute respiratory failure due to any cause aids in the recovery of respiratory function. The use of ECMO for acute respiratory failure due to near drowning was reported to be a successful therapeutic option in those patients who do not respond to optimal conventional therapies. We performed veno-venous ECMO for 2 acute respiratory failures due to near-drownings. All cannulations were performed percutaneously via both femoral veins. The 2 patients were successfully weaned off ECMO, but one patient experienced diffuse hypoxic brain damage and a subarachnoid hemorrhage.

• Journal of Chest Surgery
• /
• v.43 no.2
• /
• pp.180-183
• /
• 2010

Submitral left ventricular aneurysm (SMLVA) is a rare disease entity that exclusively occurs in the black population. We herewith report on a surgical case of SMLVA in a 68-year-old male who presented with ventricular tachycardia. He underwent surgical repair under standard hypothermic cardiopulmonary bypass. In the state of apical elevation, a vertical ventriculotomy was made directly over the aneurysm, which was located at the posterobasal aspect of the left ventricle. Radiofrequency ablation was performed on the endocardium all around the neck of the aneurysm and then patch endoaneurysmorrhaphy was carried out with particular care not to injure the mitral valve and subvalvular structure. His postoperative recovery was uneventful. There has been no dysfunction of the mitral valve or recurrence of the ventricular tachycardia at 2 years' follow-up.

• Journal of Chest Surgery
• /
• v.41 no.4
• /
• pp.480-483
• /
• 2008

Even though some authors have reported on the advantages of early total correction of complex heart disease, for low birth weight premature neonates, most surgeons prefer a multi-step approach to early total correction due to the many problems, such as the technical problems, the cardiopulmonary bypass management and etc. We report here on a successful case of early one-stage total repair of coarctation of the aorta and a ventricular septal defect in a 1,250 gram premature neonate.

• Journal of Chest Surgery
• /
• v.51 no.3
• /
• pp.172-179
• /
• 2018

Background: This study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR). Methods: We conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications. Results: A total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from $225{\times}10^3/{\mu}L$ preoperatively to 94.5, 54.5, and $50.1{\times}10^3/{\mu}L$ on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052). Conclusion: There was no difference in the 30-day mortality of moderate-to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.

• Journal of Yeungnam Medical Science
• /
• v.11 no.1
• /
• pp.49-54
• /
• 1994

Postoperative brain damage is one of most serious complications of cardiopulmonary bypass (CPB). To prevent brain damage during CPB, adequate cerebral perfusion for cerebral oxygen demand should be maintained. This study monitored jugular venous oxyhemoglobin saturation ($SjO_2$), which reflects the overall balance of cerebral oxygen supply and demand, intermittently in 10 patients undergoing cardiac surgery. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, $SjO_2$ did not change, and it was stable during the hypothermic period of CPB. But a significan reduction in $SjO_2$ was observed during the rewarming period, and $SjO_2$ had an inverse linear correlation with esophageal temperature. Furthermore, the percent decrease of $SjO_2$ was related to rewarming speed. Therefore, therapeutic approaches for $SjO_2$ desaturation include slower rewarming, increasing cerebral blood flow, decreasing the cerebral metabolic rate for oxygen, increasing oxygen content, and increasing perfusion flow rate.