• Journal of Chest Surgery
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• 제19권3호
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• pp.475-478
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• 1986

Syphilitic aortic aneurysm is a rare lesion today. We experienced a case of huge syphilitic ascending aortic aneurysm with aortic insufficiency. Surgical correction was done by replacement of ascending aorta with woven Dacron graft and aortic valve replacement under cardiopulmonary bypass. There is no abnormality in postoperative aortography. The postoperative course was uneventful.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 2002년도 제2차 추계학술대회
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• pp.6-6
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• 2002

• Journal of Chest Surgery
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• 제31권12호
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• pp.1147-1158
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• 1998

배경:이동식 인공심폐기는 심정지 기간 동안 안정한 혈역학 상태를 유지하여 생존율을 향상시킬 수 있기 때문에 강력하고 효과적인 심폐소생법의 하나로 그의 사용이 증가하고 있다. 본 연구진은 초기모델의 한국형 이동식 심폐소생기를 이용한 심폐소생술과 기존의 개흉식 심폐소생술을 비교하여 혈역학 유지와 소생 여부 및 신체장기들에 미치는 효과를 알아보고자 하였다. 대상 및 방법: 한국산 잡견 8마리(30∼51kg)를 대상으로 개흉식 심폐소생술군과 심폐소생기를 이용한 심폐소생술군으로 각각 4마리 씩 나누었다. 4분 간의 심실세동형 심정지 기간이 지난 후 15분 간의 기본 심폐소생술(basic life support; BLS)을 실시하고 30분 간의 고급 심폐소생술(advanced life support; ALS)을 실시하여 자발순환회복, 혈역학 상태, 혈구성분에 미치는 효과, 혈액 가스 검사, 생화학 검사 및 생존율 등을 알아보았다. 심장압박과 폐환기는 두 군 모두 동일한 조건으로 유지하였으며, 고급 심폐소생술 시작과 동시에 제세동을 하고 에피네프린 및 탄산수소나트륨을 투여하여 자발순환회복을 유도하였다. 측정한 관찰값은 심정지전 관찰값으로부터의 변화율(%)로 환산하여 평균±표준편차로 표시하였다. 결과: 고급 심폐소생술 초기에 평균 체동맥압은 심폐소생기군에서 개흉식 심폐소생술군 보다 높게 유지되었고 (90±19% vs. 71±32%, p<.05), 평균 폐동맥압은 심폐소생기군이 개흉식 심폐소생술군 보다 낮게 유지되었다 (105±24% vs. 146±6%, p<.05). 자발순환회복은 모든 실험견에서 나타났다. 자발순환회복 후 심폐소생기군에서 혈중 헤마토크리트치, 적혈구와 혈소판 수가 유의하게 감소하였고 혈중 유리헤모글로빈치는 유의하게 증가하였다(p<.05). 혈액가스검사와 lactate 및 CK-MB치는 두 군간에 차이가 없었다. 실험 후 조기사망은 심폐소생기군에서 2마리, 개흉식 심폐소생술군에서 3마리에서 있었다(생존기간 228±153 vs. 31±36 시간, p=ns). 나머지는 모두 장기 생존율을 보였다. 결론: 본 연구결과 이동식 심폐소생기를 이용한 심폐소생술은 심정지 기간 동안 안정한 혈역학 상태를 유지하여 자발순환회복 및 장단기 생존율을 향상시킬 수 있다. 추후 이동식 심폐소생기 개선과 임상적용을 위해 초기모델을 수정 보완하는 실험연구가 더 필요하리라 본다.

• Journal of Chest Surgery
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• 제47권5호
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• pp.468-472
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• 2014

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.

• Journal of Chest Surgery
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• 제27권4호
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• pp.318-324
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• 1994

Cross-clamping of the descending thoracic aorta results in proximal hypertension,increase in left ventricular afterload,and impairment of distal organ perfusion. Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamping of the thoracic aorta. At Seoul National University Hospital, 7 patients were treated for the thoracic or thoracoabdominal aortic aneurysm using left atrium-femoral artery bypass with Bio-medicus centrifugal pump between October,1989, and January,1993. There were atherosclerotic thoracic aneurysm in 3 cases, thoracoabdominal aortic aneurysm due to chronic aortic dissection in 3 cases,aortic rupture due to trauma in 1 case. Total of 7 patients were operated by graft replacement with reimplantation of important branches. None of these cases developed severe complications and hospital death. We believe that the Bio-Medicus centrifugal pump is a simple and safe means of perfusing the lower body, kidneys, and spinal cord without necessitating heparinization.

• Journal of Chest Surgery
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• 제7권1호
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• pp.73-78
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• 1974

Influences on organ function were studied in animals during prolonged extracorporeal circulation with a bubble type of oxygenator. More than six hours of total cardiopulmonary bypass was performed under mild hypothermia by means of an extracorporeal circulation system in five dogs. Obtained results were summarized as follows. 1. The renal function was not so impaired seriously until four hours of extracorporeal circulation. However, there was more serious impairment of renal function in this study when extracorporeal circulation was carried out for a period of five hours or more. 2. There was gradual hepatic damage during extracorporeal circulation and the damage was more significant after bypass for a period of five to six hours. 3. There was a significant decrease in serum K during bypass, irrespective of the pump oxygenator prime with a high K solution. The reason for this is complex and due to many factors, however, it was evidently related to serum glucose levels during extracorporal circulation.

• Journal of Chest Surgery
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• 제13권3호
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• pp.256-261
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• 1980

Left atrial myxoma constitutes the most significant cardiac tumors, which occupies 30 to 50% of the total in most pathological series with the age range from 3 to 83 years, mostly between the age of 30 to 60 years. Over 90% of myxomas occur in the atria, with 3 to 4 times as many occurring in the left as in the right. They may cause severe and progressive disease mimicking mitral valvular disease with non-specific general symptoms. Recent attentions were focussed in the clinical features along with various diagnostic techniques including angiocardiography, echocardiography and cross-sectional sector scanning echocardiography, and definitive treatment with surgical removal under direct vision using cardiopulmonary bypass. There are several reports on the atrial myxomas removed from various cardiac chambers in Korea, and we report another typical case of left atrial myxoma of 6.8 x 3.8 x 1.7 cm3 attached to the upper margin of fossa ovalis with a short pedicle, also with calcification at it`s distal free end. 29 year old young mother complaining of mild fever, vaginal spotting, numbness of left upper and lower extremities, nocturnal attack of dyspnea and palpitation for 2 months was diagnosed as large left atrial myxoma with the aid of angiocardiography and echocardiography. Trans-right-atrial, transseptal surgical removal of the tumor was successfully performed under the cardiopulmonary bypass for 22 minutes on 24th of July 1980. Postoperative hospital course was uneventful and discharged from hospital on the 12th POD with complete recover from the previous symptoms and signs.

• Journal of Chest Surgery
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• 제24권11호
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• pp.1068-1073
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• 1991

Bleeding after open heart surgery with cardiopulmonary bypass was a cause of concern. requiring reexploration of the chest in approximately 8 percent of patients who have had operations on the heart. From April., 1983 to October, 1991, 16 patients[2%] out of 777 patients who underwent open cardiac surgery had emergency reexploration with bleeding at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. In 12 cases[75%], reexploration was performed for continuous bleeding and the reminder[4 cases] were performed for suspected tamponade & hypotension. There were 9 cases[56%] of congenital heart disease and 7 cases of acquired heart disease. The mean blood loss were 997$\pm$472ml /sq. M in total cases and 1442$\pm$ 647ml /sq. M in cases repair of cyanotic heart disease. The mean interval till reoperation was 16.6hr [1hr~72hr] and 41 hr[12~72hr] in tamponade cases and 8.4hr[1hr~24hr] in continuous bleeding cases. The bleeding sites were identified in 7 cases: aortotomy site in 2 cases, ventriculotomy site, SVC, thymus, pleura and sternum wiring site in each other case. But no specific sites was found in the remaining 9 cases. The 8 cases had complications but all except 1 cases with hypoxic brain damage were recovered without sequale. We conclude that emergency thoractomy after open heart surgery may be lifesaving and-/or diminishing complications with bleeding if performed promptly with excessive bleeding, tamponade and unexpected hypotension.

• Journal of Chest Surgery
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• 제23권2호
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• pp.268-274
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• 1990

Bleeding after cardiopulmonary bypass remains a cause for concern, requiring reexploration of the chest in approximately 3 percent of patients who have had operations on the heart. We examined the possibility that this problem might be alleviated by desmopressin acetate [DDAVP], synthetic vasopressin analogue that lacks vasoconstrictor activity. In a prospective, randomized trial, we studied the effect of intraoperative desmopressin acetate in 20 patients [the treated group 10 patients and the control group 10 patients] undergoing various cardiac operations requiring cardiopulmonary bypass. The result showed that the early postoperative [during first 24hrs] and mean postoperative blood loss [first 3 days] of the treated group were significantly reduced than the control group[447\ulcorner199ml in the treated group versus 746\ulcorner199ml in the treated group versus 746\ulcorner295 ml in the control group, p=0.014; mean\ulcornerstandard deviation and 675\ulcorner276 ml in the treated group versus 1006\ulcorner303 ml in control group, p=0.019]. The mean red-cell transfusion in first 3days were reduced in the treated group than the control group [3.3\ulcorner1.7 units vs 4.9\ulcorner1.7units, P=0.051]. There were no untoward side effects of desmopressin acetate. We conclude that the administration of desmopressin acetate can be recommended to reduce blood loss and blood conservation in patients undergoing cardiac operations.

• Journal of Chest Surgery
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• 제27권11호
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• pp.902-906
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• 1994

Between May 1991 and August 1993, 16 patients underwent repair of complete atrioventricular septal defect without another major anomaly at Cardiovascular Center,Yonsei University College of Medicine. Ages of the patients ranged from 3 months to 38 years with a mean of 42 months. Among 16, 10 patients[63%] are associated with Down`s syndrome. All patients underwent primary repair except and one who received had been repaire of coactation of aorta and patent ductus arteriosus 2 month before. Preoperative mitral valve regurgitation [MR] was evaluated with Doppler echocardiography and angiography which revealed absent or grade I in 1, grade II in 8, grade III in 4, and grade IV in 3. Operative technique was performed under the moderate hypothermic cardiopulmonary bypass with crystalloid cardioplegia. Intraoperative echocardiography was performed epicardial approach [n=7] in the operative table or transthoracic approach [n=9] at intensive care unit. In all patients except 3, MR were improved. But in 3 patients, was not improved or exagerated comparing preoperative one. All of them were died.One patient was showed MR grade IV in intraoperative echocardiography, we re-repaired atriventricular valve with cardiopulmonary bypass. During follow-up period [at a mean of 11 months after repair], doppler echocardiography was performed in all patients. The follow up echocardiography revealed that the degree of MR in immediate postoperative period was not changed except in two patients in whom it was aggravated. Thus it seems that intraoperative and early postoperative echocardiography was employed important role of survival and can be predictable for long term results.