• Journal of Chest Surgery
• /
• 제20권2호
• /
• pp.230-240
• /
• 1987

Cardioplegia and myocardial protection were performed under cardiopulmonary bypass during open-heart surgery with the use of cold St. Thomas Hospital cardioplegic solution [4=C] for the coronary artery perfusion and normal saline solution [4- C] for the topical cardiac cooling. To maintain the state of myocardial protection, coronary artery reperfusion was carried out using St. Thomas Hospital cardioplegic solution at the interval of 30 minutes. A total number of patients studied were 57 cases, including 37 cases of correction for congenital cardiac anomalies and 20 cases for acquired heart valvular diseases. Cardiopulmonary bypass time during the surgery was observed to be average of 87.89*47.55 hours, aortic cross-clamping time to be average of 76.68~44.27 hours raging from 30 to 191 minutes. In order to evaluate the effects of myocardial protection in the surgery, serum enzyme levels were determined. To observe the relationship between aortic cross-clamping time and myocardial protection effects, patients studied were divided into the following 3 groups. I group: aortic cross-clamping time, 60 minutes, II group: aortic cross-clamping time, 90 minutes, III group: aortic cross-clamping time, over 91 minutes. 1. Changes in serum enzyme levels in postoperative period. [1] SCOT; The postoperative value [increased over 200 units] for ischemic myocardial injury during operation was observed in 11 cases [19.3% of the total] of the total patients studied, of which 4 cases [13.3%] in I group, 1 case [10.0%] in II group, and 6 cases [35.3%] in III group. [2] LDH; The positive value [increased over 900 units] for ischemic myocardial injury during operation was observed in 9 cases [15.7% of the total] of the total patients studied, of which 2 cases [6.6%] in I group, 1 case [10.0%] in II group, and 6 cases [35.3%] in III group. [3] CPK; The positive value [increased over 800 units] for ischemic myocardial injury during operation was observed in 10 cases [17. 5% of the total] of the total patients studied, including 4 cases [13. 3%] in I group, 1 case [10.0%] in II group, and 5 cases [29.4%] in III group. 2. The myocardial protection method used in the present study was demonstrated to be effective for the myocardial protection in the surgery with aortic cross-clamping time of up to 90 minutes. A few ischemic myocardial injury were observed in the surgery with aortic cross-clamping time over 91 minutes, but no significant cardiac dysfunction was noted. The surgery with aortic cross-clamping time of up to 191 minutes did not appear to give rise any significant interference with postoperative recovery.

• Journal of Chest Surgery
• /
• 제22권2호
• /
• pp.225-233
• /
• 1989

Cardioplegia and myocardial protection were performed under cardiopulmonary bypass during open heart surgery with the use of St. Thomas Hospital cardioplegic solution [4 [C] for the coronary artery perfusion and normal saline solution [4[ c] for the topical cardiac cooling. To maintain the state of myocardial protection, coronary artery reperfusion was carried out using St. Thomas Hospital cardioplegic solution at the interval of 30 minutes. A total number of patients studied were 57 cases, including 37 cases of correction for congenital anomalies and 20 cases for acquired heart diseases. Cardiopulmonary bypass time during the surgery was observed to be average of 87.89*47.55 hours, aortic cross-clamping time [ACCT] to be average of 76.68*44.27 hours raging from 30 to 191 minutes. In order to evaluate the effects of myocardial protection in the surgery, serum enzyme levels were determined. To observe the relationship between ACCT and myocardial protection effects, patients studied were divided into the following 3 groups. I group: ACCT 60 minutes, II group: ACCT 90 minutes, III group: ACCT over 91 minutes [1] SGOT; The positive value [increased over 200 units] for ischemic myocardial injury during operation was observed in 11 cases [19.3% of the total] of the total patients studied, of which 4 cases [13.3%] in I group, 1 case [10.0%] in II group, and 6 cases [35.3%] in III group. [2] LDH; The positive value [increased over 900 units] for ischemic myocardial injury during operation was observed in 9 cases [15.7% of the total] of the total patients studied, of which 2 cases [6.6%] in I group, 1 case [10.0%] in II group and 6 cases [35.3%] in III group. [3] CPK; The positive value [increased over 800 units] for ischemic myocardial injury during operation was observed in 10 cases [17.5% of the total] of the total patients studied, including 4 cases [13.3%] in I group, 1 case [10.0%] in II group, and 5 cases [29.4%] in III group [4] The myocardial protection method used in the present study was demonstrated to be effective for the myocardial protection in the surgery with ACCT of up to 90 minutes. A few ischemic myocardial injury were observed in the surgery with ACCT over 91 minutes, but no significant cardiac dysfunction was noted. The surgery with ACCT of up to 191 minutes did not appear to give rise any significant interference with postoperative recovery.

• Journal of Chest Surgery
• /
• 제31권2호
• /
• pp.95-101
• /
• 1998

짧은 기간의 허혈은 뒤에 오는 장시간의 허혈 및 재관류시에 심근의 손상방지에 효과가 있는 것으로 보고되고 있으나 그 기전에 대해서는 논란이 많다. 본 연구에서는 심근에 단기간의 허혈조건을 부여한 후 심근보호액을 이용하여 심정지를 유도하였고 다시 재관류하였을 때 심근 기능의 회복에 미치는 영향을 연구하기 위해 적출 쥐 심장모델을 이용하여 2 시간의 저장기를 이용하여 재관류시의 기능을 비교하였다. 10 마리의 실험군에서는 심근보호액을 이용한 심정지전에 1 분간의 전체 허혈기를 가지고 5 분간의 재관류를 3 번 반복하는 방법으로 허혈조건부여를 하였으며 대조군에서는 위와 같은 조건부여 없이 2 시간의 심근보호액을 이용한 심정지 및 저장기를 가졌다. 2 시간의 저장기를 $0^{\circ}C$의 심근보호액에서 가진 후 재관류를 하여 두 군간의 회복시의 기능을 비교하였다. 재관류 20 분후의 회복기 기능의 비교에서 허혈 조건부여를 한 실험군에서 대조군에 비하여 좌심실 발생압 및 좌 심실압 순간 변화율에서 우수한 회복율을 보였다. 심정지전의 수치를 100으로 본 경우의 재관류시의 좌심실 발생압의 회복율에서 허혈 조건부여를 준 실험군에서는 93.20$\pm$15.7%의 회복율을 보인 반면 대조군에서는 67.3$\pm$15.6%의 회복율을 보여 차이가 있었다. 좌심실압 순간 변화율의 회복율에서 대조군은 54.7$\pm$18.2%의 회복율을 보인 반면 실험군에서는 78.1$\pm$15.1% 의 회복율을 보였다. 심박동수 및 관동맥 관류량에서는 양 군에서 통계적으로 유의한 차이를 발견하지 못하였으며 같은 압력으로 관류한 심근보호액의 관류량에서도 유의한 차이를 보이지 않았다. 이상의 결과 허혈 조건부여는 적출 쥐 심장에서 심근보호액을 이용한 심정지 및 2 시간의 저장 후 재관류시의 심근 기능 회복에 재관류시 심근기능 회복에 도움이 된다고 생각되며 이는 심근보호액의 관류량 및 관류저항과는 다른 기전에 의한 것으로 생각된다.

• Journal of Chest Surgery
• /
• 제29권10호
• /
• pp.1076-1080
• /
• 1996

허혈후 재관류시 일산화질소의 전구체인 L-arginin에 심근기능에 미치는 영향은 각 연구의 조건에 따라 일정하지 않다. 저자들은 L-arginine의 농도에 의한 심근보호효과의 차이를 알아보고자 본 연구를 시행하였다. 란겐돌프 관류장치하의 흰쥐 적출심장에 37.5$^{\circ}C$에서 30분의 허혈과 30분의 재관류를 실시하면서 재관류시 관류액에 L-arginine을 첨가하여 농도를 1, 2, 3, 4 mm/L로 하였고 대 조군에는 L-arginine을 첨가하지 않았다. 허혈기 직전과 재관류 30분에 좌심실 수축기능(좌심실 발생압, 좌심실압 최대 순간 증가율), 이완기능(좌심실압 최대 순간 감소율)과 관상관류량을 측정하였다. L-arginine 농도가 1mm/L, 2 mm/L인 실험군은 좌심실 발생압, 좌심실압 최대 순간증가율, 좌심실압 최대 순간감소율 및 관상관류량의 회복률이 대조군에 비해 통계적 유의성은 없었으나 우수한 경향을 보였다. 그러나 L-arginine의 농도가 증가함에 따라 회복률은 감소하여 4 mM/L농도의 실험군은 대조군보다 유의하게 낮은 회복률을 보였다(p(0.05). 이러한 연구결과를 통해 심근허혈후 재관류시 심근기능 및 관상관류량 회복을 향상시키기 위해서는 L-arginine을 2mM/ 이하의 농도로 투여 해야 하며 향후 그 이상의 높은 농도에서 나타난 회복 저하에 관한 연구가 필요할 것으로 생각된다.

• Journal of Chest Surgery
• /
• 제23권4호
• /
• pp.646-653
• /
• 1990

Currently numerous methods are in use for myocardial protection from the ravages of ischemia and hypoxia. This study was designed to compare with FDP-GIK[Group II, n=8] and GIK cardioplegic solution[Group I, n=8] in ability of myocardial protection and was examined in the isolated working rat heart subjected to long period[120 min] of hypothermic[10 - 15K] ischemic arrest with multidose[every 30 min] cardioplegic infusion. During postischemic reperfusion period 20 min, hemodynamic functions[aortic flow, coronary flow, peak aortic pressure, cardiac output, heart rate], biochemical enzymatic & electrical activities were evaluated. The time from onset of reperfusion to the return of regular sinus rhythm was significantly reduced from 87$\pm$3 sec to 17$\pm$2 sec[P<0.05]. The postischemic recovery of aortic flow was better in the group II [95.1$\pm$3.3% of its preischemic control level] than in the Group I [75.4$\pm$6.8%] [P<0.05]. Cardiac output and stroke volume was also better in the group[91.3$\pm$1.6%, 89.4$\pm$2.6%, respectively] than in the Group I [79.1$\pm$3.7%, 77.0$\pm$4.8%, respectively] [P<0. 05]. Creatine kinase leakage was also significantly reduced from 33.8$\pm$4.9 IU /10 min / gm * dry weight to 15.4$\pm$3.6 IU /10 min /gm * dry weight[P<0.05]. It is suggested that adding FDP to GIK cardioplegic solution improves its ability to protect the heart against long period of hypoxic ischemia.

• Journal of Chest Surgery
• /
• 제26권2호
• /
• pp.75-79
• /
• 1993

Myocardial protection against ischemic and reperfusion injuries is still in troublesome eventhough couples of the way of myocardial protection have been applied since 1970's. One of the possibility in myocardial protection is adding Fructose-l,6-diphosphate(FDP) in cardioplegic solution. It is assumed that FDP can promote ATP production under anaerobic condition as well as inhibiting the supressing effect of lactate on phosphofructokinase. We compared the myocardial protecting effects of FDP in crystalloid cardioplegic solution (St. Thomas formula, 10$^{\circ}C$, pH = 7.4) and reperfusate using isolated rat hearts in modified Langendorf apparatus by the parameters of preischemic and post reperfusing heart rate, time to first beat, occurance of arrhythmia, time to stabilization, and the rate of left ventricular pressure developing. Group A (n = 10), containing no FDP in cardioplegic and reperfusing solutions was control. Group B (n = 5), containing FDP in cardioplegic solution, showed statistically significant superiority of postischemic left ventricular pressure development than the control group. Group C (n = 5), containing FDP in reperfusate, showed statistically significant myocardial depressing effect than the controls. Other parameters were unremarkable. The cause is uncertain, but it is assumed that the negative feedback inhibition of FDP in energy metabolism or unknown blocking effect of FDP on certain transmembrane ionic currents is present. In conclusion, 1) FDP in cardioplegic solution has beneficial effect on postischemic left ventricular preservation. 2) FDP is strong acid when is hydrolyzed, so precise acid titration is neccessary. 3) FDP in reperfusate has negative left ventricular preservation, otherwise the mechanism is still uncertain.

• Journal of Chest Surgery
• /
• 제33권8호
• /
• pp.630-637
• /
• 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 Radiation Protection and Research
• /
• 제47권1호
• /
• pp.22-29
• /
• 2022

Background: A comprehensive, traceable, and easy-to-understand radiation risk indicator is desired for radiological protection. The early-onset hypothesis could be used for this purpose. Materials and Methods: An indicator for early death (IED) was developed and calculated using the epidemiological dataset from the 14^th Report of the Life Span Study (LSS) of Hiroshima and Nagasaki. By clarifying the calculation process, IED for all-cause mortality was estimated. In addition, the characteristics of IED for solid cancer mortality and cardiovascular mortality as well as those of men and women, and their dependence on age at exposure were investigated for detailed analysis. Results and Discussion: The IED for all-cause mortality was estimated to be approximately 4 years for an acute radiation exposure of 1 Gy regardless of the fitting dose range. The cumulative death rate for all solid cancers also indicated the early-death tendency (approximately 7-10 years at 1 Gy). Although, there is a slight difference in the characteristics of the risk obtained from the LSS study and this study, it is considered that the IED in a unit of years can also be used to show the overall picture of risk due to radiation exposure. Conclusion: We developed and calculated the indicator for early death, IED, for the cumulative mortality rate of all causes of death, all solid cancers, and circulatory diseases. The quantitative values of IED were estimated to be 4 years for all causes of death, 7-10 years for all solid cancers. IED has an advantage for intuitively understanding the meaning of radiation risk since it can be obtained by a simple and traceable method.

• Journal of Chest Surgery
• /
• 제35권7호
• /
• pp.523-529
• /
• 2002

배경: 관상동맥 우회술은 수술경험이 축적됨에 따라 근래에 조기수술성적이 점차 향상됨이 보고되고 있다. 본 연구에서는 관상동맥 우회술을 시행 받은 환자들에서 후향적 분석을 통하여 최근의 수술성적을 알아보고자 하였다. 대상 및 방법: 1996년 1월부터 2001년 8월까지 한양대학병원에서 154명의 환자가 관상동맥 우회술을 시행받았다. 전체 환자를 1996년부터 1998년까지 시행 받은 47명(제1기)과 그 이후에 시행 받은 107명 (제2기)으로 나누어 입원 기록을 근거로 술전진단, 수술방법, 사망률과 합병증을 후향적으로 분석하였다. 결과: 성비는 제1기에 남자 35명, 여자 12명, 제2기에 남자 78명 여자 29명으로 비슷한 분포를 보였고 평균 연령은 제1기 $55.9{\pm}62$세에서 제2기 $61.0{\pm}8.0$세로 의미 있게 증가하였다(p<0.05). 평균 좌심실 구출률은 제1기에 $54.6{\pm}11.8$% 제2기에 $56.9{\pm}13.0$%였다. 수술 위험 인자의 분포 중 술전의 심근경색이 제1기에 13명 (27.7%), 제2기에 14명(13.1%)로 의미 있는 차이를 보였다(p<0.05). 수술은 전례에서 중등도 저체온의 체외순환 하에서 시행하였고, 심근 보호 방법으로는 제1기에는 심실세동 상태에서의 간헐적 대동맥 차단, 또는 결정질 냉심정지액이 주로 사용되었고 제2기에서는 냉혈 심정지액이 사용되었다. 체외순환시간은 제1기에서는 $149.2{\pm}48.7$분 제2기에서는 $113.1{\pm}30.6$분으로, 대동맥 차단시간은 제1기에서는 $81.3{\pm}26.5$분 제2기에서는 $72.2{\pm}23.9$분으로 각각 의미 있게 단축되었다(p<0.05). 내흉동맥의 사용율은 제1기에서는 42%(20/47), 제2기에서는 81%(87/107)로 증가하였으며 환자 1명당 문합수도 제1기 $2.5{\pm}0.6$개소에서 제2기 $3.0{\pm}1.1$개소로 의미 있게 증가 하였다(p<0.05). 대동맥내풍선 펌프는 제1기에 7명, 제2기에 17명에서 사용되었는데 술 전 사용율은 제1기에 28.6%(2/7) 제2기에 52.9%(9/17)로 증가하였고 좌심실 기능 부전(LVEF<40%), 또는 울혈성 심부전 소견이 있는 환자에서 광범위 하게 적용하였다. 수술 사망율은 제1기에 5명이 사망하여 10.6%(5/47)을 나타내었고 제2기에 1명이 사망하여 0.9%(1/107)로 의미 있게 감소하였다(p<0.05). 결론: 체외순환을 이용한 관상동맥 우회술은 근래에 더욱 안전하게 시행될 수 있으며 수술의 보편화와 수술 경험의 축적에 따른 체외순환 과대동맥 차단 시간의 단축, 심근 보호의 발달 그리고 좌심실 기능 부전이나 심부전이 있는 환자의 적절한 관리, 특히 대동맥내 풍선펌프의 광범위한 적용이 수술 사망률을 줄이는데 기여했을 것으로 사료된다.

• Journal of Chest Surgery
• /
• 제13권4호
• /
• 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%.