• Title/Summary/Keyword: Circuit pressure

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Establishment of Featal Heart Surgery with an Improvement of the Placental Blood Flow in Cardiopulmonary Bypass Using Fetal Lamb Model (양태아를 이용한 심폐우회술에서의 태반혈류개선을 통한 태아심장수술의 기반기술 확립)

  • 이정렬;박천수;임홍국;배은정;안규리
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.11-18
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    • 2004
  • Background: We tested the effect of indomethacine and total spinal anesthesia on the improvement of placental flow during cardiopulmonary bypass on fetal lamb. Material and Method: Twenty fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Ten served as a control group in which placenta was worked as an oxygenator during bypass (Control group). The remainder worked as an experimental group in which pretreatment with indomethacine and total spinal anesthesia was performed before bypass with the same extracorporeal circulation technique as control group (Experimental group). Observations were made every 10 minutes during a 30-minute bypass and 30-minute post bypass period. Result: Weights of the fetuses ranged from 2.2 to 5.2 kg. In Control group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of Pa$CO_2$ increased from 61.9 to 129.6 mmHg at each time points during bypass. Flow rate was suboptimal (74.3 to 97.0 $m\ell$/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. On the contrary, in Experimental group, means of arterial pressure reamined higher (45.8 to 30 mmHg) during bypass (p<0.05). Means of Pa$CO_2$ were less ranging from 59.8 to 79.4 mmHg during bypass (P<0.05). Flow rates were higher (78.8 to 120.2 $m\ell$/kg/min) during bypass (p<0.05). There were slower deterioration of cardiac function after cessation of bypass. Conclusion: In this study, we demonstrated that the placental flow was increased during fetal cardiopulmonary bypass in the group pretreated with indomethacine and total spinal anesthesia. However, further studies with modifications of the bypass including a creation of more concise bypass circuit, and a use of axial pump are mandatory for the clinical application.

Steroid Effect on the Brain Protection During OPen Heart Surgery Using Hypothermic Circulatory Arrest in the Rabbit Cardiopulmonary bypass Model (저체온순환정지법을 이용한 개심술시 스테로이드의 뇌보호 효과 - 토끼를 이용한 심폐바이패스 실험모델에서 -)

  • Kim, Won-Gon;Lim, Cheong;Moon, Hyun-Jong;Chun, Eui-Kyung;Chi, Je-Geun;Won, Tae-Hee;Lee, Young-Tak;Chee, Hyun-Keun;Kim, Jun-Woo
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.471-478
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    • 1997
  • Introduction: The use of rabbits as a cardiopulmonary bypass(CPB) animal model is extremely dif%cult mainly due to technical problems. On the other hand, deep hypothermic circulatory arrest(CA) is used to facilitate surgical repair in a variety of cardiac diseases. Although steroids are generally known to be effective in the treatment of cerebral edema, the protective effects of steroids on the brain during CA are not conclusively established. Objectives of this study are twofold: the establishment of CPB technique in rabbits and the evaluation of preventive effect of steroid on the development of brain edema during CA. Material '||'&'||' Methods: Fifteen New Zealan white rabbits(average body weight 3.5kg) were divided into three experimental groups; control CA group(n=5), CA with Trendelenberg position group(n=5), and CA with Trendelenberg position + steroid(methylprednisolone 30 mglkg) administration group(n=5). After anesthetic induction and tracheostomy, a median sternotomy was performed. An aortic cannula(3.3mm) and a venous ncannula(14 Fr) were inserted, respectively in the ascending aorta and the right atrium. The CPB circuit consisted of a roller pump and a bubble oxygenator. Priming volume of the circuit was approximately 450m1 with 120" 150ml of blood. CPB was initiated at a flow rate of 80~85ml/kg/min, Ten min after the start of CPB, CA was established with duration of 40min at $20^{\circ}C$ of rectal temperature. After CA, CPB was restarted with 20min period of rewarming. Ten min after weaning, the animal was sacrif;cod. One-to-2g portions of the following tissues were rapidly d:ssected and water contents were examined and compared among gr ups: brain, cervical spinal cord, kidney, duodenum, lung, heart, liver, spleen, pancreas. stomach. Statistical significances were analyzed by Kruskal-Wallis nonparametric test. Results: CPB with CA was successfully performed in all cases. Flow rate of 60-100 mlfkgfmin was able to be maintained throughout CPB. During CPB, no significant metabolic acidosis was detected and aortic pressure ranged between 35-55 mmHg. After weaning from CPB, all hearts resumed normal beating spontaneously. There were no statistically significant differences in the water contents of tissues including brain among the three experimental groups. Conclusion: These results indicate (1) CPB can be reliably administered in rabbits if proper technique is used, (2) the effect of steroid on the protection of brain edema related to Trendelenburg position during CA is not established within the scope of this experiment.

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Impact of Pulmonary Vascular Compliance on the Duration of Pleural Effusion Duration after Extracardiac Fontan Procedure (수술 전 폐혈관 유순도가 심장 외 도판을 이용한 Fontan 수술 후 늑막 삼출 기간에 미치는 영향)

  • Yun Tae-Jin;Im Yu-Mi;Song Kwang-Jae;Jung Sung-Ho;Park Jeong-Jun;Seo Dong-Man;Lee Moo-Song
    • Journal of Chest Surgery
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    • v.39 no.8 s.265
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    • pp.579-587
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    • 2006
  • Background: Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have poor surgical outcome; prolonged pleural drainage, protein losing enteropathy, pulmonary thromboembolism and death. We hypothesized that low pulmonary vascular compliance (PVC) is a risk factor for prolonged pleural effusion drainage after the Fontan operation. Material and Method: A retrospective review of 96 consecutive patients who underwent the Extracardiac Fontan procedures (median age: 3.9 years) was performed. Fontan risk score (FRS) was calculated from 12 categorized preoperative anatomic and physiologic variables. PVC $(mm^2/m^2{\cdot}mmHg)$ was defined as pulmonary artery index $(mm^2/m^2)$ divided by total pulmonary resistance $(W.U{\cdot}/m^2)$ and pulmonary blood flow $(L/min/m^2)$ based on the electrical circuit analogue of the pulmonary circulation. Chest tube indwelling time was log-transformed (log indwelling time, LIT) to fit normal distribution, and the relationship between preoperative predictors and LIT was analyzed by multiple linear regression. Result: Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 $mm^2/mmHg/m^2$ (median: 24.8), 3 to 268 days (median: 20 days), and 1.1 to 5.6 (mean: 2.9, standard deviation: 0.8), respectively. FRS, PVC, cardiopulmonary bypass time (CPB) and central venous pressure at postoperative 12 hours were correlated with LIT by univariable analyses. By multiple linear regression, PVC (p=0.0018) and CPB (p=0.0024) independently predicted LIT, explaining 21.7% of the variation. The regression equation was LIT=2.74-0.0158 PVC+0.00658 CPB. Conclusion: Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after the extracardiac Fontan procedure.

Investigation of Plugging and Wastage of Narrow Sodium Channels by Sodium and Carbon Dioxide Interaction (소듐과 이산화탄소 반응에 의한 소듐유로막힘 및 재료손상 현상 연구)

  • Park, Sun Hee;Min, Jae Hong;Lee, Tae-Ho;Wi, Myung-Hwan
    • Korean Chemical Engineering Research
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    • v.54 no.6
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    • pp.863-870
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    • 2016
  • We investigated the physical/chemical phenomena that a slow loss of $CO_2$ inventory into sodium after the sodium-$CO_2$ boundary failure in printed circuit heat exchangers (PCHEs), which is considered for the supercritical $CO_2$ Brayton cycle power conversion system of a sodium-cooled fast reactor (SFR). The first phenomenon is plugging inside narrow sodium channels by micro cracks and the other one is damage propagation referred to as wastage combined with the corrosion/erosion effect. Experimental results of plugging shows that sodium flow immediately stopped as $CO_2$ was injected through the nozzle at $300{\sim}400^{\circ}C$ in 3 mmID sodium channels, whereas sodium flow stopped about 60 min after $CO_2$ injection in 5 mmID sodium channels. These results imply that if pressure boundary of sodium-$CO_2$ fails a narrow sodium channel would be plugged by reaction products in a short time whereas a relatively wider sodium channel would be plugged with higher concentration of reaction products. Wastage by the erosion effect of $CO_2$ (200~250 bar) hardly occurred regardless of the kinds of materials (stainless steel 316, Inconel 600, and 9Cr-1Mo steel), temperature ($400{\sim}500^{\circ}C$), or the diameter of the $CO_2$ nozzle (0.2~0.8 mm). Velocities at the $CO_2$ nozzle were specified as Mach 0.4~0.7. Our experimental results are expected to be used for determining the design parameters of PCHEs for their safeties.

Improvement of Fontan Circulatory Failure after Conversion to Total Cavopulmonary Connection (완전 대정맥-폐동맥 연결수술로 전환 후의 폰탄순환장애 개선)

  • Han Ki Park;Gijong Yi;Suk Won Song;Sak Lee;Bum Koo Cho;Young hwan Park
    • Journal of Chest Surgery
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    • v.36 no.8
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    • pp.559-565
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    • 2003
  • By improving the flow pattern in Fontan circuit, total cavopulmonary connection (TCPC) could result in a better outcome than atriopulmonary connection Fontan operation. For the patients with impaired hemodynamics after atriopulmonary Fontan connection, conversion to TCPC can be expected to bring hemodynamic and functional improvement. We studied the results of the revision of the previous Fontan connection to TCPC in patients with failed Fontan circulation. Material and method: From October1979 to June 2002, eight patients who had failed Fontan circulation, underwent revision of previous Fontan operation to TCPC at Yonsei University Hospital. Intracardiac anomalies of the patients were tricuspid atresia (n=4) and other functional single ventricles (n=4). Mean age at TCPC conversion was 14.0$\pm$7.0 years (range, 4.6~26.2 years) and median interval between initial Fontan operation and TCPC was 7.5 years (range, 2.4~14.3 years). All patients had various degree of symptoms and signs of right heart failure. NYHA functional class was 111 or IV in six patients. Paroxysmal atrial fibrillation (n:f), cyanosis (n=2), intraatrial thrombi (n=2), and protein losing enteropathy (PLE) (n=3) were also combined. The previous Fontan operation was revised to extracardiac conduit placement (n=7) and intraatrial lateral tunnel (n=1). Result: There was no operative death. Major morbidities included deep sternal infection (n=1), prolonged pleural effusion over two weeks (n=1), and temporary junctional lachyarrhythrnia (n=1). Postoperative central venous Pressure was lower than the preoperative value (17.9$\pm$3.5 vs. 14.9$\pm$1.0, p=0.049). Follow-up was complete in all patients and extended to 50,1 months (mean, 30.3$\pm$ 12.8 months). There was no late death. All patients were in NYHA class 1 or 11. Paroxysmal supraventricular tachycardia developed in a patient who underwent conversion to intraatrial lateral tunnel procedure, PLE was recurred in two patients among three patients who had had PLE before the convertsion. There was no newly developed PLE. Conclusion: Hemodynamic and functional improvement could be expected for the patients with Fontan circulatory failure after atriopulmonary connection by revision of their previous circulation to TCPC. The conversion could be performed with low risk of morbidity and mortality.

Recent Progress in Air-Conditioning and Refrigeration Research : A Review of Papers Published in the Korean Journal of Air-Conditioning and Refrigeration Engineering in 2012 (설비공학 분야의 최근 연구 동향 : 2012년 학회지 논문에 대한 종합적 고찰)

  • Han, Hwataik;Lee, Dae-Young;Kim, Sa Ryang;Kim, Hyun-Jung;Choi, Jong Min;Park, Jun-Seok;Kim, Sumin
    • Korean Journal of Air-Conditioning and Refrigeration Engineering
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    • v.25 no.6
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    • pp.346-361
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    • 2013
  • This article reviews the papers published in the Korean Journal of Air-Conditioning and Refrigeration Engineering during 2012. It is intended to understand the status of current research in the areas of heating, cooling, ventilation, sanitation, and indoor environments of buildings and plant facilities. The conclusions are as follows : (1) The research works on thermal and fluid engineering have been reviewed as groups of fluid machinery, pipes and valves, fuel cells and power plants, ground-coupled heat pumps, and general heat and mass transfer systems. Research issues are mainly focused on new and renewable energy systems, such as fuel cells, ocean thermal energy conversion power plants, and ground-coupled heat pump systems. (2) Research works on the heat transfer area have been reviewed in the categories of heat transfer characteristics, pool boiling and condensing heat transfer, and industrial heat exchangers. Researches on heat transfer characteristics included the results for natural convection in a square enclosure with two hot circular cylinders, non-uniform grooved tube considering tube expansion, single-tube annular baffle system, broadcasting LED light with ion wind generator, mechanical property and microstructure of SA213 P92 boiler pipe steel, and flat plate using multiple tripping wires. In the area of pool boiling and condensing heat transfer, researches on the design of a micro-channel heat exchanger for a heat pump, numerical simulation of a heat pump evaporator considering the pressure drop in the distributor and capillary tubes, critical heat flux on a thermoexcel-E enhanced surface, and the performance of a fin-and-tube condenser with non-uniform air distribution and different tube types were actively carried out. In the area of industrial heat exchangers, researches on a plate heat exchanger type dehumidifier, fin-tube heat exchanger, an electric circuit transient analogy model in a vertical closed loop ground heat exchanger, heat transfer characteristics of a double skin window for plant factory, a regenerative heat exchanger depending on its porous structure, and various types of plate heat exchangers were performed. (3) In the field of refrigeration, various studies were executed to improve refrigeration system performance, and to evaluate the applicability of alternative refrigerants and new components. Various topics were presented in the area of refrigeration cycle. Research issues mainly focused on the enhancement of the system performance. In the alternative refrigerant area, studies on CO2, R32/R152a mixture, and R1234yf were performed. Studies on the design and performance analysis of various compressors and evaporator were executed. (4) In building mechanical system research fields, twenty-nine studies were conducted to achieve effective design of mechanical systems, and also to maximize the energy efficiency of buildings. The topics of the studies included heating and cooling, HVAC system, ventilation, renewable energy systems, and lighting systems in buildings. New designs and performance tests using numerical methods and experiments provide useful information and key data, which can improve the energy efficiency of buildings. (5) In the fields of the architectural environment, studies for various purposes, such as indoor environment, building energy, and renewable energy were performed. In particular, building energy-related researches and renewable energy systems have been mainly studied, reflecting interests in global climate change, and efforts to reduce building energy consumption by government and architectural specialists. In addition, many researches have been conducted regarding indoor environments.