• 대한의생명과학회지
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• 제7권1호
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• pp.7-15
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• 2001

Although extracorporeal circulation (ECC) has been routinely used for cardiovascular surgery, hyperoxemia during ECC may produce oxygen toxicity and cellular injury. This study was performed to investigate the clinical influences of hyperoxemic ECC during cardiovascular operation. 40 adult patients scheduled for elective cardiovascular surgery were classified into normoxemic (arterial oxygen tension: 115 mmHg, n＝20) and hyperoxemic (arterial oxygen tension: 380 mmHg, n＝20) ECC. At preoperative and postoperative period, total leukocyte and neutrophil counts, platelet counts, iron, glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine in peripheral arterial blood, malondialdehyde (MDA) and troponin-T concentration (TnT) in coronary sinus blood, pulmonary vascular resistance (PVR), and postoperative blood loss volume (BLS) were measured and compared between groups. Hyperoxemic group had postoperatively higher total leukocyte and neutrophil counts, MDA, TnT, PVR total BLS, iron, glucose, AST, ALT, BUN, and creatinine than normoxemic group (p<0.05).0 conclusion, hyperoxemic ECC results in greater inflammatory response and oxidative damaging effects on the heart lung, liver and kidney, probably being adverse to postoperative patient recovery. For reducing these deleterious effects and improving postoperative outcomes, management lowering oxygen tension during ECC is recommended.

• Journal of Chest Surgery
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• 제13권1호
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• pp.48-51
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• 1980

Open heart surgery patients have additional risks arising from the special nature of the operative procedure. And postoperative infections in patients with extracorporeal circulation are associated with high incidence of serious sequelae. To investigate the incidence and organisms of contamination, and the relation between the duration of extracorporeal circulation and contamination, following study was done. Eighty-four of the open heart surgery patients were examined with cultures from the blood and priming solution before and after bypass. 1. Cultures before bypass were sterile, but 2 cases of cultures from the blood and priming solution after bypass were positive, and culture positive group was 5% of all patients. 2. The organisms were Gram-negative, aerobic coliform bacilli; 3. The culture positive group had significantly longer bypass time.

• Journal of Yeungnam Medical Science
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• 제1권1호
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• pp.101-106
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• 1984

체외순환전 심폐기내 충전액의 이산화탄소분압, 산도, 완충염기, 산소분압을 측정하고 저체온 체외 순환 15분후의 각각의 치를 측정하여 비교 분석한 결과 다음과 같은 결론을 얻었다. 1. 이산화단소분양은 충전액은 $12.1{\pm}7.8mmHg$로 매우 심한 저이산화탄소혈증 이었으나 체외순환 후 15분에서 $35.7{\pm}5.7mmHg$로 정상 범위이었다. 2. 산도는 충전액은 최저 pH 6.93, 최고 pH 7.99(평균 $7.45{\pm}0.29$)로 매우 심한 변동폭을 보였으나 체외순환후 15분에는 pH $7.35{\pm}0.05$로 정상범위이었다. 3. 완충염기는 충전액은 $7.9{\pm}3.5mmol/l$로 매우 낮았으나 체외순환후 15분에는 $19.6{\pm}1.2$로 정상치에 가깝게 유지되었다. 4. 산소분압은 충전액은 $667.1{\pm}45.6$으로 매우 심한 과산소혈증 이었으나 체외순환후 15분에는 $280.7{\pm}131.7$로 크게 감소되었다. 이상의 결과로 미루어 보아 체외순환전 심폐기내 충전액의 저이산화탄소분압 및 고산소분압 상태는 체외순환중 생체내에는 크게 영향을 마치지 않는것으로 사료된다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.205-213
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• 1985

It is well documented that calcium is essential to cardiac contraction and the amplitude of contractility is proportional to the ionized calcium not to total calcium. Changes of serum ionic calcium before and after extracorporeal circulation were observed in fifty two patients operated on at Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, from May 21st, 1984, to July 6th, 1984. They were 28 males and 24 females including 21 acyanotic congenital heart diseases, 21 cyanotic congenital heart diseases, and 10 acquired valvular heart diseases. In general, preoperative serum ionic calcium was around the normal level, but those of immediate postoperative day and postop-first day were decreased subnormally with significance [P<0.05 vs. preop.]. From postop-third day, serum ionic calcium was returned to normal range. No significant difference was noticed in subgroups divided by 10 Kg of body weight and by the methods of myocardial protection. But the change of serum ionic calcium in the patients with prolonged pump time over 90 minutes was remarkable and the values were as follow; on immediate postop-day 1.780.18 mEq/L vs. 1.970.20 mEq/L [P<0.005],on postop-first day, 1.940.20mEq/L vs. 2.060.12 mEq/L [P<0.025], on postop-third day, 2.030.11mEq/L vs. 2.150.13mEq/L [P<0.01], and on postop-seventh day, 2.030.09mEq/L vs. 2.190.11mEq/L [P<0.005]. In summary, the serum ionic calcium was lowered after extracorporeal circulation and even severer degree according to the prolongation of bypass time. So, after extracorporeal circulation esp. in the cases with prolonged bypass time, early correction of lowered serum ionic calcium would be helpful to the postoperative hemodynamics.

• Journal of Chest Surgery
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• 제17권3호
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• pp.409-417
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• 1984

In the early days of open heart surgery, acute respiratory failure following extracorporeal circulation was a significant deterrent to an uncomplicated recovery. Although a marked improvement in prevention and treatment of postoperative respiratory failure has been achieved, the problem has not been completely eliminated and continues to be a causative factor in morbidity and mortality Fates following open heart surgery. We have attempted to evaluate postoperative respiratory failure in patients undergoing cardiac operation with the aid of extracorporeal circulation. Our series comprised 92 patients who underwent elective open heart surgery at the Department of Thoracic and Cariodvascular Surgery, School of Medicine, Kyungpook National University, from January, 1980 to December, 1982. In our study, the overall incidence of acute respiratory failure following open heart surgery was 18.8 percent. The duration of extracorporeal circulation in a series of 18 patients who developed postoperative respiratory failure [Group B] was longer in the mean value [120.3 minutes] than the uncomplicated 74 patients [Group A] [85.8 minutes]. The duration of artificial ventilation after open heart surgery in Group A averaged 13.4 hours as contrasted with 76.5 hours in Group B. In Group B, the inspired oxygen concentration [FiO2] in artificial ventilation was continued in the higher level than Group A until 18 hours after operation. Upon pulmonary function test performed pre-and postoperatively, residual volume[RV], RV/TLC and FEV 1.0/FVC were remained essentially unchanged following extracorporeal circulation, whereas forced vital capacity [FVC], FEV 1.0 and FEF 25-75% were significantly decreased in the early postoperative days. The incidence of acute respiratory failure was significantly higher in a series of patients who developed postoperative complications, such as re- exploration due to massive bleeding, low cardiac output, acute renal failure and arrhythmias. A total of 9 patients died, giving an overall mortality was 33.3 percent whereas the mortality was only 1.1 percent for patients without respiratory failure.

• Journal of Chest Surgery
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• 제37권2호
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• pp.180-183
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• 2004

우폐하엽의 폐암이 심낭과 좌심방의 하폐정맥 유입구를 침범한 62세 남자 환자에서 심폐체외순환을 이용하여 우폐 중하엽절제술을 시행하였다. 환자는 수술 후 제2일째에 우폐상엽의 국한성 폐부종이 발생하였으며 폐부종이 치료된 후 우폐의 기관지늑막루가 발생하였다. 유경대망을 이용하여 기관지 늑막루를 봉합하였다. 그 후의 임상 경과는 양호하였으며 환자는 현재 6년째 재발 없이 건강히 지내고 있다.

• Journal of Chest Surgery
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• 제14권2호
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• pp.144-152
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• 1981

The effect of cardiopulmonary bypass procedures on the blood components were studied through the measurements of several serum enzymes, SGOT, SGPT, CPK and LDH with its isozymes in the patients who had surgery for their heart diseases. They wre 85 patients: 40 Males and 45 Females. Their ages ranged widely between one and fifty-six. They were divided into 5 groups: Group I.patent ductus arteriosus without extracorporeal circulation, Group II-atrial septal defect, Group III-ventricular septal defect, Group IV-tetralogy of Fallot, and Group V-valve replacement. Generally serum enzymes revealed the increased values after surgery and the tendency returning toward preoperative levels. With the high total serum LDH levels seen uniformly after operation which persisted long in patients with replaced valves, the changes of LDH-isozymes were further analyzed. The isozymes, especially LDI and LDs increased their activities postoperatively, and the other fractions varied little. And $LD_1$/$LD_2$ ratios also showed similar rises and falls while the elevated values lasted longer in the patients with cardiac valve replacement. The significant values of LDH-isozymes in predicting the hemolysis occuring after extracorporeal circulation and in following the patients whose valves were replaced have been further discussed with the special stress placed on the $LD_1$/$LD_2$ratios.

• Journal of Chest Surgery
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• 제24권10호
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• pp.951-959
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• 1991

The level of serum potassium concentration is very important aspect in postoperative cardiac patients The postoperative cardiac arrhythmia and digitalis intoxication are known to be closely related with hypokalemia and also to cause the irreversible cardiac dysfunction. In this study, the changes of the level in serum and urine concentrations during, after extracorporeal circulation[EGG], Predict and Postdict periods are analyzed and compared statistically with postoperative cardiac patients 46 persons according to divided 8 groups. 1. There was no difference significantly in concentrations of serum and urine potassium in each period according to age, sex and disease types. 2. There was no difference significantly in concentrations of serum and urine potassium in each period according to the use of normothermia and hypothermia. 3. There was no difference significantly in concentrations of serum and urine potassium in each period according to the length of extracorporeal circulation time and aortic cross clamping time. 4. There was no difference significantly in concentrations of serum and urine potassium in each period according to the amount of the infused cardioplegic solution and level of Hct.

• Journal of Chest Surgery
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• 제46권1호
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• pp.80-83
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• 2013

We report on the application of a venovenous type extracorporeal membrane oxygenator (ECMO) in high-risk tracheal procedures in six cases consisting of five patients with tracheal stenosis. An ECMO should be helpful for preventing respiratory emergency during a tracheal procedure.

• Journal of Chest Surgery
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• 제13권4호
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• pp.394-404
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• 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%.