• Journal of Chest Surgery
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• 제21권4호
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• pp.613-618
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• 1988

The exposure of blood to foreign materials can cause the denaturation of plasma protein components such as immunoglobulins and complements. And those phenomena increase the morbidity and mortality after intracardiac operations through the cardiopulmonary bypass. From April, 1987 to September, 1987, we had observed the serial changes of plasma total protein IgG, IgA, IgM, complements[C3, C4] in bubble oxygenator group[n=5] and membrane oxygenator group[n=5]. Statistically significant difference between two groups were present in total protein and C3. We conclude that using membrane oxygenator in long extracorporeal circulation can reduce the activation of alternative pathway of complement system, and which can reduce post-perfusion complications of the lung though we can`t prove it in mass populations.

• 순환기질환의공학회:학술대회논문집
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• 순환기질환의공학회 2006년도 제6회 학술대회
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• pp.36-37
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• 2006

• Journal of Chest Surgery
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• 제22권4호
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• pp.562-572
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• 1989

The changes of serum glutamic oxaloacetic transaminase [SGOT], serum glutamic pyruvic transaminase [SGPT], serum lactic dehydrogenase [LDH] and serum creatine phosphokinase [CPK] were examined during and after the open heart surgery. In the total of 52 patients with heart diseases including 40 cases of congenital heart anomalies and 12 cases of acquired valvular heart diseases who undergone open heart surgery under cardiopulmonary bypass. The results obtained are as follows: 1. The average value of SGOT before surgery was 30.27 [ 18:86 units. The enzyme was reached to the maximum of 139.88 [ 89.43 units on the 1st day after the operation [p< 0.05], the enzyme activity was gradually decreased from the 3rd day after the operation, returned to the normal range on the 7th day after the operation. 2. The average value of SGPT before surgery was 14.36 [ 7.45 units. The enzyme was reached to the maximum of 34.67 [ 27.64 units on the 2nd day after the operation, but it was valueless statistically, the enzyme activity was gradually decreased from the 3rd day after the operation, returned to the normal range on the 5th day after the operation. 3. The average value of LDH before surgery was 263.07 * 86.66 units. The enzyme was reached to the maximum of 662.29 * 303.60 units on the 2nd day after the operation [p < 0.05], the enzyme activity was gradually decreased from the 5th day after the operation, returned to the normal range on the 7th day after the operation. 4. The average value of CPK before surgery was 141.35 * 43.44 units. The enzyme was reached to the maximum of 377.42 [ 222.02 units on the 1st day after the operation [p < 0.05], the enzyme activity was gradually decreased from the 5th day after the operation, returned to the normal range on the 7th day after the operation. 5. In the relationships of the serum enzymes and duration of the extracorporeal circulation, the values on the group over 90 minute of the extracorporeal circulation were increased than on the group below 90 minute of the extracorporeal circulation, but it was valueless statistically.

• Journal of Chest Surgery
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• 제8권2호
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• pp.135-142
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• 1975

Total body perfusion using Sarns Heart-Lung-Machine, five head pump motor system with Travenol disposable bubble oxygenator was attempted in the dogs by the hemodilution method with total prime of buffered Hartman`s solution under moderate hypothermia. The first of all, the functions of Sarns Heart-Lung-Machine and effects of the hemodilution perfusion by buffered Hartman`s solution was studied. At the same time the changes of pressure of artery and vein, gas contents of the blood, and influence on the blood pictures were observed before, during, and after perfusion in 1-2 days. Hemodilution rates were the ranges of 85.0ml/kg to 97.3ml/kg and perfusion flow rates were maintained with the average 80. 5ml/kg/min [the ranges of 73.3ml/kg/min to 92.8ml/kg/min]. Hypothermia was employed between $35^{\circ}C$ and $31^{\circ} of the esophageal temperature. The total body perfusion was continued for 50-60 minutes. In the total cardiopulmonary bypass, atriotomy, ventriculotomy, and atrioventriculotomy were performed respectively. Arterial pressure was ranged approximately between 50 mmHg and 140 mmHg, but generally, it was maintained over 75 mmHg. Venous pressure was measured between 3.8 cm$H_2O$ and 16.0 cm$H_2O$. Optimum oxygenation could be achieved when oxygen flow into the oxygenator was maintained approximately at 5. 5L/min. In this way, the $pO_2$, $pCO_2$, and oxygen saturation were measured before, during, and afterperfusion in 1-2 days. The $pCO_2$ ranged approximately between 26.0 mmHg and 38.5 mmHg, but generally, it was maintained in the average 30.9-32.5mmHg. The $pO_2$ was ranged between 73.0mmHg and 332.2 mmHg, but it was maintained in the average 103.0-219.0 mmHg. Oxygen saturation was measured over 95. 0% during and after extracorporeal circulation respectively. Erythrocyte count, hemoglobin, hematocrit, and leucocyte count were decreased to 49.2%, 49.0%, 49.4%, and 21. 1% of the preoperative value during extracorporeal circulation respectively and these reductions were not recovered until 1-2 days after perfusion. These. resulted from relatively high degree of hemodilution rate and operative bleeding during these experimental studies. The platelets count was also decreased about to 71% during perfusion, on the contrary, it was increased progressively after perfusion and in 1-21 days after perfusion, the value was returned to preoperative contro1 level. Three dogs were all recovered after extracorporeal circulation.

• Journal of Chest Surgery
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• 제42권2호
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• pp.244-247
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• 2009

좌심방 부속지류는 매우 드문 질환으로 염증반응이나 퇴행성 변화로 발생할 수 있지만, 동반된 다른 기형이 없을 경우 선천성으로 생각할 수 있다. 선천성 좌심방 부속지류는 대부분 증상이 없어 우연히 발견되지만, 심방 세동, 상심실성 빈맥, 전신 색전증상, 심정지 등 합병증이 발생할 수 있어 진단되면 증상이 없어도 수술을 권장하고 있다. 개흉술을 통해 접근이 가능하지만, 기저부가 넓은 경우나 좌심방 부속지내에 혈전이 있는 경우에는 체외순환이 필요해 정중흉골 절개술이 필요할 수 있다. 저자들은 부분 심낭 결손증으로 오인되었던 선천성 좌심방 부속지류를 좌측 개흉술을 통해 체외순환 없이 성공적으로 수술하였기에 증례 보고를 하는 바이다.

• Journal of Chest Surgery
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• 제16권1호
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• pp.83-90
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• 1983

During the period of March 1981 to September 1982 a series of survey has been done on the value of amylase in blood and urine of 24 patients who went through the operation of heart surgery, for congenital and acquired heart diseases, with extracorporeal circulation at the Department of Thoracic _ Cardiovascular Surgery, School of Medicine, Hanyang University. In order to analyze the iteration and inter-relation of the value of amylase in blood and urine and the extra corporeal circulation time. The duration of extra-corporeal circulation time up to 60 minutes was classified as Group A while above 60 minutes was classified as Group B. The results are as follow; 1. 3 patients [23.07%] among 13 patients of Group A and 3 patients [27.27%] among 11 patients, showed increased amylase value after the surgery. 2. The average value in blood after operation was 120.3190.71 unit in Group A and 130.90113.15 unit in Group B. It was 11.59 units [9.63%] higher in Group A than in Group B. 3. 1 patient [7.7%] among 13 patients of Group A and 2 patients[18.18%] among 11 patients of Group B, the frequency of Group B was 10.48% higher. 4. The average Value of amylase in urine after the surgery was 111.9254.87 unit in Group A and 151.54111.17 unit in Group B. It was 39.62 unit [32.72%] higher in Group A than in Group B. 5. The longer the duration of extra corporeal circulation time showed the higher the amylase value in blood and urine after the operation. 6. Although the value of amylase in blood and urine was increased after operation, no patients Were found to have developed clinical pancreatitis.

• Journal of Chest Surgery
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• 제49권3호
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• pp.199-202
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• 2016

A 7-month-old girl with no medical history was treated with mechanical circulatory support due to myocarditis. Her cardiac contractility did not improve despite more than one week of extracorporeal membrane oxygenation treatment. Thus, we planned a heart transplant. However, a high level of cytomegalovirus was found in blood laboratory results by quantitative polymerase chain reaction. The patient's heart contractility recovered to normal range four days after ganciclovir treatment. She was discharged with slightly decreased cardiac contractility with a left ventricular ejection fraction of 45%.

• Journal of Chest Surgery
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• 제49권3호
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• pp.203-206
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• 2016

Patients with venoarterial extracorporeal membrane oxygenation (ECMO) frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA) decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.

• Journal of Chest Surgery
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• 제38권1호
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• pp.13-22
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• 2005

배경 : 심장수술과 같은 체외순환(Extracorporeal circulation)이 요구되는 상황에서 조직관류에 우월할 것으로 보이는 박동성 혈류장치를 이용하려는 시도가 계속되어 왔다. 본 연구에서는 체외순환 조건에서 박동 혈류가 비박동 혈류보다 조직관류에 우월하다는 가설을 직접 증명하기 위해 치근 개발된 조직관류측정기($QFlow^{TM}-500$ Perfusion Measurement System, Thermal Technologies Inc.,Cambridge, MA, USA)의 열확산 탐침(Thermal Diffusion Probe)으로 조직 관류량을 실시간 및 연속적으로 직접 측정함으로써, 체외순환에서 박동 혈류와 비박동 혈류가 신장에 미치는 영향을 직접 관찰하고자 하였다. 대상 및 방법: 몸무게가 25 kg에서 40 kg 사이의 돼지를 암수 구별 없이 총 12마리를 각각 6마리씩 두개 군으로 나누어 실험을 진행하였다. 동물의 심장을 노출시킨 후, 좌측 측하복부를 절개하여 좌신장을 노출하여 관류측정기의 열확산 탐침을 신장의 피질내에 $2\~3$ cm 깊이로 거치하였다. 9볼트의 배터리로 심정지를 유도하면서 대동맥 차단을 하여 총심폐우회술을 시행한 후, 1군(n=6)은 Biopump에, 2군(n=6)은 박동식 혈류를 제공하는 T-PLS (Twin-Pulse Life Support System)에 연결하였다. 실험 동안 pump flow는 2 L/min로 유지하였다. 체외순환 전과 시작 후 10분마다 심박수, 혈압, 및 신장 관류치를 측정하여 60분까지 측정하고, 동맥혈가스분석, 전혈구 계산, 혈액 뇨질산, 크레아티닌 및 혈장 용혈헤모글로빈을 체외순환 시작 전과 60분 후에 측정하였다. 결과: 두 군 사이에 기초치는 유사하였다. 평균 혈압은 체외순환 전에는 두 군 간에 차이가 없었으나, 체외순환 20분 이후부터는 2군에서 높은 경향이 있었고(1군 $39.84\~45.5$ mmHg, 2군 $48.7\~52$ mmHg), 특히 60분에서의 평균혈압은 통계적으로 유의한 차이를 보였다(1군$\;41.2{\pm}4.3\;mmHg,\;48.7{\pm}5.4\;mmHg,\;p=0.023$). 체외순환 전 측정한 신장 관류치는 두 군간에 차이가 없었으나, 체외순환을 시작한 이후부터는 2군에서 지속적으로 더 높은 경향이 있었으며(1군 $48.5\~64$ mL/min100 g, 2군 $65.8\~88.3$ mL/min/100 g), 특히 30분에서의 측정값은 통계적으로 유의한 차이를 보였다(1군$47.5{\pm}18.3\;mL/min100\;g,$ 2군$83.4{\pm}28.5\;mL/min100\;g,\;p=0.026$). 혈액 뇨질산, 크레아티닌, 그리고 혈장 용혈헤모글로빈의 변화는 두 군간에 차이가 없었다. 결론: 일정한 펌프 혈류 조건에서 박동성 혈류의 평균 혈압이 더 높다는 것은, 비박동성 혈류보다 조직관류압(Tissue Perfusion Pressure) 측면에서 우수하여 말초장기의 조직관류 효과에 유리한 요인이라고 볼 수 있다. 본 연구를 토대로 장시간의 체외순환에서는 신장기능을 대표하는 수치들에도 영향을 미칠 수 있으리라 예상되며, 신장 이외에 다른 주요 장기에 미치는 영향에 대한 연구를 더 진행할 필요가 있을 것으로 생각한다.

• Journal of Chest Surgery
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• 제13권4호
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• pp.356-363
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• 1980

Even now, the hemorrhagic syndrome after cardiac surgery with the aid or a pump oxygenator constitutes a significant problem. The purpose of this study is to postulate the possible causes of the bleeding after open hear surgery [OHS]. Fifteen consecutive OHS patients with various heart diseases were selected and platelet count, plasma fibrinogen, serum calcium level were observed pre-, intra- and post- operatively until 21 th postoperative day [POD]. The platelet count was significantly decreased with initiation of extracorporeal circulation [ECC] and continued to decrease slowly until cessation of ECC. Within 10 minutes after ECC the platelet count stared to increase. But it was significantly less than preoperative count until 5th POD. The peak count was found on 14th POD and the platelet count was gradually decreased. Plasma fibrinogen also decreased significantly during operation, but it recovered up to preoperative amount within 5 hours after termination of ECC. Thereafter it rapidly increased until 3rd POD when it reached its peak. From 3rd POD it showed slow downward slope until 21st POD, but it remained in significantly higher level than preoperative amount. Serum calcium levels showed minimum fluctuations during the whole course of study. Conclusively, the decrease in platelet count and fibrinogen amount may play a considerable role for the postoperative hemorrhage. But numerous other effects of ECC must be accounted for.