• Journal of Chest Surgery
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• v.37 no.9
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• pp.735-741
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• 2004

Blood cardioplegia is known as an established cardioplegic solution during open heart surgery. Recently, the Histidine-Tryptophan-Ketoglutarate (HTK) solution has been introduced as a cardioplegia in Korea. This study was designed to compare the myocardial protective effect between the cold blood cardioplegia (CBC) and HTK solution. Material and Method: Forty patients who underwent valve surgery or coronary artery bypass surgery were randomly divided into CBC group (n=20) and HTK group (n=20). The perioperative hemodynamic and clinical data were analyzed. The concentration of CK-MB, Troponin 1 and Lactate from coronary sinus and radial arterial blood were compared for the evaluation of the myocardial damage. The postoperative serial CK-MB levels were measured. Result: The characteristics of preoperative patients were similar in two groups. The hemodynamic parameters and postoperative clinical data were also similar between the two groups. There were no statistical significances between the CBC and HTK group in the difference of biochemical markers: Δ CK-MB (15.3$\pm$26.0 vs 19.3$\pm$14.3), ΔTro-1 (2.4$\pm$4.9 vs 2.0$\pm$2.20), ΔLac (1.6$\pm$1.0 vs 1.9$\pm$2.5). The serial CK-MB levels were not significantly different between the two groups. Conclusion: These results suggested that the myocardial protective effect of HTK solution was similar to cold blood cardioplegia during open heart surgery.

• Journal of Chest Surgery
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• v.35 no.8
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• pp.573-579
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• 2002

Background: In this study, the role and the surgical outcome of the modified Blalock-Taussig shunt in the treatment of the infants with cyanotic complex congenital heart diseases were investigated. Material and Method: Over the last 12 years, 105 modified BT shunts were performed in 100 infants. Postoperative course, shunt patency rate, complications, mortality and its risk factors were reviewed restrospectively. Result: The mean age at operation was 43.0$\pm$36.6 days. Sex ratio was 60:40(M:F). The postoperative oxygen saturations were lowest after mean duration of 11 hours after the shunt procedure. The operative mortality was 8%(8) with 3 late deaths. Causes of operative death included failure of maintenance of minimum oxygenation during the procedure(2), immediate postoperative shunt occlusion(2), respiratory failure(2), low cardiac output due to heart failure and pericardial effusion(2) and sepsis(2). Late deaths resulted from acute cardiac arrest during the follow up cardiac catheterization, hypoxic myocardial failure, and arrhythmia. Year of surgery, shunt size, age at operation, and complexity of the anomalies were not the risk factors for mortality. Six month shunt patency rate was 97% and overall patency rate was 96%. Postoperative complications comprised of shunt occlusion(6), phrenic nerve palsy(3), and wound infection(2). Conclusion: We demonstrated that modified Blalock-Taussig shunt was a useful tool to palliate the infants with complex cyanotic heart disease in whom early complete repair was not feasible with acceptable mortality and patency rate. An adequate postoperative management and a meticulous surgical technique may be key factors for the better results.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.130-137
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• 1999

Background: In cardiac surgery, hypothermia is associated with a number of major disadvantage, including its detrimental effects on enzymatic function, energy generation and cellular integrity. Warm cardioplegia with normothermic cardiopulmonary bypass cause three times more incidence of permanent neurologic deficits than the cold crystalloid cardioplegia with hypothermic cardiopulmonary bypass. Interruptions or inadequate distribution of warm cardioplegia may induce anaerobic metabolism and warm ischemic injury. To avoid these problems, tepid blood cardioplegia was recently introduced. Material and Method: To evaluate whether continuous tepid blood cardioplegia is beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Warm group(37$^{\circ}C$) consisted of 18 patients who underwent valvular surgery with continuous warm blood cardioplegia. Tepid group(32$^{\circ}C$) consisted of 17 patients who underwent valvular surgery with continuous tepid blood cardioplegia. Result: Heartbeat in 100% of the patients receiving continuous warm blood cardioplegia and 88.2% of the patients receiving continuous tepid blood cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic cross clamp. There were no differences between these two groups in CPB time, ACC time, the amount of crystalloid cardioplegia used and peak level of potassium. During the operation, the total amount of urine output was more in the warm group than the tepid group(2372${\pm}$243 ml versus 1535${\pm}$130 ml, p<0.01). There were no differences between the two groups in troponin T level measured 1hr and 12hrs after the operation. Conclusion: Continuous tepid blood cardioplegia is as safe and effective as continuous warm blood cardioplegia undergoing cardiac valve surgery in myocardial protection.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.877-883
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• 1998

Background: Cardiopulmonary bypass(CPB), a standard adjunct for open heart surgery, can also play an important role in treating patients with noncardiac diseases. Material and Method: We report a collective analysis of noncardiac applications of cardiopulmonary bypass experienced at Seoul National University Hospital from 1969 to 1996. Out of a total of 20 patients, 8 were treated for membranous obstruction of inferior vena cava(MOVC), 5 for malignant melanoma, 3 for pulmonary embolism, 1 for double lung transplantation, 1 for intracranial giant aneurysm(GA), 1 for renal cell carcinoma(RC), and 1 for liposarcoma. CPB was used to induce profound hypothermia with circulatory arrest in 6 patients(MOVC 4, GA 1, RC 1). Result: CPB time was 113 mins on average for MOVC, 161 mins for GA, and 156 mins for RC, while the lowest rectal temperature was 26$^{\circ}C$ on average in MOVC, and 19$^{\circ}C$ in GA and RC. Postoperative recovery was good in all MOVC patients. The patient with GA, who underwent reoperation for the removal of hematoma, died 14 days postoperatively. The patient with RC recovered from the operation in a good condition but died from metastatic spread 6 months later. CPB was instituted for pulmonary embolectomy in 3 patients, in whom postoperative courses were uneventful, except in 1 patient who showed transient neurologic symptoms. CPB was used in a patient with double-lung transplantation for hemodynamic and ventilatory support. The patient was weaned successfully from CPB but died from low output and septicemia 19 days postoperatively. CPB without circulatory arrest was used to treat in 4 patients with MOVC. These patients showed good postoperative courses. CPB was used to administer high concentrations of chemotherapeutic agents to the extremities in 6 patients(malignant melanoma 5, recurrent liposarcoma 1). CPB time was 153 mins on average. No complications such as edema and neurologic disability were found. Conclusion: Although CPB has a limited indication in noncardiac diseases, if properly applied, it can be a very useful adjunct in a variety of surgical cases.

• The Journal of Internal Korean Medicine
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• v.31 no.4
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• pp.892-900
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• 2010

Objectives : To save the lives of patients with cardiac arrests, CPR must be performed rapidly and precisely. Regarding its critical necessity, there is a growing tendency to encourage whomever witnesses the cardiac arrest to perform basic CPR. However, the attitude toward basic CPR nor its current state of education in Korean Oriental Medical arena, which is one of the dual axes unique to Korean medical system, are not known. This is a kind of pilot study to research attitudes toward and the educative effect of basic CPR among oriental medical doctors in Korea. Methods : We carried out surveys and tests targeting nineteen apprentice doctors working in Dongguk University Ilsan Oriental Hospital, who were receiving training for 'AHA BLS course for healthcare providers', on the attitude toward and educative effect of basic CPR before and after the education. Results : The pre-educational survey showed that most of the participants felt the necessity to be trained in the BLS course, were not confident about performing CPR, and not well-acquainted with the whole process of performing CPR. After education, however, none of them responded with a lack of confidence to perform basic CPR, and the score of the confidence to perform basic CPR was significantly increased, too (from $2.05{\pm}0.71$ to $4.05{\pm}0.40$, n=19, p<0.001). Moreover, all of them answered they were satisfied with this BLS course, and it aroused their sense of responsibility as oriental medical doctors. All the participants passed the exam, and their average score for BLS scheme performance was $28.2{\pm}1.3$. Conclusions : It is necessary, in the future, to set up a management system for intensive, regular and continuous reeducation and expand the research on the perception and attitude targeting larger numbers and more multilevel groups of oriental medical doctors.

• The Journal of Korean Medicine
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• v.17 no.1 s.31
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• pp.407-432
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• 1996

Clinical Observation was made on 37 cases of Endotracheal intubation patients in the ICU of Oriental Medical Hosptal of Tae- Jon University from January in 1992 to June in 1995. 1. There were many cases of Endotracheal intubation in ischemic attack hemorragic in order. 2. Cerebral embolism mostly occured in the MCA territory and cerebral thrombosis, ICH, in the pons, generally. 3. On admission the consciousness of the most patients was 3 to 7 point by GCS. 4. The ordinary preceeding disease was hypertension. 5. Most patients were discharged from ICU after 2 days. 5. Most patients were discharged from ICU after 2 days. 6. Endotracheal intubation was done most frequently from 1 p.m. to 3 p.m. and intubated time was less than 2 hours. 7. Endotracheal intubation was done in case of heart arrest than dyspnea cases. 8. The main complication of patients of C.V.A. in ICU were urinary tract infection, pneumonia in order. 9. There were no side effects after and by Endotracheal intubation.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.732-739
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• 1985

This study was experimentally undertaken to evaluate the effect of the coronary vasodilator-mixed cardioplegic solution on myocardial protection during prolonged aortic cross-clamping. The dogs were divided into two groups: control group A[received hypothermic cardioplegic solution without any additive coronary vasodilator], and comparing group 8[received hypothermic cardioplegic solution, mixed with various coronary vasodilators and Inderal]. Group A further was divided into two subgroups: subgroup A-1[ischemic time, 90 minutes], and subgroup A-2 [ischemic time, 240 minutes]. Group B further was divided into five subgroups: subgroup B-1 [received papaverine mixed hypothermic cardioplegic solution], subgroup B-2[received nitroglycerin mixed hypothermic cardioplegic solution], subgroup B-3 [received nitroprusside mixed hypothermic cardioplegic solution, subgroup B-4[received hydralazine mixed hypothermic cardioplegic solution], and subgroup B-5 [received inderal mixed hypothermic cardioplegic solution]. The specimens from all of the subgroups were studied by electron microscopic examination. The specimens of subgroups [B-l, B-2 8-3, and B-4], received coronary vasodilators mixed hypothermic cardioplegic solutions, were also compared by methylene blue induced staining of the myocardium and coronary vessels. The results obtained were as followings: l. On electron microscopic examination, all of the specimens, including subgroup A-2, showed no irreversible change of the myocardium. But the best result was obtained from the subgroup B-l, treated by papaverine mixed hypothermic cardioplegic solution. The subgroup B-2, treated by nitroglycerin, was next. And the subgroup B-5, treated by Inderal, was agreeable, comparing the electron microscopic finding with control group in the effect of myocardial protection. 2. The distribution in the myocardium of cardioplegic solution was demonstrated with the aid of methylene blue staining in the subgroups of B-l, B-2, B-3, and B-4, and they were the groups treated by papaverine, nitroglycerin, nitroprusside, and hydralazine in their grouping order. The best result was obtained from the subgroup B-1 [papaverine]. The subgroup B-2 [nitroglycerin] was next. The subgroup B-3 [nitroprusside] was moderate in finding of the colorization. The subgroup B-4 [hydralazine] was the poorest in the distribution of the cardioplegic solution in the myocardium. From these results, it appeared that myocardial protection during ischemic arrest for open heart surgery could be enhanced considerably when coronary dilatation was assured.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.733-744
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• 2001

Background: The optimal therapeutic strategies for patients with coarctation of the aorta(CoA) and ventricular septal defect(VSD) remain controversial. This study was undertaken to determine the outcome and the need for reintervention following single-stage repair of coarctation with VSD in infants younger than 6 months. Material and Method: Thirty three consecutive patients who underwent single-stage repair of CoA with VSD, from January 1995 to December 2000, at Sejong General Hospital were reviewed retrospectively. Mean age and body weight at repair were 54$\pm$37 days(12 days-171 days) and 3.9$\pm$1.1 kg(1.5~6 kg), respectively. The surgical repair of CoA was performed under deep hypothermic circulatory arrest(CA) in the early period of the study and under regional cerebral perfusion through a direct innominate arterial cannulation without CA in the later period. The technique used in the repair of the CoA was resection and extended end-to-end anastomosis(EEEA; n=16) and extended side-to-side anastomosis(ESSA; n=2) in the early period, and resection and extended end-to-side anastomosis(EESA; n= 15) in the later period. The simultaneous closure of VSD was done with a Dacron patch(n= 16) and autologous pericardium(n=17). Aortic arch hypoplasia was present in 29 patients(88%) and its types were distal(n=18), complete(n=5), and complex(n=6)

• Journal of Chest Surgery
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• v.40 no.9
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• pp.624-628
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• 2007

Between 2001 and 2006, 3 neonates that had multilevel left ventricular outflow tract obstruction and a ventricular septal defect underwent the Norwood-Rastelli procedure. The body weights ranged from 2.9 to 3.1 kg. The patients had a near normal sized mitral valve and left ventricle. We simultaneously performed a modified Norwood procedure with native tissues-to-tissue anastomosis without circulatory arrest, and a Rastelli type procedure using a non-valved conduit from the right ventricle to the pulmonary artery and intracardiac patch baffling from the left ventricle to the pulmonary valve via the ventricular septal defect. The postoperative courses were uneventful. During follow-up, there was one late mortality caused by a cardiac catheterization related complication at 7 months after surgery, One patient required a Rastelli conduit change. Two patients are doing well during a follow-up period of 1 and 5 years, respectively.

• Fire Science and Engineering
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• v.29 no.1
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• pp.67-72
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• 2015

This paper aims to compare the effectiveness of the chest compression when a person pushes on the infant's chest by using two fingers with the support during infant cardiopulmonary resuscitation, with the effectiveness of it without the support, and to find which one is better. For the study, 50 college woman students were tested during the simulation and the result of the test has been analyzed by chi-square test, Fisher's exact test. In case of the chest compression by using the support, the depth of the chest compression comes to $3.73{\pm}0.33cm$. On the other hand, in case of the chest compression without the support, $2.50{\pm}0.59cm$. It is founded that the method of pushing on the chest by using the support is more effective than that without the support (p < 0.001). It is concluded that the way that a person pushes on the infant's chest by using two fingers with the support during infant cardiopulmonary resuscitation has turned out to be more effective and useful. It is thought that in the future, the further study for it should be conducted.