• Journal of Chest Surgery
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• v.27 no.9
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• pp.759-763
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• 1994

Between November 1990 and December 1993, 9 patients underwent surgical intervention for acute active endocarditis at Gyeongsang National University Hospital. All the patients were operated on within the first six weeks after onset of symptoms for various reasons. Surgical indications for early surgery were heart failure, systemic septic emboli, new murmur and growing vegetation. Most common infecting organism was Staphylococcus[55 %], and the others were Streptococcus, anaerobes, Candida and unknown in 1 case. The infection was in the mitral valve in 5 patients, the aortic valve in 2, the aortic and mitral in 1, and the aortic and pulmonary in 1. There was one operative death[11 %] and no late death. Preoperative Functional Class were II in 4 patients, III in 5 and after surgery all the patients improved to Class I. We conclude that early surgical intervention in acute active endocarditis is effective in most instances.

• Journal of Chest Surgery
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• v.27 no.8
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• pp.650-655
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• 1994

The author analyzed 99patients with VSD weighting less than 10kg of body weight who underwent surgical correction from 1981 to 1992 at cardiovascular department of Hanyang University hospital. Patients occupied 29.3% of total cases who were underwent surgical corrections for congenital heart diseases during that time. Of the 99 patients, 51 patients were male [52%] and 48 patients[48%] were female. Age ranged from 28 days to 36 months with mean age of 13.6 months. Mean body weight was 7.53kg. According to Kirklin`s anatomical classification, type II defect was most common [61.6%]. Associated anomaly was found in 48 patients [48.5%]. Patent foramen ovale was most commonly associated cardiac anomaly [14.1%] and followed by atrial septal defect [12.1%], patent ductus arteriosus [10.1%]. Cardiac catheterization data were analyzed. The most common range of Qp/Qs, Rp/Rs, Pp/Ps were above 3.0, 0.1 - 0.25, and above 0.75 respectively. Among the indications of surgical correction, there were pulmonary hypertention in 69 patients, congestive heart failure in 44 patients, frequent respiratory infection in 47 patients, growth retardation in 33 patients. The most common surgical approach and method for VSD closure were right atriotomy[48.3%] and dacron patch closure[93.3%]. Complication rate was 13.1% [13 cases], and overall mortality was 17.1% [17 cases]. The cause of death consisted of low cardiac output syndrome[11 cases], acute renal failure[3 cases], sepsis[2 cases] and pulmonary insufficiency[1 case] in order of frequency.

• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.350-362
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• 1999

Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.4
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• pp.1728-1736
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• 2013

The purpose of this study is to identify prognostic predictors of postoperative acute renal failure(ARF) for the patient undergoing cardiac surgery. Retrospectively review the electronic hospital database at a A hospital from Jan 2008 to Dec. 2011. 483 patients were included in this study. They were divided into a occurrence of ARF group(n=59) and a non occurrence of ARF group(n=424). ARF occurred in 59 cases (12.2%). Multi-variable logistic regression analysis identified that preoperative risk factors include creatinine(OR 3.92, p=<.001), advanced age(OR 2.142, p=.015), female(OR 2.165, p=.015), hypertension(OR 2.513, p=.005), NYHA(New York Heart Association) class II(OR 3.081, p=.003), and III(OR 6.759, p=.004), and intraoperative risk factor includes blood transfusion(OR 3.753, p=<.001), and postoperative factors include bilirubin(OR 4.541, p=.028), creatine(OR 8.554, p=.003), and cardiac output(OR 0.214, p=.033) as a prognostic predictors. The development of postoperative ARF could be a reason for increase in rate of complication and mortality after cardiac surgery. therefore the prevention of ARF is of paramount importance and treatment strategies are urgently needed.

• Journal of Chest Surgery
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• v.57 no.1
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• pp.36-43
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• 2024

Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory failure, which frequently necessitates invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, the limited availability of ECMO resources poses challenges to patient selection and associated decision-making. Consequently, this retrospective single-center study was undertaken to evaluate the characteristics and clinical outcomes of patients with COVID-19 receiving ECMO. Methods: Between March 2020 and July 2022, 65 patients with COVID-19 were treated with ECMO and were subsequently reviewed. Patient demographics, laboratory data, and clinical outcomes were examined, and statistical analyses were performed to identify risk factors associated with mortality. Results: Of the patients studied, 15 (23.1%) survived and were discharged from the hospital, while 50 (76.9%) died during their hospitalization. The survival group had a significantly lower median age, at 52 years (interquartile range [IQR], 47.5-61.5 years), compared to 64 years (IQR, 60.0-68.0 years) among mortality group (p=0.016). However, no significant differences were observed in other underlying conditions or in factors related to intervention timing. Multivariable analysis revealed that the requirement of a change in ECMO mode (odds ratio [OR], 366.77; 95% confidence interval [CI], 1.92-69911.92; p=0.0275) and the initiation of continuous renal replacement therapy (CRRT) (OR, 139.15; 95% CI, 1.95-9,910.14; p=0.0233) were independent predictors of mortality. Conclusion: Changes in ECMO mode and the initiation of CRRT during management were associated with mortality in patients with COVID-19 who were supported by ECMO. Patients exhibiting these factors require careful monitoring due to the potential for adverse outcomes.

• Journal of Chest Surgery
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• v.26 no.9
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• pp.714-717
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• 1993

Primary rhabdomyosarcoma of the heart is a rare lesion. Because of their rarity and acute onset, rapid progression and deterioration of symptom, there have been few cases treated by surgery irradiation and chemotherapy. We have experienced a patient with acute biventricular failure secondary to a rhabdomyosarcoma arising from the left atrium and invading the right atrium.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.899-904
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• 1988

In Behcet syndrome, cardiac involvements are rare and have been reported pericarditis, myocarditis, right heart endocardial fibrosis, right ventricle mural thrombus with pulmonary embolism, active endocarditis, granulomatous endocarditis, conduction disturbance, acute aortic insufficiency, mitral valve prolapse. Our three patients underwent AVR because of aortic insufficiency and ascending aorta enlargement combined with Behcet syndrome. Two patients had mitral regurgitation too. So one underwent MAP and the other underwent MVR concomitantly. One who underwent AVR have been well for 50 months. Another who underwent AVR+MAP and redo AVR due to aortic paravalvular leakage was died of congestive heart failure. The other who underwent AVR+MVR and repeated AVR three times because of aortic paravalvular leakage is in condition of aortic paravalvular leakage. Paravalvular leakage is considered to recur due to progressive dilatation and fragility of aortic root that is the result of pathologic change of Behcet syndrome in it. If Open heart surgery is needed in Behcet`s syndrome during inflammatory reaction is active, postoperative complications such as paravalvular leakage or suture line rupture may be prevented with pre- and postoperative anti-inflammatory management.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.977-982
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• 1995

Early repair of complex congenital heart malformation may lead to life-threatening respiratory and hemodynamic embarrassment on sternal closure. We performed delayed sternal closure in nine neonates to avoid a fatal outcome in these situations. Primary elective open sternum was used in 8 [66.7% and primary sternal closure in 4 [33.3% of the 12 patients studied. one patient with primary sternal closure underwent delayed sternal reopening in the intensive care unit. Of the 9 patients with open sternum, 2 patients died of low cardiac output and acute renal failure respectively before delayed sternal closure. 7 patients could undergo delayed sternal closures 3 days after initial operation. The mean age at open cardiac procedure was 14.3 days [range 3 to 30 and mean preoperative weight was 3.4kg [range 2.8 to 4.1 . The aortic cross-clamping time was longer in the group with open sternum than the group with closed sternum [p=0.042 . There was no morbidity and mortality related to delayed sternal closure. Given the low morbidity and potential benifits, this technique should be used in neonates after open heart procedures when postoperative mediastinal compression produces frank low cardiac output or respiratoy compromise during a trial of sternal closure.

• Journal of Chest Surgery
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• v.49 no.6
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• pp.427-434
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• 2016

Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. Results: The risk of acute kidney injury was about ${\times}3$ higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.844-849
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• 1996

During the 2 years period, we hav performed acute peritoneal dialysis in twenty two children after cardiopulmonary bypass among 198 patients who underwent surgery due to complicated congenital heart diseAses . were fluid over- load (10 cases), oliguria (9 cases) and hyperkalemia (3 cases). Bypass time greAter than 90 minutes was a predictor of the need for dialysis(p< 0.05). Five neonates (38 %) operated on instituted peritoneal dialysis but it was insignificant determinant factor (p 08). Sixteen patients recovered their renal suction, but 4 patients died due to respirAtory fAilure or sepsis. All the patients which could not recover their renal function, expired although the renal failure was not re- sponsible for the mortality. We think that early peritoneal dialysis is helpful in cases of oliguia, fluid overload or hyperkalemia after cradiopulmonary bypass.