• Journal of Chest Surgery
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• v.26 no.7
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• pp.513-520
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• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1299-1305
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• 1996

The rat thoracic aorta was harvested to determine whether either hyperkalemla or hypothermia impairs the endothelium-dependent re axation of the vascular smooth muscle. Isolated thoracic aorta segments were studied in five groups(n=10 in each group). In group I(control), the isolated aortic seglnents were suspended in organ bath without any intervention. In group ll(endotheilum removAl). the endothelium of the aortic segment was removed by gentle rubbing of the intimal surface with a pair of forceps. In group III(457), IV(4mST), and V(3757), the aortic segments were exposed for 45minutes to 4$^{\circ}C$ St. Thomas hospital cardioplegic solution(57 : NaCl, 144.3; KCI, 19.6, MgCl:, 15.7 : CaCl, 2.2 mmol/L).4$^{\circ}C$ modified St. Thomas hospital cardioplegic solution(NaCl, 144.3 : KCI. 140.0 : MgCl:, 15.7; CaCl:. 2.2 mmol/L). and 37$^{\circ}C$ 57, before suspending in the organ bath, respectively. Then, aorta segments were suspended in organ baths(physiologic salt solution, 37$^{\circ}C$, 95% oxygen and 5% carbon dioxide) for Isometric tension recording. The vasodilatation to acetylcholine (10-2 to 10-2mol/L) was not impaired in control, 457, 4mST, nd 3757 groups. The vasodilatation to acetylcholine was impaired in endothelium removal group. The vasodilatation to sodium nitroprusslde (10-2 to 10-2 mol/L) was not impaired in all groups. In conclusion, both hyperkalemia and hypothermia do not alter irreversibly the function of the rondothelium of the thoracic aorta of the rat.

• Journal of Korean Neurosurgical Society
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• v.30 no.7
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• pp.903-906
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• 2001

Objective : The brain temperature is about $0.4-1^{\circ}C$ higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. Methods : Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia( over $38^{\circ}C$), normothermia($36-38^{\circ}C$) and hypothermia(under $36^{\circ}C$). Total 1671 paired sample data were collected and analyzed. Results : The temperature difference between the cerebral cortex and the axilla was $0.45{\pm}1.04^{\circ}C$ in hyperthermic patients, $0.97{\pm}1.1^{\circ}C$ in normothermic patients and $1.04{\pm}0.81^{\circ}C$ in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). Conclusion : From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.

• Acute and Critical Care
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• v.33 no.4
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• pp.246-251
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• 2018

Background: Target temperature management (TTM) improves neurological outcomes for comatose survivors of out-of-hospital cardiac arrest. We compared the efficacy and safety of a gel pad cooling device (GP) and a water blanket (WB) during TTM. Methods: We performed a retrospective analysis in a single hospital, wherein we measured the time to target temperature ($<34^{\circ}C$) after initiation of cooling to evaluate the effectiveness of the cooling method. The temperature farthest from $33^{\circ}C$ was selected every hour during maintenance. Generalized estimation equation analysis was used to compare the absolute temperature differences from $33^{\circ}C$ during the maintenance period. If the selected temperature was not between $32^{\circ}C$ and $34^{\circ}C$, the hour was considered a deviation from the target. We compared the deviation rates during hypothermia maintenance to evaluate the safety of the different methods. Results: A GP was used for 23 patients among of 53 patients, and a WB was used for the remaining. There was no difference in baseline temperature at the start of cooling between the two patient groups (GP, $35.7^{\circ}C$ vs. WB, $35.6^{\circ}C$; P=0.741). The time to target temperature (134.2 minutes vs. 233.4 minutes, P=0.056) was shorter in the GP patient group. Deviation from maintenance temperature (2.0% vs. 23.7%, P<0.001) occurred significantly more frequently in the WB group. The mean absolute temperature difference from $33^{\circ}C$ during the maintenance period was $0.19^{\circ}C$ (95% confidence interval [CI], $0.17^{\circ}C$ to $0.21^{\circ}C$) in the GP group and $0.76^{\circ}C$ (95% CI, $0.71^{\circ}C$ to $0.80^{\circ}C$) in the WB group. GP significantly decreased this difference by $0.59^{\circ}C$ (95% CI, $0.44^{\circ}C$ to $0.75^{\circ}C$; P<0.001). Conclusions: The GP was superior to the WB for strict temperature control during TTM.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.270-280
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• 1987

One hundred thirteen cases of open heart surgery were performed in the department of thoracic and cardiovascular surgery of Inha General Hospital from April 1986 to April 1987. There were 73 cases of congenital heart disease and 40 cases of acquired valvular heart disease, including one redo case respectively. The technique of deep hypothermia with circulatory arrest was used widespreadly for infants and small children, and early extubation was performed as possible in the great number of all cases. There were three operative deaths [2.7%], all in congenital cases, and three follow-up deaths, all in acquired cases.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.624-627
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• 1994

Congenital coronary arteriovenous fistula is a rare cardiac defect that causes coronary arterial flow to drain into the right cardiac chambers, the pulmonary artery, the coronary sinus, or the left cardiac chambers. The most frequently involved vessel is the right coronary artery. We experienced a case that had a coronary arteriovenous fistula associated with valvular heart disease. With the cardiopulmonary bypass done under hypothermia, mitral valve replacement was accomplished and the fistulas of both proximal and distal portions of the right coronary artery were closed with 3-0 prolene. Postoperative course was uneventful.

• Proceedings of the Korean Institute of Navigation and Port Research Conference
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• 2015.10a
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• pp.141-143
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• 2015

최근 지구 온난화의 환경 변화에 극지 항로의 개척의 기회가 열렸다. 우리나라 선박은 극지항해 중 한랭손상의 경험이 매우 낮을 뿐만 아니라 열악한 선내의료 환경에서 손상 환자의 발생 시 정확한 응급처치는 어려울 수 있다. 한랭손상 중 저체온증과 동창, 동상에 대해 선내에서 정확한 환자평가와 응급처치를 위해서 국내 외의 응급처치 분야의 교육 자료를 조사하고 선내 한랭손상 응급처치의 기초 자료를 제공하기 위한 목적으로 수행하였다.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.481-482
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• 1994

Blunt cardiac trauma is typified by the injury caused by the steering wheel in automobile collision. We experienced a case of IVC rupture due to in-car TA. The operation was performed under deep hypothermia with circulatory arrest to close the ruptured site by continuous over and over suture method with 3-0 prolene.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.721-725
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• 1995

One case of surgical correction of a large aortopulmonary window in a 4 months old female is reported in detail. Clinical symptoms consisted of fatigue when feeding and recurrent upper respiratory tract infection. Under cardiopulmonary bypass with moderate hypothermia and cardioplegic arrest of the heart, the aortopulmonary window was approached through a vertical incision at the anterior wall of window itself. The defect was closed with pericardial patch using continuous suture posteriorly and sandwitch technique anteriorly. The patient was weaned from the cardiopulmoanry bypas without hemodynamic problem and postoperative course was uneventful. This surgical technique is recommandable as it provides good exposure of the defect and can be performed easily and safely.

• Journal of Chest Surgery
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• v.57 no.1
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• pp.103-107
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• 2024