• Journal of Chest Surgery
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• v.21 no.6
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• pp.1040-1051
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• 1988

From 1959 through Jun. 1988, 2094 cases of various Cardiovascular diseases were operated, which were consisted of 1215 open heart surgery under extra-corporeal circulation or hypothermia and 879 conventional Cardiovascular Surgery at Department of Thoracic & Cardiovascular Surgery in National Medical Center. There were 1111 congenital heart anomalies and 983 acquired cardiovascular diseases. Among 1111 congenital cases, acyanotic cases were 748 and cyanotic cases were 363. In acquired heart cases, valvular heart diseases [702 cases] were the most frequent and a small No. of cardiac tumor and coronary artery diseases were included. Overall operative mortality was 9.3%, consisting of 4.6% for acyanotic anomaly, 20.6% for cyanotic anomaly and 8.7% for acquired heart diseases. In open heart surgery, overall mortality was 11.6% and 6% in conventional cardiovascular surgery.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.363-373
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• 1986

Even though the pathogenesis is still controversial, electrocardiographic changes after congenital open heart surgery depend on various etiologic factors. Author reviewed 261 cases of congenital open heart surgery patient experienced in the Dept. of Thoracic & Cardiovascular Surgery, Pusan National University Hospital, since July, 1981 to Sept., 1985. The results were summarized as followed: 1. The age distribution was from 3 to 29 years old with mean age 10.8 years. And the most frequent congenital heart defect we had done operation was VSD. 2. Preoperatively, the most frequent ECG finding was abnormal QRS complex and postoperatively the most frequent ECG change was arrhythmia. 3. The most frequent arrhythmia before operation was intraventricular conduction disturbance. 4. Right ventriculotomy incision produced the more frequent abnormal ECG changes postoperatively than right atriotomy or pulmonary arteriotomy. 5. According to the operative technique, outflow patch graft of TOF repair produced the highest frequency of ECG changes after operation, and in comparing simple and patch closure of VSD, the latter was higher frequency of ECG changes, in valvotomy and infundibulectomy of PS, the latter was higher too. 6. The common symptom and signs in abnormally ECG changed patients after operation were palpitation, dyspnea, congestive heart failure and murmur in this order., 7. The longer the time of CPB, the more number of abnormally ECG changed patients had been developed after operation. 8. The most of postoperative ECG changed patients recovered spontaneously or with only medication and were clinically insignificant. And the rest other minor group recovered with temporary pacing. Eight cases out of 261 [3.1%], these with abnormal QRS complex and arrhythmia couldn`t recover in spite of every effort and eventually succumbed.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.274-280
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• 1977

As a major cause for postoperative hypoxia, the importance of increased physiological shunting is increasingly emphasized. This study is a review and analysis of postoperative physiological shunting following open heart surgery with the aid of extracorporeal circulation. Sixteen patients were selected from among 21 patients who underwent elective open heart surgery at the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, from December, 1975 to September, 1977. The results were as follows: 1. The degree of postoperative physiological shunt was progressively increased from 18.8% mean value one hour after surgery to 22.7% mean value, reaching a peak on the second postoperative days. 2. For up to one week, large physiological shunt[15%] was persisted in one patient. 3. Comparing long[more than 90 minutes] with short[less than 90 minutes] perfusion time group using pump oxygenator, it was found that the physiological shunt increased about 3% in the long as compared with the short perfusion time group. 4. The mean blood pressure was 70-80 mmHg without a remarkable causal relationship between physiological shunt and mean blood pressure. 5. On elevated $PaO_2$[>200 torr], the physiological shunt was decreased less than 20% of cardiac output, but on diminished $PaO_2$[102 torr] after two days, it was 22.7% of cardiac output. From above results, a contrary causal relationship between $PaO_2$ and physiological shunt was obtained. Co Reviewing chest X-rays postperfusion, it was demonstrated that no remarkable causal relationship between roentgen-ray evidence and physiological shunt could be obtained.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.482-487
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• 1990

The leading cause of death in patients with chronic renal failure is cardiovascular diseases. The problems relevant to cardiac surgery in these patients are occurring more frequently with a growing number of patients at risk. Among these, important risk factors related to uremic patients undergone open heart surgery are fluid and electrolytes imbalance, coagulopathy, increased susceptibility to infection. Since 1968 when Lansing and colleagues reported the first successful aortic valve replacement in patients with chronic renal failure and infective endocarditis, there have been increasing reports of the cardiopulmonary bypass surgery in chronic renal failure patients with acceptable perioperative morbidity and mortality From Jan. 1988 to Nov. 1989 we have experienced four uremic patients necessitating open heart surgery ; one needing a coronary artery bypass graft and the other 3 needed cardiac valve replacement. Based on our observations we would like to suggest followings 1]Intraoperative ultrahemofiltration during C-P bypass thought to be an excellent means for the control of hyperkalemia and fluid balance. 2] The immediate postoperative application of peritoneal dialysis instead of hemodialysis is beneficial in controlling fluid and electrolyte imbalance. 3]The cause of one early postoperative death was not associated to renal failure, rather it was the result of an accidental rupture in the right ventricular wall.

• Journal of Yeungnam Medical Science
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• v.5 no.2
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• pp.183-187
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• 1988

Although halothane is one of the most widely used inhalation anesthetics, it may cause postanesthetic complications such as halothane hepatitis. Halothane hepatitis has been reported intermittentely with variable incidence. However it is not easy to prove halothane as a causative agent, because there are many factors causing postoperative hepatic dysfunction. The author had a case of acute hepatitis developing after open heart surgery used halothane. 37-year-old female underwent an open heart surgery for ASD repair under halothane anesthesia On the 14th postoperative day, she developed high fever of 38 C. Liver function tests showed marked elevation of SGOT, SGPT, and bilirubin, followed by gross jaundice. HB, Ag(-) and HB, Ab(+) were reported. She died of acute respiratory, hepatic, and renal failure on the 19th postoperative day Possible causes of the hepatitis were considered halothane, blood transfusion, and drugs.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.24-35
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• 1985

Between January 1980 and July 1984, 321 cases of open heart surgery for infants or small children under 10Kg of body weight were performed, which occupied the great part of total open heart surgery done in the same period. The mean age was 16.58.7 months [ranging from 2 days to 51 months], and the mean body weight was 7.8a1.8Kg [from 2.8 to 10Kg] which was below the third percentile compared with the mean age. The technique of deep hypothermia with total circulatory arrest, which contributed to great improvement in operative condition, was used increasingly and widespreadly in this period. For each anomaly, the number of patients and operative deaths were as follows: VSD, 11 of 184 [6.0%]; TOF, 8 of 47 [17.8%]; TGA, 13 of 30 [43.3%]; ASD, none of 9; TAPVR, 1 of 8 [12.7%]; C-ECD, 3 of 6 [50%]; Tricuspid Atresia, 4 of 5 [80%]; Pulmonary Atresia, 2 of 4 [50%]; Congenital Mitral Anomaly, 1 of 3 [33.3%]; P-ECD, none of 3

• Journal of Chest Surgery
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• v.12 no.3
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• pp.233-239
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• 1979

Ventricular septal defect associated with patent ductus arteriosus is well known cardiac anomaly that can be treated successfully by operation. This anomaly is found at low frequency. Seven cases of the combined malformation were operated on during the period from 1959 to 1978 in the Department of Thoracic Surgery, Seoul National University Hospital. Right heart catheterization and retrograde aortogram can diagnose the disease correctly. Staged operation in one case and one-stage operation in 5 patients were done. In all cases of the open heart surgery the closure of the ductus was done by transpulmonary suture of the PDA opening. Among 6 patients of the open heart surgery 2 operative death [33.3%] and one late death [total 50%] were noted. Four type II and one type I and one Type IV VSDs were found. In one case the anomaly was accompanied with aortic insufficiency by herniation of the right coronary cusp through Type I VSD.

• Journal of Chest Surgery
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• v.22 no.3
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• pp.402-415
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• 1989

Extracorporeal circulation leads to functional disorder and structural damage of organs, especially hematologic and pulmonary system, mainly by sequestration of neutrophils and deposition of macrophages at lung. Then, proteases are secreted, which insult vascular basement membrane of pulmonary capillary and alveolar septa of the lung. Among these, the most important protease at lung is elastase, because major component of lung is elastin. For prevention of lung injury, inactivators or antidotes to elastase should be necessary and Alpha 1-Proteinase Inhibitor is the elastase inactivator. Clinical experimental study was carried out to investigate the immediate postoperative change of serum Alpha 1-PI level following cardiopulmonary bypass for 20 heart cases [congenital 16 cases, acquired 4 cases] and 10 control [subtotal gastrectomy] cases. Also preliminary study was performed for 31 cases of open heart patients. The results were as follows: l. Immediate postoperative serum levels of Alpha 1-PI was significantly decreased at open heart surgery group [P< 0.005], but not decreased at control group. 2. There were no significant difference in change of serum Alpha 1-PI level between and membrane and bubble oxygenator group.Z 3. There were no significant difference in changes of serum Alpha 1-PI level between CHD and AHD. Alpha 1-PI is consumed at lung during cardiopulmonary bypass and increase after operation compensatedly and protect multiple organic damage especially lung. Therefore, Alpha 1-PI can be indicator for evaluation of prevention and treatment of pump-lung syndrome.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.460-471
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• 1994

Between Feb. 1990 and Aug. 1993, 180 cases of the open heart surgery were performed under cardiopulmonary bypass in the Department of Thoracic & Cardiovascular surgery, Gil General Hospital. There were 83 cases with congenital heart diseases [CHD] and 97 cases with acquired heart diseases [AHD]. The CHD consisted of 78 acyanotic[mortality: 3.8 %] and 5 cyanotic cases with heart anomaly[mortality:l case]. The AHD were 97 cases, which contained 53 valvular, 27 ischemic heart diseases, 10 aortic diseases, 5 cases with myxoma, 1 case with post-infarct VSD, and 1 case with removal of infected pacing wire in right ventricle. In the 53 valvular heart diseases, there were 45 cases with valve replacement[MVR 27, AVR 9,MVR + AVR 9] and 8 cases with valvuloplasty. The number of the implanted prosthetic valves were 53. In MVR, 25 St. Jude, 6 Sorin, 3 Carpentier-Edward and 2 Intact medical valves were used. In aortic position, 13 St. Jude, 3 Sorin and 1 Intact medical valves were applied. The operative mortality was 5.6 % [3/53]. The annuloplasty applying artificial ring was performed in 17 patients[4 cases associated with MVR] and the number of the implanted ring was 19, which included 14 Duran ring[10 mitral, 4 tricuspid] and 5 Carpentier ring [3 mitral, 22 tricuspid]. In the 27 ischemic heart diseases, there were 9 cases with left main coronary artery lesions, 7 one vessel, 5 two vessels, and 6 three vessels. Average number of anastomosis was 2.8 per patient. The operative mortality was 14.3 % [4/27]. Among the 10 patients with aortic diseases, 7 cases were aortic dissection[type A: 5, type B: 2] and 3 cases were descending thoracic aortic aneurysm. The operative morality occurred in 3 cases. The overall mortality and the operative mortality of congenital and acquired heart disease was 7.8 %, 4.8% and 10.4%, respectively.

• Journal of Chest Surgery
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• v.14 no.4
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• pp.403-407
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• 1981

Thirty-five cases of heart disease were operated on with cardiopulmonary bypass between November, 1980 and September, 1981. 1. There were 8 cases of congenital anomaly and 17 cases of acquired heart diseases. 2. There were 7 male and ] 8 female patients, with a mean age of 21 .9 years [range 7 to 42 years]. 3. There were 2 cases of valve replacement cases with operative mortality of 8.3%. 4. Operative mortality for congenital anomaly was ~ 6.7% and 5.9% for acquired heart diseases. 5. Over all operative mortality was 11.4%.