• Journal of Chest Surgery
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• 제13권4호
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• pp.414-417
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• 1980

During the period from 1958 to July 31, 1980, there were 1764 Cardiovascular Surgical cases consisting of 1166 congenital and 598 acquired lesions in the Department of Cardiothoracic Surgery, Seoul National University Hospital. For 1764 cases 1162 open heart surgery and 602 conventional operations were performed. Among 1166, congenital lesions 266 adult cases were found. Adult cases occupy 15.1% of the total cases consisting of 24.5% of acyanotic and 19.9% of cyanotic group. Over all operative mortality of adult cases was 6.8% compared with 12.4% of total cases. Left over congenital cardiovascular anomalies in Korea can be safely operated at the present time. The oldest operated patient among adult congenital cardiovascular anomalies was 57 years old female atrial septal defect case. For 1162 cases open heart surgery bubble oxygenators were utilized except 2 membrane oxygenators. Various kinds of bubble oxygenators have been used but recently Shiley**** oxygenators are being used exclusively with satisfactory results.

• Journal of Chest Surgery
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• 제25권5호
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• pp.451-457
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• 1992

The hollow fiber oxygenator is the most advanced one for the cardiopulmoanry bypass. They have two different types of the hollow fiber systems according to the way how the blood go through the fibers. One is inside blood flow type and the other outside type. In order to find out which is better to prevent blood cell destruction, we selected 40 valve replacing patients and divided them into 2 groups prospectively. In group I [n=20], inside blood flow type[BCM-7a], CO2 excretion is more effective than group II, that is partly because of the relative large surface area of the BCM-7. In group II [n=20], outside blood flow type [MAXIMAa], they have better quality to preserve platelet count. We also studied about several other items such as SaO2, Hemoglobin and RBC, WBC, fibrinogen, LDH, plasma hemoglobin, haptoglobulin and so on. But we cannot find any differences between two groups with any statistical meanings [p<0.05]. We conclude that both of two oxygenators are excellent in the aspects of gas exchange and blood cell preservation.

• Journal of Yeungnam Medical Science
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• 제40권3호
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• pp.276-282
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• 2023

Background: Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited. Methods: We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO. Results: We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis. Conclusion: Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

• Journal of Chest Surgery
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• 제14권1호
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• pp.17-25
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• 1981

In 1980, 416 cases of open heart surgery were done in this Department with over all operative mortality of 12.3%. 1. There were 288 congenital anomalies consisting of 174 acyanotic and 114 cyanotic varieties, which showed operative mortality of 6.9% and 25.4% respectively. 2. There were 128 cases of acquired lesions, 124 valvular disease and 3 myxoma being the main lesions. 3. There were 128 cases of valve replacement with operative mortality of 7.8%. 4. The most frequently operated anomaly was VSD, 90 pure VSD and 21 cases were associated with one or 2 cardiac anomalies. Over all operative mortality in 111 VSD cases was 8.1% but in 90 pure VSD cases it was 6.7%. 5. Tetralogy of Fallot showed the highest incidence in cyanotic group with 88 cases, consisting of 68 pure and 20 with other cardiac anomalies. Over all mortality in 88 cases was 19.3% but in pure form 16.2%. 6. In 128 valve replacement cases over all mortality was 9.4%. There were 85 mitral, 11 aortic, 2 tricuspid, 21 mitral with aortic, 6 mitral with tricuspid, 3 mitral, aortic, and tricuspid valve replacement cases. For mitral valve replacement operative mortality was 5.9%. 7. Twenty-one cases of babies under 10kg body weight were operated on with over all operative mortality of 28.6%. Sixteen cases of VSD were found with operative mortality of 25%. 8. Among 128 cases of valve replacement 7 were under the age of 15 years and 12 were between 15 and 20 years old. Five pediatric cases underwent mitral valve replacement without mortality, 9 year old boy was the youngest among them. In this Department open heart surgery for infancy and complex anomalies showed still hip operative risk which should be improved in the coming years. For open heart surgery Shiley oxygenators and 2 sets of A-O de-lux 5 head roller pump were utilized exclusively. For valve replacement Ionescu-Shiley bovine pericardial xenografts were mainly used. In pediatric and rural patients Persantin with aspirin regimen was satisfactorily administered for anticoagulation after valve replacement. Routinely Coumadin was administered for one year after valve replacement* In patients who had thrombus on valve sites, chronic atrial fibrillation, and giant left atrium Persantin-Aspirin regimen was used when one year coumadin administration was discontinued.

• 멤브레인
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• 제10권1호
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• pp.47-53
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• 2000

인공폐는 실제 폐의 기능을 대행하는 장치이며, 주요 기능은 정맥혈에서 이산화탄소를 제거하고 산소를 첨가하여 동맥혈화하여 개심수술시 신체의 모든 조직에 충분한 양의 동맥혈을 공급한다. 또한 체외순환 생명보조장치(ECLS 또는 ECMO)는 심한 호흡부전증에 일반적으로 이용되지만 미래의 폐 이식에 사용될 것이다. 현재 미세다고엉 폴리프로필렌 중공사를 사용하고 있는 막형 인공 폐는 두 가지 문제가 있다. 환자의 체계적인 항응고가 필요하며, 오랜 기간의 사용은 막을 통하여 혈액 쪽에서 가스 쪽으로 혈청 누출을 일으킨다. 본 연구는 미세다공성 폴리프로필렌(PP)막에 폴리디메틸실록산(PDMS)을 적충한 PP/PDMS막을 제조하고, 폴리프로필렌 막에서 유발하는 혈청 누출을 최소화하는 기술에 대하여 연구하였다. Lee-White법에 의한 whole blood의 혈전형성 실험 후 사용된 막의 기체 투과도는 PP막에서는 크게 저하되었지만, PP/PDMS막에서는 거의 동일하게 유지되었다. 그러므로 PP막에서 유발되는 혈청 누출을 PP/PDMS막에서는 해결할 수 있었다. 또한, PP/PDMS막에서는 이산화탄소의 기체토과율이 산소보다 11.5배였다.

• Journal of Chest Surgery
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• 제19권4호
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• pp.644-662
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• 1986

Seventy cases of open heart surgery were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, Inje College, from Oct. 1985 to Oct. 1986. And the results were summarized as follows. 1. Among the 70 cases, there were 48 cases of congenital heart anomalies and 22 cases of acquired rheumatic valvular heart diseases. Age range of the congenital patients was 7 months to 31 years with the mean age of 10 years, and the acquired patients was 18 to 62 years with the mean age of 40 years. 2. The heart-lung machine used for cardiopulmonary bypass was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 5 of membrane type and 65 of bubble type. For all cases GIK [glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 3. Among the 48 congenital anomalies, there were 12 cases of ASD group, 29 of VSD group, 3 of ECD, 3 of TOF and one of PDA + MR, and to all of which the appropriate radical operations were applied. 4. Among the 22 acquired valvular diseases, there were 11 cases of mitral valve diseases [MS; 4, MSr; 3, MRs; 4], 3 cases of aortic valve diseases [AR:1, ARs;1, ASr;1], 4 cases of double valve diseases [MRs+TR; 3, MRs+ARs; 1] and 4 cases of triple valve diseases [MSr+ASr+TR; 3, MSr+Ar+TR; 1]. To all the diseased mitral and aortic valves, artificial valve replacement was applied except one [As], in which valve plication was applied. And to all the diseased tricuspid valve, DeVega annuloplasty was applied. 5. The number of replaced artificial valves were 29 in 25 patients [congenital; 3, acquire; 22]. In MVR, 6 of mechanical valves [St. Jude Medical valve; 6] and 15 of tissue valves [Carpentier-Edward valve; 11, lonescu-Shiley valve; 4] were used. In AVR, 6 of mechanical valves [St. Jude Medical valve; 6] and 2 of tissue valves [Carpentier-Edward valve; 2] were used. 6. Postoperative complications were occurred in 12 cases. Among them 11 cases were recovered with intensive cares, but one patient [VSD + Fistula of Valsalva sinus] was expired with low cardiac out put syndrome.

• Journal of Chest Surgery
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• 제21권2호
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• pp.351-365
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• 1988

During one year[1987], 110 cases of open heart surgeries were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, Inje Medical College. And the results were summarized as follows. 1. Among the 110 cases, there were 77 cases of congenital heart diseases and 33 cases of acquired heart diseases. Age range of the congenital patients was 8 months to 30 years with the mean age of 8 years, and acquired patients was 16 to 56 years with the mean age was 32 years. 2. The heart lung machine used for cardiopulmonary bypass was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 50 of membrane type and 60 of bubble type. For all cases GIK[glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 3. Among the 77 congenital anomalies, there were 67 cases of acyanotic patients[ASD: 12, VSD: 50, PS: 1, AP window: 1, Gerbode defect: 1, ECD: 2] and 10 cases of cyanotic patients[TOF: 10], and to all of which the appropriate radical operations were applied. 4. Among the 33 acquired diseases, there were one case of left atrial myxoma, one of annuloaortic ectasia, 20 of mitral valve diseases[MS: 2, MSr: 8, MR: 2, MRs: 8], 9 of double valve diseases[MRs+AR: 1, MRs+ARs: 2, MRs+TR: 1, MSr+TR: 3, MSr+ASr: 1, MSr+ARs: 1], 2 of triple valve diseases[MSr+AR+TR: 1, MSr+ASr+TR: 1]. The left atrial myxoma was removed well with right atriotomy and atrial septal approach. And to the annuloaortic ectasia, Bentall operation was applied with good result. Mitral valve replacement[MVR] was applied to 20 cases of mitral valve diseases, double valve replacement[MVR+AVR] was applied to 6 cases of double valve diseases, MVR & tricuspid annuloplasty[TVA] was applied to 3 cases of mitral 5. The number of replaced valve were 39 in 31 cases. In MVR, 5 of mechanical valves[St. Jude Medical Valve] and 26 of tissue valves[Carpentier-Edward valve] were used. In AVR, 3 of mechanical valves and 5 of tissue valves were used. 6. Postoperative complications were occurred in 23 cases, and among them 21 cases were recovered with intensive cares, but 2 cases were expired[mortality: 1.8%].

• Journal of Chest Surgery
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• 제25권7호
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• pp.693-701
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• 1992

Extracorporeal cardiopulmonary bypass[CPB] has been associated with a wide variety of hematologic derangements, including a transient deformation and hemolysis of red blood cells[RBCs], which is supposed to be due to mechanical trauma and/or metabolic alterations. Since membrane integrity is, in part, maintained by energy requiring process, inadequate function of erythrocyte glycolytic pathway, which is inevitalble during CPB, may cause depletion of high energy phosphate pool and result in hemolysis. The authors performed an investigation to assess whether administration of Fructose-l, 6-diphsphate [FDP], which has been known to enhance intracellular glycolytic activities, could counteract erythrocyte hemolytic events caused by CPB. Sixty pateints with cyanotic congenital heart diseases, who underwent open heart surgery under CPB longer than 60 minutes, were randomly divided into two groups depending on whether use of FDP[Group FDP] or not[Group Control]. The age, sex, CPB time, preoperative hemoglobin level, disease entities were all similar[Table 1], and membrane type oxygenators were used in all patients. In Group, FDP, a dose of 250mg/kg body weight of FDP was administered by intravenous dripping every 12 hours from the morning of the operation to postoperative 48 hours, To demonstrate the degree and pattern of hemolysis of erythrocyte, reticulocyte count, indirect /direct bilirubin, haptoglobin, plasma hemoglobin, lactate dehydrogenase were measured every 12 hours from the time of cessation of CPB to 48 hours and RBC morphologic study, osmotic fragility test were done every 24 hours. All parameters revealed less hemolytic in group FDP [Fig. 1~5], though the differences between two groups were not significant, except plasma hemoglobin, lactate dehydrogenase changes. A pattern of sequential changes of plasma hemoglobin, lactate deh-ydrogenase showed the highest level at the time of CPB stop and abrupt decrease in following 24 hours in both groups, and statistically significant differences were demonstrated in group FDP at least for the first 12 hours postoperatively[p<0.05]. The authors conclude that they can expect the benificial effect of FDP on the maintenance of membrane stability of RBC probably by energy enhancement during the shock status of CPB, but FDP could not completely prevent the damaging effect on RBC by cardiopulmonary bypass

• 멤브레인
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• 제33권2호
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• pp.61-69
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• 2023

최근 COVID-19로 인해 증가한 급성 폐부전 중증환자 치료를 위한 인공폐 기술의 필요성이 부각되었다. 또한, 빠르게 진행되고 있는 인구고령화는 인공장기(artificial organ, AO) 기술에 대한 높은 수요를 불가피하게 만들고 있다. 분리막은폐, 신장, 간 및 췌장을 포함한 많은 AO 기기의 핵심 부품이다. 특히 인공폐(artificial lung, AL) 기술은 지난 50년간 빠르게 발전해왔지만, 장기부전 환자의 생존율은 50% 내외로 여전히 낮은 편이다. 현재 대부분의 AL 관련문헌은 임상결과에 집중되어 있으며, AL 분리막의 개발연구는 매우 부족한 편이다. 이에 대한 원인 중 하나는 AL 기술이 생명공학을 포함하여 고분자 화학 및 분리공정 기술을 아우르는 융합적 기술개발을 요구하기 때문인 것으로 판단된다. 본 총설에서는 헬스케어산업에서 AL 분리막 기술의 역할과 기술개발이 필요한 난제들을 정리하였다. 특히, 분리막 소재의 혈액적합성, 분리성능, 모듈 디자인 및 공정 구성 측면에서 다양한 연구개발이 필요하다는 부분을 강조하고자 한다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.220-238
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• 1976

Six cases of congenital heart disease were operated on by means of cardiopulmonary bypass between December, 1975 and April, 1976. Two cases of ventricular septal defects (VSD), two cases of VSD, associated with ruptured aneurysm of sinus Valsalva, two cases of atrial septal defects (ASD) and one case of pulmonic stenosis with patent ductus arteriosus were operated. Sarns roller pumps and Bentley Temptrol oxygenators were used for extracorporeal circulation. Pump oxygenator was primed with Ringer's lactate solution, 5% dextrose in water, mannitol, and ACD blood. Flow rate ranged from 2.0 to $2.4L/M^2/min$. Bicarbonate was added to the oxygenator with estimated amount as 15 mEq/L/hr. Venous catheters were introduced into superior and inferior vena cava, and oxygenated blood was returned to the body through aortic cannula inserted into ascending aorta. Moderate hypothermia ($30^{\circ}C$) was induced by core cooling. Aorta was cross clamped for 15 minutes and released for 3 minutes, and repeated clamping when necessary. Atrial and ventricular septal efects were closed by direct sutures. Aneurysms of sinus Valsalva ruptured into the right ventricle were repaired through right ventriculotomy by d:rect closure with Dacron patch reinforcement. Cardiopulmonary bypass time varied from 66 to 209 minutes, and aorta cross clamping time ranged from 13 to 56 minutes. Postoperative bleeding was minimal except one case who needed for evacuation of substernal hematoma. Intra- and postoperative urinary output was satisfactory. Acid-base balance, partial pressure of $O_2$, electrolytes, and hematological changes during intra- and post-perfusion period remained at the acceptable ranges. No mortality was experienced.