• Journal of Chest Surgery
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• 제11권4호
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• pp.422-427
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• 1978

Alterations in the serum and urine potassium were studied in twenty patients who underwent open heart surgery in National Medical Center during the period from Jan.1978 to June 1978. There were twelve cases congenital heart disease and eight acquired heart disease. Rigg-Kyvsgaad mark IV roller pump and Polystan bubble oxygenator were used in all patients. Hemodilution was carried out by priming the oxygenator with Hartmann`s solution. Measurements were made of the serum electrolyte, gas analysis and twenty four hour urine electrolytes. During the bypass, the serum potassium decreased Significantly from 4.2?.47 to 3.6?. 72 mEq. per liter. [p<0.05] Fifty seven miliequivalant of potassium chloride were added during operation-urine potassium was higher in the diuretic group than in the non diuretic group. Plasma potassium level in the diuretic group was more significantly reduced than nondiuretic group. In this series large amount of urine potassium loss was noted on the day of operation, the first and second post operative day.

• Journal of Chest Surgery
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• 제22권4호
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• pp.525-547
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• 1989

Hemorrhagic tendency observed in open heart surgery patients has been attributed, among other causes, to increased fibrinolytic activity during extracorporeal circulation. But the exact mechanism of enhanced fibrinolytic activity which occurs during extracorporeal circulation is still unknown. So, we studied and compared the changes of parameters of fibrinolytic and protein C system according to time obtained from the plasma of 31 adult open heart surgery patients[EGG group] and 10 adult general thoracic surgery patients[control group], in order to confirm the hypothesis that the activated protein C system might affect the fibrinolytic system during extracorporeal circulation. In ECC group, the nature of the enhanced fibrinolytic activity that evolved during extracorporeal circulation was characterized by significant increase in fibrin degradation products[P < 0.01] and significant decrease in plasminogen and alpha2-antiplasmin[P < 0.05, P < 0.01] in spite of adequate amount of heparin administration. These changes were most pronounced in the early phase of extracorporeal circulation and normalized after termination of extracorporeal circulation. The results of these observations were the same after volume correction with the value of hematocrit. The change of volume corrected protein C ratio during extracorporeal circulation revealed similar pattern to those of plasminogen and alpha2-antiplasmin [P < 0.01], but volume corrected ratio of free protein S showed significant increase after the commencement of extracorporeal circulation then decreased after extracorporeal circulation. Although the above mentioned changes occur similarly in both bubble type oxygenator-used and membrane oxygenator-used patients groups, but the degree of decrease was more severe in membrane oxygenator-used patients group [P < 0.01] and showed much slower recovery to reach to the preextracorporeal circulation level. These results confirm the hypothesis that the enhanced fibrinolysis during extracorporeal circulation might be caused by the activation of protein C system and the activation is possibly linked to the appearance of thrombin from contact activation of blood after wide exposure to the synthetic surfaces of extracorporeal circuit. Key words: Extracorporeal circulation, Enhanced fibrinolysis, Protein C system.

• Journal of Chest Surgery
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• 제32권11호
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• pp.978-983
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• 1999

Background: Complement activation with transpulmonary leukocyte sequestration is considered a main mediator leading to ischemia-reperfusion lung(I-R) injury. We studied the role of leukocytes in the formation of I-R injury in ovine cardiopulmonary bypass(CPB) model with a membrane oxygenator. Material and Method: Five sheep were used. CPB circuitry consisted of a roller pump(American Optical Corp., Greenwich, CT, USA) and a membrane oxygenator(UNIVOX-IC, Bentley, Baxter Health Corp, Irvine, CA, USA). The CPB time was fixed at 120 min. Ten minutes after the start of CPB, total CPB was established. Thereafter a total CPB of 100 min was performed, followed by another 10 min of partial CPB. The CPB was discontinued and the animals were fully recovered. For measuring left and right atrial leukocyte counts, blood samples were taken before thoracotomy, 5 min and 109 in after the start of CPB, and 30 min and 120 min after weaning. C3a was measured before thoracotomy, 109 min after the start of CPB, and 30 min and 120 min after weaning. Plasma malondialdehyde(MDA) was checked before thoracotomy, 109 min after the start of CPB, and 30 min after weaning. One to two grams of lung tissue were taken for water content measurement before thoracotomy, 109 min after the start of CPB, and 30 min after weaning. Lung biopsy specimens were examined by light and electron microscopy. Result: Of 5 animals, 4 survived the experimental procedures. Of these, 3 animals survived on a long-term basis. No significant differences in transpulmonary gradients of leukocyte were found and no significant complement activation was expressed by C3a levels. MDA level did not show significant changes related to lung reperfusion despite an increase after the start of CPB. On both light and electron microscopic examinations, mild to moderate acute lung change was observed. Interstitial edema, leakage of erythrocytes into the alveolar space and endothelial cell swelling were the main findings. Water content of the lung showed a slight increase after the start of CPB, but there was no statistical significance. Conclusion: These findings indicate that ischemia-repersusion lung injury may not be from complement activation-leukocyte sequestration but from another source of oxygen free radicals related to CPB.

• Microbiology and Biotechnology Letters
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• 제20권4호
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• pp.445-450
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• 1992

An enhancement of the oxygen transfer rate in a 1$\ell$ bioreactor for mammalian cell culture by using a silicone rubber tubing as an oxygenator was investigated. When the silicone membrane was used to supply oxygen to the culture broth, the oxygen transfer coefficients ($k_{\iota}a$) measured in deionized-distilled water were markedly increased. Effect of surface aeration without the tubing aeration was very low under $1.0hr^{-1}$ of $k_{\iota}a$. The enhancing effects of agitation rates on $k_{\iota}a$ were much more effective than those of aeration rates. The increase of $k_{\iota}a$ with increasing tube length was observed as a result of the large surface area for oxygen supply. However, 2 m of the tube length was adequate for a 1$\ell$ vessel. The larger blade type of impeller was effective to enhance the kLa values because of its high mixing intensity. In culture medium supplemented with 5% serum, kLa values were reduced to approximately 40% probably due to the viscosity. We also obtained the normal cell concentration of $5{\times}10^6$ cells/m$\ell$ of HepG2 on microcarriers, which could be achieved in a typical bioreactor for animal cell culture.

• Journal of Chest Surgery
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• 제23권5호
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• pp.854-863
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• 1990

Since the open heart surgery was performed, various kinds of problem concerning the extracorporeal circulation[EGG] have been known. The author investigated the changes of serum potassium ion before and after ECC among the 102 patients including 63 adults and 39 children who underwent open heart surgery from April 19S6 to February 1990 in Chung-Ang University Hospital. The mean values of potassium ion before and after ECC were analyzed according to the influencing factors such as priming solution, aortic cross clamping time, the underlying disease, the type of oxygenator and the amount of cardioplegic solution. The results were as follows: l. In the aspect of congenital and acquired heart disease groups, the mean values of serum potassium ion[Mean\ulcornerS.D.] before and after ECC revealed a significant change only in the acquired heart disease group[congenital; 3.87$\pm$0.48mEq /L vs. 4.05$\pm$0.73mEq /L, P>0.05, acquired: 4.40 $\pm$0.98mEq /L vs. 4.11$\pm$0.52mEq /L, P<0.05]. Between the two groups, the changes of the mean values of serum potassium ion before and after ECC were significant[P<0.05]. But all values were within normal limits. 2. In the aspect of the aortic cross clamping time[ACCT], in the groups of less or more than 120 minutes, the mean values of serum potassium ion before and after ECC revealed no significant change[less than 120 min; 3.97+-0.64mEq /L vs. 3.99+0.67mEq /L, P>0.05, more than 120 min; 4.34+0.82mEq /L vs. 4.27+0.62mEq /L, P>0.05], and The changes of mean values of serum potassium ion between the two groups were not significant[P>0.05]. 3. In both membrane and bubble oxygenator groups, the mean values of serum potassium ion before and after ECC did not reveal a significant difference respectively [membrane; 4.74 +1.40mEq /L vs. 4.28+0.3lmEq /L, P>0.05, bubble; 4.02 +0.60mEq /L vs. 4.05 L0.68mEq/L, P>0.05], and no differences between the membrane and bubble oxygenator groups[P >0.05]. 4. In the groups of membrane and bubble oxygenator in the cases of ACCT more than 120 minutes, the mean values of serum potassium ion before and after ECC did not reveal a significant difference respectively[membrane; 4.36$\pm$0.85mEq /L vs. 4.37$\pm$0.26mEq /L, P>0.05, bubble; 4.30 $\pm$0.80mEq/L vs. 4.23$\pm$0.67mEq/L, P>0.05], and no differences between the two groups[P>0.05]. 5. In spite of increased amount of cold potassium cardioplegic solution, the mean values of serum potassium ion before ECC were similar to those of serum potassium ion after ECC[less than 20ml /kg

• Journal of Chest Surgery
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• 제29권4호
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• pp.449-453
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• 1996

A successful resection of dissecting thoracoabdominal aortic aneurysm is presented in a patient who had undergone kidney transplantation 20 months previously. Because the transplanted kidney is more sensitive to ischemia than the normal kidney, a femoro-femoral bypass with a pump oxygenator was used for perfusion of the transplanted kidney during crossclamping. During the clamping time of 1)8 minutes, kidney perfusion was maintai ed with a perfusion pressure of (19 to 31) 27mmHg and the flow was 0.53 to 0.81 L/min. 32mm sized Hemashield (22 Cm in length) was interposed. The postoperative course was uncomplicated. We believe that performing the femoro- femoral bypass with a pump oxygenator is an effective and simple method for renal and spinal protection in such operations.

• Journal of Biomedical Engineering Research
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• 제28권5호
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• pp.684-693
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• 2007

Previous trials for development of a pulsatile-Extracorporeal Life Support had some defects such as insufficient blood flow, high pressure at its membrane oxygenator and the high risk of blood cell damage. To solve those problems of previous pulsatile-ECLSs, we suggest dual pulsatile blood pump structure for the new pulsatile-ECLS. Two pulsatile pumps areconnected in a parallel manner and this new structure raises the inflow capacity and efficiency and it decreases the high blood pressure at membrane oxygenator. In in-vitro experiments, The Energy Equivalent Pressure Increment(EEP inc.) was 10%, and it showed that its pulsatilty was $5{\sim}10$ times higher than other commercial ECLS In in-vivo experiments, we had applied a new pulsatile-ECLS to 30 Kg pigs and a new pulsatile-ECLS couldsupport high blood flow and pulsatility above 2 L/min, 10% EEP inc.

• Journal of Chest Surgery
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• 제57권3호
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• pp.312-314
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• 2024

A 3-year-old boy with Glenn physiology exhibited refractory heart failure with reduced ejection fraction. To improve the patient's oxygen saturation, he underwent ventricular assist device (VAD) implantation with concomitant Fontan completion. The extracardiac conduit Fontan operation was performed with a 4-mm fenestration. For VAD implantation, Berlin Heart cannulas were positioned at the left ventricular apex and the neo-aorta. Following weaning from cardiopulmonary bypass, a temporary continuous-flow VAD, equipped with an oxygenator, was utilized for support. After a stabilization period of 1 week, the continuous-flow VAD was replaced with a durable pulsatile-flow device. Following 3 months of support, the patient underwent transplantation without complications. The completion of the Fontan procedure at the time of VAD implantation, along with the use of a temporary continuous-flow device with an oxygenator, may aid in stabilizing postoperative hemodynamics. This approach could contribute to a safe transition to a durable pulsatile VAD in patients with Glenn physiology.

• Journal of Chest Surgery
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• 제13권4호
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• pp.375-384
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• 1980

Since 1958 up to the end of October 31, 1980, 2032 cases of cardiovascular lesions were operated, including 1225 open heart surgery and 354 valve replacement patients. There were 1271 Congenital anomaly cases and 761 acquired lesions including 149 vascular lesions. Among 1~271 congenital malformations 819 cases belong to acyanotic and 452 to cyanotic group. Over all mortality was 11.1 %, consisting of 12.4% for congenital and 8.9% for acquired lesions. Mortality for 1225 open heart surgery cases was 15% and 13.8% for various 354 valve replacement cases. In most of the open heart surgery cases Shiley oxygenator was utilized and Ionescu-Shiley bovine pericardial xenograft bioprosthesis**** valves were used mainly for valve replacement.

• Journal of Chest Surgery
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• 제14권1호
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• pp.1-8
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• 1981

Alterations in serum enzymes were studied in twenty-five patients who underwent open heart surgery in N.M.C. during the period from June 1979, to Feb. 1980. There were fifteen congenital and ten acquired heart diseases. In all patients, Rygg-Kyvsgaard five head roller pump and Polystan bubble oxygenator were used and serial determination of total level of Creatine phosphokinase [CPK], Lactic dehydrogenase [LDH], Glutamic oxaloacetic transaminase [SGOT] were made preoperatively, operation day [just after aortic clamp release, 2 hrs later, 4 hrs later, 6 hrs later], and postoperative days up to 5th day. Immediate postoperative clinical courses were also evaluated. Twenty-five patients were divided into two groups: Group A[13] was cardiopulmonary bypass time more than 95 minutes and aortic clamp time more than 45 minutes. Group B[12] was cardiopulmonary bypass time less than 95 minutes and aortic clamp time less than 45 minutes. The peak levels of SGOT, LDH in Group A were more significantly elevated than Group B [P<0.05]. But peak levels of CPK were not significant between two groups. In the view of clinical evaluation, poor clinical courses were more frequent in Group A [54%] than Group B[8%].