• Journal of Chest Surgery
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• 제24권9호
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• pp.843-852
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• 1991

We prospectively studied postoperative cardiac arrhythmia after open heart surgery to analyze the types and incidence of cardiac arrhythmia and to predict preoperative risk factors. And also we evaluated the effectiveness of atrial and ventricular epicardial electrodes which were placed during operation Between March 1990 and August 1990, We had operated on in 211 patients and we studied 201 consecutive patients excluding 10 patients. The study group included 99 males and 102 female patients, ages 1 month to 75 years[Mean$\pm$SD=28.0$\pm$21.7 years]. Postoperatively, all patients were regularly seen by the cardiac surgeon and cardiologist, They had continuous electrocardiographic monitoring for the first 3 days, initially in the intensive care unit and were checked routine electrocardiography on the postoperative 7 days, The postoperative cardiac arrhythmia were analyzed and possible associations of this arrhythmia with various pre, intra, and postoperative factors were studied by univariate and multivariate discriminant analysis, The overall incidence of postoperative cardiac arrhythmia except relative sinus bradycardia was 36.8%;[74/201], The incidence of postoperative cardiac arrhythmia in acyanotic congenital heart disease: 19.4%, cyanotic congenital heart disease: 20.8%, cardiac arrhythmia surgery: 33.3%, acquired valvular heart disease: 60.9% and coronary artery occlusive disease: 38.9%. Both univariate and multivariate studies indicated the pre operative symptom duration[p = 0013], the duration of medication[p=0.003], presence of preoperative arrhythmia[p<0.001] and pre-operative left atrial dimension in echocardiography to be the factor promoting postoperative cardiac arrhythmia. Multivariate discriminant analysis showed that the presence of preoperative cardiac arrhythmia, bypass time and the duration of preoperative symptom duration conveyed considerable risk factor on post-operative arrhythmia. The atrial wire electrodes were used diagnostically in 36 and were used therapeutically in 89 among 201 patients. Atrial pacing were used to treat relative sinus bradycardia, accelerated junctional tachycardia or premature atrial or ventricular contractions in 51 patients. Atrioventricular sequential pacing were used in 16 patients and ventricular pacing were used in 20 patients. Hemodynamics were evaluated in 2 patients of relative sinus bradycardia before and after atrial pacing. The atrial pacing increased the amount of cardiac output to 15% more. Because of their great utility in the diagnosis and treatment of arrhythmias, we conclude that routine placement of atrial and ventricular electrodes at the time of operation is indicated regardless of the nature of the open-heart procedure.

• Journal of Chest Surgery
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• 제26권8호
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• pp.613-619
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• 1993

As developing surgical techniques and postoperative cares, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other type of pulmonary resection, but a postpneumonectomy complication is a life-threatening serious problem if it occurred. We performed one hundred twenty-five cases of pneumonectomy for treatment of various causes of pulmonary diseases in Kosin Medical College during about ten years, and we experienced 41 cases of postoperative complications in 29 patients, so we analyzed them. The most common complication is an empyema thoracis in 13 cases[10.4%], of which one case combined with bronchopleural fistula died on early postoperative day. Of them except one case, the early postoperative empyema thoracis[within 30 days] were 6 cases, and the late postoperative empyema thoracis[above 30 days] were 6 cases. The main etiologic pathogens were a staphylococcus in early postoperative empyema and a streptococcus in late postoperative empyema, but the most cases were mixed infections with pseudomonas, klebsiella, acinectobacter, and candida. The treatment of postoperative empyema thoracis were that 4 cases were treated with open drainage using chest tube, 7 cases with Clagett`s operation, and 1 case with thoracoplasty. The next common complication was a postoperative serious respiratory insufficiency in 7 cases. And the other complications were massive postoperative bleeding in 5 cases, of which 2 cases advanced to occurrence of postoperative empyema thoracis, and wound disruption in 4 cases, cardiac arrhythmia in 3 cases, contralateral pneumothorax and pneumonia in each of 2 cases, esophagopleural fistula in 1 case. The postoperative deaths were 9 cases[7.2%] of 125 cases, the causes of death were respiratory insufficiency in 6 cases, sepsis in 2 cases, and cardiac arrhythmia in 1 case.

• Journal of Chest Surgery
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• 제25권9호
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• pp.905-911
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• 1992

Automatic junctional tachycardia is one of common atrial arrhythmia after open heart surgery which is often refractory to antiarrhythmic agents. We have experienced refractory automatic junctional tachycardia in two patients. In the first, it occured after cryosurgery for AV nodal reentry tachycardia and simultaneous dissection of a posterior septal bypass tract. In the second, it complicated the postoperative course of a patient who received intracardiac repair for double outlet right ventricle, ventricular septal defect, and pulmonary stenosis. Conventional therapy with atrial pacing, verapamil, digoxin, and electrical cardioversion were ineffective. Therefore, amiodarone was administered intravenously and it controlled automatic junctional tachycardia. The need for accurate and rapid diagnosis of this condition along with results of treatment are discussed.

• Journal of Chest Surgery
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• 제47권4호
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• pp.416-419
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• 2014

Recurrent ventricular arrhythmia can be fatal and cause serious complications, particularly when it is caused immediately after an operation. Incorrect placement of a Swan-Ganz catheter can trigger life-threatening ventricular arrhythmia, but even intensive care specialists tend to miss this fact. Here, we report a case of recurrent ventricular arrhythmia causing a severe hemodynamic compromise; the arrhythmia was induced by a severely angulated Swan-Ganz catheter. The recurrent ventricular arrhythmia was not controlled by any measures including repositioning of the catheter, until the complete removal of the Swan-Ganz catheter. It is necessary to keep in mind that the position of the pulmonary artery catheter should be promptly checked if there is intractable recurrent ventricular arrhythmia.

• Journal of Chest Surgery
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• 제19권4호
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• pp.549-557
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• 1986

In cardiac patients who received multidose cold blood potassium cardioplegia for intracardiac procedures, the intraoperative and the immediate postoperative blood potassium levels were decreased at aortic cross-clamp time below 2 hours and increased at aortic cross-clamp time above 2 hours, but they were within normal limit [not hypokalemia or hyperkalemia]. In spite of increased infusion numbers and amount of cold blood potassium cardioplegia, the postoperative blood potassium levels were similar to the postoperative levels, the immediate postoperative A-V blocks were transient and the postoperative arrhythmia were rare.

• Journal of Chest Surgery
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• 제19권3호
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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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• 제25권2호
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• pp.188-193
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• 1992

Life-threatening cardiac arrhythmia is a frequent complication of open heart surgery. There are many causes of postoperative cardiac arrhythmias. Electrolyte imbalance such as hypokalemia and acidemia are major causes of ventricular arrhythmias. Infrequently, however, antiarrhythmic agents and /or hypomagnesemia induce[s] a ventricular arrhythmia such as "torsade de pointes" by increasing the repolarization time of myocardium, Recently, we have experienced two cases of "Torsade de pointes" associated with hyp-omagnesemia after replacement of mitral valve and one of whom after use of procainamide. Intravenous infusion of magnesium immediately and successfully abolished the torsade de pointes in both cases.intes in both cases.

• Clinical and Experimental Pediatrics
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• 제53권4호
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• pp.532-537
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• 2010

목 적 : 선천성 심장병의 개심술 직후에 발생하는 부정맥은 술 후 조기 사망의 주된 원인의 하나인데, 이는 심폐 우회술 및 심근보호법의 발달, 술 후 집중치료와 적절한 약물 치료로 감소시킬 수 있다. 이에 이번 연구에서는 선천성 심장병의 개심술 후 조기에 발생한 부정맥의 빈도와 종류, 그 위험 인자들을 조사하여 보았다. 방 법: 2002년 1월부터 2008년 12월까지 선천성 심장병으로 경북대학교병원에서 개심술을 시행받은 561명의 환자를 대상으로 하였다. 이들의 의무기록지를 후향적으로 조사하여 진단명, 수술방법, 수술 후 부정맥이 발생한 시기와 기간, 부정맥의 종류와 치료방법, 부정맥으로 동반된 합병증 및 사망률, 부정맥 발생 당시 혈액 전해질 수치 등을 분석하였다. 결 과 : 소아 개심술 후 조기 부정맥의 빈도는 7.3% (42/578 개심술)로 남아 23명, 여아 18명이었으며, 개심술을 시행 받은 나이는 평균 $8.7{\pm}19.8$개월, 몸무게는 평균 $5.8{\pm}4.0kg$이었다. 발생한 부정맥 종류는 방실 접합부 이소성 빈맥이 17례로 가장 많았고, 다음으로 가속 심실고유 율동이 13례였으며, 또한 대혈관 전위에 대한 동맥 전환술에서 가장 많은 빈도의 부정맥을 보였다(36.4%). 대부분의 부정맥은 치료에 반응이 좋았다. 개심술 후 조기 부정맥의 위험 인자로는 수술 당시 작은 몸무게, 어린 나이, 긴 인공 심폐기 시간과 긴 대동맥 차단 시간이었다($P$<0.05). 부정맥이 발생한 환자에서 그렇지 않은 환자에 비해 인공호흡기 사용시간과 집중치료실 입원기간이 의미있게 길었으나($P$<0.05), 사망률에서는 의미있는 차이가 없었다. 결 론 : 선천성 심장병의 개심술 후 발생하는 조기 부정맥은 주의깊은 감시와 적극적인 치료로 치명적인 결과를 줄일 수 있다. 최근 개심술의 나이가 낮아짐에 따라 술 후 조기 부정맥에 대한 더욱 세심한 관리가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제44권1호
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• pp.18-24
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• 2011

Background: We evaluated the efficacy of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in chronic atrial fibrillation associated with valvular heart disease. Material and Methods: From November 2005 to June 2009, ninety four patients have undergone valvular heart surgery with Cox-maze IV procedure. Preoperative duration of atrial fibrillation was $7.6{\pm}6.5$ years and follow-up duration was $22.7{\pm}12.3$ months. Results: There were two (2.1%) postoperative deaths not related to maze procedure. Two cerebrovascular accidents, five low cardiac output syndromes and two permanent pacemaker implantations have occurred after surgery. Preoperative ejection fraction on echocardiography was $55.3{\pm}8.1%$ and ejection fraction of postoperative six month was $54.7{\pm}6.5%$. Left atrial size of preoperative and postoperative were $61.5{\pm}11.6\;mm$ and $53.1{\pm}8.4\;mm$ at each. Freedom from atrial fibrillation rate at postoperative six-month was 80.7% and the cases of recurrence of atrial fibrillation after six months were three (3.3%). Risk factors for failure or recurrence of maze procedure were old age (p=.010) and preoperative moderate or severe tricuspid regurgitation (p=.033). Conclusion: The Cox-maze IV procedure using RFBP2 and cryothermy is quite safe and freedom from atrial fibrillation at postoperative 6 month was 82.5%. Risk factors for failure or recurrence of atrial fibrillation after Cox-maze IV were old age and preoperative over moderate tricuspid regurgitation.

• Journal of Chest Surgery
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• 제22권1호
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• pp.32-41
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• 1989

We scrutinized the 64 cases of TGA and Taussig-Bing anomaly who underwent Senning and Mustard operations from Jan. 1981 to May 1988. The ratio of male to female was 45; 19, and the age at operation varied from 2 months to 18 years [mean 18.9*32.9 months]. The in-hospital mortality was in 24 cases [37.5%] and the major causes were myocardial failure and congestive heart failure associated with arrhythmias. The risk factors for hospital mortality were complex TGA, prolonged bypass time and high postoperative CVP. In addition, mortality increased during the first year the procedure was used. Late mortality occurred in 6 cases and the major causes was congestive heart failure, and there was not any significant risk factor noted in late mortality. Early arrhythmia developed in 37.5%, all of which were transient and self limited and 7 cases of early mortality were related to the arrhythmias. Late arrhythmias developed in 8 cases, but 7 cases were transient. One case died with junctional tachycardia. Of significance the one case that died late by arrhythmia had a similar junctional tachycardia in the early postoperative period. The survival rate in all cases disregarding initial in-hospital mortality 1YSR 89.8% and 5YSR 84.3%, but because of short duration of follow up this is not significant. We concluded that early hospital mortality could be decreased by operating at an earlier age and by adjusting the appropriate operation method.