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The Norwood Operation in Infants with Complex Congenital Heart Disease (복잡 선천성 심기형 환자에서의 Norwood 술식)

  • 박정준;김용진
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.263-269
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    • 1997
  • From April 1987 to May 1996, 13 infants underwent a Norwood operation for complex congenital heart diseases including hypoplastic left heart syndrome (n : 7), mitral stenosis with small VSD and subaortic stenosis (n : 1), mitral atresia with ventricular septal defect, coarctation of aorta, and subaortic stenosis (n = 1), interrupted aortic arch with ventricular septal defect and subaortic stenosis (n : 1), tricuspid atresia with transposition of the great arteries (n = 1), and complex double-inlet left ventricle (n : 2). All patients without hypoplastic left heart syndrome were associated wit hypoplasia of ascending aorta and arch. Age at operation ranged from 3 days to 8.7 months (mean 60.6 $\pm$ 71.6 days, median 39 days). The operative mortality( < 30 days) was 46% (6 patients). Late mortality was 15% (2 patients). All operative deaths occured during the Erst 24 hours after the operation as a result of cardiopulmonary bypass weaning failure (5 patients) and sudden hemodynamic instability postoperatively (1 patient). Late death was due to aspiration pneumonia in two cases. There are 5 long-term survivals (39%). Three of them have undergone a two-stage repair with a modified Fontan operation in two and total cavopulmonary shunt in one at 12, 17, 4.5 months after Norwood procedure with no mortality. Two patients have entered a three-stage repair strategy by undergoing a bidirectional cavopulmonary shunt at 3 and 5.5 months after initial operation with 1 operative death. The actuarial survival rate for all patients at the first-stage operation, including hospital deaths and ate death was 30.8% at 1 year. In conclusion, the operative mortality of Norwood operation was relatively high compared to other operation for major cardiac anomalies, continuing experience will lead to an improvement in result.

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Influence of Intracerebroventricular Isoproterenol on the Renal Function of the Rabbit (가토신장기능에 미치는 측뇌실내 Isoproterenol의 영향)

  • Kim, Haeng-Bae;Choi, Bong-Kyu;Kook, Young-Johng
    • The Korean Journal of Pharmacology
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    • v.18 no.1
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    • pp.1-10
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    • 1982
  • In an attempt to delineate the role of beta-adrenoceptors found to be existing in the brain tissue in the central regulation of renal function, isoproterenol, a ${\beta}-adrenergic$ agonist, was administered directly into a lateral ventricle of the rabbit brain and the changes of renal function were observed. Also, the effects of propranolol, a specific ${\beta}-adrenergic$ blocking agent, and its influence upon the isoproterenol action were studied. Isoproterenol, in doses ranging from 5 to $50\;{\mu}g/kg\;i.c.v.$, elicited antidiuresis which seemed to be related to the decreased renal hemodynamics brought about by the systemic hypotension. With moderate doaes of $15\;{\mu}g/kg$ the antidiuresis was less prominent and there was a tendency toward natriuresis, but with higher doses the natriuretic effect became less evident, overrun by the systemic hypotension. Propranolol, $500\;{\mu}g/kg\;i.c.v.$, produced little effect on the renal function, but it eliminated the antidiuretic action of $50\;{\mu}g/kg$ isoproterenol i.c.v. and reversed it to a diuretic and natriuretic one, along with increases in renal plasma flow and glomerular filtration rate. The systemic hypotension also was markedly attenuated by propranolol pretreatment. Thus, it was evident that the renal action of i.c.v. isoproterenol was not blocked by propranolol and became explicit only when the hypotensive action of isoproterenol which seems to he propranolol-sensitive is removed. Various possibilities to account for this disparity in sensitivity were discussed. It is suggested from these observations that the central ${\beta}-adrenoceptors$ might also be involved in the regulation of renal function along with ${\alpha}-adrenoceptors$, though less significant than the latter.

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Influence of Intraventricular Taurine on the Cardiovascular System of the Rabbit (측뇌실내 Taurine이 가토의 혈압 및 심박에 미치는 영향)

  • Lim, Dong-Yoon;Choi, Dong-Joon;Kim, Bong-Han
    • The Korean Journal of Pharmacology
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    • v.28 no.1
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    • pp.27-40
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    • 1992
  • The purpose of the present study is an attempt to investigate the effect of intraventricular taurine, which is a naturally occuring amino acid containing sulfur and has inhibitory action in brain, on heart rate and blood pressure in the urethane anesthetized rabbits and also to elucidate the mechanism of its cardiovascular actions. Taurine $(0.15{\sim}1.5\;mg)$ injected into the lateral ventricle of anesthetized normontensive rabbits produced a dose-related fall in arterial blood pressure and heart rate, which were marked and long-lasting along with considerable respiratory depression. However, the intravenous administration of taurine at the same dose with intraventricular injection did not induce any changes in blood pressure as well as heart rate. Depressor responses induced by taurine were inhibited significantly by pretreatment with chlorisondamine, clonidine, strychnine and bicuculline but not by atropine, vagotomy, propranolol and metoclopramide. Moreover, taurine did not affect the pressor responses of norepinephrine. Taurine-induced bradycardic effects were blocked clearly by pretreatment with chlorisondamine, propranolol, clonidine, strychnine and bicuculline, while they were not influenced by atropine, vagotomy and metoclopramide. These experimental results suggest that intraventricular taurine causes long-lasting hypotensive and bradycardic actions, and that these cardiovascular effects may be exerted through taurinergic (glycinergic) and GABAergic receptors which are associated with catecholaminergic neurons in brain.

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Outcome of neonatal palliative procedure for pulmonary atresia with ventricular septal defect or tetralogy of Fallot with severe pulmonary stenosis: experience in a single tertiary center

  • Jo, Tae Kyoung;Suh, Hyo Rim;Choi, Bo Geum;Kwon, Jung Eun;Jung, Hanna;Lee, Young Ok;Cho, Joon Yong;Kim, Yeo Hyang
    • Clinical and Experimental Pediatrics
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    • v.61 no.7
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    • pp.210-216
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    • 2018
  • Purpose: The present study aimed to evaluate progression and prognosis according to the palliation method used in neonates and early infants aged 3 months or younger who were diagnosed with pulmonary atresia with ventricular septal defect (PA VSD) or tetralogy of Fallot (TOF) with severe pulmonary stenosis (PS) in a single tertiary hospital over a period of 12 years. Methods: Twenty with PA VSD and 9 with TOF and severe PS needed initial palliation. Reintervention after initial palliation, complete repair, and progress were reviewed retrospectively. Results: Among 29 patients, 14 patients underwent right ventricle to pulmonary artery (RV-PA) connection, 11 palliative BT shunt, 2 central shunt, and 2 ductal stent insertion. Median age at the initial palliation was 13 days (1-98 days). Additional procedure for pulmonary blood flow was required in 5 patients; 4 additional BT shunt operations and 1 RV-PA connection. There were 2 early deaths among patients with RV-PA connection, one from RV failure and the other from severe infection. Finally, 25 patients (86%) had a complete repair. Median age of total correction was 12 months (range, 2-31 months). At last follow-up, 2 patients had required reintervention after total correction; 1 conduit replacement and 1 right ventricular outflow tract (RVOT) patch enlargements. Conclusion: For initial palliation of patients with PA VSD or TOF with severe PS, not only shunt operation but also RV-PA connection approach can provide an acceptable outcome. To select the most proper surgical strategy, we recommend thorough evaluation of cardiac anomalies such as RVOT and PA morphologies and consideration of the patient's condition.

Effects of Cyclobuxine D on the Derangement Induced by Ischemia and Reperfusion in the Isolated Rat Heart (Ischemia에 의해 유발된 흰쥐의 적출 심장 손상에 대한 Cyclobuxine D의 보호효과)

  • Lee, Jong-Hwoa;Moon, Chang-Kyu;Kwon, Jun-Tack;Cho, Byung-Heon;Kim, Yu-Jae;Kim, Jong-Bae;Kim, Chang-Ho;Cha, Young-Deog;Kim, Young-Suk
    • The Korean Journal of Pharmacology
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    • v.26 no.1
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    • pp.7-12
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    • 1990
  • Cyclobuxine D is a steroidal alkaloid, which was extracted from Buxus microphylla var. koreana Nakai. In our previous studies, we clarified several pharmacological actions of cyclobuxine D: an antiinflammatory action, hypotensive and bradycardiac effects, negative inotropic effects on the several smooth muscles and cardiac muscle. The present study was undertaken to elucidate possible mechanisms by protection of myocardial tells from ischemia and reperfusion induced derangement in cardiac function and metabolism by cyclobuxine D. For this purpose, the isolated rat heart was used. Rat hearts were perfused for 60 min under ischemia conditions in the presence and absence of cyclobuxine D and verapamil, and for 30 min under reperfusion conditions. Ischemia produced a marked decline in contractile force, an increase of resting tension, an immediate release of ATP metabolites and an accumulation of calcium in the left ventricle. Cyclobuxine D (100ng/ml) ameliorated the myocardial injury produced by ischemia.

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Clinical Study of CT-diagnosed Olivopontocerebellar Atrophies (Olivopontocerebellar Atrophy의 임상상과 전산화단층뇌촬영 소견)

  • Park, Mee-Yeong;O, Khyoung-Yhun;Hah, Jung-Sang;Byun, Yeung-Ju;Park, Choong-Suh
    • Journal of Yeungnam Medical Science
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    • v.5 no.2
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    • pp.87-93
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    • 1988
  • The diagnosis of OPCA could be made clinically with important aid of brain CT scanning, although the definite and conclusive diagnosis only by postmortem pathological determination. We reviewed, clinically and with brain CT examination, 12 cases of patients with OPCA who were admitted to the Yeungnam University Hospital for a recent 5 years. The result were as following. : 1. The distribution of age is from 49 to 72, mainly 50 to 60. Man is more frequent than women at the 4.5 times. 2. The interval period from Sx. onset to diagnosis is 1 year to 6 years. 3. The usual initial Sxs. were dizziness(58%), ataxia(33%), and other less frequent Sxs. were weakness of low extremities, dysarthria, headache and urinary incontinence. The clinical manifestations at the initial diagnosis were cerebellar disturbance(100%), dysarthria(83%), and increased deep tendon reflexes(58%). 4. The results of brain CT finding are like this : ${\cdot}$ the width of cerebellar sulci is more than 1mm, other 4 cases more than 2mm. ${\cdot}$ the width of cerebellar pontine cistern of the patient if usually 3 to 4mm, other 2 cases extended to the 5mm. ${\cdot}$ the A. P and lateral lengths of 4th. ventricle is 4mm and 4 to 8mm respectively. ${\cdot}$ 6 cases of whole patients show coincidentally cerebral atrophy.

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A Case of Wilms Tumor with Thrombi which Invaded the Right Ventricule (종양색전이 우심실까지 침범한 Wilms 종양 1례)

  • Uhm, Ji Hyun;Won, Sung Chul;Lyu, Chuhl Joo;Yang, Chang Hyun;Kim, Byung Soo;Hwang, Eui Ho;Park, Young Hwan;Seo, Chang Ok
    • Clinical and Experimental Pediatrics
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    • v.45 no.3
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    • pp.390-394
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    • 2002
  • Wilms tumor is the second most common malignant retroperitoneal tumor. Inferior vena cava and right atrial involvement is found in about 4-10% and 0.5-3% of cases, respectively. But, right ventricular involvement has not been reported. We experienced a case of Wilms tumor with right ventricular invasion in a 2 year-old male who presented intermittent hematuria and abdominal pain. Computed tomogram and echocardiogram showed a homogeneous mass extended to right ventricle via inferior vena cava. He received pre-operative chemotherapy followed by operation, radiation therapy including heart, and post-operative chemotherapy.

Blood Pressure Response to Raised Intracranial Pressure in Rabbits and Cats -Effect of Reserpine and 6-Hydroxydopamine- (가토(家兎) 및 묘(猫)에서의 두개내압항진(頭蓋內壓亢進)에 의한 혈압반응(血壓反應)에 관하여 -Reserpine 및 6-Hydroxydopamine의 영향(影響)-)

  • Lee, Je-Hyuk
    • The Korean Journal of Pharmacology
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    • v.13 no.2
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    • pp.19-34
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    • 1977
  • 1) The relationship of arterial blood pressure and heart rate with raised intracranial pressure induced by the epidural balloon method was investigated in anesthetized rabbits and cats. 2) In both animals marked increase of the blood pressure was observed when the intracranial pressure became close to the blood pressure. 3) In both animals marked decrease in the blood pressure and transitory marked decrease in the heart rate were observed, when the level of the intracranial pressure exceeded that of the blood pressure. 4) In reserpinized animals raised intracranial pressure produced decrease in the blood pressure and heart rate. 5) During raised intracranial pressure, the 6-hydroxydopamine-treated (by intracerebral administration) animals showed increase of the blood pressure less than control animals. 6) The depressor response to raised intracranial pressure in the reserpinized animals was reversed to the marked pressor one by the administration of norepinephrine into the lateral ventricle. 7) These results suggest that the pressor response to raised intracranial pressure is due to the increase of norepinephrine release resulted from local stimulation of the central sympathetic neurons by the raised intracranial pressure.

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Increased Expression of ATP-sensitive $K^+$ Channels Improves the Right Ventricular Tolerance to Hypoxia in Rabbit Hearts

  • Choi, Seong-Woo;Ahn, Jun-Seok;Kim, Hyoung-Kyu;Kim, Na-Ri;Choi, Tae-Hoon;Park, Sung-Woo;Ko, En-A;Park, Won-Sun;Song, Dae-Kyu;Han, Jin
    • The Korean Journal of Physiology and Pharmacology
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    • v.15 no.4
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    • pp.189-194
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    • 2011
  • ATP-sensitive $K^+$ channels ($K_{ATP}$) are major component of preventing ischemia-reperfusion injury. However, there is little information regarding to the expressional difference of $K_{ATP}$ and its function between left and right ventricles. In this study, we measured the lactate dehydrogenase release of rabbit heart slices in vitro and determined the difference of the $K_{ATP}$ expression at the both ventricles by measuring the level of $K_{ATP}$-forming Kir6.2 (OcKir6.2) mRNA using in situ hybridization. The hearts were preconditioned with 15 min hypoxia and reoxygenated for 15 min before a hypoxic period of 60 min, followed by reoxygenation for 180 min. With hypoxic preconditioning (100% $N_2$) with 15 min, left ventricles (LV) showed higher release of LDH comparing with right ventricles (RV). Adding $K_{ATP}$ blocker glibenclamide ($10{\mu}M$) prior to a hypoxic period of 60 min, hypoxic preconditioning effect of RV was more abolished than LV. With in situ hybridization, the optical density of OcKir6.2 was higher in RV. Therefore, we suggest that different $K_{ATP}$ expression between LV and RV is responsible for the different response to hypoxia and hypoxic preconditioning of rabbit hearts.

Change of Somatosensory Evoked Field Potential according to the Severity of Hydrocephalus in Kaolin-induced Hydrocephalus of Rats (수두증 흰쥐 모델에서 수두증 정도에 따른 체성 감각 유발 장전위의 변화)

  • Kim, Dong-Seok;Lee, Kwang-Soo;Park, Yong-Goo;Kim, Se-Hyuk;Choi, Joong-Uhn;Lee, Bae-Hwan;Ryou, Jae-Wook;Zhao, Chun-Zhi
    • Journal of Korean Neurosurgical Society
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    • v.29 no.1
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    • pp.5-14
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    • 2000
  • Objective : Somatosensory evoked potential(SSEP) has been known to be a good method for evaluating brain stem function, but it is not sufficient to check the fine changes of cortical functions. A fine change of cortical function can be expressed with somatosensory evoked cortical field potential(SSEFP) rather than general SSEP. To confirm the usefulness of SSEFP for evaluating the cortical function, the authors simultaneously measured SSEFP and the intracranial pressure-volume index(PVI) in kaolin-induced hydrocephalic rats. Method : Hydrocephalus was induced with injection of 0.1ml kaolin-suspended solution into the cisterna magna in 60 Sprague-Dawley rats. The authors measured PVI and SSEFP 1 week after injection of kaolin-suspended solution. To evaluate the severity of induced hydrocephalus, we measured the transverse diameter of the lateral ventricle on the coronal slice of the rat brain 0.40mm posterior to the bregma. Result : The typical wave form of SSEFP in control rats showed a negative-positive complex wave at early latency. In SSEFP of normal rats, N0 is 10.0 msec, N1 15.3 msec, P1 31.2 msec and N1-P1 amplitude $15.4{\mu}V$. As hydrocephalus progressed, the peak latency of N1 and P1 were delayed. In mild hydrocephalus, negative peak waves were split. The N1-P1 amplitude was decreased only in severe hydrocephalus. The changes of the characteristics of SSEFP according to the severity of hydrocephalus were well correlated with the changes of PVI. Shunting normalized the characteristics of SSEFP in relation to ventricular sizes and PVI in hydrocephalic rats. Conclusion : SSEFP may be useful for evaluating the impairment of cortical function in hydrocephalus.

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