• Journal of Chest Surgery
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• v.31 no.4
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• pp.353-361
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• 1998

Hypothermia is widely acknowledged as fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. The ideal way to rotect the heart is to electromechanically arrest it and perfus it with blood that is aerobic arrest. However alternative technique has been developed, based on the principles of electromechanical arrest and normothermic aerobic perfusion using continuous warm blood cardioplegia. To determine if continuous warm blood cardioplegia was beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Group included is 31 patients undergoing valvular surgery who received intermittent cold crystalloid cardioplegia. Group II included 30 patients undergoing valvular surgery who received continuous warm blood cardioplegia. Our results suggest that the heartbeat in 100% of patients treated with continuous warm blood cardioplegia converted to normal sinus rhythm spontaneously after the removal of the aortic cross-clamp, compared to only 31% of the cold cardioplegia group. After operation, pericardial closure rate was 90% area in the warm group, compared to 35% area in the cold group. 12 hours after the operation, the total amount of urine output in the warm group was greater than that in the cold group(2863${\pm}$127 ml versus 2257${\pm}$127 ml; p<0.05). After the operation, left diaphragmatic elevation developed in 55% of the cold group but in 0% of the warm group. CK-MB level in the warm group was significantly lower than cold group(2.28${\pm}$0.62 versus 9.96${\pm}$2.12; p<0.01) 1 hour after operation and CK-MB level in the warm group was significantly lower than cold group(1.80${\pm}$1.01 versus 6.00${\pm}$1.74; p<0.05) 12hours after operation. Continuous warm blood cardioplegia is at least as safe and effective as hypothermic technique in patients undergoing cardiac valvular surgery. Conceptually, this represents a new approach to the problem of maintaining myocardial preservation during cardiac operations.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.454-464
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• 2001

Background: It has been recognized that systemic inflammatory reaction and oxygen free radical formed by activated leukocyte in the procedure of cardiopulmonary bypass(CPB) frequently produce postoperative cardiac and pulmonary dysfunction. The purpose of this study was to evaluate the efficacy of leukocyte-depleting filters in the cardiopulmonary bypass circuit for patients undergoing open heart surgery(OHS). Material and method: The study involved 15 patients who underwent OHS with a Leukoguard-6 leukocyte filter placed in the arterial limbs of the bypass circuit(filter group, n=15) and 15 patients who did not have the filter(control group, n=15). We analyzed the differences between the groups in intraoperative changes of peripheral blood leukocyte and platelet counts, pre- and postbypass changes of malondialdehyde(MDA), troponin-T(TnT), 5'-nucleotidase(5'-NT) in coronary sinus blood, spontaneous recovery rate of heart beat after CPB, pre-and postoperative cardiac index(Cl) and pulmonary vascular resistance(PVR), and the amounts of postoperative bleeding and sternal wound complication. Result: During CPB, total leukocyte count of the filter group(9,567$\pm$ 842/㎣) was significantly less than that of the control group(13,573+1,167/㎣) (p<0.01), but there was no significant difference in platelet count between the groups. Postoperative levels of MDA(3.78+0.32 $\mu$mol/L vs 5.86+0.65 $\mu$mo1/L, p<0.01), TnT(0.40$\pm$0.04 ng/mL vs 0.59$\pm$0.08 ng/mL, p<0.05) and 5'-NT(3.88$\pm$0.61 U/L vs 5.80$\pm$0.90 U/L, p<0.05) were all significantly lower in the filter group than the control group. Postoperative Cl was higher in the filter group than the control group(3.26$\pm$0.18 L/$m^2$min vs 2.75$\pm$0.17 L/$m^2$/min, p=0.05). PVR of the filter group was lower than that of the control group(65.87$\pm$7.59 dyne/sec/cm$^{5}$ vs 110.80+12.22 dyne/sec/cm$^{5}$ , p<0.01). Spontaneous recovery rate of heart beat in the filter group was higher than that in the control group(12 patients vs 8 patients, p<0.05). Postoperative wound infection occurred in one case in the filter group and 4 case in the control group(p<0.05). Postoperative 24 hour blood loss of the filter group was more than that of the control group (614$\pm$107 mL vs 380+71 mL, p=0.05).

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1306-1315
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• 1996

This study reviewed the changes of hemodynamlcs and centrAl pulmonary artery dimension in 54 patients who underwent bidirectional cavopulmonary shunt(BCPS) between February 1992 and December 1995 at Seoul National University Childrell's Hospital. Ag and body weight of patients averaged 36.8 $\pm$ 37.7 months and 8.0$\pm$3.0 kg, respectively Eightynine percent of patients had more than 2 violations of the risk factors for Fontan operation, resulting overall hospital mortality of 16.6%(9154). Serial hemodynamic and anglographic examinations before and mean 16.3 $\pm$ 14.3 months iirter BCPS were compared. The arterial oxygen saturation improved from a preoperative value of 71 9: 10.1 % to 79.H $\pm$ 8. 5% (n:4), p<0.05). The values of arterial oxygen saturation were lower as the age of the patients with BCPS in place was older(n=22, R'=0.341, p=0.004). A mean pulmonary artery pressure and pulmonary vascular resistance reduced from 31 $\pm$17 to 1).5$\pm$3.SmmHg(n=22, p<0.05) and from ).2$\pm$2.1 to 2.3$\pm$2.7 unit (n=7. p>0.05), respectively. Follow-up study showed a significant Increase of absolute values of ipsilateral pulmoanry artery (n: 14, p<0.05), but no change of contralateral pulmonary artreries (n: 14. p=not significant(HSI). However, there w re significant decreases in diameters of both ipsilateral and contralateral pulmonary arteries standardized by patients' body surface areas(16.8% decrease, n: 14, p< 0. 05 for ipsilatreal, 25.1%, n=14, p<0.05 for contralateral). Pulmonary artery indices for cross sectional areas of both pulmonary arterises decreased 9.3 $\pm$ 13.8% with showing a trend of more decrease as the follow-up duration was longer, We conclude that the bidirectional cavopulmonary shunt provide an excellent.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.391-400
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• 2004

Xenotransplantation in discordant species results in immediate and irreversible hyperacute rejection due to natural antibodies, IgM. With this, antibody depletion is one option to reduce hyperacute rejection, we investigated the effect of PCPP (postcentrifugal plasmapheresis) on the depletion of natural antibodies and the effect of antibody titer on xenograft survival. Material and Method: Outbred swines (n=4) weighing 10∼20 kg were used as donors and mongrel dogs (n=4) weighing 25∼30 kg were used as recipients. Recipient canines underwent plasmapheresis (COBE TPE Laboratories, Lakewood. CO, USA). Pre-transplantation PCPP was peformed on day －2 and day 0. There were three groups (Group 0: no PCPP, Group 1: 1 pla sma-volume (PV) at day －2 and 2 PV at day 0, Group 2: 2 PV at day －2 and 2 PV at day 0). A swine heart was heterotopically transplanted into a recipient's abdominal infrarenal aorta and inferior vena cava. Mean percent depletion of total IgM and IgG in plasma of the recipients was calculated. Serum albumin, electrolyte, complement activity and coagulation factors were measured. Histopathologic examination of heart specimens was performed. Result: Mean percent depletion of IgM and IgG were 95.7$\pm$1.2%, 80.5$\pm$2.4% in the group 2 at the end of PCPP. The percent depletion of serum albumin concentration was decreased from 2.8 to 1.4 g/㎗ in the group 1 and 3.0 to 1.5 g/㎗ in the group 2. Complement hemolytic activity was decreased in group 1 and 2, but returned to normal level within 24 hours. Complement hemolytic activity was reduced to 10% of pre-PCPP level in group 2. Serum fibrinogen decreased to 20% or less and was recovered within 24 hours in group 2. Antithrombin III decreased but less than fibrinogen. PT and aPTT were sometimes but not always prolonged during plasmapheresis. After plasmapheresis, PT and aPTT were prolonged beyond the measurable level. D-dimer was not found during PCPP, but appeared and maintained from 10 minutes after trasplantation. Graft Survival time was 5 min in group 0, and it was 90$\pm$0 min in the group 2. Histopathologic changes were more typically characterized by edema, hemorrhages, thrombosis in all groups at the end of experiment. Conclusion: PCPP effectively removed immuoglobulins and reduced the titer of natural antibodies, as a result, significantly prololonged swine heart xenograft survival.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1093-1099
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• 1999

배경 : 류마티스성 승모판막 폐쇄부전증과 퇴행성 승모판막 폐쇄부전증에서 승모판막 성형술의 결과와 비교하여 류마티스성 승모판막 폐쇄부전증에서도 승모팍막성형술이 적합한 치료방법이 될 수 있는지를 알아보았다. 대상 및 방법 : 95년 1월부터 98년 12월 까지 승모판막 성형술을 시행받은 184명의 환자중에서 류마티스성 승모판막 폐쇄부전증 49례(1군)의 퇴행성 승모판막 폐쇄부전증 78례(2군)를 대상으로 하였다. 평균연령은 1군이 36.3$\pm$14.6(16-74세) 2군은 52.5$\pm$13.4(14-77)세였다 총 추적 관찰기간은 1군이 72.2인년 2군이77.2인년이었다 두군에서 수술후와 수술후 6개월 1년 및 이후 1년 단위로 주기적인 심초음파를 시행하였고 이를 통계적 검정하였다. 결과 : 두 군간에 수술전 혈류역학적인 차이를 보이지 않았고 수술전 평균 승모판막 폐쇄 부전의 정도는 1군이 3.0$\pm$0.4, 2군이 3.9$\pm$0.3였으나 수술후 추적 관찰에서 각각 0.9$\pm$0.9와 0.8$\pm$0.7정도의 양호한 판막 성형술의 결과를 보였고 승모판막 면적의 변화나 승모판막에서의 평균압력차이 등 혈류역학적인 결과에도 차이를 보이고 있지 않았다 수술조기 사망과 후기 사망은 없었으며 재수술율은 1군이 인년대비 1.4% 2군이 인년대비 2.6%였고 색전발생율은 1군이 인년대비 2.8% 2군이 1.3%였다. 심내막염발생은 1군에서만 1례있었으며 상기 결과들에서 두군간에 의미있는 차이를 보이고 있지는 않았다 결론 : 향후 장기적인 추적 관찰이 필요하나 중기 성적에서 승모판막 성형술이 류마티스성 승모판막 폐쇄 부전증에서도 효과적인 치료방법임을 알수 있었다.다 출생후 폐포막의 FN의 활성은 출생후 5일 및 7일에 최고주에 달했다. 출생직후 1-2일경에 혈관의 조직내 FN의 활성이 양성을 나타내지만 3일이후 활성이감소되었다. 폐포대식세포내 FN의 활성은 출생후 증가되었다. 폐조직내 소기관지의 FN의 활성은 출생후 완만하게 상승되었다. 큰 폐포세포는 출생 1-3일에 일정량의 FN 반응이 세포질과 미세융모내에 관찰되었다. 결론 : 이상과 같은 결과로 흰쥐의 폐포의 분화과정이 계속되는 출생후 폐에서 FN의 분비는 7일이내에 성숙흰쥐의 폐포내 반응과 비슷한 반응으르 보이며 이때 폐의 실질조직은 분화가 거의 완료되었을 것으로 사료되었고 큰 폐포세포에서도 FN이 분비되는 것으로 결론지울수 있다.X>에서 $1,332.75{\mu}g/mL$으로 최 대값을 나타내었으며, 추출시간 4.24시간 및 시료에 대한 용매비 9.71 mL/g에서 가장 높게 나타났다. 추출온도가 높고, 추출시간이 증가할수록 총 polyphenol 함량이 증가하는 경향을 나타내었다. Gallic acid 함량은 $65.84^{\circ}C$에서 $30.51{\mu}g/mL$으로 최대값을 나타내 었으며, 추출시간 1.65시간 및 시료에 대한 용매비 17.17mL/g에서 가장 높은 추출율을 보였다. Gallic acid 함량에 대한 추출조건의 영향은 추출시간과 용매비에 영향을 받는 것으로 나타났으며, 설정된 범위 내에서 온도에 대한 영향은 거의 나타나지 않는 것으로 나타났다. 실험연구가 더 필요하리라 본다. 혈액학적 변화를 유도하고 환자의 연령, 혈소판 수, 대동맥 차단 시간, 체외 순환 시간, 술후 PT 및 aPTT와 같은 다인적 상황들이 술후 출혈에 영향을 미친다는 점들을 시사하고

• Journal of Chest Surgery
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• v.31 no.5
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• pp.456-465
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• 1998

Cardiopulmonary bypass(CPB) in children is associated with the accumulation of body water after cardiac operation, as a consequence of an inflammatory capillary leak. Following work by Elliott in 1991, modified ultrafiltration(MUF) was introduced after bypass as a means of hemoconcentrating patients and a potential way of removing water from the tissues. We have carried out a prospective randomized study of 20 children undergoing open heart surgery, comparing MUF with nonfiltered controls. MUF was carried out for a mean of 18.9 minutes after completion of CPB to a hematocrit of 37.1%(mean). The mean water volulme removed by the ultrafiltration was 38.4 ml/kg and the mean blood volume retransfused from the oxygenator during the ultrafiltration was 32.1 ml/kg. Fluid balance, hemodynamics, hematocrit, osmolarity and dosage of drug treatment were recorded for 4∼12 hours postoperatively. The results were analyzed using Student t-test and ANOVA, comparing controls(n=10) to MUF(n=10). Blood loss(ml/kg/24hr) was 14.5(mean) in MUF versus 13.7 in controls; blood transfused(ml/kg/24hr) 6.6 in MUF versus 15.2 in controls; plasma transfused(ml/kg/24hr) 65.7 in MUF versus 59.6 in controls. There was rise in arterial blood pressure and hematocrit during MUF. Percent rise of systolic blood pressure was 28.8% in MUF versus 18.7% in controls(p=0.366); percent rise of diastolic blood pressure was 28.8% in MUF versus 8.5% in controls(p=0.135); and percent rise of mean blood pressure was 36.2% in MUF versus 8.2% in controls (p=0.086). Percent rise of hematocrit was 40.0% in MUF versus 23.5% in controls(p=0.002). There was no significant difference in the inotropic requirement and the postoperative serum osmolarity between two groups. The number of days on the ventilator, the duration of stay in the intensive care unit, and the postoperative hospital stay were not significantly different between the two groups.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.454-459
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• 2002

Clinical analysis of the relation between the clinical data of chest trauma patients and bone scan results was done to investigate the sensitivity and specificity of bone scan for the diagnosis of rib or chondral fracture. Material and Method： 445 patients treated due to chest trauma in Dongguk University Kyungju Hospital from July 1998 to December 2001 were studied. Age and sex distribution, causes of chest trauma, interval from the injury to arrival at hospital, final diagnosis, relationship between the chest pain and bone scan results, relationship between local tenderness and bone scan results, and sensitivity and specificity of bone scan were studied. Result： The male was 61.6% and the female was 38.4%. Age distribution was nearly even from the twenties to the sixties. The traffic accident was the most common cause of chest injury(60.4%). Most patients(76.6%) were arrived to the hospital within 6 hours after chest trauma. Rib fracture was the most common final diagnosis(46.5 %). The relationship between the duration of chest pain and tenderness and the bone scan results were significant, and the same in the relationship between the duration of local tenderness and the bone scan results, but the latter is more significant. The sensitivity of bone scan was 99.4% and the specificity was 90.4%. Conclusion： If the patient complains the chest pain continuously and the local tenderness around the chest is continued over 3 weeks, it is good to perform the bone scan. Further study including the MRI may be helpful for more evaluation in chest trauma patients.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.941-947
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• 2000

Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.25-31
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• 2007

Background: Cerebral protection is one of the most important procedures during aortic arch surgery. We can minimize neurological complications through short period of total circulatory arrest and resuming of brain perfusion. We evaluated 11 patients who underwent arch replacement using antegrade brain perfusion via right axillary artery. Material and Method: Between July 2004 and July 2006, 11 patients (male 9, female 2) underwent aortic arch replacement with antegrade brain perfusion via right axillary artery. Preoperative diagnosis was listed; 5 type A aortic dissections (5/11, 45.5%), 5 aortic aneurysms (5/11, 45,5%) and 1 type A IMH (intramural hematoma, 1/11, 9%). The mean age at the time of operation was $60.3{\pm}12.8$ years. For antegrade brain perfusion, we performed right axillary artery cannulation in all patients. Retrograde brain perfusion was used briefly during total circulatory arrest. Result: The mean total circulatory arrest time was $31.1{\pm}16.9$ minutes and the mean retrograde brain perfusion time was $21{\pm}17.8$ minutes. Mean antegrade brain perfusion time was $77.9{\pm}17.5\;(43{\sim}101)$ minutes. We had neither operative mortality nor permanent neurological complications. Conclusion: By means of antegrade brain perfusion via right axillary artery, that could lead to decrease circulatory arrest time and minimize damages to severely atheromatous arch vessels, we can expect to reduce neurological complications after aortic arch replacement. Further investigation with iarge patient populations will be required.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.90-96
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• 2007

Background: Postoperative atrial fibrillation is the most frequently arrhythmic complication associated with coronary artery bypass graft surgery. This study was designed to investigate the incidence of atrial fibrillation in patients undergoing OPCAB and on-pump CABG and to identify the risk factors associated with its development. Material and Method: 247 consecutive patients were evaluated among 306 patients who underwent the coronary artery bypass graft surgery between January, 2002 and December, 2005. 178 patients underwent OPCAB (OPCAB group) and 69 patients underwent On-pump CABG (On-pump CABG group). The incidence and the risk factors of atrial fibrillation in two groups were determined. Result: There were no significant differences between two groups with respect to the preoperative demographic characteristics of the patients. The incidences of postoperative atrial fibrillation were 25 cases (14%) in OPCAB group and 15 cases (21%) in On-pump CABG group. Age over 65 years, net positive fluid imbalance for postoperative 3 days, and chest tube bleeding for postoperative 3 days were independent predictive factors in OPCAB group. Age over 65 years and net positive fluid imbalance for postoperative 3 days were independent predictive factors in On-pump CABG group. In multivariate analysis, age over 65 years was the only risk factor of postoperative atrial fibrillation in both groups. Conclusion: Atrial fibrillation is a common complication after procedures of myocardial revascularization. There wasn't a low incidence of postoperative atrial fibrillation in OPCAB, compared with On-pump CABG. Age over 65 years was associated with postoperative atrial fibrillation irrespective of the use of cardiopulmonary bypass.