• 제목/요약/키워드: Arterial Bypass

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개심술 후 저류공기의 효과적인 제거를 위한 동정맥도관의 설치 (Arterio-Venous Line Connection for Effective Intracardiac Deairing after Open Heart Surgery)

  • 정성운;김종원;박준호
    • Journal of Chest Surgery
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    • 제36권11호
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    • pp.834-838
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    • 2003
  • 배경: 개심술 후 공기 제거는 매우 중요한 시술이다. 그러나, 심장 내의 공기 분포, 시술로 인한 합병증, 심폐바이패스의 시간 연장으로 여전히 제한적이다. 인위적으로 동정맥루를 만들어 공기를 제거하고 그 효과를 경식도초음파로 확인하였다. 대상 및 방법: 심폐바이패스 완료 직전에 압력표준변환선을 동맥과 정맥회로에 설치해둔 마개에 연결하면 동맥과 정맥사이에 작은 동정맥루가 형성된다. 심장 내의 공기정도와 공기제거시간은 경식도 초음파와 압력표준변환선으로 확인하였다. 결과: 간단한 방법으로 심폐바이패스의 시간단축, 수분 내에 공기가 제거되는 것을 경식도초음파로 확인하였다. 결론: 동맥과 정맥 사이에 작은 연결관으로 동정 맥루를 만드는 것은 매우 간단하며 개심술 후 공기 제거와 공기색전증 예방에 효과적인 방법이다.

A Comparative Study Between On-Pump and Off-Pump Coronary Artery Bypass Grafting on Clinical Outcomes

  • Moon Seong-Min;Choi Seok-Cheol
    • 대한의생명과학회지
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    • 제10권3호
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    • pp.237-243
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    • 2004
  • In recent, many cardiac centers have preferred off-pump coronary artery bypass grafting (CABG) to on-pump CABG to prevent the adverse effects of cardiopulmonary bypass. The present study was performed to prove beneficial effects of off-pump CABG. Sixty adult patients scheduled for elective CABG were randomly assigned to On-pump group (n=30) or Off-pump group (n=30). Arterial blood samples were drawn before and after the operation (Pre-OP and Post-OP, respectively) for measuring CBC, prothrombin time, activated thromboplastine time, blood gas analysis, creatine kinase-MB (CK-MB) level, and lactate dehydrogenase (LDH) level. Perioperative parameters including heparin and protamine usages, complications, blood components usages, blood loss, ventilation and ICU-staying time, and hospitalization were also evaluated. Platelet count at Post-OP was high in Off-pump group whereas CK-MB and LDH levels were low compared with On-pump group. Off-pump group had significantly lower heparin and protamine usages, lower total leukocyte count, higher hematocrit and hemoglobin levels, less blood loss, lower usages of blood components, shorter ventilation and ICU-staying time, and lower incidence of pleural effusion than On-pump group. Other variables did not significantly differ between two groups. These results showed that Off-pump CABG was a satisfactory technique with less inflammatory reaction, less cardiac damage, less postoperative complications, and less cost.

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관상동맥 우회로술에서 내유동맥 이식편의 처치방법에 따른 문합전 내유동맥 혈류량의 비교 (Preparation of the Internal Mammary Artery Graft in Coronary Artery Bypass Surgery - Comparison of Free Mammary Artery Flows -)

  • 최종범;김형곤;정진원
    • Journal of Chest Surgery
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    • 제26권2호
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    • pp.148-153
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    • 1993
  • To compare two methods of mammary pedicle graft preparations with free internal mammary artery flow, we studied 31 patients who had the left internal mammary artery harvested for coronary artery bypass grafting. The free flow was measured at the transected opening of 2 to 3 cm distal to the point of bifurcation on mean arterial pressure of 50 to 55 mmHg during cardiopulmonary bypass. Group I comprised 14 patients, whose grafts were sprayed and wrapped in sponges soaked in diluted papaverine solution (60 mg in 40 ml Hartmann's solution). An average 80 minutes after the preparations, free flow of the internal mammary artery ranged from 20 to 80 ml/min (mean 37.7 ml/min). Group II comprised 17 patients, who had internal mammary artery takedown under the exact conditions used in group I. The grafts were sprayed and wrapped in sponges soaked in the diluted papaverine solution as in group I. After an average of 28 minutes, free flow ranged from 8 to 28 ml/min (mean 17.6 ml/min). Intraluminal papaverine of the same dilution was then injected without any hydrostatic dilatation and flows increased upto 37 to 150 ml/min (mean 74.7 ml/min). This study shows that intraluminal papaverine preparation method markedly increases free mammary artery flow which is inadequate with external papaverine preparation.

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Femoro-Supragenicular Popliteal Bypass with a Bridging Stent Graft in a Diffusely Diseased Distal Target Popliteal Artery: Alternative to Below-Knee Popliteal Polytetrafluoroethylene Bypass

  • Byun, Joung Hun;Kim, Tae Gyu;Song, Yun Gyu
    • Journal of Chest Surgery
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    • 제50권5호
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    • pp.371-377
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    • 2017
  • Background: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. Methods: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral-above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. Results: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. Conclusion: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.

Extracranial-Intracranial Bypass Surgery Using a Radial Artery Interposition Graft for Cerebrovascular Diseases

  • Roh, Sung-Woo;Ahn, Jae-Sung;Sung, Han-Yoo;Jung, Young-Jin;Kwun, Byung-Duk;Kim, Chang-Jin
    • Journal of Korean Neurosurgical Society
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    • 제50권3호
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    • pp.185-190
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    • 2011
  • Objective : To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods : The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results : Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion : EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

소아에서 인공심폐기 충전액의 첨가용액으로서 사용한 crystalloid와 colloid 용액에 관한 임상연구 (A Prospective Clinical Study of Crystalloid and Colloid Solutions as Priming Additive Fluids for Cardiopulmonary bypass of the Small Children)

  • 한재진;서경필
    • Journal of Chest Surgery
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    • 제25권5호
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    • pp.469-479
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    • 1992
  • Searching for the clinical effects of colloid solutions that used to increasing the oncotic pressure of priming solutions at the cardiopulmonary bypass, 29 patients [who were diagnosised as simple VSD around 10kg of body weight and scheduled to be operated from June 1990 to December 1990 at Sejong General Hospital] were divided randomly and prospectively to the two groups: A group [15] was received 4gm% albumin as addition to the priming solutions and B Group [14] the same amount of Ringer`s lactated solution. 34 clinical parameters [Body weight, sex, age, body surface area, Qp/Qs, pulmonary arterial pressure, cardiopulmonary bypass time, anesthetic time, intraoperatively infused crystalloid and colloid amount, hemoglobin, hematocrit, serum sodium concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum protein, serum albumin concentration, urine output, central venous pressure, postoperatively infused colloid amount, immedediate post-operative peak inspiratory pressure, cardiac index, blood pressure and pump flow during cardiopulmonary bypass, inotro-pic assist, diuretics, extubation period, total drain amount, duration of ICU] were measured and compaired between the two groups. There were no differences of preoperative and operative clinical parameters. And postoper-atively, practically there were no nearly differences at the clinical outcomes between the two groups, but some parameters [cardiac index, PIP, BP and pumpflow during CPB, etc] contributed to being preferable to the Group A at certain times [P<0.05]. Conclusively, it might be thought that the priming solution of cardiopulmonary bypass added by colloid solution had some beneficial effects on the patients, especially younger and associated with complex anomaly to be expected taken longer time of cardiopulmonary bypass, and more studies about the neonatal and complex anomaly cases were needed in that points.

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대동맥질환에 대한 외과적 고찰 (Surgical Observations of Diseases of the Aorta)

  • 노준량
    • Journal of Chest Surgery
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    • 제9권2호
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    • pp.251-264
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    • 1976
  • Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

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패혈증을 동반한 감염된 대퇴동맥 가성동맥류 환자에서 폐쇄공우회술을 이용한 치험 (Obturator Bypass Surgery in a Patient with an Infected Femoral Artery Pseudoaneurysm with Sepsis)

  • 전희재;한일용;윤영철;이양행;황윤호;조광현
    • Journal of Chest Surgery
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    • 제42권1호
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    • pp.107-110
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    • 2009
  • 자가 또는 이식혈관의 감염은 반복적인 파열 및 패혈증으로 인해 환자의 생명을 위협하는 심각한 질병이다. 대퇴동맥을 포함한 서혜부 감염이 생긴 경우 가장 성공적인 치료원칙은 감염된 조직의 광범위한 절제와 동맥재건술이다. 본원에서는 뇌동정맥루, 뇌출혈환자에서 대퇴동맥을 천자하여 시행한 혈관조영술후 패혈증을 동반한 감염된 가성동맥류가 발생하여 폐쇄공우회술을 이용하여 치험하였기에 보고하는 바이다.

ECMO를 시행했던 환자에서 발생한 대퇴동맥 파열 및 감염의 치료에 있어 폐쇄공 우회술을 시행한 치험 - 1예 보고 - (Obturator Bypass Surgery in a Patient with an Infected Femoral Artery Rupture after Performed ECMO - A case report -)

  • 방정희;우종수;최필조;조광조;박권재
    • Journal of Chest Surgery
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    • 제43권3호
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    • pp.312-315
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    • 2010
  • 이식한 자가혈관이나 인조혈관의 감염은 반복적인 파열 및 폐혈증으로 환자의 생명까지도 위태롭게 하는 심각한 질병이다. 따라서 대퇴동맥을 포함한 서혜부의 감염의 치료에 있어 제일 중요한 원칙은 감염부위의 광범위한 절제와 감염부위와 격리된 동맥재건술이다. 본원에서는 ECMO를 시행했던 환자에서 발생한 대퇴동맥 파열과 주변부의 감염에 대하여, 위의 치료원칙을 제일 잘 반영할 수 있는 수술방법인 폐쇄공 우회술을 성공적으로 시행하였기에 보고하는 바이다.

관상동맥 풍선확장술 후의 개심술 (Aortocoronary bypass after PTCA)

  • 송명근
    • Journal of Chest Surgery
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    • 제26권1호
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    • pp.32-35
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    • 1993
  • During the period from September 1989 through December 1992, 118 cases of coronary arterial bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. Twenty-one of these had history of recent or remote percutaneous transluminal coronary angioplasty. They consisted of 13 males[age,58.7 + 5.4 years] and 8 females[age, 63.6 + 2.8years] with the mean age of 60.6. History of old myocardial infarction was noted in 24%[5/21] of the patients and congestive heart failure in 2 cases. The angina by type of presentation is unstable in all of the patients. The patterns of involvement of coronary arterial disease were left main disease[1], single vessel disease[5], double vessel involvement[10], and triple vessel involvement[5]. We performed 4 cases of single bypasses, 7 cases of double, 8 cases of triple, and 2 cases of quadruple bypasses. Total of 51 grafts[LIMA:12, RSVG:39] were inserted in 21 cases with average of 2.4 grafts per patient. The methods of myocardial protection were cold blood cardioplegia[8 cases], intermittent aortic occlusion[11], and continuous coronary perfusion with local coronary sharing[2]. There were no operative or late death. The only cardiac complication was 1 case of low cardiac output required IABP. The other complications were 1 case of sternal wound infection and 1 case of postoperative bleeding required reoperation. And there was no case of perioperative myocardial infarction. Postoperatively, 3 cases of recurrent angina were detected at 5, 7, and 18months after surgery. One of them was managed successfully with repeat PTCA[who was recurred 18 months postoperatively], and the other two with medication. I conclude that we can approach the patients more aggressively with PTCA, because of our acceptable operative risks.

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