• Journal of Chest Surgery
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• v.28 no.2
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• pp.143-149
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• 1995

From January, 1983, to August, 1993, 23 cases of pericardiectomy for chronic constrictive pericarditis were carried out. The 15 male and 8 female patients ranged in age from 7 to 68 years[mean 39.1 years . All patients underwent pericardiectomy through a median sternotomy. Postoperative complications were low cardiac output[2 patients , wound infection[2 patients , pneumonia[2 patients , and unilateral phrenic nerve palsy[2 patients . One patient died of low cardiac output 1 day after pericardiectomy due to the associated transposition of great artery and hypoplastic right lung. Clinical and pathological findings showed that the cause of constrictive pericarditis was tuberculous in 8 cases[34.8% , idiopathic in 12 cases[52.2% and pyogenic in 3 cases[13.0% . Central venous pressure fell below 10cmH2O by immediate in 6 cases, fell below 10cmH2O by 24hrs in 5 cases and continued above 10cmH2O after 24hrs in 12 cases. Preoperative NYHA functional class of patients showed class I-1, classII-4, class III-14, and class IV-3. Postoperativly NYHA functional class was improved to class I-15, classII-6, class III-1.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.598-604
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• 1985

One hundred consecutive patients with the Tetralogy of Fallot underwent total correction at National Medical Center during the period 1977 to 1984, Oct. During this study period, we adopted more active policy towards reconstruction of right ventricular outflow tract across pulmonary valve. The mortality was 48% for patients less than 15 kg and 19% in patients above 15kg. Initially Bretschneider`s solution was used as cardioplegia, which was replaced by St. Thomas` solution since 1983, Jan. After then overall mortality dropped to 9% compared to 45% of initial learning period. Heart block occurred In 11 patients, 10 of whom died of combined low cardiac output syndrome. Pure low cardiac output syndrome was noted in 18 patients, most of whom responded to medical measures well except 4 patients. Recently sepsis of Serratia marcescence, which occurred explosively during several months to open heart surgery patients, attacked 3 tetralogy patients resulting in 2 hospital deaths. Our experience has shown that body weight, choice of cardioplegia and accumulation of experience as well as advance of operative and postoperative techniques are still important factors affecting survival rate at initial learning period.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1192-1202
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• 1992

Postoperative cardiac outputs and other hernoaynamic values were serially measured in fifteen patients of cyanotic congenital heart disease, after use of blood cardioplegic solution. Cardiac indices showed no change untill eight postoparative hours, then it began to decline to reach as low as 3.22$\pm$0.7L/min/m2 at 12 hours. After then gradual increse occ-ured to recover upto immediate postoperative value at 20 hours. Sharp decrese of heart rate and increse of systemic vascular resistance during 8~16 hours and steady increase of stroke indices during the whole study periods were observed. These observations suggested that the myocardium recovered gradually after open heart surgery, and that the decrease of cardiac indices during 8~16 hours could be a result of decrease of heart rates and increase of afterload. The changes of cardiac indices correlated with the changes of heart rate, postoperative time and mixed venous oxygen saturation [p<0.05]. No other hemodynamic values found to be in statistically significant correlation with the changes of cardiac indices. Left ventricular dysfunction seemed to occur more frequently during 8~12 hours, but it was not statistically significant. [p=0.73] In conclusion, great care must be taken during 2~3 days after the operation of cyanotic congenital heart disease, not to fall into a low cardiac output state, by maintaing adequate heart rates and reducing afterload especially when the systemic vascular resistance increases.

• Journal of Chest Surgery
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• v.45 no.3
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• pp.161-165
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• 2012

Background: Median sternotomy can weaken the upper abdominal wall and result in subxiphoid incisional hernia. We evaluated risk factors associated with the development of subxiphoid incisional hernias after coronary artery bypass grafting (CABG). Materials and Methods: Of 1,656 isolated CABGs performed between January 2001 and July 2010, 1,599 patients who were completely followed up were analyzed. The mean follow-up duration was $49.5{\pm}34.3$ months. Subxiphoid incisional hernia requiring surgical repair developed in 13 patients (0.8%). The hernia was diagnosed $16.3{\pm}10.3$ months postoperatively, and hernia repair was performed $25.0{\pm}26.1$ months after the initial operation. Risk factors associated with the development of subxiphoid incisional hernia were analyzed with the Cox proportional hazard model. Results: Five-year freedom from the hernia was 99.0%. Univariate analysis revealed that female sex (p=0.019), height (p=0.019), body surface area (p=0.046), redo operation (p=0.012), off-pump CABG (p=0.049), a postoperative wound problem (p=0.041), postoperative bleeding (p=0.046), and low cardiac output syndrome (p<0.001) were risk factors for the development of the hernia. Multivariable analysis showed that female sex (p=0.01) and low cardiac output syndrome (p<0.001) were associated with subxiphoid hernia formation. Conclusion: Female sex and postoperative low cardiac output syndrome were risk factors of subxiphoid hernia. Therefore, special attention is needed for patients with high-risk factors.

• Journal of Chest Surgery
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• v.15 no.2
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• pp.218-221
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• 1982

Delayed cardiac tamponade in an uncommon and frequently fatal complication after open-heart surgery. We had been experienced two cases of delayed cardiac tamponade as a complication of open-heart surgery and treated successfully by reinsertion of pericardial drain through subxiphoid route. First case was 60 years old female patient and underwent MVR under impression of MSi + Ti Second case was 19 years old male patient and underwent total correction of T.O.F.with Blalock shunt [Lt]. Both cases had Initial symptoms, which were epigastric pain, chest tightness, dropped blood pressure, and increased pulse rate and respiratory rate, mimic as low cardiac output syndrome after open-heart surgery. Roentgenogram of the chest showed a rapid increased cardiothoracic ratio. It is important to realize the presence of late cardiac tamponade for proper diagnosis of complication after open-heart surgery.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.398-406
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• 1985

103 cases of open heart surgery were performed in the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital in 1984. There were 90 congenital cardiac anomaly and 13 acquired heart diseases. Out of 90 congenital cardiac anomaly, 63 cases of acyanotic group and 27 cases of cyanotic group were noted. In 63 cases of acyanotic group, 11 ASD, 45 VSD and 7 other acyanotic anomaly were included. In 27 cases of cyanotic group, 4 Trilogy of Fallot, 15 TOF, 3 Pentalogy of Gasul and 5 other cyanotic anomaly were found. Among 13 cases of acquired heart diseases, 12 valvular lesions and 1 atrial myxoma were noted. Two open mitral commissurotomy and ten valve replacements were performed for 12 valve lesions. The frequent complications were acute respiratory insufficiency and low cardiac output syndrome occurred in 5 cases. The perioperative mortality was 4.8% in acyanotic congenital cardiac anomaly, 7.4% in cyanotic congenital cardiac anomaly, and 0% in acquired heart diseases. Overall mortality for 103 cases of open heart surgery was 4.9%.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• Clinical and Experimental Pediatrics
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• v.52 no.7
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• pp.752-755
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• 2009

It is well known that hemodynamic load is one of the most important determinants of cardiac structure and function. Circadian variations in blood pressure (BP) are usually accompanied by consensual changes in peripheral resistance and/or cardiac output. In recent years, reduction in circadian variations in BP and, in particular, loss of nocturnal decline of BP were observed in hypertensive patients with left ventricular hypertrophy (LVH). The patients with only a slight or no loss of nocturnal decline of BP were considered "non-dippers". Regression of LVH was observed after prolonged antihypertensive therapy. Restoration of the circadian rhythm of BP was also observed. However, the classification of patients into "dippers" and "non-dippers" is arbitrary and poorly standardized and repeatable, and in the recent studies, most hypertensive patients with LVH were "dippers". Therefore, we should be particularly cautious about the conclusions drawn using this index. On the other hand, reduced activity of low-pressure cardiopulmonary baroreceptors and impaired day-to-night modulation of autonomic nervous system activity were observed in patients with only LVH. Therefore, alterations in cardiac structure may impair BP modulation. On the other hand, the reverse can also be trueprimary alterations in BP modulation, through a persistently elevated afterload, can increase cardiac mass. Thus, the interrelationship between cardiac structure and BP modulation is complex. Hence, new and more specific methods of evaluating circadian changes in BP are needed to better clarify the abovementioned reciprocal influences.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.34-39
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• 1997

Between May, 1994 and December, 1995, 122 adult cardiac surgical procedures requiring cardiopulmonary bypa s were performed at Kang Dong Sacred Heart Hospital, including 18 cases(14.8%) that were associated with preoperative(n:9), intraoperative(n=7), postoperative(n:2) use of an IABP (intra-aortic balloon pump). The reasons for IABP were low cardiac output and PTCA(percutaneous transluminal coronary angioplasty) failure in preoperative period, CPB(cardiopulmonary bypass) weaning difficulty in intraoperative period, and intractable arrhythmia in postoperative period. The mean age of the IABP patients was 61.8 $\pm$ 6.9 years(range, 39 to 75years). The overall hospital mortalities in patients with preoperative and intraoperative IABP insertion were 3 and 42.9% respectively. Two patients with postoperative IABP insertion are alive. The rate of IABP weaning is 66.7% for preoperative group, 85.7% for intraoperative group and 100% for postoperative group . In conclusion, if there were no irreversible myocardial damages, IABP could be used safely and emergently at any perioperative period for hemo ynamic stability, CPB weaning, and to overcome low cardiac output syndrome.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.676-682
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• 1990

From August, 1978, to August, 1989, 22 patients underwent pericardiectomy for chronic constrictive pericarditis on the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. There were 14 male and 6 female patients ranging from 11 years to 70 years old[mean age, 44. 1 years]. All patients underwent radical pericardiectomy through a median sternotomy. There was 1 postoperative death[4.s%]. This patient died of low cardiac output 7 days after pericardiectomy. Postoperative complications were hemothorax[2 patients], low cardiac output[2 patients], generalized seizure[1 patient], wound infection[1 patient] and pneumonia[1 patient]. Clinical and pathological findings showed tuberculous origin in 12 patients[54.6%], unknown etiology in 8 patients[36.4%] pyogenic pericarditis in 2 patients[9.1%]. Three hemodynamic responses to pericardiectomy were observed: [1] rapid response, where central venous pressure[CUP] fell below 10 cmH2O by 24 hours in 6 patients; [2] delayed response. Where CVP fell below 10 cmH2O by 48 hours in 12 patients; and [3] no response of CVP in 4 patients. Follow-up ranged from 6 to 62 months with an average of 35.3 months. Postoperative Functional Class was obtained for 21 surviving patients and showed 18 patients[81.8%] to be New York Heart Association functional class I or II.