• Journal of Chest Surgery
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• v.41 no.5
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• pp.633-635
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• 2008

Cardiac rupture after blunt chest trauma is a relatively uncommon diagnosis, and it is associated with a very high mortality rate. A 41-years-old man crashed his car into a guardrail and he was then transported to hospital. Although unstable vital signs are the most common symptoms of cardiac injury, this patient had stable vital signs. The chest CT scan showed pericardial effusion, and echocardiography did not clearly reveal cardiac tamponade, but the right atrium was slightly collapsed. Cardiac injury was suspected, and surgery was commenced for obtaining the diagnosis and treatment. A 2cm laceration at the junction of the left atrium and the lefl inferior pulmonary vein was discovered and this was repaired with $4{\sim}0$ Polypropylne monofilament sutures. We report here on the successful management of a patient with left atrial rupture following blunt chest trauma.

• Journal of Yeungnam Medical Science
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• v.23 no.1
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• pp.19-25
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• 2006

Background: There is limited data on comparisons between the effect of histidin-etryptophan-ketoglutarate (HTK) solution and cold blood cardioplegic (CBC) solution in pediatric cardiac surgery. The purpose of this study was to compare the myocardial protective effect of HTK solution and CBC solution in patients undergoing pediatric cardiac surgery. Materials and Methods: We selected 49 patients with ventricular septal defect and atrial septal defect. HTK solution was used in 21 patients and CBC solution was used in 28 patents. HTK solution was given as a single dose, whereas CBC solution was used in the usual multi-dose method. The incidence of EKG change and concentration of Troponin T and CK-MB were compared for the evaluation of myocardial damage. Results: There were no significant differences in the incidence of ST, T segment change by EKG and serial cardiac enzyme levels between two groups. Conclusion: These results suggested that the myocardial protective effect of HTK solution was similar to CBC solution in simple pediatric cardiac surgery.

• Journal of Chest Surgery
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• v.47 no.3
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• pp.249-254
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• 2014

Background: Delirium after cardiac surgery is associated with serious long-term negative outcomes and high costs. The aim of this study is to evaluate neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine, compared with the current postoperative sedative protocol (remifentanil) in patients undergoing open heart surgery with cardiopulmonary bypass (CPB). Methods: One hundred and forty two eligible patients who underwent cardiac surgery on CPB between April 2012 and March 2013 were randomly divided into two groups. Patients received either dexmedetomidine (range, 0.2 to $0.8\;{\mu}g/kg/hr$; n=67) or remifentanil (range, 1,000 to $2,500\;{\mu}g/hr$, n=75). The primary end point was the prevalence of delirium estimated daily via the confusion assessment method for intensive care. Results: When the delirium incidence was compared with the dexmedetomidine group (6 of 67 patients, 8.96%) and the remifentanil group (17 of 75 patients, 22.67%) it was found to be significantly less in the dexmedetomidine group (p<0.05). There were no statistically significant differences between two groups in the extubation time, ICU stay, total hospital stay, and other postoperative complications including hemodynamic side effects. Conclusion: This preliminary study suggests that dexmedetomidine as a postoperative sedative agent is associated with significantly lower rates of delirium after cardiac surgery.

• Journal of Chest Surgery
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• v.44 no.1
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• pp.9-17
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• 2011

Background: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. Material and Methods: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age $54.4{\pm}15.1$ years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of $DLP^{(R)}$ (Medtronic Inc, Minneapolis, MN) or $RMI^{(R)}$ (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system ($EBS^{(R)}$; Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of $2.4{\sim}3.0\;L/min/m^2$ and an activated clotting time (ACT) of around 180 seconds. Results: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. Conclusion: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.

• Biomedical Science Letters
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• v.7 no.2
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• pp.91-98
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• 2001

The present study was prospectively designed to assess the clinical effect of leukocyte-depleted blood cardioplegic solution (BCS) on myocardium during cardiac surgery with cardiopulmonary bypass (CPB). 30 adult patients scheduled for elective cardiac surgery were divided into control group (n＝15), which infused routine BCS, and leukocyte-depleted (LD) group (n＝15), which infused leukocyte-depleted BCS. Total and differential leukocyte counts in BCS, malondialdehyde (MDA) and troponin-T (TnT) concentrations in coronary sinus blood, and cardiac index (CI) were measured at preoperative and postoperative period. The BCS in LD group had less total leukocyte counts with neutropenia than that in control group (P＜0.01). MDA (3.70$\pm$0.35 vs 5.90$\pm$0.57 $\mu$mol/L, p<0.05) and TnT (0.42$\pm$0.03 vs 0.60$\pm$0.09 ng/mL, p<0.05) were significantly low in LD group compared with control group, while LD group had higher CI (3.28$\pm$0.16 L/min/$m^2$, p<0.05) than control group (2.69$\pm$0.18 L/min/$m^2$). These results suggest that leukocyte-depleted blood cardioplegic solution has a better myocardial protective effect with less generations of oxygen free radicals and ischemia/reperfusion injury.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.1-6
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• 2000

Background: TNF-$\alpha$ plays a major role in producing left ventricular dysfunction cardio-myopathy pulmonary edema and inhibits the compensatory mechanism of congestive heart failure. IL-6 is an acute reactant of immune reaction and also known to control immune reaction but its function in the myocyte was not clearly investigated. Author's performed this experiment to investigate the contents of TNF-$\alpha$ and IL-6 on the assumption that TNF-$\alpha$ and IL-6 may reside in nonfailing heart that has gone cardiac surgery and play some role in cardiac function. Material and Method : Right auricular tissues were sampled from 12 patients who had undergone total corrective surgery for both congenital and acquired heart diseases from January 1998 to June 1998 in Kosin Universcfy Gospel hospital. The quantitive analysis of TNF-$\alpha$ and IL-6 were assessed by ELISA method in right auricular tissue. Hemodynamic values about the pressure of ventricle atrium aorta pulmonary artery and cardiac index pulmonary and systemic vascular resistance and cardiac output were measured by echocardiography and cardiac catheterization and biochemical analyses of LDH & AST were done before operation. statistical analysis was by Paired Student t-test. Patients were divided into children(under 15 years olds) and adults groups and the data was compared beween two groups. Conclusion: Mild pulmonary hypertension and increased pulmonary vascular resistance were existed in both group. The contents of tissue TNF-$\alpha$ IL-6 in each group were independent of each data.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.106-115
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• 1989

Clinical results with the xenograft cardiac valves were reviewed for 212 patients who underwent heart valve replacement from January 1981 to December 1987. One hundred and twenty-four Carpentier-Edwards k 88 Ionescu Shiley valves were used. Overall operative mortality was 11 out of 212[5.1%]: 5 out of 153[3.39o] for mitral valve replacement [MVR], 2 out of 34[5.9%] for aortic valve replacement [AVR], 0 out of 4[0%] for Tricuspid valve replacement [TVR], and 4 out of 21[19.1%] for double valve replacement [DVR;MVR+ AVR]. Two hundred and one operative survivors were followed up for a total of 824.3 patient-years [a mean 3.9*1.8 yrs], and the follow up was 78.1%. The linealized complication rates were 0.1% emboli / patient-year, 1.0% endocarditis/ patient-year and 2.2% overall valve failure / patient-year. A linealized rate of primary tissue failure was 0.7*/o/ patient-year. The actuarial survival rates including the operative mortality were 92*2.8% at 4 years and 85*4.3% at 7 years after surgery using the Xenograft cardiac valves. Probabilities of freedom from thromboembolism and overall valve failure were 73*11.0% and 69*2.4% at 7 years after surgery using the Xenograft cardiac valves respectively. The intrinsic durability of the Xenograft cardiac valves appears to be relatively well satisfactory over the long term [4 to 7 years] and the risk of failure appears well balanced by the advantages of a low incidence of thromboembolism and no mandatory anticoagulant therapy.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.25-32
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• 2010

Background: Patients with vascular diseases commonly have coronary artery disease and associated cardiac problems. Therefore, their underlying heart diseases may be induced or exacerbated after vascular surgery. The effectiveness of SPECT imaging, which is a relatively simple and non-invasive imaging modality, for assessing these underlying heart diseases is still controversial. This study was performed to evaluate the clinical effect of tests and treatment based on SPECT imaging prior to vascular surgery on the development of post-operation cardiac complications. Material and Method: Sixty three patients who were treated at Inje University Pusan Paik Hospital between April 2004 and September 2007 and who underwent adenosine infusion technetium-99m (Tc-99m) tetrofosmin SPECT imaging prior to vascular surgery were selected for this study and we retrospectively reviewed their records. Result: The sensitivity and specificity of detecting a perfusion defect on SPECT to predict the development of cardiac complications was relatively low at 41.2% and 52.2%, respectively. However when coronary angiographies were done on the patients with abnormal SPECT and this was followed by aggressive treatment such as coronary artery intervention and coronary artery bypass grafting based on the angiography results, there was a tendency for lower cardiac complication rates. Conclusion: SPECT imaging shows low effectiveness as a screening test for predicting cardiac complications after vascular surgery.

• Journal of Chest Surgery
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• v.53 no.6
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• pp.361-367
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• 2020

Background: Malignant primary cardiac tumors are extremely rare, but have a poor prognosis. This study evaluated the surgical outcomes of patients with this disease. Methods: Forty patients who underwent surgery for malignant primary cardiac tumors between January 1998 and December 2018 were enrolled. Participants were divided into 3 groups based on resection margins (R0, 14 patients; R1, 11 patients; and R2, 11 patients) and their surgical outcomes were compared. Heart transplantation was performed in 4 patients with unresectable tumors. Results: Early mortality was reported in 2 cases (5%) due to postoperative bleeding and cerebral hemorrhage secondary to brain metastasis. The 1- and 2-year survival rates were 67.5% and 42.5%, respectively. The median survival time of the patients was 20.3 months (range, 9.2-37.6 months). The median survival time was 48.7, 20.3, and 4.8 months in patients with R0, R1, and R2 resections, respectively (p=0.023). Tumor recurrence occurred in 21 patients (61.7%), including 4 cases of local recurrence and 17 cases of distant metastasis. In patients who underwent heart transplantation, the median survival time was 29.5 months, with 3 cases of distant metastasis. Conclusion: Although surgery for malignant primary cardiac tumors has a poor prognosis, complete resection of the tumor may improve surgical outcomes.

• Journal of Chest Surgery
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• v.45 no.3
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• pp.148-154
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• 2012

Background: The adequate management of mild to moderate dilatation of the ascending aorta during cardiac operations remains controversial. In this study, we present the short-term outcomes of 90 patients undergoing ascending aortic wrapping with a Dacron graft during other cardiac operations. Materials and Methods: From March 2008 to January 2011, 90 consecutive patients underwent treatment for ascending aortic aneurysm using the external wrapping technique during the concomitant procedure. The study group consisted of 49 male and 41 female patients with a mean age of $58.7{\pm}13$years. The primary cardiac surgical procedures were coronary artery bypass grafting (CABG) in 3, aortic valve replacement in 2, and aortic valvuloplasty in 85 patients (isolated in 62 and combined with CABG or mitral valvuloplasty in 23). The ascending aorta diameter was measured using a computed tomography scan within 4 weeks after surgery, and was compared with the preoperative value. Results: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within a month after surgery from $46.4{\pm}4.3$ mm to $33.0{\pm}3.5$ mm (p<0.05). There was no early mortality or major surgical complication. During the mean follow-up period of $15.4{\pm}5.2$ months, there was only one late death caused by septic multiorgan failure. Conclusion: Dacron wrapping of the ascending aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of moderately dilated ascending aorta in selected patients.