• Journal of Chest Surgery
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• 제23권6호
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• pp.1090-1106
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• 1990

This study was undertaken to investigate whether adenosine administered during cardioplegic arrest could enhance myocardial protection and improve recovery of function after ischemia. Isolated Langendorff-perfused rat hearts were subjected to 40 minutes of normothermic [37oC] ischemia. Control hearts [n=10] received modified St. Thomas’ cardioplegic solution, and the remaining hearts received modified St. Thomas’ cardioplegic solution with either 20 \ulcornerM [n=10], 200 \ulcornerM [n=10] adenosine. After ischemia of 40 minutes and 30 minutes of reperfusion, left ventricular contractility was superior in all groups of adenosine-treated hearts compared with control hearts. Furthermore, there was a significant incremental increase in functional recovery with increasing dose of adenosine. Post-ischemic diastolic stiffness was significantly better in all adenosine groups compared with controls. No differences were noted in coronary flow or myocardial water content between adenosine-treated and control hearts. These data demonstrate that adenosine administered in these concentrations provides myocardial protection, preservation of myocardial ATP and creatine phosphokinase and improved post-ischemic functional hemodynamic recovery after normothermic ischemia, presumably metabolically by reducing depletion of adenosine triphosphate, inducing rapid cardiac arrest and enabling improved post-ischemic recovery.

• Journal of Chest Surgery
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• 제17권4호
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• pp.557-564
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• 1984

Of the valve replacement patients operated between 1983 and June, 1984, 75 patients need more than 60 minutes of aortic cross-clamping time. 42 patients performed single valve replacement [35 MVR, 7 AVR with or without TAP] and remainder needs double valve replacement with or without TAP. The average aortic clamping time was 95.1 minutes. They need 30 minutes more extra-corporeal circulation time than aortic clamping time. The patients were divided into two groups by usage of cardioplegic solution. Group I [n=31] with Bretschneider solution and group II with potassium cardioplegic solution [M.G.H. modification] were analyzed by extra-corporeal circulation data,/CG and Echocardiography findings, and clinical data. There was no difference between two groups in Bivon addition amounts [cc/kg] and E.F. and S.F. by echocardiography, group I need 1 more electrocardioversion to convert sinus rhythm postoperatively. Also no difference could be found in patients whose preoperative C.I. was above 2.0 between two group. But significant postoperative decrease in E.F. was found in group I whose preoperative C.I. was below 2.0. Relatively longer ECC time was also needed in same group. Ischemic changes in ECG and low cardiac output syndrome was, however more prevalent in groupII. As a whole, the clinical data was satisfactory with both cardioplegic solution in clinical practice.

• Journal of Yeungnam Medical Science
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• 제23권1호
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• pp.19-25
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• 2006

심실중격결손이나 심방중격결손과 같이 대동맥 차단시간이 길지 않은 질환에 있어서는 HTK용액의 심근보호효과가 냉혈심정지액과 비슷한 효과를 가짐을 알 수 있었다. 따라서 한번 투여로 2~3시간의 수술이 가능한 장점을 가진 HTK용액을 소아에서도 유용하게 사용할 수 있을 것으로 생각되며 향후 복잡심기형과 같은 긴 대동맥차단이 요구되는 소아환자의 안정성에 대해서는 더 많은 연구가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1066-1075
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• 1996

한국산 잡견을 대상으로 세 종류의 심정지액으로 심장을 정지 보존 후,심장을 적출하여 $0^{\circ}C$에서 보존하면서 일정한 시간별로 6회에 걸쳐 좌심실 근육조직을 채취하여 -75$^{\circ}C$ 냉동고에 저장한 후,초고속 액체 크로마토그라피법으로 purine metabolites를 측정하였다. UW 용액(UWS)군의 ATP 농도는 St. Thomas 용액 (5751군과 혈성 심정 지액 (BCPS)군에 비하여 높으나, 575 군과 BCPS 군 간에는 특이한 차이가 없었다. UWS 군과 BCPS 군의 ADP 농도가 4,8, 12, 24 시간대의 575 군보다 높지만, UWS 군과 BCPS 군 사이에는 특이한 차이가 없었다. AMP 농도는 세군 모두에서 변화가 많지 않았고, adenosine, inoslne, hypoxanthlnc 농도는 시간 경과 에 따라 점차 증가하였고, xanthine의 농도는 매우 소량이어서 비교가 불가능하였다. 본 연구 결과, UW용액이 장시간의 심근보존능력에는 아직 문제점이 있으나, 전신 저체온법을 동시에 시행한 St. Thomas 용액이나 혈성 용액 보다는 보다 우수한 보존용액으로 사료된다.

• Journal of Chest Surgery
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• 제33권9호
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• pp.707-715
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• 2000

Background: Cold blood cardioplegic solution has been used to protect myocardium during open heart surgery with the hypothesis stating that it provides more oxygen supply to myocardium compared to crystalloid caridoplegic solution. We repeatedly infused cold blood cardioplegic solution to achieve myocardial protection. We biopsied a small portion of papillary muscle of patients with mitral valve replacement or double valve replacement during aortic cross-clamp time and evaluated the method of myocardial protection through the observation of changes in ultrastructure. We then analysed the relationship between changes in ultrasructure and peak postoperative CK-MB value and SGOT value. Material and method: We report observation on changes of myocardial ultrastructure, postoperative CK-MB and SGOT, and electrocardiogram in 31 patients who underwent cardiac operation. There were 11 males and 20 females, and they ranging in age from 28 to 69 years(mean score was 2.08$\pm$0.560, it was 2.37$\pm$0.558 at 40 minutes, and it was 2.36$\pm$0.523 at 70minutes. Mitochondrial score increased significant at 40 minutes. Mean value of postoperative peak CK-MB and SGOT were 37.3$\pm$17.061IU, 144.5$\pm$125.5IU respectively. We were not able to find any new Q were in EKG after the operation. There was no significant relationship between myocardium mitochondrial score and mean value of postoperative peak CK-MB and SGOT. Conclusion: In conclusion, with this study the cold blood cardioplegic solution was incomplete in preserving ultrastructure of myocardium even with satisfactory results in serum enzyme and EKG evaluation.

• Journal of Chest Surgery
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• 제25권11호
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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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• 제25권3호
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• pp.211-219
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• 1992

Hypothermic cardioplegia is a well established method to optimize myocardial preservation during ischemic arrest, and it has been demonstrated that oxygenation of crystalloid cardioplegic solutions markedly enhances myocardial protection, The addition of a small amount of red blood cells to a crystalloid cardioplegic solutions improves capillary perfusion. Considering these results, we changed our cardioplegic solution from cold oxygenated crystalloid[Group 2] to cold oxygenated diluted blood[Group 1]. In this investigation, we examined the effects of two hypothermic potassium cardioplegic solutions on myocardial preservation in 50 patients[30 of Group 1 and 20 of Group 2] of child age group. Factors considered preoperatively included age, sex, body weight, preoperative diagnosis, and they showed no statistical differences, Intraoperative factors considered included duration of cardiopulmonary bypass, duration of aortic occlusion, operative mortality, which also revealed no statistically significant differences, We measured the serum levels of GOT[glutamate oxaloacetate transaminase] and CPK [creatine phosphokinase] during the first two days postoperatively, which, in both groups, showed significantly higher values until postoperative 1 day, and decreasing tendancy thereafter, however we failed to find any significant difference between two groups regarding the serum levels of those enzymes each day. Time for extubation and use of inotropics also revealed no significant differences. Defibrillation was needed less in Group 1 than in Group 2[p<0.05], and one case of supraventricular tachyarrhythmia occured in Group l. We conclude that cold oxygenated diluted blood cardioplegia provides no less preservation than does an oxygenated crystalloid cardioplegic solution in child age group.

• Journal of Chest Surgery
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• 제23권4호
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• pp.646-653
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• 1990

Currently numerous methods are in use for myocardial protection from the ravages of ischemia and hypoxia. This study was designed to compare with FDP-GIK[Group II, n=8] and GIK cardioplegic solution[Group I, n=8] in ability of myocardial protection and was examined in the isolated working rat heart subjected to long period[120 min] of hypothermic[10 - 15K] ischemic arrest with multidose[every 30 min] cardioplegic infusion. During postischemic reperfusion period 20 min, hemodynamic functions[aortic flow, coronary flow, peak aortic pressure, cardiac output, heart rate], biochemical enzymatic & electrical activities were evaluated. The time from onset of reperfusion to the return of regular sinus rhythm was significantly reduced from 87$\pm$3 sec to 17$\pm$2 sec[P<0.05]. The postischemic recovery of aortic flow was better in the group II [95.1$\pm$3.3% of its preischemic control level] than in the Group I [75.4$\pm$6.8%] [P<0.05]. Cardiac output and stroke volume was also better in the group[91.3$\pm$1.6%, 89.4$\pm$2.6%, respectively] than in the Group I [79.1$\pm$3.7%, 77.0$\pm$4.8%, respectively] [P<0. 05]. Creatine kinase leakage was also significantly reduced from 33.8$\pm$4.9 IU /10 min / gm * dry weight to 15.4$\pm$3.6 IU /10 min /gm * dry weight[P<0.05]. It is suggested that adding FDP to GIK cardioplegic solution improves its ability to protect the heart against long period of hypoxic ischemia.

• Journal of Chest Surgery
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• 제33권8호
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• pp.613-622
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• 2000

Background: The aim of this study is to define the cardioprotective effects(functional and metabolic) of newly developed DelNido cardioplegic solution(containing plasma solution, mannitol, magnesium and lidocaine). Material and Method: This study assessed the function of rat hearts after itermittent infusion of DelNido cardioplegia with different preserving methods(Air or Icebox) for 2hours and perfusing the hearts on a Langendorff apparatus. Heart rate, left ventricular developed pressure(LVDP) and coronary flow, were measured at pre-ischemic, post-reperfusion 15min, 30min and 45min. Coronary flow was standardized to dry heart weight. Each weight was weighted to calculate water content. Creatine kinase-MB isoenzyme release was measured and ultrastructural assessment was done with electron microscopes. Result: DelNido group was better than St, Thomas group and Icebox group was better than Room-air group. Conclusion: DelNido cardioplegia have better myocardial protective effects than St. Thomas cardioplegia when they were preserved in the Room-air. But we can not tell the difference between Delnido cardiplegia with Air preserving method and St. Thomas cardioplegia with Icebox.

• Journal of Chest Surgery
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• 제18권4호
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• pp.700-710
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• 1985

Three hundred and sixty seven cases of open heart surgery were done in the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital from July, 1981 to October, 1985. 1. The age distribution of congenital heart disease patients was 3 to 41 years old and mean age was 12.7 years and of acquired heart disease was 9 to 57 years old and mean age was 30.9 years. 2. There were 281 cases [64.9%] of acyanotic congenital heart anomalies, 43 cases [11.7%] of cyanotic anomalies and 86 cases [23.4%] of acquired heart disease. 3. For myocardial protection, Bretschneider and potassium glucose solution had been used as cardioplegic solution but recently GIK solution is being used as secondary cardioplegic method by infusing repeatedly every 30 to 40 minutes time interval with excellent results. 4. The overall mortality was 8.2%. And the mortality rate in each disease entity is 2.5% in congenital acyanotic cases, 32.6% in congenital cyanotic cases and 11.6% in acquired valvular disease.