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Open Heart Surgery for Six Cases of the Conegnital Heart Disease (선천성(先天性) 심장병(心臟病)의 개심술(開心術) -6례(例) 수술경험(手術經驗) -)

  • Lee, Sung Haing;Lee, Sung Koo;Han, Sung Sae;Lee, Kihl Rho;Kim, Song Myung;Lee, Kwang Sook;Lee, Chong Kook
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.220-238
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    • 1976
  • Six cases of congenital heart disease were operated on by means of cardiopulmonary bypass between December, 1975 and April, 1976. Two cases of ventricular septal defects (VSD), two cases of VSD, associated with ruptured aneurysm of sinus Valsalva, two cases of atrial septal defects (ASD) and one case of pulmonic stenosis with patent ductus arteriosus were operated. Sarns roller pumps and Bentley Temptrol oxygenators were used for extracorporeal circulation. Pump oxygenator was primed with Ringer's lactate solution, 5% dextrose in water, mannitol, and ACD blood. Flow rate ranged from 2.0 to $2.4L/M^2/min$. Bicarbonate was added to the oxygenator with estimated amount as 15 mEq/L/hr. Venous catheters were introduced into superior and inferior vena cava, and oxygenated blood was returned to the body through aortic cannula inserted into ascending aorta. Moderate hypothermia ($30^{\circ}C$) was induced by core cooling. Aorta was cross clamped for 15 minutes and released for 3 minutes, and repeated clamping when necessary. Atrial and ventricular septal efects were closed by direct sutures. Aneurysms of sinus Valsalva ruptured into the right ventricle were repaired through right ventriculotomy by d:rect closure with Dacron patch reinforcement. Cardiopulmonary bypass time varied from 66 to 209 minutes, and aorta cross clamping time ranged from 13 to 56 minutes. Postoperative bleeding was minimal except one case who needed for evacuation of substernal hematoma. Intra- and postoperative urinary output was satisfactory. Acid-base balance, partial pressure of $O_2$, electrolytes, and hematological changes during intra- and post-perfusion period remained at the acceptable ranges. No mortality was experienced.

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Experimental Studies on Extracorporeal Circulation by Sarns Heart-Lung Machine with Total Prime of Hartman's Solution (Sarns 심폐기의 혈희석 체외순환에 관한 실험적 연구)

  • 김근호
    • Journal of Chest Surgery
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    • v.8 no.2
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    • pp.135-142
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    • 1975
  • Total body perfusion using Sarns Heart-Lung-Machine, five head pump motor system with Travenol disposable bubble oxygenator was attempted in the dogs by the hemodilution method with total prime of buffered Hartman`s solution under moderate hypothermia. The first of all, the functions of Sarns Heart-Lung-Machine and effects of the hemodilution perfusion by buffered Hartman`s solution was studied. At the same time the changes of pressure of artery and vein, gas contents of the blood, and influence on the blood pictures were observed before, during, and after perfusion in 1-2 days. Hemodilution rates were the ranges of 85.0ml/kg to 97.3ml/kg and perfusion flow rates were maintained with the average 80. 5ml/kg/min [the ranges of 73.3ml/kg/min to 92.8ml/kg/min]. Hypothermia was employed between $35^{\circ}C$ and $31^{\circ} of the esophageal temperature. The total body perfusion was continued for 50-60 minutes. In the total cardiopulmonary bypass, atriotomy, ventriculotomy, and atrioventriculotomy were performed respectively. Arterial pressure was ranged approximately between 50 mmHg and 140 mmHg, but generally, it was maintained over 75 mmHg. Venous pressure was measured between 3.8 cm$H_2O$ and 16.0 cm$H_2O$. Optimum oxygenation could be achieved when oxygen flow into the oxygenator was maintained approximately at 5. 5L/min. In this way, the $pO_2$, $pCO_2$, and oxygen saturation were measured before, during, and afterperfusion in 1-2 days. The $pCO_2$ ranged approximately between 26.0 mmHg and 38.5 mmHg, but generally, it was maintained in the average 30.9-32.5mmHg. The $pO_2$ was ranged between 73.0mmHg and 332.2 mmHg, but it was maintained in the average 103.0-219.0 mmHg. Oxygen saturation was measured over 95. 0% during and after extracorporeal circulation respectively. Erythrocyte count, hemoglobin, hematocrit, and leucocyte count were decreased to 49.2%, 49.0%, 49.4%, and 21. 1% of the preoperative value during extracorporeal circulation respectively and these reductions were not recovered until 1-2 days after perfusion. These. resulted from relatively high degree of hemodilution rate and operative bleeding during these experimental studies. The platelets count was also decreased about to 71% during perfusion, on the contrary, it was increased progressively after perfusion and in 1-21 days after perfusion, the value was returned to preoperative contro1 level. Three dogs were all recovered after extracorporeal circulation.

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The Effect of Cardiopulmonary Bypass on Serum Magnesium (체외순환에 의한 혈청 Magnesium의 변화)

  • Chae, Hurn;Rho, Joon Ryang;Suh, Kyung Phill;Lee, Yung-Kyoon
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.239-244
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    • 1976
  • Alterations in the serum magnesium level were studied in twenty patients who had open-heart surgery during the period from August 1974 to May 1975. The patients were chosen at random. The operative procedures included repair for congenital heart diseases in fifteen patients and cardiac valve replacement for acquired valvular heart diseases in five patients. The age ranged from 8 to 46 years, with an average of 19 years. None of the patients had a history of gross neuromuscular abnormalities. Cardiopulmonary bypass was carried out using a roller pump and a disposable oxygenator. The prime solution consisted of 2 units of ACD banked blood and approximately an equal volume of non-blood additives in adults, while a relatively smaller volume was added in children. The average flow rate was 2,733 ml per minute. Blood samples for magnesium and arterial blood pH were obtained the day after admission 25 minutes after initiation of the bypass and on the morning the day after operation. Preoperative data were then compared with those obtained during the bypass and postoperatively by a paired test. During the bypass, the serum magnesium level decreased significantly from $1.425{\pm}0.029$ to $1.210{\pm}0.063mEq.$ liter (p<0.001). Also, there was a significant decrease in serum magnesium from $1.425{\pm}0.029$ preoperatively to $1.255{\pm}0.083mEq$. per liter (p<0.001). Also, there was a significant decrease in serum magnesium from $1.425{\pm}0.029$ preoperatively to $1.255{\pm}0.083mEq$. per liter postoperatively (p<0.01). The duration of bypass was less than 90 minutes in 10 patients (group A) and exceeded 90 minutes in the remaining 10 (group B). There was no statistical correlation between the groups A and B ($p{\gg}0.20$). Statistical analyses of the serum magnesium level and arterial blood pH showed no significant correlation with correlation coefficient; being -0.3485(pre-op), -0.2971(during bypass), and -0.1008(post-op), respectively. In all the patients, no gross neuromuscular abnormalities were found postoperatively. At present, the clinical significance of the serum magnesium level during and after bypass is controversial. In the near future, however, it is expected that improvements in prime solution and heart-lung machine will solve this problem.

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Surgical Treatment of Postinfarct Ventricular Double Rupture - A case report - (심근경색 후 발생한 심실이중파열의 외과 치료)

  • Kim Young Sam;Yoon Young Han;Kim Joung Taek;Kim Kwang Ho;Lim Hyun Kyoung;Kwan Jun;Baek Wan Ki
    • Journal of Chest Surgery
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    • v.38 no.10 s.255
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    • pp.717-720
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    • 2005
  • Here we report a case of posterior left ventricular (LV) free wall rupture following postinfarct ventricular septal rupture (VSR). A 58-year-old man was transferred to the hospital under the impression of acute myocardial infarction. Posterior VSR was seen on echocardiographic examination. The intraaortic balloon pump catheter was introduced percutaneously and the emergent operation was proposed. Sudden circulatory collapse was developed shortly after the anesthetic induction and the patient's chest was hurriedly opened while on cardiopulmonary resuscitation. The acute cardiac tamponade was seen and the blood was seen pumping from the longitudinal tear at the mid-level of LV posterior wall, measuring 2 cm in length. The cardiopulmonary bypass was set and LV reconstruction was done. The postoperative recovery was delayed due to the brain injury presumably caused by preoperative cardiac arrest.

Operatonal characteristics of the PLS linac vacuum system (PLS 선형가속기 진공계의 운전특성)

  • 김임경;박용정;김경렬;남궁원
    • Journal of the Korean Vacuum Society
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    • v.5 no.4
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    • pp.269-277
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    • 1996
  • The vacuum systems of PLS linac provides average pressure of $2.6\times 10^{-6}$Pa under high power microwave of 54 MW peak with 4.1 $\mu \textrm s$ pulse width and 10 Hz repetition rates. The base pressure of system is$2.4\times 10^{-6}$Pa with 45$^{\circ}C$ cooling water. The outgassing rate of the system is decreased from $3.0\times 10^{-11}Torr-l/sec-\textrm{cm}^2$ at the initial stage after installation to $1\times 10^{-12}Torr-l/sec-\textrm{cm}^2$ at present. Total accumulated microwave energy dose is about 140 GJ per module. All ion pumps are working under saturated regime and effective pumping speeds of 60 I/s, 230 I/s ion pumps are 45 I/s, 65 I/s, 140 I/s under the operating range. Main problems occurred in recent year are troubles of ion pump controller and vacuum gauge controller, vacuum leak of energy doubler window and electron gun ceramic, and water leak in the dummy load of acceleraing columns. Total of 41 troubles with 140. 8 hours down time give good system availability of 98%. Down time can be reduced by high power waveguide valves and water dummy loads under development, and then availability is expected to be increased up to 99.5%.

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A Survey on the Demand for Home Care of the Mother's of the Hospitalized Children (입원 환아 어머니의 가정간호 요구도 조사)

  • Dim Young Hae;Kwon Bong Sook;Park Soon Og;Bae Young Soon;Lee Young Eun;Lee Ji Won;Lee Hwa Ja;Chung Gyung Ae
    • Child Health Nursing Research
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    • v.3 no.1
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    • pp.99-107
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    • 1997
  • The subjects of the study were the 120 mothers who had children hospitalized in 6 hospitals in P city during the period from Feb. 1. to May 30. 1996. The purpose of the study are(1) the problems encountered when they carried out Home Care after discharge and (2) the degrees of demand that they had against Home Care Services. In order to investigate the purposes above-mentioned the researchers used the 55 items of Home Care services belonging to 10 areas selected by Korea Home-Care Association in 1994. The items were modified and supplemented to 4-point scale. The selected data were analyzed by SPSS : PC+ and the following results were derived. 1. The subjects payed great attention to 5 items such as 'pain control, OPD visits, diet-control problems' among the 15 sources of anxiety that they had against Home Care services after discharge. Especially, 'OPD visits and knowledge deficit' would to be overcome by the nursing activities of the Home Care Nurses. 2. The acknowledge level of the subjects to the Home Care Project that governmental plans to carry out was surveyed and found as under 50. 0% responded they heard about Home Care Nursing System. 60.8% said that they thought the system was 'very necessary' and 'somewhat necessary'. 65.0% said they would like to use the system. However, the acknowledge level of 50.0% is still low and is thought to need further national promotion and propagation. 3. The demand of the subjects against 55 Home Care Services was investigated and found as

    . 'Assessment, Lab, basic nursing technology, relay ' transfer, training ' education and curative nursing' showed comparatively high scores. However, the items belonging to pediatric Home Care Services such as 'umbilical cord care, breast-feeding, infant care, and post-partum care & loan of breast-pump' showed relatively low scores.

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  • Oxygen Permeation Properties of Tubular $Ba_{0.5}Sr_{0.5}Co_{0.8}Fe_{0.2}O_{3-{\delta}}$ (BSCF) Membranes under Different Condition of Feed Side and Permeate Side (공급 측과 투과 측 조건에 따른 $Ba_{0.5}Sr_{0.5}Co_{0.8}Fe_{0.2}O_{3-{\delta}}$ (BSCF) 관형 분리막의 산소투과 특성)

    • Kim, Jong-Pyo;Park, Jung-Hoon;Lee, Yong-Taek;Choi, Young-Jong
      • Membrane Journal
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      • v.21 no.2
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      • pp.155-162
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      • 2011
    • Dense tubular $Ba_{0.5}Sr_{0.5}Co_{0.8}Fe_{0.2}O_{3-{\delta}}$ (BSCF) membranes were prepared by extrusion technique. The phase structure of the $Ba_{0.5}Sr_{0.5}Co_{0.8}Fe_{0.2}O_{3-{\delta}}$ membranes was characterized by X-ray diffraction (XRD) and scanning electron microscope (SEM). Relative density of $Ba_{0.5}Sr_{0.5}Co_{0.8}Fe_{0.2}O_{3-{\delta}}$ tubular membrane was 94.10%. Oxygen permeation was measured at difference operating condition of feed side and permeate side in the temperature range from 700 to $950^{\circ}C$. The oxygen permeation flux of dense tubular $Ba_{0.5}Sr_{0.5}Co_{0.8}Fe_{0.2}O_{3-{\delta}}$ membrane reached maximum 1.37 mL/$min{\cdot}cm^2$ at $900^{\circ}C$ exposed to ambient air (feed side) and vacuum pump (permeate side).

    Clinical Results of Surgical Treatment of an Isolated Complete Atrioventricular Septal Defect (완전방실중격결손증의 외과적 요법에 관한 임상적 고찰)

    • 이정상
      • Journal of Chest Surgery
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      • v.24 no.2
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      • pp.123-134
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      • 1991
    • Twenty eight patients had undergone repair of an isolated complete atrioventricular septal defect between April 1986 and September 1990 in Seoul National University Children`s Hospital. The group comprised 13 male and 15 female patients. They ranged in age from 2 months to 8 years[mean 18.6months] and in weight from 3. 4kg to 23kg[mean 9.0$\pm$4.6kg]. They were analysed as Rastelli type A in 17 patients, Rastelli type B in 2 patients, and Rastelli type C in 9 patients. Seven patients had concomitant Down`s syndrome. All patients had large left-to-right shunt[mean pulmonary to systemic flow ratio 3.5 $\pm$2.2 ranging from 0.68 to 10.0] and high pulmonary systolic pressure[mean 74$\pm$18.8mmHg, ranging from 35 to 110]. In 11 patients, one patch technique was used to close the atrial and ventricular septal defect and 16 patients were undergone by two patch technique. We urgently managed only one patient by pulmonary artery banding whose anatomy was Rastelli type C and severe mitral regurgitation was identified. Postoperative complete A - V block was noted in 3 patients, two of whom were dead in operating room due to combined LVOTO and myocardial failure, and one patient with Rastelli type C was undergone by VVI type permanent pacemaker insertion 1wk later after two patch technique, but we had to manage him by modified Konno operation and total correction due to LVOTO and VSD leakage and severe mitral regurgitation 3 years later. Another two reoperation cases due to severe mitral regurgitation after two patch technique were undergone, one of whom we managed by mitral annuloplasty 3 months later but aggravated mitral regurgitation made us to control him by MVR 3 months later. Another one case of VSD leakage and tricuspid regurgitation was managed by total correction but she died of respiratory insufficiency 14 days later. We experienced pulmonary hypertensive crisis in 3 patients, who were dead in two cases comparing with one control case. So operative mortality is 9/27[33.6%], in one patch group of 3/11[29.2%] comparing with two patch group of 6/16[37.5%]. In summary, causes of death were pump weaning failure, myocardial failure and low cardiac output syndrome and pulmonary hypertensive crisis, resp. failure, complete AV block. Mean follow up period is 15.8$\pm$10.7 months[ranging from 3months to 37 months]

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    Risk Factors of Coronary Artery Bypass Grafting According to Ventricular Function (좌심실기능에 따른 관상동맥우회술의 위험인자)

    • 이헌재;현성렬
      • Journal of Chest Surgery
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      • v.30 no.9
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      • pp.885-890
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      • 1997
    • Patients with coronary artery disease and depressed ventricular function have better longterm benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from truly 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction < 40%, n=24) and Normal EF group(Ejection fraction $\geq$ 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EP group. The left internal thoracic artery was used less frequently in Low EP group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33olo in Normal EP group, but without s atistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit.

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    Clinical Experience of Continuous Epidural Analgesia Using Baxter $Infusor^{(R)}$ (Baxter $Infusor^{(R)}$를 이용한 경막외 진통제 지속 주입)

    • Bae, Sang-Chull;Lee, Jang-Won;Kim, Ill-Ho;Song, Hoo-Bin;Park, Wook;Kim, Sung-Yell
      • The Korean Journal of Pain
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      • v.4 no.2
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      • pp.127-132
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      • 1991
    • Recently a non-electronic, disposable and portable infusor(Baxter infusor with patient control module, Baxter health care Co., Deerfield IL 60015 USA: BI $\bar{c}$ PCM) has been developed that will deliver both a continuous drug infusion as well as allow the patient to deliver extra doses of medication on a demand basis under predetermined limitation of analgesics. Patients may also not require as high analgesic dose rate to control pain when the acceptable and tolerable level of pain relief can be maintained by this device. From April l99l, we have used a total l93 units of BI $\bar{c}$ PCM. These units consisting of two components which one made by a balloon reservoir(capacity 65 ml, flow rate 0.5 ml/hr) to store medication and to regulate the pump power(490 torr), and another two PCMs to regulate additional analgesic administration by patients demand at intervals of 1S minutes and 60 minutes. The dose administered to the patient can be varied by changing the concentration of the infusate within the balloon reservoir. These devices were utilized for the pain control of 44 patients. These patients were divided into two groups. Twenty seven cases had cancer pain and 17 cases had non-cancer pain. The Touhy needle(No. l8 G.) tip was inserted into the epidural space and was used to guide the catheter to the spinal nerve level corresponding to the most painful area. The device was connected to the opposite site of the catheter tip and was filled with 60 ml of mixture solution such as 0.5% bupivacaine 15 ml, morphine HCl 10 mg, trazodone 10 ml, Tridol 3 ml and normal saline 31 ml were administed as the initial dose. When the initial dose was less effective, the next dose could be varied by increasing the concentration of bupivacaine, by adding more morphine (5~10 mg), and by reducing the volume of normal saline. Using these modules of drug self administration, we experienced the following: 1) Improvement of patient's self titration of analgesic requirement was provided. 2) The patients anxiety with pain recurrence resulting from delays in administering pain control medication was decreased significantly. 3) The working load accompanying with the single bolus injection as the usual method was reduced remarkably. 4) There was urinary retention in 5 cases and pruritus in 4 eases which developed as side effects but respiratory depression and vomiting was not encountered in a single case.

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