• Title/Summary/Keyword: retrograde flow

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Analysis of the Lower Extremity Reconstruction with Free Tissue Transfer in Recent 5 Years (최근 5년간 유리 피판술을 이용한 하지재건의 분석)

  • Baek, Seong-Jun;Heo, Chan-Yeong;Oh, Kap-Sung
    • Archives of Reconstructive Microsurgery
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    • v.8 no.2
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    • pp.130-138
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    • 1999
  • The lower extremity injuries are extremely increasing with the development of industrial & transportational technology. For the lower extremity injuries that result from high-energy forces, particularly those in which soft tissue and large segments of bone have been destroyed and there is some degree of vascular compromise, the problems in reconstruction are major and more complex. In such cases local muscle coverage is probably unsuccessful, because adjacent muscles are destroyed much more than one can initially expect. Reconstruction of the lower extremity has been planned by dividing the lower leg into three parts traditionally The flaps available in each of the three parts are gastrocnemius flap for proximal one third, soleus flap for middle one third and free flap transfer for lower one third. Microvascular surgery can provide the necessary soft tissue coverage from the remote donnor area by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde flow flaps are well established in island flaps. Retrograde flow anastomosis could not interrupt the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. During 5 years, from March 1993 to Feb. 1998, we have done 68 free flap transfers in 61 patients to reconstruct the lower extremity. From analysis of the cases, we concluded that for the reconstruction of the lower extremity, free flap transfer yields a more esthetic and functional results.

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Evaluation of the Potential of Retrograde Flow Competition in the Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting (우위대망동맥을 이용한 관상동맥우회술 후 역행성 혈류 발생가능성의 연구)

  • Chung, Bong-Kyu;Sun, Kyung;Kwon, Joon;Kim, Kwang-Ho;Jung, Jae-Seung;Son, Ho-Sung;Lee, Sung-Ho;Kim, Kwang-Taik;Kim, Hyung-Mook
    • Journal of Chest Surgery
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    • v.35 no.1
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    • pp.20-26
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    • 2002
  • Background: Due to the concern of flow competition or retrograde steal, it has been generally suggested that the right gastroepiploic artery(RGEA) pedicled graft should be used in critical coronary stenosis lesion. The study was designed to evaluate the potential of retrograde flow competition in the RGEA pedicled graft by measuring the native pressure differences(PD) between the normal coronary artery and celiac arterial pressure, which would be compared with trans-stenosis pressure gradients(TSPG) in coronary artery occlusive disease. Material and Method: Between July, 1998 and February, 1999, pressures of the right coronary artery and the right gastroepiploic artery(or the celiac artery) were measured in patients with the patent right coronary artery(n=12). The PD between the arteries was compared with the TSPG in the occlusive coronary arteries(n=32). Result: The pressures of the normal right coronary artery and celiac artery were 143$\pm$23 vs. 134$\pm$17mmHg in systole(p<0.005), 74$\pm$13 vs. 73$\pm$14mmHg in diastole(p=NS), and 100$\pm$16 vs. 97$\pm$15mmHg in mean (p<0.05). The PD between the arteries were -8~25mmHg in systole, -4~7mmHg in diastole, and -1~10mmHg in mean. The TSPG measured in the occlusive coronary arteries were -4~19(7$\pm$5.8)mmHg in the lesion less than 75% stenosis vs. 7~74(27$\pm$18.3)mmHg in the 75% or over stenosis lesion(p<0.005). The normally existing pressure difference between the coronary arteries and RGEA(15~20mmHg) was significantlyless than the TSPG in .the occlusive coronary artery with 75% or over stenosis(p<0.001). Conclusion: If the pressure gradient between the RGEA and the coronary artery distal to the stenosis is the main determinant of development of retrograde flow competiton in the RGEA pedicled graft, the above data suggests that there will be little chance of competition when It is used in the coronary lesion with 75% or over stenosis.

The Local Myocardial Perfusion Rates of Right Atrial Cardioplegia in Hearts with Coronary Arterial Obstruction (관상동맥 협착을 동반한 심장에서 심근보호액 우심방 관류법의 심근 국소관류량)

  • Lee, Jae-Won;Seo, Gyeong-Pil
    • Journal of Chest Surgery
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    • v.25 no.1
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    • pp.1-16
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    • 1992
  • The quantitatively measured local myocardial perfusion rates with microspheres are used as an objective indicator of even distribution of cardioplegic solution, and the efficacy of the retrograde right atrial route of cardioplegia is evaluated in hearts with various levels of coronary arterial obstruction. After initial antegrade cardioplegia under the median sternotomy and aortic cannulation, 60 hearts from anesthetized New Zealand white rabbits are divided in random order as normal group [ligated left main coronary artery ; MA, MR] and diagonal group [ligated proximal diagonal artery ; LA, LR]. Half of each group [N=10] are perfused with antegrade cardioplegia[A] under the pressure of 100 cmH2O and the other half with retrograde right atrial route[R] under the pressure of 60 cmH2O[St. Thomas cardioplegic solution mixed with measured amount of microspheres]. The myocardium is subdivided into segments as A[atria], RV[right ventricle]. S[septum], LV[normally perfused left ventricular free wall], ROI[ischemic myocardium of left ventricular free wall]. LV and RQI are further divided into N[subendocardium] and P[subepicardium]. The resulting local myocardial perfusion rates and N /P of each group are compared with Wilcoxon rank sum test. The weight of the hearts is 5.94$\pm$0.66g, and there are no statistically significant dif-ferences[p>0.05, ANOVA] between six compared group. The mean flow rate[F: ml /g / min] of MR group is comparable with MA group[p>0.05], but in N and L group, there are significantly depressed F with right atrial route of cardioplegia, which means elevated perfusion resistance with this route. In spite of no significant differences in delivered doses of microsphere[DEL] between compared groups[p>0.05, ANOVA], there are significantly depressed REC and NF in hearts with right atrial cardioplegia which suggests increased requirement of cardioplegic solution with this route. The interventricular septum shows poor perfusion with right atrial route of cardioplegia without obstruction of supplying coronary arteries. But, with obstruction of coronary artery supplying septum as in M group, the flow rate is superior with right atrial route of infusion. The left ventricular free wall perfusion rates of every RQI with R route are superior to that of A route[p<0.05]. But, in LV segments, there are unfavorable effects of right atrial cardioplegia in L group, although the subendocardial perfusion is well maintained in N group. The LV free wall of left main group shows depressed perfusion rates with antegrade route as compared with RQI segments of diagonal group. But, by contraries, there are increased perfusion rates and superior N /P ratio with retrograde right atrial route. It implies more effective perfusion with right atrial route of cardioplegia in more proximal coronary arterial obstruction[i.e., M group as compared with L group]. As a conclusion, all region of ischemia have superior perfusion rates with right atrial car-dioplegia as compared with antegrade route, and especially excellent results can be obtained in hearts with more proximal obstruction of coronary arteries which would otherwise result in more severe ischemic damage. But, the depressed perfusion rates of the segments with normal coronary artery in hearts with coronary arterial obstruction may be a problem of concern with right atrial cardioplegia and needs solution.

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Hemodynamic Analysis of Blood Flows in the Extraembryonic Blood Vessels of Chicken Embryos (유정란 태아외부혈관 내부 혈액유동에 대한 혈류역학적 연구)

  • Lee, Jung-Yeop;Lee, Sang-Joon
    • 한국전산유체공학회:학술대회논문집
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    • 2008.03b
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    • pp.6-9
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    • 2008
  • Analyzing the characteristics of blood flow in the blood vessels is very important to diagnose the circulatory diseases. In order to investigate the hemodynamic characteristics in vivo, the measurements of blood flows inside the extraembryonic arterial and venous blood vessels of chicken embryos were carried out using an in vivo micro-PIV technique. The circulatory diseases are closely related with the formation of abnormal hemodynamic shear stress regions, thereby it is important to get blood velocity and vessel's morphological information according to the vessel configuration and the flow conditions. In this study, the flow images of RBCs in blood vessels were obtained using a high-speed CMOS camera with a spatial resolution of approximately 14.6${\mu}$m${\times}$14.6${\mu}$m in the whole circulation network of blood vessels. The blood flows in the veins and arteries show steady laminar and unsteady pulsatile flow characteristics, respectively. The mean blood flows merged (in veins) and bifurcated (in arteries) smoothly into the main blood vessel and branches, respectively, without any flow separation or secondary flow which accompanying large variation of shear stress. Vorticity was high in the inner regions for both types of vessels, where the radius of curvature varied greatly. The instantaneous flows in the arterial blood vessels showed noticeable pulsatility due to the heart beat, and the main features of the velocity waveforms, including pulsatile shape, retrograde flow, mean velocity, maximum velocity and pulsatile frequency, were significantly dependent on the pulsatile condition which dominates the arterial blood flow. In near future, these in vivo experimental results of blood flow measured in various extraembryonic blood vessels would be very useful to understand the hemodynamic characteristics of human blood flows and various blood flow researches for clinically useful hemodynamic discoveries as well.

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Fenestration Operation to Correct Acute Renal Failure After Total Aortic Arch Replacement in DeBakey typeI Aortic Dissection -1 case report- (만성 DeBakey I형 박리성 대동맥류의 대동맥궁 치환술 후 잔존 복부대동맥 내막피판에 의해 발생한 급성 신부전의 외과적 치료 -1례 보고-)

  • 편승환;노재욱;방정희;조광조;우종수
    • Journal of Chest Surgery
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    • v.31 no.4
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    • pp.402-408
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    • 1998
  • A 56-year old female underwent total aortic arch replacement March 1995, because of an expanding chronic Debakey type I aortic dissection. This aortic dissection had an intimal tear at the origin of the right carotid artery. Retrograde and antegrade propagation of dissection resulted in aortic arch blood flow separation and expanding pseudolumen to the abdominal aorta. Sudden anuria(ARF) developed 3 hours later postoperatively and renal doppler ultrasonography and aortography showed diminished blood flow of renal arteries. We performed balloon aortic dilatation but failed. She could be restored good renal flow after intimal flap fenestration resection and thrombectomy of the abdominal aorta. This patient could be discharged in a state of mild CRF after 2 months of ICU care for respiratory and renal failure.

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Micro-computed tomographic evaluation of the flow and filling ability of endodontic materials using different test models

  • Torres, Fernanda Ferrari Esteves;Guerreiro-Tanomaru, Juliane Maria;Chavez-Andrade, Gisselle Moraima;Pinto, Jader Camilo;Berbert, Fabio Luiz Camargo Villela;Tanomaru-Filho, Mario
    • Restorative Dentistry and Endodontics
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    • v.45 no.2
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    • pp.11.1-11.9
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    • 2020
  • Objectives: This study compared the flow and filling of several retrograde filling materials using new different test models. Materials and Methods: Glass plates were manufactured with a central cavity and 4 grooves in the horizontal and vertical directions. Grooves with the dimensions used in the previous study (1 × 1 × 2 mm; length, width, and height respectively) were compared with grooves measuring 1 × 1 × 1 and 1 × 2 × 1 mm. Biodentine, intermediate restorative material (IRM), and mineral trioxide aggregate (MTA) were evaluated. Each material was placed in the central cavity, and then another glass plate and a metal weight were placed over the cement. The glass plate/material set was scanned using micro-computed tomography. Flow was calculated by linear measurements in the grooves. Central filling was calculated in the central cavity (㎣) and lateral filling was measured up to 2 mm from the central cavity. Results: Biodentine presented the least flow and better filling than IRM when evaluated in the 1 × 1 × 2 model. In a comparison of the test models, MTA had the most flow in the 1 × 1 × 2 model. All materials had lower lateral filling when the 1 × 1 × 2 model was used. Conclusions: Flow and filling were affected by the size of the test models. Higher grooves and materials with greater flow resulted in lower filling capacity. The test model measuring 1 × 1 × 2 mm showed a better ability to differentiate among the materials.

Safety of Aprotinin Under Hypothermic Circulatory Arrest (초저체온 및 순환정지하에서 Aprotinin의 안전성)

  • 장병철;김정택
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.501-505
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    • 1997
  • It was reported that use of aprotinin in elderly patients undergoing hypothermic circulatory arrest was associated with an increased risk of renal dysfunction, and myocardial infarction as a result of intravascular coagulation. We reviewed 20 patients who received high-dose aprotinin under deep hypothermic circulatory arrest with(NP group, n= 11) or without selective cerebral perfusion(SP group, n=9). The activated clotting time was exceeded 750 seconds in all but 1 patient. After opening aortic arch, retrograde low flow perfusion was maintained through femoral artery to prevent air embolization to the visceral arteries. Four patients among 20 died during hospitalization'due to bleeding, coronary artery dissection pulmonary hemorrhage and multiple cerebral infarction. Postoperatively, cerebrovascular accidents occurred in two patients; one with preoperative carotid artery dissection and the other with unknown multiple cerebral infarction. In conclusion, use of aprotinin in young patients undergoing hypothermic circulatory arrest did not increase the risk of renal dysfunction or intravascular coagulation if ACT during circulatory arrest is maintained to exceed 750 seconds with low-flow perfusion.

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Protective Effect on the Rat's Myocardium with Changes in Magnesium Concentrations (마그네슘 농도변화에 따른 흰쥐의 심근 보호효과)

  • Hong, Chi-Uk;Jo, Gyu-Seok;Yu, Se-Yeong
    • Journal of Chest Surgery
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    • v.30 no.1
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    • pp.11-16
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    • 1997
  • The Increasing use of coronary perfusates for the protection of the human heart during ischemic cardiac arrest has placed great emphasis on the need for a rational and safe formulation. For the purpose of this study isolated rat hearts were connected to retrograde nonworking perfusion system proposed by Langendorff, and then perfused for 20 minutes by coronary infusates of magnesium concentration of 1.66 m Mol per liter(group A, n: 10) or 15mMo1 per liter(group B, n: 10). After 20 minutes perfusion, cold cardioplegic solution (modified St. Thomas'Hospital solution) was infused for 2 minutes, and prepared within 4$^{\circ}C$ Krebs-Henseleit solution. Finally, 20 minutes of cononay reprsfuslon was reestablished after I hour of cold ischemic cardiac arrest. Hemodynamic parameters (heart rate, left ventricular pressure, $\pm$ dp/dt max. and coronany flow) and enzymes assay (creatine phosphokinase, lactic dehydrogenase and flutamic oxaloacetic transaminase) were performed each other at whic rat heart was perfused for 20 minutes and reperfused for 20 minutes thereafter. There were significant differences in the recovery rate of heart rate, systolic left ventricular pressure, + dp/dt max, and coronary flow and reperfusion-perfusion ratio of creatine phosphokinase(P < 0.05). But, there were no signicant differences in the recovery rate of dp/dt max, and reperfunion-perfusion ratio of lactic dehydrogenase and glutamic oxaloacetic acid (P > 0.05).

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Development of Computerized Spirometer (Computerized spirometer의 개발)

  • Cha, E.J.;Park, I.S.;Song, C.H.;Kim, D.W.;Goo, Y.S.;Lee, T.S.
    • Proceedings of the KOSOMBE Conference
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    • v.1996 no.11
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    • pp.189-191
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    • 1996
  • Computerized spirometer was developed in a form of proto type system. The system consisted of pneumotachometer, flow measurement unit, fan ventilator unit, and software program. Patient's respiratory flow signal was first converted to corresponding pressure drop signal by a screen type pneumotachometer, sensed by a differential pressure transducer, amplified and low pass filtered, and digitized at a rate of 100 Hz, then fed into a PC thru RS-232C serial port. Customized application software controls data acquisition followed by computation of test parameters. The fan ventilator unit dries and eliminates microorganism in the pneumotachometer after each test. The system performs conventional spirometic tests and manages the test results in a database for retrograde research. The proto type system was fully developed and the commercialized system is currently being built up.

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Diagnosis of Subclavian Steal: Contrast Enhanced 3D MR Angiography vs 2D TOF

  • 이호규;김건언;최중곤;서대철
    • Proceedings of the KSMRM Conference
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    • 2001.11a
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    • pp.136-136
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    • 2001
  • Purpose: Subclavian steal refers to the retrograde flow of blood in a vertebral artery that supplies t ipsilateral shoulder and arm caused by proximal subclavian artery stenosis or occlusion. T purpose of this exhibit is to demonstrate MR findings of subclavian steal on contrast-enhanc 3D (CE 3DMRA) and 2D TOF MR angiography. Method: Four patients(men 3 and women 1, age: 28-78years) with subclavian steal obtained both CE 3DMRA and digital subtraction angiography(DSA) including subclavian arterie Sequential imaging was undertaken during first pass after double dose of Gd-DTPA (0 mM/kg) Injected by a power injector. Coronal source images were obtained with coronal D-fast low angle shot sequence(TR/TE/flip angle=3.8/l.3/35, acquisition time= 10sec/one measurement). Precontrast imaging was subtracted from enhanced images and maximu intensity projection was done. 2D time-of-flight MR angiography(2D TOF) of the carot bifurcation was added in all cases with post-saturation. All studies were review retrospectively.

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