Microbial Contamination of Autologous Peripheral Blood Stem Cell / 대한수혈학회지

BACKGROUND: The incidence and clinical consequences of microbiological contamination of autologous peripheral blood stem cells are not well documented. Therefore, we retrospectively analysed our experience with microbial contamination of autologous peripheral blood stem cell concentrates. METHOD: We have determined the incidence and clinical significance of positive microbiologic cultures in series of 52 peripheral blood stem cell concentrates in 14 patients undergoing multiple apheresis procedures for autologous stem cell rescue. Specimens for bacterial cultures were obtained after processing of the autografts just prior to freezing. RESLUTS: The incidence of microbial contamination was 7.7%. The microorganism cultured was coagulase negative Staphylococcus. The patient with contaminated leukapheresis products received two culture-positive stem cell concentrates and three culture-negative stem cell concentrates without adverse clinical sequelae. No microorganism present in the stem cell autograft was recovered in vivo in the posttransplantation period, although fever as a sign of infection occurred in this patient. CONCLUSIONS: Although microbial contamination may occur during autologous peripheral blood stem cell collection and cryopreservation, this report suggests that peripheral blood stem cell contamination may not play a significant role in the infectious complications of autologous peripheral blood stem cell transplantation.

Effects of Verapamil Cardioplegia on the Hypertrophied Left Ventricle Undergoing Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Verapamil, a calcium channel blocker, is known to protect the myocardium against ischemia and reperfusion injury. The hypertrophied myocardium is at greater risk for ischemic damage compared to the normal heart during cardiopulmonary bypass (CPB). We evaluated the myocardial protective effect of verapamil cardioplegia on the hypertrophied left ventricle during CPB. METHODS: Seventeen patients with end-diastolic anterior wall thickness (DAWT) greater than 11 mm in an M-mode echocardiogram were consented to participate in this study. Patients were randomized to receive either standard hyperkalemic blood cardioplegic solution (n = 8) or the same solution with verapamil (n = 9). End systolic anterior wall thickeness (SAWT) and DAWT were measured by an M-mode echocardiogram and the left ventricular ejection fraction (LVEF) was calculated with a 2-dimension echocardiogram before and after CPB. Simultaneously, hemodynamic variables were measured. RESULTS: There was no significant difference of DAWT and LVEF between both groups before and after CPB. DAWT was increased after CPB but this increase was attenuated by verapamil in patients with LVH. LVEF was decreased in both groups after CPB and the decrease in the verapamil group was not statistically significant but in the control group. Cardiac index and stroke volume index didn't show any significant differences between the two groups after CPB, either. CONCLUSIONS: DAWT increased which means myocardial edema was significant in patients with LVH; however, a verapamil cardioplegic solution decreased the amount of increase in DAWT. However, theverapamil cardioplegic solution didn't improve the hypertophied ventricular systolic function after CPB.

Clinical Experiences of Cardiac Surgery Using Minimal Incision / 대한흉부외과학회지

BACKGROUND: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. MATERIAL AND METHOD: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. RESULT: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. CONCLUSION: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

Minimally Invasive Approach for Reoperative Mitral Valve Replacement / 대한흉부외과학회지

Minimally invasive techniques for various cardiac disease are widely accepted in these days. We report a successful case of reoperative mitral valve replacement approached successfully by a small right parasternal incision.

Less Invasive Surgical Transcatheter Closure in an Old Patient with Patent Ductus Arteriosus Porstmann's Procedure / 대한흉부외과학회지

Of several techniques for closure of the patent ductus arteriosus, the less invasive surgical ranscatheter closure without thoracotomy (the Porstmann's procedure) may have a place between the Rashkind procedure and thoracotomy. We describe here a 68 year old woman with calcified patent ductus arteriosus which was successfully closed by the Porstmann's procedure.

Monitoring of Activated Coagulation Time with Kaolin vs. Celite Activator in Cardiac Surgical Patients with Aprotinin / 대한흉부외과학회지

BACKGROUND: High-dose aprotinin has been reported to enhance the anticoagulant effects of heparin during cardiopulmonary bypass ; hence, som authors have advocated reducing the dose of heparin in patients treated with aprotinin. MATERIAL AND METHOD: The ACT was measured before, during and after cardiopulmonary bypass, with Hemochron 801 system using two activators of celite (C-ACT) and kaolin (K-ACT) as surface activator. From June, 1996 to February, 1997, 22 adult patients who were scheduled for elective operation were enrolled in this study. RESULT: The ACT without heparin did not differ between C-ACT and K-ACT. At 30 minutes after anticoagulation with heparin and cardiopulmonary bypass, the average C-ACT was 928+/-400 s; K-ACT was 572+/-159s (p<0.05). After administration of protamine, C-ACT was 137+/-26 s; K-ACT was 139+/-28s, which were not statistically significant. CONCLUSION: Our results showed that the significant increase in the ACT during heparin-induced anticoagulation in the presence of aprotinin was due to the use of celite as surface activator, rather than due to enhanced anticoagulation of heparin by aprotinin. We conclude that the ACT measured with kaolin provides better monitoring of cardiac surgical patients treated with high dose aprotinin than does the ACT measured with celite. The patients treated with aprotinin should receive the usual doses of heparin.

Effects of Three Different Regimens of Aprotinin Dosage on Blood Loss During Open Heart Surgery / 대한마취과학회지

BACKGROUND: High dose of aprotinin has been known to reduce the requirement for homologous transfusion and the loss of blood during cardiac operation. The aim of this study was to investigate an effective minimal dose of aprotinin. METHODS: With IRB approval 61 patients undergoing cardiac operation were divided into four groups. Group I was control (n=15). Group II(high dose aprotinin, n=16) received an infusion of 24,000 KIU/kg of aprotinin followed by continous infusion of 6,000 KIU/kg per hour until the end of operation. A bolus of 24,000 KIU/kg was added to pump prime solution. Group III(low dose aprotinin, n=16) received a bolus of 24,000 KIU/kg to prime solution. Group IV(minimal dose aprotinin, n=14) received a bolus of 12,000 KIU/kg to prime solution. Coagulation profiles were analysed and blood loss through chest tubes & amount of homologous transfusion was measured. Statistical analysis was performed using one-way variance analysis. RESULTS: Group II demonstrated less amount of blood loss than group I with statistical significance. Blood loss in group III was reduced about 20% but the reduction was not statistically significant. Group IV could not reduce the blood loss. CONCLUSION: This study shows the efficacy of high and low dose(not statistically significant) aprotinin infusion during cardiac surgery in postoperative blood loss. Use of aprotinin less than low dose regimen may not be effective in reducing the blood loss and amount of homologous transfusion in cardiac operation.

Comparison of Radial and Femoral Arterial Pressure in Pediatric Patients Undergoing Open Heart Surgery / 대한마취과학회지

BACKGROUND: It has been known that a reversal of usual relationship between aortic and radial artery pressures(RAP) can occur in adult patients following cardiopulmonary bypass(CPB). The phenomenon of a pressure gradient between RAP and femoral artery pressure(FAP) were evaluated in pediatric patients before and after CPB. METHODS: 141 perdiatric patients undergoing open heart surgery were allocated into 2 groups. Group 1(n=77): infant's body weight was below 10kg. Group 2(n=64): child's body weight was between 10 and 20kg. After induction of anesthesia RAP was measured through 22G(1 inch) or 24G(3/4 inch) catheters and FAP was measured through 20G(2 inch) or 22G(1 inch) catheters using calibrated transducers. Hematocrit, rectal and nasopharyngeal temperature and left atrial pressure(LAP) were recorded 10 min after induction, immediately, l5, 30 and 60 min after CPB. Values are expressed as mean+/-SD and analysed using paired and unpaired t-test; p<0.05 was considered significant. RESULT: Systolic femoral arterial pressure(SFAP) was higher than radial arterial pressure(SRAP) before CPB in both groups. After CPB, the pressure gradient persisted in group 2 but was reversed with statistical significance in group l. CONCLUSION: When hypotension occurs during cardiac surgery, a comparison is recommended between radial and femoral or aortic pressure before treatment for hypotension is contemplated.

Comparison of Radial and Femoral Arterial Pressure in Pediatric Patients Undergoing Open Heart Surgery / 대한마취과학회지

BACKGROUND: It has been known that a reversal of usual relationship between aortic and radial artery pressures(RAP) can occur in adult patients following cardiopulmonary bypass(CPB). The phenomenon of a pressure gradient between RAP and femoral artery pressure(FAP) were evaluated in pediatric patients before and after CPB. METHODS: 141 perdiatric patients undergoing open heart surgery were allocated into 2 groups. Group 1(n=77): infant's body weight was below 10kg. Group 2(n=64): child's body weight was between 10 and 20kg. After induction of anesthesia RAP was measured through 22G(1 inch) or 24G(3/4 inch) catheters and FAP was measured through 20G(2 inch) or 22G(1 inch) catheters using calibrated transducers. Hematocrit, rectal and nasopharyngeal temperature and left atrial pressure(LAP) were recorded 10 min after induction, immediately, l5, 30 and 60 min after CPB. Values are expressed as mean+/-SD and analysed using paired and unpaired t-test; p<0.05 was considered significant. RESULT: Systolic femoral arterial pressure(SFAP) was higher than radial arterial pressure(SRAP) before CPB in both groups. After CPB, the pressure gradient persisted in group 2 but was reversed with statistical significance in group l. CONCLUSION: When hypotension occurs during cardiac surgery, a comparison is recommended between radial and femoral or aortic pressure before treatment for hypotension is contemplated.