ABSTRACT
No abstract available.
ABSTRACT
The patency of graft vessels and their effects on the native coronary circulation were studied by evaluation of 78 graft sites in 35 patients who underwent selective bypass graft angiography among 152 CABG cases at a mean follow-up 12.6 month. The result were as follows ; 1) The overall graft patency rate was 70.5% : 73.8% for left anterior descending artery, 68.4% for left circumflex arterty, 64.7% for right coronary artery. 2) The patency rate of internal mammary artery was 77.8%. 3) In twenty eight patients who underwent native coronary angiography, twelve pateints showed progression of coronary artery disease in grafted vessel and two patients showed progression of coronary artery disease in non-grafted vessel. 4) The treadmill test was performed before and after coronary artery bypass graft in thirteen patients. Among 13 patients, nine patinets showed improved exercise tolerance. 5) The percutaneous transluminal coronary angioplasty were successfully performed for dilating three cases of stenotic vein graft and two cases of left main lesions after CABG and one case of stenotic left internal mammary artery graft.
Subject(s)
Humans , Angiography , Angioplasty, Balloon, Coronary , Arteries , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease , Coronary Circulation , Coronary Vessels , Exercise Test , Exercise Tolerance , Follow-Up Studies , Mammary Arteries , Transplants , VeinsABSTRACT
This is a 30-year review of 4,059 patients who underwent cardiac operations at Yonsei University Medical Center between September 1, 1956 and August 31, 1986. Of these, there were 1,191 patients with acquired and 2,868 with congenital cardiac lesions, constituting 29% and 71% of the group, respectively. Of 1,191 patients with acquired lesions, the number in each major category and the operative mortality were as follows: closed mitral commissurotomy, 210 and 0.95%; open mitral commissurotomy, 164 and 43%, mitral valve replacement, 370 and 3.5%, aortic valve replacement, 154 and 9.7%; double valve replacement 123 and 2.4%, and coronary artery bypass grafting 94 and 85%. Of 2,868 patients with congenital cardiac lesions, the number and operative major categories were as follows: repair of tetralogy of Fallot, 593 and 93% repair of ventricular septal defect 817 and 7.1%, closure of atrial septal defect 403 and 1.5%, and closure of patent ductus arteriosus, 550 and 1.3%.
Subject(s)
Humans , Academic Medical Centers , Cross-Sectional Studies , Heart Diseases/surgery , Korea , Postoperative Complications/mortalityABSTRACT
Surgical revascularization is very effective for the relief of chest pain, improvement of exercise tolerance and ventricular performance in certain ischemic heart diseases. Bypass graft angiography and native coronary angiography after coronary artery bypass graft(CABG) were required for the evaluation of graft patency, progression of the native coronary artery disease and to predict the prognosis of the patients after CABG. The cases included in this study involved 15 patients who underwent selective bypass graft angiography among 102 CABG cases. Thirty eight sites were bypassed by saphenous vein and two sites by internal mammary artery. The results were as follows: 1) The overall patency rate of the saphenous vein bypass graft was 76.3% and the two sites of the internal mammary artery bypass graft were both patent. 2) The patency rate of direct anastomosis was 86.2% and of sequential anastomosis, 44.4%. 3) In eight patients who underwent native coronary angiography, five patients showed progression of grafted coronary artery disease. Among them, two patients had accompanying progression of coronary artery disease in non-grafted vessels. 4) Follow up treadmill test performed in six patients showed improvement of exercise tolerance in all patients. 5) There was some increase in the ejection fraction of the left ventricle after CABG in six patients who received follow up left ventriculography.
Subject(s)
Humans , Angiography , Chest Pain , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease , Coronary Vessels , Exercise Test , Exercise Tolerance , Follow-Up Studies , Heart Ventricles , Mammary Arteries , Myocardial Ischemia , Prognosis , Saphenous Vein , TransplantsABSTRACT
We studied the angiographic findings in 65 patients wtih congenital pulmonary atresia, ages 4 days to 14 years(mean 3.3 yrs), form 1981 to 1986 at Severance Hospital Yonsei University. 1. 6 had pulmonary atresia with anintact interventricular septum, 38 had it with cardiac anomaly Renodynamically simulating TOF, and 21 associatedwith more complicated cardiac anomalies. 2. In the group with an intact ventricular septum, 5 showed confluentintrapericardial pulmonary artery, all segmental pulmonary arteries connceted to intrapericardial pulmoanryartery. 3. In the group simulating TOF, aorta arose from RV with or without overriding in 35. In 27 patients withconfluent intrapericardial pulmonary artery, 23 had more than 10 segmental pulmoanry arteries connceted tointrapericardial artery and 5 had severely hypoplastic hilar pulmonary arteries. In 11 with nonconfluentintrapericardial pulmonary artery, 4 had more than 10 segmental pulmonary arteries connected to central pulmonaryartery and 9 had severely hypoplastic hilar pulmonary arteries. 4. In the group associated with more complicatedcardiac anomaly, included 8 patients with atrioventricular discordance, 7 with univentricular heart and 6 withtricuspid atresia. In 17 patients with confluent intrapericardial artery, 16 had more than 10 segmental pulmoanryarteries conncected to intrapeircardial artery, one showed severe hypoplasia of hilar pulmonary arteries. Inanother 4 with nonconfluence, no one showed more than 10 segmental arteries conncted to intraperdicardial or hilarpulmonary artery.
Subject(s)
Humans , Aorta , Arteries , Heart , Pulmonary Artery , Pulmonary Atresia , Ventricular SeptumABSTRACT
A method for one-lung anesthesia in which a 14 Fogarty emboiectomy catheter is used to occlude a main bronchus is described. The method is quick, simple, effective and reliable. It eliminates most of the problems which occurs with the standard technique of using a double-lumen cuffed endotracheal tube. During one-lung mannual ventilation, anesthesia was maintained with ketamine I.V. infusion and pancuronium. Before and after one-lung anesthesia, halothane-nitrous oxide-oxygen and pancuronium were used. No significant problems regarding blood pressure, pulse rate, EKG and arterial blood gases were encountered in 3 lung cancer cases who had a pneumonectomy, a lung biopay and a left lower lobectomy.
Subject(s)
Anesthesia , Blood Pressure , Bronchi , Catheters , Electrocardiography , Gases , Heart Rate , Ketamine , Lung , Lung Neoplasms , Pancuronium , Pneumonectomy , VentilationABSTRACT
Clinical problem occuring in the early post operative period after cardiopulmonary bypass may ne related to the altered function of capillary bed which was affected by activation of complement system. This is so called post perfusion syndrome. We selected 20 patients with confirmed congenital heart disease by cariac catheterization. We studied the changes in the C3 , immunolglobulins, total protein, and WBC count while performing open heart surgery. The results were as followed. 1. C3 level was lowest during cardiopulmonary bypass and returned to the normal level after 8 days. 2. Each immunoglobulin level decreased just after cardiopulmonary bypass, especially the IgG level, and immunoglobulins slowly returned to the normal range after 8 days. 3. Serum total protein level and electrophoretic fractions were comperatively reduced as much as immunoglobulin levels. 4. WBC count was lower just before cardiopulmonary bypass than baseline.
Subject(s)
Humans , Capillaries , Cardiopulmonary Bypass , Catheterization , Catheters , Complement System Proteins , Heart Defects, Congenital , Immunoglobulin G , Immunoglobulins , Oxygenators , Perfusion , Reference Values , Thoracic SurgeryABSTRACT
During cardiac catheterizations in 20 cases with congenital heart disease, intracardiac shunts were measured by two methods, dye dilution method and the Fick method, and the results were compared. Arterial dilution curves were used for the estimation of both the right-to-left and left-to-right shunts-Venous dilution curves were used for measurement of left-to-right shunts. In cases with a left-to-right shunt, the amount of the shunt was expressed as per cent of total pulmonary blood flow and, in cases with a right-to-left shunt, as per cent of total systemic blood flow. The following results were obtained. 1. In 8 cases with a right-to-left shunt, the amount of the shunt was 35.6 +/-18.1% by the Fick method and 34.0 +/-19.2% by arterial dilution curves. The difference was not statistically significant(p> 0.l). In 15 cases with a left-to-right shunt, the amount of shunt was 41.3 +/-26.6% by the arterial dilution curve and 36.6 +/-14.O% by the Fick method. The difference was not statistically significant(p> 0.1). Also venous dilution curve was performed in 8 cases of left-to-right shunt and the amount of the shunt was 33.0 +/-21.0%, as compared to 35.5 +/-17.3% by the Fick methods. The difference was not statistically significant (p> 0.1). 2. Arterial dilution curves could be used to localize right-to-left shunts and venous dilution curves left-to-right shunts, whereas tile Fick method was helpful only for the localization of left-to-right shunts. 3. It was possible to detect small left-to-right (less than 10%) and right-to-left (less than 5%) shunts by dye dilution curves, which was not possible with the Fick method. 4. In detection of small intracardiac shunts as well as in shunt localization, the dye dilution method was more accurate than the Fick method. The difference of the amount of the shunt estimated by the two methods was not statistically significant.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Cardiac Output , Dye Dilution Technique , Heart Defects, Congenital/physiopathology , Heart Function TestsABSTRACT
Open heart surgery under cardiopulmonary bypass which is combined with moderate hypothermia and 5% dextrose priming offers several advantages over the conventional methods; i.e., simplification of the machine, economy in operation, elimination of the need for a large amount of heparinized blood, avoidance of hemaological complications and utilization of the unit as a standby method. The results of open heart operations with this method in our initial 10 cases were comparable to other methods. None of the complications and the mortality were directly attributable to the oxygenator itself.
ABSTRACT
A hypothermic, low flow perfusion, using 5% dextrose in water as the priming fluid in the pump-oxygenator, was carried out to observe oxygen consumption, blood pH changes, and CO2 tension during the bypass period. A low oxygen consumption which was approximately one third of the preperfusion value, was observed during the total by-pass period. This is believed to be due to the effect of low flow rates employed, hypothermia and low CO2 tension observed in these animals. The pH of the arterial blood and the partition of the total CO2 remained within a fairly normal range. There was a marked reduction in CO2 tension during the bypass period. Its harmful effect on the oxyhemoglobin dissociation curve and cerebral circulation was discussed. The hemodilution attendant to the use of 5% dextrose in water as the priming fluid is considered insignificant.
Subject(s)
Animals , Dogs , Glucose/adverse effects , Heart-Lung Machine , Hypothermia, Induced , Plasma Substitutes/adverse effectsABSTRACT
No abstract available.