ABSTRACT
BACKGROUND: The efficacy of the hemostasis of prophylactic aprotinin after cardiac valve replacement was evaluated from January 1994 to December 1996 at Pusan National University Hospital. MATERIAL AND METHOD: In a randomized study, 20 patients received aprotinin(2x106 KIU as a loading dose for 30 minutes after anesthesia, 1x106 KIU for priming and 5x105 KIU/hr as a maintenance dose from the completion of loading dose till skin closure) and another 20 untreated patients served as controls. RESULT: Aprotinin produced a significant reduction in postoperative blood loss compared with controls and significantly decreased total exposure to allogenic blood products compared with the control group(p<0.05). CONCLUSION: We conclude that aprotinin effectively reduces postoperative blood loss and trasfusion in patient undergoing cardiac valve replacement.
Subject(s)
Humans , Anesthesia , Aprotinin , Heart Valves , Heart , Hemostasis , Postoperative Hemorrhage , Skin , Thoracic SurgeryABSTRACT
BACKGROUND: Medtronic-Hall mechanical valve is a world widely using prosthesis. But, in Korea, the clinical result from Medtronic-Hall valve replacement is not frequenthy available. MATERIALS AND METHODS: From March 1986 to May 1990, 50 patients underwent valve replacement surgery with Medtronic-Hall valve at Pusan National University Hospital. Seventeen were male and thirty three were female and ra nging in age from 16 to 70 years of age (mean=35 years). RESULTS: The causes of valvular lesion were rheumatic in 43 patients, bicuspid aortic valve in 3 patients, degenerative lesion in three patients and bacterial endocarditis in one patient. The operative procedures were mitral valve replacement (MVR) in 38, aortic valve replacement (AVR) in 5 and double valve replacement (DVR) in 7. The most commonly used valve size was 21mm in AVR, 29mm in MVR. Concomitant surgical procedures were performed in 15 patients; left atrial thrombectomy in 9, left atrial auricle obliteration in 6 and tricuspid annuloplasty in 5 (Kay: 2, DeVega: 3). New York Heart Association functional class was mostly Class I or II (91.5%) preoperatively and Class IIIor IV (87.2%) after operation. The findings of postoperative echocardiogram of LAD, LVESD, LVEDD were reduced compared with preoperative period and ejection fraction was increased compared with preoperative period. Postoperative complications were massive bleeding in three, low cardiac output syndrome in two, thromboembolism in one and fulminant hepatitis in one patient. There were three hospital deaths and their causes were low cardiac output syndrome in two and rupture of left ventricle in one patient. The 5 year survival rate was 93.65+/-0.71% and 10 year actuarial survival rate was 88.27+/-6.42%. CONCLUSIONS: Medtronic-Hall mechanical valve has low valve related complication rate. It's durability and hemodynamic performance is comparable to other mechanical valves.
Subject(s)
Female , Humans , Male , Aortic Valve , Bicuspid , Cardiac Output, Low , Endocarditis, Bacterial , Heart , Heart Valve Prosthesis , Heart Ventricles , Hemodynamics , Hemorrhage , Hepatitis , Korea , Mitral Valve , Postoperative Complications , Preoperative Period , Prostheses and Implants , Rupture , Surgical Procedures, Operative , Survival Rate , Thrombectomy , ThromboembolismABSTRACT
BACKGROUND: Multiple trauma patients have rapidly increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Multiple trauma can involve injuries to the heart, lung, and great vessels and influence the lives, necessitate prompt diagnosis and treatment. Most of the thoracic injuries can be managed with conservative method and simple surgical procedures, such as closed thoracostomy, but in certain cases open thoracotomy is necessary. MATERIALS AND METHODS: The author analyzed the surgical result of 70 cases of open thoracotomy after multiple organ injury including thoracic organ. RESULTS: The most common type of thoracic lesion was hemothorax with or without pneumothorax and diaphragmatic rupture was the second. Sixty percent of the patients were associated with bone fractures, 42.9% with abdominal injuries, and 37.1% with head injuries. The modes of operation were ligations of torn vessels for bleeding control (48.6%), repair of diaphragm (35.7%), and repair of lung laceration (25.7%) in this order of frequency and additional procedures were splenectomy (14.3%), hepatic lobectomy (8.6%) and repair of liver lacerations (5.7%). Postoperative complications were atelectasis (8.6%), wound infection (8.6%), and pneumonia (4.3%). Postoperatively six patients died (The mortality rate was 8.6%) and the causes of death were respiratory failure (2), acute renal failure (2), sepsis (1), and hypovolemic shock (1).