Surgical Repair of the Congenital Aneurysm of the Rght Atrium / 대한흉부외과학회지

The four most common types of congenital malformations involving the right atrium(RA) and the coronary sinus(CS) are congenital enlargement of the RA, single RA diverticulum, multiple diverticula of the RA, and aneurysm of the RA or CS. A previously healthy 6year-old child was presented with signs of upper respiratory tract infection. Chest X-ray and echocardiogram revealed a severely isolated right atrial enlargement. The abnormally dilated right atrim was widely resected under cardiopulmonary bypass. Pathology revealed multifocal myocardial loss associated with mild fibrotic changes of the endocardium and epicardium. Our experience on this rare congenital disease is presented along with a review of the literature.

Surgical Repair of the Congenital Aneurysm of the Rght Atrium / 대한흉부외과학회지

The four most common types of congenital malformations involving the right atrium(RA) and the coronary sinus(CS) are congenital enlargement of the RA, single RA diverticulum, multiple diverticula of the RA, and aneurysm of the RA or CS. A previously healthy 6year-old child was presented with signs of upper respiratory tract infection. Chest X-ray and echocardiogram revealed a severely isolated right atrial enlargement. The abnormally dilated right atrim was widely resected under cardiopulmonary bypass. Pathology revealed multifocal myocardial loss associated with mild fibrotic changes of the endocardium and epicardium. Our experience on this rare congenital disease is presented along with a review of the literature.

The Clinical Analysis of the Intermittent Warm Blood Cardioplegia by Admixing Potassium Only / 대한흉부외과학회지

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant. CONCLUSION: The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.

Coronary Artery Bypass Surgery in Patients with End-Stage Renal Disease / 대한흉부외과학회지

BACKGROUND: As cardiac disorders, especially coronary artery disease is increasing in end-stage renal disease patients, the indications for coronary artery bypass surgery are increasing now. They have high risks for postoperative morbidity and mortality after coronary artery bypass surgery. MATERIAL AND METHOD: Between March of 1996 and May of 2000, medical records of 25 patients with end-stage renal disease who underwent coronary artery bypass surgery at Asan medical center were reviewed retrospectively. We reviewed the short-term results of preoperative risk factors, preoperative renal function, perative methods, operation results, hospital course, postoperative morbidity and mortality. RESULT: Preoperative creatinine clearance was 12.68+/-5 ml/min and serum creatinine level was 6.18+/-3 mg/dL(range 1.7-14. 4). Preoperatively, 11 patients(44%) received dialysis and the others(14 patients, 56%) were not supported by dialysis due to adequate urine output. Of the non-dialysis patients(14 cases), 8 patients were newly supported by dialysis, perioperatively. Of the preoperative hemodialysis patients(9 cases), two patients changed dialysis method postoperatively to peritoneal dialysis. Operative mortality occured in 2 patients(8%) and the causes of death were sepsis from aspiration pneumonia and mediastinitis, and postoperative bleeding and mediastinitis, respectively. Postoperative complications were developed in 14 patients(56%). There were 2 cases(8%) late mortalities and the cause of death was catheter-induced peritonitis. The actuarial survival rates in hospital survivals at 4 years was 82+/-13%. CONCLUSION: The coronary artery bypass surgery of end-stage renal disease patients were performed with acceptable mortality(8%). However , because the morbidity and mortality from morbidity were very frequent, perioperative prevention of infectious complications and careful patient management are very important.

Postcardiotomy Biventricular Assist Device in Adult Heart Disease / 대한흉부외과학회지

A 65-year-old male patient with preoperative severe left ventricular dysfunction and mitral and tricuspid insufficiency went into low cardiac output and failure to wean, biventricular assistance was provided with centrifugal pumps. The patient survived the ordeal. This is the first reported case of a survival after biventricular assistance using the centrifugal pump.