The Clinical Effect of Administration of Magnesium Sulfate in Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: Hypomagnesemia is a common complication after cardiac surgery with cardiopulmonary bypass. The purpose of this study was to assess the clinical beneficial effect of administration of magnesium sulfate in cardiac surgery. MATERIAL AND METHOD: Thirty five patients scheduled for elective cardiac surgery were randomly assigned to magnesium group (n=20) which received magnesium sulfate in priming solution (1 g) and cardioplegic solution (1 g) or control group (n=15) which did not receive it. Arterial blood samples were drawn for measuring Mg++ and electrolytes contents, blood gas analysis, CBC, total protein, albumin, blood urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine phosphokinase (CpK), creatine kinase-MB (CK-MB), lactate dehydrogenase(LDH), troponin-I (TNI), prothrombin time (PT) and activated pratial thromboplastin time level (aPTT). Venous blood samples were drawn before and after the operation for measuring activated clotting time level (ACT). RESULT: Mg++ levels in magensium group were higher than those of control group at intraoperative and postoperative periods (p<0.05). dysrhythmias were lower in magnesium group (8 cases out of 17 patients, 46.4%) than in control group (10 cases out of 10, 100%, p=0.050). CONCLUSION: These results showed that administration of low dose magnesium sulfate during cardiac surgery prevented hypomagnesemia and lowered incidence of dysrhythmia.

Results of Femoro-Below Knee PTFE Bypass Graft

PURPOSE: Saphenous vein allografts are used for femoral-below knee bypass graft purposes in chronic lower limb ischemia. Polytetrafluoroethylene (PTFE) is an acceptable material for bypass graft, when it is difficult to gain a suitable vein for the graft material, such as the great saphenous, small saphenous, or arm vein. However, some controversy exists as to whether PTFE is equivalent to the saphenous vein as bypass graft material for femoral below knee revascularization. A retrospective analysis was performed to obtain results about femoral-below knee bypass graft using PTFE in chronic lower ischemia patients. METHOD: Between July 1992 and June 2002, 56 patients with chronic lower limb ischemia underwent femoral-below knee bypass graft. The results of treatment were analyzed retrospectively by the patients's clinical records. Kaplan-Meier analysis was used to estimate patency rate. RESULT: There were 52 men and 2 women, of mean age 66.6 years. The primary patency rate was 65.6%, 44.9%, 38.0%, and 34.0%, and the secondary patency rate was 85.7%, 72.0%, 72.0%, and 56.1%, after 1, 2, 3, and 5 years, respectively. The limb salvage rate was 78.8% in severe lower limb disease, such as disabling claudication, non-healing ulcer, and gangrene. The major amputation rate was 14.3%. There was no mortality within one month after bypass operation. The primary and secondary rates were not correlated with diabetes, inflow procedure, or severity of lower limb ischemia. CONCLUSION: The overall results of this study show that PTFE grafts have an acceptable patency rate when used for femoral-below knee bypass surgery in patients with chronic lower limb ischemia. This study suggests that early diagnosis of occlusion in graft and adjuvant procedures offers improved patency and limb salvage rate.

Crawford Type III and IV Thoracoabdominal Aortic Aneurysm: 4 Cases Report

Thoracoabdominal aortic aneurysm is rare but potentially lethal, and its repair continues to present a surgical challenge because of obligate intraoperative visceral, renal, and spinal cord ischemia. In the past, the authors have experienced 4 cases of Crawford Type III and IV thoracoabdominal aortic aneurysm which were treated by a direct surgical approach. The diagnosis was made by CT scan, and aortogram. We repaired the thoracoabdominal aortic aneurysms with Knitted Dacron graft by a single inclusion button that encompasses the origins of the celiac, superior mesenteric, and right renal artery and left renal artery reconstruction with a separate side arm PTFE graft. the visceral ischemia time was less than 45 minutes in 3 operable cases and no paraplegia occurred after thoracoabdominal aortic reconstruction. two cases of Type IV thoracoabdominal aortic aneurysm with emergent presentation were fatal but elective surgical repairs of Type III and IV thoracoabdominal aortic aneurysm were survived. Appropriate patient selection and prevention of visceral or spinal cord ischemia may be helpful in the repair of Type III and IV thoracoabdominal aortic aneurysm.