Intraoperative Management of Patients Undergoing Off-pump Coronary Artery Bypass Graft Using the Tissue Stabilizer / 대한마취과학회지

BACKGROUND: Coronary artery bypass graft with cardiopulmonary bypass is the standard surgical coronary revascularization procedure; however, there are many adverse effects such as air embolism, and high rate of neurologic and coagulation complications. In this article, we describe hemodynamic alterations during coronary bypass grafting (CABG) without cardiopulmonary bypass but using a medical tissue stabilizer. METHODS: Thirty patients were included in our study who underwent an off-pump CABG (OPCAB) between 1/1999 and 12/1999. RESULTS: We created 73 anastomoses. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could be corrected by anesthetic interventions such as fluid load and low dose inotropics. Complications included postoperative panperitonitis (one patient), and delirium tremens (one patient). On the other hand, major complications, such as intraoperative myocardial infarction and stroke did not occur. The median postoperative length of hospital stay was 14 days. Overall operative mortality was 3.3% (one patient). CONCLUSIONS: On the basis of the present data, off-pump coronary artery bypass grafting appeared to be a safe and effective technique in selected patients with appropriate coronary lesions. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon.

Hemodynamic Changes and Clinical Symptoms Resulting from Stellate Ganglion Block / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) is the most common nerve block procedure in pain clinics. To evaluate changes in the hemodynamics and peripheral blood flow on the affected extremity after SGB, SGB was performed unilaterally one at a time on the right and left stellate ganglions by injecting 1% mepivacaine 10 ml without epinephrine in a designated healthy man. METHODS: SGB was repeated 16 times in one subject (right side SGB: 8, left side SGB: 8) by the same clinician. The mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and peripheral blood flow were measured in the supine position before (control), and 3, 6, 9, 12, and 15 minutes after SGB using thoracic electrical bioimpedence (Bioz system A-10043, Cardiodynamics, USA), sphygomanometer, and flow meter. RESULTS: The values after SGB including MAP, HR, CI, and SVRI increased slightly compared to the control value. However, peripheral blood flow increased significantly (p < 0.05). The SGB did not affect systematic hemodynamics and the comparison between left and right SGB in hemodynamic changes were not clinically significant. Following SGB, ptosis (100%), nasal stiffness (100%), skin temperature elevation (100%), hoarseness (100%), numbness (81%), dizziness (25%), and swallowing difficulty (25%) were observed. CONCLUSIONS: We concluded that SGB showed to be a hemodynamically safe clinical technique.

The Effect of Vitamin E on the Endothelial Function Following a Single High-Fat Meal in Normal Subjects, Patients with Coronary Heart Disease and Patients with Diabetes

BACKGROUND AND OBJECTIVES: The hyperlipidemia by a high-fat diet induce the endothelial dysfunction. We have performed this study to determine the relationship between postprandial hypertriglyceridemia and endothelial function and to know the effects of vitamin E on the endothelial function. MATERIALS AND METHOD: Endothelial function was measured by flow-mediated brachial artery vasodilation (FMD) as percent diameter changes. We have serially measured lipid profiles and FMD after a meal in normal subjects (10 males, mean:26 yr), which test was repeated according to types of meal (high-fat, low-fat and high-fat meal with 800 IU vitamin E). The second stage of this study is consisted of 10 patients with coronary artery disease (CAD, mean:50 yr) and 10 diabetes (DM, mean:48 yr). RESULTS: The serum triglycerides were significantly increased at 2 and 4 hours after a high-fat meal. The FMD was transiently decreased (p<0.001) to 7+/-4% and 7+/-2% at 2 and 4 hours only after a high-fat meal from 13+/-4% at fasting state. The FMD was inversely related with postprandial hypertriglyceridemia (r=0.52, p<0.05). The baseline FMD in patients with CAD and DM were all lower, 9+/-4% and 10+/-5% respectively, than 15+/-2% of normal subjects. The FMD in patients with CAD were improved to 13+/-4%, 13+/-4% and 11+/-6% at 2, 4, and 6 hours after a meal plus vitamin E, respectively. The FMD in diabetic patients were not decreased as same manor in normal subjects. CONCLUSION: The vitamin E can prevent the endothelial dysfunction which is induced by postprandial hypertriglyceridemia in normal subjects and can improve the endothelial dysfunction in patients CAD as well as DM.

Clinical Experiences in Radiofrequency Catheter Ablation / 대한내과학회지

OBJECTIVES: Among the current therapeutic options for paroxysmal supraventricular tachycardias, only surgery and ablative techniques are curative. However, surgery is associated with substantial cost, morbidity, and rarely death. Recently, catheter ablation techniques have been developed to treat paroxysmal supraventricular tachycardias. These techniques are effective and low-risk curative treatment for supraventricular tachycardias. This article shall describe our clinical experiences in radiofrequency catheter ablation for supraventricular tachycardias and review the literature. METHODS: The study population consisted of 154 patients with supraventricular tachycardias from January 1993 to August 1995. Eighty one patients were men and seventy three patients were women, and their mean age was 41.29 +/- 15.41 years. Radio-frequency currents(mean) were applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus or atrioventricular node. RESULTS: Among 154 patients, the mechanisms for paroxysmal supraventricular tachycardias were found to be atrioventricular reentrant tachycardia involving a concealed accessory pathway in 51(33.1%), Wolff-Parkinson-White syndrome in 57(37%), and atrioventricular nodal reentrant tachycardia in 46 (29.9%). Successful outcomes were achieved in 46 of 46 patients(100%) with atrioventricular nodal reentrant tachycardia, 7 of 8 patients(87.5%) with double accessory pathways, 69 of 72 patients(95.8%) with left-sided accessory pathway, and 19 of 28 patients (67.9%) with right-sided accessory pathway. Total 141 of 154 patients(91.6%) with supraventricular had a successful outcome with radio-frequency current application(mean). CONCLUSIONS: Radiofrequency catheter ablation techniques are highly effective in ablating accessory pathways or modifying atrioventricular node, with low morbidity and no mortality.

Transesophageal Echocardiography in the Detection of Intracardiac Source of Cerebral Emboli

BACKGROUND: Intracardiac pathology resulting in embloic phenomena is a well-recognized cause of cerebral ischemia and infarction. Recently, the use of transesophageal echocardiography(TEE) has gained wide acceptance because of its superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purposes of this study are to evaluate the effectiveness of TEE for detection of intracardiac source of cerebral emboli. METHOD: From 1991 to 1995, 215 patients were included in this study. All patients underwent both transthoracic and transesophageal imaging with saline contrast administration and Doppler color flow imaging. The study group consisted of 132 men and 83 women with a mean age of 51 years(range 15-74). We also reviewed TEE result of all patients according to two groups, which were divided by the presence of clinical cardiac abnormalities. RESULT: 1) TEE identified a potential cardiac source of embolism in 43.7%(94 to 215) of the overall study group compared with only 3.7%(8 to 215) by TTE. 2) Success rate of TEE was 93.5%(201 to 215). 3) Abnormalities noted by TEE included 23 patients with LA spontaneous echo contrast, 20 patients with patient foramen ovale, 16 patients with aortic atheroma, 16 patients with LA thrombi, 8 patients with atrial septal aneurysm, 5 patients with aortic valve prolapse, 4 patients with mitral valve prolapse, and 2 patients with LV thrombi. 4) In the 62 patients with cardiac disease, TEE identified 16 patients with LA spontaneous echo contrast, 12 patients with LA thrombi, 2 patients with patent foramen ovale, 1 patient with aortic atheroma, 1 patient with atrial septal aneurysm and 1 patients with aortic valve prolapse. In the 152 patients with no cardiac disease, TEE identified 18 patients with patent foramen ovale, 15 patients with aortic atheroma, 7 patients with artial septal aneurysm, 7 patients with spontaneous echo contrast, 4 patients with aortic valve prolapse, 1 patient with mitral valve prolapse and 1 patient LA thrombi. CONCLUSION: TEE was very useful method in investigating potential intracardiac source of cerebral emboli. Thus, the use TEE combined with TTE in patients with unexplained stroke should be recommended.

Quantification of Large Pericardial Effusion by Two-Dimensional Echocardiography

BACKGROUND: The accurate information about the volume of pericardial effusion can assist in clinical decisions and has impartant prognostic value. In addition, accurate quantification of serial change in effusion volume is necessary in assessing pericardial disease and making a decision of immediate drainage. This study was performed to evaluate the efficacy of 2-D echocardiographic quantification of pericardial effusion. METHOD: The study populations are 22 patients with large pericardial effusion whose volume of effusion is confirmed by paracentesis or surgical drainage. Through the echocardiographic reviw, the volume of pericardial sac and heart was calculated by method of D'cruz and then, the effusion volume was derived as the difference of two volumes. Each echocardiographically calculated volume of pericardial effusion was compared with the measured volume drained percutaneously or surgically. RESULTS: The volume of pericardial effusion calculated echocardiographically was excellently correlated with the drained volume(r=0.90, p < 0.01). The echo-free space was well correlated with the volume of pericardial effusion in the anterior aspect of the heart(r=0.71, p < 0.01), but not in the posterior aspect. CONCLUSION: 2-D echocardiographic Quantification of pericardial effusion is simple and reliable method, and its clinical efficacy may be great.

The Characteristics of Primary Cardiac Tumors Occured in Korean People

OBJECTIVES: Primary cardiac tumors are rare, being found in approimately 1 in 10,000 to 33 in 1,000 routine autopsies in patients of all ages. The purpose of this study is to evaluate the status of primary cardiac tumor in Korea, Their clinical and pathological characteristics. We analysed our 13 cases of primary cardiac tumors confirmed by operative findings, and all cases which were published in several literatures. METHOD: Thirteen cases of primary cardiac tumors confirmed by pathologic findings from 1982 in keimyung university hospital, and 116 cases of published data from 1962 were reviewed their pathologic and clinical findings. RESULTS: One hundred and twenty nine cases were included in this study, The age was ranged from 15 dyas to 75 years old. 45 cases(35%) were male and 84(65%) were female. 119 cases(92.2%) were revealed benign tumor : 115 myxoma, 2 rhabdomyoma, 1 lipoma and 1 fibroma. 10 cases(7.8%) were malignant tumors : 4 angiosarcoma, 2 fibrous histiocytoma, 2 rhabdomyosarcoma, 2 fibrosarcoma. The most common site of benign tumor was left atrium, and of malignant tumor was right atrium. CONCLUSION: Most of primary cardiac tumors were benign. And left atrial myxoma was most common primary cardiac tumor. Angiosarcoma was most common malignant tumor, occured in right atrium most frequently.

The Tissue Damage due to Radiofrequency Energy in Bovine Skeletal Muscle

BACKGROUND: Radiofrequency(RF) catheter ablation has rapidly emerged as the treatment of choice for symptomatic reentrant arrythmia associated with accessory pathway or atrioventricular node conduction. Rarely RF catheter ablation therapy can produce the cardiac perforation, ventricular function insufficiency and arrythmia. So, the purpose of this study was to determine the correlation between the RF energy and muscle injury. METHODS: Bovine skeletal muscle was immersed in normal saline, and the entire chamber was heated to 36-37degrees C by water bath. The 4mm tip 7 Fr electrode catheter was placed horizontally on the skeletal muscle surface withoup pressure. RF energy was delicered to tissue for the pulse duration of 10, 20, 30, 40, 50, 60 seconds and voltage of 10, 15, 20, 25, 30, 35, 40, 45volt and total 432 lesions were produced. Horizontal, vertical lesion diameters and depths were measured, and the area and volume of lesion were calculated. RESULTS: Increasing voltage and duration of RF increased the horizontal and vertical diameter, depth, area and volume of lesion(p<0.0001). The RF pulse duration and voltages made lesion below 5mm depth were 45volt applied dbelow 20seconds, 40volt applied below 25seconds, 35volt applied below 32seconds, 30volt applied below 38seconds, 25volt applied during any duation of time. CONCLUSION: So, for prevention of undesirable tissue damage, the adequate pulse duration and voltage of RF must to be delivered to tissue.

Trend of Serum Lipid Levels in Normal Koreans

The authors underwent the serum lipid study, involving the lipoprotein fraction, and the HDL-cholesterol mean values in normal Korean adults visited to Hanyang University Hospital, and also compared with the previously reported serum lipid studies. The results are as follows; 1) The mean values of triglyceride, total cholesterol, and phospholipid were 103.3+/-17.1mg%, 188.9+/-18.2mg%, and 196.7+/-19.8mg%, respectively. 2) Compared with the past 7 years triglyceride showed increasing tendency with significance, and cholesterol and phospholipid showed slightly increasing tendency. 3) In the serum lipoprotein fraction, the mean values of alpha-lipoprotein, pre-beta-lipoprotein, and beta-lipoprotein were 37.2+/-5.9%, 16.0+/-4.2%, and 48.6+/-5.2%, respectively. 4) Compared with the past 10 years, the alpha-, and pre-beta-lipoprotein showed increasing tendency, meanwhile, beta-lipoprotein revealed decreasing tendency. 5) The mean value of HDL-cholesterol was 52.3+/-14.6mg%, and the ratio of HDL-cholesterol to total cholesterol(HDL-cholesterol/total cholesterol) was 28.2+/-7.9. 6) Compared with the past 2 years, HDL-cholesterol level showed slightly increasing tendency.

Clinical Study of Japanese Encephalitis in 1982, Seoul and Surronding area

Japanese Encephalitis had been epidemic nationally in Korea in 1982, even it has a tendency of decrease lately. We had experienced and treated 42 patients in Han Yang University hospital and following results were obtained. 1. It is commoner in male and popular in age of 10-29. 2. Main initial symptoms are fever and headache, followed by mental change, vomiting and tightness of neck. 3. Mortality rate is 23.8% and higher in male. 4. It is noticed to be effective that therapy is focused to increased intracranial pressure by Glycerol and steroid and maintain good general care.