Midterm results of aortic root enlargement with AVR in patients with narrow aortic root and AS / 대한흉부외과학회지

BACKGROUND: For AVR using conventional prosthetic valves in adult patients with a narrow aortic root, aortic root enlargement is necessary to reduce postoperative pressure gradient across the aortic valve (deltaP). An evaluation of early and mid-term results of aortic root enlargement with AVR and echocardiographic follow up of deltaP and left ventricular function was performed. METHOD: From Aug. 1991 to Feb. 1998, eighteen patients aged 17 to 59 years(mean, 38+/-12 years) underwent Manouguian procedure with AVR. Aortic annular circumstance was enlarged 10.0mm to 18.0mm(mean, 12.6+/-6.3mm). Eight patients(44.0%) had NYHA class III status before operation, and seven cases of them underwent concomitant MVR. Valve pathology was ASr in 6 cases, AS in 4 cases, nd ASr+MSr in 8 cases. Replaced valve size was 21mm in 8 cases and 23 mm in 10 cases, and St. Jude Medical mechanical valve was used in 10 cases and Carbomedics in 8 cases. RESULT: Follow-up duration was 6 to 57 months (mean, 26+/-18 months), and total follow-up was 287 patient-year. There were one hospital death and one late death, therefore, actuarial survival rate was 85.7% at 56 months. Peak deltaP wad decreased significantly at postoperative mid-term period as 13+/-5mmHg, compared with thepreoperative one (42+/-8mmHg) (p<0.01). LVM(gm/m(2)) was also diminished as 35.8%(115+/-36gm/m(2))at postoperative mid-term period, compared with preoperative one (179+/-56gm/m(2))(p<0.05). CONCLUSIONS: There were no specific complications related to the procedure. And we could have adequate enlargement of aortic annulus to suitable prosthetic valve that have no effect of patient-prosthese mismatch.

Off-pump CABG for Unstable Angina Complicated With COPD / 대한흉부외과학회지

In an attermpt to aviod the deleterious effects of cardiopulmonary by pass such as pulmonary complication neurologic complication and renal failure off-pump CABG has been rediscovered and developed. We experienced off-pump CABG in 2 cases with unstable angina complicated with COPD and report herein the cases with review of literature.

Clinical Experience of Pectus Excavatum Corrected by Ravitch Method / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to analyze the clinical results ad operative compatability by Ravitch methods with pectus excavatum. MATERIAL AND METHOD: From 1984 to 1997, were performed Ravitch operations in 40 patients of pectus excavatum and analyzed the effects of correction and postoperative complication according to time of operation retrospectively. The group comprised 35 mem and women whose mean age was 8.9+/-7.9 years(between 2 to 35 years). All patients had corrected with Ravitch operation or its modified operation. Modified fixations were accomplished with K-wire in 15 patients and internal plate in 2 and the materials were removed 3 months after operation. The result of correction was estimated with the degree of changed distance between inner surface of sternal body and vertebral in 3 months after correction. RESULT: Postoperative complications were wound disruption in 14 patients. Estimated distances after correction ranged 0.4 cm to 4 cm. The acceptability for chest wall correction was high(6 excellent, 29 good in criteria of Humphreys). CONCLUSION: We concluded that the benefits of Ravitch operation were a high acceptability of patients and their family, and sufficient correction with no specific complications related operation.

Hematologic Changes and Factors Related to Postoperative Hemorrhage Following Cardiopulmonary Bypass / 대한흉부외과학회지

BACKGROUND: Cardiopulmonary bypass (CPB)-induced hemostatic defects may result increased possibility of excessive hemorrhage and additional multiple transfusion reactions or reoperation. Particularly, fibrinolytic activation and decreased platelet count and function by CPB were proposed as a predictor of hemorrhage during postoperative periods in several reports. MATERIALS AND METHODS: Present study, which was conducted in 20 adult patients undergoing CPB, was prospectively designed to examine the hematologic changes, including fibrinolytic activation during and after CPB and to clarify the relationships between these changes and the magnitude of the postoperative nonsurgical blood loss. The serial blood samples for measurment of hematologic parameters were taken during operation and postoperative periods. Blood loss was respectively counted via thoracic catheter drainage at postoperative 3, 6, 12, 24, 48 hours and total period. RESULTS: The results were obtained as follows:Platelet count rapidly declined following CPB (p<0.01), which its decreasing rate was an inverse proportion to total bypass time (TBT, r=0.55, p=0.01), And platelet count in postoperative 7th day was barely near to its control value. Fibrinogen degradating product (FDP) and D-dimer level significantly increased during CPB (p<0.0001, p<0.0001, respectively), and both of fibrinogen and plasminogen concentration correlatively decreased during CPB (r=0.57, p<0.01), implying activation of fibrinolytic system. Postoperative bleeding time (BT), postoperative activated partial thromboplastin time (aPTT) and postoperative prothrombin time (PT) were significantly prolonged as compare with each control value (p=0.05, p<0.0001, p<0.0001, respectively). Total blood loss was positively correlated with patient's age, aortic clamping time (ACT) and TBT, while there was negative correlation between platelet count and blood loss at pre-CPB, CPB-off and the 1st postoperative day, and in some periods. Postoperative aPTT and postoperative PTwere positively related to postoperative 6 hr and 48 hr blood loss (r=0.53, p=0.02; r=0.43, p=0.05) but not to total blood loss, whereas there was no relationship between postoperative BT and blood loss at any period. CONCLUSIONS: These observations suggest that CPB results various hematologic changes, including fibrinolytic activation and severe reduction in platelet count. Diverse factors such as age, platelet count, ACT, TBT and postoperative aPTT and PT may magnify the postoperative bleeding. This study will be a basic reference in understanding CPB-induced hemostatic injuries and in decreasing the postoperative hemorrhage.

Clinical Experiences of Open Heart Surgery / 대한흉부외과학회지

BACKGROUND: From Sept. 1985 to Sept. 1997, 2,000 cases of open heart surgery (OHS) were performed in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. MATERIAL AND METHOD: Among the total of 2,000 cases of OHS, 1532 cases were congenital heart disease (CHD) and 468 cases were acquired heart disease (AHD). The age distribution was 9 days (4.0kg) to 68 years in CHD and 11 to 66 years in AHD. In 1532 cases of CHD, there were 1403 acyanotic cases and 129 cyanotic cases. RESULT: The CHD cases consisted of 940 ventricular septal defects (61.4%), 324 atrial septal defects (21.1%), 112 tetralogy of Fallot (7.3%), 46 pulmonary stenosis (3%), 38 endocardial cushion defects (2.5%), 15 valsalva sinus ruptures (1%), 4 transposition of great arteries (0.3%), 4 double outlet right ventricles (0.3%), and etc. Corrective operations were applied for congenital heart disease with a result of 3.1% hospital mortality. Of 468 AHD, 381 cases were valvular heart diseases, 48 ischemic heart diseases, 12 cardiac tumors, 8 annuloaortic ectasias, 16 dissecting aortic aneurysms and etc. In the 381 valvular heart diseases, there were 226 single valve replacements (36 aortic valve replacements (AVR), 188 mitral valve replacements (MVR), and 2 tricuspid valve replacements (TVR), among these were 71 cases of double valve replacements (AVR & MVR), 54 cases of MVR with tricuspid valve annuloplasty (TVA), and 18 cases of AVR, MVR with TVA. The total implanted prosthetic valves were 466. In MVR, 123 St. Jude Medical valves, 90 Carpentier-Edwards valves, 65 CarboMedics valves, 42 Sorin valves and 16 other valves were used. In AVR, 68 St. Jude Medical valves, 36 CarboMedics valves, 14 Carpentier-Edwards valves and 9 other valves were used. Coronary Artery Bypass Surgery (CABG) were performed in 48 cases. The patterns of bypass graft were 14 patients of single vessel graft, 21 patients of two vessels graft, 10 patients of three vessels graft and 3 patients of four vessels graft. CONCLUSION: The hospital operation mortality rate of congenital acyanotic, cyanotic and acquired heart diseases were 2.0%, 15.5%, and 5.1% respectively. The overall mortality rate was 3.6% (72/2,000).