Supravalvular Aortic Stenosis with Aortic Regurgitation / 대한흉부외과학회지

Supravalvular aortic stenosis is an uncommon, congenital narrowing of the ascending aorta which originates just distal to the level of the ostium of the coronary artery. We conducted a successful surgical treatment in a 39 year- old female patient with a congenital supravalvular aortic stenosis and aortic regurgitation who did not show signs of William's syndrome. After we performed an inverted Y-shaped aortotomy toward the noncoronary sinus and right coronary sinus, pantaloon shaped prosthetic patch(Vascutek, Ino, USA) was used to repair the narrowing sinotubular junction. The aortic valve was replaced concommittently using Sorin Bicarbon 19mm. Her postoperative course was uneventful. The patient discharged at 9th postoperative day in good health.

Short Term Clinical Experiences of 52 Sorin Bicarbon Mechanical Valves / 대한흉부외과학회지

From June 1995 to May 1997, we have implanted 52 Sorin Bicarbon mechanical valves in 41 patients. They were 16 men and 25 women, and their mean age was 47.4+/-14.8 (range; 18~74 y.o.). 35 (27 mm~31 mm) were in mitral position, 15 (19 mm~25 mm) in aortic position, and 2 (31 mm) in tricuspid position. 3 CABGs and a tumor excision were taken concomittantly. 35 patients were primary operation, and 6 were re-do operations. By intraoperative transesophageal doppler echocardiography, transvalvular peak/mean pressure gradient was 6.1+/-2.7/2.4+/-1.4 mmHg in mitral position and 27.6/10.7 mmHg in aortic position. The effective valve opening area in mitral position was 3.2+/-0.6 cm2. Follow-up was total 508.6 patient-months, and mean follw-up was 12.7+/-9.2 months. NYHA class was improved from 2.6+/-0.6 to 1.2+/-0.3 in average postoperatively. During that period, there was no operative death. 2 late non-valve related deaths were occurred. One was died of COPD, and the other was possible acute myocardial infarction. Among 7 postoperative complications, one valve related complication (minimal paravalvular leakage) was noticed. In conclusion, Sorin Bicarbon mechanical valve is believed one of the safe choice in clinical settings. It showed excellent hemodynamic and mechanical functions, and very low postoperative valve related complications in short term clinical experience.

The Effects of Esmolol or Labetalol on Hemodynamic and Catecholamine Level in Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Sympathetic blocking agent, esmolol (selective beta 1 blocker) or labetalol ( alpha and beta blocker) would prevent the hypertension and tachycardia from endotracheal intubation. We have carried out the study to see the effects of esmolol or labetalol on the blood pressure, heart rate, rate pressure product and plasma catecolamines during the endotracheal intubation. METHODS: Thirty-three ASA physical status 1 or 2 adult patients were allocated into three groups; Group I:control (n=10), Group II:esmolol (n=11) and Group III: labetalol (n=12). In Group I, 2 ml of normal saline, in Group II, 1 mg/kg of esmolol, and in Group III, 0.2 mg/kg of labetalol were given 3, 2 and 4 minutes before endotracheal intubation. Blood pressure and heart rate were measured after arrival at the operating room, before endotracheal intubation and after endotracheal intubation at 15, 60, 120, 180 and 300 seconds interval under the inhalation anesthesia (enflurane-N2O-O2). Rate-pressure product was calculated from the heart rate and systolic blood pressure (RPP = heart rate x systolic blood pressure). The plasma cathecolamines, dopamine, norepinephrine and epinephrine, were measured before intubation as a baseline value and 2 minute after intubation. RESULTS: Systolic blood pressure, rate-pressure product and heart rate were significantly lower in esmolol and labetalol groups than in control group after intubation ( p 0.05). Plasma level of dopamine, norepinephrine and epinephrine showed higher values after intubation in all three groups ( p0.05). The side effects of esmolol and labetalol did not appear at all. CONCLUSION: 1 mg/kg of esmolol given 2 min before intubation or 0.2 mg/kg of labetalol given 4 min before intubation reduce increasing of blood pressure and heart rate, caused by adnergic response following endotracheal intubation, significantly. The reason is that esmolol and labetalol do not decrease release of catecholamines but attenuate responses of elevated catecholamines following endotracheal intubation.