Alterations in Thyroid Hormone Levels after Open Heart Surgery / 대한흉부외과학회지

The hemodynamic effects of thyroid hormones which is well established, affect myocardial contractility, heart rate, and myocardial oxygen consumption. The alterations in thyroid function test are frequently seen in patients with nonthyroidal illness and often correlate with the severity of the illness and the prognosis. In this study, thyroid hormone changes were investigated in 20 patients who received cardiopulmonary bypass(CPB). All patients showed a state of biochemical euthyroidism preoperatively. The results were as follows : 1. Serum triiodothyronine(T3) reached to its nadir(30.05+/-17.5ng/dl, p<0.001) at 10 minutes after the start of CPB and remained low(p<0.05) throughout the study period. 2. Serum thyroxine(T4) concentration slightly decreased after CPB, but maintained within normal range. 3. Serum free thyroxine(fT4) concentration slightly increased after CPB, but maintained within normal range. 4. Serum thyroid stimulating hormone(TSH) concentration increased 10 minute after CPB, reached to its nadir(3.37+/-0.81uIU/ml, p<0.001) at 2 hours after CPB. After then, serum TSH concentration decreased and reached its normal levels at 24 hours after CPB. 5. The patients whose postoperative recovery was uneventful(Group 1) had higher serum T3 levels than those who had postoperative complications(Group 2)(p<0.05). Group 1 showed elevating patterns of serum T3 in the fourth day after operation, whereas group 2 did not show such an elevating pattern. These findings are similar to the euthyroid sick syndrome seen in severely ill patients and indicate that patients undergoing open heart surgery have suppression of the pituitary-thyroid axis.

Clinical Results of Aortic Valve Replacement / 대한흉부외과학회지

From August 1986 until June 1995, single aortic valve replacement was performed in 65 patients at the Chonnam National University Hospital. Forthy-eight were male and 17 were female patients, ranging from 19 to 68 years of age (median=43 years). The causes of the valve lesions were rheumatic in 29 patients (44.6%), bicuspid aortic valve in 6 patients (6.2%), endocarditis in 6 patients (6.2%), unknown in others. Concomitant surgical procedures were performed in 10 patients: repair of congenital defect in 5, pericardiectomy in 1, coronary artery bypass grafting in 1, noncoronary sinus plication in 1, Valsalva sinus aneurysmectomy in 1, subaortic membrane resection in 1. Used valves were St. Jude-Medical valve in 42, Duromedics valve in 22, Bjork-Shiley valve in 2, Carpentier-Edward valve in 1. There were 3 hospital deaths (4.6%), and 2 late deaths (3.2%). Follow-up was 95.2% complete. The 10-year acturial survival rate was 85.3%. Postoperative complications were low cardiac output in 8, arrythmia in 5, valve related hemolysis in 1, cerebral infarction in 1, and gastrointestinal bleeding in 2. Reoperation was performed in 4 for surgical bleeding, in 3 for paravalvular leak. The mean improvement in New York Heart Association functional class is from 2.79+-0.66 preoperatively to 1.25+-0.49 postoperatively (p<0.001) The change of cardiothoracic ratio from preoperative to postoperative is 0.57+-0.06 to 0.54+-0.05 (p<0.05). The left ventricular ejection fraction change is not significant perioperatively. There are no mechanical failures. This early and intermediate-term follow-up suggests that in adults in whom valve repair is not possible, the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and a low rate of thromboembolic event.

Treatment of multiple rib fracture and flail chest with Judet's strut: 105 Case Report / 대한흉부외과학회지

There were 105 patients with multiple rib fracture or flail chest who had underwent surgical rib fixation using Judet's strut from Aug. 1989 to Aug. 1995. They were 86 men and 19 women, and the age distribution was from 17 to 77(mean 48+/-12). The most common cause of accident was a traffic accident(81%). The mean number of rib fracture was 5.5 and the distribution of patient were flail chest(72, 64.7%), severe displaced rib Fracture(18, 17.1%), traumatic chest wall deformity(10, 95%) and others(5, 4.7%). The operative mortality was 1 patient(0.96%) and the incidence of postoperative complication were 13 patients(12.3%). The duration of perioperative artificial ventilator therapy was 90.5+/-22.6 hours. Our method allowed shorter duration of an artificial ventilation and decreased a functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and thus obviates the need for artificial ventilation and prevents post-traumatic chest deformity.

Surgical Treatment of Persistent Ductus Arteriosus Complicated by Bacterial Endocarditis with Pulmonary Artery Embolism: 1 case report / 대한흉부외과학회지

A fifteen-year-old boy was transported to our hospital emmergency room due to sudden onset of chest pain, hemoptysis and dyspnea. He was diagnosed as persistent ductus arteriosus that had developed acute bacterial endocarditis with pulmonic valve vegetation and pulmonary embolism with pulmonary infarction. After conservative antibiotic therapy (vancomycin+aminoglycoside), we operated this patient successfully - patch closer of the ductus and pulmonary valve valvuloplasty - under the cardiopulmonary bypass.

Surgical Treatment of Persistent Ductus Arteriosus Complicated by Bacterial Endocarditis with Pulmonary Artery Embolism: 1 case report / 대한흉부외과학회지

A fifteen-year-old boy was transported to our hospital emmergency room due to sudden onset of chest pain, hemoptysis and dyspnea. He was diagnosed as persistent ductus arteriosus that had developed acute bacterial endocarditis with pulmonic valve vegetation and pulmonary embolism with pulmonary infarction. After conservative antibiotic therapy (vancomycin+aminoglycoside), we operated this patient successfully - patch closer of the ductus and pulmonary valve valvuloplasty - under the cardiopulmonary bypass.