Alterations in Circulating Thyroid Hormones in Children with Open Heart Surgery

Lee, Won Bae,Lee, Byung Churl CATHOLIC MEDICAL CENTER 1987 Bulletin of the Clinical Research Institute Vol.15 No.1

Many nonthyroidal illnesses in adults cause alterations in thyroid hormone metabolism. Despite depressed serum total thyroxine and triiodothyronine levels, these patients are considered to be euthyroid. We prospectively studied sequential alteration in circulating thyroid hormones in children with open heart surgery. We studied 25 children with open heart surgery and 20 normal children. Children with open heart surgery were studied immediately before induction of anesthesia, immediately after surgery, and 24, 48, 72 hours after surgery. Serum concentrations of T_3, T_4, reverse T_3 and TSH were measured by radioimmunoassay. The results are follows: 1. Significant reduction in serum T_3, and T_4 concentration (32 and 52%) was observed at 24 hours after surgery with a progressive increase toward normal values at 72 hours after surgery. 2. Significant elevation in serum reverse T3 concentration (291%) was observed at 24 hours after surgery with a progressive decrease to 148%of control at 72 hours after surgery. 3. Serum TSH concentration was not changed significantly. Our study demonstrated prospectively that euthyroid sick syndrome occurred in majority of children with open heart surgery.

부산 백병원에서 실시한 개심술의 최근 기법

조광현 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Background 3,175 cardiac surgeries were performed in the Pusan Paik Hospital from Sep. 1985 to April 2002, and recently several kinds of current techniques for open heart surgery were adopted with good results. ■ Method Retrospective analysis of the cases and review of the results of operation and usefulness of current techniques such as OFF-Pump CABG. ARCH-FIRST TECHNIQUE. MICRO-WAVE ABLATION, TRANSPLANTATION and MINIMAL INCISION were done. ■ Results ① Among the total cases (3,179), open heart and non-open heart surgery cases were 1,988 and 218, respectively. ② 188 cases of CABG were done. Among them, 20 cases underwent OFF-PUMP coronary artery bypass surgery. 21 cases underwent complete arterial revascularization, and 14 cases underwent both. ③ 75 cases of aortic aneurysm (ascending or arch aneurysm) were operated undercardiopulmonary bypass. The causes of these aneurysm were dissecting aneurysm (45), annuloaortic ectasia(24), non-dissecting chronic aneurysm(5). In the surgery of arch aneurysm. 7 cases underwent ARCH-FIRST TECHNIQUE with good results. ④ In the treatment of atrial fibrillation coupled with valvular heart disease. MICRO-WAVE ABLATION were performed in 18 cases with 83.3 % sinus rhythm recovery. ⑤ Four cases of heart transplantation were performed, using Shumway method, with 3 survivals and one death. ⑥ Minimally invasive incision (using lower sternal incision) was performed successfully in the cases of tricuspid valve diseases(10) and congenital septal defects (50). ■ Conclusion The over all postoperative hospital mortality with open heart surgery was not so high as 3.5 %, whereas more proper management of the all patients with current techniques must be continued.

개심술 및 일반 흉부수술 환자에서 Cefpiramide sodium(Cefirad^(�))의 임상적 효과

김상형,나국주,오봉석,문은선 최신의학사 1995 最新醫學 Vol.38 No.6

Investigating the Effect of Acupressure on the Patients’ Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial

Bagher Khoram,Amin K. Yoosefinejad,Mozhgan Rivaz,Seyed S. Najafi 사단법인약침학회 2020 Journal of Acupuncture & Meridian Studies Vol.13 No.6

Background: Anxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects. Objectives: The purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open-heart surgery. Method: This is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoints over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study. Results: The results showed that before acupressure, there was no statistically significant difference between state anxiety scores and intergroup traits, and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group, respectively include (p < 0.001) (p = 0.01), but these changes in the control group did not show a statistically significant difference. After completing the second phase of the intervention at the actual sites, systolic blood pressure (p = 0.007) and heart rate (p = 0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups. Conclusion: Based on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety. Further larger-scale and rigorous studies are warranted.

소아 개심술 환아에서의 Cardiac Troponin I의 변화

김여향,현명철,이상범,Kim, Yeo Hyang,Hyun, Myung Chul,Lee, Sang Bum 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.2

목 적 : 수술 중, 후의 심근 손상은 선천성 심질환에 대한 개심술 후 심장 기능 부전의 주원인이다. 이 연구에서는 심근 세포에서만 발견되는 cardiac troponinI를 측정함으로서 수술 중, 후 심근 손상 정도와 회복 여부를 반영할 생화학적 표지자로서의 가치를 확인하고자 하였다. 방 법: 2001년 4월부터 7월까지 선천성 심질환으로 진단받고 개심술을 위해 본원에 입원한 환아 34명을 대상으로 하였다. Cardiac troponin I 치의 측정을 위해 술전 24시간 이내, 술후 1, 2, 3, 7일째에 각각 채혈을 시행했고, CPB 시간, ACC 시간, 기도 삽관시간, 수술 후 입원 기간을 측정하였다. 결 과 : Cardiac troponin I 치는 수술 후 1일째가 수술 전에 비해 유의한 증가가 있었고, 2, 3, 7일째에는 점차적으로 유의한 감소를 보였다. 심질환 별로는 수술 후 1일째 대혈관 전위에서 cardiac troponin I 치가 가장 높았고, 활로씨 4징, 방실중격결손, 심실중격결손, 심방중격결손 순으로 높은 치를 나타내었다. 심장폐 우회술 시간이 길수록, ACC 시간이 길수록 수술 후 1일째 cardiac troponin I 농도가 높았고, cardiac troponin I 농도가 높을수록 기도삽관 시간이 길었으나 입원 기간과는 상관관계가 없었다. 결 론: 개심술 후 시간에 따라, 개심술을 시행한 심질환에 따라 cardiac troponin I 농도의 의미 있는 증가와 점차적인 감소를 보임으로써 cardiac troponinI는 개심술 후 심근 손상의 정도 및 심근 손상에서의 회복 여부를 반영하는 생화학적 표지자로 가치가 있을 것으로 생각된다. Purpose : The major cause of cardiac dysfunction, after open heart surgery for congenital heart disease, is perioperative myocardial injury. Cardiac troponin I is found only within the myocardial cell, so it can be used as a biochemical marker of the myocardial injury. We performed this study to evaluate the worth of cardiac troponin I as a biochemical marker reflecting the extent of perioperative myocardial injury and recovery. Methods : Thirty-four patients who had undergone elective open heart surgery of congenital heart disease(CHD) from April to July 2001 were enrolled in this study. We measured types of CHD, serial cardiac troponin I(baseline 1 day before operation, postoperative day 1, 2, 3, 7), duration of cardiopulmonary bypass(CPB), aortic cross clamping(ACC), intubation and postoperative hospital stay. Results : Compared with the baseline before operation, there was a significant, increase of cardiac troponin I on the postoperative day 1 and a significant gradual decrease on the day 2, 3, 7. The levels of cardiac troponin I were the highest in the transposition of great artery(TGA) repair on the postoperative day 1 and high in the tetralogy of Fallot(TOF), atioventricular septal defect (AVSD), ventricular septal defect(VSD) and atrial septal defect(ASD) repair with decreasing sequence. The longer duration of CPB, ACC and intubation, the higher of cardiac troponin I, but there were no significant correlations between cardiac troponin I levels and duration of hospital stay. Conclusion : Because there was significant increases or decreases of cardiac troponin I according to the perioperative time and types of the congenital heart disease, it is a worthy biochemical marker which reflects the extent of perioperative myocardial injury and recovery after open heart surgery.

반세기 전 한국에서 근무하였던 한 미국흉부외과 의사 -Dr George Schimert-

김원곤 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.2

Dr. George Schimert, born in 1918 in Switzerland, received his medical degrees from universities in Hungary and in Germany. After immigration to the United States, he continued medical training at several hospitals. In 1956, for pursuit of cardiac surgery, he had joined the group headed by Dr. Walt Lillehei at the University of Minnesota. During this period, in 1958, he joined Seoul National University Hospital as a overall medical adviser and adviser in surgery for 15 months in partnership with the University of Minnesota Medical School. During his stay in Korea, in addition to the works in the medical administration and education, he contributed to the early establishment of thoracic surgery program. In August 6, 1959, he performed open heart surgery using cardiopulmonary bypass for an ASD patient at Seoul National University Hospital. However, the patient died 6 hours after the operation. In 1960, after returning to the United States, he began his career at Buffalo General Hospital as the first director of its cardiac surgery program. In 1985, the Dr. George Schimert Lectureship and Medical Conference was established to honor his contributions and achievements. He died December 7, 2002.

최근 10년간 원광의대병원에서 시행한 소아 심장혈관 수술의 임상적 고찰

윤향석,정수미,최두영,오광수,오연균,김종덕,양현웅,이삼윤,김형곤,최종범,최순호,노병석 圓光大學校 醫科學硏究所 1995 圓光醫科學 Vol.11 No.2

We reviewed 10 years experiences of the clinical aspects and early postoperative results in 544 pediatric patients(age less than 16 years old). Among them. 529 cases had the congenital heart diseases, and 15 had the acquired diseases. Open heart surgery was performed in 413 patients. 115 cases were treated with non-open heart surgery. 16 with interventional catheterization. Annual increase of the cardiac patients was not significant in recent 10 years, except slight increase in 1994. The mean age of the study patients had been evidently changed to younger year by year. Total mortality rate of the open heart surgery was 6.4%. The cyanotic congenital heart diseases were high in early postoperative mortality by 25.7%, whereas 4% in acyanotic group. The age group less than one month was most highest in surgical mortality(66.7%). There were no deaths in patients with patent ductus arteriosus(103 cases), atrial septal defect(83 cases) or pulmonary stenosis(17 cases). Among 220 patients with ventricular septal defects(VSD). 10(4.5%) were died early postoperatively. In cyanotic group, the patients with pulmonary atresia with ventricular septal defects(PAVSD), transposition of the great arteries(TGA), interrupted aortic arch(IAA), complex cardiac anomalies with isomerism seemed to be most susceptible to an early death.

개심술을 받은 환자에서 C형 간염 항체검사

박승국,안성훈,최세영,허정욱,이광숙,유영선 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.3

C형 간염 진단법으로 anti-HCV 검사법이 개발된 이후 수혈후 간염의 대부분이 C형 간염이 원인으로 밝혀지고, 특히 장기이식, 다량 수혈을 받은 위험군에서의 anti-HCV 양성율이 높게 나타남이 보고되고 있다. 이에 저자들은 많은 양의 혈액을 수혈받은 개심술 환자에서 anti-HCV 양성율을 조사하고자 하였다. 각종 심장질환으로 개심술을 받은 61명을 대상으로 수술전과 수술후 1, 3, 6,개월에 각각 간기능 검사를 시행하였고, 수술후 1개월과 6개월에 Abbott사의 ,kit를 이용한 효소결함합착법으로 anti-HCV 검사를 시행하였다. 개심술 전후 간기능검사에서 유의한 변동은 없었다(p〉0.05). 대상환자 61명중 1명 (1.6%)에 불과하나 일단 C형 간염에 감염될 경우 만성간염, 간경변중, 간암 등의 이행율이 높고 한국인 공혈자와 일반국민에서 anti-HCV 양성율이 1-1.5%이며 이들의 혈액을 수혈받을 경우 수혈후 간염의 약 90%가 C형 간염이 원인인 점과 anti-HCV 검사로 수혈후 간염을 약 70%까지 감소시킬 수 있다는 보고에 따라 향후 개심술 환자가 수혈을 받을 때는 필히 수혈받을 혈액을 anti-HCV 검사르 시행함으로 해서 C형 간염의 예방에 큰 기여가 되리라 생각되고 개심술후에는 주기적으로 간기능검사와 anti-HCV 검사를 해 볼 필요가 있으리라 사료된다. To evaluate the prevalence of antibody to hepatitis C virus (anti-HCV) in patients with open heart surgery we did a prospective study of alanine aminotransferasa (ALT) before operation and one, three and six months after operation and of anti-HCV one and six months after operation in 61 patients who had taken open-heart surgery. No significant change was noted in liver function test before and after operation. One(1.6%) of 61 patients was anti-HCV positive after operation. Hepatitis C virus is the major cause of post-transfusion hepatitis in Korea and in the world. But the positive rate of anti-HCV was very low in our study. It is uncertain whether the cause is due to false negativity, failure of detection of anti-HCV or low positivity of anti-HCV of dornated blood.

소아 선천성 심장병 개심술 후 발생한 조기 부정맥

최희정,김여향,조준용,현명철,이상범,김규태,Choi, Hee-Joung,Kim, Yeo-Hyang,Cho, Joon-Yong,Hyun, Myung-Chul,Lee, Sang-Bum,Kim, Kyu-Tae 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

목 적 : 선천성 심장병의 개심술 직후에 발생하는 부정맥은 술 후 조기 사망의 주된 원인의 하나인데, 이는 심폐 우회술 및 심근보호법의 발달, 술 후 집중치료와 적절한 약물 치료로 감소시킬 수 있다. 이에 이번 연구에서는 선천성 심장병의 개심술 후 조기에 발생한 부정맥의 빈도와 종류, 그 위험 인자들을 조사하여 보았다. 방 법: 2002년 1월부터 2008년 12월까지 선천성 심장병으로 경북대학교병원에서 개심술을 시행받은 561명의 환자를 대상으로 하였다. 이들의 의무기록지를 후향적으로 조사하여 진단명, 수술방법, 수술 후 부정맥이 발생한 시기와 기간, 부정맥의 종류와 치료방법, 부정맥으로 동반된 합병증 및 사망률, 부정맥 발생 당시 혈액 전해질 수치 등을 분석하였다. 결 과 : 소아 개심술 후 조기 부정맥의 빈도는 7.3% (42/578 개심술)로 남아 23명, 여아 18명이었으며, 개심술을 시행 받은 나이는 평균 $8.7{\pm}19.8$개월, 몸무게는 평균 $5.8{\pm}4.0kg$이었다. 발생한 부정맥 종류는 방실 접합부 이소성 빈맥이 17례로 가장 많았고, 다음으로 가속 심실고유 율동이 13례였으며, 또한 대혈관 전위에 대한 동맥 전환술에서 가장 많은 빈도의 부정맥을 보였다(36.4%). 대부분의 부정맥은 치료에 반응이 좋았다. 개심술 후 조기 부정맥의 위험 인자로는 수술 당시 작은 몸무게, 어린 나이, 긴 인공 심폐기 시간과 긴 대동맥 차단 시간이었다($P$<0.05). 부정맥이 발생한 환자에서 그렇지 않은 환자에 비해 인공호흡기 사용시간과 집중치료실 입원기간이 의미있게 길었으나($P$<0.05), 사망률에서는 의미있는 차이가 없었다. 결 론 : 선천성 심장병의 개심술 후 발생하는 조기 부정맥은 주의깊은 감시와 적극적인 치료로 치명적인 결과를 줄일 수 있다. 최근 개심술의 나이가 낮아짐에 따라 술 후 조기 부정맥에 대한 더욱 세심한 관리가 필요할 것으로 생각된다. Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.

영아의 선천성심질환에 대한 개심술후의 집중치료에서 복막투석용 도관삽입의 의의

오재화,윤향석 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.2

Background: We reviewed 5 years' experience with peritoneal drainage(PDr) in infants who underwent open heart surgery. The aim of this study was to investigate the effect of PDr on fluid balance and several parameters of intensive care. We hypothesized that PDr is safe and effective in infants with low-output cardiac failure after cardiac operations. Methods: Six(3.3%) of 60 consecutive infants who underwent open heart surgery required peritoneal dialysis(PD) during the PDr. Simple PDr was performed in remaining 54 infants. The silicone rubber PD catheter was inserted into the center of abdominal cavity just after the operation, and the subsequent PDr was maintained during the intensive care. Results: Early postoperative mortality in all in infants with congenital heart disease was 1.6%. Total amount of intake was 6.30±1.59 ㎖/㎏/hr, and total output was 6.95±2.32 ㎖/㎏/hr, urine output was 5.08±2.55 ㎖/㎏/hr, pleural fluid 0.78±0.52 ㎖/㎏/hr, peritoneal fluid 1.20±0.90 ㎖/㎏/hr. The ratio of the output to the intake(O/I) was 1.1. None of the complications required early termination of the drainage. Hemodynamics and pulmonary function were maintained steadily during the postoperative intensive care. Conclusions: The early institution of peritoneal drainage(PDr) in infants with congenital heart disease after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function.