This study was designed to determine if topical cardiac hypothermia is a necessary adjunct to intraoperative myocardial protection. In this study, 105 patients ranging in age from 22 to 74 years were included. Myocardial temperature was measured at the ventricular septum. All patients received cold blood cardioplegia without topical cooling. In most of the patients(90%) the myocardial temperature was dropped to 10-15degrees C without topical cooling. In Group A, myocardial temperature was dropped rapidly to 10-15degrees C with, 1,000ml or less cardioplegic solution. In Group B, the amount of cardioplegic solution required for lowering myocardial temperature to 10-15degrees C was 1,000-2,000ml. In Group C, myocardial temperature was not dropped below 18degrees C or cardioplegic solution over 2,000ml was required for lowering myocardial temperatur. Eight patients(8/61, 8%) in group A, 12 patients(12/35, 34%) in group B and 8 patients(8/9. 89%) in group C had Complete obstructive lesions in at least one of major branches of coronary artery(p=0.001). Myocardial perfusion score was different among the groups(8.27+/-2.27 in group A, 9.98+/-2.21 in group B, 10.30+/-2.49 in group C, p<0.002). These data suggest that routine topical hypothermia may be unnecessary if myocardial temperature of less than 15degrees C could be attained with cold blood cardioplegia, especially in case of myocardial perfusion score below 10.
Cardioplegic Solutions* ; Heart Arrest, Induced ; Humans ; Hypothermia ; Perfusion ; Ventricular Septum

No abstract available.
Truncus Arteriosus*

Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

We evaluated the feasibility and safety of this method by reviewing the early outcome of the patients who underwent coronary artery bypass grafting(CABG) utilizing parallel sequential anastomoses with saphenous vein grafts, comparing with the outcome of the patients revascularized with grafts having only single distal anastomosis. During the one-year period of 1995, a total of 79 patients underwent isolated CABG, among whom 39 patients with sequential vein grafts(sequential group) and 40 patients without sequential grafts(non-sequential group). There was no difference between the two groups in terms of preoperative status, except in the extent of the coronary disease; 87.2% of the sequential group and 45.0% of the non-sequential group had left main and/or triple vessel involvement. 318 distal coronary anastomoses were done; 198 for the sequential group(5.1/patient) and 120 for the non-sequential group(3.0/patient). In the sequential group, the mean durations of cardiopulmonary bypass and aortic clamp per one distal anastomosis were 33.5 and 21.1 minutes, respectively. In the non-sequential group, these were 41.8 and 22.7 minutes. There were two operative deaths, both in the non-sequential group. There was no difference in the incidence of postoperative complications including myocardial infarction. During the follow-up period(2 to 15 months), 8 patients(3 in the sequential and 5 in the non- sequential group) complained of residual or recurrent angina. Comparison of preoperative and postoperative 201Thallium myocardial perfusion scans in 30 patients showed improved or normal perfusion reserve in 83.3% of segments bypassed with sequential grafts and 82.5% of segments bypassed with non-sequential graft(s). These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft. These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Disease ; Coronary Stenosis ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Revascularization* ; Perfusion ; Postoperative Complications ; Saphenous Vein ; Transplants ; Veins

In the preoperative evaluation before coronary artery bypass surgery, review of the coronary arteriogram is the most important step. Expected "normal" lumen diameter at a given coronary anatomic location is a basis for quantative estimation of coronary disease severity that could be more useful than the traditional "percent stenosis". The distribution and number of major coronary artery branches are determinants of number of bypass grafts needed. We reviewed the coronary artery anatomy in 174 adult patients who revealed no coronary pathology in angiographic studies done from September 1994 to June 1996. Quantative analysis was done in all cases by a single person using a Computerized System (Arripro 35(r)). The results were follows; 1) The mean diametre of left main coronary artery was 4.45 mm (range 2.74~6.72). The pattern of branching was bifurcation in 67.24%, trifurcation in 28.74% and quadrifurcation in 4.02% of the patients. 2) The mean diametre of left anterior descending artery was 3.17 mm (range 2.10~5.85), 2.79 (range 1.55~5.59) and 2.17 mm (range 1.37~3.81) in the proximal, mid, and the distal portions, respectively. The number of diagonal branches of left anterior artery was from one to four (mode=2). 3) The mean diametre of proximal and distal left circumflex artery were 3.17mm (range 1.74~4.89) and 2.19 mm (range 1.21~4.46). The number of obtuse marginal branches of left circumflex artery is from one to six (mode 2). 4) The mean diametre of proximal and distal right coronary artery, the posterior descending artery and the largest posterolateral branch were mean 3.51 mm (range 2.07~5.67), 2.09 mm (range 1.42~3.60), 2.09 mm (range 1.02~3.60) and 2.30 mm (range 1.39~4.39). 5) The right coronary artery dominant was 163 cases (93.68%) of the total 174 cases. 6) The large significant acute marginal artery was visualized in more than half of the people.
Adult ; Arteries ; Computer Systems ; Coronary Artery Bypass ; Coronary Disease ; Coronary Vessels ; Humans ; Pathology* ; Single Person ; Transplants

No Abstract available.
Tracheal Stenosis*

No abstract available.
Carpal Tunnel Syndrome* ; Humans

No abstract available.
Microsurgery* ; Radiosurgery* ; Trigeminal Neuralgia*

BACKGROUND: The washing of packed red blood cells could remove pro-inflammatory mediators,cell debris,and micro-particles contained in packed red blood cells,and the preci- rculation-ultrafiltration (recirculation and ultrafiltration of circuit itself before cardiopulmonary bypass)could attenuate the initial inflammatory reaction and remove the initial proinflam- mat ory medi at ors.Thi s st udy was performed t o eval uat e whet her the washing of packed red blood cells and precirculation-ultrafiltration can reduce the production of cytokines that have an important role in myocardial reperfusion injury.This study investigated the effects of washing the packed red blood cells and precirculation-ultrafiltration on the production of cytokines during and after cardiopulmonary bypass and open heart surgery. MATERIAL AND METHOD: Forty eight infants with VSD undergoing open heart surgery under cardiopulmonary bypass were randomized into control group (group C,n=12),washing group (group W,n=12), precirculation-ultrafiltration group (group F,n=12),and combined group(washing and precirculation-ultrafiltration,group WF,n=12).Blood samples were obtained before,during,and after the bypass to assess plasma level of tumor necrosis factor-alpha (TNF-alpha ),interleukin-6 (IL-6),and interleukin-8 (IL-8). RESULTS: Expressions of TNF-alpha were significantly reduced in combined group (group WF)compared with group C,group W,and group F(p < 0.05). Expression of IL-6 were significantly reduced in group W,group F,and group WF compared with group C (p < 0.05),but similar among group W,group F,and group WF (p=0.053).Expression of IL-8 were reduced in group W and group WF compared with group C (p < 0.05),but similar among group W,group F,and group WF (p=0.067). CONCLUSION: In conclusion,the washing of packed red blood cells and precirculation-ultrafiltration blunted the increase of TNF-alpha ,IL-6,and IL-8 during and after open heart surgery with cardiopulmonary bypass.However,the clinical benefits of these treatments remains unproven.
Blood Cells ; Cardiopulmonary Bypass ; Cytokines* ; Erythrocytes* ; Heart* ; Humans ; Infant ; Interleukin-6 ; Interleukin-8 ; Myocardial Reperfusion ; Plasma ; Thoracic Surgery* ; Tumor Necrosis Factor-alpha ; Ultrafiltration

OBJECTIVE: The purpose of this study was to identify differences in measurement methods for blood pressure (Direct measurement, HP automatic indirect measurement, and SE 7000 Korean made indirect measurement), and to evaluate the clinical trial of the Korean made automatic indirect blood pressure measurement. MATERIAL & METHODS: From June, 1999 to February, 2000, fifty five consecutive patients were randomized into hypertension group (n=20), normotension group (n=20), and hypotension group (n=15). Measuring blood pressure by indirect methods (HP NIBP M 1008B and SE 7000 NIBP Korean made) was done simultaneously in the same arm with arterial line for direct blood pressure measurement (HP M1006A). The procedures were repeated ten times at intervals of 2 minutes. Statistical analysis was performed using SPSS (version 8.0 for windows) software package. Values were expressed as means and standard deviation and means were compared using t-test. Statistical significance was considered present with a p value less than 0.05. RESULTS: In the hypertension group and noromotension group, the disparity between HP direct measurement and indirect SE 7000 NIBP did not show any differences compared to the disparity between HP direct measurement and indirect HP NIBP. In the hypotension group, the disparity in the diastolic pressure between HP direct measurement and indirect SE 7000 NIBP was significantly different compared to the disparity between HP direct measurement and indirect HP NIBP (p<0.001), however, disparities in systolic pressure did not showed any differences. CONCLUSION: Direct blood pressure measurement (HP M1006A) can be replaced with indirect blood pressure measurements (HP NIBP M 1008B & SE 7000 NIBP) in normotension and hypertension patients. Korean made indirect measurement was found to be more accurate compared to HP indirect measurement in hypotension patients, but more study is needed.
Arm ; Blood Pressure* ; Humans ; Hypertension ; Hypotension ; Vascular Access Devices