• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.934-938
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• 2006

Organ malperfusion may mask the presence of aortic dissection and is one of major cause of death in patient with aortic dissection. Several key mechanism appear to contribute to the development of malperfusion, therefore optimal choosing of treatment is necessary to obtain better result. In cases of extremity malperfusion, open bypass procedures have been used for primary treatment, but noninvasive interventional procedures are also recommended as good alternatives in some cases. Here in, we report a case of successful aortic replacement followed by stent insertion in patient with extremity malperfusion caused by acute aortic dissection.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.110-115
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• 2008

Malperfusion of a major organ with aortic dissection has various clinical features according branch. The morbidity and mortality rate can increase without suspicion especially postoperative period. Surgical outcomes and prognosis are influenced by early expeditious diagnostic and therapeutic measures are mandatory for successful treatment. The authors report four successful cases of acute aortic dissection with mal perfusion of various organs, such as the brain, kidney, and the lower extremities.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.194-201
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• 2003

Malperfusion of major organs which frequently accompanies acute aortic dissection is one of the major causes of death. Malperfusion does not only develop before surgery, but also during or after surgery in various manifestations according to the aortic branches involved. Expeditious diagnostic and therapeutic measures based on high degree of clinical suspicion are mandatory for successful treatment. The authors report four cases of acute aortic dissection accompanied by malperfusion of various organs that were successfully treated.

• The Korean Journal of Nuclear Medicine
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• v.39 no.1
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• pp.9-14
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• 2005

Purpose: Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkinson-White) syndrome. Materials and Methods: Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECG with Fitzpatrick's algorithm or electrophysiologic study and radiofrequency catheter ablation. Results: Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients (mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent ($11.0{\pm}8.5%$, range:$3{\sim}35%$) and mild to moderate severity ($-71{\pm}42.7%$, range:$-2l7{\sim}-39%$) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patient with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Conclusion: Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but it did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

• Tuberculosis and Respiratory Diseases
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• v.57 no.5
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• pp.489-493
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• 2004

Unilateral pulmonary artery agenesis is a rare congenital anomaly usually associated with other cardiovascular anomalies such as tetralogy of Fallot or septal defect. Unilateral pulmonary artery agenesis without other coexisting cardiovascular abnormality (isolated unilateral pulmonary artery) is extremely rare and often asymptomatic until adulthood. In these patients, diagnostic clue is found in a plain chest roentgenogram, showing a hyperlucent contracted hemithorax. We have recently experienced a case of isolated right pulmonary artery agenesis, which was diagnosed by chest dynamic CT, perfusion scan, echocardiogram and 3-dimensional reconstruction cardiac CT angiography in a 50-year old female who had suffered from mild dyspnea on exertion and improved with conservative treatment. We report this case with a brief review of the relevant literature.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.467-472
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• 2007

Background: Lung transplantation is the definitive therapy for end stage lung disorders. The success of allogenic lung transplantation has led to an increasing shortage of donor lungs from humans, including cadavers, and attention has now turned to transplantation of lungs from other species. However, there are many biological hurdles when using organs from other species because of hyperacute rejection after discordant xenotransplantation. Material and Method: Pigs (n=6, weighing $20{\sim}30kg$ each) for the donors and mongrel dogs (n=6, weighing $20{\sim}28kg$ each) for the recipients were used in this experiment. The left kidney of a pig was perfused to a mongrel dog for 30 minutes through the femoral artery and vein of the dog, and the right kidney was perfused for 30 minutes sequentially. Then, both lungs of the pig were perfused to the dog through the pulmonary artery and left atrium with using the same time intervals. The levels of IgM and IgG were measured from the blood and specimens of the kidney and lung. Result: The average levels of serum IgM gradually decreased after the perfusion, but the average levels of serum IgG did not charge from before to after perfusion. The immunohistochemical findings revealed decreased deposition of IgG and IgM after the perfusion. Conclusion: We conclude that the levels of the serum natural antibodies would be decreased with pre-transplantation xenograft perfusion in the recipient and the occurrence rate of hyperacute rejection after transplantation would be decreased.

• The Korean Journal of Nuclear Medicine
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• v.37 no.2
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• pp.83-93
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• 2003

Background: Lung-to-heart uptake ratio (LHR) in $^{201}Tl-chloride$ myocardial perfusion scan is believed to be a reliable marker for left ventricular (LV) dysfunction, but the clinical value of LHR is controversial for $^{99m}Tc-MIBI$ imaging. Furthermore, most of results suggesting lung uptake of $^{99m}Tc-MIBI$ as a potential marker for LV dysfunction used immediate post-stress images, instead of routine images acquired 1 hour after tracer injection. The goal of our study was to investigate whether LHR evaluated with routine gated $^{99m}Tc-MIBI$ imaging can reflect the degree of perfusion defect or left ventricular performance. Subjects and Methods: 241 patients underwent exercise $^{99m}Tc-MIBI$ myocardial SPECT were classified into normal myocardial perfusion (NP, n=135) and abnormal myocardial perfusion (AP, n=106) group according to the presence of perfusion defect. LHR was calculated from anterior projection image taken at 1-hour after injection. Two legions of interest (ROIs) were placed on left lung above LV and on myocardium showing the highest radioactivity. Subjects were classified by left ventricular ejection fraction (LVEF), as Gr-I: >50%, Gr-II: 36-50%, Gr-III: <36% and by summed stress score (SSS), as Gr-A: <4, Gr-B: 4-8, Gr-C: 9-13, Gr-D: >13, LHR was compared among these groups. Results: In NP group(n=135), LHR, were higher in men than women ($men:\;0.311{\pm}0.03,\;women:\;0.296{\pm}0.03,\;p<0.05$). Significant difference, in LHR were found between NP and AP groups both for men and women ($men:\;0.311{\pm}0.03\;vs\;.\;0.331{\pm}0.06,\;women:\;0.296{\pm}0.03\;vs.\;0.321{\pm}0.07.\;p<0.05$). There were weak negative correlation between LHR and LVEF (r=-0.342, p<0.05) and weak positive correlation between LHR and SSS (r=0.478, p<0.05) in men, but not in women (LVEF: r=-0.279, p=0.100, SSS: r=0.276, p=0.103). Increased LHR was defined when for more than mean + 2SD value ($men{\geq}0.38,\;women{\geq}0.37$) of the LHR of the subject with normal perfusion. Increased LHR were observed more frequently in subjects with lower LVEF (Gr-I: 11.1%, Gr-II: 27.0%, Gr-III: 35.4%, p<0.05) and higher SSS(Gr-A: 14.0%, Gr-B: 5.7%, Gr-C: 18.2%, Gr-D: 40.7%, p<0.05). Conclusions: LHRs obtained from routine $^{99m}Tc-MIBI$ gated SPECT images were weakly correlated with LVEF and perfusion defect. Although significant overlaps were observed between normal and abnormal perfusion group, LHRs could be used as an indirect marker of severe perfusion defect or reduced left ventricular function.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.427-430
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• 2003

The surgical managements for the complicated aortic disease is still one of most challenging fields for the cardiac surgeons. The endovascular stent graft procedure has been tried recently to avoid serious complications caused by traditional graft replacement technique. However, indications for the procedures or management methods for the complications have not been clearly elucidated so far. We report a case of successful management for the newly-onset aneurysmal dilation of the distal aorta after an endovascular stent graft procedure in a patient with acute aortic dissection type IIIB.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.5
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• pp.362-368
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• 2008

Purpose: It is well known that lung to heart ratio (LHR) is one of the high risk findings in TI- 201 myocardial perfusion SPECT. We evaluated the clinical efficacy of LHR to identify severe coronary artery disease in adenosine stress Tc-99m tetrofosmin gated myocardial perfusion SPECT (gSPECT). Materials and Methods: The study population was 157 patients who underwent both adenosine stress Tc-99m gSPECT and coronary angiography (CAG) within one month. According to the results of CAG and gSPECT LHR and the incidence of increased LHR were compared. Results: Among 53 patients with normal coronary arteries increased LHR was found in 2 patients (3.8%) and 0 in 44 patients (0%) with one vessel disease, 2 in 27 with two vessel disease (7.4%) and 8 in 33 with triple vessel disease (24.2%). Significant differences were found in LHR between subgroups of summed stress score, summed rest score and LV ejection fraction (LVEF). There were weak negative correlation between LHR and LVEF and weak positive correlation between LHR and SSS and SRS. Conclusion: Increased LHR had higher incidence in patients with triple vessel disease, severe LV dysfunction and/or extensive perfusion defect than those of normal group. Although its sensitivity might be low to identify severe coronary artery disease, LHR could be helpful in abnormal myocardial perfusion SPECT to stratify risk and prognosis.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.949-960
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• 1997

Background. Limited ischemic tolerance of the lung has remained one of the factors that limits the expansion of pulmonary transplantation as a treatment for end-stage pulmonary disease. Numerous studies on safe long term preservation for lung transplantation has been performed for the purpose of developing ideal preservation solution with extracellular type or intracellular type solutions. In this. study, we examined the efficacy of L DG solution in lung preservation longer than 20 hours by comparison with modified Euro-Collins solution. Iwethods. Thirty-(our adult mongrel dogs were divided into two groups. Donor lungs were flushed with LPDG solution(n=9) or modified Euro-Collins(MEC) solution(n=8) and stored for 24 hours at 1$0^{\circ}C$. All donor lungs were perfused through the pulmonary arteries with solutions containing prostaglandin El and verapamil. Left canine lung allotransplantations wereperformed. Assessment(hemodynamic indices and arterial blood gas analysis) of left implanted lung was made by occluding the right pulmonary artery for ten minutes using pulmonary artery Cuff. Assessment was repeated at the interval of 30 minutes, one hour, and two hours later after reperfusion and then chest X-ray, computed tomogram and lung perfusion scan were obtained. In survival dogs follow-up studies were done with assessment with chest X-ray, computed tomogram of the chest and lung perfusion scan on 7th day postoperatively. After preservation above 20 hours, pathological examinations for ultrastructural findings on right lung were performed in each group. Results. With respect to arterial oxygen tension, LPDG group was superior to MEC but there was no statistical significance for 2 hours after reperfusion. Mean pulmonary artery pressure was less increased(p < 0.05) and cardiac output higher(p <0.05) than MEC group until 2 hours after reperfusion. After 2 hours of reperfusion, both groups showed transplanted lung function deteriorated gradually. Perfusion scan of the transplanted lung in LPDG group showed better perfusion rate in immediate post-reperfusion, 3 days and 7 days later respectively but there was no statistical significance and corelation with PaO2 and computed tomoRravhic views. In scanning electron microscopy of pulmonary artery after preservation, LPDG group relatively shows less irregular protrusion of the inner surface of endothelial cell of poulmonary artery than MEC group. Conclusions, e concluded that LPDG solution can offer safe lung preservation above 20 hours with adequate immunosuppressive therapy and prevention of the infection.