• Title/Summary/Keyword: 맥아

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Relation of Neoaortic Root Dilation and Aortic Insufficiency after Arterial Switch Operation (동맥전환술 후의 신생대동맥근부 확장과 대동맥판막폐쇄부전의 관계)

  • 박한기;김도균;홍유선;이종균;최재영;조범구;박영환
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.921-927
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    • 2003
  • Arterial switch operation (ASO) has been the most effective surgical option for transposition of the great arteries. But, the inappropriate dilation of the neoaortic root has been reported and its effect on neoaortic valve function and growth of aorta has not been well documented. Material and Method: Forty-eight patients who underwent cardiac catheterization during follow up after arterial switch operation were included in this study. Arterial switch operation was performed at a median age of 18 days (range 1∼211 days). Preoperative cardiac catheterization was performed in 26 patients and postoperative catheterization was performed in all patients at 15.8$\pm$9.6 months after ASO. Postoperative ratios of the diameters of neoaortic annulus, root and aortic anastomosis against the descending aorta were compared to the size of preoperative pulmonary annular, root and sinotubular junction. Preoperative and operative parameters were analyzed for the risk factors of neoaortic insufficiency. Result: There were two clinically significant neoaortic insufficiencies (grade$\geq$II/IV) during follow up, one of which required aortic valve replacement. Another patient required reoperation due to aortic stenosis on the anastomosis site. Post-operatively, neoaortic annulus/DA ratio increased from 1.33$\pm$0.28 to 1.52$\pm$.033 (p=0.01) and neoaortic root/DA ratio increased form 2.02$\pm$0.40 to 2.56$\pm$0.38 (p<0.0001). However, the aortic anastomosis/DA ratio showed no statistically significant difference (p=0.06). There was no statistically significant correlation between the occurrence of neoaortic insufficiency and neoaortic annulus/DA ratio and neoaortic root/DA ratio. Non-neonatal repair (age>30days) (p=0.02), preopeative native pulmonaic valve stenosis (p=0.01), and bisuspid pulmonic valve (p=0.03) were the risk factors for neoaortic insufficiency in univariate risk factor analysis. Conclusion: After ASO, aortic anastomosis site showed normal growth pattern proportional to the descending aorta, but neoaortic valve annulus and root were disproportionally dilated. Significant neoaortic valve insufficiency rarely developed after ASO and neoaortic annulus and root size do not correlate with the presence of postoperative neoarotic insufficiency. ASO after neonatal period, preoperative native pulmonary valve stenosis, and bicuspid native pulmonic valve are risk factors for the development of neoaortic insufficiency.

Surgical Treatment of Thoracoabdominal Aortic Aneurysm (흉복부 대동맥류의 외과적 치료)

  • Kim, Kyung-Hwan;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.33 no.11
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    • pp.886-893
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    • 2000
  • 배경: 흉복부 대동맥류는 질환 자체가 광범위하고 수술 중 척수를 포함한 각종 장기의 보호 및 허혈 방지라는 면에서 아직도 수술 합병증이 높은 질환이다. 본 연구에서는 그 동안의 임상경험을 바탕으로 치료성적, 합병증 발생, 사망률 등을 검토하였다. 대상 및 방법: 1990년 1월부터 1999년 12월까지 흉복부동맥류로 수술을 시행한 38명의 환자를 대상으로 의무 기록 검토을 통한 후향적 분석을 시행하였다. 결과: 남자가 22명, 여자가 16명, 평륜 연령은 46.2$\pm$12.3세였고, 크로포드 진단분류 상 1형 이 13례(34.2%), 2형이 19례(50%), 3형이 4례(11%), 4형이 2례(4.8%)였다. 만성 대동맥박리증에 관련된 경우가 29례(76.3%)로 가장 많았고, Marfan 증후군이 동반된 경우가 9례(23.7%)에서 있었다. 원위부 대동맥 관류를 35례에서 시행하였으며, 고동맥-고정맥 심폐바이패스를 31례에서, 좌심방-고동맥 바이패스를 4례에서 시행하였다. 심폐바이패스를 이용한 31례중 4례에서 초저체온하 완전순환정지를 이용하였다. 대동맥 차단 중 복강내 주요 대동맥 분지로의 선택적 관류를 시행하였다. 대동맥류의 최대직경은 평균 8.2$\pm$2.4cm이었고, 동맥류가 파열된 경우는 11례(28.9%)에서 있었다. 전례에서 인조혈관을 이용한 대동맥의 치환술을 시행하였다. 단계적으로 흉복부 대동맥을 겸자하면서 인공혈관을 문합하였고, Adamkiewicz 동맥으로 생각되는 부위의 늑간 동맥을 문합해주었는데, 8번째부터 12번째 흉추 사이의 늑간 동맥 중 역류혈류가 나타나고 상대적으로 내경이 큰 것들을 문합해 주었다. 술 후 조기사망은 3례에서 있었으며, 사인은 심폐기 이탈 실패 (2례), 저혈압 및 산증(1례) 등이었다. 조기 합병증으로는 애성 5례, 출혈 5례, 창상간염 3례, 장기간의 인공호흡기보조가 3례 등이 있었다. 치명적인 조기 합병증인 하지마비는 2례(5.3%)에서 발생하였고, 이 중 1례는 대동맥의 심한 석회화로 늑간동맥을 문합해 주지 못했던 경우였다. 35명의 환자에서 평균 추적기간은 103.1$\pm$6.1 개월, 2년 생존율은 93.8%, 5년 생존율은 86.1%, 8년 생존율은 80.7%였다. 추척기간 동안 4례의 만기사망이 관찰되었고, 사인은 2례에서는 갑작스런 의식소실이 발생하여 규명하기 어려웠으며, 대동맥-식도루 발생에 의한 경우가 1례, 경동맥류 파열에 의한 경우가 1례 등이었다. 만기 합병증으로는 복부 대동맥류(2례), 상행 대동맥 및 대동맥 근부 확장(1례), 대동맥-늑막루(1례), 창상 부위 탈장(1례), 역행성 사정(1례) 등이 있었다. 결론: 저자들은 흉복부대동맥류의 수술에 있어 심폐우 회술 혹은 좌심방-고동맥 바이패스를 통한 원위부 관류 및 저체온법, 수술 시 척수의 혈류공급과 관련된 늑간동맥의 연결 등으로 주요 신경합병증의 발생을 줄이고 좋은 성적을 거두고 있다고 판단하였으며 향후 임상 경험 축적과 함께 보다 정련된 위험인자의 분석이 필요하다고 본다.

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Hepatic Venous Return in Atrial Isomerism Evaluated by MR (심방 이성체 환자의 간정맥 환류에 대한 자기공명영상 소견)

  • 홍용국;박영환
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.493-500
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    • 1997
  • We performed this study to evaluate hepatic venous drainage in atrial isomerism by MR and the clinical significance of anomalous hepatic venous return in total cavopulmonary shunt operation. Numbers and locations of hepatic veins in twenty-two patients with isomerism(thirteen with right isomerism and nine with left isom rism) were evaluated by MR. Operative procedure of hepatic veins and postoperative arterial oxygen saturation were compared with hepatic vein connection in six patients after total cavopulmonary shunt operation. Among nine patients with left isomerism, hepatic venous return was totally anomalous via a single opening in eight, and via two separate openings in one. Among thirteen patients with right isomerism, partial anomalous hepatic venous connection directly to the atrium was seen in four. One showed total anomalous hepatic venous connection to atrium through one opening. Total cavopulmonary shunt operation was performed in 6 patients. Hepatic veins were connected to pulmonary arteries in four patients who had one atrial opening of hepatic vein andlor IVC, or two ipsilateral atrial opening of hepatic veins and IVC. In conclusion, hepatic vein drainage to atrium is variable in atrial isomerism. MR is useful for evaluation of hepatic vein drainage in atrial isomerism and surgical pla ning.

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Study on Relationship Between Intima Medial Thickness and the Plaque in Stroke Patients on Carotid Artery Sonography (뇌경색 환자에서 초음파로 측정한 경동맥 내막-중막두께와 죽상경화반의 관련성에 대한 연구)

  • Lee, Mi-Hwa;Kwon, Duk-Mun;Kang, Yeong-Han
    • Journal of radiological science and technology
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    • v.32 no.2
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    • pp.161-168
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    • 2009
  • The carotid intima-media thickness (IMT) is an early structural marker of the atherosclerotic process and is the only non-invasive test that is currently recommended by the American Heart Association for evaluation of the risk. However, use of this parameter has a limitation because it assumes uniform thickness throughout the blood vessel, whereas atherosclerosis is a focal phenomenon that is confined to intima. In fact, plaque can be found along the atherosclerotic blood vessels even though its value is unknown. The aim of this study is to analyze the carotid plaque and IMT in the stroke patients. We investigated the patients with ischemic stroke, who were admitted to the department of neurology at the Stroke Special Hospital from January to March 2008. After the carotid IMT and plaque were assessed by B-mode ultrasonography, IMT and carotid plaque to risk variables (age, sex) were analyzed. The distribution of CCA IMT was significantly different in terms of age (p = 0.004). Likewise, the distribution of carotid plaque was also significantly different in terms of age (p = 0.006). Carotid plaque was 69 and 92% in normal and abnormal CCA IMTs respectively. The results showed that the CCA IMT was closely associated with carotid plaque.

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The Content of Amino Acids and Anti-inflammatory Effect of Lentinula edodes Syrup by Different Malt Concentrations (맥아 첨가비율을 달리한 표고당화액의 세포독성, 항염증효과 및 아미노산 함량)

  • Ha, Neul-I;Bak, Ok Ran;Kim, Kyung Je;Jin, Seong Woo;Koh, Young Woo;Im, Seung Bin;Jeong, Hee Gyeong;Seo, Kyoungsun
    • Proceedings of the Plant Resources Society of Korea Conference
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    • 2019.04a
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    • pp.104-104
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    • 2019
  • 표고(Lentinula edodes)에 다량 함유되어 있는 아미노산은 면역효과와 밀접한 관련이 있는 것으로 알려져 있다. 표고 특유의 향미에 대한 소비자들의 선호도가 상이하여, 표고를 맥아로 당화하여 소비자들의 섭취 편이성을 향상시키고, 아미노산을 포함한 당화액을 제조하여 면역효과가 증강된 제품을 개발하고자 본 연구를 수행하였다. 또한 버섯류를 비롯한 담자균류에는 다양한 약효성분이 함유되어 있어 민간에서도 자주 사용된 기록이 있다. 최근 고등담자균류인 버섯의 성분 및 유용성에 관심이 크게 증가하고 있는 추세이며, 이에 따라 버섯류에 대한 식품학적 및 약리학적 측면에서 연구가 활발히 진행되고 있다. 표고(L.edodes)와 당화효소로 사용한 맥아의 비율에 따라 A (표고 1 kg : 맥아 50 g), B (표고 1 kg : 맥아 100 g), C (표고 1 kg : 맥아 200 g), D (표고 1 kg : 맥아 300 g), E (표고 1 kg : 맥아 300 g) 5개의 시험구를 설정하였으며, 제조된 표고당화액을 농축 후 동결건조 하여 분말로 분쇄 후 시료로 사용하였다. 표고당화액의 면역효과를 검증하고자, Raw 264.7에 표고당화추출분말 A, B, C, D, E를 각각 10, 50, 100 및 $500{\mu}g/mL$의 농도로 처리하여 각 시료에 대한 세포 독성과 항염증효과를 확인하였다. 세포독성 시험결과, E 시험구의 경우 $100{\mu}g/mL$의 농도에서 75.3%, $500{\mu}g/mL$의 농도에서 66.3%의 세포생존율을 나타내 독성을 보였다. 또한 A, B, D를 각각 $500{\mu}g/mL$의 농도로 처리 했을 때, 94.1%, 83.1%, 80.2%의 NO 생성율을 나타내어 E 시험구를 제외하고는 세포독성이 없는 것으로 확인되었다. 표고당화추출분말의 구성아미노산 함량은 C 시험구에서 19,699.01 mg%로 가장 높게 나타났으며, A 시험구에서 17,231.14 mg%, B 시험구에서 17,152.38 mg%순으로 높게 나타났다. E 시험구에서 13,367.98 mg%로 가장 낮게 나타났다. 모든 표고당화추출분말에서 총 16종의 유리아미노산 이 검출 되었으며, C 시험구에서 2,562.06 mg%로 가장 높게 나타났고, B 시험구에서 2,243.16 mg%, D 시험구에서 1,895.29 mg%, A 시험구에서 1,672.82 mg%순으로 높게 나타났다.

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Aortic Unfolding Measurement Using Non-Contrast Cardiac CT: Normal Range of Low-Risk Subjects (관상동맥 석회화 CT에서 측정한 대동맥 전개: 저위험 환자군에서의 정상 범위)

  • Ji Won Lee;Byoung Wook Choi
    • Journal of the Korean Society of Radiology
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    • v.83 no.2
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    • pp.360-371
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    • 2022
  • Purpose This study aimed to assess the factors influencing aortic unfolding (AU) defined by aortic width on coronary artery calcium (CAC) scan and determine the normal limits for AU. Materials and Methods In this retrospective study, we measured AU in 924 asymptomatic subjects who underwent CAC scanning during routine health screening from June 2015 to June 2018. Multivariate regression analysis was used to evaluate the factors influencing AU. After the exclusion of subjects with risk factors associated with AU, 283 subjects were included in the analysis of normal values of AU. Mean AU, standard deviation, and upper normal limit were calculated. Results Sex, age, CAC score, body mass index, body surface area, hypertension, left ventricular hypertrophy, plasma creatinine, and smoking were significantly associated with AU. The mean AU was 102.2 ± 12.8 mm for men and 93.1 ± 10.7 mm for women. AU increased with advancing age (9.6 mm per decade). Conclusion AU determined from a single measurement on CAC scans was associated with cardiovascular risk factors. The normal limits of AU were defined by age, sex, and body surface area in low-risk subjects in this study.

Type A Aortic Dissection with Aortocaval Fistula -Report of 1 case- (대동맥-상대정맥루를 동반한 A형 대동맥 해리증 수술 치험 -1례보고-)

  • 김흥수;양승인;정성운;김종원;이형렬
    • Journal of Chest Surgery
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    • v.35 no.8
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    • pp.599-604
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    • 2002
  • Acute or chronic aortic dissection may lead to the rupture, which is the major cause of death. A dissecting aneurysm of ascending aorta(Stanford type A dissection) can rupture into the superior vena cava producing a aortocaval fistula, which is rare, but has been reported mostly in the cases of abdominal aortic aneurysm. We report a case of 67-year-old man with type A chronic dissection and aortocaval fistula, presenting symptoms of superior vena syndrome. The preoperative diagnosis was composed of radiologic examinations, including computed tomography, magnetic resonance imaging angiography and aortography. The dissecting aneurysm was resected and replaced, and the aortocaval fistula was repaired under deep hypothermic circulatory arrest. The details are described here.

Surgical Treatment for Atherosclerosis of Aaortoiliac Artery (대동맥장골동맥의 죽상경화증에 대한 수술적치료)

  • 금동윤;정진악;신화균;이재원
    • Journal of Chest Surgery
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    • v.34 no.2
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    • pp.133-137
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    • 2001
  • 배경: 하지에 영향을 미치는 죽상경화증은 복부대동맥과 이에 중요분지인 총장골동맥을 침범할 수 있다. 또한 국소분절을 침범할 수 있으나 다중분절은 침범할 수도 있다. 대상 및 방법: 을지의과대학교 흉부외과학 교실에서는 1995년 1월부터 1999년 12월까지 대동맥총장골동맥의 죽상경화증을 주소로 우회술을 시행받은 23례의 환자들을 후향적으로 조사하였다. 결과: 모든 환자는 남자였고 평균연령은 60.15$\pm$8.7세였다. 전 예에서 흡연의 과거력이 있었으며 동반질환으로 당뇨병 8례, 고혈합 7례, 관상동맥질환 6례, 그리고 판막질환 1례였다. 대동맥장골동맥 죽상경화증에 대한 수술방법으로는 대동맥양측대퇴동맥 우회술(7례), 대동맥양측동맥 우회술 및 대퇴동맥슬와동맥 우회술(8례), 대동맥양측대퇴동맥 우회술(2례), 액와대퇴동맥 및 고고동맥 우회술(3례), 고고동맥 우회술(3례)였다. 훌후 합병증으로 후복막상 출혈 3례, 마비성 장폐색 3례, 폐렴3례, 뇌졸중 1례, 급성신부전 2례, 창상감염 2례였다. 해부학적 우회술을 받은 환자중 3례에서 수술 사망이 발생하였다. 결론: 해부학적 우회술은 대동맥장골동맥의 폐쇄성질환에 표준적인 수술방법이지만 또한 해부학적 우회술 역시 술후 유병률 및 사망률이 낮은 좋은 수술법으로 사료된다.

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Supravalvular Aortic Stenosis with Aortic Regurgitation (대동맥판막 폐쇄부전증을 동반한 대동맥판막 상부 협착증)

  • 김정태;이철주;소동문;한정선
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.591-594
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    • 1999
  • 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.

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Surgical Management of Aortic Valve Injury after Nonpenetrating Trauma (외상성 대동맥 판막 손상의 수술적 처치)

  • Seo, Yeon-Ho;Kim, Kong-Soo;Kim, Jong-Hun
    • Journal of Chest Surgery
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    • v.40 no.3 s.272
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    • pp.232-235
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    • 2007
  • We present 2 cases of patients who underwent surgical repair and replacement of an injured aortic valve that was secondary to nonpenetrating trauma. Primary repair was undertaken on an 18-year old boy, but he had persistent moderate aortic regurgitation for five years after surgery. Another 64-year old man was treated successfully with surgical replacement of the aortic valve via employing a prosthetic mechanical valve. Attempts at valvuloplasty for the treatment of traumatic aortic valve injury have not been uniformly successful, and prosthetic valve replacement is recommended for repair, except for highly selected cases.