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Aortic Root Remodeling Procedure in Marfan Syndrome associated with Aortic Dissection: Yacoub-David Technique (말판증후군과 동반된 해리성 대동맥류에 대한 대동맥 근부 개형술(改型術): Yacoub-David 수술법)

  • Park, Hyung-Joo;Lee, Seong-Jin;Park, Young-Woo;Choi, Tai-Myung;Shin, Won-Yong;Kwak, Soo-Dal;Ko, Jeong-Kwan;Lee, Cheol-Sae;Youm, Wook
    • Journal of Chest Surgery
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    • v.34 no.7
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    • pp.557-558
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    • 2001
  • We operated on a Marfan patient who had Stanford type A acute aortic dissection, aortic root aneurysm, and aortic regurgitation. The Yacoub-David aortic root remodeling procedure which preserves native aortic valve and replaces all three aortic sinuses and ascending aorta by a Dacron graft, was applied for this patient. A 24mm Hemashield graft was designed to three tongues at the aortic root end to meet the shape of the Valsalva sinuses. The patient recovered from the procedure uneventfully and there was no aortic regurgitation posto-peratively.

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Delayed Diagnosis of Cardiac Tamponade That Was Caused by Intramural Hematoma of the Ascending Aorta -A case report- (상행대동맥 벽내 혈종에 의해 발생한 심낭 압전의 지연 진단 - 1예 보고 -)

  • Hwang, Yoo-Hwa;Song, Suk-Won;Yi, Gi-Jong
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.194-198
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    • 2010
  • Intramural hematoma of the aorta (IMH) is the precursor or a variant of a classic aortic dissection where hemorrhage occurs within the aorta wall in the absence of an initial intimal tear. IMH has a high rate of mortality and morbidity. The optimal therapy for IMH is uncertain, yet the involvement of the ascending aorta is usually considered as an indication for surgery due to the associated risk of rupture or cardiac tamponade. We report here on a case of a 71-year-old man who presented with syncope. Because of misdiagnosis, he underwent computed tomography (CT) after 5 hrs from arriving to the ER. Computed tomography of the aorta revealed intramural hematoma of the ascending aorta with cardiac tamponade. He also had vascular complications such as acute renal failure and visceral ischemia. We performed emergency graft replacement of the total arch and ascending aorta. He was discharged without complication on postoperative day 14.

Scientific Palpation Theory for the Manufacture of the Palpation Diagnosis Tool and Health Life (진맥기 제작과 생활의학 활용을 위한 과학적 진맥이론)

  • 장동순;신미수;백영수
    • Proceedings of the Korean Society for Emotion and Sensibility Conference
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    • 2000.11a
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    • pp.118-126
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    • 2000
  • 동양의학에서 인체의 주된 생리 정보는 체질과 맥진에서 얻어질 수 있다 체질은 선천적인 오장 육부 기능에 대한 정보를 제공한다. 체질에 대한 판단은 얼굴형상, 맥진, 사주 등의 방법에 의한다. 반면에 진맥은 현재의 오장육부의 건강 상태를 나타낸다. 오장육부의 생체정보는 인체경락의 전기 전도도를 측정하는 방법에 의해서도 얻어질 수 있으나 본 논문에서는 진맥에의한 방법만을 토론한다. 체질과 진맥 정보는 치병에 있어서 처방의 기간과 강도를 결정 할 수 있는 결정적인 변수이다. 이 두가지 정보 중에서 하나라도 결핍될 경우 병에 대한 효율적인 대응이 어려워진다. 그 이유는 처방의 강약 조절이 어렵고 그 결과 다른 부작용 유발가능성이 크다. 본 논문에서는 진맥이론의 일반적 전개를 위하여 음양오행 성질의 과학적인 정의를 기초로 하였다. 구체적인 맥상의 판단에는 (1) 음의 맥과 양의 맥의 절대적 크기와 상대적 비(즉 음양의 강도와 비), (2) 오행의 성질에 기초한 맥의 형상, 그리고 (3) 맥의 느낌이나 성질등 3가지 정보를 종합한 방법으로 맥상을 파악한다. 이러한 맥진기술 이론은 분류방법이 간단할 뿐만아니라 이론이 일반적이다. 그래서 한의학의 전문가는 물론이고 일반인 모두 쉽게 익혀 덜인의 건강상태를 스스로 파악하는 것이 가능하다. 진맥기 제작의 기년 이론으로서 역할을 할 수 있다. 오행이론에 기초 할 경우 맥상은 5가지 대표적인 맥으로 분류된다. 맥의 이름은 황제내경에 제시된 한의학적인 이름과 함께 맥상을 쉽게 유추 할 수 있는 실생활적인 이름을 병용하였다. 예를 들어 위장이 약할 때 나타나는 홍맥을 진빵같이 부드러운 맥으로, 폐가 나쁠 때 나오는 흩어지는 모맥을 도우너츠형 연기맥으로, 신장이 나쁠 때 나오는 단단한 석맥을 고구마형상의 돌덩어리맥으로, 간이 나쁠 때 나오는 긴장된 현맥을 팽팽한 고무줄맥으로 그리고 심장이 나쁠 때 나오는 작고 연한 구맥을 튀어오르는 물방울맥으로 명명하였다. 이외에 진맥에 의하여 인체의 한열이나 지삭 부침등의 정보가 가능하며, 이러한 정보는 고혈압이나 중풍 확률, 비만 가능성 지수, 골다공증 선행지수 그리고 심장기능 파악(불전맥이나 대맥) 등 다양한 인체 정보를 파악하는 데 응용될 수 있음을 강조한다.

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A Study on the Precipitation Mechanism of Quartz Veins from Sangdong Deposit by Analyses of Vein Texture and Trace Element in Quartz (상동광산 석영맥의 조직 및 석영의 미량원소 분석을 통한 광맥 침전 기작 도출)

  • Youseong Lee;Changyun Park;Yeongkyoo Kim
    • Economic and Environmental Geology
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    • v.56 no.3
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    • pp.239-257
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    • 2023
  • Sangdong deposit, a W-Mo skarn deposit, is located in Taebaeksan mineralized district, hosting vertically developed scheelite-quartz veins that formed at the late ore-forming stage. In this study, we tried to examine the geochemical signatures of ore-forming fluids and vein-forming mechanisms by analyzing the micro-texture of quartz veins and trace element concentrations of quartz. As a result of texture analyses, quartz veins in the hanging wall orebody and the foot wall orebody commonly exhibit the blocky and the elongate blocky texture, respectively, whereas quartz veins in the main orebody show both textures. These textural differences indicate that quartz veins from the hanging wall orebody were precipitated by the primary hydrofracturing due to H2O saturation in the igneous body with relatively high temperature and pressure at a vein-skarn stage, and after that, repeated hydrofracturing caused the formation of quartz veins from the main orebody and foot wall orebody. The results of trace element concentrations show that Li++Al3+↔Si4+ is a main substitution mechanism. However, those of the foot wall orebody were clearly divided into a Li+-dominated substitution and a Na+-, K+-dominated substitution. Considering that quartz veins from the foot wall orebody commonly show the elongate blocky texture, such a distinction means that it is a result of repeated injections of fluid with the different composition. Ti concentrations of quartz from the hanging wall, main, and the foot wall orebody are 28.6, 8.2, and 15.7 ppm in average, respectively. Given a proportional relationship between the precipitation temperature and Ti concentrations, it seems that quartz veins from the hanging wall orebody were precipitated at the highest temperature. Al concentrations of the hanging wall, main, and the foot wall orebody having an inverse relationship with fluid pH are 162.3, 114.2, and 182.5 ppm in average, respectively. These results show that Al concentrations in vein-forming fluids were not changed dramatically. Moreover, these concentrations are extremely low in comparison with the other hydrothermal deposits. This indicates that quartz in overall ore veins at Sangdong deposit was precipitated from the constant condition with slightly acidic to near neutral pH.

Postoperative Arrhythmias after Open Heart Surgery in Adults (성인에서의 개심술후 부정맥)

    • Journal of Chest Surgery
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    • v.31 no.11
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    • pp.1056-1062
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    • 1998
  • Background: We prospectively investigated types, incidences, and risk factors for arrhythmias after open heart surgery in adults. Materials and methods: From June 1994 to May 1995, we performed 302 cases of adult cardiac surgery at our department. This study group consisted of 150 men and 152 women, with a mean age of 43.9±28.0(range 16 to 75)years. We included all the patients irrespective of their operative types or disease entities. Results: The overall incidence of arrhythmias after open heart surgery in adults was 58.3%. The incidence of postoperative arrhythmias for redo-valvular heart surgery was 77.8%, and those for simple valvular procedure, coronary artery bypass surgery, aortic surgery, and congenital heart disease were 70.8%, 45.3%, 40.0%, and 29.5%, respectively. Eight out of twelve risk factors showed statistical significance for the development of postoperative arrhythmias. They were preoperative history of arrhythmias, antiarrhythmic drug medication, previous cardiac surgery, larger left ventricular end-diastolic, end-systolic dimension, left atrial dimension on preoperative echocardiogram, longer cardiopulmonary bypass time and aortic cross clamping time. Univariated analyses for age and types of cardioplegic solution did not show statistical significance. Conclusions: Prospective study on postoperative arrhythmias occurrence, treatment and prevention of is warrauted to draw more clear conclusion.

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Total Aortic Replacement - A Case Report - (대동맥 전장 치환 치험 1례)

  • Kim, Doo-Sang;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.173-177
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    • 1998
  • A 28 years old pregnant woman(Gestational age 35 weeks) had been operated emergency Cesarian section for delivery and emergency graft replacement of ascending aorta and total arch for acute type A aortic dissection. 1 year and 6 months later, she underwent aortic graft replacement from descending thoracic aorta to both common iliac arteries because of further progression of aortic dissection. So far she has a complete artificial graft aorta.

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The Study on Correlation between Carotid IMT and Colon Polyps (목동맥 내막과 중막 두께와 대장 용종 발생의 상관관계에 관한 연구)

  • Goo, Eun-Hoe
    • Journal of the Korean Society of Radiology
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    • v.12 no.7
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    • pp.853-859
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    • 2018
  • This study aims to investigate the correlation between the occurrence of colon polyps and carotid IMT by age. This study checked the correlation between the occurrence of colon polyps and carotid IMT, grouping patients who had a colonoscopy and carotid ultrasonography simultaneously by age based on cross-tabulation. As a result of the analysis, by age, the older the patients with metabolic syndrome, the higher the correlation between the occurrence of colon polyps and carotid IMT became. Also, when carotid IMT was more than 1.1mm, the incidence of polyps was high. In conclusion, there was a high correlation of the occurrence rate of colon polyps with carotid ultrasonography and colonoscopy, and the older the patient and the thicker the carotid IMT, the higher the correlation became.

Endovascular Treatment of Aortic Dissection due to Suture Line Dehiscence after Aortic Graft Replacement for Type A Aortic Dissection: A Report of Two Cases (A형 대동맥박리의 대동맥 이식편 치환술 후 봉합선 열개의 혈관내 치료: 2건의 증례 보고)

  • Woo Jin Shim;Young Hwan Kim
    • Journal of the Korean Society of Radiology
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    • v.85 no.3
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    • pp.668-675
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    • 2024
  • Aortic anastomotic leak is an uncommon complication after ascending aortic replacement for acute aortic dissection. Redo-surgery is the traditional standard treatment despite high mortality and morbidity. Recently, endovascular treatment has been attempted as an alternative approach in a few case reports. Here, we present two cases of aortic anastomotic leak due to suture line dehiscence after aortic graft replacement for type A aortic dissection, which were successfully treated by coil with subsequent N-butyl cyanoacrylate embolization and an AmplatzerTM vascular plug.

Aortic Root Replacement with Valve Preservation in a Patient with Annuloaortic Ectasia (대동맥판을 보존한 대동맥근부치환술 - 증례보고 -)

  • 김대준;윤치순;장병철
    • Journal of Chest Surgery
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    • v.31 no.12
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    • pp.1234-1237
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    • 1998
  • Patients with aortic root disease, frequently seen in Marfan syndrome have progressive dilatation of the aortic sinuses and dilatation and distortion of the aortic annulus, leading to aortic incompetence. They are currently treated with composite graft replacement of the ascending aorta and aortic valve and reimplantation of the coronary arteries. Recently, we experienced an aortic root replacement with aortic valve preservation in a patient with annuloaortic ectasia. The ascending aorta and sinus was excised except the aortic annulus and aortic valve. The aortic valve was reimplanted inside of a collagen-impregnated tubular Dacron graft. The coronary arteries were also reimplanted. The patient was followed up for six months and reevaluated with the echocardiography. Postoperative Doppler echocardiography revealed normal aortic valve function. With this technique, it is possible to preserve the native aortic valve if the aortic leaflets are anatomically normal.

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Endovascular Aortic Balloon Clamping for Various Heart Disease (대동맥 내 풍선 차단법을 이용한 여러 가지 심장수술)

  • Choi, Jin-Ho;Park, Pyo-Won
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.61-67
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    • 2008
  • Background: Conventional ascending aortic cross clamping is often limited. This study was carried out to evaluate the safety and efficacy of an endovascular aortic clamping technique with an intraaortic balloon catheter. Material and Method: From April 2004 to January 2007, surgery with endoaortic clamping was performed in seven patients. A retrograde access perfusion (RAP) catheter was used in six patients and a Pruitt's balloon catheter in two patients. The indication for the operation was a retrosternal pseudoaneurysm of the aortic root in six patients, diffuse calcification of the ascending aorta with aortic regurgitation in 2 patients and an atrial septal defect in one patient. Five patients had at least two prior cardiac surgeries. Result: Successful insertion of the catheter and endoaortic clamping was achieved in all patients. Conclusion: The endovascular aortic clamping technique with a balloon catheter was a useful alternative method for patients in whom conventional cardiac surgery was limited.