• Journal of Chest Surgery
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• v.43 no.6
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• pp.648-654
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• 2010

Background: This study assessed the early results of endovascular repair of acute type B aortic dissection and the aortic wall changes following endovascular repair. Material and Method: From July 2008 to May 2009, the preoperative and follow-up computed tomography (CT) scans of 5 patients with acute type B aortic dissection were evaluated, and these patients had underwent stent graft implantation within 13 days of the onset of dissection (mean: 7 days; range: 3~13). The whole lumen (WL), true lumen (TL) and false lumen (FL) diameters were measured at the proximal (p), middle (m) and distal (d) third of the descending thoracic aorta. Result: The study included four men and one woman with an average age of $59.4{\pm}20.1$ years (age range: 37~79 years). The follow-up CT was performed and evaluated at 7 days and 6 months. The primary tear was completely sealed in all the patients. No paraplegia, paresis or peripheral ischemia occurred and none of the patients died. No endoleaks developed in any of the patients during follow-up. The TL diameters increased from 20.4 to 33.5 mm in the proximal third (p/3), from 19.5 to 29.8 mm in the middle third (m/3) and from 15.2 to 23.5 mm in the distal third (d/3). The FL diameters decreased from 18.7 to 0 mm in the p/3, from 15.4 to 0 mm in the m/3 and from 21.4 to 8.7 mm in the d/3. The changes in the TL diameter were statistically significant in the middle and distal aorta, and those changes in the FL diameter were not statistically significant. There was a decrease in the WL after repair, but this was not statistically Significant. In three patients, the false lumen disappeared completely on follow-up CT at 6 months. Two patients had patent false lumens and no thrombosis. Conclusion: The early results showed that endovascular repair was effective in treating acute type B aortic dissection, and endovascular repair promoted positive aortic wall changes.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.811-816
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• 2007

Background: We analyzed our experience of arrhythmia surgery in patients with congenital heart disease. Material and Method: A retrospective review was performed on 43 consecutive patients with congenital heart disease, who underwent arrhythmia surgery between June 1998 and June 2006. Result: The median age at surgery was 52 years ($4{\sim}75$ years). The most frequent cardiac anomaly was an atrial septal defect (23/43, 53.5%). The types of arrhythmias were atrial flutter-fibrillation, intermittent non-sustainable ventricular tachycardia and others in 37, 2 and 4, respectively. Arrhythmia surgery consisted of a bi-atrial maze operation in 18 patients (modified cox maze III procedure in 5 patients, and a right side maze plus pulmonary vein cryo-isolation in 13), right side maze operation in 18 patients, cavo-tricuspid isthmus cryoablation for benign atrial flutter in 4 patients, right ventricular endocardial cryoablation in 2 patients and extranodal cryoablation for atrioventricular node re-entry tachycardia in 1 patient. The median follow-up was 23.8 months ($1{\sim}95.2$ months). There was no early mortality, and one late non-cardiac related death. The overall rates of restored sinus rhythm before discharge and $3{\sim}6$ months after surgery were 79% and 81%, respectively (bi-atrial maze group: 72% and 83%, right-side maze group: 77%, 77%). Conclusion: Arrhythmias associated with congenital heart disease can be safely treated surgically with an excellent intermediate-term outcome.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.79-86
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• 2009

Background: Background: Computed tomography (CT) is the main tool for detecting abnormalities of the thoracic aorta, but conventional CT only shows the cross-sectional images. These CT images have some limitations fo accuratly measuring the thoracic aortic diameters at various levels. Multidetector computed tomography (MDCT) overcomes these limitations. We measured the thoracic aortic diameter perpendicular to the loop-shaped thoracic aortic course and this was studied in relation to age, gender, height, weight, the body surface area, the body mass index and the presence of hypertension. Material and Method: Thirty hundred thirty one patients (males: 141 patients and females: 190 patients) who had no abnormalities of the thoracic aorta were investigated using MDCT aortography. They were divided into three age categories: 20~39 years old, 40~59 years old and over age 60. The image was reformed with multiplanar reconstruction and the diameter of the aorta was measured perpendicular to the aortic course at 5 anatomic segments. Level A was the mid-ascending aorta, level B was the distal ascending aorta, level C was the aortic arch, level D was the aortic isthmus and level E was the mid-descending aorta. Result: The mean age was 49.5 years old for males and 54.9 years old for females (p<0.05). The mean diameter of the thoracic aorta at level A was 31.1 mm, that at level B was 30.2 mm, that at level C was 26.5 mm, that at level D was 24.0 mm and that at level E was 22.6 mm. The diameters at all the levels were gradually increased with age. Hypertensive patients had larger diameters than did the non-hypertensive population. There was a positive correlation between the ascending aortic diameter (levels A&B) and height and the body surface area, but there were no statistical differences at the aortic arch (level C) and the descending aorta (levels D&E). There were no statistical differences of the weight and body mass index at all levels. Conclusion: The diameters of the thoracic aortas were directly correlated with gender, age and hypertension. Height and the body surface area were only correlated with the ascending aorta. Weight and the body mass index have no statistical difference at all levels. We measured the age related thoracic aortic diameters and the upper normal limits and we provide this data as reference values for the thoracic aortic diameter in the Korean population.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.815-821
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• 2006

Background: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications, We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the card endarterectomy. Material and Method: We analyzed retrospectively the medical records of 74 patients(76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. Result: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were $23.48{\pm}10.04$ mmHg in 25 cases with changes in electroencephalography(group A) and $47.16{\pm}16.04$ mmHg in 51 cases without changes in electroencephalography(group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups(p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site. Conclusion: Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroercephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper alway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.

• The Korean Journal of Nuclear Medicine
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• v.32 no.2
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• pp.129-136
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• 1998

Purpose: Myocardial SPECT is an effective test for detecting coronary artery disease in the general population. But the diagnostic accuracy between sexes is not defined. The purpose of this study is to compare the diagnostic accuracy between males and females. Materials and Methods: One hundred and seventy seven male and 98 female patients who underwent myocardial SPECT within 1 month of coronary angiography were studied. Myocardial SPECTS were considered abnormal if fixed or reversible perfusion defects were detected. Stenosis severity of ${\geq}$ 50% luminal diameter reduction of any artery defined coronary artery disease (CAD). Results: Overall sensitivity for detection of CAD was 98% in men and 97% in women (p=not significant). However, specificities, accuracies, and positive predictive values (PPV) in men and women were 49% vs 31% (p<0.05), 81% vs 57% (p<0.01), 78% vs 48% (p<0.01), respectively. Diagnostic accuracies for detection of right coronary artery disease were not different in both sexes, however, accuracies for detection of left anterior descending artery disease and left circumflex artery disease were significantly lower in female (p<0.05). Conclusion: A significant difference of diagnostic accuracy between sexes, especially in LAD and LCx disease, was noted. Artifacts from breast attenuation might be a cause for the lower diagnostic accuracy in female.

• 한국지구과학회:학술대회논문집
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• 2010.04a
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• pp.108-109
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• 2010

IMPACT Silver 주식회사는 Zacualpan 프로젝트의 Royal Mines(이하 로얄 광산)을 인수했다. $124.5\;km^2$에 해당하는 지역의 소유권은 두 개의 멕시코 사기업으로부터 가행중인 광산의 채굴권 구입과 운영 중인 기반시설의 임대를 조건으로 한다. 프로젝트 지역은 멕시코시티로부터 남서방향으로 100 km와 Taxco Silver 광산으로부터 북서방향으로 25 km 떨어진 지점에 위치한다. 기반시설은 비포장 도로, 충분한 전력과 물의 공급 및 숙련공들을 갖추어 우수한 평가를 받고 있다. 소유권은 멕시코인의 개인소유 하에서 무한한 매장량 혹은 자원량을 갖고 운영된 채광과 가공시설을 인수하는 것이다. 소유권 지역을 대상으로 한 IMPACT Silver사의 주 탐사목적은 이미 알려진 광화대의 확장을 위한 잠재성 평가와 다른 지역에서 신규 광상의 유망지역을 발견하는 것이다. Zacualpan 프로젝트의 로얄 광산은 남동 Guerrero terrane의 북부에 위치한다. Teloloapan subterrane은 주로 저변성 녹색편암상으로 구성된 쥬라기 후기에서 백악기 초기의 화산성 퇴적층으로 구성된다. 대부분의 유망지역은 Lower Villa de Ayala층의 중성 내지 염기성 화산성 쇄설암을 모암으로 한다. 다상의 변성작용은 지역 전반에 걸쳐 나타나고, Zacualpan 광산지역에서 수반되는 광화작용을 규제한다. Zacualpan 광산지역은 Sierra Madre del Sur로 알려진 유망 광화대에 해당한다. 이 지역은 화산성 괴상 황화광상과 천열수 맥상광상이 우세하다. 대부분의 천열수 광화작용은 3.2-3.8억 년 전 마그마의 생성이 활발한 판구조 체제 동안 발생하였다. 역사적으로 가장 주요한 지역은 Lipton Vein이다. 현재 Zacualpan 지구에서 채광량은 은 200-500 g/t 정도로 보고되고 있다. 일부 지역은 고품위 은 광화작용(은 1,000 g/t 이상)을 수반하고 있으며, 이는 탐사의 주 타겟이 되고 있다. Zacualpan에서 은 광화작용은 은이 부화된 중유황 천열수 맥상광상으로 상당히 유명하다. Fresnillo, Pachuca 및 Taxco 광산을 포함한 멕시코 소유의 대규모의 잘 알려진 광산들이 이에 해당한다. 이러한 광산들은 부산물로서 금, 아연, 연이 생산된다. 이러한 광상들은 맥상과 각력상 및 산점상 또는 망상세맥의 형태로 산출된다. 광화작용은 석영과 탄산염 맥 내에 주로 황철석과 다양한 섬아연석, 방연석, 은 혹은 금 광물들을 수반한다. 경제성을 갖는 광화작용의 수직적인 연장은 평균적으로 대략 300 m이고, 멕시코 중부에 위치한 Fresnillo의 광화작용은 100 m에서 960 m의 연장을 갖는 것으로 알려져 있다. 아주 오랫동안 Zacualpan에서 광산관계자의 관측과 IMPACT Silver에서 최근 작업의 결과를 토대로, Zacualpan 광산지역의 탐사모델은 새로운 광상의 탐사를 위한 가이드로서 개발되었다. Zacualpan 광산지역에서 가장 높은 경제성을 갖는 광화작용은 북서와 남북방향의 맥 구조를 따라 수반된다. 이러한 맥 구조들은 종종 이 지역을 가로질러 수 km까지 추적되지만, 경제성을 갖는 광화작용은 맥 구조를 따라서 구조적으로 유리한 지역에서 부광대를 형성한다. 부광대를 형성하기 위한 가장 유리한 구조적 지역은 북서와 남북방향으로 발달한 맥 구조들이 교차하는 지역이다. 지난 30년간 채광된 주요 부광대는 폭이 2-6 m 이고 수평연장은 30-150 m 그리고 수직연장은 230-300 m에 이른다. 가장 높은 생산량을 보이는 부광대는 남북방향의 이차 맥들이 Guadalupe 광산의 Lipton 맥을 가로지르는 지역에서 발달한다. 남동쪽으로 현재 Compadres 광산의 Silver Shoot No. 1으로부터 고품위 은을 생산하는 지역은 북서방향의 San Agustin 맥이 북향의 Cometa Navideno 맥에 의해 절단되는 지역에서 산출한다. 모암은 광화작용을 규제하는 또 다른 중요한 요소이다. 광산지역에서 경제성을 갖는 모든 광화작용은 중성 내지 염기성 화산암 특히 안산암과 관련 모암에 배태된다. 부광대가 셰일 혹은 편암으로 전이되는 지역에서, 맥들은 소규모의 세맥으로 나뉘어 진다. Zacualpan의 전형적인 천열수 광상에서 부광대는 상부로 가면서 은의 함량이 증가하고, 하부로 가면서 연 아연의 함량이 증가하는 수직적 대상을 보인다. 금의 함량 변화는 보다 예측이 어려우나 상당히 중요하다. Zacualpan 광산지역의 탐사모델에 사용된 토양 채취, 정밀지도제작, 트렌치 및 시추탐광은 현재 IMPACT Silver사가 이 지역을 대상으로 한 가장 효율적인 탐사방법으로 입증되었다. Zacualpan 프로젝트의 로얄 광산은 하루 500 톤을 제련하는 기반시설과 수반된 채굴권을 갖는 가행 광산들을 포함한다. 현재 IMPACT Silver사는 두 곳의 타겟 지역에서 정밀지도제작, 토양 및 암석 채취, 12공 총 1866 m의 시추탐광에 의한 사전조사로 구성된 4 단계 탐사를 수행했다. 암석 1,953개, 토양 1,631 개, 389 개의 시추코어 시료가 채집되고 분석되었다. 이러한 작업은 추가탐사를 요구하는 수많은 유망 광화대를 규명했다. Compadres 광산에서 현재 가행중인 지하갱 시료는 레벨 1에서 0.9 m의 폭을 갖는 광체에서 은 680 g/t과 금 0.3 g/t, 레벨 3에서 1.67 m의 폭을 갖는 광체에서 은 12,591 g/t과 금 12.07 g/t의 품위를 갖는 것으로 나타났다. 레벨 1에서 3까지 2-3 m의 폭과 30-40 m 연장으로 채광되었다. 시추탐광은 고품위를 갖는 몇몇의 중첩된 맥을 발견했다. Compadres 광산에서 남동방향으로 200 m지점에 위치한 Soledad 지역에서 5 개의 시추공으로부터 동일 맥 시스템이 발견되었고, 고품위 부광대의 상부로 간주되는 몇몇 중요 지점이 발견되었다. 초기 단계의 탐사는 유망 시추탐광 지역인 중간정도 내지 고품위 유망 광화대를 규명했다.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.275-280
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• 2006

Background: Aortopulmonary window (APW) is a very rare congenital heart anomaly, often associated with other cardiac anomalies. It causes a significant systemic to pulmonary artery shunt, which requires early surgical correction. Accurate diagnosis and surgical correction will bring good outcomes. The purpose of this study was to describe our 20-year experience of aortopulmonary window. Material and Method: Between March 1985 and January 2005, 16 patients with APW underwent surgical repair. Mean age at operation was $157.8{\pm}245.3$ ($15.0{\sim}994.0$) days and mean weight was $4.8{\pm}2.5$ ($1.7{\sim}10.7$) kg. Patent ductus arteriosus (8), atrial septal defect (7), interruptedaortic arch (5), ventricular septal defect (4), patent foramen ovate (3), tricuspid valve regurgitation (3), mitral valve regurgitation (2), aortic valve regurgitation (1), coarctation of aorta (1), left superior vena cavae (1), and dextrocardia (1) were associated. Repair methods included 1) division of the APW with primary closure or patch closure of aorta and pulmonary artery primary closure or patch closure (11) and 2) intra-arterial patch closure (3). 3) Division of the window and descending aorta to APW anastomosis (2) in the patients with interrupted aortic arch or coarctation. Result: There was one death. The patient had 2.5 cm long severe tracheal stenosis from carina with tracheal bronchus supplying right upper lobe. The patient died at 5th post operative day due to massive tracheal bleeding. Patients with complex aortopulmonary window had longer intensive care unit and hospital stay and showed more morbidities and higher reoperation rates. 5 patients had reoperations due to left pulmonary artery stenosis (4), right pulmonary artery stenosis (2), and main pulmonary artery stenosis (1). The mean follow-up period was $6.8{\pm}5.6$ (57.0 days$\sim$16.7 years)years and all patients belonged to NYHA class 1. Conclusion: With early and prompt correction of APW, excellent surgical outcome can be expected. However, optimal surgical method needs to be established to decrease the rate of stenosis of pulmonary arteries.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.4
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• pp.291-298
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• 2007

Purpose: To investigate the feasibility of TI-201 SPECT with intra coronary injection (lC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of TI-201 and images were compared with those of stress-reinjection (Re-I) SPECT. Methods: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of TI-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of TI-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of TI-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (${\leq}$grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. Results: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. Conclusion: Intracoronary TI-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary TI- 201 SPECT is considered to be limited.

• Journal of the korean veterinary medical association
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• v.45 no.6
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• pp.539-543
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• 2009

심근 손상은 창상 환자에서 심장 기능에 뚜렷한 영향을 미칠 수 있지만 심각한 창상에 가려져 종종 간과됩니다. 심하지 않은 심근손상에 의한 부정맥은 스스로 치유되기도 하지만 저혈압, 쇠약, 순환부전과 같은 증상을 일으키는 부정맥은 조기에 인지하여 치료하지 않을 경우 생명을 위협할 수 있음을 잊어서는 안 될 것 같습니다.

• Proceedings of the KTCVS Conference
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• 1998.10a
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• pp.56-56
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• 1998