• Title/Summary/Keyword: Bleeding heart

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NOAC for Patients with AF and ACS (급성관동맥증후군을 동반한 심방세동 환자에서 NOAC 치료)

  • Kim, Dong Hyeok;Choi, Jong-Il
    • International Journal of Arrhythmia
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    • v.17 no.1
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    • pp.41-45
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    • 2016
  • Atrial fibrillation (AF) can occur in acute coronary syndrome (ACS), which is a serious medical condition and may require the use of antiplatelet agents in addition to anticoagulants for stroke prevention. Recently, novel or non-vitamin K antagonist oral anticoagulants (NOACs) have been increasingly used for stroke prevention in patients with AF instead of traditional OACs. The duration of treatment or treatment with a stepwise approach (e.g. triple, double, or monotherapy) is determined depending on the clinical setting and the balance between the risks of ischemic stroke and bleeding. However, some concerns and controversies in the use of NOACs in patients with AF and ACS need to be addressed. Here, the current management for NOAC therapy in patients with ACS and AF will be reviewed based on recently published guidelines.

Literary Study on the Climacteric Syndrome (갱년기(更年期) 장애(障碍)에 대(對)한 문헌적(文獻的) 고찰(考察))

  • Kim, Kyung Su;Yoo, Dong Youl
    • Journal of Haehwa Medicine
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    • v.13 no.1
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    • pp.107-128
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    • 2004
  • This thesis is focused to get treatment on climacteric syndrome through literary study. The results are followed as below. 1. The climacteric syndrome is beginning with lowering of secretion of female hormone. It's not understood as abnormal disease but as normal phenomenon. 2. The causes of climacteric syndrome are defined as deficiency of the Kidney, stagnation of Liver, disharmony between Heart and Kidney, insufficiency of both the Heart and the Spleen, blood stagnation. 3. The causes of climacteric bleeding are continuous with overstrain, injury of the five emotions, blood heat, deteriorating blood. 4. The treatment of climacteric syndrome are mainly nutrition of Kidney and Liver, that of Kidney heat, descending Yang of Liver, nutrition of blood of heart, having a comunication with Kidney and Heart, nutrition of Spleen and Stomarch. 5. For the prescriptions on climacteric syndrome, the treatments such as Jaguium(左歸飮), Wooguium(右歸飮), Soyosan(逍遙散加減), Jibakjihwangtang(知柏地黃湯加減), Esuntang(二仙湯), Ejihwan(二至丸加味), Sihogayonggolmoryutang(柴胡加龍骨牡蠣湯加減) are used. And the acupuncture points such as Conception Channel, the Spleen Channel, the Urinary Bladder Channel, the Kidney Channel which are related to the lower belly of woman.

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Effects of Menstrual Cycle on Heart Rate Variability in Dysmenorrhea Patients (월경통 환자의 월경주기에 따른 심박변이도(Heart Rate Variability) 차이에 대한 고찰)

  • Kim, Eun-Sook;Moon, Seung-Joon;Cho, Han-Baek;Lim, Eun-Mee;Ko, Seong-Gyu;Cho, Jung-Hoon
    • The Journal of Korean Obstetrics and Gynecology
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    • v.23 no.2
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    • pp.124-130
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    • 2010
  • Purpose: The aim of the study was to investigate menstrual cycle phase differences in Heart Rate Variability(HRV) in dysmenorrhea patients. Methods: 16 dysmenorrhea patients were enrolled. The severity of dysmenorrhea was measured by Visual Analog Scale(VAS). Recordings for HRV analysis were obtained during the two phases of the menstrual cycle (follicular phase 4~10 days and luteal phase 18~23 days from the start of bleeding). Results: No measure of HRV was significantly different between two menstrual cycle phases. Conclusion: We concluded that menstrual cycle was not significantly associated with changes in autonomic nervous system as measured by HRV in dysmenorrhea patients.

Percutaneous Extracorporeal Membrane Oxygenation for Graft Dysfunction after Heart Transplantation

  • Lim, Jae Hong;Hwang, Ho Young;Yeom, Sang Yoon;Cho, Hyun-Jai;Lee, Hae-Young;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.47 no.2
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    • pp.100-105
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    • 2014
  • Background: We evaluated the safety and efficacy of percutaneous extracorporeal membrane oxygenation (ECMO) in patients with primary graft dysfunction after heart transplantation. Methods: Of 65 patients (44 males and 21 females) who underwent heart transplantation from January 2006 to December 2012, 13 patients (group I) needed peripheral ECMO support due to difficulty in weaning from cardiopulmonary bypass (CPB) and 52 patients (group II) were weaned from CPB without mechanical support. The mean age of the patients at the time of operation was $54.4{\pm}13.6$ years. There were no differences in the preoperative characteristics of the two groups. Multivariable analysis was performed to identify the risk factors for ECMO therapy. Results: All group I patients were successfully weaned from ECMO after $53{\pm}9$ hours of circulatory support. Early mortality occurred in four patients (1 [7.7%] in group I and 3 [5.8%] in group II, p>0.999). There were no differences in the postoperative complications between the two groups, with the exception of reoperation for bleeding. A greater number of group I patients underwent reoperation for bleeding (5 [38.5%] in group I vs. 6 [11.5%] in group II, p=0.035). In multivariable analysis, preoperative mechanical support (ECMO and intra-aortic balloon pump) and longer CPB time were the risk factors of ECMO therapy for graft dysfunction (odds ratio, 6.377; 95% confidence interval, 1.519 to 26.77; p=0.011 and odds ratio, 1.010; 95% confidence interval, 1.001 to 1.019; p=0.033). Conclusion: Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.

Delayed Sternal Closure Using a Vacuum-Assisted Closure System in Adult Cardiac Surgery

  • Hyun Ah Lim;Jinwon Shin;Min Seop Jo;Yong Jin Chang;Deog Gon Cho;Hyung Tae Sim
    • Journal of Chest Surgery
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    • v.56 no.3
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    • pp.206-212
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    • 2023
  • Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.

Aortopulmonary septal defect with anomalous origin of the RPA from aorta and PDA (개방성 동맥관과 우폐동맥 이상기시를 동반한 대동맥 폐동맥 중격결손증 1례 보)

  • 남구현
    • Journal of Chest Surgery
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    • v.17 no.3
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    • pp.398-401
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    • 1984
  • Aortopulmonary septal defect is rare congenital heart disease. An 8-year-old girl was diagnosed as a ventricular septal defect with patent ductus arteriosus at Department of Thoracic and Cardiovascular Surgery of Chungnam National University Hospital. On operation, the defect was confirmed as an aortopulmonary septal defect [Type I], anomalous origin of right pulmonary artery from aorta [Type Ill] and patent ductus arteriosus. The defect was repaired anatomically with cardiopulmonary bypass. But she was not survived because of uncontrollable bleeding from aorta.

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The Unusual Suspect: Anemia-induced Systolic Anterior Motion of the Mitral Valve and Intraventricular Dynamic Obstruction in a Hyperdynamic Heart as Unexpected Causes of Exertional Dyspnea after Cardiac Surgery

  • Mun, Jeong-Beom;Oh, Ah-Reum;Park, Hwa-Sun;Park, Chul-Hyun;Park, Kook-Yang;Moon, Jeonggeun
    • Journal of Chest Surgery
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    • v.46 no.6
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    • pp.457-460
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    • 2013
  • Dynamic left ventricular (LV) outflow tract obstruction is a characteristic feature of hypertrophic cardiomyopathy; however, it can also occur in association with hyperdynamic LV contraction and/or changes in the cardiac loading condition, even in a structurally normal or near-normal heart. Here, we report a case of anemia-induced systolic anterior motion of the mitral valve and the resultant intraventricular obstruction in a patient who underwent coronary artery bypass grafting and suffered from anemia associated with recurrent gastrointestinal bleeding.

Pre-and postoperative cardiac catheterization in 20 patients ungergoing closure of VSD whose murmur was sustained after open heart surgery (술후 심잡음이 들리는 심실중격결손증의 수술전후 혈역학적 비교)

  • 박병순
    • Journal of Chest Surgery
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    • v.17 no.4
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    • pp.780-785
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    • 1984
  • We had studied 20 cases of VSD patients whose murmur was sustained after open heart surgery from 1977 to 1984. The postoperative cardiac catheterization was performed on post-op. 20th day. Their ages ranged from 5 to 25 years old. Among them, 4 patients had significant residual shunt which required reoperation. [1 patient; re-op, 3 patient; refused]. Sex ratio was 13:7 in male and female. Associated anomalies were PDA, ASD, Pulmonary stenosis, Mitral insufficiency. Except 1 case, all of them was Kirklin type II VSD. Postoperative complications were I RBBB, residual shunt, cardiac tamponade due to bleeding, wound infection. Preoperative pulmonary artery systolic pressure was highly related to residual shunt in our study. Postoperative LVEDV returned to normal range on the 3rd week.

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Nuss Operation with Simultaneous Intracardiac Repair -A case report- (선천성 심기형에 동반된 누두흉에서 동시에 시행안 심기형 교정 및 Nuss 수술 -1예 보고-)

  • 허재학;장지민;김욱성;장우익;정철현
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.536-538
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    • 2004
  • There are still some controversies regarding one stage repair of pectus deformity with congenital heart disease due to probable complications after extensive resection of deformed cartilages. We performed Nuss operation with simul-taneous intracardiac repair in 8 year old patient with pectus excavatum and partial atrioventricular septal defect. The result of operation was satisfactory without prolongation of operation time, bleeding or instability of chest wall.