• Clinical and Experimental Pediatrics
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• 제56권2호
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• pp.90-93
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• 2013

Congenital coronary arteriovenous fistulas (CCAFs) are rare coronary artery abnormalities in which blood is shunted into a cardiac chamber or great vessel. If the fistula itself is large and tortuous, it is generally recommended to occlude the fistula to prevent several complications. In approaches of transcatheter occlusion, the transvenous approach is preferred over the transarterial approach. The transvenous approach would enable the cannulation of a relatively larger catheter or sheath without potential damage to the femoral vessels or normal coronary arteries, which can occur in the transarterial approach. The transvenous approach may also minimize the blind pouch after releasing the devices. Herein, we report the success of transvenous proximal closure of a CCAF using an Amplatzer vascular plug (AVP) in a 3-year-old patient with cardiomegaly. Complete occlusion was achieved by a single AVP and thrombus formation of the distal aneurysmal portion of the fistula. We suggest that this strategy of closing the proximal end with a dilated fistula using a single AVP by the transvenous approach may be a good option in treating CCAFs in a young child.

• Journal of Chest Surgery
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• 제28권3호
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• pp.316-319
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• 1995

Systemic emboli occur in approximately one-third of patients with cardiac myxoma. Embolization is common because of the friability of the tumor and intracardiac location. Embolic episodes in young patients with normal sinus rhythm should arouse suspicions of cardiac myxoma in the absence of active endocarditis. We present one case of 17 years old girl having saddle embolism combined with left atrial myxoma. We planned staged operation. First, the emergency thromboembolectomy of aortic bifurcation was performed through bilateral transfemoral approach with use of Forgaty catheter. One week later, the extirpation of myxoma was successfully done with ECC.

• Journal of Korean Neurosurgical Society
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• 제63권1호
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• pp.14-25
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• 2020

Proximal flow control achieved with a balloon guide catheter (BGC) during endovascular treatment of acute ischemic stroke is reviewed in this article. In clinical practice, BGCs offer a multi-faceted approach for clot retrieval by creating proximal flow arrest, reducing embolic burden, and shortening procedure time. Evaluation of frontline thrombectomy procedures with BGCs revealed advantages of combined use over the conventional guide catheter (CGC), notably in the significant reduction of distal emboli to both the affected and previously unaffected territories. Recently, new measures of early and complete reperfusion at first thrombectomy pass have been identified as independent predictors of improved outcomes, which were consistently demonstrated with use of BGC as a safe and effective option to minimize number of passes during intervention. Prior randomized controlled trials reported the positive correlation between BGC-treated patients and a lower risk of mortality as well as shortened procedure time. While BGC use is more common in stent retriever-mediated mechanical thrombectomy, preliminary data has shown the potential benefit of device application during contact aspiration thrombectomy to achieve successful recanalization. However, the question of which major endovascular strategy reigns superior as a frontline remains to be answered. Along with clinical case assessments, BGC performance during in-vitro simulation was analyzed to further understand mechanisms for optimization of thrombectomy technique.

• The Journal of the Acoustical Society of Korea
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• 제14권2E호
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• pp.73-86
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• 1995

전향 초음파 영상 캐서터의 트랜스듀스 (FLUIC) 부분은 진동자인 원형 전기음향 소자와 원뿔꼴 반사체인 음향 반사체로 구성된다. 소형의 전기음향 소자는 캐서터의 회전자 축 측면에 탑재된다. 전향 초음파 영상 캐서터의 특징은 기존의 IVUS 트랜스듀서가 제공할 수 없는 캐서터 전단에서 혈관의 단층 2-D 영상과 종래의 측면 영상을 동시에 제공하는 것이다. FLUIC의 트랜스듀서에 사용된 음향 반사체를 설계하기 위해 근사화된 레이 추적 기법을 이용하였다. 음향 반사체로부터 2차 외절 특성을 예측하기 위해 회절전달함수방식에[1] 의한 1차 음원으로 부터의 장 예측모델을 확장하여 일반화 하였다. 확장된 모델은 단순한 평판 반사체에 적용하여 시뮬레이션과 실험에 의해 검증되었으며 FLUIC의 잘 특성을 해석하는데 사용되었다.

• 대한수의학회지
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• 제39권3호
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• pp.665-671
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• 1999

The aim of this study was to establish selective hepatic artery catheterization technique through percutaneous femoral artery puncture and to offer digital subtraction angiography (DSA) of hepatic artery in beagle dogs. Percutaneous femoral artery puncture was performed with Sheldinger's method. Microferret$^{TM}$-18 Infusion catheter(William, Cook, Europe) was introduced into abdominal aorta. Then, under fluoroscopy, iopamidol 370(Bracco, Italy) was injected to identify celiac artery and 'J' shaped guide wire was introduced into celiac artery. Catheter could be introduced into celiac artery through guide wire. In this manner, catheter was located at the insertion of hepatic artery and DSA was performed. In DSA of beagle dogs, hepatic artery which was divided into lateral branch, right-medial branch, right-lateral branch of hepatic artery, cystic artery and gastroduodenal artery was opacified without superimposition of any other body structure and so was the parenchyme of liver afterward. In autopsy angiographic finding of resected liver, cystic artery, caudate branch, lateral branch, right-medial branch, right-lateral branch and quadrate branch of hepatic artery were identified. It was concluded that selective hepatic artery catheterization technique was a minimally invasive method that facillitated the approach of hepatic artery and DSA was an excellent tool to visualize the vessle of liver in dogs.

• Tuberculosis and Respiratory Diseases
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• 제60권6호
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• pp.690-693
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• 2006

중심정맥카테터 삽입 후 생길 수 있는 드문 합병증 중에 하나인 흉수 발생은 카테터와 관련된 혈관벽의 손상을 흉수 발생의 기전으로 설명하고 있다. 저자들은 우측 쇄골하정맥으로 이어지는 이상혈관 내로 카테터가 위치한 후 혈관 파열로 인하여 발생한 흉수 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제60권12호
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• pp.390-394
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• 2017

Purpose: Atrioventricular nodal reentry tachycardia (AVNRT) is less common in pediatric patients than in adult patients. Thus, data for pediatric AVNRT patients are insufficient. Hence, we aimed to analyze the patient characteristics, treatment, and any recurrences in pediatric AVNRT patients. Methods: We reviewed the records of 50 pediatric AVNRT patients who had undergone radiofrequency catheter ablation (RFCA) between January 1998 and December 2016 at a single regional center. The patients were aged ${\leq}18years$. Results: Among 190 pediatric patients who underwent RFCA for tachyarrhythmia, 50 (26.3%; mean age, $13.4{\pm}2.6years$) were diagnosed as having AVNRT by electrophysiological study. Twenty-five patients (25 of 50, 50%) were male. Twenty patients (20 of 50, 40%) used beta-blockers before RFCA. All patients had no structural heart disease except 1 patient with valvular aortic stenosis and coarctation of the aorta. RFCA was performed using the anatomic approach under fluoroscopic guidance. The most common successfully ablated region was the midseptal region (25 of 50, 50%). Slow pathway (SP) ablation and SP modulation were performed in 43 and 6 patients, respectively. Complication occurred in 1 patient with complete atrioventricular block. During follow-up, 6 patients had recurrence of supraventricular tachycardia, as confirmed by electrocardiography. Among them, 5 underwent successful ablation at the first procedure. In 1 patient, induction failed during the first procedure. Conclusion: RFCA is safe and effective in pediatric AVNRT patients. However, further research is needed for establishing the endpoints of ablation in pediatric AVNRT patients and for identifying risk factors by evaluating data on AVNRT recurrence after RFCA.

• International Journal of Arrhythmia
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• 제19권3호
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• pp.285-339
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• 2018

Catheter ablation of atrial fibrillation (AF) is one of the most complex interventional electrophysiological procedures. The success of AF ablation is based in large part on freedom from AF recurrence based on electrocardiography (ECG) monitoring. Arrhythmia monitoring can be performed with the use of noncontinuous or continuous ECG monitoring tools. AF ablation is an invasive procedure that entails risks, most of which are present during the acute procedural period. However, complications can also occur in the weeks or months following ablation. Recognizing common symptoms after AF ablation and distinguishing those that require urgent evaluation and referral to an electrophysiologist is an important part of follow-up after AF ablation. This section reviews the complications associated with catheter ablation procedures performed to treat AF. The types and incidence of complications are presented, their mechanisms are explored, and the optimal approach to prevention and treatment is discussed. Finally, surgical and hybrid AF ablation technology and the indications for concomitant open or closed surgical ablation of AF, stand-alone and hybrid surgical ablation of AF are covered in this section.

• Tuberculosis and Respiratory Diseases
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• 제44권5호
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• pp.1094-1104
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• 1997

연구배경 : 자연 기흉은 기저 질환이 없는 건강한 사람에서 발생하는 원발성 자연 기흉과, 결핵이나 만성폐쇄성 폐질환에서 발생하는 속발성 자연기흉으로 나뉘어지며, 자연 기흉에 대한 치료는 다양하지만 흔히 흉관 삽입을 우선적으로 고려하고 있다. 흉관삽입법은 특별한 술식과 삽입시 통증, 피하기종, 감염 등의 합병증이 문제되는 바 본 저자들은 흉관에 비해 직경이 훨씬 작은 8 French 도관을 자연 기흉의 치료에 적용했을 때 단기적인 치료 효과가 있음을 이전 연구에서 확인한 바 있다. 본 연구는 의인성 기흉의 치료에 이용되어져 왔던 작은 직경의 도관을 자연 기흉의 치료에 적용하였을 때, 치료 성공후 추적관찰을 통하여 재발율을 조사하여 장기적인 치료적 효과를 살펴보고자 하였다. 방법 : 1990년 1월부터 1996년 1월까지 중앙대학교 부속병원 내과와 흉부외과에서 8 French 도관 또는 흉관 삽입법으로 치료받은 원발성 또는 속발성 자연 기흉 환자 62명을 대상으로 하였으며 이들은 기흉의 크기가 가 25% 이상, 기흉의 크기에 관계없이 호흡곤란이나 흉통이 발생하였을 때, 기흉의 크기가 증가할 때, 다시 재발한 자연 기흉 환자를 대상으로 하였다. 긴장성 기흉, 혈흉, 화학적 흉막유착술이나 흉강경하 기포절제술을 한 경우는 대상에서 제외되었다. 임상특성(성별, 연령별, 과거 기흉의 유무, 기흉의 크기, 기저 질환의 유무)을 조사하고 합병증, 유치기간, 의무기록이나 개인적 접촉을 통하여 관찰 후 재발율을 비교 분석 하였다. 결과 : 8 French 삽입군과 흉관 삽입군의 추적 관찰기간의 중앙값은 각각 28개월, 22개월로 양군간에 유의한 차이를 보이고 있지 않았다. 8 French 도관 삽입군과 흉관 삽입군의 대상환자들의 임상적 특성-성별, 연령별, 기저 질환의 유무, 기흉의 크기의 분포에는 유의한 차이가 없었다. 원발성 및 속발성을 포함한 자연 기흉을 대상으로 비교한 결과, 도관 또는 흉관의 유치기간은 8 French 도관 삽입군이 $6.2{\pm}3.8$일로 흉관삽입군의 $9.1{\pm}7.5$일에 비해 유의하게 짧았다(p=0.047). 원발성 자연 기흉을 대상으로 두군을 비교하여, 8 French 도관 삽입군의 치료와 관련된 합병증은 6.25%로 흉관삽입군의 23.8%에 비해 더 적은 경향을 관찰할 수 있었다(0.041 ; one-tailed, p=0.053, two-tailed). 8 French 도관 삽입군과 흉관 삽입군에서 재발율에 있어서는 유의한 차이를 나타내지 않았다. 결론 : 이상의 결과로 원발성 또는 속발성 자연 기흉에 대한 치료로 지금까지의 흉관삽입법에 대하여 더 작은 직경의 도관을 삽입하여 치료에 의한 합병증의 빈도를 줄이면서, 치료기간을 줄이고 장기적인 재발을 예방할 수 있을 것으로 기대되며, 더 많은 환자를 대상으로하여 전향적인 연구가 앞으로 필요할 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제29권2호
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• pp.249-254
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• 2000

Objective : As a minimally invasive strategy, endoscopic technique was introduced for removal of the traumatic intracerebral hematoma. Material and Method : A 54-year-old man with three-day history of seizure and progressive mental deterioration after traffic accident was presented. Computerized Tomography(CT) of the brain showed a huge intracerebral hematoma on the right frontal lobe and ventricle. The operation was performed via right frontal superolateral keyhole with 2cm eyebrow skin incision. Using 0-degree and 30-degree angled lens 4mm rigid endoscopes, nearly all of the hematoma was evacuated under the direct endoscopic visualization and a ventricular catheter was exactly placed into the frontal horn of the right lateral ventricle at the end of procedure. Results : The seizure was discontinued and neurological status had been improved during postoperative periods. Postoperative CT demonstrated that most of the hematoma was removed and the ventricular drainge tube was exactly placed in the right foramen of Monro. Conclusion : With endoscopic technique, the authors successfully evacuated traumatic intracerebral hematoma and exactly placed the ventricular drainage catheter under direct visualization. This technique may be considered as an another option for removal of traumatic intracerebral hematoma.