• Clinical and Experimental Pediatrics
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• 제56권4호
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• pp.176-181
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• 2013

Purpose: Apical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO). Methods: We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side. Results: The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients. Conclusion: Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.

• 한국추진공학회지
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• 제18권2호
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• pp.80-85
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• 2014

노즐개방형 측추력기는 고체 추진기관을 사용하는 비행체의 궤도 수정 기능을 제공하는 장치이다. 노즐개방형 측추력기는 비교적 낮은 연소온도를 가지는 추진제, 안정된 추력을 공급하기 위한 중립형 추진제 그레인, 선택적 노즐 사용이 가능한 노즐개방장치로 구성되었다. 궤도 수정이 요구되면 추력 반대방향으로 필요한 추력만큼 노즐을 개방하여 비행체에 측추력을 발생시킨다. 궤도 수정 후 추력방향으로 노즐을 개방하여 측추력을 제거함으로써 추력 발생을 정지한다. 지상연소시험을 통해 측추력기의 작동과정을 확인하였으며, 본 연구를 통하여 개발된 노즐개방형 측추력기는 노즐개방을 통한 측추력 제어를 통해 비행체의 궤도 수정에 활용할 수 있다.

• Journal of Chest Surgery
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• 제50권1호
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• pp.47-49
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• 2017

Percutaneous closure of atrial septal defect (ASD) has become an increasingly common procedure. Serious complications of the procedure, such as cardiac migration, are rare, and usually occur <72 hours after device placement. In this report, we present the case of a patient who underwent successful surgical treatment for the migration of an ASD occluder device to the thoracic aorta 12 months after ASD closure.

• Journal of Chest Surgery
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• 제48권3호
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• pp.202-205
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• 2015

Formation of an aneurysm in the sinus of Valsalva of the aortic root is usually due to an area of congenital weakness in its wall. This aneurysm may progressively dilate and rupture into any of the cardiac chambers or into the pericardial cavity. Though this is conventionally treated by surgery, interventional therapy using various closure devices is becoming more common. Embolization of these closure devices may occur. We report a case of embolization of such a device into the left pulmonary artery which during surgical retrieval, unmasked the hidden ventricular septal defect (VSD). Therefore one has to be cautious while making a diagnosis of rupture of the sinus of Valsalva of right coronary sinus without VSD.

• Journal of Chest Surgery
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• 제39권11호
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• pp.864-867
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• 2006

경피적 혈관 봉합기는 혈관 조혈술 및 중재시술 후에 환자와 의사의 불편을 덜 수 있는 비교적 안전하고 간편한 방법으로 알려져 있으나 몇몇 합병증이 보고되고 있다. 본원에서는 경피적 혈관 봉합기를 사용하여 지혈을 받은 후 대퇴동맥 혈관내막염이 발생한 62세 남자 환자를 적절한 항생제 치료 및 자가 대복재정맥을 이용한 혈관 재건술로 성공적으로 치료하였기에 보고하는 바이다.

• 한국화재소방학회논문지
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• 제25권2호
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• pp.132-137
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• 2011

부속실 단독가압의 제연설비 구역에서 계단실 출입문의 크기 변화가 개방 및 폐쇄조건에 미치는 영향을 분석하기 위해서 자동폐쇄장치의 구조와 저항모멘트의 관계를 정리하였으며, 부속실 출입문의 크기 변화를 고려하여 개방력과 폐쇄력을 측정하였다. 그 결과 부속실 출입문의 크기가 증가할수록 개방 및 폐쇄조건에 도달하기 위한 힘의 크기는 증가하였으며, 폐쇄시간, 회전속도, 회전각도와 힘의 관계, 자동폐쇄장치의 효율을 고려한 부속실 출입문의 설계범위가 존재함을 확인하였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권2호
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• pp.147-162
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• 2022

Purpose: To design a prospective study on endovascular closure of congenital portosystemic shunts. The primary endpoint was to assess the safety of endovascular closure. The secondary endpoint was to evaluate the clinical, analytical and imaging outcomes of treatment. Methods: Fifteen patients (age range: 2 days to 21 years; 10 male) were referred to our center due to congenital portosystemic shunts. The following data were collected prior to treatment: age, sex, medical history, clinical and analytical data, urine trimethylaminuria, abdominal-US, and body-CT. The following data were collected at the time of intervention: anatomical and hemodynamic characteristics of the shunts, device used, and closure success. The following data were collected at various post-intervention time points: during hospital stay (to confirm shunt closure and detect complications) and at one year after (for clinical, analytical, and imaging purposes). Results: The treatment was successful in 12 participants, migration of the device was observed in two, while acute splanchnic thrombosis was observed in one. Off-label devices were used in attempting to close the side-to-side shunts, and success was achieved using Amplatzer™ Ductus-Occluder and Amplatzer™ Muscular-Vascular-Septal-Defect-Occluder. The main changes were: increased prothrombin activity (p=0.043); decreased AST, ALT, GGT, and bilirubin (p=0.007, p=0.056, p=0.036, p=0.013); thrombocytopenia resolution (p=0.131); expansion of portal veins (p=0.005); normalization of Doppler portal flow (100%); regression of liver nodules (p=0.001); ammonia normalization (p=0.003); and disappearance of trimethylaminuria (p=0.285). Conclusion: Endovascular closure is effective. Our results support the indication of endovascular closure for side-to-side shunts and for cases of congenital absence of portal vein.

• Clinical and Experimental Pediatrics
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• 제50권5호
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• pp.469-475
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• 2007

목 적 : 이차공 심방 중격 결손의 Amplatzer 기구를 이용한 경피적 폐쇄의 안정성, 효용성 및 임상 결과를 수술적 폐쇄법과 비교하기 위하여 본 연구를 시행하였다. 방 법 : 2000년 1월부터 2006년 6월까지 가천의과학대학교 길병원에서 이차공 심방 중격 결손으로 진단 받은 환자 115명을 대상으로 하였다. 그 중 70명에게 결손의 수술적 폐쇄술을 시행하였고, 45명의 환자에게 Amplatzer 기구를 이용한 경피적 폐쇄술을 시행하였다. 수술군과 시술군의 사망율, 합병증, 입원기간과 효용성을 조사하여 결과를 비교분석하였다. 결 과 : 전체 남녀 비는 1:2.4였다. 두 환자군에서 평균 연령과 결손크기는 유의한 차이가 없었다. 성공율은 시술군에서 97.8%, 수술군에서 100%였다. 전체 합병증은 수술군에서 시술군보다 많이 발생하였다(64.0 vs. 15.6%, P<0.05). 입원기간은 시술 군이 수술군보다 짧았다($4.2{\pm}1.2$ vs. $12.4{\pm}4.7days$, P<0.0001). 잔류단락은 시술군(8.9%)에서 수술군(4.3%)에 비해 더 많이 발생하였는데, 3개월후 추적 검사에서는 모두 소실되었다. 결 론 : 이차공 심방 중격 결손증의 Amplatzer 기구를 이용한 경피적 폐쇄는 수술을 대체할 수 있는 안전하고 효과적인 방법이다. 경험이 축적되고 기구가 발전하면서 경피적 폐쇄술의 적용 범위가 점차 확대되고 있다.

• Journal of Chest Surgery
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• 제54권5호
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• pp.383-388
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• 2021

Background: Achieving external access to and manual occlusion of the left atrial appendage (LAA) during minimally invasive mitral valve surgery (MIMVS) through a small right thoracotomy is difficult. Occlusion of the LAA using an epicardial closure device seems quite useful compared to other surgical techniques. Methods: Fourteen patients with atrial fibrillation underwent MIMVS with concomitant surgical occlusion of the LAA using double-layered endocardial closure stitches (n=6, endocardial suture group) or the AtriClip Pro closure device (n=8, AtriClip group) at our institution. The primary safety endpoint was any device-related adverse event, and the primary efficacy endpoint was successful complete occlusion of blood flow into the LAA as assessed by transthoracic echocardiography at hospital discharge. The primary efficacy endpoint for stroke reduction was the occurrence of ischemic or hemorrhagic neurologic events. Results: All patients underwent LAA occlusion as scheduled. The cardiopulmonary bypass and aortic cross-clamp times in the endocardial suture group and the AtriClip group were 202±39 and 128±41 minutes, and 213±53 and 136±44 minutes, respectively (p=0.68, p=0.73). No patients in either group experienced any device-related serious adverse events, incomplete LAA occlusion, early postoperative stroke, or neurologic complication. Conclusion: Epicardial LAA occlusion using the AtriClip Pro during MIMVS in patients with mitral valve disease and atrial fibrillation is a simple, safe, and effective adjunctive procedure.

• Clinical and Experimental Pediatrics
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• 제57권7호
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• pp.297-303
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• 2014

Transcatheter closure of atrial septal defects has become a popular procedure. The availability of a preprocedural imaging study is crucial for a safe and successful closure. Both the anatomy and morphology of the defect should be precisely evaluated before the procedure. Three-dimensional (3D) echocardiography and cardiac computed tomography are helpful for understanding the morphology of a defect, which is important because different defect morphologies could variously impact the results. During the procedure, real-time 3D echocardiography can be used to guide an accurate closure. The safety and efficiency of transcatheter closures of atrial septal defects could be improved through the use of detailed imaging studies.