• Journal of Chest Surgery
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• v.26 no.1
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• pp.32-35
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• 1993

During the period from September 1989 through December 1992, 118 cases of coronary arterial bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. Twenty-one of these had history of recent or remote percutaneous transluminal coronary angioplasty. They consisted of 13 males[age,58.7 + 5.4 years] and 8 females[age, 63.6 + 2.8years] with the mean age of 60.6. History of old myocardial infarction was noted in 24%[5/21] of the patients and congestive heart failure in 2 cases. The angina by type of presentation is unstable in all of the patients. The patterns of involvement of coronary arterial disease were left main disease[1], single vessel disease[5], double vessel involvement[10], and triple vessel involvement[5]. We performed 4 cases of single bypasses, 7 cases of double, 8 cases of triple, and 2 cases of quadruple bypasses. Total of 51 grafts[LIMA:12, RSVG:39] were inserted in 21 cases with average of 2.4 grafts per patient. The methods of myocardial protection were cold blood cardioplegia[8 cases], intermittent aortic occlusion[11], and continuous coronary perfusion with local coronary sharing[2]. There were no operative or late death. The only cardiac complication was 1 case of low cardiac output required IABP. The other complications were 1 case of sternal wound infection and 1 case of postoperative bleeding required reoperation. And there was no case of perioperative myocardial infarction. Postoperatively, 3 cases of recurrent angina were detected at 5, 7, and 18months after surgery. One of them was managed successfully with repeat PTCA[who was recurred 18 months postoperatively], and the other two with medication. I conclude that we can approach the patients more aggressively with PTCA, because of our acceptable operative risks.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.105-110
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• 2008

Renovascular hypertension results from a lesion that impairs blood flow to a part of or all, of one or both kidneys. Renal artery stenosis is the major cause of renovascular hypertension and the most common cause of treatable secondary hypertension. Recently, percutaneous transluminal renal angioplasty(PTRA) with or without stent placement, has become the preferred choice for correcting symptomatic renal artery stenosis since it is less invasive than surgical reconstruction. PTRA with balloons designed for the dilatation for the dilatation of the coronary artery can be tried in small sized renal artery stenosis. We report a case of renovascular hypertension in a 13-year-old male who had small sized renal artery stenosis. Hypertension was controlled by PTRA with balloon dilatation.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.363-366
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• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Korean Journal of Clinical Pharmacy
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• v.22 no.2
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• pp.103-112
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• 2012

Performance of coronary angiography for exact diagnosis and treatments of cardiovascular disease have been increased recently and it also brings increase of the contrast-induced nephropathy (CIN) referred from increasing use of radiological contrast agents. The variation of estimated glomerular filtration rate (eGFR) is an indicator of CIN, which is known to increase when renal function is decreased. Therefore, this study was to evaluate the affecting factors including concomitant drug on variation of eGFR of patients who underwent coronary angiography according to the conditions of renal function. Medical records of 66 patients were evaluated retrospectively and the patients underwent coronary angiography or angioplasty with nonionic and isotonic contrast media (iodixanol) at Chungnam national university hospital from 1 Jan 2008 to 30 Jul 2010. Patients group was divided into 2 groups; the patients in stages 3-4 chronic kidney disease (CKD) and the patients in stage 2 CKD. Each group was researched about the effect of concomitant drug and clinical characteristics on eGFR variation. The change of eGFR was compared among baseline and 2 or 3 day after coronary angiography. In results, the eGFR variation in group over age 75 was significantly decreased after radiological contrast agents exposure (p $$\leq_-$$ 0.05). The eGFR variation in anemia was significantly decreased after radiological contrast agents exposure in stage 2 CKD (p > 0.05). The eGFR variation in group under $HbA_{1c}$ 6.5% was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). The eGFR variation by taking statins, angiotensin converting enzyme inhibitors, calcium channel blockers and nitroglycerin was increased after radiological contrast agents exposure in stage 2 CKD (p $$\leq_-$$ 0.05). The eGFR variation by using of diuretics was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). The eGFR variation by taking statins, nitroglylcerin was increased after radiological contrast agents exposure in stages 3-4 CKD(p > 0.05). The eGFR variation in group over contrast dosage 150 ml was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). Therefore, when undergoing coronary angiography, contrast dosage should be minimized less than 150 ml, and diuretics should be restricted as possible in stages 3-4 CKD. Patients over age 75 require special attention to prevent CIN, and if patients undergo coronary angiography in stages 3-4 CKD, $HbA_{1c}$ is also requried to maintain below 6.5% to prevent CIN.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.864-867
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• 2006

Percutaneous suture closure device is known as relatively safe and convenient tool, which can decrease not only bed rest period of patient but also time consuming effort of manual compression of doctor after femoral artery puncture. However[C1], there are also some reports on complication of its use. We report a 62-year-old male patient who had femoral artery endarteritis[0] with pseudoaneurysm as a complication of percutaneous suture closure device after percutaneous coronary angiography[C2]. He was treated successfully by appropriate antibiotics and vessel reconstruction using autologous saphenous vein patch.

• The Korea Journal of Herbology
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• v.26 no.4
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• pp.149-154
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• 2011

Objectives : Myocardial infarction is caused by heart cell death in a region where coronary arteries supplying blood to the region are occluded. In the present study, we determined whether ethanol extract of Cortex fraxini (HY5053) could attenuate heart injury by inhibiting apoptosis. Methods : Improvement of survival of HepG2 cells, a human hepatocellular carcinoma cell line, and reduction of apoptosis under hypoxic conditions (3% $O_2$) were assessed by trypan blue staining and DNA fragmentation assay, respectively. To assess the impact of HY5053 on the heart injury, Sprague-Dawley rats underwent 1 day of the left anterior descending coronary artery occlusion. HY5053 was given by intraperitoneal injection (200 mg/kg) 1 hr prior to the occlusion. Subsequently, the heart were harvested, excised into 4 slices, and the slices were stained with 2,3,5-triphenyl tetrazolium chloride. Finally, the extent of heart injury represented as ischemic index (%) was assessed. Results : Addition of HY5053 (400 ${\mu}g$/mL) into the culture medium for 1 day under ischemic conditions improved the cell survival by 50%, compared with control (0 ${\mu}g$/mL), consequently delayed apoptosis in 6 hr difference. Also, HY5053 (200 mg/kg) reduced the ischemic index by 44%, compared with control (0 mg/kg). Conclusions : These findings suggested that HY5053 attenuated myocardial infarction by inhibiting apoptosis. Thus, Cortex fraxini could be developed as a novel cardioprotectant to complement a currently available treatment, coronary angioplasty.

• Proceedings of the KSME Conference
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• 2003.04a
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• pp.1915-1918
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• 2003

Atherosclerosis, which is a degenerate disease, is believed to occur in the vascular system due to deposition of cholesterol and low density lipoprotein(LDL) or thrombosis on the blood vessel. Atherosclerosis narrows arterial lumen, which is known as stenosis phenomenon of blood vessel. Pathogenesis of atherosclerosis is thought to occur mainly by aging. Restenosis phenomenon is observed in the same site of insertion of a stent and balloon angioplasty after treatment of interventional theraphy. Several hypothetical theories related to the generation of atherosclerosis have been reported: high shear stress theory, low shear stress theory, high shear stress gradient theory, flow separation and turbulence theory and high pressure theory. However, no one theory clearly explains the causes of atherosclerosis. In the present study the generation of atherosclerosis in the left coronary artery is investigated. The hypotheses are verified by using the computer simulation.

• Biomaterials and Biomechanics in Bioengineering
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• v.1 no.3
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• pp.131-150
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• 2014

Vascular stenting has a great attention as a treatment for coronary arteries diseases as compared with percutaneous balloon angioplasty. In-stent restenosis and thrombosis are side effects resulting from using bare metal stent (BMS). Employing platelet therapy allowed to reduce the rate of thrombosis, however, the rate of restenosis remains a major problem. In 2002, drug-eluting stents (DESs) were introduced as an effort to reduce the restenosis. The commercially available DESs continue to suffer from coating defects that might lead to a series of adverse effects. Most importantly, multiple concerns remain regarding the polymer coating integrity on metal surfaces or the relation of polymer irregularities to longterm adverse events.

• The Korean Journal of Physiology and Pharmacology
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• v.19 no.5
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• pp.421-426
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• 2015

The increased potential for vascular smooth muscle cell (VSMC) growth is a key abnormality in the development of atherosclerosis and post-angioplasty restenosis. Abnormally high activity of platelet-derived growth factor (PDGF) is believed to play a central role in the etiology of these pathophysiological situations. Here, we investigated the anti-proliferative effects and possible mechanism(s) of murrayafoline A, a carbazole alkaloid isolated from Glycosmis stenocarpa Guillamin (Rutaceae), on PDGF-BB-stimulated VSMCs. Murrayafoline A inhibited the PDGF-BB-stimulated proliferation of VSMCs in a concentration-dependent manner, as measured using a non-radioactive colorimetric WST-1 assay and direct cell counting. Furthermore, murrayafoline A suppressed the PDGF-BB-stimulated progression through $G_0/G_1$ to S phase of the cell cycle, as measured by [$^3H$]-thymidine incorporation assay and cell cycle progression analysis. This anti-proliferative action of murrayafoline A, arresting cell cycle progression at $G_0/G_1$ phase in PDGF-BB-stimulated VSMCs, was mediated via down-regulation of the expression of cyclin D1, cyclin E, cyclin-dependent kinase (CDK)2, CDK4, and proliferating cell nuclear antigen (PCNA), and the phosphorylation of retinoblastoma protein (pRb). These results indicate that murrayafoline A may be useful in preventing the progression of vascular complications such as restenosis after percutaneous transluminal coronary angioplasty and atherosclerosis.

• Applied Microscopy
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• v.23 no.1
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• pp.139-163
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• 1993

Background: It has been well established and is now no longer a controversial issue that ischemia produces a series of inflammatory reactions and the ischemic myocardium cannot survive without adequate restoration of coronary flow, ie, reperfusion. Nevertheless, controversies that intravascular pluggings (IVP) by polymorphonuclear leukocytes (PMNs) or platelets may cause contractile dysfunction in ischemia and even in repefusion still remain. Accordingly, we attempted to examine the intravascular plug fomation as well as the ultrastructural changes in myocytes and microvessels and to determine the relation among them. Methods: 1) Human (n= 10, 39-63 years of age; 3 females and 7 males): left ventricular myocardium (LVM) was biopsied from chronic ischemic heart disease patient during bypass surgery. 2) Calf (Holstein-Friesian species, n=4): Circumflex branch of the left coronary artery (LCx) was occluded (ischemia) for 45 minutes and recanalized (reperfusion) for 3 and 6 hours, respectively and LVMs were biopsied after occlusion and recanalization, respectiverly. 3) Rat (Sprague-Dawley species, n=20): Left coronary artery (LCA) was occluded for 20 minutes and recanalized for an hour as the method described by Selye et al., (1960) and hearts were removed after occlusion and recanalization, respectively. 4) Pig (landrace type, n=7): Anterior ascending branch of the left coronary artery (LAD) was coccluded for 45 minutes and recanalized for 2 hours and LVMs were biopsied after occlusion and recanalization, repectively. All of the LVMs were routinely prepared for transmissiom electron microscopy. Rseults: In human, most of the LVM showed irreversible ultrastructural changes in myocytes and frequent IVPs by PMNs or platelets without any significant correlation with age or sex. In the animal LVM, myocytes showed reversible ultrastructural changes with slight variations in accordance with the species, duration of ischemia and reperfusion or site of biopsy, however, injuries were more severe in the subendocardial myocytes and IVPs by PMNs or platelets were frequently observed. Ultrastructural changes in the myocytes seemed to be gradually improved by recanalization, howerver, IVPs were still observed after recanalization. Conclusion: These results suggest that microvessels are more resistant to ischemic insult than the myocytes themselves and IVP by PMNs and platelets may play an important role to produce ischemic or reperfusion injuries. Thus, it is favorable that angioplasty is preceded by thrombolysis and it is likely that restoration of myocardial function requires relarively long period of time even after recanalization.