• Journal of Chest Surgery
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• 제50권2호
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• pp.105-109
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• 2017

Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation.

• Journal of Chest Surgery
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• 제20권2호
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• pp.342-347
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• 1987

Complete occlusion of the main LCA is associated with a poor prognosis if the RCA becomes severely occluded. The functional role of collateral circulation is critical in this situation. This study lends support to the hypothesis that coronary collateral circulation can provide critically needed myocardial blood flow via right to left collaterals. Not surprisingly, left ventricular function was maintained in 4 of the 5 patients studied who had main LCA occlusion and well-developed collateral circulation.

• Journal of Chest Surgery
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• 제21권5호
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• pp.905-910
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• 1988

Anomalous origin of the coronary artery from the pulmonary artery is a rare congenital coronary artery disease and the origin of the left coronary artery from the pulmonary artery represents the commonest form of these unusual lesions. Because of differences in symptomatology, clinical course and prognosis, this malformation has been divided into infant type[Bl-and-White-Garland syndrome] and adult type on the basis of the absence or presence of collateral circulation between the right and left coronary artery. The latter type has been reported relatively few cases. A 21-year-old male was admitted to the Yeungnam University Hospital, due to study of incidentally noticed heart murmur. At that time he was asymptomatic and past medical history was noncontributory. Chest roentgenogram was within normal limit and electrocardiogram was consistent with hypertrophy of left ventricle. Echocardiogram and aortogram demonstrated markedly dilated and tortuous right coronary artery and anomalous origin of the left coronary artery from the pulmonary artery. To prevent arteriosclerosis, progressive myocardial infarction, infection and aneurysmal rupture, Takeuchi operation which establish a two coronary system by transpulmonary arterial reconnection of the anomalous left coronary artery was done. Postoperative course was uneventful.

• Journal of Chest Surgery
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• 제12권3호
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• pp.297-305
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• 1979

Occlusive coronary artery disease presents a potential threat to a significant population in the United States. According to many case reports, the increasing incidence of coronary artery disease due to atherosclerosis is noted in Korean, recently. Operative vascular procedures have increased steadily in number over the past 20 years in the United States. There have been many isolated case reports about coronary artery surgery, but these had little clinical impact. Nowadays, major three coronary bypass surgery has developed principally at three cardiac centers in the United States since 1967. Among three coronary bypass operation, the aorta-coronary artery saphenous vein bypass graft was first demonstrated by Favolaro and Effler at the Cleveland Clinic in 1967. We experienced one case of coronary artery disease, which was treated successfully by aorta-coronary saphenous vein graft with mild hypothermia under extracorporeal circulation in May, 1977. Saphenous vein was removed from above the knee and was 2.5 mm in diameter. The left ventricle was not vented for the left ventricle was not overdistended. Temporary artificial pace-maker-Medtronic-was implanted for the prevention and treatment of post-operative arrhythmia and heart block in post-operative first day. He is a 57 year old male businessman who had been suffered from hypertension [200 mmHg in systolic pressure] since 4 years ago, who had intermittent conservative treatment at local clinic. He had been afflicted with severe chest pain with choking sensation for 50 days. This symptom was aggravated exposing cold weather, or cold water, but was respond to rest. Pre-operative ECG revealed no any other ischemic sign except sinus bradycardia. Significant S-T segment depression was noted at lead II, AVF after double 5 minutes exercise, indicating positive Master`s test. Serum cholesterol was slight elevated to 253 mg/dl. Final pre-operative diagnosis was made by coronary arteriogram, which showed about 1.0-cm segmental 90 % occlusive atherosclerotic lesion in the proximal part of right coronary artery above the origin of acute marginal artery. Left coronary artery revealed good patency and there was no collateral circulation between right and left coronary artery .Hospital course was not eventful. He was discharged with good result on the post-operative day. He has been free from chest pain for longer than 2 years. And also the arterial flow in the coronary bypass graft is auscultated with the pocket-sized ultrasonic velocity detector, which shows the patency of the coronary bypass graft good.

• 대한핵의학회지
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• 제27권2호
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• pp.210-217
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• 1993

To compare the myocardial viability in patients suffering from total occlusion of the right coronry artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) ($300{\sim}350{\mu}Ci$) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA ($200{\sim}250{\mu}Ci$) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar & SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 injection. Intravenous T1-201 reinjection (six pts) or $^{99m}Tc-MIBI$ (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201 (IV T1-201) images, ECG, and ventriculography. Intracoronary T1-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.

• 대한핵의학회지
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• 제28권1호
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• pp.37-43
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• 1994

심근경색후 측부순환의 존재는 심근경색의 크기를 감소시키고 생존가능한 심근의 양을 늘려 심근기능의 보존에 기여하며 심실류 혈성을 예방하는 것으로 알려져 있다. 본 연구에서는 심근경색후 측부순환의 분포와 측부순환에 따른 심근 SPECT소견을 알아보고자 시행하였다. 급성심근경색으로 진단된 환자중 2주내에 관동맥 조영술을 시행하여 TIMI grade 0, 1인 환자 56예를 대상으로 하여 측부순환이 좋은 I군과 측부순환이 나쁜 II군으로 분류하여 양군간의 임상양상 및 좌심실기능과 심근 SPECT 소견을 조사하여 다음의 결과를 얻었다. 1) 경색관련 동맥에로의 측부순환은 우관동맥 15예, 좌전하행동맥 10예, 좌회선동맥 50예 순이 었다. 2) 측부순환 경로는 좌전하행동맥에서 우관동맥으로 13예(40.6%), 우관동맥에서 좌전하행동맥으로 9예(28.1%)로 우관동맥과 좌전하행동맥 사이에 흔하였다. 3) 최고 CK 활성도는 I군에서 낮은 경향이 있었다. 4) $^{99m}Tc$-MIBI 심근 SPECT상 측부순환로가 발달한 I군에서 경색부위 가역성 관류결손 부위 빈도가 높았다 (83.4% vs 15.3%, p<0.05). 5) LVEDV, LVESV, EF는 두 군간에 차이가 없었다. 관동맥 조영술상 측부순환로의 존재는 $^{99m}Tc$-MIBI 심근 SPECT의 가역성 관류결손 부위와 유의한 연관성이 있었으며, 심근 SPECT는 기능적 측부순환을 관찰하는데 유용한 검사로 생각된다.

• Advances in biomechanics and applications
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• 제1권4호
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• pp.279-292
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• 2014

This paper presents some simulations of fluxes and pressures in the coronary network, in the case of very severe coronary disease (several stenoses on the left branches and total occlusion of the right coronary artery). In that case, coronary artery bypass graft surgery is the commonly performed procedure. However, the success of the intervention depends on many factors. Modeling of the coronary circulation is thus important since it can help to understand the influence of all these factors on the coronary haemodynamics. We previously developed an analog electrical model that includes the eventual presence of collateral flows, and can describe the different revascularization strategies (two grafts, three grafts, ...). The aim of the present work is to introduce in our simulations the time-dependence of the coronary microvascular resistances, in order to better represent the effect of the systolic ventricular contraction (which induces an elevation of the resistances because the vessels are squeezed).

• Journal of Chest Surgery
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• 제36권10호
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• pp.772-775
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• 2003

모야모야 질환은 원위부 내경 동맥과 근위부 뇌동맥들의 폐쇄성 내피 이형증으로 특징지워는 뇌혈관 질환으로, 아직까지 정확한 병인이 밝혀지지 않은 질환이다. 상기 질환은 양측 내경 동맥의 원위부에 부분적인 협착이나 폐쇄를 야기하게 되고, 이러한 뇌혈관의 해부학적인 변이는 뇌의 기저부에 매우 미세한 혈관들의 문합을 형성하게 하는데, 이러한 신생 혈관들이 뇌혈관 조영검사상 구름처럼 보인다 하여 ‘Moyamoya’라 불리운다. 모야모야 환자군들에게서 관상 동맥 질환 등으로 인한 개심술의 시행은 매우 드물다고 알려져 있으며, 이러한 환자군들에서의 인공심폐기를 이용한 개심술은 수술 중, 그리고 수술 후 허혈성 뇌질환 등의 위험성이 매우 높다고 보고되고 있다. 본 교실은 모야모야 환자에서 심방중격결손 폐쇄와 관상동맥우회술을 인공심폐기를 이용한 개심술을 시행하여 성공적으로 치료하였기에 간략한 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제5권2호
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• pp.107-112
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• 1972

Recently we experienced a case of the portal hypertension, extrahepatlc origin in the National Medical Center, Seoul. The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceal rupture 6 years later and had recurring esophageal varices with bleeding this time.At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatlvely no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophagenl variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again. In this time, recurring esophageal varices were noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression,and following results were obtained. 1] No postoperatlve troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge. 2] During operation the portal pressure was 300 mm $H_2O$ and immediately lowered to 170 mm $H_2O$ after shunt.

• Korean Journal of Radiology
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• 제20권1호
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• pp.83-93
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• 2019

Objective: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). Materials and Methods: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. Results: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77-0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = -0.61, p < 0.001) and changes in EF (β = -0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17-0.85; p = 0.019). Conclusion: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.