• The Korean Journal of Nuclear Medicine
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• v.37 no.5
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• pp.269-277
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• 2003

목적: 게이트 심근관류 스펙트는 심근의 관류와 좌심실 기능을 동시에 평가할 수 있는 유용한 방법이다. 현재, 게이트 영상 획득시 8 단위영상이 널리 사용되지만, 아직 가장 적절한 단위영상의 수에 대해서는 논의의 여지가 있다. 본 연구는 동일한 환자에서 8 단위영상과 16 단위영상으로 게이트 심근관류 스펙트를 2회 연속적으로 시행하여 국소적 심근관류, 좌심실 용적과 구혈률등을 비교하였다. 대상 및 방법: 42명(평균 연령: 55세, 남: 녀=26: 16)의 관상동맥 질환이 의심되거나 알려진 환자를 대상으로 안정시 Tc-99m MIBI를 이용한 게이트 스펙트를 8 단위영상과 16 단위영상으로 2회 연속하여 시행하였다. 좌심실의 확장기말 용적, 수축기말 용적과 구혈률을 각각 얻었으며 확장기말의 단층영상을 18 분절로 나누고 각 분절마다 심근의 관류정도를 4등급으로 나누어 국소적 심근관류를 평가하였다. 결과: 8 단위영상과 16 단위영상 게이트 스펙트에서 국소적 심근관류의 일치도는 85.7% (tau-b=0.786, p<0.001)로 우수하였다. 두 방법간에 1등급의 차이는 100 분절(13.2%), 2등급 차이는 8 분절(1.1 %)이 있었고 3등급 차이는 없었다. 좌심실의 확장기말 용적, 수축기말 용적, 구혈률은 두 방법간에 높은 상관성을 보였으며(r=0.993, 0.989, 0.935), 좌심실 구혈률은 8 단위영상을 사용할 때 평균 1.8% 낮게 측정되어 통계적인 유의성은 있었으나(p<0.05), 그 차이는 크지 않았다. 결론: 8 단위영상과 16 단위영상을 사용한 게이트 심근관류 스펙트에서 국소적 심근관류의 일치도는 우수하였으며, 좌심실의 기능적 계수의 차이도 크지 않았다. 비록 높은 단위영상을 사용했을 때 더 정확하고 자세한 정보를 얻을 수 있다 하더라도, 구혈률과 용적 등을 얻는 일상적인 임상검사에는 8 단위영상 또한 그 역할을 충분히 할 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.150-156
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• 2003

Tricuspid regurgitation has been considered as a secondary lesion when it is combined with left valvular heart diseases. However, there have been some reports which show that tricuspid regurgitation keeps going and results in congestive heart failure even after a successful operation for left valvular heart disease. So far, there are no definite operation indications and predictive factors for the tricuspid re-gurgitation which is resulted from the left sided valvular heart disease. We designed this study to evaluate the effects of pulmonary artery pressure and left ventricular ejection fraction on the prognosis of tricuspid regurgitation, and to make an operation indication for the patients with secondary tricuspid regurgitation. Material and Method: We reviewed the medical records of patients who underwent surgery for the left sided valvular heart disease with tricuspid regurgitation and were followed for more than 1 year with echocardiograms. There was a total of 114 cases. We compared the grades of tricuspid regurgitations and pulmonary artery pressures and left ventricular ejection fractions on the basis of echocardiograms which were checked preoperatively and on the last follow up. Result: There were 43 cases of tricuspid an-nuloplasty. In these patients, the grades of tricuspid regurgitations were improved in 42 cases (97.7%). But in 71 cases without annuloplasty, 29 cases (41%) were improved, 32 cases (45%) had no change, and 29 cases (14%) were aggravated. This finding shows significant differences in the prognoses of tricuspid regur-gitations between the two groups (p<0.05). There was no difference in pulmonary artery pressures and ejection fractions between the patients who showed progression of tricuspid regurgitations and those who didn't (p > 0.05). The improvements of tricuspid regurgitations are not statistically related to the changes of pulmonary artery pressures or left ventricular ejection fractions. Conclusion: This study shows that it is impossible to predict the prognoses of tricuspid regurgitations with preoperative pulmonary artery pressures or left ventricular ejection fractions. Also, the excellent results of tricuspid annuloplasty is proven in controlling the secondary tricuspid regurgitations. Therefore, when tricuspid regurgitation is detected preoperatively, the procedures to correct the tricuspid regurgitation at the time of the operation for the left-sided valvular heart disease must be considered positively, regardless of the grades of tricuspid regurgitations, to prevent sig-nificant tricuspid regurgitation that may develop later.

• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.18-27
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• 2006

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, but is one of the most common causes of myocardial ischemia which would result in high mortality within the first year of life. This is our early result of the surgical management for these patients. Material and Method: From June 1989 to July 2003, 6 patients with ALCAPA and one patient with ARCAPA (Anomalous origin of the Right coronary artery from the pulmonary artery) underwent surgical repair. We have reviewed the all medical records, electrocardiogram, chest X-ray and echocardiography retrospectively. Result: Three of the patients were boys and four were girls. The median age at the operation was 5.4 months (Range: 3$\∼$33 months). The average body weight of at the operation was 6.7 kg (Range: 3.7$\∼$11.3 kg). A mean follow up period was 18 months. Only 3 patients were initially diagnosed as ALCAPA. And 3 patients had moderate mitral regurgitation. Immediate coronary artery reimplantation on diagnosis with the aim of restoring a two-coronary system circulation was done. The average bypass time was 114$\pm$37 minutes, and the average aortic cross clamping time was 55$\pm$22 minutes. The average stay of intensive care unit was 5$\pm$3 days, the mean mechanical ventilator time was 38$\pm$45 hours and the hospital stay after operation was 12$\pm$5 days. There were significant improvements in electrocardiogram and chest X-ray of the all patients except one late death patient. The ventricular function showed almost normal recovery after operation; the EF (Ejection Fraction) increased from 41.2$\pm$ 10.3$\%$ to 60.5$\pm$ 15.8$\%$ within 1 month and to 59.8$\pm$13.9$\%$ within 1 year after operation, the SF (Shortening Fraction) increased from 23.6$\pm$4.7$\%$ to 38.6$\pm$8.4$\%$ within 1 month and to 37.4$\pm$7.9$\%$ within 1 year after operation, LVEDDI (Left Ventricular End-diastolic Dimension Index) decreased from 100.8$\pm$25.6 mm/$m^{2}$ to 90.3$\pm$ 19.2 mm/$m^{2}$ within f month and to 79.3$\pm$ 15.8 mm/$m^{2}$ within 1 year after operation. Concomitant mitral repair was done in two patients with anterior mitral leaflet prolapse. In every patient, mitral valve showed less than mild regurgitation during follow up. One late death occurred in which patient Dor procedure was applied 10 months after initial operation due to the dilated cardiomyopathy Conclusion: In the management of this rare and could be fatal Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), early suspicion and correct diagnosis is of most important. But, after diagnosis, immediate restoration of 2 coronary systems could result in good outcome.

• Korean Journal of Clinical Laboratory Science
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• v.37 no.2
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• pp.88-95
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• 2005

Even though the echocardiograph has been recognized as the method of choice among various diagnostic tools to detect congestive heart failure (CHF), there were some limitations in relation to the consumption of time, labor and process. We analyzed results of N-terminal probrain-type natriuretic peptide (NT-proBNP) and various parameters of the echocardiographic findings to clarify the diagnostic usefulness of NT-proBNP in detecting patients with CHF. We analyzed the sera from total of 242 cases from in-patients and out-patients, which were requested from the cardiovascular section of department of Internal Medicine at Chungnam National University Hospital from March 2003 to May 2004. The procedures were performed in order as shown below; sampling, NT-proBNP analysis, data acquisition and data analysis. All data including personal information and echocardiographic findings ware acquired by medical record review. When classifying the study population into six groups according to the degree of left ventricular ejection fraction (LVEF), the serum level of NT-proBNP was higher in the group with 51-60% of LVEF (P=0.023). There were low correlation between the serum level of NT-proBNP and various parameters of the echocardiographic findings with LVESD (r=0.1513), LVEDD (r=0.0831), LVEF (r=0.2035), IVST (r=0.03) and LVPWT (r=0.0728), respectively. When comparing NT-proBNP with atrial and/or ventricular enlargement, the patient group with both left atrial and left ventricular enlargement (p=0.186) or only left atrial (p=0.105) or only left ventricular enlargement (p=0.256) showed higher level of NT-proBNP without statistical significance than patient group with no enlargement. Searching the optimal cutoff of the serum level of NT-proBNP, the sensitivity (98.9%) and the specificity (100%) was highest at the cutoff of 300 pg/mL than any other cutoffs. These findings suggested that the analysis of NT-proBNP in serum might detect the patients with CHF earlier than with the echocardiograph, especially in patients with asymptomatic or mild symptomatic CHF. In conclusion, NT-proBNP test was proved to be clinically useful to diagnose CHF patients.

• Journal of Institute of Control, Robotics and Systems
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• v.10 no.12
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• pp.1164-1171
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• 2004

A new multi-scale simulation model is proposed to analyze heart mechanics. Electrophysiology of a cardiac cell is numerically approximated using the previous model of human ventricular myocyte. The ion transports across cell membrane initiated by action potential induce an excitation-contraction mechanism in the cell via cross bridge dynamics. Negroni and Lascano model (NL model) is employed to calculate the tension of cross bridge which is closely related to the ion dynamics in cytoplasm. To convert the tension on cell level into contraction force of cardiac muscle, we introduce a simple geometric model of ventricle with a thin-walled hemispheric shape. It is assumed that cardiac tissue is composed of a set of cardiac myocytes and its orientation on the hemispheric surface of ventricle remains constant everywhere in the domain. Application of Laplace law to the ventricle model enables us to determine the ventricular pressure that induces blood circulation in a body. A lumped parameter model with 7 compartments is utilized to describe the systemic circulation interacting with the cardiac cell mechanism via NL model and Laplace law. Numerical simulation shows that the ion transports in cell level eventually generate blood hemodynamics on system level via cross bridge dynamics and Laplace law. Computational results using the present multi-scale model are well compared with the existing ones. Especially it is shown that the typical characteristics of heart mechanics, such as pressure volume relation, stroke volume and ejection fraction, can be generated by the present multi-scale cardiovascular model, covering from cardiac cells to circulation system.

• Journal of Ginseng Research
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• v.44 no.3
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• pp.483-489
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• 2020

Background: Korean Red Ginseng (KRG) has been known to possess many ginsenosides. These ginsenosides are used for curing cardiovascular problems. The present study show the protective potential of KRG against doxorubicin (DOX)-induced myocardial dysfunction, by assessing electrocardiographic, hemodynamic, and biochemical parameters and histopathological findings. Methods: Animals were fed a standard chow and adjusted to their environment for 3 days before the experiments. Next, the rats were equally divided into five groups (n = 9, each group). The animals were administered with KRG (250 and 500 mg/kg) for 10 days and injected with DOX (20 mg/kg, subcutaneously, twice at a 24-h interval) on the 8th and 9th day. Electrocardiography and echocardiography were performed to study hemodynamics. Plasma levels of superoxide dismutase, catalase, glutathione peroxidase, and malondialdehyde were measured. In addition, the dose of troponin I and activity of myeloperoxidase in serum and cardiac tissue were analyzed, and the histopathological findings were evaluated using light microscopy. Results: Administration of KRG at a dose of 250 and 500 mg/kg recovered electrocardiographic changes, ejection fraction, fractional shortening, left ventricular systolic pressure, the maximal rate of change in left ventricle contraction (-dP/dt_max), and left ventricle relaxation (-dP/dt_max). In addition, KRG treatment significantly normalized the oxidative stress markers in plasma, dose dependently. In addition, the values of troponin I and myeloperoxidase were ameliorated by KRG treatment, dose dependently. And, KRG treatment showed better histopathological findings when compared with the DOX control group. Conclusion: These mean that KRG mitigates myocardial damage by modulating the hemodynamics, histopathological abnormality, and oxidative stress related to DOX-induced cardiomyopathy in rats. The results of the present study show protective effects of KRG on cardiac toxicity.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.355-362
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• 2017

Background: Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. Methods: This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. Results: Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. Conclusion: Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

• Journal of Yeungnam Medical Science
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• v.33 no.2
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• pp.125-129
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• 2016

Stress induced cardiomyopathy (SC) is characterized by transient left ventricular (LV) dysfunction in the absence of coronary artery disease. We report on a patient with panhypopituitarism who developed SC resulting from withdrawal of hormonal replacement therapy (HRT). A 52-year-old male visited our hospital for progressively worsening dyspnea. The patient had discontinued HRT 7 days ago, which had been administered for 18 months after transsphenoidal adenomectomy for pituitary macroadenoma. Initial electrocardiogram showed marked sinus bradycardia. Transthoracic echocardiography showed apical ballooning with an LV ejection fraction of 25%. No significant obstructive lesions were observed on coronary angiography. With a clinical diagnosis of SC associated with panhypopituitarism, HRT was restarted, including glucocorticoid and thyroxine, along with standard heart failure management. His LV function had normalized at 2-month follow-up. He remains asymptomatic and administration of beta-blocker and angiotensin converting enzyme inhibitor were discontinued He currently only requires HRT.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.38 no.8
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• pp.715-720
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• 2014

In order to maximize the effect of left ventricular assist device (LVAD) on ventricular unloading, the therapy should be begun at appropriate level of heart failure severity. We predicted pumping efficacy of LVAD according to the severity of heart failure theoretically. We used 3 dimensional finite element model of ventricle coupled with 6 Wind-kessel compartmental model of vascular system. Using the computational model, we predicted cardiac responses such as contractile ATP consumption of ventricle, left ventricular pressure, cardiac output, ejection fraction, and stroke work according to the severity of ventricular systolic dysfunction under the treatments of continuous LVAD. Contractile ATP consumption, which indicates the ventricular energetic loading condition decreased maximally at the $5^{th}$ level heart-failure under LVAD therapy. We conclude that optimal timing for LVAD treatment is $5^{th}$ level heart-failure when considering LVAD treatment as "bridge to recovery".

• Biomedical Science Letters
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• v.17 no.4
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• pp.329-336
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• 2011

The female has previously been shown to be an independent risk factor for mortality and morbidity after coronary artery bypass grafting surgery (CABG). The aim of this retrospective study is to evaluate gender differences of the perioperative outcomes in elderly patients underwent CABG. Data for seventy elderly patients (>70 years) that underwent CABG (between January 2005 and July 2011) were divided into two groups: male patients (n=33, male group) and female patients group (n=37, female group). Heights, body weights, body surface area and coronary artery obstruction rate (right coronary artery territory) in the female group were lower than those of the male group ($P$ <0.05). History of hypertension, hyperlipidemia, congestive heart failure and percutaneous coronary artery intervention in the female group was higher than that of the male group ($P$ <0.05). Total cholesterol and brain natriuretic peptide levels in the female group were higher than those of the male group ($P$ <0.05). Platelet count in the female group was higher than the male group at preoperative (Pre-OP) period ($P$ <0.05). Erythrocyte count, hematocrit and hemoglobin levels in the female group were lower than those of the male group at Pre-OP period ($P$ <0.05). But, erythrocyte count, hematocrit and hemoglobin levels in the female group were higher than those of the Male group at postoperative (Post-OP) period ($P$ <0.05). Left ventricular ejection fraction in the female group was higher than the male group at Post-OP period ($P$ <0.05). Hospital stay length in the female group was higher than the male group ($P$ <0.05). Post-OP bleeding volume and incidence of ventricular premature contraction in the female group were lower than those of the male group ($P$ <0.05). These results suggest that despite female gender have a greater risk factors and require a longer hospitalization than male, there was no significant difference incidence of mortality and complication.