• Journal of Chest Surgery
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• 제16권2호
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• pp.157-163
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• 1983

Ebstein's anomaly is a rare congenital cardiac malformation oand the ideal surgical correction seems controversial at present, and some problems are left unsolved in the surgical correction of this anomaly. Between June 1978 and June 1982, 12 patients with Ebsteins' anomaly underwent corrective open heart surgery at Seoul National University Hospital. Except for one patient, who had no ASD, all had a huge right atrium, secundum type ASD, and definite atrialized right ventricle. Typically, displaced tricuspid valve leaflets were found in all cases, but the degree of displacement and deformity were variable. In the point of NYHA functional classification, five were in class II, six were in class III, and one was in class IV. Ten patients were operated on by tricuspid valve replacement and pication. Two patients were operated on only by plication and annuloplasty techniques, and in all cases, ASD was closed. Postoperatively, four patients suffered from complete A-V block, and two of them died immediately. The remaining two patients took pacemaker generator implantation with good results. The other eight patients were in good condition. Tricuspid valve replacement using tissue valve and plication of the atrialized rght ventricle seems to be a good method of surgical correction for Ebstein's anomaly.

• Journal of Chest Surgery
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• 제23권3호
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• pp.474-481
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• 1990

We have experienced 44 cases of coarctation of aorta in the age of infancy and children from April 1986 to September 1989 at Seoul National University Children`s hospital. Patients were thirty males and fourteen females, and their age ranged from one month to ten years[mean 23.84 $\pm$33.06 months] with thirty-two infant cases. In the infantile age, congestive heart failure was the most common chief complaint[18/32], and above that age, frequent upper respiratory infection was most common[8/12]. We experienced thirteen cases of isolated COA, twenty-two cases of COA with VSD, eight cases of COA with VSD, eight cases of COA with intracardiac complex anomalies and one case of COA with atrial septal defect. The associated intracardiac complex anomalies were three Taussig-Bing type double outlet right ventricle, one single ventricle, one transposition of great arteries, one atrioventricular septal defect, one hypoplastic aortic arch with left heart hypoplasia, and one Tetralogy of Fallot. Operative techniques of COA were twenty-three subclavian flap arterioplasty, 12 resection and end to end anastomosis, eight onlay patch angioplasty, and I direct angioplasty after resection of web. Among the cases with other cardiac anomalies, staged operation was done in twenty-nine patients, and single stage total correction was performed only in three patients. There were seven operative mortality[15.9%], all being in infantile age group, and among fourteen cases associated with large VSD[Qp/Qs>2.0, mean pulmonary arterial pressure>50mmHg], four patients were died, but there was no mortality in patients with small VSD. With above results, we are intended to discuss about the interval between staged operation, the fate of VSD after coarctoplasty in case of COA with VSD, causes of death, complications etc.

• Journal of Chest Surgery
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• 제32권3호
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• pp.224-236
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• 1999

배경: 역동적 심근성형술에서 골격근 수축에 의한 단기 혈역학적 변화를 관찰하고 이에 미치는 인자를 분석하고자 하였다. 대상 및 방법: 이를 위해 20-30kg 사이의 한국산 잡견 10마리를 두 그룹으로 나눠 심장 상태를 정상과 심부전 상태로 구분하였고 골격근 상태도 활성도 및 수축력의 차이가 나도록 구분하였다. 그룹 A에서는 5마리의 정상 심장상태의 실험견에 심근성형술을 시행한 뒤 8주후 혈역학 검사를 실시하였고, 그룹 B에서는 5마리의 실험견에 8주동안 매주 1 mg/kg의 doxorubicin을 주입하여 만성 심부전 상태를 만들면서 동시에 좌측 광배근의 사전 조건화를 위한 근육훈련을 한후 심근성형술을 시행하고 바로 혈역학 검사를 실시하였다. 결과: 그룹 A의 정상 심장 상태에서 광배근 수축으로 평균 우심방 압력을 제외한 나머지 좌심실 혈역학 지수에는 유의한 변화가 없었다. 그룹 B에서는 광배근 수축으로 심박출량(cardiac output; CO)은 16.7$\pm$7.2%, 좌심실 압력발생 속도(positive pressure development rate of left ventricle; dp/dt)는 9.3$\pm$3.2%, 일회 심박출량(stroke volume; SV)은 16.8$\pm$8.6%, 좌심실 박출작업량(left ventricular stroke work; SW)은 23.1$\pm$9.7% 증가하였고, 좌심실 이완기말압(left ventricular end-diastole pressure; LVEDP)은 32.1$\pm$4.6%, 평균 폐동맥쐐기압(mean pulmonary capillary wedge pressure; mPCWP)은 17.7$\pm$9.1% 감소하였다(p<0.05). 그러나 그룹 A에서 imipramine을 7.5 mg/kg/hour의 속도로 34$\pm$2.6분 투여하여 CO이 17.5$\pm$2.7%, 좌심실 수축기압(left ventricular systolic pressure)이 15.8$\pm$2.5% 감소하고 LVEDP가 54.3$\pm$15.2% 증가한 일시적 급성 심부전 상태를 유도한 뒤(p<0.05), 이 상태에서 광배근을 자극하였더니 CO은 4.5$\pm$1.8%, dp/dt는 3.1$\pm$1.1%, SV는 5.7$\pm$3.6%, SW는 6.9$\pm$4.4% 증가하였고, LVEDP는 11.7$\pm$4.7% 감소하였다(p<0.05). 그룹 A의 급성 심부전 상태와 그룹 B의 만성 심부전 상태에서 모두 광배근 수축으로 변화한 CO, dp/dt, SV, SW, LVEDP 같은 좌심실 혈역학 지표들의 변화의 폭을 비교하면 그룹 B에서 그룹 A에서보다 더 컸다(p<0.05). 그룹 A에서 유도된 급성 심부전 상태와 그룹 B의 만성 심부전 상태가 CO, dp/dt, SV, SW, LVEDP 같은 좌심실 혈역학 지표들 면에서 통계학적으로 차이가 없고(p>0.05), 육안적으로 광배근을 관찰하였을 때 그룹 A에서는 광배근의 유착 및 염증소견이 모두에서 있었고 그중 2마리에서는 광배근의 수축을 목격할 수 없었던 반면, 그룹 B에서는 5마리 모두에서 광배근이 활발하게 수축하였다는 점을 함께 고려하면 그룹 B에서의 더 큰 증폭 효과가 광배근의 활성도 및 수축력의 차이로부터 기인한다고 평가할 수 있다. 결론: 이상에서 역동적 심근성형술의 수축기 혈역학적 변화는 심부전 상태에서만 긍정적인 개선 효과를 나타내며, 그 효과의 극대화를 위해서는 근육의 수축력을 유지하는 것이 매우 중요함을 알 수 있다.

• Reproductive and Developmental Biology
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• 제34권2호
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• pp.81-88
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• 2010

Our objective of current study was to investigate the development of bone and heart in association with diabetes mellitus (DM). DM was induced by administering an intraperitoneal injection of streptozotocin (STZ; 60 mg/kg) to 4-week-old Sprague-Dawley rats. Body weight and blood glucose were monitored, and rats were sacrificed after 2 or 5 weeks. The left ventricle (LV), including the interventricular septum, was weighed, and body weight and tibial bone length were assessed. Young diabetic rats showed reduced growth in terms of tibial length and body weight compared to controls. Moreover, diabetic males showed more significant growth suppression and reduced LV size than diabetic females. Morphometric analysis of tibiae from diabetic rats revealed suppressed bone growth at 2 and 5 weeks, with no difference between genders. STZ-induced diabetes decreased bone growth and retarded pre-pubertal heart development. As a result, diabetes may increase cardiovascular risk factors and lead to eventual heart failure. Therefore, new therapeutic approaches are required for diabetic children exhibiting growth retardation. Heart growth factor, exercise, and cardiopulmonary physical therapy may be required to promote heart development and physiological function.

• Journal of Chest Surgery
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• 제24권1호
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• pp.15-25
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• 1991

From February 1988 to December 1990, 42 patients underwent so called REV operation for pulmonary stenosis or atresia with or without anomalies of ventriculoarterial connection and truncus arteriosus. The principles of operative technique are mobilization of pulmonary arterial tree beyond the pericardial reflection, transection of pulmonary trunk between the pulmonary ventricle and pulmonary artery, suture of distal pulmonary arterial stump to the upper margin of Pulmonary ventriculotomy site with absorbable suture, and anterior patch with 0.625% glutaraldehyde fixed autologous pericardium with monocusp inside it. Age at operation ranged 3-156months [mean 41.8 month] with twelve of whom infants. Operative indications were pulmonary atresia, with ventricular septal defect[16], and pulmonary stenosis with double outlet right ventricle[8], with ventricular septal defect[16], with double outlet right ventricle[8], with complete transposition of the great arteries[8], with corrected transposition of the great arteries[6], with Fallot`s tetralogy[3], and truncus arteriosus[1]. There were six hospital deaths[14%] and no late death. Twenty-four of 36 survivals were followed up more than 12 months with good clinical results. Postoperative angiocardiogram was performed in fifteen patients. Hemodynamically, two patents had residual pressure gradients along the pulmonary outflow tract, one patient showed severe pulmonary regurgitation; morphologically, there were six significant stenosis of left pulmonary arterial tree, two of whom showed significant pressure gradients. Our present experience with REV operation suggests that this technique make it possible to perform anatomic repair in a wide variety of congenital anomalies of abnormal ventriculoarterial connection associated with pulmonary outflow tract obstruction without using the prosthetic material, even in infants, with relatively low mortality and morbidity.

• Korean Journal of Radiology
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• 제20권1호
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• pp.102-113
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• 2019

Objective: To assess the accuracy and potential bias of computed tomography (CT) ventricular volumetry using semiautomatic three-dimensional (3D) threshold-based segmentation in repaired tetralogy of Fallot, and to compare them to those of two-dimensional (2D) magnetic resonance imaging (MRI). Materials and Methods: This retrospective study evaluated 32 patients with repaired tetralogy of Fallot who had undergone both cardiac CT and MRI within 3 years. For ventricular volumetry, semiautomatic 3D threshold-based segmentation was used in CT, while a manual simplified contouring 2D method was used in MRI. The indexed ventricular volumes were compared between CT and MRI. The indexed ventricular stroke volumes were compared with the indexed arterial stroke volumes measured using phase-contrast MRI. The mean differences and degrees of agreement in the indexed ventricular and stroke volumes were evaluated using Bland-Altman analysis. Results: The indexed end-systolic (ES) volumes showed no significant difference between CT and MRI (p > 0.05), while the indexed end-diastolic (ED) volumes were significantly larger on CT than on MRI (93.6 ± 17.5 mL/m² vs. 87.3 ± 15.5 mL/m² for the left ventricle [p < 0.001] and 177.2 ± 39.5 mL/m² vs. 161.7 ± 33.1 mL/m² for the right ventricle [p < 0.001], respectively). The mean differences between CT and MRI were smaller for the indexed ES volumes (2.0-2.5 mL/m²) than for the indexed ED volumes (6.3-15.5 mL/m²). CT overestimated the stroke volumes by 14-16%. With phase-contrast MRI as a reference, CT (7.2-14.3 mL/m²) showed greater mean differences in the indexed stroke volumes than did MRI (0.8-3.3 mL/m²; p < 0.005). Conclusion: Compared to 2D MRI, CT ventricular volumetry using semiautomatic 3D threshold-based segmentation provides comparable ES volumes, but overestimates the ED and stroke volumes in patients with repaired tetralogy of Fallot.

• Investigative Magnetic Resonance Imaging
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• 제12권1호
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• pp.40-48
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• 2008

목적: 개정 도씨 술식과 승모판 고리성형을 동시에 시행한 후 심실의 형태와 기능의 초기 변화를 자기공명영상을 이용하여 평가하고자 하였다. 대상 및 방법: 총 21명의 확장성 심부전 환자를 대상으로 하여 8명에서 개정 도씨 술식을, 6명에서 승모판 고리성형을, 7명에서 두 수술을 동시에 시행하였다. 영화 자기공명영상을 이용하여 수술 전과 후에 좌심실의 형태와 기능을 평가하였다. 좌심실의 이완기말 용적과 수축기말 용적, 장축과 단축의 길이를 측정하고 이로부터 좌심실의 일회박출량, 박출률, 구형지수를 계산하여 구하였다. 이렇게 구해진 인자들을 분석하고 술식이 서로 다른 3군에서 어떻게 다른지 비교하고 두 수술을 동시에 시행할 때의 효과를 해석하였다. 결과: 자기공명영상은 수술 전 $12\;{\pm}\;15$ 일 (범위 1-58 일)과 수술 후 $38\;{\pm}\;50$ 일 (범위 7- 231 일)에 시행하였다. 두 수술을 동시에 시행한 군에서 다른 군에 비하여 수술 전 좌심실의 확장이 더 심하였고 수축력이 더 감소되어 있었다. 수술 후, 좌심실의 이완기말 용적과 수축기말 용적은 수술 형태와 관계없이 모든 환자에서 유의하게 감소하였다. 박출률은 개정 도씨 술식을 받은 환자 군에서만 유의하게 증가하였다 (25.4% to 40.7%). 구형지수는 개정 도씨 술식을 받은 환자에서는 증가하였고 승모판 고리성형을 받은 환자에서는 감소하였다 (0.65 to 0.78 vs. 0.75 to 0.65). 두 수술을 동시에 시행한 환자에서는 유의한 구형지수의 변화가 없었다. 결론: 개정 도씨 술식과 승모판 고리성형을 동시에 시행받은 확장성 심부전 환자에서 좌심실의 형태와 기능의 초기 변화는 좌심실 용적과 일회박출량의 현저한 저하이다. 승모판 고리성형에 의한 구형지수의 감소는 개정 도씨술식에 의한 구형지수의 증가에 의해 상쇄되어 좌심실의 형태는 변하지 않는다. 두 수술을 동시에 시행한 후 좌심실 박출률의 향상은 조기에 일어나지 않는다.

• Journal of Chest Surgery
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• 제19권4호
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• The Korean Journal of Physiology and Pharmacology
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• 제23권1호
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• pp.71-79
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• 2019

Body surface potential map, an electric potential distribution on the body torso surface, enables us to infer the electrical activities of the heart. Therefore, observing electric potential projected to the torso surface can be highly useful for diagnosing heart diseases such as coronary occlusion. The BSPM for the heart of a patient show a higher level of sensitivity than 12-lead ECG. Relevant research has been mostly based on clinical statistics obtained from patients, and, therefore, a simulation for a variety of pathological phenomena of the heart is required. In this study, by using computer simulation, a body surface potential map was implemented according to various occlusion locations (distal, mid, proximal occlusion) in the left anterior descending coronary artery. Electrophysiological characteristics of the body surface during the ST segment period were observed and analyzed based on an ST isointegral map. We developed an integrated system that takes into account the cellular to organ levels, and performed simulation regarding the electrophysiological phenomena of the heart that occur during the first 5 minutes (stage 1) and 10 minutes (stage 2) after commencement of coronary occlusion. Subsequently, we calculated the bipolar angle and amplitude of the ST isointegral map, and observed the correlation between the relevant characteristics and the location of coronary occlusion. In the result, in the ventricle model during the stage 1, a wider area of ischemia led to counterclockwise rotation of the bipolar angle; and, during the stage 2, the amplitude increased when the ischemia area exceeded a certain size.

• Journal of Chest Surgery
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• 제51권2호
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• pp.130-132
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• 2018

Coronary sinus ostial atresia (CSOA) with persistent left superior vena cava (LSVC) in the absence of an unroofed coronary sinus is a benign and rare anomaly that may be taken lightly in most instances. However, if overlooked in patients undergoing univentricular heart repair such as bidirectional Glenn or Fontan-type surgery, fatal surgical outcomes may occur due to coronary venous drainage failure. We report a case of CSOA with a persistent LSVC that was managed through coronary sinus rerouting during a total cavopulmonary connection, and provide a review of the literature regarding this rare anomaly.