• The Korean Journal of Nuclear Medicine
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• v.13 no.1_2
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• pp.7-14
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• 1979

Radionuclide cardiac angiography has distinct advantages in safety, patient comfort, cost and ease of performance. This method offers diagnostic accuracy equivalent to that of cardiac catheterization. By this method the qualitative and quantitative diagnosis of the cardiac shunts are available. Also for it is repeatable with ease and more physiologic, it has application in following pre- and post-operative shunt patients. We performed the radionuclide cardiac angiographies in 147 cases of heart diseases and 26 cases of normal group. 1. The detection of left-to-right shunt was possible in 22 of 24 patients, and 2 patients were not diagnosed due to small shunt amount. (Qp/Qs<1.3) In 21 patients of right-to-left shunt, all were diagnosed by radionuclide cardiac angiography. 2. With the pulmonary time-activity curve, $C_2/C_1$ ratio was calculated. In normal control group, a range of $C_2/C_1$ ratios of $21{\sim}38%$ was established with a mean value of $28.6{\pm}4.6%$. In patients with left-to-right shunts determined by catheterization data, the range of $C_2/C_1$ ratio was $33{\sim}90%$, with a mean value of $67.8{\pm}12.2%$. 3. In 8 cases of left-to-right shunt, $Q_p/Q_s$ ratios determined by radionuclide cardiac angiography were compaired with those of cardiac catheterization. The correlation coefficient was 0.907. (P<0.001) 4. Postoperative radionuclide cardiac angiographies were done in 21 cases. 3 of 13 patients with left-to-right shunts were found to have residual shunts. 8 patients with right-to-left shunts were confirmed to have no residual shunt.

• Journal of Chest Surgery
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• v.15 no.2
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• pp.194-203
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• 1982

In this investigation we undertook to evaluate the utility of radionuclide cardiac angiography in the detection of cardiac shunts before and after surgical correction. Time-activity curves of ventricles and lungs were evaluated after bolus intravenous injection of 99mTc-human serum albumin in 512 preoperative patients and 551 post-operative patients. Omitting 31 cases of technical failure due to poor bolus, we detected shunts in 459 cases of 481 preoperative evaluations, so the detectability was 95.4%. The cases which couldn`t be detected by this method had small amount of shunt. Also the degree of shunt detected by radioisotope methods were well correlated with oxymetry method. [r=0.89, p<0.01 ] In postoperative evaluations, 18 out of 411 patients with left to right shunt and 10 out of 140 right to left shunt were found to have remnant shunts with radionuclide cardiac angiography. Of the 28 cases with failed operation, 2 were confirmed in reoperation, 2 by cardiac catheterization, 2 by two -dimensional echocardiography. All except one .f these patients had membranous ventricular septal defects and those with left to right shunts had moderate to severe pulmonary hypertension and shunt amount. Also those had larger septal defects than control group. We consider that radionuclide cardiac angiography is a simple and noninvasive method which can show the preoperative diagnosis and postoperative follow up of cardiac shunts.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.403-407
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• 2007

The authors encountered a case of simultaneous radiation-induced multiple meningiomas and ventriculoperitoneal [VP] shunt-related pneumocephalus. A 35-year-old man, who had undergone surgery for medulloblastoma 21 years previously and subsequently received high dose craniospinal irradiation with adjuvant chemotherapy and later underwent a VP shunt because of hydrocephalus, presented with a severe headache and weakness of both lower extremities. Computed tomography showed an air pocket lesion in the left temporal lobe and a large amount of pneumocephalus with a bony defect of the left tegmen tympani. In addition, a 3 cm sized well enhancing mass was noted in the in the right middle cranial fossa and additional small enhancing nodule in the left frontal pole. He was treated by left temporal craniotomy and repair of the bony and dural defects of the left tegmentum tympanum through extradural and intradural approaches, respectively. Afterwards, he underwent right temporal craniotomy and gross total removal of a rapidly growing right middle fossa mass and a left frontal mass. The histological examination was consistent with atypical meningioma, WHO grade II. In conclusion, physicians have to consider the serious long term complications of high dose radiation therapy and VP shunt placement and need to perform the neuroradiologic follow-up after such treatments for several decades.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.10-16
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• 1988

Ten patients with tetralogy of Fallot were studied angiocardiographically before a modified Blalock-Taussig shunt and again 25*3.2 months after the previous shunt. All of ten patients had patent previous shunt at the time of follow up examination. Pre-and postoperative diameters of left and right pulmonary artery and descending aorta were measured and pulmonary artery index [the sum of the crossectional areas of the right and left pulmonary arteries standardized by the body surface area] was calculated. The ratio of mean diameter of left and right pulmonary arteries to the diameter of the descending aorta [LPA+RPA/2xDA] was increased postoperatively by 0.20*0.068 [p=0.020]. Mean PAI [pulmonary artery index] increased from 283.8*178.4 mm/m2 BSA to 345.8~144.5 mm/m2 BSA after shunt operation [p=0.019]. This results suggested that the modified Blalock-Taussig shunt was effective to help growth of the pulmonary arteries in most cases of the study populations but the ones with the PAI>233mm*/m* BSA appeared less benefited by Blalock Taussig shunt. Calculation of PAI could be an aid to making a decision whether to perform a one stage corrective surgical procedure or a palliative shunt procedure in the patient with small pulmonary arteries.

• Journal of Chest Surgery
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• v.16 no.3
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• pp.310-315
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• 1983

The combined anomaly of pulmonary stenosis with atrial or ventricular septal defects is usually associated with decreased pulmonary blood flow and right to left shunt, and result in generalized cyanosis. Non-cyanotic pulmonary stenosis patients have generally been considered to have isolated pulmonary stenosis with intact septa. We are going to report a case of pulmonary stenosis with septal defects who have no frank cyanosis at rest because of the predominant intracardiac shunt from left to right. Recently, we managed surgically a case of pulmonary valvular stenosis combined with secundum type atrial septal defect, type II ventricular septal defect, and patent ductus arteriosus. The clinical manifestations of this patient were exertional dyspnea, frequent upper respiratory infection, chest discomfortness and lethargy since late childhood and these had been progressively aggravated. Pulmonary valvular stenosis, atrial septal defect and ventricular septal defect were closed through simply right atriotomy and patent ductus arteriosus through pulmonary arteriotomy. Immediate postoperative course was uneventful and one year follow up is excellent.

• The Korean Journal of Nuclear Medicine
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• v.20 no.1
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• pp.85-91
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• 1986

In detecting, localizing and quantitating cardiac shunts, radionulide angiocardiography has been known to be a simple and safe method compared with oxymetry method. To ascertain the availability of the results obtained by radionuclide angiocardiography for the evaluation of patients with cardiac shunt, author compared the Qp/Qs ratios(pulmonary to systemic flow ratios) obtained by radionuclide angiocardiography with the results of oximetry method in 40 patients with left to right shunt, and also compared the results of radionuclide angiocardiography examined before and after shunt operation in 8 patients. The results were as follows: 1) Of the 161 patients examined radionuclide angiocardiography, 98 were thought to have cardiac shunts: right to left shunt id 27, left to right shunt in 71. Of the 71 patients who had left to right shunt, 40 who were examined with both radionuclide angiocardiography and oxymetry had following congenital heart disease: VSD in 21, ASD in 9 and PDA in 10. 2) Comparison of Qp/Qs ratios obtained during radionuclide angiocardiography and oxymetry revealed good correlation (linear regression analysis yielded correlation coefficient of 0.80) in 32 patients whose Qp/Qs ratio obtained during oxymetry were below 3.0, but very poor correlation in 8 patients whose Qp/Qs ratios were above 3.0 3) Radionuclide angiocardiography is a relatively safe and simple method in postoperative evaluation of patients with cardiac shunt.

• The Korean Journal of Nuclear Medicine
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• v.18 no.1
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• pp.9-17
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• 1984

The purpose of this study is to investigate significance of new method for quantification of left to right cardiac shunts using deconvolution analysis as an adjunct to gamma variate analysis in patients with bad bolus injection. In the present study, quantitative radionuclide angiocardiography (QRAC) was performed with and without deconvolution analysis (DA) in 37 patients with left to right shunt and 103 control patients without shunt. The results obtained were as follows; 1) The mean value of $Q_p/Q_s$ in 103 control patients was $1.10{\pm}0.12$ without DA, and was $1.01{\pm}0.03$ with DA. 2) Correlation(r) between oximetry and QRAC with DA was 0.87 and correlation(r) between oximetry and QRAC without DA was 0.61. 3) The 13 patients with left to right shunt, whose $Q_p/Q_s$ was greater than 3.0 by QRAC without DA, was studied by DA. Then the $Q_p/Q_s$ values were measurable in these 13 patients by DA and they showed significant correlation with oximetry. (r=0.68) The results indicate that deconvolution analysis technique for quantification of a left to right shunt provides more reliable and accurate shunt quantification, and reduces the influences of poor bolus injection.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.594-600
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• 1989

Primary intracardiac repair of tetralogy of Fallot with low mortality and early good results, has been accomplished in recent years. But palliative procedures have been reserved for those hypoplastic pulmonary arteries, a hypoplastic left ventricle or anomalies of the coronary artery would make total correction difficult. And the Blalock-Taussig shunt operation is recognized as a standard and popular palliative procedure. I undertook a retrospective determination of the effect of the Blalock-Taussig shunt operation on the development of the main pulmonary artery and the right and left pulmonary arteries. Between January, 1980, and April, 1987, at the Severance Hospital, 16 patients were studied by cardiac catheterization and angiocardiography, before undergoing Blalock-Taussig shunting procedures for the palliation of severe symptoms of tetralogy of Fallot, and some time later, usually prior to a second procedure. The mean interval between catheterizations was 22.25 months. Patients with tetralogy of Fallot and pulmonary atresia or with an occluded shunt were not included. The primary and secondary angiograms of each patient were reviewed, and measurements of the diameter of the main pulmonary artery, the right and left pulmonary arteries, and the descending thoracic aorta were taken. The results are as follows; 1. The hematocrit decreased from 56.39% to 50.34%[p< 0.05], and the arterial oxygen saturation increased from 62.00 % to 81.31 %[p< 0.001] following shunt procedures 2. The ratio of the diameter of the right pulmonary artery plus the left pulmonary artery to the diameter of the descending thoracic aorta increased 1.30 k 0.28 times [p< 0.01]; but the ratio of the diameter of the main pulmonary artery to the diameter of the descending thoracic aorta increased 1.10 * 0.33 times, which was not. significant[p< 0.05]. 3. The interval between shunting and second catheterization was not related to the magnitude of change in the pulmonary arteries[r=0.141, p >0.05]. 4. The changes in the ratio of the diameter of the right pulmonary artery plus the diameter of the left pulmonary artery to the diameter of the descending thoracic aorta was inversely related to the initial ratio[r=0.757, p >0.001], but the change in the ratio of the diameter of the main pulmonary artery to the descending thoracic aorta was not related[r=0.059, p >0.05]. 5. There were no differences in enlargement of the pulmonary artery on the side of the shunt [ipsilateral] versus enlargement on the opposite side [p >0.05], nor according to the size of the shunt[p >0.05]. In conclusion, this study suggests that the Blalock-Taussig shunt is effective for the development of the right and left pulmonary arteries but not effective for the main pulmonary artery.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.220-224
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• 2024

A coronary artery fistula (CAF) is an abnormal vascular connection between the coronary arteries and the cardiac chambers or major vessels. Although rare, CAFs can lead to substantial coronary morbidity and mortality. This study outlines the surgical management of a CAF originating from the left coronary artery and connecting to the right atrium, in a patient experiencing angina with a marked left-to-right shunt. The surgical approach involved ligation of the coronary artery and reduction of the aneurysmal portion, resulting in the patient's uneventful recovery.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.299-304
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• 1985

The partial A-V canal defect consist of ostium primum type atrial septal defect with a cleft mitral anterior leaflet. The clinical findings depend upon the site and size of the left-to-right shunt, the degree of A-V valvular regurgitation, and the degree of resultant pulmonary artery hypertension. We experienced 3 cases of similar condition. The data were as follow: 1. Chest P-A showed increased pulmonary vascularity and moderate cardiomegaly with left atrial enlargement. 2. E.K.G. showed left axis deviation, left atrial enlargement, and left ventricular hypertrophy. 3. Right heart catheterization showed significant 02 step up of SVC-RA and left-to-right shunt. 4. Left ventriculogram showed mitral regurgitation and filling of both atrium. Operative findings were as follow: 1. Primum type atrial septal defect [2x2 cm]. 2. Cleft in the anterior leaflet of the mitral vave. 3. No evidence of ventricular septal defect and tricuspid anomaly. Through a right atriotomy with moderate hypothermia, the mitral cleft was approximated with interrupted sutures. The interatrial communication was closed by a patch of Dacron/pericardium. The patch was attached to junction of the mitral and tricuspid valves along the crest of the ventricular septum using interrupted sutures and the other site using continuous sutures. Postoperative course was uneventful and discharged in good general condition except postoperative bleeding in case 3.