• Journal of Chest Surgery
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• 제57권1호
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• pp.70-78
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• 2024

Background: This study investigated the outcomes of biventricular repair using right ventricle to pulmonary artery (RV-PA) conduit placement in patients aged <1 year. Methods: Patients aged <1 year who underwent biventricular repair using an RV-PA conduit between 2011 and 2020 were included in this study. The outcomes of interest were death from any cause, conduit reintervention, and conduit dysfunction (peak velocity of ≥3.5 m/sec or moderate or severe regurgitation). Results: In total, 141 patients were enrolled. The median age at initial conduit implantation was 6 months. The median conduit diameter z-score was 1.3. The overall 5-year survival rate was 89.6%. In the multivariable analysis, younger age (p=0.006) and longer cardiopulmonary bypass time (p=0.001) were risk factors for overall mortality. During follow-up, 61 patients required conduit reintervention, and conduit dysfunction occurred in 68 patients. The 5-year freedom from conduit reintervention and dysfunction rates were 52.9% and 45.9%, respectively. In the multivariable analysis, a smaller conduit z-score (p<0.001) was a shared risk factor for both conduit reintervention and dysfunction. Analysis of variance demonstrated a nonlinear relationship between the conduit z-score and conduit reintervention or dysfunction. The hazard ratio was lowest in patients with a conduit z-score of 1.3 for reintervention and a conduit z-score of 1.4 for dysfunction. Conclusion: RV-PA conduit placement can be safely performed in infants. A significant number of patients required conduit reintervention and had conduit dysfunction. A slightly oversized conduit with a z-score of 1.3 may reduce the risk of conduit reintervention or dysfunction.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.158-165
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• 2024

Objective : Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is conducted for flow augmentation. In this study, we measured the STA cut flow of a Korean population and evaluated the relationship between STA cut flow and long-term patency of the bypass. Methods : A retrospective study was conducted. Intraoperative measurement of STA flow was conducted using a microvascular flow meter on patients who underwent STA-MCA. After cutting the distal end, the STA flow rate was measured with no resistance and recorded. After finishing anastomosis, STA flow was measured and recorded. The cut flow index was calculated by dividing post anastomosis flow by cut flow in intracranial atherosclerotic stenosis patients. Results : The median STA cut flow was 35.0 mL/min and the post anastomosis flow was 24.0 mL/min. The cut flow of STA decreased with aging (p=0.027) and increased with diameter (p=0.004). The cut flow showed no correlation with history of hypertension or diabetes mellitus (p=0.713 and p=0.786), but did correlate a positively with history of hyperlipidemia (p=0.004). There were no statistical differences in cut flow, STA diameter, and post anastomosis flow between the frontal and parietal branches (p=0.081, p=0.853, and p=0.990, respectively). Conclusion : The median STA cut flow of a Korean population was 35 mL/min. Upon reviewing previous articles, it appears that there are differences in the STA cut flow between Western and Asian patients.

• Korean Journal of Radiology
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• 제22권11호
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• pp.1834-1840
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• 2021

Objective: To analyze the computational fluid dynamics (CFD) of femoral artery pseudoaneurysm (FAP), identify a suitable location and timing for percutaneous thrombin injection (PTI) based on this analysis, and report our clinical experience with the procedure. Materials and Methods: CFD can be used to analyze the hemodynamics of the human body. An analysis using CFD recommended that the suitable location of the needle tip for PTI is at the center of the aneurysm sac and the optimal timing for starting PTI is during the early inflow phase of blood into the sac. Since 2011, seven patients (three male and four female; median age, 60 years [range, 43-75 years]) with FAP were treated with PTI based on the devised suitable location and time. Prior to the procedure, color Doppler ultrasonography was performed to determine the location and timing of the thrombin injection. Results: The technical success rate of the PTI was 100%. The amount of thrombin used for the procedure ranged from 200 IU to 1000 IU (median, 500 IU). None of the patients experienced any symptoms or signs of embolic complications during the procedure. Follow-up CT images did not reveal any embolism in the lower extremities and showed complete thrombosis of the pseudoaneurysm. Conclusion: Based on our study of CFD, PTI administered centrally in the FAP during early inflow, as seen on color Doppler, can be an effective technique.

• Korean Journal of Radiology
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• 제22권1호
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• pp.97-105
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• 2021

Objective: The present study aimed to investigate the association between myocardial blood flow (MBF) quantified by dynamic CT myocardial perfusion imaging (CT-MPI) and the increments in heart rate (HR) after stress in patients without obstructive coronary artery disease. Materials and Methods: We retrospectively included 204 subjects who underwent both dynamic CT-MPI and coronary CT angiography (CCTA). Patients with more than minimal coronary stenosis (diameter ≥ 25%), history of myocardial infarction/revascularization, cardiomyopathy, and microvascular dysfunction were excluded. Global MBF at stress was measured using hybrid deconvolution and maximum slope model. Furthermore, the HR increments after stress were recorded. Results: The median radiation dose of dynamic CT-MPI plus CCTA was 5.5 (4.5-6.8) mSv. The median global MBF of all subjects was 156.4 (139.8-180.4) mL/100 mL/min. In subjects with HR increment between 10 to 19 beats per minute (bpm), the global MBF was significantly lower than that of subjects with increment between 20 to 29 bpm (153.3 mL/100 mL/min vs. 171.3 mL/100 mL/min, p = 0.027). This difference became insignificant when the HR increment further increased to ≥ 30 bpm. Conclusion: The global MBF value was associated with the extent of increase in HR after stress. Significantly higher global MBF was seen in subjects with HR increment of ≥ 20 bpm.

• 대한핵의학회지
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• 제38권6호
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• pp.498-505
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• 2004

목적: 신혈관성고혈압의 진단에서 캅토프릴 투여후 $^{99m}Tc$-DTPA 신기능곡선 및 신기능의 기준 별로 비교된 바 없다. 이 연구는 단측 신동맥협착에 의한 신혈관성고혈압에서 캅토프릴 스캔의 진단 기준별 성적을 비교함이었다. 대상 및 방법: 1995년 5월에서 2004년 5월까지 신혈관성고혈압이 의심되어 캡토프릴신장스캔과 신혈관조영술을 시행한 64명 중 신혈관협착 있어서(n=51), 혈관재성형술을 받은 37명 중 양측성 신혈관협착 13명을 제외한 24명을 대상으로 하였다. 동맥경화가 14예, 섬유근성이형성증이 4명, 기타 혈관염이 6명이었다. 캅토프릴 및 기저 스캔은 The Society of Nuclear Medicine의 표준화된 지침에 의하여, 신기능곡선(5등급) 및 상대적 신기능, 협착이 있는 신장의 캅토프릴과 기저 스캔의 신기능곡선의 등급차이(CBren), 신기능의 차이(BCfun) 및 캅토프릴스캔시 반대측 신기능곡선과의 등급 간의 차이(CNren) 를 구하였다. 결과: 24명(남/여=16/8, 나이 $39.2{\pm}18.4$세)중 8명이 완치, 11명이 호전되어 신혈관성고혈압으로 진단되었고, 5명이 혈압의 변화가 없었다. 신혈관성고혈압과 본태성고혈압군 간에 나이(median 30 vs. 52; p<0.05), 원인(동맥 경화/기타: 9/10 vs. 5/0, p<0.05), CBren (median 2.5 vs. 0; p<0.005), BCfun (median 4 vs -0.5; p<0.05), CNren (median 2 vs. 0; p<0.05)의 유의한 차이가 있었다. 성별, creatinine과 기저 및 캅토프릴시 신기능은 차이가 없었다. 수신자판단특성곡선하의 면적은 나이 0.826, CBren 0.929, BCfun 0.804, CNren 0.784로 곡선하의 면적은 유의한 차이가 없었다. 양성 및 음성예측도는 나이 38세 이하의 기준으로 100%(12/12), 42%(5/l2), BCfun 1% 이상 92%(11/12), 50%(3/6), CBren 1이상 92%(13/14), 75%(3/4), CNren 1이상 90% (17/19), 60% (3/5)였다. 유용한 진단기준으로 알려진 BCfun 5% 이상은 100%(4/4), 29%(4/14)였다. 결론: 캅토프릴스캔에서 신기능곡선과 신기능 모두 유용한 신혈관성고혈압의 기준이 되며, 신기능곡선은 기저스캔과의 비교없이도 정상 신장의 신기능곡선을 비교하여 신혈관성고혈압을 진단할 수 있다.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.21-26
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• 2012

The radial artery superficial palmar branch free flap is based on the perforators of the superficial palmar branch of the radial artery and its venae comitantes. This flap can be used as a sensible flap including palmar cutaneous branch of the median nerve. Forty radial artery superficial palmar branch free flaps were performed at Centum Institute during October 2010 to December 2011. There were 32 males and 8 females and their mean age were 48 years (range 30 to 66 years). The thumb injured in 13 patients, the index finger in 16 patients, the middle finger in 4 patients, the ring finger in 2 patients, and the little finger in 5 patients. The mean size of the flap was $2.5{\times}3.5$ cm(range $2{\times}2.5$ to $3{\times}7$ cm). The donor site was always closed primarily. The overall survival rate was 90.2 percent. The flaps showed well-padded tissue with glabrous skin. All patients have touch sensation and showed 12 mm two point discrimination in an average(range 8 to 15 mm). Donor site morbidity was conspicuous. One patient showed unsightly scar. Early postoperative range of motion of the affected thumb showed slightly limited radial and palmar abduction. But it improved after postoperative 2 months, and patients did not complaint limitation of motion. In conclusion, the radial artery superficial palmar branch free flap can be used as an option for soft tissue reconstruction of finger defects where local or island flaps are unsuitable.

• 대한간호학회지
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• 제30권3호
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• pp.549-559
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• 2000

The purpose of this study was to investigate the correlation between the knowledge and educational needs related to recurrent in coronary artery bypass graft patients as a basis to provide an individual nursing education for the population. The subjects consisted of 110 patients who had coronary artery bypass graft(CABG) at Asan Medical Center in Seoul and Sechong hospital in Buchon. Data was obtained from a knowledge questionnaire and a learning needs questionnaire between November 1998 and February 1999. Data were analyzed using SAS program for Wilcoxon rank sum test and Spearman correlation coefficient. The results were as follows : 1. With regard to the 18 items to measure knowledge, the mean (median) of items 'don't know' was 4.9(4) items. The mean (median) of items answered wrong was 3.2(3) items. The number of items answered 'don't know' tend to show higher in those who had less education, blue color jobs and myocardiac infarction history than in their counter parts. There were higher frequency of items answered 'don't know' in those who had no hypertension 2. With regard to the level of knowledge by questionnaire about CABG, The most "I dont know" (59.1%) highly response was 'He has to be treated with anticoagulant drug to prevent revasculized vessel from obstructing.' The seond highest response (56.4%) was 'If you were hypotensive, the coronary attack would collapse. 'During the hospitalized day, the patient has complete bedrest.' The highest error probability was cholesterol has not to intake.', 'After surgery, the sexual life is need controlled for 1 year. 3. The mean of educational needs was 3.38. With regard to the level of learning needs by sentence about CABG, 'Food that benefit heart disease', 'Recurrence possibility of heart disease', 'Management method of operation site', 'Risk symptom that visit hospital or report immediately' were higher than other sentenses. With regard to the level of learning needs by factor 'food(5 items)', 'disease(9 items)' and 'exercise(3 items)' showed the highest than other factors. The educational needs by patients characteristics tend to show higher in males, under the age of 49, middle or high school degree, previous experience of admission with coronary artery disease, history of myocardial infarction, expierience of PTCA, history of cerebro-vascular accident, previous expierience of smoking than in their counter parts. 4. The number of items answered 'don't know', wrong and correct weren't correlated with the level educational needs. As the results, the number of items answered 'don't know' tend to show higher in those who had less educated, blue color jobs and myocardiac infarction history than in their counter parts. There were higher frequency of items answered 'don't know' in those who had no hypertension .There were higher frequency of items answered 'don't know' on anti-thrombolitic theraphy, hypotension and pain relief. Also there were higher frequency of items answered wrong on bed rest period, cholesterol intake, and sexual life. Educational needs were higher in young age group, had previous experience of procesure and history of other disease. And when we educate CABG patients, education for diet, recurrence possibility of disease, management methods of operation site and risk symptom should be emphasized.

• Anatomy and Cell Biology
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• 제56권4호
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• pp.570-574
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• 2023

The intercostobrachial nerve (ICBN) originates from the second intercostal nerve's lateral cutaneous branch, while the median nerve (MN) typically arises from the brachial plexus's lateral and medial roots. The medial cutaneous nerve of the arm, a branch of the medial cord of the brachial plexus, often connects with the ICBN. Variations were observed during the dissection of a 50-year-old male cadaver, including MN having two lateral roots (LR), LR1 and LR2, joining at different levels. Three ICBNs innervated the arm in this case, with the absence of the medial cutaneous nerve of the arm compensated by branches from the medial cutaneous nerve of the forearm. Understanding these anatomical variations is crucial for surgical procedures like brachioplasty, breast augmentation, axillary lymph node dissection, and orthopedic surgery. Surgeons and medical professionals must be aware of these variations to enhance preoperative planning, minimize complications, and improve patient outcomes in these procedures.

• Anatomy and Cell Biology
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• 제56권2호
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• pp.205-210
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• 2023

Left coronary artery divides into anterior interventricular branch and circumflex branch. As both the arteries run in their corresponding grooves, an arteriovenous trigone is formed between conus arteriosus and left auricle called triangle of Brocq and Mouchet. The triangle base is formed by great cardiac vein. This study aims to describe the frequency of triangle and its type and relationship between various boundaries and content of triangle and to supplement the existing knowledge of clinicians. This observational and descriptive study was conducted on 40 formalin fixed cadaveric hearts in department of anatomy, Kalpana chawla government medical college. The triangle was found in 92.5% of specimen with most common type being closed (51.3%) which is followed by inferiorly open in 35.1%, superiorly open in 8.1% and completely open in 5.4% hearts. Most frequent content of triangle was median artery followed by diagonal branches of anterior interventricular and circumflex branches. The mean area of the triangle was 246.3 mm². Relationship of vein with two arterial branches was either superficial or deep. The knowledge of different patterns of existence will be required for angiographic procedures. Further the triangle is a potential epicardial access route to left fibrous ring. Thus detailed knowledge of variations will help cardiologist to achieve better outcome in interventional procedures with minimal complications.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.428-432
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• 2010

Objective : An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. Methods : Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. Results : Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. Conclusion : Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.