• 제목/요약/키워드: Mitral value

검색결과 33건 처리시간 0.022초

Bjork-Shiley 기계판막의 임상적 연구 (Clinical Analysis of Bjork-Shiley Mechanical Valve Replacement)

  • 김병열
    • Journal of Chest Surgery
    • /
    • 제22권3호
    • /
    • pp.393-401
    • /
    • 1989
  • Between Dec. 1984, and May, 1988,96 prostheses were implanted in 80 patients at Dept. of Thoracic k Cardiovascular Surgery of National Medical Center. 43 patients had mitral valve replacement, 21 underwent aortic valve replacement, and 15 had double valve replacement [Mitral k Aortic], and 1 had tricuspid valve replacement. Seventy-one cases [88.8 %] were in NYHA Class III or IV. The mean duration of follow up was 22.1 months and follow-up information was available for 74 [92.5 %] of the patients. The overall actuarial survival rate at 45 months was 93.05 % and overall hospital mortality was 10 %, late Mortality was 5 %. The linearlized incidence of thromboembolism [2.4%/pt-yr], thrombotic valve obstruction [1.6 %/pt-yr], anticoagulant related bleeding [0.8 %/pt-yr]. There were no fatal valve related complications. The blood was studied in 40 patients 1 year after valve operation. Hgb and reticulocyte count were within normal values and Serum LDH value was slightly elevated but it was not of clinical significance. In conclusion, Monostrut Bjork-Shiley valve prosthesis to be a reliable valve substitute with an acceptable incidence of complications.

  • PDF

잡견에 있어서 새로운 심장수술기법의 적용 (Application of the New Surgical Technique for Orthotopic Heart Transplantation in Dogs)

  • 원태희;한재진;김기봉;노준량
    • Journal of Chest Surgery
    • /
    • 제33권3호
    • /
    • pp.207-211
    • /
    • 2000
  • Backgroud: Conventional cardiac transplantation with each atrial anastomosis designed by Shumway and associates has been used widely in cardiac transplantation because of its simplicity and efficiency. There have been many reports about the postoperative atrioventricular value regurgitation resulting from the alteration in atrial geometry after cardiac transplantation by Shumway's technique. New surgical technique of direct anastomosis of superior vena cava, inferior vena cava, right pulmonary vein and left pulmonary vein was introduced to overcome the those problems. We performed this study to test the feasibility of this new surgical technique prior to application to clinical practice. Material and Method: Conventional cardiac transplantation was performed on 12 mongrel dogs(Group I) and cardiac transplantation with new surgical mthod of direct anastomosis of SVC, IVC, left and right pulmonary veins was performed on 11 mongrel dogs(Group II). After weaning from cardiopulmonary bypass, we compared the postoperative rhythm, hemodynamic data, and echocardiographic findings between two groups. Result : The cardiopulmonary bypass time and graft ischemic time were 119.0$\pm$4.4 minutes, 162.0$\pm$4.5 minutes respectively in group I, and 140.0$\pm$7.1 minutes, 180.5$\pm$5.4 minutes respectively in group II. The cardiopulmonary time and graft ischemic time in group II were longer than those of group I (p<0.05). There were 3 cases of failure to weaning from cardipulmonary bypass onein group I and two in group II, and this difference was not significant statistically. Sinus rhythm was regained postoperatively in 58% (group I) and 82%(group II), without statistical significant between 2 groups. Postoperative echolcardiography showed 2 cases of tricuspid value regurgitation and 1 case of mitral regurgitation in group I, and no regurgitation of atrioventricular value in group II. Conclusion: Although these was no statistically significant difference between 2 groups, there was tendency of less arrhythmia and less atrioventricular valvular regurgitation in group II. We suggested that the new surgical technique could be a useful strategy in heart transplantation, especially in the case of size mismatching between donor and recipient.

  • PDF

A Retrospective Study of Radiographic Measurements of Small Breed Dogs with Myxomatous Mitral Valve Degeneration: A New Modified Vertebral Left Atrial Size

  • Soyon An;Gunha Hwang;Seul Ah Noh;Young-Min Yoon;Hee Chun Lee;Tae Sung Hwang
    • 한국임상수의학회지
    • /
    • 제40권1호
    • /
    • pp.31-37
    • /
    • 2023
  • Vertebral left atrial size (VLAS) is an important indicator to predict myxomatous mitral valve degeneration (MMVD) in dogs. When the caudal margin of cardiac silhouette and the dorsal margin of caudal vena cava (CdVC) could not be seen exactly, another way to evaluate VLAS is needed. The objective of this study was to assess whether a new modified VLAS (m-VLAS) could be used as an indicator to predict MMVD in 57 small breed dogs with MMVD. The m-VLAS was also used to classify American College of Veterinary Internal Medicine staging groups and left heart enlargement confirmed with echocardiograph (EchoLHE) groups. The m-VLAS was measured as the distance from the ventral aspect of the carina to the dorsal aspect of the intersection of the cardiac silhouette and the farthest LA caudal margin, not the CdVC, followed by drawing the same line beginning at the cranial edge of T4. Based on VLAS values and m-VLAS values measured for dogs with MMVD, correlations between these values and left heart enlargement groups were then evaluated. There were significant differences in both the VLAS and the m-VLAS between EchoLHE groups. The AUC of the ROC curve of the m-VLAS to detect EchoLHE was higher than that of the VLAS. The optimal cutoff value for the m-VLAS was >2.7, which had a higher specificity (86.84%) than the VLAS specificity (71.05%). This study reveals that a new m-VLAS is a more specific indicator than the VLAS for predicting left side heart enlargement in small breed dogs. Therefore, the m-VLAS can be used as a clinically useful radiographic measurement alternative to or better than the VLAS.

An Assessment of Vertebral Left Atrial Size in Relation to the Progress of Myxomatous Mitral Valve Disease in Dogs

  • Kim, Sun Hwa;Seo, Kyoung Won;Song, Kun Ho
    • 한국임상수의학회지
    • /
    • 제37권1호
    • /
    • pp.9-14
    • /
    • 2020
  • Left atrial enlargement (LAE) is an important diagnostic factor in dogs with myxomatous mitral valve disease (MMVD). It is associated with the onset of congestive heart failure (CHF). Recently, a new radiographic left atrial measurement called vertebral left atrial size (VLAS) was introduced. This can be considered as a left atrial enlargement above 2.3. It appears to be related to the severity of MMVD. However, serial changes in VLAS in relation to disease progression and improvement in patients have yet to be studied. This study aims to assess the value of VLAS as a left atrial size monitoring indicator by examining correlations with VHS, LA/Ao ratio and LVIDDN, and comparing serial changes in dogs. A total of 126 dogs were studied with their owners' consent. The dogs were classified into four MMVD groups (Control, B1, B2, C-D) following the ACVIM Guideline by performing a physical examination, radiography and echocardiography. Besides, 24 and 17 dogs were reevaluated to compare values in relation to the progression and improvement of MMVD. VLAS showed significant increase according to the progress of the MMVD stage. This was the same in the Maltese breed group. A strong positive correlation was found between LVIDDN, VHS, LA/Ao ratio, and VLAS. The results of this study found VLAS to be significantly different according to left atrium size, and there was a correlation between disease progression and VLAS levels in each dog. Therefore, VLAS may be used to detect changes in left atrium size as an additional monitoring index of MMVD.

ATS 인공 심장 판막의 단기 및 중기 임상성적 (Short and Intermediate Term Results of the ATS Heart Valve Replacement)

  • 임창영;문승철;양진영;구원모;김대식;이건;이헌재
    • Journal of Chest Surgery
    • /
    • 제32권11호
    • /
    • pp.1031-1035
    • /
    • 1999
  • Background: ATS mechanical valve is a recently introduced pyrolytic carbon bileaflet prosthesis. This report is to evaluate the results of hemodynamic and anticoagulant therapy after ATS valve replacement. Material and Method: From May 1995 to October 1998, 53 patients received 65 ATS prosthesis; 38 Mitral(27-33 mm), 27 Aortic(19-25 mm). 2 CABGs and 5 Tricuspid annuloplasty were taken concomitantly. The follow up period was 769 patient-months(mean 16.2$\pm$10.0), varied from 1 month to 39 months with 92.5% follow up rate. All patients were evaluated with Doppler echocardiography, 7-14 days after operation. Result: NYHA functional class was improved significantly, from 2.6$\pm$0.8 preoperatively to 1.3$\pm$0.4 postoperatively. The average value of peak and mean transvalvular pressure gradients were 25.7$\pm$13.5 mmHg, 12.7$\pm$8.3 mmHg in aortic position. In the mitral position, the average values of peak and mean transvalvular pressure gradient and valve area were 5.9$\pm$2.5 mmHg, 3.1$\pm$0.8 mmHg and 2.9$\pm$0.5 $\textrm{cm}^2$, respectively. In the anticoagulant therapy, mean INR was 2.5$\pm$0.6 in mitral valve replacement and 1.9$\pm$0.5 in aortic valve replacement. There was no anticoagulant related complication. During that period, there were 3 hospital death(5.9%) and 1 late death(1.9%). Conclusion: The early clinical results of the ATS heart valve replacement is quite satisfactory, and low target INR reginmen is safe. And long term follow of hemodynamic characteristics is also necessary.

  • PDF

계통발생에 따른 척추동물의 뇌후구에 대한 전자현미경적 연구 (Electron Microscopic Studies on Olfactory Bulbs in the Vertebrates by Phylogenetics)

  • 최명봉;정영화;서지은
    • Applied Microscopy
    • /
    • 제15권2호
    • /
    • pp.31-68
    • /
    • 1985
  • Authors are trying to unveil the ultrastructural organization of olfactory bulb, which has been summerized under light microscopic level or communicated only in some detail in different view point until now. For the critical point of view, since the phylogenetical approach will give the ultimate value in the correlative study between structural and functional bases (Brodal, 1969), the present study was carried out light and electron microscopic analyses of the structures of the neurons and synaptic organizations in olfactory bulbs from different animals in phylogenetical scale. We selected each one species from five animal classes: the house rabbit(Oryctolagus cuniculus var. domesticus [Gmelin]) from Mammalia, the domestic fowl (Gallus gallus domesticus Brisson) from Aves, the viper (Agkistrodon hylys [G.P. Pallas]) from Reptilia, a frog (Bombiana orientalis Boulenger) from Amphibia and the crussian carp (Carassius carassius [Linne]) from Pisces. For light microscopic study, samples were fixed in 10% formalin and paraffin sections were stained with hematoxylin-eosin. For the electron microscopic study, the tissues were fixed by perfusion through the heart or immersion with 1% paraform-aldehyde-glutaraldehyde mixture (phosphate buffer, pH 7.4), and final tissue block trimmed under dissecting microscope were osmicated (1% OsO4), they were embedded in Araldite or Epon 812, and ultrathin sections were made by LKB-V ultratome following the inspection of semi-thin sections stained with toluidine blue-borax solution. Ultra-thin sections contrasted with uranyl acetate and lead citrate were observed with JEM 100CX electron microscope. We have summerized our morphological analyses as follows: 1. The olfactory bulb of rabbit, viper and frog shows the eight layers of fila olfactoria, glomerular, external granular, external plexiform, mitral cell, internal plexiform, internal granular, medullary but domestic fowl shows the five layers of glomerular, fibrillar, mitral, granular and medullary and the three layers of fibrilla, glomerular and medullary in crussian carp. The sharpness of demarcation between the layers shows deferential tendency according to phylogenetical order. 2. Mitral cells of vertebrate have large triangular or oval shape with spherical nuclei which contain not so much chromatin. The cytoplasm contains numerous cell organelles, of which Nissl's bodies or granular endoplasmic reticula arranged as parallel strands. Development of granular endoplasmic reticula were declined as the phylogentical grade is going lower. 3. Tufted cells of all animal are mostly spindle or polygonal contour and contain oval nuclei which located in periphery of cytoplasm. The nuclei of rabbit, fowl, viper and frog has relatively space chromatin, but a nucleus of crussian carp contain irregularly aggregated chromatin in karyoplasm. Their cytoplasmic volume and cell organelle contents are in between those of mitral cell and granular cell. They contain moderate amount of mitochondria, granular endoplasmic reticula, a few Golgi complex, polysomes, lysosome, etc. 4. Granule of cells of all the vertebrate amimals studied exhibit similar features; cells and their dense nuclei show spherical or oval contour, and they have the thin rim of cytoplasm which contain only a few cell organelles. 5. In rabbit, the soma of mitral cells were in contact with boutons with two types of synaptic vesicles, that is, round and flat vesicles, especially flat vesicles in boutons were showing reciprocal synapses. However, in domestic fowls, vipers, frogs and crussian carps, there were found boutons showing only spherical synaptic vesicles. 6. The boutons containing round synaptic vesicles were made contact with the some of tufted cell of olfactory bulb in the rabbits, fowls, vipers and frogs, but no synaptic boutons were observed in soma of tufted cells in crussian carps. In the frogs, there were observed dendrites were contact with the soma of tufted cells. 7. In the neuropils of plexiform, granular and glomerular layers olfactory bulbs in the vertebrate, the synapses were axo-large dendrites, axo-median and small dendrites, dendrodendritic, and axo-axonal contacts. However, in the neuropil of crussian carps, synapses were observed only in glomerular layer.

  • PDF

개심수술중 심근 미세구조의 변화 (Changes of Myocardial Ultrastructure During Open Heart Surgery)

  • 허진;공준혁;이종태
    • Journal of Chest Surgery
    • /
    • 제33권9호
    • /
    • pp.707-715
    • /
    • 2000
  • Background: Cold blood cardioplegic solution has been used to protect myocardium during open heart surgery with the hypothesis stating that it provides more oxygen supply to myocardium compared to crystalloid caridoplegic solution. We repeatedly infused cold blood cardioplegic solution to achieve myocardial protection. We biopsied a small portion of papillary muscle of patients with mitral valve replacement or double valve replacement during aortic cross-clamp time and evaluated the method of myocardial protection through the observation of changes in ultrastructure. We then analysed the relationship between changes in ultrasructure and peak postoperative CK-MB value and SGOT value. Material and method: We report observation on changes of myocardial ultrastructure, postoperative CK-MB and SGOT, and electrocardiogram in 31 patients who underwent cardiac operation. There were 11 males and 20 females, and they ranging in age from 28 to 69 years(mean score was 2.08$\pm$0.560, it was 2.37$\pm$0.558 at 40 minutes, and it was 2.36$\pm$0.523 at 70minutes. Mitochondrial score increased significant at 40 minutes. Mean value of postoperative peak CK-MB and SGOT were 37.3$\pm$17.061IU, 144.5$\pm$125.5IU respectively. We were not able to find any new Q were in EKG after the operation. There was no significant relationship between myocardium mitochondrial score and mean value of postoperative peak CK-MB and SGOT. Conclusion: In conclusion, with this study the cold blood cardioplegic solution was incomplete in preserving ultrastructure of myocardium even with satisfactory results in serum enzyme and EKG evaluation.

  • PDF

비대성심근증 환자의 이완기능평가: 승모판과 폐정맥 유속을 측정한 위상차 MRI의 이용 (Diastolic Function in Patients with Hypertrophic Cardiomyopathy: Evaluation Using the Phase-contrast MRI Measurement of Mitral Valve and Pulmonary Vein Flow Velocities)

  • 김은영;최연현;김성목;이상철;장성아;오재건
    • Investigative Magnetic Resonance Imaging
    • /
    • 제18권4호
    • /
    • pp.314-322
    • /
    • 2014
  • 배경: 심장의 이완기능 이상은 비대성심근증 환자에서 흔히 발견되는 문제이다. 본 연구는 비대성심근증 환자의 심장 이완기능을 평가하는 데 있어, 승모판과 폐정맥의 유속을 이용한 MRI의 역할을 알아보고자 하였다. 방법과 결과: 승모판과 폐정맥의 유속을 이용한 위상차 MRI와 심초음파검사가 59명 (남:여 = 44:15, 평균 연령 = 51세)의 비대성심근증 환자에서 시행되었다. 49명의 환자가 심초음파검사에서 다양한 정도의 심장 이완기능 이상을 보였다; grade 1 (20명), grade 2 (27명), and grade 3 (2명). MRI로 계산한 승모판 유속인자들 (E, A, E/A ratios)은 심초음파검사로 구한 동일 인자들과 양의 상관관계를 보였다 (Pearson's r values = 0.47, 0.60, 0.75 for E, A, E/A, respectively, all P < 0.001). MRI로 폐정맥 유속정보를 이용하는 경우, pseudo-normalized pattern (8명)이 정상 충만 양상(filling pattern) (17명)과 구분될 수 있었고, 이들을 이용하여 이완기능 정도를 평가를 하는 경우, 심장 MRI가 심초음파검사와 중등도의 일치도를 보였다 (kappa value = 0.45, P < 0.001). 결론: 비대성심근증 환자에서 위상차 MRI를 이용한 심장 이완기능 평가는 임상적으로 적용 가능한 방법이며, 폐정맥 유속 분석을 추가하는 경우, 정상과 pseudo-normal을 구분하는데 유용하다.

관상동맥-폐동맥 이상기시증(Anomalous Origin of Coronary Artery from Pulmonary Artery)의 수술적 치료: 중기 성적과 좌심실 및 승모판 기능의 변화 양상에 대한 연구 (Surgical Treatment of Anomalous Origin of Coronary Artery from the Pulmonary Artery: Postoperative Changes of Ventricular Dimensions and Mitral Regurgitation)

  • 강창현;김웅한;서홍주;김재현;이철;장윤희;황성욱;백만종;오삼세;나찬영;한재진;이영탁;김종환
    • Journal of Chest Surgery
    • /
    • 제37권1호
    • /
    • pp.19-26
    • /
    • 2004
  • 배경: 이 논문의 목적은 관상동맥-폐동맥 이상기시증의 수술적 치료의 중기 성적을 확인하고 수술 후 좌심실 기능과 승모판 폐쇄부전의 변화양상을 분석하고자 하였다. 대상 및 방법: 1985년부터 2003년 까지 관상동맥-폐동맥 이상기시증으로 수술적 치료를 받은 15명의 환자들을 연구대상으로 하였다. 1998년 이전(9명)에는 다양한 수술방법을 사용하였으나, 1998년 이후(6명)부터는 1) 대동맥과 주폐동맥 양쪽 모두 관류와 심정지액 주입을 시행하였고, 2)관상동맥의 재이식 시 주폐동맥의 일부를 이용하여 도관을 만들어 대동맥에 연결하였고, 그리고 3)승모판 폐쇄부전은 특별한 수술적 교정을 시행하지 않았다. 결과: 대상 환자들의 연령의 중앙값은 6개월(1개월∼34년)이었다. 수술방법은 좌쇄골동맥-좌전행지 문합술이 1예, 좌관상동맥 결찰술이 2예, Takeuchi 술식이 2예, 그리고 관상동맥 재이식술이 10예에서 시행되었다. 평균추적관찰 기간은 5.5 $\pm$ 5.8년(2개월 ∼ 14년)이었으며, 수술 후 조기사망이 1예, 만기사망이 1예에서 발생하여 5년 생존율은 85.6$\pm$9.6%이었다. 수술전 좌심실 이완기말과 수축기말직경은 수술 후 3개월 이내에 의미있게 감소하였고(p<0.05), 수술 전 3도 이상의 의미 있는 승모판 폐쇄부전은 6예(40.0%)에서 관찰되었으나 모두 수술 후 1개월 이내에 2도 이하로 감소하였다. 3예의 환자에서 재수술이 필요하였으며 재수술의 원인은 관상동맥 문합부위의 협착과 승모판 폐쇄부전이었다. 그러나 1998년 이후의 환자군에서는 조기사망, 만기사망, 그리고 재수술 등의 예가 없었다. 결론: 관상동맥-폐동맥 이상기시증은 수술 후 만족할 만한 생존율과 좌심실직경의 감소와 그리고 승모판 폐쇄부전의 개선을 확인할 수 있었다 그러나 장기적으로 관상동맥의 문제가 승모판 폐쇄부전의 재발과 장기생존율에 영향을 미칠 수 있음을 확인할 수 있었다. 1998년 이후 단일화된 수술방침으로 시행한 결과 만족할 만한 결과를 얻을 수 있었다.

영역기반 윤곽선 기법과 표면 분할 유동모델에 기반한 근위 등속 표면적 기법을 이용한 혈류량 추정 (Blood Flow Rate Estimation using Proximal Isovelocity Surface Area Technique Based on Region-Based Contour Scheme and Surface Subdivision Flow Model)

  • 진경찬;조진호
    • 전자공학회논문지SC
    • /
    • 제38권1호
    • /
    • pp.45-52
    • /
    • 2001
  • PISA 방법은 주로 승모판에서 역류하는 혈류량을 측정하기 위해 사용되고 있다. 이 방법은 PISA isotach의 기하학적 모양에 대한 모델링에 관한 것이다. PISA의 일반적인 유동모델은 isotach의 표면이 수식적으로 반구이거나 비반구임을 가정하여 계산된 것이지만, 본 논문에서는 영역기반방법으로 isotach를 추정한 후, 타원체의 높이에 기초한 실제적인 표면분할 유동모델을 이용하여 유체량을 추정하였다. 제안한 밥법을 평가하기 위해, $30cm^3/sec-60\;cm^3/sec$의 실제 유량을 가지는 동적인 180개의 유동영상에 대해서 기존 방법들과 비교하였다. 실험한 결과, 반구 유동모델의 유체량 평균이 $29\;cm^3/sec$로 실제 유체량 평균보다 35%정도 적게 추정을 하였고, 제안한 방법의 평균은 $45\;cm^3/sec$으로 비반구 유동모델의 평균과 같았고, 유체량 변화파형도 유사한 결과를 가짐을 알 수 있었다.

  • PDF