• Tuberculosis and Respiratory Diseases
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• v.68 no.5
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• pp.273-279
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• 2010

Background: Pulmonary hypertension is considered as a poor prognosis factor in patients with chronic obstructive pulmonary disease (COPD). There has been reported brain natriuretic peptide (pro-BNP) is related with increased right ventricular (RV) workloads. However, there are few studies that evaluate the relationship between BNP and pulmonary arterial pressure (PAP), RV function and St. George Respiratory Questionnaire (SGRQ) score in patients with COPD, and the effects of angiotensin converting enzyme inhibitor (ACEI) on these parameters. Methods: Pulmonary function test, echocardiography, blood BNP, and SGRQ score were evaluated in stabilized moderate degree COPD patients ($FEV_1$/FVC< 70%, $50%{\leq}FEV_1$ < 80%) aged 45 years and over, without worsening of symptoms within recent 3 months. After treating with ramipril 10 mg for 3 months, the same evaluation was repeated. Results: Twenty-two patients were included in this study. BNP was significantly correlated with PAP (Pearson coefficient ${\rho}=0.51$, p=0.02), but not with RV ejection fraction (EF) and predicted $FEV_1%$. The values for predicted $FEV_1%$ showed significant correlation with SGRQ total score and activity score, but not with BNP or PAP. After ramipril treatment, PAP showed significant decrease ($42.8{\pm}8.1$ vs. $34.5{\pm}4.5mm$ Hg p=0.0003), tricuspid annular plane systolic excursion significant increase ($21.5{\pm}3.3$ vs. $22.7{\pm}3.1mm$ p=0.009). BNP showed a tendency to decrease without statistical significance ($40.8{\pm}59.6$ vs. $18.0{\pm}9.1pg/mL$ p=0.55). SGRQ scores showed no significant change. Conclusion: BNP showed significant correlation with resting PAP, which means BNP could be used as markers for pulmonary hypertension. Treatment with ACEI didn't show significant change in the level of BNP, while pulmonary hypertension and RV function were improved.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.123-134
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• 1991

Twenty eight patients had undergone repair of an isolated complete atrioventricular septal defect between April 1986 and September 1990 in Seoul National University Children`s Hospital. The group comprised 13 male and 15 female patients. They ranged in age from 2 months to 8 years[mean 18.6months] and in weight from 3. 4kg to 23kg[mean 9.0$\pm$4.6kg]. They were analysed as Rastelli type A in 17 patients, Rastelli type B in 2 patients, and Rastelli type C in 9 patients. Seven patients had concomitant Down`s syndrome. All patients had large left-to-right shunt[mean pulmonary to systemic flow ratio 3.5 $\pm$2.2 ranging from 0.68 to 10.0] and high pulmonary systolic pressure[mean 74$\pm$18.8mmHg, ranging from 35 to 110]. In 11 patients, one patch technique was used to close the atrial and ventricular septal defect and 16 patients were undergone by two patch technique. We urgently managed only one patient by pulmonary artery banding whose anatomy was Rastelli type C and severe mitral regurgitation was identified. Postoperative complete A - V block was noted in 3 patients, two of whom were dead in operating room due to combined LVOTO and myocardial failure, and one patient with Rastelli type C was undergone by VVI type permanent pacemaker insertion 1wk later after two patch technique, but we had to manage him by modified Konno operation and total correction due to LVOTO and VSD leakage and severe mitral regurgitation 3 years later. Another two reoperation cases due to severe mitral regurgitation after two patch technique were undergone, one of whom we managed by mitral annuloplasty 3 months later but aggravated mitral regurgitation made us to control him by MVR 3 months later. Another one case of VSD leakage and tricuspid regurgitation was managed by total correction but she died of respiratory insufficiency 14 days later. We experienced pulmonary hypertensive crisis in 3 patients, who were dead in two cases comparing with one control case. So operative mortality is 9/27[33.6%], in one patch group of 3/11[29.2%] comparing with two patch group of 6/16[37.5%]. In summary, causes of death were pump weaning failure, myocardial failure and low cardiac output syndrome and pulmonary hypertensive crisis, resp. failure, complete AV block. Mean follow up period is 15.8$\pm$10.7 months[ranging from 3months to 37 months]

• Journal of Chest Surgery
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• v.32 no.5
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• pp.422-427
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• 1999

Background: Tachycardia induced heart failure model would be the model of choice for the dilated cardiomyopathy. This more closely resembles the clinical syndrome and does not require major surgical trauma, myocardial ischemia and pharmacological or toxic depression of cardiac function. When heart failure is progressive, application of new surgical procedures to the faling heart is highly risky. It has been shown that recovery trajectory from heart failure is a new method in decreasing animal mortality. The purpose is to establish the control datas for recovery trajectory in the canine heart failure model. Material and Method: 21 mongrel dogs were studied at 4 stages(baseline, at the heart failure, 4 and 8 weeks after recovery). Heart failure was induced during 4 weeks of continuous rapid pacing using a pacemaker. Eight weeks of trajectory of recovery period was allowed. Indices of left ventricular function and dimension were measured every 2 weeks and the hemodynamics were measured by use of Swan-Ganz catheterization and thermodilution method every 4 weeks. Values were expressed as mean${\pm}$standard deviation. Result: 4(20%) dogs died due to heart failure. Left ventricular end-diastolic volume at the 4 stages were 40.8${\pm}$7.4, 82.1${\pm}$21.1, 59.9${\pm}$7.7 and 46.5${\pm}$6.5ml. Left ventricular end-systolic volume showed the same trend. Ejection fractions were 50.6${\pm}$4.1, 17.5${\pm}$5.8, 36.3${\pm}$7.3, and 41.5${\pm}$2.4%. Blood pressure and heart rate showed no significant changes. Pressures of central vein, right ventricle, pulmonary artery, and pulmonary capillary wedge showed significant increase during the heart failure period, normalizing at the end of recovery period. Stroke volumes were 21.5${\pm}$8.2, 12.3${\pm}$3.5, 17.9${\pm}$4.6, and 15.5${\pm}$3.4ml. Blood norepinephrine level was 133.3${\pm}$60.0pg/dL at the baseline and 479.4${\pm}$327.3pg/dL at the heart failure stage(p=0.008). Conclusion: Development of tachycardia induced heart failure model is of high priority due to ready availability and reasonable amenability to measurements. Recovery trajectory after cessation of tachycardia showed reduction of cardiac dilatation and heart function. Application of new surgical procedures during the recovery period could decrease animal mortality.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.85-104
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• 1969

This experiment was carried out to study the effect of rapid hemorrhage on cardiopulmonary hemodynamics of the cooled dogs. Hypothermia was induced by means of body surface cooling with ice water. Lowest esophageal temperatures ranged from 24 to 26 degree. Dogs were bled via the femoral artery into a reservoir in amount of the equivalent blood volume of 3% of body weight of the dogs. Some dogs were reinfused with the same amount of blood which they lost and others infused with 5% dextrose solution. Fourty adult mongrel dogs were divided into three groups: group I[15 dogs]; dogs were bled in normothermic state. Five dogs had no further treatment, but five dogs were reinfused with blood and five infused with 5% dextrose solution 30 minutes after bleeding. GroupII[10 dogs]; dogs were bled as group I after having been cooled. Five dogs were reinfused with blood as group I. Group III[15 dogs]; dogs were first bled and then cooled. Reinfusion procedures were the same as in group l Results were as follow: 1. The heart rate showed a slight decrease after bleeding in group I and then increased over the control level after 60 minutes. After reinfusion and infusion, the heart rate was also increased gradually and after three hours almost returned to the control level. In group II and groupIll, the heart rate decreased remarkably and after reinfusion showed a light increase but after infusion tended to decrease cotinually. 2. The stroke volume showed remarkable decrease after bleeding in group I., and recovered to control level after reinfusion and infusion,and then gradually decreased again. In group III, the stroke volume showed no remarkable change after hypothermia, and tended to decrease after reinfusion. In group III, the stroke volume decreased remarkably after bleeding and hypothermia,and clearly increased after reinfusion and infusion and then returned to control level. 3. Femoral mean pressure declined very rapidly and significantly right after bleeding and showed a remarkable prompt rise after reinfusion and infusion in group I [67% recovery]. On the other hand, it declined remarkably after hypothermia and bleeding and showed a slight rise after reinfusion and infusion in group II[46% recovery] and III [41% recovery]. 4. Venous pressure declined slightly after bleeding and tended to return to the control level after reinfusion and infusion,in group I. In group II, it did not change significantly during hypothermia but showed a slight decline after bleeding and returned toward control level after reinfusion. In group III, it declined slightly after bleeding and showed no significant change after hypothermia and rose over the control level after reinfusion and infusion. 5. Right ventricular systolic pressure decreased markedly after bleeding and then increased progressively after 30 minutes. It increased after reinfusion and infusion as well, approaching the control level in group I. In group II, it showed no significant change during hypothermia, but decreased remarkably after bleeding and then returned to near control level after reinfusion. In group III, it was decreased markedly after bleeding but did not change significantly during hypothermia and showed a slight increase after reinfusion. 6. The respiratory rate increased gradually after bleeding and decreased gradually after reinfusion but did not return to the control level, whereas it decreased near to the control level after infusion,and tended to increase in group I. In group II, it decreased significantly after hypothermia and bleeding but returned near to the control level after reinfusion. In group III, it showed a remarkable decrease after hypothermia and increased slightly after reinfusion and infusion but did not returned to the control level. In group I, the tidal volume decreased slightly after hemorrhage, and increased gradually to near the control level after 3 hours following reinfusion.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.494-498
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• 2009

Purpose : Applicability of transcatheter closure of atrial septal defect (ASD) has been expanded by accumulation of clinical experiences and evolutions of the device. This study was performed to evaluate the safety and efficacy of transcatheter closure of ASD with Amplatzer septal occluder (ASO) in young children less than 3 years of age. Methods : From May 2003 to December 2005, 295 patients underwent transcatheter closure of ASD with ASO in the Severance Cardiovascular Hospital, Yonsei University Health System. Among them, 51 patients less than 3 years of age were enrolled in this study. We investigated procedural success rate, rate of residual shunt, frequency of complications, procedure/fluoroscopy time, and need of modified techniques for device implantation. Results : The median age was 2.1 years and median body weight was 12 kg. Implantation of device was successful in 50 patients (98%). Seven patients (15%) showed a small residual shunt 1 day after the procedure, but complete occlusion had been documented at 6 month follow-up in all patients (100%). The pulmonary to systemic flow ratio (Qp/Qs), peak systolic pulmonary artery pressure, and peak systolic right ventricular pressure had decreased significantly after closure of ASD. There were 2 complications including device embolization (1, 2%) and temporary groin hematoma (1, 2%). Conclusion : Transcatheter closure of ASD with ASO can be performed with satisfactory results and acceptable risk even in young children less than 3 years of age. We could suggest that even in very young children with ASD, there is no need to wait until they grow to a sufficient size for the transcatheter closure.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.195-202
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• 2010

Purpose : Despite recent advances in pulmonary hypertension management and surgery, appropriate guidelines remain to be developed for operability in congenital heart disease with pulmonary artery hypertension (PAH). Our aim was to evaluate clinical outcomes of patients with severe PAH who underwent surgical closure of left-to-right shunt lesions (LRSL) on the basis of pulmonary reactivity. Methods : We retrospectively reviewed 21 patients who underwent surgical closure of LRSL with severe PAH (${\geq}8$ Wood unit) from January 1995 to April 2009. The median age at operation was 26 years. Atrial septal defect, ventricular septal defect (VSD), VSD and patent ductus arteriosus (PDA), and PDA was present in 11, 4, 4, and 2 patients, respectively. Results : Operability was based on vasoreactivity of PAH. Of the 21 patients, 5 showed response to pulmonary vasodilator therapy and 8 showed vasoreactivity after balloon occlusion of defects. The remaining 8 patients were considered operable because of significant left-to-right shunt (Qp/Qs ${\geq}1.5$). Five patients underwent total closure of defects and 16 were left with small residual shunts. The median follow-up duration was 32 months. There was no significant postoperative mortality or morbidity. Systolic pulmonary artery pressure (PAP) decreased in all but 2 patients. All patients except 1 showed improvement of New York Heart Association functional class. Conclusion : Closure of LRSL in patients with severe PAH on the basis of pulmonary vasoreactivity seems reasonable. PAP and clinical symptoms improved in most patients. Further research is needed for the evaluation of long-term results.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.254-259
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• 2010

Background: Diagnosing chronic pulmonary embolism at an early stage is difficult because of the patient’s nonspecific symptoms. This condition is not prevalent in Korea, and in fact, there have been only a few case reports on this in the Korean medical literature. We analyzed the surgical outcome of performing pulmonary thromboendarterectomy in patients with chronic pulmonary embolism. Material and Method: The study subjects included those patients who underwent surgery for chronic pulmonary embolism from 1996 to 2008. For making the diagnosis, echocardiography, chest CT and a pulmonary perfusion scan were performed on the patients who complained of chronic dyspnea. Result: Pulmonary endarterectomy was performed as follows: by incision via a mid-sternal approach (7 patients); by incision via a left posterolateral approach (1 patient); using the deep hypothermic circulatory arrest technique (4 patients); under ventricular fibrillation (3 patients); and under cardioplegic arrest (1 patient). The postoperative systolic pulmonary artery blood pressure significantly decreased from a preoperative value of $78.9{\pm}14.5\;mmHg$ to $45.6{\pm}17.6\;mmHg$ postoperatively (p=0.000). The degree of tricuspid regurgitation was less than grade II after surgery. Two patients died early on, including one patient who had persistent pulmonary hypertension without improvement and right heart failure. Conclusion: Patients who have chronic pulmonary embolism are known to have a poor prognosis. However, we think that early surgical treatment along with making the proper diagnosis before the aggravation of right heart failure can help improve the quality of a patient's life.

• The Journal of the Korea Contents Association
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• v.14 no.5
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• pp.251-261
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• 2014

Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term outcome, compared with thrombolytic therapy in patients with acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients.1,974 patients (Group I: n=1,018, $age{\geq}65years$, $73.8{\pm}5.99years$; Group II: n=956, age<65years, $52.8{\pm}7.96years$) who underwent primary PCI for AMI at Chonnam National University Hospital between 2006 and 2010 were analyzed according to their clinical, angiographic characteristics for hospital and one-year survival. Group I had a higher percentage of women, diabetes mellitus, hypertension, multi-vessel disease and lower prevalence of current smoking, hyperlipidemia, familial history than Group II. Culprit lesions were at the left anterior descending artery, left circumflex artery, right coronary artery and left main artery in 42.8% vs. 45.0%, 34.1% vs. 29.6%, 14.6% vs 14.6, 2.7% vs. 1.6%, respectively (p=0.007). Stent diameter was smaller in group I ($3.17{\pm}0.39$ vs. $3.29{\pm}0.42mm$, p=0.001). In-hospital mortality was higher in group I (8.4 vs. 1.9%, p<0.001). There were significant differences in the rates of major adverse cardiac events between the two groups during one-year clinical follow-up (20.1 vs.14.0%, p<0.001). On multiple logistic regression analysis, systolic blood pressure<100mmHg, serum $creatinine{\geq}1.3mg/dL$, Killip class> I, multivessel disease, left ventricular ejection fraction <40% and cerebro vascular disease were independent predictors of one-year motality in patients over 65 years after PCI.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.626-632
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• 2006

Background: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvement of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. Material and Method: Between January 2001 and December 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. Result: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from $91{\pm}21$ mmHg to $40{\pm}17$ mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. Conclusion: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.591-597
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• 2008

Background: Pulmonary endarterectomy is widely accepted as a treatment for chronic thromboembolic pulmonary hypertension. Based on our experiences, we sought to find ways to reduce perioperative complications and to improve surgical outcomes in patients undergoing pulmonary endarterectomy. Material and Method: This study was designed as a retrospective analysis of 20 patients with pulmonary hypertension who underwent pulmonary endarterectomy between January 1998 and March 2008. All patients presented with chronic dyspnea. Deep vein thrombosis (DVT) was the major cause of chronic pulmonary thromboembolism (55%). Seventeen patients (85%) underwent inferior vena cava (IVC) filter placement. Thirteen patients underwent surgery under total circulatory arrest, while the others underwent surgery while on low flow cardiopulmonary bypass. Concomitant tricuspid annuloplasty was done in 6 patients (66%) whose tricuspid regurgitation was as severe as grade IV/IV. The mean follow-up duration was $45{\pm}32$ months. Result: Using of University of California, San Diego (UCSD), thromboembolism classification, 4 patients (20%) were type 1, 8 patients (40%) were type II, and 8 patients (40%) were type III. Right ventricular systolic pressure was reduced significantly from $77{\pm}29$ mmHg to $37{\pm}19$ mmHg after pulmonary endarterectomy (p<0.001). The degree of tricuspid regurgitation and the NYHA functional class were all improved postoperatively. Reperfusion edema occurred in 7 cases (35%). The incidence of reperfusion edema was higher in the UCSD type III group than in the other group (25% vs 50%, p=0.25) and the length of postoperative intensive care unit stay was longer in type III group ($5{\pm}2$ days vs $9{\pm}7$ days, p=0.07). The early mortality rate was 10%, and the late mortality rate was 15% (n=3); one death was due to progression of underlying non-Hodgkin's lymphoma, and the other deaths were related to recurrent thromboembolism and persistent pulmonary hypertension, respectively. Conclusion: Pulmonary endarterectomy, as a curative surgical method for treating chronic thromboernbolic pulmonary hypertension, should be performed aggressively in patients diagnosed with chronic thromboembolic pulmonary hypertension, and an effort should be made to reduce the frequency of perioperative complications and to improve surgical outcomes.