• Journal of Chest Surgery
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• 제22권5호
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• pp.748-752
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• 1989

We experienced 6 patients with the sinus Valsalva aneurysm rupture during last 12 years [Jan. 1977-Sep. 1989]. Of them. 5 cases were reviewed. They consist of 3 males and 2 females, and the age ranged from 12 years to 40 years with the mean age of 25 years. 4 patients showed congestive heart failure symptoms. The diagnosis was made by 2D-Echo and cine-angiogram. In 4 patients. sinus Valsalva aneurysm ruptured from the Rt. coronary sinus to the Rt. ventricle, and in one from non-coronary sinus to the Rt. atrium. In 2 cases, resection of the aneurysm and simple stitch closure was made. Resection of the aneurysm k patch closure and AVR in one, closure of the fistula, AVR and patch closure of the associated VSD in one, and closure of the fistula, AVR k TVR in one were made in another 3 cases. There was no postoperative mortality case.

• Journal of Chest Surgery
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• 제31권3호
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• pp.304-307
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• 1998

Valsalva동 동맥류는 발생빈도가 낮은 질환으로 대부분이 선천성이며 동양인에서 보다 빈번하게 발생하는 것으로 보고되고 있다. Valsalva동 동맥류는 심장내로 진행되어 우심실이나 심방으로 파열되는 경우가 대부분이고 심외성 Valsalva동 동맥류는 발생빈도가 매우 낮다. 심외성 Valsalva동 동맥류는 대부분 대동맥판폐쇄부전을 야기하고 동맥류에 의한 압박으로 우심실 유출로 협착, 심근 허혈 및 심근 경색 등을 일으킬 수 있으며 심낭내로 파열된 경우 심인성 쇼크나 돌연사를 일으키므로 매우 주의를 요하며 확진되면 외과적으로 교정하는 것이 바람직하다. 저자들은 좌관상동맥동 및 무관상동맥동에 발생한 동맥류에 의해 심근허혈 및 대동맥판폐쇄부전이 발생하였던 예를 외과적으로 치료하여 양호한 성적을 얻었기에 문헌고찰과 더불어 보고하고저 한다.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1976년도 제10차 학술대회연제 순서 및 초록
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• pp.85.2-85
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• 1976

Harford는 구씨관기능의 측정에 impedance audiometry의 진단학적 가치를 설명한 바 있다. 고막에 천공이 없는 경우 중이강내의 과도한 음압은 tympanogram에 의해 간접적으로 구씨관기능부전을 나타내는 것은 주지의 사실이다. 구씨관기능이 정상인 경우 valsalva maneuver에 의해 고막은 외측으로 밀려나갈 것이며 이것은 balance meter needle의 운동을 야기시킬 것이다. 이에 저자들은 고막, 중이, 구씨관기능이 모두 정상소견을 보이는 사람을 대상으로 valsalva maneuver에 의해 야기될 수 있는 balance meter needle의 운동거리를 측정함으로써 정상인에서의 구씨관에 의한 중이강의 공기체적의 변동양을 조사하였다. 즉, electroacoustic bridge (Madsen ZO 70) with silicone rubber probe tip을 사용하여 고막, 중이, 구씨관기능이 모두 정상인 사람에서 valsalva maneuver에 의한 balance meter needle의 운동범위는 1.0~4.0(평균치 $1.6{\pm}0.06$)이었으며, 그 치가 1.0미만인 경우에는 어떤 정도의 구씨관기능의 저하 내지 부전을 진단할 수 있는 것으로 생각되어 impedance audiometry에 의한 구씨관기능검사의 의의를 고찰하며 보고하는 바이다

• Journal of Chest Surgery
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• 제37권7호
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• pp.578-584
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• 2004

발살바동 동맥류는 드문 심장 기형으로 수술 후 장기 생존율이 잘 알려져 있지 않다 본 연구는 발살바동 동맥류의 수술적 치료 후 장기 성적을 알아보고자 하였다. 대상 및 방법: 1991년 1991년 3월부터 2003년 11월까지 발살바동 동맥류로 수술한 35명(남자 23, 여자 12, 평균 연령 35.2세, 범위 11세∼64세)의 환자를 대상으로 하였다. 술 전 NYHA 기능적 분류는 26명(74.3%)에서 class III∼IV였다. 술 전 심초음파상 평균 심구출률은 63.32 $\pm$ 11.43%였고 9명(25.7%)의 환자는 대동맥 판막 폐쇄 부전 grade III∼IV였다. 발살바동 파열부위의 수술은 직접 봉합이 14예(46.7%), 첩포를 이용한 폐쇄는 16예 (53.3%)에서 시행되었다. 대동맥 판막 치환술은 5예에서(14.3%) 성형술은 3예에서(8.6%) 시행되었다. 그리고 3명(8.6%)의 환자에서는 Bentall's 수술을 했으며 동반된 수술은 심실 중격 결손 폐쇄 12예 (34.3%), 심방 중격 결손 폐쇄 3예(8.6%)였다. 평균 심폐체외순환 시간은 116.79 $\pm$ 38.79분이었고 평균 대동맥 차단 시간은 81.2 $\pm$ 28.97분이었다. 결과: 수술 사망은 없었다. 1예에서 완전 방실 차단으로 영구 심장 박동기를 삽입했다. 재수술은 3예에서 시행하였는데 1예는 발살바동 동맥류 재발로 직접 봉합했고 1예는 대동맥 판막 기능 부전이 악화되어 인공 판막 치환술을, 1예는 인공 판막 치환술 후 판막 열개로 Bentall's 수술을 시행했다. 평균 추적 기간은 58.55$\pm$38.38개월이었으며 만기 사망은 1예 있었다. 5 year freedom from reoperation rate는 87.1 $\pm$ 7%였다. 결론: 발살바동 동맥류의 수술적 치료는 안전하며 만족할 만한 결과를 얻었다.

• Journal of Korean Biological Nursing Science
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• 제11권1호
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• pp.68-76
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• 2009

Purpose: The purpose of this study was to evaluate the hemodynamic changes in degree and duration that occur during Valsalva maneuver (VM). Furthermore, we wanted to investigate the patterns and mechanisms of physiological hemodynamic control. Method: Thirty six healthy college students were recruited from Y university. Each participant was provided with written informed consent. Blood pressure (BP), heart rate (HR), cardiac output (CO) were continuously recorded using the Finometer. Result: During the phase I of VM, means of systolic and diastolic pressures were increased by 32.15% and 38.28%, respectively, compared with basal values. HR and CO were decreased by 9.91% and 13.01%, respectively. Immediately after the maneuver (phase III), systolic and diastolic pressures were decreased by 5.05% and 6.24%, respectively, compared with those obtained in the phase II. HR and CO were elevated by 13.33% and 11.93%, respectively, compared to the levels of earlier phases. BPs were represented with overshoot in the phase IV, and recovered by baseline values about 20 sec after VM. Conclusion: These results demonstrated that hemodynamic changes are variable in the event of VM even in healthy humans. It will be valuable to accumulate more quantitative hemodynamic information in special populations such as the elderly and the patients with cardiovascular problems.

• Journal of Chest Surgery
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• 제18권2호
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• pp.265-272
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• 1985

Congenital aneurysm of sinus of Valsalva is one of the rare congenital heart disease, which is usually asymptomatic until rupture. The aneurysm usually ruptures into a cardiac chamber and produces an aorto-intracardiac fistula. Ruptured aneurysm is a grave lesion in that it causes heart failure and subsequent death. If, however, it is discovered in its early stages and operated on properly, it can be corrected with considerable success. Form January 1975 through December 1984, 18 consecutive patients with congenital aneurysm of sinus of Valsalva underwent corrective surgery using total cardiopulmonary bypass in our department of Thoracic Surgery. 1. The incidence was about 0.9% of surgical cases of congenital heart disease during that period. 2. 13 were males and 5 females, with ages ranging 12 years to 52 years. 3. Associated anomalies were VSD in 14, infundibular PS in 1, aberrant muscle band in RVOT in 1, and secondary aortic insufficiency in 9. 4. 17 were suggested to arise from right coronary sinus and 1 from noncoronary sinus; Among 17, 12 ruptured into right ventricle, and one from noncoronary sinus into right atrium. 5. Surgical correction was performed by means of direct suture closure with combined pledget or patch graft after aneurysm resection, and associated lesions were also corrected simultaneously. 6. There was only one case of operative mortality, and all the other patients were relatively uneventful in their follow-up studies.

• Journal of Chest Surgery
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• 제18권3호
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• pp.407-413
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• 1985

Ruptured aneurysms of the sinus Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Five patients underwent operative treatment in Catholic Medical Center in recent 2.5 year period. Three patients were male and two patients were female, ages ranged from 20 to 54 years. Bacterial endocarditis was suspected or proved in 3 patients. In 3 patients in our series had a ruptured congenital aneurysms and in 2 patients acquired aneurysms by bacterial endocarditis. Associated cardiac lesions were common; such as aortic insufficiency in 3 patients, atrial septal defect in 2 patients, mitral stenoinsufficiency in 1 patient and tricuspid insufficiency in 1 patient. All aneurysmal ruptures of the sinus Valsalva arose from right coronary sinus and in 4 patients ruptured into right ventricle and in 1 patient into right atrium. Surgical techniques consisted of direct closure 4 in patients and closure with Dacron patch in 1 patient. And we preferred double approach, that is, through both the aorta and the involved cardiac chamber in cases in whom aortic insufficiency was present. So additional aortic valve replacement performed in 2 patients due to severe aortic insufficiency and aortic valvuloplasty performed in 1 patient. One patient who underwent direct closure of ruptured sinus Valsalva and double valve replacement died due to low cardiac output syndrome just after the operation. Operative results were relatively good in remainders.

• Journal of Yeungnam Medical Science
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• 제23권2호
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• pp.227-231
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• 2006

기도가 닫힌 상태에서 강하게 숨을 뿜어내는 발살바법은 망막의 정맥압을 상승시키고 이에 따라 망막 출혈을 유발시킬 수 있다. 힘든 배변을 경험한 55세 남자가 우안의 중심시력 감소로 인해 본원을 방문하였다. 전신적인 질환으로 고혈압, 만성 변비를 앓고 있었고 동공을 산대하여 정밀 안저검사를 한 결과 유두 한 개 정도 크기의 망막전 출혈과 황반와주위로 작은 크기의 망막내 출혈이 관찰되었다. 특별한 치료없이 망막 출혈은 자연 흡수되어 시력은 정상으로 회복되었다. 배변으로 인해 급작스런 시력감퇴를 나타낸 발살바 망막증을 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1482-1486
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• 1992

Ruptured aneurysms of the sinus of Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Eight patients underwent operative treatment at Chonnam University Hospital from June, 1986 to May, 1992. Six of the patients were male and two female. Age ranged from eight to fifty six years. Associated cardiac lesions were common including AR and VSD in four patients respectively. Diagnosis was made by 2D-Echo and cine-angiogram. In six patients aneurysms of the sinus of valsalva ruptured from the right coronary sinus to the right ventricle and in two from right coronary sinus to the right atrium Direct closure of aneurysmal rupture and patch closure of VSD in four cases, resection of the aneurysm and direct closure in one case, direct closure of the fistula and AVR in two cases, direct closure in one case were performed. One patient combined with VSD, pulmonary hypertention and bacterial endocarditis underwent operation, but he died of sudden cardiac arrest the day after the operation. Operative results were relatively good in the other patients.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2003년도 학술회의 논문집 정보 및 제어부문 B
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• pp.943-945
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• 2003

This study is to evaluate the change of intra-abdominal pressure related with intravesical and intrarectal pressure in patients with spinal cord injury according to daily activities and postural changes which make the abdominal pressure elevated. The intravesical and the intrarectal pressures were obtained during patient's speech, sneeze, cough, valsalva and various postural changes with supine to decubitus, derubitus to supine, supine to sit, and sit to supine according to empty and full bladders, respectively. The order of higher intravesical and intrarectal pressure rise during various maneuvers were valsalva, sneeze, supine to sit and cough, respectively. Higher correlation coefficient between the intrvesical and intrarectal pressures were noted during cough, sneeze, valsalva and supine to sit in empty bladder than full one. These results demonstrated that the intravesical and intrarectal pressures were influenced by daily activities and postural changes of increasing the intra-abdominal pressure. The intrarectal pressures according to daily activities such as cough, sneeze, valsalva and postural change were significantly related with intravesical pressures.