• Clinical and Experimental Pediatrics
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• 제56권3호
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• pp.101-106
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• 2013

Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD.

• 대한의용생체공학회:의공학회지
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• 제36권4호
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• pp.135-142
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• 2015

Outflow cannulation site of left ventricular assist device(LVAD) chosen by considering anatomical structure of thoracic cavity and vascular system. Though outflow cannulation site influences blood perfusion at each branch, there is no standard rule or quantitative data. In this study, we computed the amount of blood perfusion at each arterial branch numerically according to outflow cannulation sites(ascending aorta, aortic arch, descending aorta). We generated computational meshes to the three-dimensionally reconstructed arterial system. Clinically measured arterial pressure were used for inlet boundary condition, porous media were applied to mimic blood flow resistance. Blood perfusion through left common carotid artery was 2.5 times higher than other cases, and that through right common carotid artery was 1.1 times higher than other branches. Although this is simulation study, will be useful reference data for the clinical study of LVAD which considers blood perfusion efficiency.

• Journal of Chest Surgery
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• 제13권4호
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• pp.455-461
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• 1980

This is one case report of surgically treated ventricular septal defect [VSD] with aortic insufficiency [AI] at department of thoracic and cardiovascular surgery, Hanyang university hospital. He had had progressive dyspnea on exertion and palpitation for 3 years prior to admission to our hospital. On examination, the blood pressure was 120/0 mmHg and the pulse rate 88 times/min. Bobbing motion of the head, Water hammer pulse, Corringan`s pulse, Quincke`s pulse and to and fro murmur were present. The heart murmur was consistent with .VSD and AI. Cardiomegaly was seen in chest X-ray. EKG, echocardiogram, aortogram and right heart catheterization was performed. On Sep. 9, 1980, open heart surgery was performed under the impression of VSD with AI. Infracrystal type VSD measuring 2 x 1.5 cm in diameter was closed with Teflon patch graft through the transverse ventriculotomy. AI was due to prolapsed, elongated right coronary and noncoronary cusp, especially noncoronary cusp. The prolapsed, elongated aortic leaflets were plicated by placing three 8-figure sutures between the free edge and the base of the leaflet [Frater`s method] through a transverse aortotomy. Postoperatively, he made an uneventful recovery, his blood pressure was 120/70 mmHg and showed no signs AI or residual shunt at discharge.

• Journal of Chest Surgery
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• 제18권2호
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• pp.151-156
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• 1985

A clinical analysis was done on 50 cases of ventricular septal defect, operated from April 1981 to March 1984 at the department of Thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. Among 50 cases, 34 cases were males and 16 cases were females. Their age ranged from 1 to 26 years and the mean age was 9.7 years. The main symptoms at admission were frequent upper respiratory infection [50%], exertional dyspnea [42%] and palpitation [34%]. In anatomical classification by Kirklin, type I constituted 20%, type II 76%, type IV 4%. Associated congenital cardiac lesions were pulmonic stenosis [6 cases], patent foramen ovale [5 cases], aortic insufficiency [3 cases] and persistent left superior vena cava [1 case]. When a normal electrocardiogram pattern was present, Qp/Qs, Rp/Rs and pulmonary artery systolic pressure and Pp/Ps were relatively low. Among cases of above 1 cm2/M2 BSA in size of defect, Pp/Ps and pulmonary artery systolic pressure were increased than the cases of below 1 cm2/M2 BSA [P=0.01]. The postoperative right bundle branch block was occurred in 21 cases [75%] among 28 cases of right ventriculotomy approach. The operative mortality was 2% [1 case] among 50 cases and complication rate was 14% [7 cases].

• Journal of Chest Surgery
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• 제17권3호
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• pp.339-345
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• 1984

Thirty four patients with a ventricular septal defect, aged 2 months to 24 years [median 2.33 years], had lung biopsies during open heart procedures to assess the degree of pulmonary vascular disease. The patients were divided into two groups according to their age; group 1 - under 2 years of age [15 patients], and group 2- over 2 years of age [19 patients]. The, pathologic change of the pulmonary arterioles was correlated with pre-operative hemodynamic data in 34 patients. There was no significant correlation between the severity of pulmonary vascular disease according to Heath-Edwards classification and the patients age [X2=1.8381, P=0.1751 ]. There was a significant correlation between degree of medial wall thickness and arteriolar diameter and the level of preoperative peak pulmonary artery pressure and peak systemic artery pressure [Pp/Ps]. Also, there was a good correlation between the preoperative pulmonary vascular resistance and systemic vascular resistance [Rp/Rs]. There was no significant correlation between wall thickness and Pp/Ps, and Rp/Rs below the age of 2 years. We conclude that, in patients over 2 years of age, there was a significant correlation between the medial wall thickness of the pulmonary arteriole and elevation of Pp/Ps and Rp/Rs. This is not true in patients under 2 years of age.

• Journal of Chest Surgery
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• 제12권2호
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• pp.119-126
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• 1979

This is one case report of the extremely rare congenital cardiac malformation, Double-outlet of left ventricle in corrected transposition of great arteries. 11-year-old boy complained acrocyanosis and exertional dyspnea, the parents noticed cyanosis since birth. Physical examination revealed acrocyanosis, clubbed fingers and toes, G-III pansystolic murmur on 2nd and 3rd ICS, LSB. Right heart catheterization revealed significant $O_2$ jump in ventricular level. Right and left ventriculography showed the both catheters arriving in the same ventricle i.e. anterior chamber, morphological left ventricle was in right and anterior position, simultaneous visualization of aorta and pulmonary artery and aorta locating anterior and right side of pulmonary artery. Echo cardiogram surely disclosed interventricular septum. Conclusively it was clarified that the patient has Double-outlet of left ventricle and corrected transposition of great arteries [S.L.D.]. Operation was performed to correct the anomalies under extracorporeal circulation with intermittent moderate hypothermia. Right-sided ventriculotomy disclosed the following findings. 1. Right-sided ventricle was morphological left ventricle. 2. Left-sided ventricle was morphological right ventricle. 3. Right side atrioventricular valve was bicuspid. 4. Left side atrioventricular valve was tricuspid. 5. Aortic valve was superior, anterior and right side of pulmonary valve. 6. Subpulmonary membranous stenosis. 7. Non-committed ventricular septal defect. We made a tunnel between VSD and aorta with Teflon patch so that arterial blood comes through VSD and the tunnel into aorta. After correction the patient needed assisted circulation for 135 min. to have adequate blood pressure. Postoperatively by any means, adequate blood pressure could not be maintained and expired in the evening of operation day.

• Journal of Chest Surgery
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• 제30권1호
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• pp.11-16
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• 1997

The Increasing use of coronary perfusates for the protection of the human heart during ischemic cardiac arrest has placed great emphasis on the need for a rational and safe formulation. For the purpose of this study isolated rat hearts were connected to retrograde nonworking perfusion system proposed by Langendorff, and then perfused for 20 minutes by coronary infusates of magnesium concentration of 1.66 m Mol per liter(group A, n: 10) or 15mMo1 per liter(group B, n: 10). After 20 minutes perfusion, cold cardioplegic solution (modified St. Thomas'Hospital solution) was infused for 2 minutes, and prepared within 4$^{\circ}C$ Krebs-Henseleit solution. Finally, 20 minutes of cononay reprsfuslon was reestablished after I hour of cold ischemic cardiac arrest. Hemodynamic parameters (heart rate, left ventricular pressure, $\pm$ dp/dt max. and coronany flow) and enzymes assay (creatine phosphokinase, lactic dehydrogenase and flutamic oxaloacetic transaminase) were performed each other at whic rat heart was perfused for 20 minutes and reperfused for 20 minutes thereafter. There were significant differences in the recovery rate of heart rate, systolic left ventricular pressure, + dp/dt max, and coronary flow and reperfusion-perfusion ratio of creatine phosphokinase(P < 0.05). But, there were no signicant differences in the recovery rate of dp/dt max, and reperfunion-perfusion ratio of lactic dehydrogenase and glutamic oxaloacetic acid (P > 0.05).

• Journal of Chest Surgery
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• 제22권5호
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• pp.739-747
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• 1989

Between September 1986, and August 1989, eight infants underwent operation for repair of coarctation of the aorta in the first year of life. The patients included 7 males and 1 female ranging in age 19 days and 9 months. Weights ranged from 3.5 Kg to 7 Kg [mean 5 Kg]. All patients had preductal coarctation of the aorta. Each infant had associated cardiac anomalies, including ventricular septal defect [7 infants] and patent ductus arteriosus [5 infants]. All had intractable congestive heart failure, despite aggressive medical therapy. Pressure gradient across the coarctation ranged from 10 mmHg to 60 mmHg. Operative techniques were subclavian flap aortoplasty in five cases, Gore-Tex patch aortoplasty in three cases. In addition to coarctation repair, six infants had concomitant banding of the pulmonary artery. Four infants required ventilator support for several days. There was no operative death. Complications developed in two. One infant had tracheal stenosis after a tracheostomy. Another infant had restenosis of the aorta revealed by cardiac catheterization 30 months after surgery. The pressure gradient was 30 mmHg, necessitating balloon dilatation aortoplasty. Results were satisfactory. During follow up, we performed total correction procedures [patch closure of the ventricular septal defect, infundibulectomy, pulmonary valvotomy and pulmonary artery angioplasty] in one case. Continuing follow-up finds all patients in good condition.

• Journal of Chest Surgery
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• 제23권3호
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• pp.430-437
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• 1990

We clinically evaluated 121 cases of ventricular septal defect which we operated from April, 1986 to December, 1989 at Inha General Hospital, Seong-Nam, Department of Thoracic and Cardiovascular Surgery, College of Medicine, Inha University. These patients were occupied 54.8% of all congenital heart diseases operated on its same period. Of the 121 patients, 63 patients were male[52.1%] and 58 patients were female[47.9i]. The two most common symptoms were frequent upper respiratory infection and dyspnea on exertion. By Kirklin s anatomical classification, type I constituted 34.7%, type II 61.98%, type III 0.03% and type IV not occupied. Associated cardiac anomalies were found in 34 cases, and PDA was most common associated anomaly, occupied in 22 cases. On the cardiac catheterization data, there were statistically significant correlation between VSD size[cm2 /BSAm2] and systolic pulmonary arterial pressure[sPAP], pulmonary to systemic flow ratio[Qp/Qs] & pulmonary to systemic pressure ratio[Pp/Ps] respectively, Type II [r=0.53, p<0.01] was more correlated than type I [r=0.49, p<0.05] between VSD size and Qp /Qs. We could not found the correlationship between age and Qp/Qs [Type I; r=0.16, Type II; r=-0.15] All cases were operated under cardiopulmonary bypass and 58 cases[46.3%] were operated through the right atrial approach, and 34 cases[28.1%] through the pulmonary arterial approach. Operative mortality rate was 4.13%[5 cases].

• The Korean Journal of Physiology and Pharmacology
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• 제26권6호
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• pp.511-518
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• 2022

Sepsis-associated myocardial injury, an invertible myocardial depression, is a common complication of sepsis. Neogambogic acid is an active compound in garcinia and exerts anthelmintic, anti-inflammatory, and detoxification properties. The role of neogambogic acid in sepsis-associated myocardial injury was assessed. Firstly, mice were pretreated with neogambogic acid and then subjected to lipopolysaccharide treatment to induce sepsis. Results showed that lipopolysaccharide treatment induced up-regulation of biomarkers involved in cardiac injury, including lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), and troponin I (cTnI). However, pretreatment with neogambogic acid reduced levels of LDH, CK-MB, and cTnI, and ameliorated histopathological changes in the heart tissues of septic mice. Secondly, neogambogic acid also improved cardiac function in septic mice through reduction in left ventricular end-diastolic pressure, and enhancement of ejection fraction, fractional shortening, and left ventricular systolic mean pressure. Moreover, neogambogic acid suppressed cardiac apoptosis and inflammation in septic mice and reduced cardiac fibrosis. Lastly, protein expression of p-p38, p-JNK, and p-NF-κB in septic mice was decreased by neogambogic acid. In conclusion, neogambogic acid exerted anti-apoptotic, anti-fibrotic, and anti-inflammatory effects in septic mice through the inactivation of MAPK/NF-κB pathway.