• Title/Summary/Keyword: cardiac risk factor

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Risk Factor, Mortality and Infection Rate of Mediastinum After Delayed Sternal Closure in Congenital Heart Surgery Patients (선천성 심장수술 후 지연 흉골 봉합시 사망률 및 종격동 감염률 그리고 위험인자)

  • 이진구;박한기;홍유선;박영환;조범구
    • Journal of Chest Surgery
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    • v.35 no.7
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    • pp.517-522
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    • 2002
  • Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

Left Ventricular Hypertrophy and Prelude to Hypertensive Cardiovascular Diseases: from the Pediatric Cardiologist's Point of View (좌심실 비대와 고혈압성 심혈관 합병증: 소아 심장 의사의 관점)

  • Cho, Min-Jung
    • Childhood Kidney Diseases
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    • v.15 no.1
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    • pp.14-21
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    • 2011
  • Although left Left ventricular hypertrophy (LVH) is not only an adaptive response of the heart to increased cardiac workload in hypertension, it surelybut also is the most potent risk factor of overt cardiovascular complications such as coronary heart disease, heart failure, arrhythmia and stroke in the hypertensive population. Also it has become generally accepted that subclinical cardiovascular disease begins in childhood and LVH is the most readily assessed marker for that. As LVH can be seen in children and adolescents with even mild blood pressure elevation with the reported prevalence of 10 to 47%, aggressive antihypertensive treatment is critical in preventing the development of hypertensive heart disease in that those cases.

송엽(松葉)이 고지방식이(高脂肪食餌)로 유발된 백서(白鼠)의 지방(脂肪)과 혈청지질(血淸脂質)에 미치는 영향(影響)

  • Kim, Dae-Hyun;Soh, Kyung-Sun
    • Journal of Pharmacopuncture
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    • v.10 no.1 s.22
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    • pp.109-119
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    • 2007
  • In order to study the effects of Pinus densiflora on hyperlipidemia and lipid in rats, we divided the rats into groups(Normal group, Control group and Sample group) and perfomed the experimental research. Hyperlipidemia and lipid in rats were induced by high fat diets for 8weeks. The sample group was administerd the extract of Pinus densiflora for 14 days and control group was administerd equal dose of oral. And then we measured the amount of serum triglyceride, Total cholesterol, LDL-cholesterol, HDL-cholesterol, Free Fatty Acid, phospholipid, Insuline, Laptin, Body weight, epididymis fat weight & rate, epididymis fat cell, Cardiac Risk Factor(CRF). The results were as followers : 1. Sample Group showed decreasing effects on Total cholesterol, Trigylceride, LDL-cholesterol, and Phospholipid levels in serum and CRF significantly. 2. Sample Group showed increasing effects on HDL-cholesterol level in serum significantly. 3. Sample Group showed decreasing effects on Insuline in serum significantly. 4. Sample Group showed increasing effects on Laptin in serum significantly. 5. Sample Group showed decreasing effects on Body weight, epididymis fat weight & rate, epididymis fat cell significantly. According to the above results, Pinus densiflora showed significant decreasing effects on hyperlipidemia and lipid in rats, it is considered that it is appropriate to apply for hyperlipidemia, obesity.

The Hypocholesterolemic Effect of Platycodi radix Saponin in Rats Fed a Hypercholesterol Diet (길경 saponin이 고콜레스테롤식이를 공급한 흰쥐의 지질대사에 미치는 영향)

  • Won, Hyang Rye
    • The Korean Journal of Community Living Science
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    • v.24 no.1
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    • pp.141-149
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    • 2013
  • The objective of this study is to find the effect of improving hyperlipidemia through Platycodi radix saponin. A hypercholoesterol diet and Platycodi radix saponin methanol extract were supplemented to the 6 week old male Spargue Dawley rats for four weeks. Results showed that the serum total cholesterol, triglyceride and LDL-cholesterol level decreased in the group supplemented with Platycodi radix saponin methanol extract(p<0.05), however, the serum total lipid and HDL-cholesterol did not show any difference from the control group according to the supplement of Platycodi radix saponin methanol extract. In the group supplemented with Platycodi radix saponin methanol extract, the total cholesterol decreased by 20%, triglyceride by 36% and LDL-cholesterol by 25% respectively, and there was no difference according to the level of Platycodi radix saponin methanol extract. AI(atherogenic index) and CRF(cardiac risk factor) were low in the group supplemented with Platycodi radix saponin methanol extract. Total lipid, total cholesterol and triglyceride in liver and feces were significantly low in the group supplemented with the Platycodi radix saponin methanol extract compared with the control group(p<0.05). According to this result, it is expected that the Platycodi radix saponin methanol extract supplemented in the hypercholesterol diet can lower atherosclerosis, the cause of cardiovascular disease, by reducing not only serum cholesterol and triglyceride but also liver cholesterol and triglyceride.

Case Report of Chengsim Yeunja-tang (CYT) for Atrial Fibrillation with cerebral-infarction. (청심연자탕으로 호전된 뇌경색을 동반한 심방세동 환자 치험 3례)

  • Kim, Jung-Chul;Oh, Sung-Won;Song, Chang-Hoon;Lee, Seul-hee;Jeong, Jong-Jin;Kim, Jong-Yun;Sun, Seung-Ho
    • The Journal of Internal Korean Medicine
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    • v.27 no.3
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    • pp.751-761
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    • 2006
  • Atrial fibrillation (AF) is a common arrhythmia that is a potent independent risk factor for stroke. The incidence of AF increases with age and most affected people have underlying cardiac disease. An aging society increases the incidence of AF patients. The case was designed to evaluate the improving effect of Chengsim Yeunja-tang (CYT) for atrial fibrillation (AF) with Cb-infarction patients. This patient was treated with CYT and had significant improvement in symptoms and change of EKG. -Heart rate decreased in patients with higher than normal heart rate -RV5+SV1 voltage decreased (LVH improved) -Arrhythmia remained steady. -Palpitation. chest discomfort, dyspnea, headache, dizziness diminished. Results suggest that CYT is an effective treatment for Taeumin AF patients.

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Mung Bean (Phaseolus aureus L.) Improves Lipid Composition Protein Concentration in Hyperlipidemic Rats (녹두(Phaseolus aureus L.) 첨가 식이가 고지혈증 흰쥐의 지질성분 개선 및 단백질 농도에 미치는 영향)

  • Kim, Han-Soo;Kang, Dong-Soo
    • Journal of Environmental Science International
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    • v.30 no.7
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    • pp.537-545
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    • 2021
  • This study aimed to investigate the improvement effect of 5% (w/w) mung bean (Phaseolus aureus L.) on lipid composition and protein concentration in hyperlipidemic rats. Seven-week-old male (Sprague-Dawley) rats were divided into four groups (n=6, each), and fed experimental diets containing mung bean meal [basal diet+5% (w/w) mung bean (BM), basal-hyperlipidemic diet+5% (w/w) mung bean (BHM)], basal-hyperlipidemic diet (BH), and control (basal diet, BD). Lipid composition in the mung bean diet groups (BM and BHM) evidenced significant reductions in serum total cholesterol, low-density lipoprotein cholesterol, atherosclerotic index, cardiac risk factor, triglyceride, phospholipid, free cholesterol, cholesteryl ester, blood glucose, nonesterified fatty acid, and an elevation in high-density lipoprotein cholesterol. The serum albumin/globulin ratio was increased in mung bean diet-supplemented rats compared to that in hyperlipidemic rats (p < 0.05). Total calcium, phosphorus and potassium concentrations in sera were higher in the BM, BHM and BD groups than in the BH group. Concentrations of sodium and chlorine in sera were lower in the mung bean diet-supplemented groups than in the hyperlipidemic group. The in vivo experiments showed that ingestion of mung bean was effective in improving lipid composition, protein concentration, and blood glucose.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

  • Park, Hyun Oh;Kang, Dong Hoon;Moon, Seong Ho;Yang, Jun Ho;Kim, Sung Hwan;Byun, Joung Hun
    • Journal of Chest Surgery
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    • v.50 no.5
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    • pp.346-354
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    • 2017
  • Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6-12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

2018 Korean Guideline of Atrial Fibrillation Management

  • Joung, Boyoung;Lee, Jung Myung;Lee, Ki Hong;Kim, Tae-Hoon;Choi, Eue-Keun;Lim, Woo-Hyun;Kang, Ki-Woon;Shim, Jaemin;Lim, Hong Euy;Park, Junbeom;Lee, So-Ryoung;Lee, Young Soo;Kim, Jin-Bae;KHRS Atrial Fibrillation Guideline Working Group
    • Korean Circulation Journal
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    • v.48 no.12
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    • pp.1033-1080
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    • 2018
  • Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.

Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes

  • Lee, Chee-Hoon;Ju, Min Ho;Kim, Joon Bum;Chung, Cheol Hyun;Jung, Sung Ho;Choo, Suk Jung;Lee, Jae Won
    • Journal of Chest Surgery
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    • v.47 no.3
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    • pp.233-239
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    • 2014
  • Background: As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). Methods: Consecutive 314 patients (mean age, $62.5{\pm}10.8$ years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ${\geq}10$ times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value. Results: There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049). Conclusion: PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.

Sternal Retraction and Subclavian Vein Catheter Occlusion during Cardiac Surgery

  • Tarbiat, Masoud;Bakhshaei, Mohammad Hossein;Derakhshanfar, Amir;Rezaei, Mahmoud;Ghorbanpoor, Manoochehr;Zolhavarieh, Seyed Mohammad
    • Journal of Chest Surgery
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    • v.54 no.5
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    • pp.377-382
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    • 2021
  • Background: Subclavian vein (SV) catheterization is a method for the delivery of fluids, drugs, and blood products, venous blood sampling, and central vein pressure monitoring in cardiac surgery. Catheter occlusion is a serious complication of SV catheterization during cardiac surgery, especially after sternal retractor expansion. Methods: In this observational study, 303 patients who had successful right infraclavicular SV catheterization from September 2019 to April 2020 were enrolled to determine the incidence of catheter occlusion. After catheterization, the lumens of all catheters were checked for the ability to infuse and withdraw blood from the catheter before and after sternal retractor expansion. The patients' characteristics, cannulation approach, on-pump or off-pump technique, occlusion of the catheter and its lumens, and any associated complications were recorded. The data were analyzed using IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA). Results: Of the 303 patients studied, 205 were male (67.7%) and 98 were female (32.3%). Catheter occlusion occurred in 11 patients with on-pump cardiopulmonary bypass (CPB) (227 patients) and 4 patients with off-pump CPB (76 patients) (p=0.863). The incidence of catheter occlusion was 4.95% (15 of 303 patients) with no cases of simultaneous 3-lumen occlusion in a catheter. The most commonly occluded lumen was the distal lumen (57.92%). Simultaneous 2-lumen occlusion occurred in 4 patients. Catheter occlusion was found in 3 of 13 malpositioned catheters (23.07%). Conclusion: The current study showed that malpositioning of the catheter tip was a risk factor for catheter occlusion and that the distal lumen of a triple-lumen catheter was the most commonly occluded lumen.