• 대한핵의학회지
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• 제16권2호
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• pp.29-36
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• 1982

Quantification of the regurgitation amount is important before and after valvular replacement surgery. Until now cardiac catheterization with cineventriculography, echocardiography have been used to measure the regurgitation amount, but also have many limitations. EKG gated cardiac blood pool scan provides a simple, non-invasive -method for quantify the regurgitation amount. By calculating the ratio of left ventricular to right ventricular stroke counts (stroke volume ratio) in gated bood pool scan, we measured the left ventricular regurgitation amount in 28 cases of valvular regurgitation and 25 cases of normal group. 1. Stroke volume ratio was higher in cases of valvular regurgitation $(2.11{\pm}0.58)$ than in cases of normal control $(1.15{\pm}0.31)$. (p<0.01). 2. Stroke volume ratio was classified by regurgitation grade using X-ray cineventriculography. In grades of mild regurgitation $(Grade\;I{\sim}II)$, stroke volume ratio was $2.02{\pm}0.29$, and in grades of severe regurgitation $(Grade\;III{\sim}IV)$, stroke volume ratio was $2.55{\pm}0.34$, so stroke volume ratio was well correlated with the grade of X-ray cineventriculography. 3. Stroke volume ratio was classfied by functional class made in New York Heart Association. In classes of mild regurgitation $(class\;I{\sim}II)$, stroke volume ratio was $2.08{\pm}0.26$, and in classes of severe regurgitation $(class\;III{\sim}IV)$, stroke volume ratio was $2.55{\pm}0.38$, Stroke volume ratio well represented the functional class. 4. After aortic and mitral valve replacement in 28 patients, the stroke volume ratio, decreased from $2.11{\pm}0.58\;to\;1.06{\pm}0.26$. Gated blood pool scan provides a noninvasive method of qnantifying valvular regurgitation and assessing the result of surgical interventions.

• Clinical and Experimental Pediatrics
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• 제46권6호
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• pp.591-596
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• 2003

목 적 : 3개월 이하 영아에서의 가와사끼병은 매우 드물고, 그 임상 양상이 비정형적이어서 조기 진단과 치료가 어렵고 심혈관계 합병증의 발생률이 높다. 이에 저자들은 이들의 임상적 특징을 알아봄으로써 이 환아군에서 가와사끼병의 조기 진단과 치료의 중요성을 강조하고자 하였다. 방 법 : 1998년 1월부터 2002년 7월까지 치료했던 전체 가와사끼병 환자 중에서 3개월 이하의 영아 11명을 대상으로 후향적 조사를 하였다. 결 과 : 전체 환자 291명 중 3개월 이하의 영아는 11명(3.8%)이었다. 이들 중 10명이 비정형 가와사끼병 환아로서, 주증상의 발현은 기존의 보고보다 적게 나타났고, 발열을 제외한 주증상 중 가장 흔한 증상은 구강점막의 변화(72.7%)였다. BCG 접종부 위의 발적은 6명의 환아에서 관찰되었는데(나머지 5명은 기록 미비로 알 수 없었음) 그중 2명에서는 아급성기에 심혈관계 합병증이 발생됨으로써 이러한 소견이 명백한 진단의 단서가 될 수 있음이 증명되었다. 면역글로불린(IVIG)의 발병 4.4일 이내의 조기 치료로 10명에서 즉각적인 임상적 호전을 보였으며, 1명에서는 IVIG 재치료를 하였다. 6명(54.5%)에서 심혈관계 합병증이 발생하였으나 추적검사에서 대부분 정상화되었다. 결 론 : 3개월 이하의 영아 가와사끼병 환아는 대부분 비정형적인 양상을 보이고 심혈관계 합병증의 발생률이 높은 고위험군으로 조기 진단과 치료가 중요하다. 이때 BCG 접종부위의 발적은 임상 증상이 거의 없는 나이 어린 영아 환아에서 매우 중요한 진단의 단서가 될 수 있으리라 생각한다.

• Journal of Cardiovascular Imaging
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• 제30권2호
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• pp.99-108
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• 2022

BACKGROUND: Adding pulsation to the Fontan circulation might change the fate of patients palliated by this procedure. Our aim was to compare the pulsatility index (PI) of the pulmonary artery (PA) between the various modifications of Fontan palliation. METHODS: Doppler-derived PI was measured in PA branches of a cohort of 28 patients palliated by 6 modifications of Fontan procedure. A group of normal individuals was included for comparison. RESULTS: Atriopulmonary connection (APC) group had the highest PA branches PI and statistically was close to the PI of the normal individuals (right pulmonary artery [RPA] PI of 1.58 vs. 1.63; p = 0.99 and left pulmonary artery [LPA] PI of 1.54 vs. 1.68; p = 0.46, respectively). The lowest PA branches PI was seen in the group of extracardiac total cavopulmonary connection (RPA PI of 0.62 and LPA PI of 0.65). Other 4 modifications including the extracardiac conduit with oversewn pulmonary valve, extracardiac conduit with preserved adjusted antegrade flow, extracardiac conduit from inferior vena cava onto the rudimentary right ventricle and lateral tunnel had a mean "RPA and LPA" PI of "1.19 and 1.17", "1.16 and 1.11", "1.13 and 1.11", "0.82 and 0.84", respectively. The modified Dunnett's post hoc test has shown a significant statistical decline in PI of all modifications compared to the normal individuals except for the APC group. CONCLUSIONS: Fontan palliated patients in different groups of surgical modification showed a spectrum of Doppler-derived PI with the highest amounts belong to the groups of pulsatile Fontan.

• Journal of Chest Surgery
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• 제45권1호
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• pp.11-18
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• 2012

Background: The aim of this study is to evaluate the clinical and rhythm outcomes of atrial fibrillation (AF) ablation through a port access approach compared with sternotomy in patients with AF associated with mitral valve diseases. Materials and Methods: From February 2006 through December 2009, 135 patients underwent biatrial AF ablation with a mitral operation via either a port-access approach (n=78, minimally invasive cardiac surgery [MICS] group) or a conventional sternotomy (n=57, sternotomy group). To adjust for the differences in the two groups' baseline characteristics, a propensity score analysis was performed. Results: After adjustment, there were no significant differences in the two groups' baseline profiles. The cardiopulmonary bypass time was significantly longer (p=0.045) in the MICS group ($176.0{\pm}49.5$ minutes) than the sternotomy group ($150.0{\pm}51.9$ minutes). There were no significant differences (p=0.31) in the two groups' rate of reoperation for bleeding (MICS=6 vs. sternotomy=2, p=0.47) or the requirement for permanent pacing (MICS=1 vs. sternotomy=3). The major event-free survival rates at two years were $87.4{\pm}8.1%$ in the MICS group and $89.6{\pm}5.8%$ in the sternotomy group (p=0.92). Freedom from late AF at 2 years was $86.8{\pm}6.2%$ in the MICS group and $85.0{\pm}6.9%$ in the sternotomy group (p=0.86). Conclusion: Both the port-access approach and sternotomy showed tolerable clinical outcomes following biatrial AF ablation with mitral valve surgery.

• 한국임상수의학회지
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• 제22권4호
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• pp.396-400
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• 2005

13년령의 암컷 말티즈견이 5개월간의 일시적인 기절현상 (syncope)을 주증상으로 내원하였다. 환축은 병력 청취 신체검사 심장검사 총혈액검사, 혈액 화학적 검사, 방사선학적 검사, 심전도 검사, 아트로핀 반응 검사 (atropine response test), 호르몬 검사, 심전도 검사 등을 통해 심장의 문제가 있는 것으로 진단되었다. 본 증례에서 심전도 검사는 아트로핀 투여에 의한 심전도 기록을 통해 sick sinus syndrome을 확진 하는데 중요한 역할을 하였다. 임상 증상은 테오필린 (THEOLANi, 근화제약, 서울, 한국, 20mg/kg, 경구 투여, 1일 2회)을 복용하면서 개선되었다. 환축은 10개월을 생존하였으나 지역 병원에서 복강의 종괴를 제거하는 수술을 받는 중 호흡곤란과 쇼크로 사망하였다. 사망 후 보호자의 반대로 부검은 이루어지지 않았다.

• Journal of Chest Surgery
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• 제33권8호
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• pp.648-654
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• 2000

Background: Cardiopulmonary bypass during open heart surgery causes systemic inflammatory respose. IL-10 is an anti-inflammatory cytokine that inhibits inflammatory process and protects organ function by down regulation of pro-inflammatory cytokine release and maintenance of blood level balance with pro-inflammatory cytokines. Mateial and Method: Plasma IL-10 levels were measured and analyzed in 22 patients who underwent open heart surgery (11 cases of coronary artery bypass graft, 11 cases of valve replacement) under cardiopulmonary bypass since 1988 January to July at Department of Thoracic and Czardiovascular surgery, Yeungnam University Hospital. 1g of methylprednisolone was administrated to thirteen patients randomly. Blood samp.es were taken and collected at the time of induction of anesthesia, 10 min before cardiopulmonary bypass, 10 min after starting of CPB, 10 min aftr aortic cross clamping, 10 min after ACC release, and 10 min, 2 hours, and `5 hours after CPB respectively. The plasma levels of IL-10 were determined by enzyme-linked immunosorbent assays(ELISA). Wilcoxon-Raule Sum test was used for statistical analysis. Result: In all 22 patients, cardiopulmonary bypass time was used for statistical analysis. Result: In all 22 patients, cardiopulmonary bypass time was 171$\pm$41.4 min and aortic cross clamp time was 118$\pm$36.5 min. Peak IL-10 level was achieved at 10 min after ACC(361.0$\pm$52.81pg/ml) and was decreased sharply at 2 hours after CPB. Peak IL-10 level was correlated positively with aortic cross clamp time(p=0.011); however, it did not correlated with bypass time(p=0.181). In valve replacement group, mean IL-10 level at peak point was 567.89$\pm$107.69 pg/ml and was significantly higher than that of coronary artery bypass group(205.67$\pm$192.70 pg/ml)(p<0.001). ACC time in valve replacement group was significantly longer than that of coronary artery bypass group(p<0.01), however, bypass time was not(p=0.212). Thirteen patients with steroid pretreatment before starting of CPB showed relatively higher plasma IL-10 level than in control group, however, no statistical significance was noted(p=0.19). Conclusion: plasma level of IL-10 was increased in association with cardiopulmonary bypass and revealed peak at 10 min after ACC release. IL-10 level was correlated positively with ACC time. Therefore, systemic inflammatory respeonse in association with cardiopulmonary bypass could be decreased by reducing ACC time during cardiac surgery.

• Journal of Chest Surgery
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• 제29권2호
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• pp.171-176
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• 1996

1983년 3월부터 1994년 6월까지 22명의 환자에게 관상동맥 우회로 조성수술과 병행한 개심수술을 시행하였다. 대상환자들의 연령은 42세에서 72세 사이로 평균 60.4$\pm$8.2세였다. 이중 17명의 환자가 남자였고, 여자환자는 5명이 었다. 좌심실 박출계수는 25%에서 65% 사이로 평균 46.9 $\pm$ 14.2%였다. 22명의 대상환자중 9명이 심근경색증의 합병증으로 발생한 기계적인 장애를 동반하고 있었으며, 이중 5명은 좌심실류, 3명은 심실중격 결손 그리고 1명은 유두근 파열에 의한승모판 폐쇄부전증이 롱반되었다. 나머지 대상환자중 9명은 류마티스성 판막질환(대동맥판막 질환 7명, 승모판막 질환 2명)을 동반하였고, 2명은 좌심방혈전, 1명은 심방중격 결손 그리고 1명은 상행대동맥류를 동반하였다. 관상동맥 이식 편수는 1개에서 4개 사이로 평균 2.1$\pm$1.0개였다 수술후 합병증은 3명에서 발생하였으며, 이중 2명은 수술전후 심근경색증, 1명은 하지의 창상감염이었다. 수술사망은 1명에서 발생하였으며, 사망원인은 수술전후 심근경색증에 의한 저심박출량에 기인하였다. 추적조사 기간은 3개월에서 136개월 사이로 평균 41.1$\pm$ 40.2개월이었으며, 이기간 동안 1명\ulcorner 사망하였다. 사망원인은 뇌출혈이었다. 장기생존한 20명의 New York Heart Association functional class는 모두 I과 II였다. 비록 대상환자의 수가 적다고는 하지만 저자들의 수술결과는 양호한 것으로, 따라서 저자들은 관상동맥 우회로 조성수술을 병행한 개심수술이 수술위험도가 높지 않으면서 만기 사망율도 줄일 수 있을 것으로 생각한다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.271-275
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• 1976

Truncus arteriosus is a rare and highly lethal cardiac anomaly characterized by a single arterial trunk emerging from the heart and supplying the coronary, systemic, and pulmonary circulations, The first successful correction of truncus arteriosus was reported by McGoon et al. in 1968 and was based on experimental work reported by Rastelli et al. in 1967 in which a conduit consisting of a homograft of the ascending aorta and aortic valve was used to establish continuity between the right ventricle and the pulmonary arteries, Modification of this procedure using a Dacron tube valved with porcine xenograft instead of a homograft have resulted in the current definite treatment for truncus arteriosus. This report describes an 3 years and 4 months old boy with heart failure from type I truncus arteriosus who was diagnosed as the V. S. D. with pulmonary hypertension preoperatively and underwent corrective surgery employing the Rastelli procedure using a Dacron conduit valved with canine xenograft, but died due to massive bleeding from the anastomosis sites in operating room.

• Journal of Chest Surgery
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• 제21권6호
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• pp.979-983
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• 1988

Calcium channel blockers may prevent myocardial injury during cardioplegia and reperfusion. This study was done to evaluate the effects of diltiazem cardioplegia on myocardial protection during ischemic arrest and recovery of myocardial function after reperfusion. Four formulations of crystalloid cardioplegic solutions, GIK solution[group I, n=12], diltiazem[lug/ml GIK] in GIK solution[group II, n=7], ],diltiazem[2ug/ml GIK] in GIK solution[group III, n=6] and diltiazem[4ug/ml GIK] in GIK solution[group IV, n=6] were compared in isolated working rat heart subjected to a long period [2 hours] of hypothermic arrest with multi-dose infusion. Diltiazem cardioplegia[group II, III and IV]was found to be superior in nearly all aspects. Diltiazem cardioplegia showed faster recovery of regular rhythm and lower incidence of ventricular fibrillation than group I did. In comparing mechanical function in all experimental hearts, the mean postischemic recoveries of aortic flow, cardiac output, peak aortic pressure, stroke volume and stroke work[expressed as a percentage of its preischemic control] were significantly greater in group II, III and IV[diltiazem cardioplegia] than in group I. The infused amount of cardioplegic solution was more increased by the addition of diltiazem to GI K solution. [p < 0.01] Creatine kinase leakage tended to be lower in hearts receiving diltiazem cardioplegia, especially in group III and IV[p<0.05] than in those receiving GIK solution only[group I]. Diltiazem cardioplegia results in the increased flow of cardioplegic solution and the decreased ischemic injury of myocardium during ischemic arrest and the improved recovery of myocardial function after reperfusion, and a dose-response relation must be established before clinical use.

• Journal of Chest Surgery
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• 제34권11호
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• pp.854-857
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• 2001

양대혈관 좌심실기시는 양대혈관이 좌심실에서 기시하는 드문 선천성 심장기형으로 정확하게 진단하기가 어렵다. 환아는 생 후 2개월에 대동맥축착교정술 및 폐동맥교약술을 받았던 3세된 남아로 대동맥하 심실중격결손, 단일관상동맥을 동반한 양대혈관 좌심실기시로 진단되어 심실중격결손의 첩포봉합, 난원공개존의 봉합 폐동맥 교약부 절제, 그리고 폐동맥간을 좌심실에서 분리 후 우심실로 전위시켜 우심실 유출로 재건술을 받았다. 본 술식은 술 후 좋은 혈역학적 특성을 보였고, 자가조직을 사용함으로써 전위된 폐동맥의 성장잠재성과 판막 기능의 보존으로 술 후 폐동맥 폐쇄부전과 관련된 우심실기능부전의 가능성이 줄어드는 장점이 예상되므로 문헌 고찰과 함께 보고한다.