• Korean Circulation Journal
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• v.53 no.11
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• pp.727-743
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• 2023

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients' busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as cost-effectiveness and insurance coverage still persist.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.562-572
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• 1989

The changes of serum glutamic oxaloacetic transaminase [SGOT], serum glutamic pyruvic transaminase [SGPT], serum lactic dehydrogenase [LDH] and serum creatine phosphokinase [CPK] were examined during and after the open heart surgery. In the total of 52 patients with heart diseases including 40 cases of congenital heart anomalies and 12 cases of acquired valvular heart diseases who undergone open heart surgery under cardiopulmonary bypass. The results obtained are as follows: 1. The average value of SGOT before surgery was 30.27 [ 18:86 units. The enzyme was reached to the maximum of 139.88 [ 89.43 units on the 1st day after the operation [p< 0.05], the enzyme activity was gradually decreased from the 3rd day after the operation, returned to the normal range on the 7th day after the operation. 2. The average value of SGPT before surgery was 14.36 [ 7.45 units. The enzyme was reached to the maximum of 34.67 [ 27.64 units on the 2nd day after the operation, but it was valueless statistically, the enzyme activity was gradually decreased from the 3rd day after the operation, returned to the normal range on the 5th day after the operation. 3. The average value of LDH before surgery was 263.07 * 86.66 units. The enzyme was reached to the maximum of 662.29 * 303.60 units on the 2nd day after the operation [p < 0.05], the enzyme activity was gradually decreased from the 5th day after the operation, returned to the normal range on the 7th day after the operation. 4. The average value of CPK before surgery was 141.35 * 43.44 units. The enzyme was reached to the maximum of 377.42 [ 222.02 units on the 1st day after the operation [p < 0.05], the enzyme activity was gradually decreased from the 5th day after the operation, returned to the normal range on the 7th day after the operation. 5. In the relationships of the serum enzymes and duration of the extracorporeal circulation, the values on the group over 90 minute of the extracorporeal circulation were increased than on the group below 90 minute of the extracorporeal circulation, but it was valueless statistically.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.308-311
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• 2010

Coarctation of the aorta is frequently associated with intracardiac disease. It is very difficult to decide on the best method for surgically treating adult patients with these combined heart diseases. We performed single-stage repair via a modified Bentall operation and by creating an intrapericardial ascending-descending aortic bypass through a median sternotomy in a patient with coarctation of the aorta and annuloaortic ectasia, and the latter was associated with aortic valve regurgitation.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.350-355
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• 2016

Background: Mitral stenosis (MS) remains one of the important heart diseases. There are many factors that influence the clinical outcomes, and little is known about how left ventricular (LV) dysfunction clinically affects the prognosis of the patient with MS after mitral valve replacement (MVR). We reviewed our clinical experiences of MVR in patients with MS who had LV dysfunction. Methods: Between January 1991 and January 2013, 110 patients with MS who underwent MVR were analyzed and divided into two groups according to ejection fraction (EF). Group 1 ($EF{\leq}45%$) included 13 patients and group 2 (EF>45%) included 97 patients. Results: Thromboembolism occurred in 8 patients after MVR (group 1: n=3, 23.1%; group 2: n=5, 5.2%) and its incidence was significantly higher in group 1 than in group 2 (p=0.014). There were 3 deaths each in groups 1 and 2 during follow-up. The overall rate of cardiac-related death in group 1 was significantly higher than in group 2 (group 1: n=3, 23.1%; group 2: n=3, 3.1%; p=0.007). The cumulative survival rate at 1 and 15 years was 83.9% and 69.9% in group 1 and 97.9% and 96.3% in group 2 (p=0.004). The Cox regression analysis revealed that survival was significantly associated with postoperative stroke (p=0.011, odds ratio=10.304). Conclusion: This study identified postoperative stroke as an adverse prognostic factor in patients with MS after MVR, and a s more prevalent in patients with LV dysfunction. Postoperative stroke should be reduced to improve clinical outcomes for patients. Preventive care should be made in multiple ways, such as management of LV dysfunction, atrial fibrillation, and anticoagulation.

• Journal of Periodontal and Implant Science
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• v.34 no.3
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• pp.607-622
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• 2004

Recently epidemiologic studies have indicated that the patients with periodontitis may have increased risk of ischemic cardiovascular events, and have suggested the important roles of blood cytokines and acute reactant proteins in the systemic infection and inflammatory response. Periodontitis and coronary heart disease (CHD) may share the common risk factors and the genetic mechanism associated with interleukin(IL)-1A, B and RA genotype may be involved in the production of IL-1. This study was aimed to investigate the relationship between angiographically defined CHD and periodontitis as chronic Gram-negative bacterial infection and to determine whether the IL-1 gene polymorphism is associated in both diseases. Patients under the age of 60 who had undergone diagnostic coronary angiography were enrolled in this study. Subjects were classified as positive CHD (+CHD, n=37) with coronary artery stenosis more than 50% in at least one of major epicardial arteries, and negative CHD (-CHD, n=30) without significant stenosis. After recording the number of missing teeth, periodontal disease severity was measured by means of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and radiographic bone loss around all remaining teeth. Gingival crevicular fluid (GCF) was collected from the 4 deepest periodontal pockets and assessed for cytokine ($IL-1{\beta}$, IL-6, IL-1ra, tumor necrosis $factor-{\alpha}$, and prostaglandin $E_2$). Additionally, blood CHD markers, lipid profile, and blood cytokines were analyzed. IL-1 gene cluster genotyping was performed by polymerase chain reaction and enzyme restriction using genomic DNA from buccal swab, and allele 2 frequencies of IL-1A(+4845), IL-1B(+3954), IL-B(-511), and IL-1RA(intron 2) were compared between groups. Even though there was no significant difference in the periodontal parameters between 2 groups, GCF level of $PGE_2$ was significantly higher in the +CHD group(p<0.05). Correlation analysis showed the positive relationship among PD, CAL and coronary artery stenosis(%) and blood $PGE_2$. There was also significant positive relationship between the periodontal parameters (PI, PD, CAL) and the blood CHD markers (leukocyte count, C-reactive protein, and lactic dehyrogenase). IL-1 gene genotyping showed that IL-1A(+3954) allele 2 frequency was significantly higher in the +CHD group compared with the -CHD group (15% vs. 3.3%, OR 5.118,p=0.043). These results suggested that periodontal inflammation is related to systemic blood cytokine and CHD markers, and contributes to cardiovascular disease via systemic inflammatory reaction. IL-1 gene polymorphism might have an influence on periodontal and coronary heart diseases in Korean patients.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.438-451
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• 1990

Pneumatic total artificial heart[TAH] has been clinically applied for the purpose of permanent or temporary use followed by cardiac transplantation in the patients with end stage heart diseases. In spite of the good durability of the pneumatic TAH, thrombus formation, bleeding and infection resulted in death. The Tomasu heart, which is a type of pneumatic TAH, was used in this study. This model is a modified Jarvik heart and consists of atrial cuffs, outflow vascular grafts and thin-layer seamless diaphragm type of ventricles. Cardiac outputs of the left artificial heart were measured by Donovan`s mock circulation under variable conditions of driving parameters, and an experimental artificial heart implantation was performed in 4 calves to observe the changes of hemodynamic parameters in early postoperative period and hematologic and bio-chemical changes in a long-term survival case. In the mock circulation test, cardiac output of the heart was increased with the increase of the left atrial pressure and left driving pressure. Maximum cardiac output was obtained at the heart rate of 120 to 130/min and percent systole of 40 to 45Zo under the condition of a constant left driving pressure of 180mmHg and left atrial pressure of 10mmHg. During the first 24 hours of TAH pumping, driving pressure ranged from 178$\pm$5mmHg to 187$\pm$8mmHg for the left heart and from 58$\pm$6mmHg to 78$\pm$28mmHg for the right heart. The Mean arterial pressure significantly increased between 2 and 8 hours after the start of pumping. The survival time ranged from 27 hours to 46 days. The causes of death were respiratory failure in 2 cases, mechanical valve failure in one, and left ventricular outflow obstruction due to thrombus in a 46-day survival case. This study demonstrated that Tomasu artificial heart operated effectively during the first 24 hours of artificial heart pumping, but thrombus formation around the valve holding area was the main problem in long-term survival case.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.812-819
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• 2003

Background: Left ventricular dysfunction is one of the important prognostic factors of early mortality and long-term survival after valve operation. We studied the intermediate term results of mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction. Material and Method: Forty four patients who underwent mitral valve reconstruction with a left ventricular ejection fraction (EF) of <45% or less (20∼45%) from April 1995 through July 2001 were reviewed retrospectively. Ages ranged from 10 to 67 years (46∼14 years) and 32 patients were in NYHA class III-IV. The mitral valve diseases were regurgitation (MR) in 28 patients, stenosis(MS) in 10, and mixed lesion in 5. The etiologies of mitral valve disease were rheumatic in 20 patients, degenerative in 14, ischemic in 5, annular dilatation in 2, congenital in 2, and endocarditis in 1. Operatively, all patients had annuloplasty and/or various valvuloplasty techniques, and a total of 52 procedures were concomitantly performed. Total cardiopulmonary bypass and aortic crossclamp time were 160$\pm$57 minutes and 112$\pm$45 minutes respectively. Result: Two operative deaths occurred as a result of left ventricular failure (4.5%). After the mean follow-up of 39 months (range, 10∼83 months), there was no late death. Transthoracic echocardiography revealed no or grade I of MR in 29 patients (72.5%) and no or mild MS in 35 patients (87.5%). The actuarial survival at 5 years was 100%. Four patients required mitral valve replacement due to progressive mitral valvular disease. The actuarial freedom from valve-related reoperation at 5 years was 84$\pm$9%. Conclusion: This study suggests that mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction offers good early and intermediate survival and acceptable freedom from valve-related reoperation, and it is the strategy for effective management for these patients.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.442-447
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• 1999

Introduction: Understanding the normal distribution of the tracheal diameter and crross- sectional area is one of the key elements in the management of various tracheal pathologies or tracheal reconstruction for the patients in growing age. However, data for Korean standard has been lacking. This study was designed to analyze retrospectively the distribution of tracheal diameter and cross-sectional area in young Koreans, which can afford fundamental data for the management of tracheal diseases. Material and Method: Of the patients who underwent computerized tomogram of the chest between May 1996 and August 1998, one hundred six young patients(age range: 0-20 years) were included. Patients with any conditions which might affect the tracheal cross-sectional area or diameter, such as tracheal disease, previous operation, mediastinal tumor, or obstructive lung disease were excluded from the study. Gender distribution was 69 males and 37 females. Tracheal diameters, anterior-posterior and transverse, were measured at the level of the thoracic inlet(level I) and the aortic arch(level II). Types of the trachea were divided into round, oval, or horseshoe shaped on cross-sectional view, and the dimension was calculated by using the equation of A=1/4$\pi$ab(A; area, $\pi$; 3.14, a; anterior-posterior diameter, b; transverse diameter). We analyzed the distribution of the diameter at each level and compared the cross-sectional area with respect to age and gender. A p-value lower than 0.05 wa considered significant. Result: The trachea of patients less than 5 years old were round in shape at both of level I and II, and no differences in cross-sectional area was observed between the levels(p=NS). As the age increased, the trachea become oval in shape at level I while it remained round in shape at level II(p=0.020). The tracheal diameter and cross-sectional area increased as the age increased with a linear correlation(r>0.9). In patients less than 5 years of age, female patients showed larger cross-sectional area than male patients (p=0.020), and it was reversed in patients older than 15 years of age(p=0.002). Conclusion: From the above results, we suggest chest computerized tomogram as a safe and reliable tool in measuring the tracheal diameter and cross-sectional area. We also provide the data as a standard for distribution of the tracheal diameter and cross-sectional area in young Korean population.

• Journal of Korea Association of Health Promotion
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• v.3 no.2
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• pp.147-164
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• 2005

The purpose of this study was to examine the effects of physical activity on women's health. I conducted literature reviews for meta-analyses and randomized controlled trials with the target diseases including cardiovascular diseases, diabetes, cancers osteoporosis, and pregnancy outcomes. Women who were active had less total mortality and smaller incidence of hypertension, coronary heart diseases, and stroke. Exercise was better than drug therapies in preventing diabetes and effective in preventing colon and breast cancers. Exercise can reduce the risks of falling injury in elderly women. Walking during pregnancy was not harmful to the mothers and their infants, and desirable to prevent the complications of pregnancy or weight gain after pregnancy. Physical activity at work and leisure-time showed similar effects on women's health. Based on these results, moderate-intensity physical activity should be recommended to all women, Resistive, muscle strength, and balance-training exercise also can be recommended. Doctors' advices are effective to make women exercise, especially using handouts or motivational interviewing techniques. It is desirable to recommend to peform other health promotion measures together such as smoking cessation, weight control and diet control.

• International Journal of Computer Science & Network Security
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• v.23 no.5
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• pp.148-162
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• 2023

Classification systems can significantly assist the medical sector by allowing for the precise and quick diagnosis of diseases. As a result, both doctors and patients will save time. A possible way for identifying risk variables is to use machine learning algorithms. Non-surgical technologies, such as machine learning, are trustworthy and effective in categorizing healthy and heart-disease patients, and they save time and effort. The goal of this study is to create a medical intelligent decision support system based on machine learning for the diagnosis of heart disease. We have used a mixed feature creation (MFC) technique to generate new features from the UCI Cleveland Cardiology dataset. We select the most suitable features by using Least Absolute Shrinkage and Selection Operator (LASSO), Recursive Feature Elimination with Random Forest feature selection (RFE-RF) and the best features of both LASSO RFE-RF (BLR) techniques. Cross-validated and grid-search methods are used to optimize the parameters of the estimator used in applying these algorithms. and classifier performance assessment metrics including classification accuracy, specificity, sensitivity, precision, and F1-Score, of each classification model, along with execution time and RMSE the results are presented independently for comparison. Our proposed work finds the best potential outcome across all available prediction models and improves the system's performance, allowing physicians to diagnose heart patients more accurately.