• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.432-435
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• 2005

An 82-year-old female non-smoker with a history of hypertension presented with increasing dyspnea, cough and some purulent sputum without fever. Upon admission, the patient was in a distressed condition. Auscultation revealed diminished breath sounds with no rales over the right lung. An examination of the heart revealed a regular rhythm and a systolic murmur radiating from the apex of the heart. There was no pitting edema in the lower extremities. The blood tests showed mild leukocytosis and an increased C-reactive protein level. The $O_2$ saturation was 98 % whilst breathing room air. The electrocardiogram demonstrated sinus tachycardia. The chest radiograph showed a moderate cardiomegaly, right lobe infiltrates, and blunting of the both costophrenic sulcus suggesting a small pleural effusion. Three days after admission, the symptoms became slightly aggravated despite being treated with empirical antibiotics for presumed community-acquired pneumonia. Transthoracic color Doppler echocardiography indicated an ejection fraction of 48 %, mild left ventricular enlargement, and moderate left atrial enlargement resulting in severe mitral regurgitation. The clinical symptoms and right pulmonary edema resolved quickly with intravenous furosemide treatment.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.171-176
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• 1996

From March, 1983 to June, 1994, twenty-two patients underwent coronary artery and combined operations. The ages of the patients ranged from 42 years to 72 years (mean 60.4$\pm$8.2 years). There were 17 male and 5 female patients. The left ventricular (LV) ejection fraction ranged from 25% to 65% (mean 46.9$\pm$14.2%). Nine patients had mechanical complication of myocardial infarction (MI), of which 5 were LV aneurysm, 3 ventricular septal defect and 1 mitral regurgitation. Nine patients had rheumatic valvular heart disease of whom 7 with aortic valve disease and 2 with mitral valve disease. Two other patients had left atrial thrombi, only one with atrial septal defect a d another with aneurysm of ascending aorta. An average of 2.1$\pm$1.0 bypasses was done, ranging from one to four. There were 3 postoperative complications; 2 perioperative MI and 1 leg wound infection. Among complicated patients, mortality was 1 patient (4.5%) due to low cardiac output syndrome after perioperative MI. With 3 to 136 months follow-up (mean 41.1$\pm$40.2 months), late mortality was 1 patient due to cerebral vascular accident. Among long-term survivors, all patients are in New York Heart Association functional class I or II. Although the number of patients was small, our surgical results were favorable. Therefore we think that coronary revascularization combined with heart operation does not increase the operative risk when associated coronary artery disease is present, and it reduces the occurrence of late death.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.200-206
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• 2013

Purpose : To assess the effect of applying an automated heart model based measurements of left ventricle (LV) and compare with manual and semi-automated measurements at Cardiovascular MR Imaging. Materials and Methods: Sixty-two patients who underwent cardiac 1.5T MR imaging were included. Steady state free precession cine images of 20 phases per cardiac cycle were obtained in short axis views and both 2-chamber and 4-chamber views. Epicardial and endocardial contours were drawn in manual, automated, and semi-automated ways. Based on these acquired contour sets, the end-diastolic (ED) and end-systolic (ES) volumes, ejection fraction (EF), systolic volume (SV) and LV mass were calculated and compared. Results: In EDV and ESV, the differences among three measurement methods were not statistically significant (P = .399 and .145, respectively). However, in EF, SV, and LV mass, the differences were statistically significant (P=.001, <001, <001, respectively) and the measured value from automated method tend to be consistently higher than the values from other two methods. Conclusion: An automatic heart model-based method grossly overestimate EF, SV and LV mass compared with manual or semi-automated methods. Even though the method saves a considerable amount of efforts, further manual adjustment should be considered in critical clinical cases.

• Tuberculosis and Respiratory Diseases
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• v.69 no.6
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• pp.418-425
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• 2010

Background: Little is known about the long-term effects of angiotensin-converting enzyme (ACE) treatment on post-tuberculosis emphysema. This study evaluated the effects of ACE inhibition on cardiac function and gas exchange in patients with post-tuberculosis emphysema. Methods: At baseline and at 6 months after initiation of ACE inhibition therapy, patients underwent pulmonary function testing, arterial blood gas analysis, and echocardiography, both at rest and post exercise. Cardiac output (CO) and right ventricular ejection fraction (RVEF) were measured at those time points as well. Results: After ACE inhibition; resting and post-exercise RVEF ($Mean{\pm}SEM,\;61.5{\pm}1.0,\;67.6{\pm}1.2%$, respectively) were higher than at baseline ($56.9{\pm}1.2,\;53.5{\pm}1.7%$). Resting and post-exercise CO ($6.37{\pm}0.24,\;8.27{\pm}0.34L/min$) were higher than at baseline ($5.42{\pm}0.22,\;6.72{\pm}0.24L/min$). Resting and post-exercise $PaO_2$ ($83.8{\pm}1.6,\;74.0{\pm}1.2mmHg$, respectively) were also higher than at baseline ($74.2{\pm}1.9,\;66.6{\pm}1.6mmHg$). Post-exercise $PaCO_2$($46.3{\pm}1.1mmHg$) was higher than at baseline ($44.9{\pm}1.1;\; Resting\;42.8{\pm}0.8\;vs.\;42.4{\pm}0.9mmHg$). Resting and post-exercise A-a $O_2$ gradient ($12.4{\pm}1.4,\;17.8{\pm}1.5 mmHg$) were lower than at baseline ($22.5{\pm}1.5,\;26.9{\pm}1.6mmHg$). Conclusion: In post-tuberculosis emphysema, RVEF and CO were augmented with a resultant increase in peripheral oxygen delivery after ACE inhibition. These findings suggest that an ACE inhibitor may have the potential to alleviate co-morbid cardiac conditions and benefit the patients with post-tuberculosis emphysema.

• The Korean Journal of Emergency Medical Services
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• v.20 no.2
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• pp.7-19
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• 2016

Purpose: To investigate the effect of early hypothermia on post-resuscitation myocardial recovery and survival time after cardiac arrest and resuscitation in a rat model of myocardial infarction(MI). Methods: Thoracotomies were performed in 10 male Sprague Dawley rats weighing 450-455g. Myocardial infarction was induced by ligation of the left anterior descending coronary artery. Ninety minutes after arterial ligation, ventricular fibrillation was induced, cardiopulmonary resuscitation was subsequently performed before defibrillation was attempted. Animals were randomized to control group and experimental group(acute MI-normothermia)($32^{\circ}C$ for 4 hours). Duration of survival was recorded. Myocardial functions, including cardiac output, left ventricular ejection fraction, and myocardial performance index were measured using echocardiography. Results: Myocardial function was significantly better in hypothermia group than the control group during the first 4 hours post-resuscitation. The survival time of the experimental group was greater than that of the control group(p<.050). Conclusion: This study suggests that early hypothermia can attenuate post-resuscitation myocardial dysfunction after acute myocardial function, and may be a useful strategy in post-resuscitation care.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.99-113
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• 1994

Pentastarch is a new synthetic hydroxyethyl starch similar to hetastarch. We report on the clinical comparisons the clinical efficacy and safety of 10% pentastarch in prime solutions for CPB in cardiac operations with that of 20% serum albumin. During CPB, group P [n = 20] received 500ml of 10% pentastarch and group A [n = 20] received 100ml of 20% albumin in prime solutions The postoperative time of ICU stay in group P and the day and amount of chest drain, hospital stay in group A were longer [p<0.05]. Fresh whole blood and PRBC were added only in group A and a higher amount of hartman solution was added in group A during CPB [p<0.05]. Prothrombin time was prolonged preoperatively and 2 days postoperatively in group A and 7 days postoperatively in group P [p<0.05] but there were no significant differences in bleeding time or fibrinogen level. Platelet count was higher immediately postoperatively in group A and preoperatively and 1, 2, and 7 days postoperatively in group P [p<0.05].Total protein and albumin level were higher 1 day postoperatively in group A and 2 and 7 days postoperatively in group P [p<0.05]. BUN was increased 2 days postoperatively in group A and Cr was increased 1 day postoperatively in group P [p<0.05]. CPK was higher preoperatively and 1, 2, and 7 days postoperatively in group A and plasma hemoglobin level was also higher 2 and 7 days postoperatively in group A [p<0.05]. There were no significant differences in arterial blood gas analysis but higher pO2 and lower pCO2 levels were maintained in group P and ejection fraction was higher 7 days postoperatively in group P [p<0.05]. Both groups were improved postoperatively in NYHA class and the hemodynamic parameters such as MAP, CO, CI, SV, LVSWI were well maintained in group P [p<0.05]. The amount of blood products used was higher in group A and urine output was higher immediately postoperatively in group A and 1, 2 days postoperatively in group P and the chest output was higher in group A. The complications were developed in 7 patients in group A and 5 patients in group P and mortality was not present in both groups.In conclusion, 10% pentastarch is as safe and effective as 20% albumin in prime solutions for cardiopulmonary bypass in cardiac operations.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.299-302
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• 1999

Heart transplantation was planned for a 10-year old boy who had dilated cardiomyopathy with severe congestive heart failure and had been on dopamine for 1month. However, partial left ventriculectomy and mitral annuloplasty were performed instead, because there was no donor heart of the adequate size and the symptoms were aggravated. The clinical symptoms were markedly improved after the surgery. Comparing the postoperative echocardiographic results with the preoperative results, there were remarkable changes in the left ventricular ejection fraction(preoperative LV EF 17% to postoperative 3 months 29%, 6 months 35%, 1 year 36%) and the left ventricular end-diastolic dimension(preoperative 72 mm to postoperative 3 months 59 mm, 6 months 61 mm, 1 year 61 mm). Partial left ventriculectomy and mitral annuloplasty reduced the cardiac loading in the dilated cardiomyopathy. Partial left ventriculectomy and mitral annuloplasty may be considered as one of the alternative surgical metho s to carry over until a heart transplantation can be performed, especially for children.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.393-397
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• 1998

A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction(LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle(LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator(EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.

• The Korean Journal of Nuclear Medicine
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• v.21 no.2
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• pp.175-182
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• 1987

For measurement of ventricular performance, ejection fraction (EF) has gained wide acceptance. But EF is influenced not only by changes in muscle function but also by changes in cardiac loading conditions. In case of valvular heart disease which is variable in loading conditions, EF cannot be reliable as an index of myocardial contractility. The end systolic pressure (ESP)-end systolic volume (ESV) relation, howver, is known to represent myocardial contractility, independent of changes in loading conditions. Similar results can be obtained by using peak-systolic pressure (PSP) instead of ESP. To evaluate the utility of the peak systolic pressure-end systolic volume index (PSP-ESVI) relation as an index of myocardial function, we measured $PSP&ESVI$ in 19 partents with coronary artery disease before $(PSP_1\;&\;ESVI_1)$ and after $(PSP_2\;&\;ESVI_2)$ sublingual administration of nitroglycerin. PSP was measured with standard mercury sphygmomanometer during gated blood pool scintigraphic study. ESVI was measured by count derived method after attenuation correction. $PSP_2\;&\;ESVI_2$ measurement was started when the fall of PSP was greater than 5 mmHg after 7-14 minutes post-administration of nitroglycerin. Mean values $({\pm}S.D.)$ of $PSP_1\;&\;ESVI_1$ was $124.9({\pm}20.7)mmHg\;&\;59.4({\pm}39.9)ml/M^2$. Mean values $({\pm}S.D)$ of $PSP_2\;&\;ESVI_2$, was $113.2({\pm}19.9)mmHg\;&\;37.5({\pm}26.1)ml/M^2$. There was a significant difference between mean values of $PSP_1\;&\;PSP_2$, (p<0.01), and mean values of $ESVI_1\;&\;ESVI_2$, (p<0.01). $PSP_1-PSP_2/ESV_1-ESVI_2,\;PSP_1/ESVI_1$ and EF were in the range of 0.14-5.19 mmHg/ml/$M^2$, 0.67-7.68 mmHg/ml/$M^2$ and 10.8%-74.5% respectively. $PSP_1-PSP_2/ESVI_1-ESVI_2$, and EF showed exponential correlation (r=0.85, P<0.01). The correlation coefficient between $PSP_1/ESVI_1$ and EF was 0.73(p<0.01). With the above results, we suggest that $PSP_1-PSP_2/ESVI_1-ESVI_2$, and $PSP_1/ESVI_1$, can be used as an index of myocardial function.

• Journal of Cardiovascular Imaging
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• v.26 no.4
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• pp.217-225
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• 2018

BACKGROUND: In patients with acute heart failure (AHF), diastolic dysfunction, especially pseudonormal (PN) or restrictive filling pattern (RFP) of left ventricle (LV), is considered to be implicated in a poor prognosis. However, prognostic significance of diastolic dysfunction in patients with ischemic heart disease (IHD) has been rarely investigated in Korea. METHODS: We enrolled 138 patients with IHD presenting as AHF and sinus rhythm during echocardiographic study. Diastolic dysfunction of LV was graded as ${\geq}2$ (group 1) or 1 (group 2) according to usual algorithm using E/A ratio and deceleration time of mitral inflow, E'/A' ratio of tissue Doppler echocardiography and left atrial size. RESULTS: Patients in group 1 showed higher 2-year mortality rate ($36.2%{\pm}6.7%$) than those in group 2 ($13.6%{\pm}4.5%$; p = 0.008). Two-year mortality rate of patient with LV ejection fraction (LVEF) < 40% ($26.8%{\pm}6.0%$) was not different from those with LVEF 40%-49% ($28.0%{\pm}8.0%$) or ${\geq}50%$ ($13.7%{\pm}7.4%$; p = 0.442). On univariate analysis, PN or RFP of LV, higher stage of chronic kidney disease (CKD) and higher New York Heart Association (NYHA) functional class were poor prognostic factors, but LVEF or older age ${\geq}75$ years did not predict 2-year mortality. On multivariate analysis, PN or RFP of LV (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.09-5.84; p = 0.031), higher stage of CKD (HR, 1.57; 95% CI, 1.14-2.17; p = 0.006) and higher NYHA functional class (HR, 1.81; 95% CI, 1.11-2.94; p = 0.017) were still significant prognostic factors for 2-year mortality. CONCLUSIONS: PN or RFP of LV was a more useful prognostic factor for long-term mortality than LVEF in patients with IHD presenting as AHF.