• Journal of Chest Surgery
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• 제26권7호
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• pp.526-531
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• 1993

Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

• 근관절건강학회지
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• 제24권1호
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• pp.37-46
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• 2017

Purpose: The purpose of this study was to examine the effects of the program to improve on smoking patients' after acute coronary syndrome (ACS) smoking cessation rate, smoking cessation related self-efficacy, carbone monoxide (CO), nicotine dependence, and pain sense. Methods: This study used a non-equivalent control group pretest-posttest design. The participants of this study were 60 ACS patients: experimental group (30), control group (30), who received percutaneous coronary intervention. The study lasted from Aug 16, 2016 to Jan 13, 2017. Smoking cessation rate, smoking cessation related self-efficacy, CO, nicotine dependence, and pain sense were measured using the structured questionnaires and CO monitor Results: An examination of the effects of this program revealed the experimental group to have a significant increase in smoking cessation rate, smoking cessation related self-efficacy than the control group, and a significant decrease in CO, nicotine dependence and pain sense than in the control group. Conclusion: The findings indicate that this smoking cessation self-efficacy improvement program is effective for hospitalized patients after ACS.

• Journal of Chest Surgery
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• 제44권4호
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• pp.273-278
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• 2011

Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. Materials and Methods: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age $67.7{\pm}11.7$ yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system ($EBS^{(R)}$Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). Results: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time $20.8{\pm}26.0$ min). The mean time from vascular access to the initiation of ECMO was $17.2{\pm}9.4$ min and mean support time was $3.8{\pm}4.0$ days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration $50.1{\pm}31.6$ days). Patients survived on average $476.6{\pm}374.6$ days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). Conclusion: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.

• 대한영상의학회지
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• 제85권2호
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• pp.428-433
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• 2024

이중 좌전하행 관상 동맥은 일반 인구에서 약 1%의 유병률을 보이는 드문 선천성 기형이다. 지금까지 이중 좌전하행 관상동맥 기형은 10가지 유형으로 보고되었다. 그중 제4형 이중 좌전하행 관상동맥은 가장 희귀한 유형 중 하나이다. 이중 좌전하행 관상동맥에 대한 지식과 인식은 정확한 진단과 관상동맥 우회 수술 및 경피적 관상동맥 중재술을 계획하는 데 중요하다. 저자들은 수개월 동안 소화불량과 발한을 주소로 내원하였고 짧은 좌전하행 관상동맥의 주요 대각분지에 약 50%-70% 협착이 있었던, 제4형 이중 좌전하행 관상동맥 기형을 가진 59세 남성의 증례를 보고하고자 한다.

• Korean Journal of Radiology
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• 제20권4호
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• pp.621-630
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• 2019

Objective: To study the prevalence and clinical characteristics of decreased myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) in symptomatic patients without in-stent restenosis. Materials and Methods: Thirty-seven (mean age, 71.3 ± 10 years; age range, 48-88 years; 31 males, 6 females) consecutive symptomatic patients with patent coronary stents and without obstructive de novo lesions were prospectively enrolled to undergo dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used to image the complete left ventricle. A bolus of contrast media (50 mL; iopromide, 370 mg iodine/mL) was injected into the antecubital vein at a rate of 6 mL/s, followed by a 40-mL saline flush. The mean MBF value and other quantitative parameters were measured for each segment of both stented-vessel territories and reference territories. The MBF_ratio was defined as the ratio of the mean MBF value of the whole stent-vessel territory to that of the whole reference territory. An MBF_ratio of 0.85 was used as the cut-off value to distinguish hypoperfused from non-hypoperfused segments. Results: A total of 629 segments of 37 patients were ultimately included for analysis. The mean effective dose of dynamic CT-MPI was 3.1 ± 1.2 mSv (range, 1.7-6.3 mSv). The mean MBF of stent-vessel territories was decreased in 19 lesions and 81 segments. Compared to stent-vessel territories without hypoperfusion, the mean MBF and myocardial blood volume were markedly lower in hypoperfused stent-vessel territories (77.5 ± 16.6 mL/100 mL/min vs. 140.4 ± 24.1 mL/100 mL/min [p < 0.001] and 6.4 ± 3.7 mL/100 mL vs. 11.5 ± 4 mL/100 mL [p < 0.001, respectively]). Myocardial hypoperfusion in stentvessel territories was present in 48.6% (18/37) of patients. None of clinical parameters differed statistically significantly between hypoperfusion and non-hypoperfusion subgroups. Conclusion: Decreased MBF is commonly present in patients who are symptomatic after percutaneous coronary intervention, despite patent stents and can be detected by dynamic CT-MPI using a low radiation dose.

• 기본간호학회지
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• 제16권4호
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• pp.497-505
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• 2009

Purpose: The purpose of this study was to identify the level of quality of life and gender differences in predictors of quality of life among patients with coronary artery disease. Methods: Participants for this descriptive survey were 67 men and 65 women who signed informed consents. They were patients who had undergone coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, or were on medication therapy after a heart attack. The Short-Form Health Survey (SF-36), Personal Resource Questionnaire-part (II), and the Center for Epidemiologic Studies Depression Scale were used to measure quality of life, social support, and depression respectively. Gender and age were controlled because they were reported as influencing factors in previous studies. Results: There were significant differences in depression and quality of life between men and women however, social support was not significantly different by gender. In multiple regression analysis, depression was a significant predictor and explained 51.9% of quality of life for men. In women, depression and social support were significant predictors and explained 50.9% of quality of life. Conclusion: Factors influencing quality of life for men and women were different, and therefore, nurses need to consider their patients' gender and use specific strategies to improve quality of life for patients with coronary artery disease.

• 대한의생명과학회지
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• 제17권4호
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• pp.329-336
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• 2011

The female has previously been shown to be an independent risk factor for mortality and morbidity after coronary artery bypass grafting surgery (CABG). The aim of this retrospective study is to evaluate gender differences of the perioperative outcomes in elderly patients underwent CABG. Data for seventy elderly patients (>70 years) that underwent CABG (between January 2005 and July 2011) were divided into two groups: male patients (n=33, male group) and female patients group (n=37, female group). Heights, body weights, body surface area and coronary artery obstruction rate (right coronary artery territory) in the female group were lower than those of the male group ($P$ <0.05). History of hypertension, hyperlipidemia, congestive heart failure and percutaneous coronary artery intervention in the female group was higher than that of the male group ($P$ <0.05). Total cholesterol and brain natriuretic peptide levels in the female group were higher than those of the male group ($P$ <0.05). Platelet count in the female group was higher than the male group at preoperative (Pre-OP) period ($P$ <0.05). Erythrocyte count, hematocrit and hemoglobin levels in the female group were lower than those of the male group at Pre-OP period ($P$ <0.05). But, erythrocyte count, hematocrit and hemoglobin levels in the female group were higher than those of the Male group at postoperative (Post-OP) period ($P$ <0.05). Left ventricular ejection fraction in the female group was higher than the male group at Post-OP period ($P$ <0.05). Hospital stay length in the female group was higher than the male group ($P$ <0.05). Post-OP bleeding volume and incidence of ventricular premature contraction in the female group were lower than those of the male group ($P$ <0.05). These results suggest that despite female gender have a greater risk factors and require a longer hospitalization than male, there was no significant difference incidence of mortality and complication.

• 한국전산유체공학회지
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• 제22권1호
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• pp.15-25
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• 2017

Swirl flow is often found in proximal coronary arteries, because the aortic valves can induce swirl flows in the coronary artery due to vortex formation. In addition, the curvature and tortuosity of arterial configurations can also produce swirl flows. The present study was performed to investigate fractional flow reserve alterations in a post-stenotic distal part due to the presence of pre-stenotic swirl flow by computational fluid dynamics analysis for virtual stenotic models by quantifying fractional flow reserve(FFR). Simplified stenotic coronary models were divided into those with and without pre-stenotic swirl flow. Various degrees of virtual stenosis were grouped into three grades: mild, moderate, and severe, with degree of stenosis of 0 ~ 40%, 50 ~ 60%, and 70 ~ 90%, respectively. In this study, three-dimensional computational hemodynamic simulations were performed under hyperemic conditions in virtual stenotic coronary models by coupling with a zero-dimensional lumped parameter model. The results showed that the influence of pre-stenotic swirl inflow is dominant on FFR alteration in mild stenosis, whereas stenosis is dominant on FFR alteration in moderate/severe stenosis. The decrease in FFR caused by swirl flow is more significant in mild stenosis than moderate/severe stenosis. Biomechanical modeling is useful for clinicians to provide insight for medical intervention strategies. This hemodynamic-based parameter study could play a critical role in the development of a non-invasive imaging-based strategy-support system for percutaneous transluminal angioplasty in cases of mild/moderate stenosis.

• Korean Circulation Journal
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• 제52권4호
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• pp.288-300
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• 2022

Background and Objectives: We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions. Methods: Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018. Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE). Results: IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588-4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774-4.718). Conclusions: These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. These clinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.

• 한국임상약학회지
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• 제26권3호
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• pp.213-219
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• 2016

Objective: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. Methods: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. Results: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). Conclusion: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.