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Surgical Correction of Tetralogy of Fallot in Adults - 101 Cases Report - (성인 활로씨 4징증 수술치험 101예 보고)

  • 조범구
    • Journal of Chest Surgery
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    • v.21 no.4
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    • pp.649-655
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    • 1988
  • One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.

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Surgical Treatment of Main Pulmonary Artery Aneurysm with Patent Ductus Arteriosus -A Case Report- (동맥관개존증에 동반된 주폐동맥류의 수술치험 - 수술치험 1례)

  • 김대식;이성주;권오우;김창회;채성수;오성철
    • Journal of Chest Surgery
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    • v.29 no.11
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    • pp.1270-1275
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    • 1996
  • Pulmonary artery aneurysms are extremely rare conditions usually associated with congenital cardiac defects that cause increased pulmonary blood flow and pulmonary hypertension. The prognosis of pulmonary artery aneurysms is fatal due to the potential for rupture of the aneurysm and the underlying severe pulmonary hypertension. A 40-year old woman was admitted to our hospital with headache following traffic accident. On admission a continuous murmur was heard over the 2nd to 3rd intercostal space along left sternal border and a calcified cystic mass at left hilar portion was incidentally discoverd on chest reontgenogram. Cardiac catherization was diagnostic of a left to right shunt at main pulmoanry artery level and pulmonary hypertension. Pulmonary angiogram demonstrated a large aneurysm of main pulmonary artery extending into proximal left pulmonary artery. The pulmonary artery aneurysm associated with patent ductus arteriosus was diagnosed definitively and the patient was underwent resection of pulmonary artery aneurysm, closure of PDA and Dacron prosthetic graft replacement under cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any problem.

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Complicatons and Residual Defects After Correction of Noncomplicated Ventricular Septal Defect (단순 심실중격결손증 수술 후 합병증 및 잔존 결손)

  • Jun, Tae-Gook;Hwang, Kyung-Hwan;Lee, Ho-Seok;Huh, Jung-Hee;Park, Kay-Hyun;Park, Pyo-Won;Chae, Hurn
    • Journal of Chest Surgery
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    • v.33 no.2
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    • pp.139-145
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    • 2000
  • Background: The purpose of this study is to review the clinical course after the correction of noncomplicated ventricular septal defect and to analyze the morbidity and risk factors of postoperative complications and evaluate residual defect during the follow-up period. Material and Method: From September 1994 to June 1998 24 patients(median age 10 months) underwent surgery under the diagnosis of ventricular septal defect. We made a retrospective review of the clinical records including the operation notes critical care unit records echocardiography results and the follow-up records. Result: There was no early mortality nd late mortality. There was no postoperative complete conduction block. Respiratory complication was the most common complication. The body weight age type of ventricular septal defect associated anomalies and operative procedure were not related to the incidence of complications. residual ventricular septal defects aortic valve regurgitation and tricuspid valve regurgitation were insignificant in postoperative hemodynamics, Conclusions: Correction of the noncomplicated ventricular septal defect was done without mortality and complete heart block. Aggressive preoperative medical treatment and early surgical treatment may decrease postoperative complications. Postoperative residual shunt and tricuspid regurgitation were not problematic during the follow-up

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Both Carotid Endarterectomy in Obstrution of Carotid Arteries and Bypass Graft with Kidney Preservation in Obstrution of Abdominal AoRta -A Report of Case (양측 경동맥협착의 혈관내막절제수술 및 신장보호액 주입을 이용한 복부대동백 폐색 수술 치험 -1례 보고-)

  • 김병철;편승환
    • Journal of Chest Surgery
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    • v.30 no.6
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    • pp.625-630
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    • 1997
  • A 56 years old male patient adklitted to our neurology department because of repeated tingling sensation in right 3, 4, 5th. (infers and weakness on grasping, which were progressively developed re ently. At this time, he had also suffered from claudication in both lower extremities. Carotid angiogram showed that right internal carotid artery was obstructed completely, and both common, both external and left internal carotid arteries had significant stenosis, Concommitantly, aortogram suggested complete obstruction just below the renal arteries. We plamled staged operation for two separated arterial lesions. Both carotid endarterectomy was performed. and we used carotid shunt for left side during operation. Abdominal aortic lesion was operated 2 weeks later We obligately clamped aorta just below the celiac artery and infuse4 kidney perservation solution to pertect kidney during ischemia. Reversed Y bypass graft and kidney perservation was successful despite of 40 minute ischemia. Postoperative courts was uneventful and patient was discharged without any specific problem.

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Right-to-left Shunting Ventricular Septal Defect in a Dog (개에서 발생한 우-좌 단락 심실 중격 결손 증례)

  • Yun, Sookyung;Kim, Boeun;Youn, Hwayoung;Choi, Mincheol;Yoon, Junghee
    • Journal of Veterinary Clinics
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    • v.32 no.4
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    • pp.343-346
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    • 2015
  • A 4-year-old castrated male Dachshund was presented with a chronic history of dyspnea and cyanosis. Complete blood count revealed marked polycythemia with a hematocrit of 79.7%. Thoracic radiographs showed mild right-sided cardiac enlargement. Echocardiography showed a large ventricular septal defect in the left ventricular outflow tract region just proximal to the aortic valve. On Doppler echocardiography, right-to-left shunt flow through the defect was found and confirmed by contrast echocardiography. Based on these diagnostic findings and clinical signs, the dog was diagnosed as right-to-left shunting ventricular septal defect. Phlebotomy and oxygen supplement were performed, but the dog died the day after presentation.

Treatment Strategy of Multiple Hemangioblastomas

  • Kim, Eui-Hyun;Park, Yong-Sook;Chang, Jong-Hee;Chang, Jin-Woo;Park, Yong-Gou
    • Journal of Korean Neurosurgical Society
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    • v.38 no.3
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    • pp.184-189
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    • 2005
  • Objective : Hemangioblastomas are highly vascular and benign neoplasm of the central nervous system[CNS]. They can often be found as multiple lesions, as is commonly observed in von Hippel-Lindau[VHL] disease. The aim of this study is to determine the proper management for multiple hemangioblastomas. Methods : Since 1990, 78cases of hemangioblastoma have been encountered. Among these, 9cases were multiple hemangioblastomas that were treated with surgical resection with or without radiosurgery. The medical, radiological, surgical and histological records were reviewed retrospectively and analyzed statistically. Results : Nine patients presented with multiple hemangioblastomas and were diagnosed as VHL disease. The mean follow-up duration was 75.7months [$6.6{\sim}159.2months$] after the first surgical treatment. Three patients were treated with surgical resection alone and six patients were treated by both surgical resection and radiosurgery. Twenty-one surgical procedures [13 surgical resections and 8 radiosurgery] were performed. One patient required ventriculoperitoneal shunt and a posterior fossa decompressive craniectomy because of post-radiation brain swelling. Another patient refused additional treatment for the newly developed lesions after the successful treatment of initial lesions. The other patient who presented with numerous lesions in the whole brain and spine underwent cranio-spinal irradiation. Remaining patients showed good results. Conclusion : The surgical outcomes for the patients with a single lesion of the CNS hemangioblastoma are favorable. However. the treatment of multiple hemangioblastoma is more difficult, and should be treated by surgical resection and radiosurgery with careful consideration.

Differential Power Processing System for the Capacitor Voltage Balancing of Cost-effective Photovoltaic Multi-level Inverters

  • Jeon, Young-Tae;Kim, Kyoung-Tak;Park, Joung-Hu
    • Journal of Power Electronics
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    • v.17 no.4
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    • pp.1037-1047
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    • 2017
  • The Differential Power Processing (DPP) converter is a promising multi-module photovoltaic inverter architecture recently proposed for photovoltaic systems. In this paper, a DPP converter architecture, in which each PV-panel has its own DPP converter in shunt, performs distributed maximum power point tracking (DMPPT) control. It maintains a high energy conversion efficiency, even under partial shading conditions. The system architecture only deals with the power differences among the PV panels, which reduces the power capacity of the converters. Therefore, the DPP systems can easily overcome the conventional disadvantages of PCS such as centralized, string, and module integrated converter (MIC) topologies. Among the various types of the DPP systems, the feed-forward method has been selected for both its voltage balancing and power transfer to a modified H-bridge inverter that needs charge balancing of the input capacitors. The modified H-bridge multi-level inverter had some advantages such as a low part count and cost competitiveness when compared to conventional multi-level inverters. Therefore, it is frequently used in photovoltaic (PV) power conditioning system (PCS). However, its simplified switching network draws input current asymmetrically. Therefore, input capacitors in series suffer from a problem due to a charge imbalance. This paper validates the operating principle and feasibility of the proposed topology through the simulation and experimental results. They show that the input-capacitor voltages maintain the voltage balance with the PV MPPT control operating with a 140-W hardware prototype.

Isolation and Identification of Succinic Semialdehyde Dehydrogenase Inhibitory Compound from the Rhizome of Gastrodia elata Blume

  • Baek, Nam-In;Choi, Soo-Young;Park, Jin-Kyu;Cho, Sung-Woo;Ahn, Eun-Mi;Jeon, Seong-Gyu;Lee, Byung-Ryong;Bahn, Jae-Hoon;Kim, Yong-Kyu;Shon, Il-Hwan
    • Archives of Pharmacal Research
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    • v.22 no.2
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    • pp.219-224
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    • 1999
  • In our search for the anticonvulsant consitutent of Gastrodia elata repeated column chromatographies guided by activity assay led to isolation of an active compound, which was identified as gastrodin on the basis of spectral data. Brain succinic semialdehyde dehydrogenase (SSADH) was inactivated by preincubation with gastrodin in a time-dependent manner and the reaction was monitored by absorption and fluorescene spectroscopic methods. The inactivation followed pseudo-first-order kinetics with the second-rate order constant of $1.2{\times}10^{3} M^{-1} min^{-1}$. The time course of the reaction was significantly affected by the coenzyme NAD^{+}$, which affected complete protection against the loss of the catalytic activity, whereas substrate succinic semialdehyde failed to prevent the inactivation of the enzyme. It is postulated that the gastrodin is able to elevate the neurotransmitter GABA levels in central nervous system by inhibitory action on one of the GABA degradative enzymes, SSADH.

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Nonautoimmune congenital hyperthyroidism due to p.Asp633Glu mutation in the TSHR gene

  • Cho, Won Kyoung;Ahn, Moon-Bae;Jang, Woori;Chae, Hyojin;Kim, Myungshin;Suh, Byung-Kyu
    • Annals of Pediatric Endocrinology and Metabolism
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    • v.23 no.4
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    • pp.235-239
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    • 2018
  • Most cases of congenital hyperthyroidism are autoimmune forms caused by maternal thyroid stimulating antibodies. Nonautoimmune forms of congenital hyperthyroidism caused by activating mutations of the thyrotropin receptor (TSHR) gene are rare. A woman gave birth to a boy during an emergency cesarean section at 33 weeks of gestation due to fetal tachycardia. On the 24th day of life, thyroid function tests were performed due to persistent tachycardia, and hyperthyroidism was confirmed. Auto-antibodies to TSHR, thyroid peroxidase, and thyroglobulin were not found. The patient was treated with propylthiouracil and propranolol, but hyperthyroidism was not well controlled. At 3 months of age, the patient had craniosynostosis and hydrocephalus, and underwent a ventriculoperitoneal shunt operation. Direct sequencing of the TSHR gene showed a heterozygous mutation of c.1899C>A (p.Asp633Glu) in exon 10. No mutations were discovered in any of the parents in a familial genetic study. We have reported a case of sporadic nonautoimmune congenital hyperthyroidism, by a missense mutation of the TSHR gene, for the first time in South Korea.

Design of Broadband Microstrip Antenna for 2.5GHz with Inverted Parasite Patch and the Proximity Stub (근접 스터브와 뒤집힌 기생 패치를 이용한 2.5GHz용 광대역 마이크로스트립 안테나의 설계)

  • Cho, Ki-Ryang;Kim, Dae-Ik;Kim, Gun-Kyun
    • The Journal of the Korea institute of electronic communication sciences
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    • v.14 no.3
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    • pp.467-474
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    • 2019
  • In this paper, we studied a method for a broadband stacked patch antenna structure which is widely used for bandwidth improvement. The characteristics according to the distance between the two patches were analyzed and the impedance matching was optimized by connecting parallel open stubs to the main patch feed line. The shunt matching stub is inserted underneath the parasitic patch and so it does not require additional space, which enables the proposed antenna structure to be advantageous in miniaturizing antenna. The effects of the various parameters on the antenna performance are examined, and we introduced the design procedure for the proposed antenna to operate in the frequency range of 2.3~2.7GHz. Experimental results show that the bandwidth of the proposed antenna is about 480MHz with 2.27~2.75GHz bandwidth. And the antenna gain was 5.8dBi at 2.3GHz and 7.8dBi at 2.6GHz within the bandwidth.