• Korean Journal of Radiology
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• 제24권7호
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• pp.647-659
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• 2023

Objective: The study was conducted to investigate the effect of correct occlusion of the left atrial appendage (LAA) on intracardiac blood flow and thrombus formation in patients with atrial fibrillation (AF) using four-dimensional (4D) flow magnetic resonance imaging (MRI) and three-dimensional (3D)-printed phantoms. Materials and Methods: Three life-sized 3D-printed left atrium (LA) phantoms, including a pre-occlusion (i.e., before the occlusion procedure) model and correctly and incorrectly occluded post-procedural models, were constructed based on cardiac computed tomography images from an 86-year-old male with long-standing persistent AF. A custom-made closed-loop flow circuit was set up, and pulsatile simulated pulmonary venous flow was delivered by a pump. 4D flow MRI was performed using a 3T scanner, and the images were analyzed using MATLAB-based software (R2020b; Mathworks). Flow metrics associated with blood stasis and thrombogenicity, such as the volume of stasis defined by the velocity threshold ($\left|\vec{V}\right|$ < 3 cm/s), surface-and-time-averaged wall shear stress (WSS), and endothelial cell activation potential (ECAP), were analyzed and compared among the three LA phantom models. Results: Different spatial distributions, orientations, and magnitudes of LA flow were directly visualized within the three LA phantoms using 4D flow MRI. The time-averaged volume and its ratio to the corresponding entire volume of LA flow stasis were consistently reduced in the correctly occluded model (70.82 mL and 39.0%, respectively), followed by the incorrectly occluded (73.17 mL and 39.0%, respectively) and pre-occlusion (79.11 mL and 39.7%, respectively) models. The surfaceand-time-averaged WSS and ECAP were also lowest in the correctly occluded model (0.048 Pa and 4.004 Pa^-1, respectively), followed by the incorrectly occluded (0.059 Pa and 4.792 Pa^-1, respectively) and pre-occlusion (0.072 Pa and 5.861 Pa^-1, respectively) models. Conclusion: These findings suggest that a correctly occluded LAA leads to the greatest reduction in LA flow stasis and thrombogenicity, presenting a tentative procedural goal to maximize clinical benefits in patients with AF.

• Korean Journal of Radiology
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• 제24권10호
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• pp.974-982
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• 2023

Objective: Recent studies have highlighted the active and potential role of perivascular adipose tissue (PVAT) in atherosclerosis and aneurysm progression, respectively. This study explored the link between PVAT attenuation and abdominal aortic aneurysm (AAA) progression using computed tomography angiography (CTA). Materials and Methods: This multicenter retrospective study analyzed patients with AAA who underwent CTA at baseline and follow-up between March 2015 and July 2022. The following parameters were obtained: maximum diameter and total volume of the AAA, presence or absence of intraluminal thrombus (ILT), maximum diameter and volume of the ILT, and PVAT attenuation of the aortic aneurysm at baseline CTA. PVAT attenuation was divided into high (> -73.4 Hounsfield units [HU]) and low (≤ -73.4 HU). Patients who had or did not have AAA progression during the follow-up, defined as an increase in the aneurysm volume > 10 mL from baseline, were identified. Kaplan-Meier and multivariable Cox regression analyses were used to investigate the association between PVAT attenuation and AAA progression. Results: Our study included 167 participants (148 males; median age: 70.0 years; interquartile range: 63.0-76.0 years), of which 145 (86.8%) were diagnosed with AAA accompanied by ILT. Over a median period of 11.3 months (range: 6.0-85.0 months), AAA progression was observed in 67 patients (40.1%). Multivariable Cox regression analysis indicated that high baseline PVAT attenuation (adjusted hazard ratio [aHR] = 2.23; 95% confidence interval [CI], 1.16-4.32; P = 0.017) was independently associated with AAA progression. This association was demonstrated within the patients of AAA with ILT subcohort, where a high baseline PVAT attenuation (aHR = 2.23; 95% CI, 1.08-4.60; P = 0.030) was consistently independently associated with AAA progression. Conclusion: Elevated PVAT attenuation is independently associated with AAA progression, including patients of AAA with ILT, suggesting the potential of PVAT attenuation as a predictive imaging marker for AAA expansion.

• 한국멀티미디어학회논문지
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• 제19권2호
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• pp.224-232
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• 2016

The methodology to visualize the shape of blood vessel and its blood flow have been attracting as a very interesting problem to forecast and examinate a disease in thrombus precursor protein. May previous visualization researches have been appeared for designing the blood vessel and also modeling the blood flow using a doppler imaging technique which is one of nondestructive testing techniques. General visualization methods are to depict the blood flow obtained from doppler effects with fragmentary stream lines and also visualize the blood flow model using volume rendering. However, these visualizeation techniques have the disadvantage which a set of small line segments does not give the overall observation of blood flows. Therefore, we propose a visualization system which reconstruct the continuity of the blood flow obtained from doppler effects and also visualize the blood flow with the vector field of blood particles. This system will use doppler phase difference from medical equipments such as OCT with low penetration and reconstruct the blood flow by the curvature estimation from vector field of each blood particle.

• Bulletin of the Korean Chemical Society
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• 제33권9호
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• pp.3048-3054
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• 2012

The use of aspirin is widely recommended for the prevention of heart attacks owing to its ability to inhibit platelet activation by irreversibly blocking cyclooxygenase 1. However, aspirin also affects the fibrinolytic and hemostatic pathways by mechanisms that are not well understood, causing severe hemorrhagic complications. Here, we investigated the ability of aspirin and aspirin metabolites to inhibit thrombin-activatable fibrinolysis inhibitor (TAFI), the major inhibitor of plasma fibrinolysis. TAFI is activated via proteolytic cleavage by the thrombin-thrombomodulin complex to TAFIa, a carboxypeptidase B-like enzyme. TAFIa modulates fibrinolysis by removing the C-terminal arginine and lysine residues from partially degraded fibrin, which in turn inhibits the binding of plasminogen to fibrin clots. Aspirin and its major metabolites, salicylic acid, gentisic acid, and salicyluric acid, inhibit TAFIa carboxypeptidase activity. Salicyluric acid effectively blocks activation of TAFI by thrombin-thrombomodulin; however, salicylates do not inhibit carboxypeptidase N or pancreatic carboxypeptidase B. Aspirin and other salicylates accelerated the dissolution of fibrin clots and reduced thrombus formation in an in vitro model of fibrinolysis. Inhibition of TAFI represents a novel hemostatic mechanism that contributes to aspirin's therapy-associated antithrombotic activity and hemorrhagic complications.

• 한국음향학회:학술대회논문집
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• 한국음향학회 1999년도 학술발표대회 논문집 제18권 2호
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• pp.131-134
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• 1999

This paper considers the acoustical characteristics of the mechanical valve employed in the Korean type Artificial Heart. $Bj\"{o}rk-Shiley$ tilting disc valve was chosen for the study and acoustic measurements were performed for the artificial heart operated in a mock circulation system as well as implanted to an animal as a Bi Ventricular Assist Device (BVAD). In the mock system, three different conditions of the valve were examined which were normal, damaged (torn off), pseudothrombus attached. Microphone measurements for the BVAD were carried out at a regular time interval for 5 days after the implantation operation. Of the recorded acoustic emissions from the artificial heart, click sounds mainly originated from the valves were further analyzed using Multiple Signal Classification (MUSIC) for estimating their spectral properties. It was shown that the spectral peaks below 4 kHz and the optimal order number for MUSIC, equivalent to the number of the spectral component, might be the key parameters which were highly correlated to the physiological states of the valve like the mechanical damage of the valve or the formation of thrombus on the valves.

• International Journal of Fluid Machinery and Systems
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• 제3권2호
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• pp.102-112
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• 2010

Artificial heart pumps have attracted the attention of researchers around the world as an alternative to the organ used in cardiac transplantation. Conventional centrifugal pumps are no longer considered suitable for long-term application because of the possibility of occurrence of blood leakage and thrombus formation around the shaft seal. To overcome this problem posed by the shaft seal in conventional centrifugal pumps, the magnetically suspended centrifugal pump has been developed; this is a sealless rotor pump, which can provide contact-free rotation of the impeller without leading to material wear. In Europe, clinical trials of this pump have been successfully performed, and these pumps are commercially available. One of the aims of our study is to numerically examine the internal flow and the effect of leakage flow through the gap between the impeller and the pump casing on the performance of the pump. The results show that the pressure head increases compared with the pump without a gap for all flow rates because of the leakage of the fluid through the gap. It was observed that the leakage flow rate in the pump is sufficiently large; further, no stagnant fluid or dead flow regions were observed in the pump. Therefore, the present pump can efficiently enhance the washout effect.

• 대한의용생체공학회:의공학회지
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• 제2권2호
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• pp.89-102
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• 1981

The recirculating flows which occur in the prosthetic heart valve have been known to cause several diseases in the human body. And the recent studies show that the shear stress at the wall of the artery is also very important factor in the formation of thrombus. And many studies knave been devoted in obtaining more information about the blood flow through the prosthetic heart valve. In this Paper, the steady axisymmetric flow through the Disc-Type Heart Valve is studied by using the numerical method. The geometry of the Disc-Type Heart Valve is simplified, and the flow is assumed to be steady axisymmetric flow. The vorticity transport equation derived from the Wavier-Stoke's equation is used as the governing equation, and the explicit finite difference method is used to obtain the steady state solution. The results for several Reynolds numbers show that the recirculating flow becomes large as the Remolds number increases. Furthermore, it can be shown that the magnitudes of the vorticity and the stresses are also increased with the Reynolds number, but there is only a little change in their configurations of distribution and in their positions of maximum values.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.73-77
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• 2002

Medical application of leeches, by means of leech's blood suction, has advantages in not only directly removing blood congestion, but also preventing hindrance to venous drainage by inhibiting local thrombus formation and inducing continuous bleeding. Nevertheless, Aeromonas hydrophila infection secondary to such suction is most common and may develop into serious conditions from local inflammatory reaction to total necrosis of replanted parts and enterocolitis as well as sepsis. Once infected, it requires infection treatment, removal of necrotic tissues and reconstruction. Hence, duration and cost of treatment increase while functional recovery falls markedly. Accordingly, we present measures to reduce Aeromonas infections as follows: First, do not manipulate as much as possible while the leeches are sucking or moving. Second, the site which suction plates of the leeches are attached, should be selected away from the surgical wound site or open wound as much as possible. Third, contaminated or blood-wet gauze should be replaced often so that the skin of surgical areas would not swell. Furthermore, bleeding or oozing should be well-drained. Fourth, the areas other than the sites of leech attachment should be covered with sterilized gauzes in order to limit leech movement.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.175-175
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• 2008

We report a rare case of late-onset brachial artery occlusion caused by subclavian artery stenosis with excessive scar tissue after open reduction and plate fixation for clavicular fracture. When he referred to us, the right hand were pale and the radial and ulnar pulses at the wrist were absent. CT-angiogram showed compression of subclavian artery by excessive scar tissue beneath the fracture site and angiography revealed stenosis of subclavian artery with thrombus and complete obstruction of blood flow in the brachial artery with emboli. Therefore, we performed embolectomy. 2 years after operation, patient was essentially asymptomatic except mild pain after long standing elevation of arm. We recommend that minimal soft tissue dissection should be needed in the operative treatment of clavicular fracture, especially soft tissue beneath the clavicle should be protected maximally.

• Journal of Chest Surgery
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• 제3권1호
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• pp.31-38
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• 1970

This is a report of three cases of successful embolectomy in peripheral arteries. First case was the patient who received a mitral commissurotomy 8 months ago. In that time, there was no evidence of left atrial thrombosis. He showed an embolism in the middle portion of left brachial artery without complaining of any ischemic pain. Embolectomy was performed 15 days after disappearance of radial pulse and resulted in no return of radial pulse postoperatively. Second case was a case of an embolism in lower portion of right brachial artery. She complained severe ischemic pain and cyanosis in the right forearm and fingers. She was also in the beginning state of cardiac failure, which was suspected from her hypertension associated with cardiomegaly and arrythmia Embolectomy was performed 17 hours after onset of acute pain. Immediate full pulsation of radial artery was obtained after embolectomy and the acute ischemic symptoms subsided gradually. Third case was an embolism in superior mesenteric artery which occured 24 hours after pneumonectomy for right bronchogenic carcinoma and the patient suddenly complained diffuse abdominal colicky pain. 7 hours after attack of abdominal pain. embolectomy with extensive reset ion of the small intestine was performed with uneventful recovery and without complication, such as short bowel syndrome, postoperatively. Histopathologically, the embolus was consisted of a tissue of anaplastic cell carcinoma, which was identical to the tumor of the resected right lung. Histological findings of other emboli of first and second case were old thrombus.