• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.228-233
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• 2000

Purpose: The aim of this study is to better understand the pattern and nature of reverse redistribution (RR) in myocardial perfusion imaging. Materials and Methods: In consecutive 20 acute myocardial infarction (MI) patients, frequency of RR was correlated with that of subendocardial MI that was detected by myocardial contrast echocardiography (MCE). RR was judged to be present when there was more than one grade of worsening in perfusion at 24 hr delayed images compared with the initial rest images. MCE evaluated the significant lack of opacification in the subendocardial myocardium relative to the subepicardial myocardium to suggest the subendocardial MI. Kendall's nonparametric correlation coefficiency was calculated. Results: Concordant cases were 15 of 20 (75%) and correlation was statistically significant (p=0.0285). Conclusion: Our results suggested that RR was correlated with MCE-detected nontransmural MI.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.32-37
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• 2018

Purpose: Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome. Materials and Methods: From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treatment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angiographic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was $70.0{\pm}9.6years$. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period. Results: As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not performed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gangrene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal amputation, below knee amputation). Conclusion: Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is simple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.966-972
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• 1997

Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ve'ntricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Pive out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical sten sis limited to left main coronary artery, left main coronary angioplasty was performed. Pive patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.282-286
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• 1997

In the era of coronary artery bypass grafting, the intraaortic balloon pump (IABP) is more widely used and its indication has been ex anded. We perf'orbed retrospective clinical analysis on the patients who have received IABP pre andfor postoperatively during the course of CABG. From January 1981 to June 1995, total 322 patients have received CABG at the Seoul National University Hospital and among them 50 patients (15.5%) were supported by IABP during the course of the operation. The mean age at the time. of the operation was 57.2 years (39∼ 75 years) and the male to female ratio was 33 : 17. The preoperative diagnosis was unstable angina in 33 (66%), stable angina in 7 (14%) and postinfarct angina in 8 patients(16%). As for the indications of the IABP, there were 13 cases(26%) with left main disease, 13 (26%) with class IV angina, 12 (24%) with difficulty in CPB weaning, 6 (12%) with postinfarct angina and 3 (6%) with severe LV dysfunction. In the remaining 3 cases, one patient was operated on after PTCA failure in emergency basis, another was a patient with AMI, and the other was one who had postoperative low c rdiac output syndrome. All IABPS were introduced via femoral artery and among them 45 cases (90%) percutaneously. The mean postoperative assist time was 22.3 hours (0.5 ∼ 168 hours) and IABP could be removed within 48 hours in most of them (44150). The operative mortality was 6.1% (3 cases) and postoperative morbidity was only one with lower extremity ischemia. The more general application of the IABP during the course of the CABG ,especially in patients with high preoperative risk factors or difficulty in CPB weaning is a good measure of protecting and recovering myocardial function with minimal risk.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.643-652
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• 2002

As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF＜40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.728-733
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• 2003

Background: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. Material and Method: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). Result: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4$\pm$1.7 and 11.2$\pm$17.7 days, in the BITA group, respectively and 2.8$\pm$2.7 and 9.7$\pm$7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9$\pm$0.7 was slightly higher in the SITA group compared to the SITA group, which was 3.1$\pm$0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. Conclusion: The results of the current data did not show a significant difference in patiency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.366-370
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• 2005

Background: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. Material and Method: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. Result: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was $165.3\pm43.1$ minutes and mean ACC time was $110.4\pm48.2$ minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. Conclusion: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the benefits of robot-assisted operation.

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.601-608
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• 2005

Background: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. Material and Method: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 44 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. Result: There were 3 ($2.2\%$) early and 4 ($3.3\%$) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 ($98.7\%$), 106/142 ($94.6\%$), and 53/56 ($94.6\%$), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. Conclusion: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularizatioh. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.