• Title/Summary/Keyword: 관동맥 우회로술

Search Result 23, Processing Time 0.04 seconds

허혈성 심질환의 자기공명 영상 진단

  • 최영희
    • Investigative Magnetic Resonance Imaging
    • /
    • v.6 no.1
    • /
    • pp.5-20
    • /
    • 2002
  • 허혈성 심질환 환자의 평가도구로서 MRI의 역할이 확대된 데에는 소위 "one-stop shop"이라는 통합적 심장검사법의 개발이 계기가 되었다. 즉 한 번의 MRI 검사로서 심실벽운동을 평가하여 심근의 기능과 예비능을 측정하여 만성 심근경색을 평가할 수 있고, 심근의 관류를 평가할 수 있고, 관동맥의 혈류 예비능과 심근의 viability를 평가하고, 관동맥 조영술을 통해, 수술 후의 우회로 평가 및 관동맥의 협착 여부의 진단이 가능한 프로토콜이 MRI장비마다 각각 개발되어 보급되고 있다. 하드웨어와 소프트웨어의 개발과 지속적인 연구를 통해서 MRI는 허혈성 심질환의 진단적 검사로서 기존의 다른 검사들과 비교하여 높은 시간적, 공간적 해상력으로 정확한 구조와 기능의 평가를 제공할 수 있는 가장 유용한 검사가 될 것으로 사료된다 특히, MR 관동맥조영술, 심근관류검사, 심근 표지법, dobutamine 부하검사, viability 평가, plaque characterization, MR spectroscopy 분야에서 현재 활발히 연구가 진행되고 있으며 향후 임상적용이 확대될 것으로 예상된다.

  • PDF

Surgical Outcome of Patients with Ischemic Cardiomyopathy Selected by the Results of Myocardial Viability by Preoperative F-18 FDG PET (F-18 FDG 양전자단층촬영을 이용한 생존심근 평가 후 수술한 허혈성 심근병증 환자의 수술 결과)

  • Kim, Jae-Sung;Lee, Dong-Soo;Hong, Suk-Keun;Lee, Young-Tak;Kim, Yu-Kyeong;Kim, Youn-Jung;Moon, Keon-Sik;Won, Tae-Kyoung;Hwang, Hweung-Kon
    • The Korean Journal of Nuclear Medicine
    • /
    • v.34 no.4
    • /
    • pp.276-284
    • /
    • 2000
  • Purpose: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. Materials and Methods: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. Results: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. Conclusion: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.

  • PDF

Total Arterial Revascularization Using Y-composite Graft for Isolated Left Main Coronary Artery Disease (단독 좌주간 관동맥 협착병변에서 Y-도관을 이용한 완전 동맥도관 관상동맥우회로 조성술)

  • Ahn, Byong-Hee;Yu, Ung;Chun, Joon-Kyung;Ryu, Sang-Wan;Choi, Yong-Sun;Kim, Byong-Pyo;Hong, Sung-Bum;Bum, Min-Sun;Na, Kook-Ju;Jung, Myung-Ho;Kim, Sang-Hyung
    • Journal of Chest Surgery
    • /
    • v.37 no.1
    • /
    • pp.35-42
    • /
    • 2004
  • Background: For the treatment of isolated left main coronary artery disease, twelve arterial revascularizations with Y-composite grafts using left internal thoracic artery and radial artery or right gastroepiploic artery were peformed. This study was performed to investigate whether V-composite graft can satisfy the blood flow required to make myocardium act properly or not. Borderline stenotic lesions on the left main coronary artery, which are very prone to remodel the bypassed vessels due to competitive flows, were also considered. Material and Method: Among 247 patients who underwent coronary artery bypass grafting from March 2000 to April 2003, 12 patients (4.7%) who had received total arterial revascularizations for the isolated left main coronary artery disease were studied retrospectively. Result: left anterior descending arteries were bypassed with left internal thoracic artery by off-pump technique in all patients, however, 2 cases of left obtuse marginal branches were bypassed under on-pump beating heart. Except for one patient, who did not have an obtuse marginal branch more than 1 mm in diameter, 11 patients had gone through complete arterial revascularizations by use of the Y shape arterial graft. Among five patients who had less than 75% stenosis, one patient showed string sign on left internal thoracic artery grafted to left anterior descending artery. However, two grafts to obtuse marginal blanches were completely obstructed and one showed slender sign. There were no graft-dominant flow in patients with stenotic lesion less than 75%. On the contrary to the result of patients with stenotic lesions less than 75%, all the patients with stenotic lesions more than 90% showed graft-dominant blood flow. Conclusion: In conclusion, it is assumed that, when stenotic lesions are over 90%, coronary artery bypass grafting with an Y shape arterial graft could possibly give enough help to the obstructed coronary arteries in blood supplying to myocardium, which needs massive quantity of blood to act well. However, when patients have borderline stenoses, through scrupulous examinations, more prudent and flexible decisions are required in choosing the treatment methods, such as, direct anastomosis of vein or artery to aorta, or adding supplementary treatment methods like percutaneous coronary intervention, rather than choosing a fixed treatment methods.

Surgical Experiences for Non-ST-segment Elevation Acute Coronary Syndrome (ST분절의 상승을 동반하지 않은 급성 관동맥 증후군의 수술 치험)

  • Yu Song-Hyeon;Lim Sang-Hyun;Chang Byung-Chul;Yoo Kyung-Jong;Hong You-Sun
    • Journal of Chest Surgery
    • /
    • v.39 no.10 s.267
    • /
    • pp.754-758
    • /
    • 2006
  • Background: Surgical role for acute coronary syndrome has been reduced in recent years due to development of drug eluting stent. We evaluated the surgical results of acute coronary syndrome in our hospital. Material and Method: Between January 2001 and August 2005, 416 patients underwent coronary artery bypass grafting (CABG) under diagnosis of non-ST-elevation acute coronary syndrome (NSTE ACS). Mean age was $61.8{\pm}9.0$ years and 276 (66.3%) patients were male. 324 (77.9%) patients had triple vessel disease and 92 (22.1%) had left main disease at angiographic study. 236 (56.7%) patients had hypertension and 174 (41.8%) had diabetes mellitus. Conventional on-pump CABG was performed in 194 patients (46.6%) and off-pump CABG in 222 (53.4%). Total arterial revascularization with no touch technique was done in 97 patients (23.3%). The number of total distal anastomosis was 1,306 and the number per patient was $3.21{\pm}1.71$. Result: Surgical mortality rate was 1.0% (4 patients) and postoperative complication rate was 15.6% (65 patients). Graft patency was checked at mean $3.7{\pm}7.6$ months (from 1 to 37 months) postoperatively with multi-directional computed tomography in 152 patients. Left internal mammary artery was patent in 95.3%, right internal mammary artery in 98.1%, radial artery in 92.2% and saphenous vein in 89.0%. Conclusion: The surgical treatment of NSTE ACS showed relatively low mortality rate and good graft patency rate. Further study is needed to compare the long term results with drug eluting stent.