• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.619-625
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• 2006

Background: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. Material and Method: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. Result: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. Conclusion: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischem to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.250-271
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• 2020

Assessment of myocardial ischemia in patients with stable angina is important in deciding whether to treat coronary artery disease and in predicting clinical outcome. The fractional flow reserve is a standard reference for the diagnosis of myocardial ischemia, but this procedure has limitations because of its invasiveness. Coronary computed tomography angiography (CCTA) is now an established tool in the anatomic diagnosis of coronary artery disease; however, there are limits to the diagnosis of hemodynamically important stenosis that causes myocardial ischemia. In order to address this problem, studies using quantification of coronary atherosclerotic plaques, myocardial perfusion, and noninvasive calculation of fractional flow reserve based on CCTA have been actively conducted and recognized for their diagnostic value. In this review, several imaging techniques of CCTA used to assess myocardial ischemia are described.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.270-296
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• 2024

Coronary CT angiography (CCTA) is recognized for its role as a gatekeeper for invasive coronary angiography in patients suspected of coronary artery disease because it can detect significant coronary stenosis with high accuracy. However, heavy plaque in the coronary artery makes it difficult to visualize the lumen, which can lead to errors in the interpretation of the CCTA results. This is primarily due to the limited spatial resolution of CT scanners, resulting in blooming artifacts caused by calcium. However, coronary stenosis with high calcium scores often requires evaluation using CCTA. Technological methods to overcome these limitations include the introduction of high-resolution CT scanners, the development of reconstruction techniques, and the subtraction technique. Methods to improve reading ability, such as the setting of appropriate window width and height, and evaluation of the position of calcified plaque and residual visibility of the lumen in cross-sectional images, are also recommended.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.659-665
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• 2003

The aim of this study was to evaluate the early and midterm results of off-pump total arterial revascularization using the skeletonized right gastroepiploic artery (RGEA) as a third arterial conduit. Material and Method: We prospectively analyzed 103 patients who underwent off-pump total arterial revascularization using bilateral internal thoracic arteries (ITAS) and RGEA. The RGEA was used as in situ graft in 88 patients, composite graft in 10 patients, and free graft in 5 patients. Postoperative coronary angiographies were performed before discharge in 100 patients, and at postoperative one year in 88 patients. Result: The RGEA showed a significantly higher free flow (130$\pm$95 ml/min) than that of right ITA(113$\pm$57 ml/min) or left ITA (107$\pm$55 ml/min), which was measured before anastomosis (p < 0.05). The total number of distal anastomoses was 3.8$\pm$0.7. The number of distal anastomoses per bilateral ITAs was 2.8$\pm$0.7 and the number of distal anastomosis per RGEA was 1.0. There were two morialities including one operative mortality. The late mortality was not related to cardiac events. Early postoperative morbidities were atrial fibrillation in 15 patients, bleeding reoperation in 4 patients, mediastinitis in 1 patients, perioperative myocardial infarction in 2 patient, and transient ARF in 3 patients. Postoperative coronary angiographies showed the early patency rate of 98.6％ (272/276) for ITAs and 97.0％ (97/100) for RGEA, respectively (p=ns), and the one-year patency rate of 95.9％ (234/244) for ITAs and 88.6％ (78/88) for RGEA, respectively (p=0.07). Flow competition between the RGEA and NCA (native coronary artery) was seen in 5 of the 100 patients (5.0％) immediate postoperatively and 7 of the 88 patients (8.0％) 1 year after surgery. Since July, 2000, we measured transit time flow intraoperatively and could reduce flow competition significantly Conclusion: The skeletonized RGEA demonstrated excellent early and midterm patency rates and could be used as a third arterial graft following the bilateral ITAs.

• The Monthly Diabetes
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• s.256
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• pp.18-21
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• 2011

당뇨병환자의 주된 사망 원인은 심장병이다. 당뇨병환자는 동맥경화증이 잘 생기고 이와 관련해 협심증, 심근경색증, 말초혈관질환, 뇌졸중이 잘 생기는 것으로 알려져 있다. 그중에서 관상동맥이 동맥경화증에 의해 막혀 생기는 대표적인 심혈관질환이 바로 협심증과 심근경색이다.

• The Monthly Diabetes
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• s.286
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• pp.54-57
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• 2013

당뇨병 환자에서 동맥 경화증은 가장 흔하고 중요한 합병증 중 하나이며 동맥경화증에 의한 관상동맥질환, 뇌혈관 질환 등 대혈관 질환은 당뇨병이 없는 사람보다 그 빈도가 2-4배 높으며 사망률 또한 높고 뇌졸중 중에서도 특히 뇌경색의 빈도가 높다.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.995-998
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• 2003

During coronary artery bypass surgery, there are several discrete maneuvers that facilitates localization of the invisible left anterior descending coronary artery. In some cases with intramyocardial left anterior descending artery, long-term patency of a bypassed graft may depend on anastomosing the internal mammary artery graft to the more proximal and superficial site of the intramyocardial left anterior descending artery. We describe an easy technique to locate the proximal superficial left anterior descending artery with a distal coronary arteriotomy and retrograde insertion of a coronary probe.

• The KIPS Transactions:PartB
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• v.12B no.5 s.101
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• pp.543-552
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• 2005

This paper proposes the extraction of coronary arteries based on DSA(Digital Subtraction Angiography) through a texture analysis of background in the angiography. DSA is a well established modality for the visualization of coronary arteries. DSA involves the subtraction of a mask image - an image of the heart before injection of contrast medium - from live image. However, this technique is sensitive to the movement of background and can result to a wrong detection by the variance of background gray-level intensity between two images. Therefore, this paper solves a structural problem resulted from a background movement bV selecting an image which has the least difference of movement through an analysis of the similarity of background texture and proposes a method to extract only the blood vessel efficiently through local gray-level correction of the selected image. Using the coronary angiogram of 5 patients clinical data, we proved that the proposed method has the lower false-detection rate, approximately $2\%$, and the higher accuracy than the existing methods.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.309-315
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• 2003

Background: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure we routinely peformed off-pump total arterial coronary revascularization. Material and Method: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. Result: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibboll A or B patency grading. Conclusion: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.

• Journal of the Korean Society of Radiology
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• v.17 no.4
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• pp.589-595
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• 2023

If complete coronary artery occlusion occurs due to severer coronary spasm, malignant arrhythmias can lead to death. Therefore, early screening for coronary artery spasm angina is essential. Among the test methods, the drug injection test through coronary angiography is generally performed. Therefore, the purpose of this study was to evaluate the advantages of ergonovine drug test for vasospasitc angina examination during coronary angiography, such as the relationship between the procedure time, contrast medium usage, and radiation exposure effects of coronary angiography. Follow-up data of 142 patients who underwent coronary angiography and variant angina examination from september 2021 to february 2023 were used. As a result of analyzing contrast usage dose and dose area product and air kerma dose and number of imaging series and procedure time, variant angina examination was statistically significantly higher than coronary angiography. (p<0.001) In conclusion, variant angina examination other than coronary artery angiography are radiologically negative. Therefore, we think it is better to avoid excessive inspection. Nevertheless, in the case of the provocation test, the longer the examination time, the higher the fluoroscopy time and the amount of contrast medium used, so it is better to conduct the test as quickly as possible or shorten it.