• Journal of Chest Surgery
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• v.35 no.5
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• pp.365-368
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• 2002

Background: Coronary artery bypass grafting(CABG) imposes large amount of medical costs, which are greatly affected by the surgical approach, quality of perioperative care and associated co-morbidities. Recently, off-pump CABG(OPCAB) has been introduced and performed with increasing frequency. To evaluate the efficacy of OPCAB in view of financial impact, we analyzed the costs and medical resources of OPCAB and compared with conventional CABG. Material and Method: From January 1998 to July 1999, 184 patients underwent CABG operation; 111 patients with OPCAB(group I) and 73 patients with conventional CABG(group II). We prospectively collected clinical data including risk factors and retrospectively reviewed the hospital resources. Result: Preoperative parameters including risk factors, postoperative mortality, morbidity and length of hospital stay were not different between the two groups, Duration of stay in the intensive care unit(ICU) (51.3 vs 128.3 hours, p<0.01) and ventilator, support time(14.9 vs 56.2 hours, p<0.01) were significantly shorter in the OPCAB group. Total hospital coats were 17,220,000 add 21,250,000(Korean Won) in group I and II, respectively(p<0.01). There were significant differences in operation fee, costs for operative materials, transfusion and diagnostic radiology between two groups. In group I, all the resources except diagnostic radiology were significantly decreased compared with group II. Conclusion: OPCAB has a beneficial effect on hospital charge and resource utilization. Shorter duration of the ICU stay and ventilatory support time may reduce the total hospital costs.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.759-764
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• 2006

Background: We analyzed post-operative angiography performed in symptomatic patients to evaluate the patency rates and the roles of grafts. Material and Method: We reviewed 52 (15%) coronary angiograms performed for recurrent angina after prior coronary artery bypass surgery from January 1995 to June 2005. A total of 345 patients underwent coronary artery bypass surgery during this period. There were 41 men and 11 women and the mean age was $64.07{\pm}15.58$ years. The median period from operation to re-angiogram was 68.5 months (range, 1 to 126 months). The numbers of grafts and peripheral anastomoses were 42 and 43 for internal thoracic artery (ITA), 14 and 20 for radial artery (RA), and 49 and 89 for saphenous vein. The mean number of anastomosis was 2.9 per patient, Result: The patency rates of ITA, RA and saphenous vein graft (SVG) were 37/43 (86%), 17/20 (85%) and 34/89 (38.2%). The patency rate of arterial grafts was significantly higher than that of SVG (p< 0.001) and the patency rate of the RA was comparable to that of ITA (p=0.942). The patency rate of sequential SVGs was higher than that of single SVG (40.3% vs 31.8%, p=0.478) and the patency rate of proximal segments in sequential anastomosis was higher than that in single anastomsis (55.6% vs 31.8%, p=0.097), but statistically not significant. Conclusion: Arterial grafts have markedly superior patency rates than SVGs, so consideration should be given to the vigorous use of arterial grafts. The patency rate of the RA was comparable to that of ITA.

• Journal of Chest Surgery
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• v.34 no.8
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• pp.591-596
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• 2001

Coronary artery bypass graft with cardiopulmonary bypass is a conventional method of operative revascularization of coronary artery disease. Because of many troubles of cardiopulmonary bypass such as systemic inflammatory reaction, mechanical trauma of blood components and coagulopathy, coronary artery bypass graft without cardiopulmonary bypass has been popularized. Material and Method: From March 1999 to September 2000, 35 patients under went CABG at our institution. Among them, 14 patients received CABG without the use of CPB and 21 patients under went CABG with the use of CPB. Mean operative time, mean postoperative tracheal intubation time, mean ICU stay, mean hospital stay, the amount of transfusion, postoperative use of inotropic agents, and postoperative changes of cardiac enzymes were compared in both groups. Result: There were differences between the CABG without CPB group and CABG with CPB group with regard to mean tracheal intubation time, the amount of transfusion and the elevation of postoperative cardiac enzymes(p<0.05). Conclusion: While CABG without CPB provided satisfactory results, more long term follow-up is required.

• The Korean Journal of Nuclear Medicine
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• v.37 no.3
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• pp.153-161
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• 2003

Purpose: Recently the occurrence of dipyridamole stress-induced short term stunning was proven and it is reported that Bland Altman analysis by repeated acquisition Tl-201 gated myocardial SPECT (gSPECT) revealed the 95% limit of agreement for LVEF was 10.3 %. The purpose of this study was to investigate the clinical value of dipyridamole induced transient LV dysfunction on Tl-201 gSPECT. Materials and Methods: Total 93 patients were included and coronary angiography was peformed in all patients less than 2 month from gSPECT. The patients with myocardial infarction were excluded. All patients underwent both dipyridamole stress and 4-h redistribution Tl-201 gSPECT. Forty nine patients of total 93 showed normal coronary arteries (Group 1) and the remaining 44 patients had coronary artery disease (Group 2). We compared LV EF, EDV and ESV during post-stress and 4-h redistribution period calculated by gSPECT using quantitative gated SPECT software and the incidence of dipyridamole induced transient LV dysfunction between group 1 and 2. The criteria for transient LV dysfunction was defined more decrease ${\geq}11%$ of LVEF during post-stress than 4-h redistribution according to previous reported Bland Altman analysis. Results: During post-stress and 4-h redistribution average of 3.1% increment in LVEF, 6.6% increment in LVEDV and 0.7% decrement in LVESV were shown after stress in Group 1, whereas 4.1% decrement, 9.7% increment and 7.2% increment in Group 2 respectively. Dipyridamole induced transient LV dysfunction was only detected in group 2 (18.2%) and not in group 1. It was more frequently observed in triple vessel disease and left main disease (31.8%, N=22) than one and two vessel disease (4.5%, N=22). Conclusion: As with Tc-99m myocardial agent post-stress LV dysfunction was observed in dipyridamole Tl-201 gSPECT. It was only detected in CAD and more frequently occurred in multivessel disease. Thus this finding seems to provide additional information in the diagnosis of coronary artery disease and prediction of prognosis.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.941-947
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• 2000

Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

• The Monthly Diabetes
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• s.84
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• pp.10-16
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• 1996

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.162-166
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• 2003

Purpose : We evaluated the effects of intravenous immunoglobulin(IVIG) on level of laboratory parameters examined serially according to the existence of coronary artery lesions in children with Kawasaki disease. Methods : Children with Kawasaki disease(n=63), treated with IVIG at a dose of 2.0 g/kg, were classified as a group with coronary artery lesions(CALs+ group, n=9) or a group without coronary artery lesions(CALs- group, n=54). Levels of various laboratory parameters were determined three times during admission; before, 24 hrs after and 7 days after IVIG administration. Results : There were no significant differences in laboratory parameters performing at, before and 7 days after IVIG administration. However WBC and neutrophil counts, and CRP were significantly higher, and the level of albumin was significantly lower at 24 hrs after IVIG administration. Conclusion : Approximately 15% of patients with Kawasaki disease showed CALs in the acute stage. Kawasaki disease patients with CALs were associated with persistent elevated levels of inflammatory parameters including WBC count, neutrophil count and CRP examined 24 hours after IVIG administration.

• Science of Emotion and Sensibility
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• v.8 no.2
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• pp.95-101
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• 2005

This study is based on previous information regarding reduced cardiac vagal activity in patients with coronary artery disease(CAD), on reduced variance(SDNN : standard deviation of all normal RR intervals), low-frequency power(LF), and the complexity of heart rate variability(HRV) in patients with chronic heart failure(CHF), and on the normalized high-frequency power of HRV is the highest in the right lateral decubitus position among 3 recumbent postures in patients with CAD, However, nothing is known about the nonlinear dynamics of HRV for the 3 recumbent postures in patients with CAD. To investigate the linear and non-linear characteristics of HRV in patients with CAD, 29 patients as CAD group and 23 patients as control group were studied. Electrocardiogram(ECG) with lead II channel was measured on these patients for 3 recumbent postures in random order. The HRV from ECG was analyzed with linear method(for time and frequency domains) and nonlinear method. The lower the high-frequency power in normalized unit(nHF) in the supine or left lateral decubitous position, the higher the increase in nHF when the position was changed from supine or left lateral decubitous to right lateral decubitous. Among the 3 recumbent postures in patients with severe CAD, the right lateral decubitus position was observed to induce the highest vagal modulation, the lowest sympathetic modulation, and the highest complexity of human physiology system.

• Journal of the Korean Society of Radiology
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• v.14 no.2
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• pp.111-120
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• 2020

Research should be actively conducted for the ability of X-ray equipment and Retrospective image analysis of X-ray equipment used in hospitals. Retrospective image analysis of X-ray machines, CT and MRI of radiology and medical equipment has been actively conducted. However, image quality measurement using angiography equipment of angiography room is mostly measured with phantom, and image quality measurement on image after being taken by actual patient is insufficient and researches on accurate image quality measurement method are remarkable. It is in short supply. Therefore, through this study, the researcher devised a method to measure the image quality of the acquired image after coronary angiography, and to provide a high quality image to the operator. The equipment and programs used were angiographic examination equipment (Axiom Artis Zee Ceiling) and Image J program. Subjects were images automatically saved in PACS program after coronary angiography.For image quality measurement, selected the AP Caudal 30° image that show the LCA vessel well and the LAO 30° image that show the RCA vessel well during the coronary angiography. In order to measure the background and ROI of the selected image by selecting an image, a criterion on how to find and measure a section where the overlap of the shadow, such as blood vessel, liver and lung is minimized, is presented. In conclusion, there is no exact standard for analyzing an image quality measurement method of angiography image. Therefore, in order to provide quality images to the practistioners, not only the technicians of the equipment but also the users who actually use them should become researchers and conduct research on image quality measurement in various ways. Thus, it is expected to provide excellent images to patients.

• The Korean Journal of Nuclear Medicine
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• v.32 no.3
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• pp.250-258
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• 1998

Purpose: ATP (adenosine triphosphate) is a potent coronary vasodilator with a rapid onset of action and a very short half-life. Myocardial perfusion scintigraphy with intravenous ATP has not yet been sufficiently proven in the diagnosis, follow-up, and risk stratification of coronary artery disease. The purpose of this study was to evaluate the safety, feasibility and diagnostic accuracy of pharmacologic stress thallium-201 myocardial SPECT using an intra-venous ATP infusion in patients with suspected coronary artery disease. Materials and Methods: Thallium-201 myocardial SPECT in 319 patients with suspected coronary artery disease were performed after the infusion of ATP (0.08 mg/kg/min for 6 min). The adverse effects were carefully monitored. Coronary angiography was also performed within 3 weeks. Results: Although 76.5% of the patients had some adverse effects, they were transient, mild, and well tolerated. In all patients, the ATP infusion protocol was completed and only 2 patients required aminophylline. The adverse effects were dyspnea in 63%, headache in 31%, flushing in 21%, chest pain in 14% and abdominal discomfort in 5% of the patients. The sensitivity and specificity were 80% and 90% respectively. Conclusion: Thallium-201 myocardial SPECT after 6 min-infusion of ATP at a rate of 0.08 mg/kg/min is safe and has a diagnostic value in detecting coronary artery disease.