• Pediatric Infection and Vaccine
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• v.5 no.2
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• pp.267-275
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• 1998

Purpose : We have studied the changes of cardiac troponin I(cTnI) level and left ventricular ejection fraction(LVEF) before and after treatment of IVGG to evaluate the efficacy of single high dose of intravenous gammaglobulin(IVGG)(2.0gm/kg) therapy for improving cardiac function and clinical symptoms and signs in patients with clinically suspected acute myocarditis. Methods : The patients consisted of 18 cases who admitted increased cTnI with clinically suspected acute myocarditis caused by viral infection, Kawasaki disease and fever unknown origin(FUO) from Jan. 1995 to Jun. 1998. The control group consisted of 20 cases suffered from hand-foot-mouth disease, herpangina and high fever with rash. The level of cTnI was measured by Chemiluminiscent immunoassay method(normal<0.1ng/ml) and cardiac function was evaluated by left ventricular ejection fraction(LVEF)(normal 64~83%) by echocardiogram. Results : The level of cTnI increased to $0.306{\pm}0.209ng/ml$ and LVEF decreased to $60.1{\pm}1.6%$ before treatment of IVGG significantly as compared with control group(P<0.05). All cases were returned to normal range of LVEF($71.4{\pm}3.7%$) and decreased cTnI significantly($0.089{\pm}0.082ng/ml$) after treated with IVGG within 1 week in patients group(P<0.05). Conclusion : The single high dose of IVGG(2.0gm/kg) therapy was rapid and effective improvement of cardiac function and clinical symptoms and signs of acute myocarditis, and the measurement of serum cTnI and LVEF may help to diagnose and evaluate efficacy of IVGG on it.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1077-1082
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• 1997

To assess the early results, risk factors and optimal timing for coronary artery bypass graft surgery(CABG) after an acute myocardial infarction(AMI), we reviewed our 19 patients who underwent CABG within 30 days after AMI, between June 1994 and October 1996. This study excluded 1 patient whose diagnosis was AMI with ventricular septal rupture. 14 of the patients were male and 5 were female. Their ages ranged from 41 to 77 years(mean age, 60.6$\pm$ 10.4 years), and the amount of time between AMI and CABG ranged from 8 hours to 24 days(mean time, 10.6$\pm$6.4 days). There were 11 anteroseptal infarctions and 8 inferior wall infarctions. 11 patients had trsnsmural infarctions and 8 had subendocardial infarctions. Indications of operations were p imary revascularization and postinfarction angina. Three patients required preoperative intra-aortic balloon pump(IABP) support, and 4 additional patients required IABP to be separated from cardiopulmonary bypass. An average of 3.6 $\pm$ 0.6 vessels per patient were bypassed. The early mortality rate for these 19 patients was 5.3% and late mortality rate was 5.5%, 1-year and 2-year actuarial survival rates were 89.5% Univariate analysis of mortality showed that an ejection fraction less than 30% and intraopretative IABP supports were associated with risk factors(p value=0.018 and 0.015 respectively). Age, sex, time to CABG, emergency operations, types and locations of infarctions were not significant. Although our studies have weak p.oints in that there was only a small number of patients and the lack of long-term results, we could conclude that early myocardial revascularization is relatively safe after AMI for those individuals with an ejection fraction greater than 30%.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.189-194
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• 2012

We report a case of cardiac lymphoma in a 40-year-old man, who had a mediastinal mass which was diagnosed as sclerosing mediastinitis pathologically. The mediastinal mass caused right pulmonary arterial stenosis. The patient developed myocardial hypertrophy and echocardiography showed restrictive physiology and severely decreased left ventricle ejection fraction, 6 months later. MRI showed global left ventricular myocardial hypertrophy and diffuse late gadolinium hyperenhancement after administration of contrast material. Thus, non-ischemic cardiomyopathy was suspected on MRI. However, pathology confirmed the myocardial abnormality as lymphoma after myocardial biopsy. Because a basal part of the left ventricle and global subendocardial myocardium were not involved on contrast-enhanced delayed MRI, the MRI abnormalities could be differentiated from amyloidosis and other myocardial diseases. The peculiar non-mass forming diffuse hypertrophy pattern of cardiac lymphoma has not been known in the MRI literature.

• The Korean Journal of Nuclear Medicine
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• v.29 no.1
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• pp.48-53
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• 1995

This study investigates a simple mathematical model for the quantitative estimation of regional myocardial blood flow in experimental canine coronary artery thrombosis using Rb-82 dynamic myocardial positron emission tomography. The coronary thrombosis was induced using the new catheter technique by narrowing the lumen of coronary vessel gradually, which finally led to partial obstruction of coronary artery. Ten Rb-82 dynamic myocardial PET scans were performed sequentially for each experiment using our 5, 10 and 20 second acquisition protocol, respectively, and three regions of interest were drawn on the transaxial slices, one on left ventricular chamber for input function and the other two on normal and decreased perfusion segments for the flow estimation in those regions. Single compartment model has been applied to the measured sets of regional PET data, and the rate constants of influx to myocardial tissue were calculated for regional myocardial flow estimates with the three parameter fits of raw data by the Levenberg-Marquardt method. The results showed that, (1) single compartment model suggested by Kety-Schmidt could be used for the simple estimation of regional myocardial blood flow, (2) the calculated regional myocardial blood flow estimates were dependent on the selection of input function, which reflected partial volume effect and left ventricular wall motion, and (3) mathematically fitted input and tissue time activity curves were more suitable than the direct application of the measured data in terms of convergence.

• 대한핵의학회:학술대회논문집
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• 1999.11a
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• pp.35.1-35.1
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• 1999

• Journal of Chest Surgery
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• v.25 no.4
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• pp.424-428
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• 1992

Post-AMI VSD is an infrequent but often catastrophic complication of acute myocardial infarction In general, the mortality is associated with end organ failure due to low output syndrome. Therefore, a stable hemodynamic is necessary to prevent the end organ failure. If a supportive therapy does not accomplish it, surgical intervention should be considered. Recently, we have experinced a case of post-AMI VSD with cardiogenic shock. Early recognition and surgical repair of post-AMI VSD gave us a good result. Postoperative result was satisfactory and recovery was uneventful. We believe that early surgical repair can be lifesaving in the case of post-AMI VSD with cardiogenic shock.

• 대한예방의학회:학술대회논문집
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• 2000.10a
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• pp.155-156
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• 2000

• Journal of Chest Surgery
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• v.35 no.12
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• pp.862-870
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• 2002

The surgical results of the patients with single ventricle(SV) associated with total anomalous pulmonary venous connection(TAPVC) has been reported with high mortality and morbidity due to their morphologic and hemodynamic complexity. A retrospective review was undertaken to report the outcome of the first-stage palliative surgery in our institution and to determine the factors influencing early death. Material and Method: Between January 1987 and June 2002, 39 patients with SV and TAPVC underwent surgical intervention with or without TAPVC repair. Age at operation ranged from 1day to 10.7months (median age, 2.4month), and 29 patients were male. Preoperative diagnosis included 20 right-dominant SV, 15 SV with endocardial cushion defect, 3 left-dominant SV, and 1 tricuspid atresia. The pulmonary venous connection was supracardiac in 22, cardiac in 5, infracardiac in 11, and mixed in 1, Obstructed TAPVC was present in 11. First-stage palliative surgery was performed in 37. Repair of TAPVC, either alone or in association with other procedures, was performed during the initial operation in 31. Univariate and multivariate analyses were performed to analyze the risk factors influencing the operative death. Result: A mean follow-up period of survivors was 34.3 $\pm$ 43.0(0.53 ~ 146.2)months. Overall early operative mortality was 43.6%(17/39). The causes were low cardiac output in 8, failure of weaning from cardiopulmonary bypass in 3, sepsis in 2, pulmonary hypertensive crisis in 1, pulmonary edema in 1, pneumonia in 1, and postoperative arrhythmia in 1. Risk factors influencing early death in univariate analysis were body weight, surgical intervention in neonate, obstructive TAPVC, preoperative conditions including metabolic acidosis, and need for inotropic support, TAPVC repair in initial operation, operative time, and cardiopulmonary bypass(CPB) time. In multivariable analysis, body weight, age at initial operation, surgical intervention in neonate, preoperative conditions including metabolic acidosis, need for inotropic support and CPB time were the risk factors. Conclusion: In this study, we demonstrated that the patients with SV and TAPVC had high perioperative mortality. Preoperative poor condition, young age, the length of operative and CPB time, the presence of obstructive TAPVC had been proven to be the risk factors. This fact suggests that the avoidance of unnecessarily additional procedures may improve the surgical outcomes of the first-stage palliative surgery. However further observation and collection of the data is mandatory to determine the ideal surgical strategy.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.518-522
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• 2003

Left ventricular thrombosis is a frequent and potentially dangerous complication in acute myocardiac infarction, but its occurrence and adequate therapy has not been known in patients with Dor procedure for the ischemic cardiomyopathy. We report a patient, 45 year-old male, who had a new left ventricular thrombus developed after coronary arterial bypass graft, Dor procedure, and removal of the left ventricular thrombus for ischemic car-diomyopathy. Left ventricular thrombus was disappeared on the follow-up cardiac MRI following intravenous heparin injection and oral coumadin therapy. This case suggest that anticoagulation therapy may prevent patients with the severe left ventricular dysfunction and apical aneurysm and dyskinesia from developing the left ventricular thrombus, and that thrombi will resolve without clinical evidence of systemic embolism.

• Journal of Yeungnam Medical Science
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• v.20 no.2
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• pp.197-205
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• 2003

서론: 급성 관동맥 증후군과 심근경색증의 진단과 예후 예측에 도움을 주는 새로운 심효소인자가 여러 가지 발견이 되어 현재 응급의료센터에서도 기본적으로 허혈성 흉통이 있는 환자에게 많이 사용하고 있다. 특히 최근에는 troponin과 CK-MB의 유용성에 대해서 많이 언급을 하고 있다. CRP도 역시 급성 관상동맥증후군에서 중요성이 인식되고 있다. 저자들은 세 가지 인자를 동시에 평가하여 상승되는 인자 수에 따라 그 중요성이 다를 수 있다는 가정 하에 총체적인 환자에 대한 정보를 제공할 수 있고, 응급실 근무 의사에게 급성 심근 경색증 환자를 좀 더 효율적으로 평가 할 수 있도록 하기 위하여 다표지 인자에 관한 연구를 시작하였다. 방법: 저자들은 응급의료센터에 내원한 급성 허혈성 흉통이 있는 환자 중 심효소 검사와 심전도에서 급성 심근 경색증에 합당한 소견을 보이고 이후 검사한 심혈관 조영술에서 심근경색증으로 확진된 환자를 대상으로 하였다. 내원 초기에 troponin T와 CK-MB, CRP를 동시에 측정하였고 또한 후향적으로 환자에 대한 기본적인 특징과 정보, 심전도 소견, 합병증 발생, 심혈관 조영술 소견과 경색관련 혈관 수, 치료 및 치료결과 등에 대한 자료를 정리하여 분석하여 보았다. 이때 환자는 두 군으로 나누어 분석하였는데, 1군은 증가된 효소수가 1개 이하인 경우이고, 2군은 2개 또는 3개 및 좌주관상동맥을 포함한 경우로 하였다. 결과: 전체 130명의 환자가 대상이 되었고, 1군 40례, 2군 90례로 2군이 훨씬 많았다. 과거력에서 이전에 관동맥 성형술을 시술받은 경우가 2군에서 유의 있게 많았다(p<0.05). 이전의 약물 복용은 전체적으로 1군에서 많았으나 질산제 복용(p<0.05)을 제외하고는 의의가 없었다. 치료는 혈전용해제 사용이 오히려 1군에서 의의있게 많았으나(p<0.05), 합병증으로 쇽이나 폐부종을 동반한 경우가 2군에서 많았다. 하지만 본 연구에서는 6개월 추적 기간중의 사건 발생이나 합병증, 예후 결과에 대한 양군간의 차이를 발견하지 못했다. 결론: 급성 심근경색증 환자에게 다표지 인자를 이용한 접근법을 적용한 결과, 기본적으로 환자에 대한 몇 가지 정보, 즉 과거에 약물 투여 여부와 혈전용해제 사용, 혈관성형술을 시술 받은 경력과 같은 기초자료에 대한 제한적인 차이를 발견할 수 있었으나, 본 연구에서는 다표지 인자를 이용하여 추적기간중 환자의 상태와 예후를 평가하고 합병증을 조기에 예측한다든지 하는 중요한 역할을 발견하지 못하였다. 그래서 향후 이에 대한 제한점을 해결한 더 보완된 연구가 필요할 것으로 사료된다.