• Journal of Chest Surgery
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• v.29 no.5
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• pp.564-568
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• 1996

Pseudoaneurysm of the ascending aorta following cardiac surgery is very unusual and it is poten- tially fatal. We report here a fourteen year-old female patient with pseudoaneurysm of the ascending aorta following a repair of a congenital ventricular septal defect at other hospital 50 months ago. Although she had a mild superficial wound infection postoperatively, she enjoyed uneventful. life until she visited our hospital for a generalized weakness and exertional dyspnea which developed a month ago. Chest CT and echocardiogram showed partially calcified pseudoaneurysm of the ascending aorta. Two aortic defects were located on the anterolateral ascending aortic wall wkere it was suspected as a previous sites of aortic and cardioplegic cannulation. The internal wall of the pseudoaneurysm was covered with neoendothelium and intervened by septal tissue. Two defects on he aortic wall were oval in shape and about 1.5cm in the greatest diameter The defects were trimmed to make a one large de- fect and it was reconstructed with patch designed from 22mm collagen impregnated double velour Dacron graft. The postoperative course was uneventful.

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.367-370
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• 2014

The study was to observe hemodynamic alterations of cardiac function to design a model of canine mitral valve insufficiency (MVI) based on chordae tendinae rupture (CTR). Ten healthy beagles with normal heart function were used in this study. To measure hemodynamics, the patient monitor was equipped for invasive blood pressure and a Swan-Ganz catheter. Hemodynamic alterations were checked promptly during CTR procedures. MVI model was made by transection of the chordae tendinae with small arthroscopy hook knife through $5^{th}$ intercostal open chest. Color Doppler at the level of the mitral valve showed high-velocity regurgitant flow immediately after CTR at intraoperative echocardiography. In hemodynamic measurements, pulmonary capillary wedge pressure (PCWP) was significantly increased, while mean arterial pressure (MAP), venous pressure (VP), pulmonary arterial pressure (PAP), cardiac output (CO) and cardiac index (CI) were significantly decreased after CTR. It was known that the left atrium was overloaded by regurgitant volume from the left ventricle. In conclusion, the MVI model induced by CTR technique in this study should be used as suitable one for the effective research of canine mitral valve disease. Further study should be needed to measure the chronic alternation of mitral valve in the model.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.171-176
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• 1996

From March, 1983 to June, 1994, twenty-two patients underwent coronary artery and combined operations. The ages of the patients ranged from 42 years to 72 years (mean 60.4$\pm$8.2 years). There were 17 male and 5 female patients. The left ventricular (LV) ejection fraction ranged from 25% to 65% (mean 46.9$\pm$14.2%). Nine patients had mechanical complication of myocardial infarction (MI), of which 5 were LV aneurysm, 3 ventricular septal defect and 1 mitral regurgitation. Nine patients had rheumatic valvular heart disease of whom 7 with aortic valve disease and 2 with mitral valve disease. Two other patients had left atrial thrombi, only one with atrial septal defect a d another with aneurysm of ascending aorta. An average of 2.1$\pm$1.0 bypasses was done, ranging from one to four. There were 3 postoperative complications; 2 perioperative MI and 1 leg wound infection. Among complicated patients, mortality was 1 patient (4.5%) due to low cardiac output syndrome after perioperative MI. With 3 to 136 months follow-up (mean 41.1$\pm$40.2 months), late mortality was 1 patient due to cerebral vascular accident. Among long-term survivors, all patients are in New York Heart Association functional class I or II. Although the number of patients was small, our surgical results were favorable. Therefore we think that coronary revascularization combined with heart operation does not increase the operative risk when associated coronary artery disease is present, and it reduces the occurrence of late death.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.200-206
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• 2013

Purpose : To assess the effect of applying an automated heart model based measurements of left ventricle (LV) and compare with manual and semi-automated measurements at Cardiovascular MR Imaging. Materials and Methods: Sixty-two patients who underwent cardiac 1.5T MR imaging were included. Steady state free precession cine images of 20 phases per cardiac cycle were obtained in short axis views and both 2-chamber and 4-chamber views. Epicardial and endocardial contours were drawn in manual, automated, and semi-automated ways. Based on these acquired contour sets, the end-diastolic (ED) and end-systolic (ES) volumes, ejection fraction (EF), systolic volume (SV) and LV mass were calculated and compared. Results: In EDV and ESV, the differences among three measurement methods were not statistically significant (P = .399 and .145, respectively). However, in EF, SV, and LV mass, the differences were statistically significant (P=.001, <001, <001, respectively) and the measured value from automated method tend to be consistently higher than the values from other two methods. Conclusion: An automatic heart model-based method grossly overestimate EF, SV and LV mass compared with manual or semi-automated methods. Even though the method saves a considerable amount of efforts, further manual adjustment should be considered in critical clinical cases.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.2
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• pp.87-91
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• 2016

Pierre Robin syndrome (PRS) is characterized by the triad of congenital mandibular hypoplasia, glossoptosis and cleft palate. Infant PRS patients are frequently suffering from upper airway obstruction, gastroesophageal reflux and growth retardation caused by above mentioned problems. We report a dental caries treatment of 3-year old girl with Pierre Robin syndrome with multiple caries. The cause of multiple caries was mainly presumed as patient's eating habit caused by her general condition. She had some feeding problems and had history of gastric tube. She was still using milk bottle and took more than an hour to finish a meal. The treatment was performed under general anesthesia considering patient's condition; mild autism, poor cooperation and respiratory problem due to micrognathia. Severely affected upper incisors were treated with pulp treatment and restored with zirconia crown for esthetic purpose. Lower incisors were treated with pulp treatment and restored with composite resin. Upper right first primary molar was restored with stainless steel crown and other primary molars were treated with composite resin. There were no postoperative complications. According to her parents, the patient's compliance to oral hygiene management was greatly improved after the treatment since she was very pleased with the esthetic result and highly motivated by her looks. The treatment without sedation or general anesthesia would be possible once the airway is improved as the mandible grows.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.17 no.8
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• pp.1947-1954
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• 2013

Previous works for detecting arrhythmia have mostly used nonlinear method such as artificial neural network, fuzzy theory, support vector machine to increase classification accuracy. Most methods require accurate detection of P-QRS-T point, higher computational cost and larger processing time. But it is difficult to detect the P and T wave signal because of person's individual difference. Therefore it is necessary to design efficient algorithm that classifies different arrhythmia in realtime and decreases computational cost by extrating minimal feature. In this paper, we propose arrhythmia detection based on binary coding using QRS feature varibility. For this purpose, we detected R wave, RR interval, QRS width from noise-free ECG signal through the preprocessing method. Also, we classified arrhythmia in realtime by converting threshold variability of feature to binary code. PVC, PAC, Normal, BBB, Paced beat classification is evaluated by using 39 record of MIT-BIH arrhythmia database. The achieved scores indicate the average of 97.18%, 94.14%, 99.83%, 92.77%, 97.48% in PVC, PAC, Normal, BBB, Paced beat classification.

• The Korean Journal of Physiology
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• v.22 no.1
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• pp.13-29
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• 1988

In order to elucidate the regulatory mechanism of intracellular calcium ion concentrations, contractions or contractures induced by $Na^{+}-removal$, calcium-application or ouabain-treatment as an index of $Na^+/Ca^{2+}$ exchange activity were studied in atrial muscle or vascular smooth muscle (aorta and renal artery) of the rabbit. The magnitude of low sodium contractures in atrial trabeculae increased with sigmoid shape when external sodium concentrations were reduced to sodium-free condition, whereas that of calcium contracture intensified in a parabolic pattern when external calcium concentrations were elevated to 8 mM. $Na^{+}-removal$ contractures were induced in a duration-dependent manner to $K^{+}-free$ exposure and same findings were observed with ouabain treatment. $Na^{+}-free$ contractures were not affected by verapamil treatment, but stimulated by $100{\mu}M\;Mn^{2+}$ and inhibited by high concentrations of $Mn^{2+}\;(2{\sim}8mM)$ in a dose-dependent manner. Ryanodine which is known to suppress the release of calcium from internal store abolished spontaneous twitch contractions induced by $K^{+}-free$ solution, but had no effect on the development $Na^{+}-free$ contractures. Na-free contractures were not always induced in vascular smooth muscle preparations. Contractures by $O\;mM\;Na^+$ were usually seen in aorta, but not often in renal artery.$50\;mM\;K^+$, noradrenaline (NA) and angiotensin II (AII) always evoked very large contraction in all preparations of vascular smooth muscle. Contractures developed by $O\;mM\;Na^+$ were not sensitive to verapamil treatment as in atrial trabeculae, but were abolished by $100{\mu}M\;Mn^{2+}$. In contrast to $Na^{+}-free$ contractures, $Mn^{2+}(100{\mu}M)$ had no effect on the contractures induced by NA or 50 mM$K^+$. Caffeine in the concentration of 10 mM evoked transient contracture in the distal renal artery. The rate of spontaneous relaxation in caffeine contracture was dependent upon the concentrations of external sodium, and had double component of relaxation when the rate of relaxation was plotted in the semilogarithmic scale of relative tension versus time. Especially late components of relaxation had more direct relation to $Na^+$ concentrations. It could be concluded that $Na^+/Ca^{2+}$ exchange mechanism in the heart has a large capacity, inhibited by $Mn^{2+}$ but not by verapamil and ryanodine, while $Na^+/Ca^{2+}$ exchange system in vascular smooth muscle has a very low capacity especially in small artery, inhibited by low concentration of $Mn^{2+}\;(100{\mu}M)$ but not affected by verapamil and ryanodine.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.679-691
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• 1985

Ninety patients underwent mitral valvular heart surgery associated with or without aortic valve surgery and subjected to a clinical study in relation to their control of postoperative atrial fibrillation. There were 26 males and 64 females ranged in age from 16 to 56 years with a mean of 35.2 years. Systemic arterial embolizations were observed in 11 patients [12.2%]. Four patients of them were in normal sinus rhythm and 7 in atrial fibrillation. Out of these, left atrial thrombi were found only in 2 at the operation. Intraoperatively confirmed left atrial thrombi were in 16 patients [17.7%] of all 90 patients: Eleven patients occurred at the age of more than 40 years, 14 were in atrial fibrillation and 2 only had previous episodes of systemic arterial embolization. Sixty three patients underwent isolated mitral valve surgery [OMC 28, MVR 35] and 27 patients associated with aortic valve surgery along with mitral valve [OMC+AVR 13, MVR+AVR 14]. Preoperatively, 44 patients [48.9%] were in normal sinus rhythm. Of them, 35 patients [79.5%] revealed normal sinus rhythm thoroughly after operation without any aid of digitalis or quinidine and 5 patients [11.4%] restored normal sinus rhythm with digitalization alone. Other 3 patients converted to normal sinus rhythm with the addition of quinidine, however, in 1 patient who was resistant to quinidine therapy, electrocardioversion was carried out on the postoperative third week showing normal sinus rhythm. Thus, the most atrial fibrillations that occurred for the first time in the postoperative period, were able to reverted to normal sinus rhythm responding well to antiarrhythmic therapy. Preoperatively, 46 patients [51.1%] were in atrial fibrillation. Of them, only 5 patients returned to sinus rhythm after operation without any aid of digitalis or quinidine and other 5 restored normal sinus rhythm with digitalization: namely 2 restored within early postoperative period and 3 after more than 3 months. Eight patients well responded to quinidine therapy showing normal Sinus rhythm. So far, 25 patients have remained in persistent atrial fibrillation on 6 to 36 months follow-up. In view of these, 17 patients [68%] were over 40 years of age, 22[80%] had long duration of symptom over 5 years and 10[40%] have had atrial thrombi before operation. Left atrial dimension were still more than 40mm in 21 patients on follow up M-mode echocardiogram. One month after operation, 87 hospital survivors were improved by at least one functional NYHA class. There were 3 operative deaths [3.3%, bleeding 1, LCOS 2] and 4 late deaths [LCOS 1, valve thrombosis 1, late bleeding 1, fulminant hepatitis 1] during follow-up period. According to our limited experience, we may conclude that better results will be expected with the addition of quinidine therapy judiciously in the cases of postoperative persistent atrial fibrillation who were aged or had longer history of symptom and left atrial thrombi.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.262-269
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• 1999

Background: To review the middle and long term results of aortic valve replacement(AVR) for 11 years, we surveyed and followed up the patients who underwent AVR. Material and Method: Between Feb. 1986 and May 1997, 134 patients underwent AVR. The patients consisted of 71 men and 63 women whose mean age was 38.9 years, ranging from 17 to 70. Result: The concomitant operations were 62 mitral valve replacement(MVR), 14 MVR + tricuspid valve annuloplasty, 10 Cabrol operation, 16 aortic annulus widening, and so forth. We used 119 mechanical(75 St. Jude Medical, 38 CarboMedics, 6 Sorin) and 15 tissue (Carpentier-Edwards) valves. Early postoperative complications occurred in 35 cases; 9 congestive heart failure, 6 low cardiac output, 5 postoperative bleeding, 5 pleural effusion, and so forth. There were 13 early postoperative deaths(9.7%) due to low cardiac output(5), CHF (2), disseminated intravascular coagulopathy(2), and so forth. The cumulative total follow-up period was 452.7 patient-years with a mean of 3.4${\pm}$3.1 years/patient. There were 9 cases of valve-related complications; anticoagulant-related bleeding(4), prosthetic valve endocarditis(2), thromboembolism(2) and prosthetic valve failure(1) occured at rate of 0.9, 0.4, 0.4, 0.2%/ pt-yr, respectively. Late valve-related death occurred in 3 cases(2.0%/pt-yr) associated with anticoagulant-related bleeding(2) and prosthetic valve endocarditis(1). Conclusion: Actuarial survival rate by Kaplan-Meier method was 91.0${\pm}$4.3 % at 11 years.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.393-397
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• 1998

A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction(LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle(LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator(EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.