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Long-term Results of Surgical Correction for Partial Atrioventricular Septal Defects -Seventeen-year Experience - (부분방실중격결손증에 대한 외과적 교정의 장기 결과)

  • 이정렬;박천수;임홍국;김용진;노준량;배은정;노정일;윤용수
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.911-920
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    • 2003
  • In this study, we analyzed the long-term surgical outcome of partial atrioventricular septal defects during the past 17 years at Seoul National University Hospital. Material and Method: A retrospective analysis on mortality, survival, and reoperation and their risk factors was done in 93 patients who underwent surgical correction of partial atrioventricular septal defects between April 1986 and December 2002. 32 patients were male and 61 were female with a median age of 68 months (3∼818 months) and a mean follow-up period of 108 months (1∼200 months). Result: There were 4 operative deaths (4.3%) and one mortality during the follow-up period. 3, 5, 10, and 15 year actuarial survival rates were 95.7%, 94.3%, 94,3%, and 94.3%, respectively. After the surgical correction, left atrioventricular valve Incompetence was improved in 61patients (67.7%), remained same as the preoperative status in 14 patients (15.1%), and was aggravated in 12 patients (12.9%). Reoperation was performed in 8 patients (9.0%) after a mean interval of 38.6 months (3∼136 months). Freedom from reoperation rates at 3, 5, 10, and 15 years after surgical correction were 94.0%, 91.4%, 91.4%, and 88,2%, respectively Reasons for reoperation were 7 left atrioventricular valve incompetence, 2 left ventricular outflow tract obstruction, a residual atrial septal defect, a left atrioventricular valve stenosis, and a right ventricular failure. Left ventricular outflow tract obstruction was the only statistically significant factor. In ten patients, significant arrhythmia was developed and three of them were supraventricular arrhythmia. Complete atrioventricular block occurred in 7 patients and permanent pacemakers were implanted in six of them. Conclusion: Surgical corrections of partial atrioventricular septal defects were performed with low operative mortality. Since left atrioventricular valve incompetence was the most common cause of reoperation and left ventricular outflow tract obstruction was the only risk factor for reoperation, a precise estimation of the left atrioventricular valve morphology and the structure of left ventricular outflow tract are needed. Although left ventricular outflow tract obstruction rarely developed, reoperation was frequently required and resection of subaortic tissue could be peformed but the possibility of recurrence was high, so modified Konno operation could be performed with satisfactory results. Complete atrioventricular block developed frequently in early periods, but was overcome with a precise anatomical understanding of conduction system and experience.

Delayed closure effect in preterm infants with patent ductus arteriosus (미숙아 동맥관개존증의 지연된 폐쇄가 예후에 미치는 영향)

  • Lee, Hyun Ju;Sim, Gyu Hong;Jung, Kyung Eun;Lee, Jin A;Choi, Chang Won;Kim, Ee Kyung;Kim, Han Suk;Kim, Beyong Il;Choi, Jung-Hwan
    • Clinical and Experimental Pediatrics
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    • v.51 no.10
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    • pp.1065-1070
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    • 2008
  • Purpose : This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d). Methods : Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively. Results : The mean gestational age (GA) was $26{\pm}2weeks$ (range, 23-32 wk), and the birth weight was $782{\pm}146g$ (range, 430-990 g). The delayed closure group was associated with early GA ($25.7{\pm}1.7wk$ vs $27.1{\pm}2.0wk$, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010). Conclusion : Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.

Report for Development of Korean Portable Cardiopulmonary Bypass II. Experimental Study of Portable Cardiopulmonary Bypass for Emergency Cardiopulmonary Resuscitation after Cardiac Arrest in Normal Dogs (한국형 이동식 심폐소생기 개발 보고 II. 응급소생술을 위한 이동식 심폐소생기의 동물 실험 연구)

  • Kim, Hyoung-Mook;Lee, In-Sung;Baek, Man-Jong;Sun, Kyung;Kim, Kwang-Taik;Lee, Hye-Won;Lee, Kyu-Back;Chang, Jun-Kuen;Kim, Chong-Won;Kim, Hark-Jei
    • Journal of Chest Surgery
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    • v.31 no.12
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    • pp.1147-1158
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    • 1998
  • Background: Portable cardiopulmonary bypass(CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation(CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. Material and Method: By using adult mongrel dogs, open-chest CPR(OCPR group, n=4) and portable-CPB CPR(CPB group, n=4) were compared with respects to restoration of spontaneous circulation(ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest(VF-CA) of arrest(VF-CA) of 4 minutes followed by basic life support(BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support(ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means±SD percent change from baseline. Result: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group(90±19 vs. 71±32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group(105±24 vs. 146±6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group(p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group(survival time 31±36 hours) and 2 in CPB group(228±153 hours, p=ns). The remainders in both groups showed prolonged survival. Conclusion: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.

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Experimental Fetal Cardiopulmonary Bypass in the Fetal Lamb Model (태아양 모델을 이용한 실험적 태아 심폐우회술)

  • 이정렬;임홍국;김원곤;김종성;최정연;김용진
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.495-503
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    • 1999
  • Background: We tested the technical feasibility of fetal cardiac bypass and collected baseline data on the fetal hemodynamics and placental functions related to the cardiopulmonary bypass in the fetal lamb model. Material and Method: Eleven fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Eight served as a group in which placenta was excluded from the extracorporeal circulation by clamping the umbilical cord during the bypass(the oxygenator group) and in the remaining three, the placenta worked as the only source of oxygen supply(the placenta group). Observations were made every 10 minute during a 30-minute bypass and 30-minute post bypass period. No prostaglandin inhibitors were used both in ewes and in fetuses. Result: Weights of the fetuses ranged from 1.9 to 5.2 kg. In the oxygenator group, means of arterial pressure, PaO2, atrial pressure, heart rate, and bypass flow rate ranged 69.8 to 82.6 mmHg, 201.7 to 220.9 mmHg, 4.1 to 4.3 mmHg, 169 to 182/min, and 140.3 to 164.0 ml/kg/min, respectively during bypass, but rapid deterioration of the fetal cardiac functions and the placental gas exchange was observed after the cessation of bypass. In the placenta group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of PaCO2 increased from 61.9 to 129.6 mmHg during bypass. Flow rate was suboptimal(74.3 to 97.0 ml/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. Conclusion: In this study, the technical feasibility of fetal cardiopulmonary bypass was confirmed in the fetal lamb model. However, further studies with modifications of the bypass including an addition of prostaglandin inhibitor, an application of the total spinal anesthesia on the fetus, a creation of more concise bypass circuit, and a use of active pump are mandatory to improve the outcome.

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Induced Breeding and Indoor Culture of the Catfish, Silurus asotus (Teleostomi : Siluridae) (메기(Silurus asotus)의 산란 유도 및 실험실 사육에 관한 연구)

  • CHOI Gyeong Cheol;KIM Dong Soo;JO Jae-Yoon;KIM Jong-Man
    • Journal of Aquaculture
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    • v.5 no.2
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    • pp.117-126
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    • 1992
  • Induced breeding and indoor rearing of the catfish, Silurus asotus were performed. Ovulation was induced by injection of 5 mg dried carp pituitary per kg body weight. Fertilization rates were $81.5\~98.0{\%}$ and hatching success was $67.0\~82.0{\%}$. There were no significant differences of daily growth rate (DGR) and food conversion ratio (FCR) between the groups fed extruded eel pellet and extruded carp pellet. No significant differences in DGR and FCR were also found between $3{\%}$ and $4{\%}$ daily feeding rates. DGR and FCR of small fry were slightly affected by dissolved oxygen (DO) level in aquaria. When the DO level maintained at $4.5\;mg/{\ell}$, the best result was obtained and DGR and FCR were $5.7{\%}$ and 0.65, respectively. At the higher level of DO, $5.5\;mg/{\ell}$, DGR and FCR were $5.52{\%}$ and 0.77, respectively, whereas at the lower level of DO, $3.5\;mg/{\ell}$, the DGR was decreased to $3.45{\%}$ and FCR was increased up to 1.01.

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Interpretation of depositional setting and sedimentary facies of the late Cenozoic sediments in the southern Ulleung Basin margin, East Sea(Sea of Japan), by an expert system, PLAYMAKER2 (PLAYMAKER2, 전문가 시스템을 이용한 동해 울릉분지 남부 신생대 후기 퇴적층의 퇴적환경 해석)

  • Cheong Daekyo
    • The Korean Journal of Petroleum Geology
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    • v.6 no.1_2 s.7
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    • pp.20-24
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    • 1998
  • Expert system is one type of artificial intelligence softwares that incorporate problem-solving knowledges and experiences of human experts by use of symbolic reasoning and rules about a specific topic. In this study, an expert system, PLAYMAKER2, is used to interpret sedimentary facies and depositional settings of the sedimentary sequence. The original version of the expert system, PLAYMAKER, was developed in University of South Carolina in 1990, and modified into the present PLAYMAKER2 with some changes in the knowledge-base of the previous system. The late Cenozoic sedimentary sequence with maximum 10,000 m in thickness, which is located in the Korean Oil Exploration Block VI-1 at the southwestern margin of the Ulleung Basin, is analysed by the expert system, PLAYMAKER2. The Cenozoic sedimentary sequence is divided into two units-lower Miocene and upper Pliocene-Pleistocene sediments. The depositional settings and sedimentary facies of the Miocene sediments interpreted by PLAYMAKER2 in terms of belief values are: for depositional settings, slope; $57.4\%$, shelf; $21.4\%$, basin; $10.1\%$, and for sedimentary facies, submarine fan; $35.7\%$, continental slope; $26.3\%$, delta; $16.1\%$, deep basinplain; $6.1\%$ continental shelf; $3.2\%$, shelf margin; $1.4\%$. The depositional settings and sedimentary facies of the Pliocene-Pleistocene sediments in terms of belief values we: for depositional settings, slope; $59.0\%$, shelf; $22.8\%$, basin; $7.0\%$, and for sedimentary facies, delta; $24.1\%$, continental slope; $22.2\%$, submarine fan; $17.3\%$, continental shelf; $7.0\%$, deep basinplain; $4.8\%$, shelf margin; $2.6\%$. The comparison of the depositional settings and sedimentary facies consulted by PLAYMAKER2 with those of the classical interpretation from previous studies shows resonable similarity for the both sedimentary units-the lower Miocene sediments and the upper Pliocene-Pleistocene sediments. It demonstrates that PLAYMAKER2 is an efficient tool to interpret the depositional setting and sedimentary facies for sediments. However, to be a more reliable system, many sedimentologists should work to refine and add geological rules in the knowledge-base of the expert system, PLAYMAKER2.

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The Study of Estimation of Chromatin Abnormality of Ogye Rooster Sperm and Activity by Diff-Quik Staining Method (Diff-Quik 염색방법에 의한 오계 닭 정자의 염색질 이상과 운동성 추정에 관한 연구)

  • Kim, Sung Woo;Choi, Ahreum;Choe, Changyong;Kim, Dongkyo;Seong, Hwan-Hoo;Kim, Jae-Hwan;Kim, Chongdae
    • Korean Journal of Poultry Science
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    • v.42 no.2
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    • pp.109-116
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    • 2015
  • Ogye rooster sperm chromatin status can be detected using well established sperm assays. In this paper, a simple and fast method to monitor rooster sperm chromatin status could be employed in field for assessment of chicken sperm quality. Using standard bright field microscope, Diff-Quik stains can be reproducibly, easily and routinely monitored with simple staining. The presence of abnormal chromatin staining of rooster sperm was determined by darker stain in head. In the fresh semen, the viabilities of three tested Ogye spermatozoa were 93.53%, 82.42% and 90.63% and normal chromatin rates were 87.96%, 74.25% and 85.10% respectively. However, after freezing, the rates of viability of thawed semen were reduced to 69.58%, 61.98% and 72.20% and normal chromatin rate also reduced to 58.91%, 48.49% and 63.34%. A significant correlation between live sperm and normal sperm nuclei was 0.875 in fresh semen and 0.513 in frozen semen. After incubation of sperm at $37^{\circ}C$ for 5min, the rates of viability, chromatin normality and sperm head activity were shown as $90.63{\pm}1.28%$, $82.44{\pm}8.09%$ and $66.68{\pm}10.29%$ in fresh semen. However, the rates of thawed semen were reduced to $67.92{\pm}7.55%$, $56.92{\pm}12.15%$ and 47.32{\pm}5.02%, respectively. The relationship between chromatin normality and sperm head movements in fresh and thawed semen were 0.564 and 0.540, respectively. With these results, the chicken sperm normality could be assessed by the Diff-Quik staining that could be used for chromatin status of sperm head and activated morphology of live spermatozoa, as a simple and rapid staining method.

Comparative Analysis of Ecological Health Conditions Before and After Ecological Restoration in Changwon Stream and Nam Stream (창원천.남천에서 생태복원 전.후의 생태건강도 비교평가)

  • Kim, Hyun-Jeong;Lee, Sang-Jae;An, Kwang-Guk
    • Korean Journal of Ecology and Environment
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    • v.43 no.2
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    • pp.307-318
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    • 2010
  • This study was to analyze the ecological conditions, based on physical habitat, chemical, and biological conditions before (2006, 2007) and after ecological restoration (2009) in five sites of Changwon Stream (CS) and six sites of Nam Stream (NS), respectively, and then to compare ecological health between the two period. The analysis of ecological health was based on the multimetric models of Index of Biological Integrity (IBI) and Qualitative Habitat Evaluation Index (QHEI) along with water chemistry in the streams. For the study, the models of IBI and QHEI were modified as 8 and 11 metric attributes, respectively. For the evaluations, the survey was conducted in the period of 2006~2007 before the restoration and in 2009 after the restoration by the city. Chemical conditions, based on conductivity, in both streams showed a typical longitudinal declines along the axis of the upstream-to-downstream. There were no significant differences (p>0.05) in water quality between the two periods. Values of IBI in the CS and NS averaged 21.6 and 19.7, respectively, indicating a C grade in the criteria of Ministry of Environment, Korea, and there was no significant differences in the IBI between the two periods. Values of QHEI after the restoration averaged 29.2 and 63.2 in the CS and NS, respectively and the values decreased markedly especially, in the NS (35.3) after the restoration. The habitat disturbance was mainly attributed to destructions (i.e., the narrower width of riparian vegetation and higher substrate exposure by the air) of artificial materials by massive flood in 2009. Overall, our results suggest that the restoration was not effective in the two streams between the two periods, even if the budget was used a lot and that such ecological restoration, not considered the natural disaster, may not effect for the stream restoration.

Studies on the Seedling Production of the Freshwater Crab, Eriocheir japonicus (De Haan) 1. Reproductive Ecology (동남참게, Eriocheir japonicus (De Haan)의 종묘생산에 관한 생물학적 기초연구 1. 번식생태)

  • KWON Chin-Soo;LEE Bok-Kyu;LEE Chae-Sung
    • Journal of Aquaculture
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    • v.6 no.4
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    • pp.235-253
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    • 1993
  • The freshwater crab, Eriocheir japonicus inhabits from sub-tropical to temperate zone in Asia. This species belongs to a large size group among freshwater crabs. Common size of this crab is 5-6cm in carapace length and occasionally 7cm in carapace length. This species of crab used to inhabit in estuaries, rivers and inland waters in Korea. However, natural population recently has been rapidly decreased because of pollution and lost their habitats by suburban development. Therefore, development of proper methods of seedling production to increase natural stock became necessity. As parts of achieving this goal, duration from mating to spawning, egg incubation period, and egg development of this species were studied. The influence of temperatures and salinities on the egg incubation and hatching was also investigated. It took 2-8 hours from mating to egg spawning and the spawning lasted 3-9 hours from the first spawning. Egg numbers per female (6cm in carapace length) were 380,000­410,000. Optimum temperature for egg incubation was $17\~23^{\circ}C$ and optimum salinity, $14.0\~31.5\%o$. Incubation period of the eggs at $14^{\circ}C,\;17^{\circ}C,\;20^{\circ}C,\;26^{\circ}C,\;and\;28^{\circ}C$ was 42, 28, 21, 15, and 14 days. respectively. Relation between temperature (X) and incubation days (Y) was LogY = Log 2764.267 - 1.608 LogX. A female can spawn 4-6 times per year by manipulation of environmental conditions. Under the conditions of $18^{\circ}C\;and\;24.5\%o$, it took 6 days up to embryo formation, 18 days up to compound eye formation, 22 days up to abdominal movement, and 25 days up to hatch out as zoea larvae.

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BREEDING OF THE PUFFER FUGU RUBRIPES (자주복 Fugu rubripes (Temminck et Schlegel)의 종묘 생산에 관한 연구)

  • PYEN Choong-Byu;RHO Bum
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.3 no.1
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    • pp.52-64
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    • 1970
  • Fingerlings hatched from the eggs of the puffer, Fugu rubripes, which were spawned on May 21, 1969, and were cultivated. The results of their growth during 150 days, until October 25th, are summarized as follows: 1. The eggs began to hatch after 163 hours, at a water temperature of 15.9 to $17.4^{\circ}C$, and the hatching rate was $61.56\%$. 2. They reached the post-larval stage 6 to 7 days after hatching, and at this time a high mortality occurred. The mortality rate was 57.26 to $68.0\%$. 3. Sixteen days after hatching some of the larger fingerlings (6.7mm in total length) began attacking some of the smaller ones (4.6mm in to total length). 4. Twenty five to twenty eight days after hatching, the fish changed their food, and at this time a second high mortality occured. The total mortality rate amounted to 90.7 to $90.9\%$ of the total hatch. 5. After the fingerling stage. cannibalism occurs. The fish usually attack the caudal part of other fingerlings. It occurs regardless of body length and when the food supply is short. 6. The food coeffiicient at the age of 46 days (when body length is 53 to 68 mm) was 5.5 for short-necked clams, 8.5 for earth-worms, and 8.7 for fishes. 7. A third hish mortality occurred 53 to 63 days after hatching, the total mortality amounting to 95.76 to $97.34\%$, and the main cause of the mortality was found to be rickets resulting from nutritional deficiency 8. The growth rates were as follows: 2.68mm just after hatching, 3.84mm at the age of 10 days; 7.96mm after 25 days; 20.96mm or 130mg after 40 days; 73.68mm or 9.06g after 80 days: and 123mm or 31.8g after 150 days. 9. The water temperature during the above period was 15.7 to $28.4^{\circ}C$ with an average of $22.10^{\circ}C$ and the salinity was 25.53 to $34.50\%$ with an average of $32.07\%$, 10. The young of this species could endure well a wide range and sudden rise in salinity, and could survive easily when the salinity suddenly fell to $5\%$, but a considerable mortality occured when it fell to $3\%$. 11. When the fish were tranferred directly to fresh water from normal sea water they died out in 9 hours and 40minutes. However, when transferred from water of $5\%$ salinity at which they were reared for 54 days, they survived for 60 hours and 40 mimutes longer than in the former case.

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