• Journal of Chest Surgery
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• v.41 no.1
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• pp.1-11
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• 2008

Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

• Ecology and Resilient Infrastructure
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• v.9 no.2
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• pp.100-106
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• 2022

The relationships between river length and weir density versus fish species observed were analyzed for 210 local rivers in the Seomjin River system (SJR). A nonlinear exponential relationship between river length and number of fish species were observed. Model coefficient was 0.03 and coefficient of determinant (R²) was 0.59, meaning that about 59.0% of total variance was explained by river length variable. Predicted value by model and observed number of species showed a difference. About 110 local rivers (about 52.4%) showed lower value than predictive value. The average index of weir's density (IWD) in the SJR was about 2.7/km, which was significantly higher than that of other river basins. As a result of nonparametric 2-Kimensional Kolmogorov-Smirnov (2-DKS) analysis based on the IWD, the threshold value affecting fish diversity was about 2.5/km (D_max=0.048, p<0.05). Above the threshold value, it means that the number of fish species would be decreased. In fact, the ratio of the expected species to the observed species was lowered to less than 70%, when the IWD is higher than the threshold value. To maintain aquatic ecological connectivity in future, it is necessary to manage IWD below the threshold value.

• Ecology and Resilient Infrastructure
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• v.9 no.2
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• pp.93-99
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• 2022

It was confirmed that the fish diversity decreased with increasing index of weir's density (IWD) in the four river systems. The IWD showed difference with watershed, it was high in the Nakdong River (NDR). Both two river systems of Gum River (GUR) and Yeongsan River (YSR) were similar, whereas relatively lower density observed in the Han River (HNR) system. A result of 2-Dimensional Kolmogorov-Smirnov (2-DKS) as a nonparametic test showed different threshold values affecting fish diversity with the river systems. The p-values based on D_max, were significantly different at 0.05 level (except for YSR). The threshold values affecting fish diversity were also different with watershed. The values were 1.6/km of the HNR, 1.3/km of the NDR, and 2.3/km of the GUR, respectively. The fish diversity was decreased when IWD is over threshold values. The IWD of total 404 rivers (about 33%) among 1,217 surveyed in this study showed above threshold value. These rivers should be considered first for evaluating river continuity. The IWD and threshold value suggested in this study would be useful for selecting a stream priority for river connectivity study.

• Animal Systematics, Evolution and Diversity
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• v.21 no.1
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• pp.45-56
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• 2005

Three species of Gastrostyla ciliates collected from the sewage treatment plant and a puddle in the valley from Korea were identified as Gastrostyla minima Hemberger, 1985, G. steinii Engelmann, 1862 and G. setifera (Engelmann, 1862). The description was based on the observation of living specimens, protargol impregnated specimens and biometric analysis. The morphological variations among the populations of these species were investigated with morphometry. These species have not been reported in Korea and their diagnostic characteristics are as follows: G. minima normally has two oval macronuclei (Ma) with one spherical micronucleus (Mi) respectively, continuous ventral cirral row (VCR) with additional one postoral ventral cirrus (poVC), five transverse cirri (TC), six dorsal kineties (DK) with broken 4th kinety, and cortical granules. G. steinii has four oval Ma with three to five Mi, discontinuous VCR with additional one poVC, four TCs, six DKs, and no cortical granules. G. setifera has two oval Ma with one spherical Mi respectively, five TCs which distinctly separate in two groups, six DKs, discontinuous VCR with additional two poVCs, and no cortical granules.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.439-448
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• 2002

Pulmonary artery banding (PAB) in the functional univentricular heart (UVH) is a palliative procedure for staging toward the Fontan procedure; however, it is known to be a risk factor. Material and method： The records of all 37 patients with functional UVHs who underwent surgical palliation using PAB between September 1989 and August 1999 were reviewed retrospectively. We investigated the aortic arch obstruction, the development and progression of subaortic stenosis after PAB, and risk factor of mortality according to surgical method. Result： In 37 neonates and infants with single ventricular physiology, aortic arch obstruction was combined in 7. There were 6 early deaths (16.2%) after PAB and 3 late deaths (8.1%) after Fontan operation. The actuarial overall survival including early mortality at 3 and 5 years were 80.7$\pm$6.6%, 72.2$\pm$8.2% respectively. Among 31 patients who survived PAB, 27 patients (87.1 %) could become candidates for Fontan operation； 22 patients (71.0%) completed Fontan operation with 3 deaths and 5 were waiting bidirectional cavopulmonary shunt(BCPS) or Fontan operation (follow-up mean 4.5 year, minimal 2 year). Subaortic stenosis developed in 8 patients after PAB (8/29, 27.6%)； 3 cases in the patients without arch anomaly (3/22, 13.6%) and 5 in those with arch anomaly (5/7, 71.4%). The subaortic stenosis was managed with Damus-Kaye-Stansel procedure (DKS) in 6 patients without operative mortality and conal septum resection in 2 without long-term survivor. Analysis of risk factors established that aortic arch obstruction was strongly associated with subaortic stenosis (p＜0.001). The only risk factor of late mortality was Fontan procedure without staged palliation by BCPS (p=0.001). Conclusion： PAB is effective as an initial palliative step in functional UVH. And the high risk group of patients with aortic obstruction can undergo effective short-term PAB as an initial palliative step, with subsequent DKS for subaortic stenosis. This strategy, initial PAB and careful surveillance, and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later Fontan procedures.