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Subvalvular Septal Myectomy and Enlargement of the Narrow Aortic Root in Patients with Aortic Valve Replacement

  • Schulte, H.D.;Birchs, W;Horstkotte, D;Kim, Y.H.;Kerstholt, J;Preusse, C.J.;Winter, J
    • Journal of Chest Surgery
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    • v.22 no.2
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    • pp.220-224
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    • 1989
  • In candidates for aortic valve replacement [AVR]it is our primary intention to implant the largest possible vale prosthesis of at least 23 mm in diameter in patients with severe valvular aortic stenosis. However, in many patients there is an additional subvalvular asymmetric septal hypertrophy which in some cases may cause an postextrasystolic increase of the LV-aortic gradient. Another component of the aortic stenosis syndrome is a narrow valvular ring, or a combination of both. After complete removal of the diseased valve and decalcification the narrow aortic ring [< 23 mm] can be widened firstly by transaortic subvalvular septal myectomy- [TSM] thus unfolding the left ventricular outflow tract[LVOT]and secondly by extending the oblique aortic incision into the aortic valve ring or further down into the anterior leaflet of the mitral valve. The sub-and supra-valvular defect will be closed by patch enlargement of the aortic root [PEAR] using autologous pericardium. These techniques allow a considerable enlargement of the valvular ring of about 4 to 10 mm in circumference. In a retrospective study using a computerized program, 847 patients with AVR [1980-1984]were reviewed to evaluate the intraoperative hemodynamic results mainly concerning relief of the transvalvular gradient. In 626 patients AVR was performed, 151 patients had double valve replacement [AVR+MVR], and 70 patients had AVR plus additional surgical procedures. Concentrating on the AVR-group [n=626] there were 103 patients with TSM, 24 patients with PEAR and 20 patients with TSM+PEAR which demonstrated that in a total, of 147 patients of this groups [23.5%] an additional procedure was necessary. The Statistical evaluation of the intraoperative pressure measurements before and after AVR in relation to the size of the implanted prostheses indicated the lowest preoperative mean gradient in patients with AVR alone, the highest in patients who afforded TSM plus PEAR. However, after AVR the mean gradients in all three groups were very low [mean 5 to 10 mmHg]. These data indicate that in patients with a narrow aortic ring and additional considerable ASH, TSM and PEAR are suitable techniques to enlarge the aortic root to enable the implantation of an adequate aortic valve prosthesis. Long-term controls have shown that autologous pericardium is a qualified graft material for the ascending aorta.

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Evaluation of Conotruncal Anomalies by Electron Beam Tomography (Conotruncal 기형 평가에서 전자선 단층 촬영 (EBT)의 정확성)

  • 최병욱;박영환;최병인;최재영;김민정;유석종;이종균;설준희;이승규
    • Journal of Chest Surgery
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    • v.33 no.4
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    • pp.290-300
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    • 2000
  • Background: To evaluate the diagnostic accuracy of EBT(Electron Beam Tomography) in the diagnosis of conotruncal anomaly and to determine whether it can be used as a substitute for cardiac angiography. Material and Method: 20 patients(11M & 9F) with TOF(n=7, pulmonary atresia 2), DORV(n=7), complete TGV(n=4), & corrected TGV(n=2) were included. The age ranged from 7 days to 26 years(median 60 days). We analyzed the sequential chamber localization, the main surgical concenrn in each disease category (PA size, LVED volume and coronary artery pattern for TOF & pulmonary atresia, the LV mass, LVOT obstruction, coronary artery pattern for complete TGV, and type of VSD and TV-PV distance for DORV, etc) and other associated anomalies(e.g., VSD, arch anomalies, tracheal stenosis, etc). Those were compared with the results of echocardiography(n=19), angiography (n=9), and surgery(n=11). The interval between EBT and echocardiography/angiography was within 20/11 days, respectively except for an angiography in a patient with corrected TGV (48 days). Result: EBT correctly diagnosed the basic components of conotruncal anomalies in all subjects, compared to echocardiography, angiography or surgery. These included the presence, type and size of VSD(n=20), pulmonic/LV outflow tract stenosis(n=15/2), relation of great arteries and the pattern of the proximal epicardial coronary arteries(16 out of 20). EBT proved to be accurate in quantitation of the intrapericardial and hilar pulmonary arterial dimension and showed high correlation and no difference compared with echocardiography, angiography, or surgery(p>0.05) except for left pulmonary arterial & ascending arterial dimension by echocardiography. LVED volume in seven TOF(no difference: p>0.05 & high correlation: r=0.996 with echocardiography), and LV mass in 4 complete TGV were obtained. Additionally, EBT enabled the cdiagnosis of subjlottic tracheal stenosis and tracheal bronchus in 1 respectively. Some peripheral PA stenosis were not detected by echocardiography, while echocardiography appeared to be slightly more accurate than EBT in detecing ASD or PDA. Conclusion: EBT can be a non-invasive and accurate modality of for the evaluation of most anatomical alteration including peripheral PS or interruption in patients with conotruncal anomalies. Combined with echocardiography, EBT study provides sufficient information for the palliative or total repair of anomalies.

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Petrology of the Volcanic Rocks in the Paekrogdam Crater area, Mt. Halla, Jeju Island (제주도 한라산 백록담 분화구 일대 화산암류의 암석학적 연구)

  • 고정선;윤성효;강순석
    • The Journal of the Petrological Society of Korea
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    • v.12 no.1
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    • pp.1-15
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    • 2003
  • The Paekrogdam summit crater area, Mt. Halla, Jeju Island, Korea, composed of Paekrogdam trachyte, Paekrogdam trachybasalt, and Manseidongsan conglomerate in ascending order. Joint systems show concentric and radial patterns around the summit crate wall. The Paekrogdam crater is a summit crater lake which erupted the tuffs, scorias and lava flows of Paekrogdam trachybasalt after the emplaceent of Paekrogdam trachyte dome. SiO$_2$ contents of mafic and felsic lavas are respectively, 48.0∼53.7 wt.% and 60.7∼67.4 wt.%, reflecting bimodal volcanism. And lavas with SiO$_2$ between 53.7 wt.% and 60.7 wt.% are not found. According to TAS diagram and K$_2$O-Na$_2$O diagram, the volcanic rocks belong to the normal alkaline rock series of alkali basalt-trachybasalt-basaltic trachyandesite and trachyte association. Oxide vs. MgO diagrams represent that the mafic lavas fractionated with crystallization of olivine, clinopyroxene, magnetite and ilmenite and felsic trachyte of plagioclase and apatite. The characteristics of trace elements and REEs shows that primary magma for the trachybasalt magma would have been derived from partial melting of garnet peridotite mantle. In the discrimination diagrams, the volcanic rocks are plotted at the region of within plate basalt (WPB).

Petrology of the Cretaceous Igneous Rocks in the Mt. Baegyang Area, Busan (부산 백양산 지역의 백악기 화산-심성암류에 대한 암석학적 연구)

  • 김향수;고정선;윤성효
    • The Journal of the Petrological Society of Korea
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    • v.12 no.1
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    • pp.32-52
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    • 2003
  • The Mt. Baegyang in Busan, composed of sedimentary basement rocks (Icheonri Formation), andesite (lava), andesitic pyroclastic rocks, fallout tuff and tuffaceous sedimentary rocks, rhyolitic pyroclastic rocks, intrusive rocks (granite-porphyry, felsite, and biotite-granite) of Cretaceous age in ascending order. The volcanic rocks show a section of composite volcano which comprised alternation of andesitic lava and pyroclasitc rocks, rhyolitic pyrocalstic rocks (tuff breccia, lapilli tuff, fine tuff) from the lower to the upper strata. From the major element chemical analysis, the volcanic and intrusive rocks belong to calc-alkaline rock series. The trace element composition and REE patterns of volcanic and plutonic rocks, which are characterized by a high LILE/HFSE ratio and enrichments in LREE, suggest that they are typical of continental margin arc calc-alkaline rocks produced in the subduction environment. Primary basaltic magma might have been derived from partial melting of mantle wedge in the upper mantle under destructive plate margin. Crystallization differentiation of the basaltic magma would have produced the calc-alkaline andesitic magma. And the felsic rhyolitic magma seems to have been evolved from andesitic magma with crystallization differentiation of plagioclase, pyroxene, and hornblende.

A Study on the Design Criteria of Pedestrian Facility (Stairs) by Motion Analysis of Walking Parameters in the Elderly (고령자 보행변수 실측을 통한 보행시설물 설계기준 정립 1: 고령자 보행특성을 고려한 계단 챌면 높이 연구)

  • ROH, Chang-Gyun;PARK, Bum Jin
    • Journal of Korean Society of Transportation
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    • v.35 no.5
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    • pp.396-408
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    • 2017
  • In Korea, the number of elderly has been increasing rapidly. So it is also expected that the economic activity and the trip frequency of the elderly will increase. On the other hand, elderly related accidents such as falls during walking are steadily increasing and the satisfaction about pedestrian environment of elderly is very low. In this paper, we found one of the reasons for these dissatisfaction in pedestrian facility, which is not considering the walking ability (about 75% of non-elderly person) of the elderly. So, we analyze the kinematic walking characteristics of the elderly with the motion analysis system, when the elderly use stairs. As a result of analysis of various walking variables, the current standard for stairway height in Korean law (18cm) requires excessive force to elderly so it was difficult for elderly to keep the balance of the body in ascending and descending walk of stairs. In this paper, we propose the stair design criteria through the cluster analysis of walking parameters reflecting the gait characteristics of the elderly. This change is not a big for non-elderly person, but it can promote more socioeconomic activities for the elderly.

Study on the Shapes of Jung-kwa, Gi-kwa, Sin-kwa, Hyul-kwa (정기신혈과(精氣神血科)의 형상(形象)에 대한 연구)

  • Choi Byung-Tae;Choi Yung-Hyun;Baek Geun-Gi;Lee Yong-Tae
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.19 no.5
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    • pp.1181-1190
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    • 2005
  • After study about the shapes of Jung, Gi, Sin, Hyul-kwa advocated by Master Jisan, the conclusions are drawn as follows. It pursues the rules of universe being changed from formless to concrete objects that the Body Essence, Vital energy, Mentality, and Blood are materialized to Jung, GE, Sin, Hyul-kwa. It can be drawn an inference from the next three theories that Jisan considered Jung, Gi, Sin, Hyul-kwa as round, square, reverse triangle, and triangle or oval shape. First, it was taken to following the shapes of viscera. Namely Jung-kwa was taken as Kidney, Gi-kwa as Lung, Sin-kwa as Heart, Hyul-kwa as Liver. Second, it was adopted from five kinds of constitutions according to the five elements in [Yeongchu Yin and Yang twenty five shapes] that is Jung-kwa is purchased with Water-earth phases, Gi-kwa with metal phase Sin-kwa with fire phase, Hyul-kwa with Wood phase, Third, it is taken in order to eliminate contradictions. Hyul-kwa disliking to move is assumed to round shape to easily move. Gi-kwa tending to disperse is chosen to square in order to be unmoved. Sin-kwa declining to stagnate of seven emotions is pursued to reverse triangle to compose oneself. Hyul-kwa inclining to gather is preferred to acreage phase to harmonize ascending tendency. Among shapes which Jisan was divided Hado, Nakseo, Bokhee pal kwoe, Moonwang pal kwoe, Jung-kwa as round is Hado, Gi-kwa as square is Nakseo, Sin-kwa as reverse triangle is Bokhee pal kwoe order shape, Hyul-kwa as acreage phase or oval shape is accord with Moonwang pal kwoe order shape. The reason being classified into Jung, GE, Sin, Hyul-kwa from the shapes of the face is that the face is the place to reflect the whole conditions of the body connected with all of the viscera and meridian system such as semen of plants. Above contents are drawn an inference from the transcription of Jisan's lectures and his writings. And it is considered that insufficient parts of the Jisan's theory must be demonstrated continuously.

Clinical Review about Corrective Surgery of Tetralogy of Fallot (팔로사징증의 근치 수술에 관한 임상적 고찰)

  • 조광현
    • Journal of Chest Surgery
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    • v.24 no.7
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    • pp.674-684
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    • 1991
  • The surgical treatment of tetralogy of Fallot [TOF] was initiated by Blalock and Taussig in 1945 with the establishment of the subclavian artery to pulmonary artery anastomosis. In an imaginative and daring effort, in 1954, Lillehei and collaborators [1955] using controlled cross-circulation, carried out the first intracardiac repair of TOF by closing the ventricular septal defect [VSD] and relieving the pulmonary stenosis under direct vision. Nowadays, total correction is the ideal operation for treatment of TOF and is accomplished with extracorporeal circulation. And the results of surgery for TOF have steadily improved over the years, thanks to important contributions of many surgeons. Nevertheless because of its protean physiologic and anatomic presentation, TOF continues to offer challenges to cardiologist and cardiac surgeons. Thirty two cases of TOF have undergone total corrective surgery using extracorporeal circulation in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, Inje University, from Oct. 1985 to Feb. 1990. Clinical considerations were applied to these cases and the results were obtained as follows. 1. The heart lung machine used for extracorporeal circulation was SarnsO 7000, 5-head roller pump, and the number and type of oxygenators were 10 of bubble type and 22 of membrane type. The mean bypass time was 148.9 minutes and the mean aortic cross clamp time was 123.8 minutes. The GIK [glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 2. 20 cases were male and 12 were female, the mean age was 8 years old and the mean body weight was 25Kg. 3. The preoperative symptoms were cyanosis [29 cases], squatting [27 cases] and etc. The mean values of preoperative Hb., Hct., and SaO2 were 16.5 gm /dl, 50.3%, and 78.5%. 4. Combined anomalies were noticed in 16 cases [50%]. Among them 10 cases were PFO and 6 cases were ASD. 5. The degree of aorta overriding were 25% in 5 cases, 25 ~ 50% in 22 cases and above 50% in 5 cases. The dPA/Ao [ratio of diameter of pulmonary artery trunk to ascending aorta] were below 25% in 5 cases, 25 ~ 50% in 10 cases, 50 ~ 70% in 6 cases and above 75% in 11 cases. 6. The types of RVOT [right ventricular outflow tract] stenosis were valvular and infundibular in 14 cases [43.6%], diffuse hypoplastic type in 12 cases [37.5%], infundibular in 5 cases, and valvular and supravalvular in 1 case. 7. One stage radical corrective surgery was applied to the all cases. In widening of the RVOT, 3 types of patches were used: MVOP [monocusp ventricular outflow patch, Polystan BioprosthesesO] in 3 cases, knitted Dacron vessel patches in 2 cases, and double layer with bovine pericardium and woven Dacron prosthesis in 26 cases. 8. Postoperative complications were occurred in 15 cases. Among them, low output syndrome were occurred in 10 cases [31.3%] and 2 of them were expired postoperatively.

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The Diagnostic Significances of Serum Carcinoembryonic Antigen in Gastrointestinal Tract Cancers (위장종양(胃腸腫瘍)에 있어서 혈청(血淸) Carcinoembryonic Antigen의 진단적(診斷的) 의의(意義)에 관(關)한 연구(硏究))

  • Kim, Jong-Tae;Won, Kyung-Hee;Kim, Yul-Ja;Lee, Chong-Suk;Lee, Hak-Choong
    • The Korean Journal of Nuclear Medicine
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    • v.17 no.1
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    • pp.1-10
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    • 1983
  • Carcinoembryonic antigen (CEA) levels were measured in the serum of 35 normal control subjects and 179 cases of various benign and malignant gastrointestinal diseases. Malignant gastrointestinal tumors include 69 cases of stomach cancer, 24 cases of hepatoma and 33 cases of colorectal cancer. Benign gastrointestinal diseases include 29 cases of peptic ulcer and 24 cases of liver cirrhosis. The results were as followings: 1) Mean serum CEA level in normal control subjects was $6.9{\pm}3.3ng/ml$ and there was; no difference in mean serum CEA level between age and sex difference. 2) In malignant gastrointestinal tumors, mean serum CEA level in colorectal cancer, hepatoma and stomach cancer, were $54.3{\pm}88.9ng/ml,\;62.1{\pm}99.7ng/ml$ respectively. Serum CEA level showed positive rate of 67% in colorectal cancer, 63% in hepatoma and 62% in stomach cancer. There was no difference in mean levels and positivity of serum CEA between these 3 malignant tumor groups. 3) Positivity of serum CEA was 61% in malignant gastrointestinal tumor group in spite of 37% in benign gastrointestinal disease group. In both mean level and positivity of serum CEA, stomach cancer was much higher than peptic ulcer. But there was no difference in mean level and positivity of serum CEA level between hepatoma and liver cirrhosis. 4) In hepatoma serum CEA level showed positive rate of 62.5% and alpha-feto protein showed a rate of 58.3%. 5) Mean serum CEA levels in patients with cancer in rectal, cecal, sigmoid colon, ascending: colon and descending colon were $73.7{\pm}106.7ng/ml,\;69{\pm}84.8ng/ml$, $15.7{\pm}9.1ng/ml,\;7.5{\pm}10.6ng/ml$ and 4.0ng/ml respectively. Positive rate of serum CEA showed 86% in sigmoid. colon cancer, 68% in rectal cancer and 66% in cecal cancer. 6) In considering of histological background, there was no correlation between the degree of differentiation of tumor cell and the serum CEA level in colorectal cancer. According to Duke's classification, the mean serum levels of CEA were $8.8{\pm}11.4ng/ml$ in group A, $15.3{\pm}16.0ng/ml$ in group B and $68.5{\pm}101.5ng/ml$ in group C respectively. Positivity-of serum CEA in group A, Band C were 40%, 50% & 69% respectively. So there was significant correlation between the degree of elevation of serum CEA and tumor extension.

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Effects of Micro-topography on Vegetation Pattern in Dunchon-dong Wetland (둔촌동 습지에서 미지형이 식물 군락 구성에 미치는 영향)

  • Nam, Jong Min;Jeon, Seung-Hye;Choi, Ho;Kim, Jae Geun
    • Journal of Wetlands Research
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    • v.16 no.4
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    • pp.353-362
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    • 2014
  • The purpose of this study is to investigate the effect of micro-topography to vegetation pattern in Dunchon-dong wetland. To characterize the effect of micro-topography, changes in water level and vegetation pattern were monitored from 2007 to 2008. Depending on the relative elevation, the study site was divided into 4 sectors. The relative areas of sectors in ascending order were 11%, 10%, 18% and 24%, respectively. During investigation period, average water pH was 6.10 (${\pm}0.13$), electron conductivity was $51.5({\pm}6.0){\mu}s/cm$, $PO_4$-P, $NO_3$-N and $NH_4$-N concentration were $0.04({\pm}0.02)mg/L$, $0.14({\pm}0.07)mg/L$, and lower than 0.01mg/L, respectively. Water level was very changeable in low-water season because the area of lowest sector was small. This characteristic increased the effect of difference of accumulated precipitation from March to April in 2007 and 2008 to plant community composition in lower sectors. Different plant guilds dominated respective sectors and annual plants were major dominant species in the study site. This study suggested that the elevation gradients are necessary to create the habitats for various plant guilds in wetland.

Anaortic Off-pump Coronary Artery Bypass Grafting in Patients with Takayasu's Arteritis

  • Na, Kwon Joong;Lee, Kyung-Hak;Oh, Se Jin;Hwang, Ho Young;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.46 no.4
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    • pp.274-278
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    • 2013
  • Background: Coronary involvement in Takayasu's arteritis is a rare but fatal disease. The aim of this study was to evaluate the early and mid-term results of Takayasu's arteritis patients who underwent coronary artery bypass grafting (CABG). Materials and Methods: Of 2,280 patients who underwent isolated CABG from January 1998 to June 2012, Takayasu's arteritis was identified in 5 patients. There were 3 female patients, and the mean age was $58{\pm}9$ years. Takayasu's arteritis was diagnosed during preoperative evaluation for coronary artery disease in 4 patients, and the initial manifestation was angina pectoris in 4 patients. All of the patients underwent anaortic off-pump CABG (OPCAB) using the in situ left or right internal thoracic arteries (ITA); 3 patients had severe stenosis of the proximal left subclavian artery and the in situ right ITA was used instead. Medical treatment for inflammatory arteritis during the perioperative and follow-up period was performed if indicated. Early, 1-year, and 5-year angiographic results and clinical outcomes were analyzed. Results: There was no surgical mortality, and all of the patients were discharged without complications on postoperative $8{\pm}2$ days. Early postoperative (postoperative $2{\pm}1$ days) angiography demonstrated a graft patency of 100% (12 of 12 distal anastomoses). One-year ($13{\pm}3$ months) angiography was performed in 4 patients, and all of the grafts were patent (100%, 9 of 9 distal anastomoses). Conclusion: By performing anaortic OPCAB in patients with Takayasu's arteritis, we were able to avoid complications associated with manipulating an atherosclerotic and severely calcified ascending aorta. The early and mid-term graft patency of OPCAB in Takayasu's arteritis was maintained when concomitant with medical treatment.