• Journal of Chest Surgery
• /
• v.39 no.2 s.259
• /
• pp.91-98
• /
• 2006

Background: There are many different opinions regarding the proximal anastomotic sites of radial artery in coronary artery bypass surgery. Therefore, we compared the clinical and angiographic findings according to anastomosis of radial artery to develop a guideline. Material and Method: From January 2003 to December 2004, 48 patients who underwent coronary artery bypass surgery using radial artery in Kangdong Sacred Heart Hospital were studied for clinical and coronary angiographic findings and were divided into group I for radial artery that anastomsed to aorta independently and group II that anastomosed to left internal mammary artery. Result: Patients in group I were 33 (men 26, women 7; mean age 61.93$\pm$6.56) and group II were 15 (men 13, women 2; mean age 59.53$\pm$6.02) and there was no difference in preoperative characteristics. Patients in group I had longer cardiopulmonary bypass time (169.36$\pm$40.28 versus 139.40$\pm$20.45, p=0.026) and patients in group II had more sequential grafts with RA per patients (5/33 versus 11/15, p < 0.05). Patients in group I used more vein graft for distal anatstomosis (47/117 ($40\%$) versus 9/48 ($18\%$), p=0.011) and there was no difference in perioperative outcome and overall survival. Mean follow-up time was 15.87$\pm$7.33 (1 to 28) months in patients of the group I and 21.40$\pm$2.85 (17 to 25) months in group II. Postoperative coronary angiography was performed 17/33 ($51.5\%$) in group I and 14/15 ($93.3\%$) in group II. Early perfect patency rate was not statistically different in left anterior descending artery (15/17 ($88.2\%$) versus 2/14 ($85.7\%$), p=1.00) and radial artery (17/20 ($85\%$) versus 30/30 ($100\%$), p=0.058). Late mortality was 1/33 ($3.0\%$) in group I and 1/15 ($6.7\%$) in group II. Conclusion: There was no difference in terms of clinical and postoperative angiographic findings except in cardiopulmonary bypass time, the number of sequential grafts with the RA per patients and the number of the used vein graft.

• Journal of Chest Surgery
• /
• v.39 no.2 s.259
• /
• pp.99-105
• /
• 2006

Background: Interrupted aortic arch is a rare congenital heart anomaly which still shows high surgical mortality. In this study, we investigated the causes of and the risk factors for mortality to improve the surgical outcomes for this difficult disease entity. Material and Method: From 1984 to 2004, 42 patients diagnosed as IAA were reviewed retrospectively. Age, body weight at operation, preoperative diagnosis, preoperative PGE1 requirement, type of interrupted aortic arch, degree of left ventricular outflow stenosis, CPB time, and ACC time were the possible risk factors for mortality. Result: There were .14 hospital deaths. Preoperative use of PGE1, need for circulartory assist and aortic cross clamp time proved to be positive risk factors for mortality on univariate analysis. Preoperative left ventricular outflow stenosis was considered a risk factor for mortality but it did not show statistical significance (p-value=0.61). Causes of death included hypoxia due to pulmonary banding, left ventricular outtract stenosis, infection, mitral valve regurgitation, long cardiopulmonary bypass time and failure of coronary transfer failure in TGA patients. Conclusion: In this study, we demonstrated that surgical mortality is still high due to the risk factors including preoperative status and long operative time. However preoperative subaortic dimension was not related statistically to operative death statistically. Adequate preoperative management and short operation time are mandatory for better survival outcome.

• Journal of Chest Surgery
• /
• v.36 no.8
• /
• pp.566-575
• /
• 2003

We reviewed our 18-year surgical experience of biventricular repair for double-outlet right ventricle. Material and Method: One hundred twelve consecutive patients (80 males and 32 females) who underwent biventricular repair for double-outlet right ventricle between May 1986 and September 2002 were included. We assessed risk factors for early mortality and reoperation. Reoperation-free survival rate and actual survival rate were analysed. Result: Most common type of ventricular septal defect was subaortic (n=58, 52%) and non-committed type was second most common (n=32, 29%). Four different surgical methods were used: intraventricular baffle repair (n=71 , 63%): right ventricle to pulmonary ariery conduit interposition or REV with left ventricle to aorta baffle repair (n=24, 21 .4%): arierial switch operation with left ventricle to pulmonary artery baffle (n=14, 12.5%): Senning atrial switch operation with left ventricle to pulmonary artery baffle (n=3, 2.7%). Thirty four patients(30%) underwent palliative procedures before definite repair. Twenty three patients (21%) required reoperations. There were 12 (10.7%) early deaths and 4 late deaths. Age younger than 3 months at repair (p=0.003), cardiopulmonary bypass and aortic cross clamp time (p=0.015, p=0.067), type of operation (arterial switch operation) (p <0.001) and type of ventricular septal defect (subpulmonic type) (p=0.002) were revealed as risk factors for early death in univariate analysis, while age under 3 months was the only significant risk factor in multivariate analysis. Patients younger than 1 year of age (p=0.02), pulmonary artery angioplasty at definitive repair (p=0.024), type of ventricular septal defect (non-committed) (p=0.001), type of operation (right ventricle to pulmonary artery conduit interposition and REV operation) (p=0.028, p=0.017) were risk factors for reoperation in univariate analysis but there was no significant risk factor in multivariate analysis. Follow-up was available on 91 survivals with a mean duration of 110.8$\pm$56.4 (2~201) months. 5, 10 and 15 year survival rates were 86.5%, 85% and 85% and reoperation free survival were 85%, 71.5%, 70%. Conclusion: Age under 3 months at repair, subpulmonic ventricular septal defect and arterial switch operation were significant risk factors for early mortality. Patients with non-committed ventricular septal defect and who underwent conduit interposition or REV operation were risk factors for reoperation. With careful attention to chose best timing and surgical approach depending on morphologic characteristics, biventricular repair for double outlet right ventricle can be achieved with good long-term outcome.

• Journal of Chest Surgery
• /
• v.37 no.1
• /
• pp.35-42
• /
• 2004

Background: For the treatment of isolated left main coronary artery disease, twelve arterial revascularizations with Y-composite grafts using left internal thoracic artery and radial artery or right gastroepiploic artery were peformed. This study was performed to investigate whether V-composite graft can satisfy the blood flow required to make myocardium act properly or not. Borderline stenotic lesions on the left main coronary artery, which are very prone to remodel the bypassed vessels due to competitive flows, were also considered. Material and Method: Among 247 patients who underwent coronary artery bypass grafting from March 2000 to April 2003, 12 patients (4.7%) who had received total arterial revascularizations for the isolated left main coronary artery disease were studied retrospectively. Result: left anterior descending arteries were bypassed with left internal thoracic artery by off-pump technique in all patients, however, 2 cases of left obtuse marginal branches were bypassed under on-pump beating heart. Except for one patient, who did not have an obtuse marginal branch more than 1 mm in diameter, 11 patients had gone through complete arterial revascularizations by use of the Y shape arterial graft. Among five patients who had less than 75% stenosis, one patient showed string sign on left internal thoracic artery grafted to left anterior descending artery. However, two grafts to obtuse marginal blanches were completely obstructed and one showed slender sign. There were no graft-dominant flow in patients with stenotic lesion less than 75%. On the contrary to the result of patients with stenotic lesions less than 75%, all the patients with stenotic lesions more than 90% showed graft-dominant blood flow. Conclusion: In conclusion, it is assumed that, when stenotic lesions are over 90%, coronary artery bypass grafting with an Y shape arterial graft could possibly give enough help to the obstructed coronary arteries in blood supplying to myocardium, which needs massive quantity of blood to act well. However, when patients have borderline stenoses, through scrupulous examinations, more prudent and flexible decisions are required in choosing the treatment methods, such as, direct anastomosis of vein or artery to aorta, or adding supplementary treatment methods like percutaneous coronary intervention, rather than choosing a fixed treatment methods.

• Journal of Chest Surgery
• /
• v.35 no.3
• /
• pp.171-176
• /
• 2002

Background: Blood-foreign interaction cause activation of coagulation and inflammatory process that may lead to multiorgan dysfunction and determine the surgical outcomes. Of the methods for assessing the biocompatibility, the platelet adhesion study is considered as the most valuable evaluation step in blood-foreign interaction. As the most studies have used in-vitro or ex-vivo conditions, we have developed a technique of quantification for platelet adhesion on the blood contact surface by using in-vivo injection of radioactive platelets. Material and Method: A coupled bypass circuit was designed to connect the proximal and descending thoracic aorta in 6 piglets(20∼25 Kg). One side of the circuit tube was consisted of a heparin coated PVC tube(10mm in ID, n=6, Experimental group), and the other, a non-heparin coated PVC tube(10mm in ID, n=6, Control group). After cannulation, the blood was circulated through the circuit for 2 hours. Platelet concentrate was prepared from homologous pig blood 24 hours before the experiment. The platelet concentrate was incubated with Tc-99m-HMPAO for 30 min and then centrifuged for 10 min. The supernatant was discarded and the radio-labeling efficacy was measured. The radio-labeled platelet concentrate was mixed with the autologous plasma to make the volume 5 ml, and the mixture was injected intravenously into the experimental animal. After 2 hour circulation, 5 pieces of the specimen(10mm in length each) were obtained from each PVC tube. The radioisotopes were counted with a gamma counter(Cobra ll, Packard, USA), and the ratio of radioisotope count was compared between the control and experimental group. Result: The radioisotope count number was 537.3221.1 Ci/min in the control group and 311.1 184.5 Ci/min in the experimental group(p=0.0104). The ratio between the groups was 1 to 0.58 (p=0.004). Conclusion: In vivo quantification using technetium-99m-HMPAO labeled platelets is simple and reproducible in evaluating platelet adhesion on a foreign surface. We suggest this technique to be a useful tool for blood compatibility test.

• Nuclear Medicine and Molecular Imaging
• /
• v.40 no.3
• /
• pp.169-176
• /
• 2006

Purpose: According to the development of CT scanner in PET/CT system, the role of CT unit as a diagnostic tool has been more important. To improve the diagnostic ability of CT scanner, it is a key aspect that CT scanning has to be performed with high dose energy and intravenous (IV) contrast. So we investigated the effect of IV contrast media on the maximum SUV (maxSUV) of normal tissues and pathologic lesions using PET/CT scanner with high dose CT scanning. Materials & Methods: The study enrolled 13 patients who required PET/CT evaluation. At first, the patients were performed whole body non-contrast CT (NCCT-120 kVp, 130 mAs) scan. Then contrast enhanced CT (CECT) scan was performed immediately. Finally PET scan was followed. The PET omission data were reconstructed twice, once with the NCCT and again with the CECT. We measured the maxSUV of 10 different body regions that were considered as normal in ail patients. Also pathologic lesions were investigated. Results: There were not seen focal artifacts in PET images based on CT with IV contrast agent. Firstly, 130 normal regions in 13 patients were evaluated. The maxSUV was significantly different between two PET images (p<0.00)). The maxSUV was $1.1{\pm}0.5$ in PET images with CECT-corrected attenuation and $1.0{\pm}0.5$ in PET images with NCCI-corrected attenuation. The limit of agreement was $0.1{\pm}0.3$ in Bland-Altman analysis. Especially there were significant differences in 6 of 10 regions, apex and base of the right lung, ascending aorta, segment 6 & segment 8 of the liver and spleen (p<0.05). Secondly, 39 pathologic lesions were evaluated. The maxSUV was significantly different between two PET images (p<0.001). The maxSUV was $4.7{\pm}2.0$ in PET images with CECT-corrected attenuation and $4.4{\pm}2.0$ in PET images with NCCT-corrected attenuation. The limit of agreement was $0.4{\pm}0.8$ in Bland-Altman analysis. Conclusion: Although there were increases of maxSUVs in the PET images based on CT with IV contrast agent, it was very narrow in the range of limit of agreement. So there was no significant effect to clinical interpretation for PET images that were corrected attenuation with high dose CT using IV contrast.

• The Korean Journal of Nuclear Medicine
• /
• v.32 no.2
• /
• pp.121-128
• /
• 1998

Purpose: $Na^+-K^+$ ATPase activity has been estimated by the degree of inhibition of cation transport by cardiac glycosides (ouabain) using Rb-86 as a substrate. The biological characteristisc of T1-201 is known to be similar to those of potassium as a transport substrate in the presence of glucose, insulin or phobol myristate acetate (PMA). The purpose of this study was to measure ouabain sensitive $Na^+-K^+$ ATPase activity using T1-201 and compare with that using Rb-86. Materials and Methods: Smooth muscle cells isolated from rat aorta or human placental umbilical artery were cultured, and used to measure cellular $Na^+-K^+$ ATPase activity. $Na^+-K^+$ ATPase activity was measured as a percentage decrease in cellular uptake of T1-201 or Rb-86 by ouabain under the presence of glucose, insulin or PMA in media. Results: $Na^+-K^+$ ATPase activity measured with T1-201, as a transport substrate, was not different from those measured with Rb-86 in rat or human smooth muscle cell preparation. Incubation with high concentration glucose resulted in about 30% decrease in enzyme activity. In contrast, insulin or PMA resulted in 10-70% or 28% increases from baseline activity, respectively. Conclusion: These results suggests that 71-201 could replace Rb-86 in measurement of ouabain sensitive $Na^+-K^+$ ATPase activity in vitro. High level of glucose concentration decreased cellular $Na^+-K^+$ ATPase activity, but insulin or PMA increased it.

• Journal of Chest Surgery
• /
• v.41 no.2
• /
• pp.229-238
• /
• 2008

Background: Protection of the brain is a major concern during thoracic aortic surgery using hypothermic circulatory arrest (HCA). This study compares the surgical outcomes of two different cerebral protection methods in thoracic aortic surgery using HCA: retrograde cerebral protection (RCP) and antegrade cerebral protection (ACP). Material and Method: We retrospectively reviewed data on 146 patients who underwent thoracic aortic surgery from May 1995 to February 2007 using either RCP (114 patients, Group 1) or ACP (32 patients, Group 2) during HCA. There were 104 dissections (94 acute and 10 chronic) and 42 aneurysms (41 true aneurysms and 1 pseudoaneurysm), and all patients underwent ascending aortic replacement. There were 33 cases of hemiarch replacement, 5 of partial arch replacement, and 21 of total arch replacement. Result: The two groups were similar in preoperative and operative characteristics, but Group 2 had more elderly (over 70 years old) patients (34.4% vs. 10.5%), more coronary artery diseases (18.8% vs. 4.4%), more total arch replacements (46.9% vs. 5.3%) and longer HCA time ($50{\pm}24$ minutes vs. $32{\pm}17$ minutes) than Group 1. The operative mortality was 4.4% (5/114) and 3.1% (1/32), the incidence of permanent neurologic deficits was 5.3% (6/114) and 3.1% (1/32), and the incidence of temporary neurologic deficits was 1.8% (2/114) and 9.4% (3/32) in Groups 1 and 2, respectively. There were no statistical differences between the two groups in operative mortality, postoperative bleeding, or neurologic deficits (permanent and temporary). Conclusion: The early outcomes of aortic surgery using HCA were favorable and showed no statistical difference between RCP and ACP. However, the ACP patients endured longer HCA times and more extended arch surgeries. ACP is the preferred brain protection technique when longer HCA time is expected or extended arch replacement is needed.

• Development and Reproduction
• /
• v.5 no.1
• /
• pp.39-45
• /
• 2001

Black rockfish Sebastes schlegeli is one of scopaenid fish giving birth to yolk-sac larvae and distributed around the coast of Korea and Japan, and is one of main species which is cultured in Korea. The difffrentiation of thyroid gland and the changes of thyroid hormones (THs) concentrations in the whole body during early development of this species were examined and the relationship between thyroid gland and their growth will be presented. Total length (TL) and body weight (BW) of the larva at the parturition were 6.3${\pm}$0.1 mm and 3.6${\pm}$0.1 mg, respectively. The larvae transformed to juvenile after 30th day after parturition. According to Hoshiai(1977), they had gown into stage Fl (TL 13.2${\pm}$0.9 mm, BW 46.5${\pm}$1.5 mg) at 50th day. The thyroid gland of black rockfish was first observed histologically in hatching larvae in mother fish. The larvae just after parturition have 1${\sim}$3 of the thyroid follicles diffrentiated between basibranchial bone and ventral aorta, at the base of the first gill arch. In this time, thyroid follic1e number (TFN),thyroid follicle diameter (TFD) and thyroid cell height (TCH) were 1.6${\pm}$0.8 pieces/inds., 18.1${\pm}$0.6 ${\mu}$m and 4.1${\pm}$0.2 ${\mu}$m, respectively. TFN and TFD at 50th day were increased to 32.5${\pm}$6.9 pieces/inds. and 41.5${\pm}$1.7 ${\mu}$m, respectively. These results indicate that they are related to the growth of black rockfish during early development. However, TCH indicates that the activity of thyroid gland appearedat special day, eg. 5, 20 and 50th day, suggesting that TCH may have some role in the physiological activity. L-thyroxine (T$_4$)concentration decreased sharply to 10 days after parturition, and at 25th day (metamorphosis stage) increased markedly to 3.44${\pm}$0.93ng/g fish. After this time, T$_4$ concentration decreased at 35th day, but then increasedagain to the highest concentration, 5.63${\pm}$0.70ng/g fish. 3,5,3'-triiodo-L-thyronine (T$_3$) concentration declined sharply from just after pafurition (4.96${\pm}$1.90 ng/g fish) to 5th day (0.30${\pm}$0.07 ng/g fish). However T$_3$ concentration increased markedly to 0.95${\pm}$0.11 ng/g fish at 30th day and then did not significantly change until 45th day, increased also sharply to 1.67${\pm}$0.23 ng/g fish at 50th day.

• Applied Microscopy
• /
• v.32 no.2
• /
• pp.91-105
• /
• 2002

Urea transport in the kidney is mediated by a family of transporter proteins that includes renal urea transporters (UT-A) and erythrocyte urea transporters (UT-B). The cDNA of five isoforms of rat UT-A, UTA1, UT-A2, UT-A3, UT-A4, and UT-A5 have been cloned. The purpose of this study was to examine the expression of UT-A (L194), which marked UT-A1, UT-A2 and UT-A4. Male Sprague-Dawley rats, weighing approximately 200 g, were divided into three group: control rats had free access to water, dehydrated rats were deprived of water for 3 d, and water loaded rats had free access to 3% sucrose water for 3 d before being killed. The kidneys were preserved by in vivo perfusion through the abdominal aorta with the 2% paraformaldehyde-lysine- periodate (PLP) or 8% paraformaldehyde solution for 10 min. The sections were processed for immunohistochemical studies using pre-embedding immunoperoxidase method and immunogold method. In the normal rat kidney, UT-A1 was expressed intensely in the cytoplasm of the inner medullary collecting duct (IMCD) cell and UT-A2 was expressed on the plasma membrane of the terminal portion of the shortloop descending thin limb (DTL) cells (type I epithelium) and of the long-loop DTL cells (type II epithelium) in the initial part of the inner medulla. Immunoreactivity for UT-A1 in the IMCD cells, was decreased in dehydrated animals whereas strongly increased in water loaded animals compared with control animals. In the short-loop DTL, immunoreactivity for UT-A2 was increased in intensity in both dehydrated and water loaded groups. However, in the long-loop DTL of the outer part of the inner medulla, immunoreactivity for UT-A2 was markedly increase in intensity in dehydrated group, but not in water loaded group. In conclusion, in the rat kidney, UT-A1 is located in the cytoplasm of IMCD cells, whereas UT-A2 is located in the plasma membrane of both the short-and long-loop DTL cells. Immunohistochemistry studies revealed that UT-A1 and UT-A2 may have a different role in urea transport and are regulated by different mechanisms.