• Journal of Chest Surgery
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• 제18권4호
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• pp.655-662
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• 1985

From January 1985 to July 1985, prosthetic heart valves were replaced in 5 patients at Keimyung University Dongsan Medical Center. The patients included three women and two men ranging in age from 22 to 41 years. Three mitral valve replacements, one aortic valve replacement and one double valve replacement [mitral and aortic valve replacement] were done at the first valve operations. Reoperation were performed 2 to 76 months after the first operations, Prosthetic valve endocarditis occurred in 3 patients, early in one and late in two and primary valve failure occurred in 2 patients. In operative findings, vegetation in prosthetic valve endocarditis and calcification in primary valve failure were found. All except one had relatively successful operative results. One died of early fungal prosthetic valve endocarditis due to relapsed prosthetic valve endocarditis with heart failure and block.

• Journal of Chest Surgery
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• 제29권8호
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• pp.822-827
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• 1996

소아에서 대동맥 판막 질환의 경우 합리적인 수술법인 Ross술식을 적용함에 있어,우리 나라의 경우 현실적으로 이용에 어려움이 있는 Ross술식에 필요한 동종이식 판막의 사용을 배제한다는 발상으로 10마리의 15 kg가량의 돼지를 이용 REV술식 등을 시행하고 3마리의 성공 례를 3개월 이상 사육하여 성돈이 된 후 그 판막의 발육 및 기능을 관찰하였다. 대동맥 및 폐동맥 등에 협착의 소견은 없었으며, REV술식으로 사용되었던 monocusp보철편의 변형 및 심한 석회화가 관찰되어 이미 판막으로의 기능 은 상실하였으나 발육에는 큰 지장이 없는 것이 확인되어 REV와 Ross술식의 병행 수술요법이 사람에 서도 적 용될 수 있을 것으로 사료되 며, 계속 석회화 방지에 관한 연구가 진행되면 더욱 좋은 성적을 기대할 수 있겠다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.55-69
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• 1987

The result of valve failure with the lonescu-Shiley pericardial xenograft was presented with the review of current knowledge. This study reviewed 557 patients, who underwent total of 683 lonescu-Shiley pericardial valve replacement from 1979 to 1985 at Seoul National University Hospital. There were 357 patients who had mitral valve replacement, 73 with aortic valve and 127 with double valve replacement. There were 35 operative deaths. The survivors were followed at OPD. There were 32 patients who had prosthetic valve failure, whose ages ranged from 11 to 58 years [mean 27.8] and their postop interval was 56 ~ 22 months [range; 6-87] The causes of valve failure are prosthetic valve endocarditis in 14, primary disruption or calcification in 13, paravalvular leakage in 4, and others in 2 patients. Redo valve replacement was done in 12 patients after a mean interval of 50 * 20 months. [range; 6-79 months] Actuarial analysis of late results indicates actuarial freedom from endocarditis at 6 year is 87.9 ~ 6.8%, and actuarial freedom from primary disruption or calcification or paravalvular leakage at 5 year is 84.4 * 2.3%. In this series, however, valve failure due to thrombosis is not included.

• Korean Journal of Radiology
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• 제23권10호
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• pp.998-1008
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• 2022

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan-Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02-6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion: Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.159-162
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• 2008

Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation, tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous, atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the atherosclerotic aorta.

• 한국식품위생안전성학회지
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• 제4권2호
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• pp.133-153
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• 1989

콜레스테롤과 Vitamin D2로 유발시킨 동맥경화증 랫트에 칠성장어유와 옥수수유의 급여에 따른 예방적 효과를 조사할 목적으로 다음 네 개의 식이군으로 나누어 실험한 바, 첫째군은 정상대조군, 둘째군은 콜레스테롤(40/kg) 과 Vitamin D2(300,000 IU/kg)를 시험개시 1일부터 연속적으로 4일간 투여한 동맥 경화증 대조군, 셋째군은 동맥경화증 유발 처치와 함께 15% 칠성 장어유 식이(w/w)를 8일간 급여한 칠성장어유 식이군, 넷째군은 동맥경화증 유발처치와 함께 15% 옥수수유 식이 (w/w)를 8일간 급여한 옥수수유 식이군으로 하여 다음과 같은 결과를 얻었다. 동맥경화증 대조군은 정상대조군에 비하여 혈청 중의 총지질, 인지질. 총콜레스테롤, HDL-cholesterol, LDL-chlesterol 치의 현저한 증가를 보였고 (p<0.01), 또한 심장의 중성지방 및 콜레스테롤치의 증가(p<0.01), 대동맥의 중성지방(p<0.01) 및 콜레스테롤치 (p<0.05)를 보였다. 한편 대동맥은 심한 손상으로 내피세포의 탈락 및 내막과 중막에 석회화, 괴사, 지방 침착을 보였고, 관상동맥은 석회화, 괴사, 백혈구의 침윤이 현저하게 관찰되었다. 칠성장어유 식이군은 정상대조군에 비하여 혈청 중성지방치의 r마소 (p<0.01), 혈청 HDL-cholesterol 치의 증가(p<0.01), 심장콜레스테롤치 (p<0.05),의 증가를 보였고, 동맥경화증 대조군에 비하여는 혈청 중의 총지질, 중성지방, 인지질, 총콜레스테롤, LDL-cholesterol , VLDL-cholesterol 치 (p<0.01), 및 LDL치의 감소(p<0.05), 또한 간장 콜레스테롤치의 증가(p<0.05), 심장의 중성지방 (p<0.01) 및 콜레스테롤치 (p<0.05)의 r마소, 대동맥 중성지방 (p<0.01) 및 콜레스테롤치 (p<0.05) 의 감소를 보였다. 또한 옥수수유 식이군에 비하여 혈청 총지질(p<0.05)의 감소, 총콜레스테롤 및 HDL-cholesterol 치의 감소 (p<0.01), 심장중성지방치의 감소 , 대동맥 중성지방치의 감소 (p<0.01)를 보였다. 한편 대동맥은 동맥경화증 대조군에 비하여 미약한 석회화와 괴사된 thru을 보였으나 칠성장어유 식이군에서와 같이 지방침착은 관찰되지 않았고 관상동맥에서도 동맥경화증 대조군에 비해 미약한 석회화와 괴사된 소견을 보였다. 이상의 결과에서 불포화지방산을 다량으로 함유한 칠성장어유 및 옥수수유는 동맥경화증 랫트에 있어 생체내 지질대사에 영향을 미침으로써 혈청지질치를 저하시키고 동맥벽내에 지방침착을 억제시켰으며, 이러한 효과는 n-6계 다불포화지방산을 많이 함유하고 있는 옥수수유보다 n-3rP 다불포화지방산을 다량으로 함유한 칠성장어유에 더욱 크게 나타났다

• 대한한의학회지
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• 제22권3호
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• pp.105-118
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• 2001

Objectives : The prescription of Semyung-Gangji-tang, designed for the treatment of hyperlipidemia and atherosclerosis, consists of herbs good for treating blood stasis and phlegm stagnancy. It invigorates the liver, kidneys and spleen. Its medical nature is not too cold or too hot and increases human vital energy. The purpose of this study is to examine the curative effects of Semyung-Gangji-tang on atherosclerosis in hyperlipidemic rabbits. Methods : Twenty-four male NZW rabbits, around 2kg of body weight, were divided into 4 groups. Group I served as the normal group. Group II served as the atherogenic model group, fed a 1 % cholesterol diet for 8 weeks and sacrificed. Group III served as the atherogenic control group, fed with a 1 % cholesterol diet for 8 weeks and with a normal diet for the next 4 weeks. Group IV served as the treatment group treated the same as the control group and medicated with Semyung-Gangji-tang for the last 4 weeks. Three animals of group I and six animals of group n were sacrificed at 8 weeks. Five animals of group I , five animals of group III and IV were sacrificed at 12 weeks. Pathological examinations and image analysis were performed on the collected tissue samples. Results : The percentage of lipid deposition area of thoracic aortas of group IV($41.74{\pm}8.93%$) at 12 weeks was decreased compared with the group III ($71.30{\pm}12.74%$) at 12 weeks, but a statistical difference was not observed. The percentage of group IV at 12 weeks was significantly decreased (P<0.05) compared with the group n ($76.41{\pm}7.43%$) at 8 weeks. Histopathologically, advanced atheromas with calcification of aortic arches were observed in all animals of the control group at 12 weeks, but were observed in 2 animals of the treatment group at 12 weeks. Histopathologically, atheromas with calcification of thoracic aortas were observed with major atherogenic lesions in control group at 12 weeks, but simple fibro-fatty streaks were observed major atherogenic lesions in treatment group at 12 weeks. Conclusions : These results indicate that Semyung-Gangji-tang has antiatherogenic effects on experimentally induced atherosclerosis in rabbits.

• Journal of Chest Surgery
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• 제24권7호
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• pp.663-668
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• 1991

To evaluate risks, complications and mortality of reoperations on heart valve prosthesis, we reviewed clinical records of 53 patients who underwent reoperation because of prosthetic valve failure[PVF], from Jan 1959 through Jun. 1991. They had undergone 48 mitral, 10 aortic valve rereplacement Primary tissue failure was the main cause of reoperation : it occurred in 51 valves at a mean postoperative interval of 58 months. Calcification and collagen disruption of prosthesis were main causes of primary tissue failure in macro and micropathology, In 3 failing mechanical prostheses, paravalvular leak was in 2 cases, another one case had the thrombi at the hinge portion. If conditions such as emergency operation with or without endocarditis, thromboembolism and advanced NYHA functional class are prevented, we think that reoperative valve replacement has similar morbidity and mortality to initial valve replacement surgery. But our sturdy represents higher mortality [22.6%] because of late surgical intervention failing the prevention of conditions leading to myocardial damage. In conclusion if the tearing, calcification, and a new murmur were detected the early reoperation should be considered to increase late survival.

• Journal of Chest Surgery
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• 제31권10호
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• pp.919-923
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• 1998

연구배경: 인체에 이식된 동종 혹은 이종조직은 궁극적으로 석회화 변성이 일어난다. 저자들은 독자적인 항석회화 처리법을 이용해 석회화에 내구성을 가진 심혈관용 조직첨포를 개발하였다. 재료 및 방법:도축장에서 채취한 신선한 소의 심막을 Hank 용액에 담아 실험실로 이송하였다. 불필요한 부분을 절제해 낸 심낭조직을 0.65% glutaraldehyde 용액(4$^{\circ}C$)에 1주일 동안 저장한 다음 phophate-buffered saline 용액(pH 7.4)로 세척하였다. 이후 2.5% 술폰산화 폴리에틸렌옥사이드(PEO-SO3) 용액으로 실온에서 2일 동안 처리한 다음 4$^{\circ}C$ NaBH4용액으로 16시간 동안 환원시켰다. 실험은 글루타르알데하이드 용액으로만 처리한 심막첨포와 항석회화 처리된 심막첨포를 각각 대조군(GA군, n=4)과 실험군(PEO-SO3군, n=4)으로 나누어 혈관벽에 이식하여 석회화 변성 정도를 비교하였다. 실험모델은 성견의 폐동맥과 대동맥 벽의 일부를 절제한 후 심막첨포로 재건하는 방법을 이용하였고, 수술 후 평균 1개월 째에 이식된 첨포를 적출하여 조직병리 변화와 칼슘 및 인 함량을 측정하였다. 결과: 실험군이 대조군에 비해 조직 위축 변성, 칼슘(폐동맥; 1.55$\pm$0.29 vs. 6.72$\pm$0.70 mg/g, 대동맥; 7.10$\pm$1.05 vs. 13.81$\pm$2.33 mg/g) 및 인의 침착량 (폐동맥; 2.58$\pm$0.40 vs. 12.60$\pm$3.40 mg/g, 대동맥; 8.11$\pm$1.07 mg/g vs. 19.33$\pm$4.31 mg/g)이 현저하게 적었다 (P<0.01). 결론:이상의 결과에서 PEO-SO$_3$로 처리한 조직첨포는, 비록 단기관찰 결과이지만, 충분한 석회화 내성을 보이며 이 조직첨포의 장기적인 안정성과 적합성에 대해서는 계속적인 연구가 필요할 것이다.

• Journal of Chest Surgery
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• 제13권4호
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• pp.422-434
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• 1980

Since 1968 up to the end of October 1980, 448 valves were replaced in 354 patients in Seoul National University Hospital. There were 238 mitral, 38 aortic, 7 tricuspid, 45 aortic with mitral, 23 tricuspid with mitral, and 3 triple valve replacement aortic mitral and tricuspid cases. Annual increase of mitral valve replacement cases and decrease of operative maortality were remarkable. Recently operative mortality of mitral valve replacement is about 5%. Sex ratio of mitral valve replacement is almost equal and there were 12 cases of pediatric patients (5%) among 238 cases, and patients under the age of 20 years were 34 (14.3%). Mitral valve replacement was done for 199 single mitral, 38 double valve and one triple valve lesions. Among 238 mitral valve replacement paients left atrial thrombus in 23(9.7%), atrial fibrillation in 132 (55.5%), and reoperation after blind mitral commissurotomy in 12(5%) cases were noted. In recent cases bioprosthetic valves, mainly lonescu-shiley valve were utilized to overcome the difficulties of postoperative late complications in anticoagnuation, especially for the rural patients and pediatric cases, in addition to the hemodynamic advantages of lonesocu valve. Among 354 patients 16 cases were congenital heart anomaly related, 5 ventricular septal defect related aortic and 4 Ebstein related tribuspid valve replacement cases. There were 2 congenital anomaly related mitral valve replacements, one for congenital mitral insufficiency of 7 years old boy and one for corrected transposition of the great vessels associated with mitral insufficiency. Among total 354 valve replacements 49 operative deaths (13.3%) were noted and in 238 mitral valve replacement 24 operative deaths occurred (10.1%). In 39 patients among 354 total valve replacements late complications were found. In 238 mitral valve replacement cases late complications were noted in 26 patients, among whom 16 cases expired. Main late complications were thrombe-embolism, subacute becteerial endocarditis, arrythmia cerebral hemorrhage due to unsatisfactory anticoagulation, and congestive heart failure in the incipient period of valve replacement were also noted. In mitral valve replacement cases long-term survival rate was 83.2% who showed marked clinical improvement. Ther were no evidences of calcification during the 2 years follow-up period for the lonescu-valve replacement cases among 19 pediatric patients. In conclusion 238 cases of mitral valve replacement were done with 24 operative deaths and 26 late complication cases among whom 16 expired. The long term survival was 83.2% of the cases. In pediatric cases in place of coumadin anticoagulation Persantin **** 75 and aspirin were administered after valve replacement. In adult cases who have difficulaties with coumadin anticoagulation and for those even with bioprosthetic heart valve replacement who needs long-term or permanent anticoagulation persantin 75 and aspirin combination regimen were administered with antisfactory results.