• Clinical and Experimental Pediatrics
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• v.50 no.5
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• pp.476-483
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• 2007

Purpose : The objective of this study was to assess ventricular function by tissue Doppler imaging (TDI) in children with congenital heart disease (CHD) who have been undergoing open heart surgery (OHS) using cardiopulmonary bypass. We tried to compare the parameters of tissue Doppler imaging before and after OHS in patients with congenital heart disease. Methods : This study was conducted on 32 patients with CHD after OHS from January 2005 to December 2005 at Kyungpook National University hospital. Patients who underwent 2-D echocardiography before and after their OHS. All patients were divided into three groups, left ventricular volume overloading group (group 1), and right ventricular volume overloading group (group 2), and right ventricular pressure overloading group (group 3). The TDIs were examined before and 1 to 3 months after OHS. Peak early diastolic (E), and peak late diastolic (A) velocity of transmitral flow were measured by pulsed wave Doppler examination. Peak systolic (Sm), peak early diastolic (Em), and peak late diastolic (Am) velocity in apical 4-chamber and 2-chamber views were measured by TDI. The author calculated E/Em ratio. Results : The patients were 14 boys and 18 girls and the average age of patients was 2 years and 3 months. The congenital heart diseases which have to get OHS were ventricular septal defect (13 cases), atrial septal defect (7), atrioventricular septal defect (3), isolated pulmonary stenosis (2) and tetralogy of Fallot (7). There were significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view (P<0.05). Conclusion : This study showed significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view after OHS. These changes might be due to the effects of cardiopulmonary bypass in OHS and/or hemodynamic changes after correction of congenital heart disease. To clarify these changes, further study on more patients is needed.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.53-57
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• 1999

We describe a case of successful extracorporeal membrane oxygenation(ECMO) in a small infant with cardiopulmonary resuscitation(CPR) failure after an open heart surgery. A 35-day-old male infant weighing 4.4 kg who had congestive heart failure and pulmonary hypertension underwent patch closure of ventricular septal defect without any intraoperative event. Postoperative course was unremarkable in the intensive care uint for about 5 hours before the junctional ectopic tachycardia developed. Sudden cardiac decompensation with bradycardia occurred about 50 minutes after the development of junctional ectopic tachycardia. He was put on ECMO by arterial cannulation at the ascending aorta and by venous cannulation at the right atrial appendage after 4 hours' CPR. The hemodynamics were stable with enough urine output during ECMO. He was weaned from ECMO 38.5 hours after initiation. Delayed sternal closure was attempted. He was extubated on postoperative day 7 and discharged home on postoperative day 21 without any neurologic sequelae.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.586-590
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• 2011

Three small breed dogs weighing less 5 kg were admitted with dyspnea and cardiac murmurs. One dog had primum type ASD and chylothorax was concurrently noted. Two dogs had secundum type ASD with and without concomitant pulmonic stenosis. Although medical treatment was attempted, two dogs with secundum type ASD died and a dog with primum type ASD was successfully managed with medication. Defects were confirmed by the postmortem examination in two cases. We first describe the comparison of clinical and diagnostic features in different anatomic, hemodynamic, and pathophysiological types of ASD in small breed dogs and they show some differences with ASD in large breed dogs.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.725-728
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• 2005

A case is described in a girl who presented with recurrent life-threatening hemoptysis at the age of 18 months, and had been diagnosed as atrial septal defect with severe cardiomegaly which was presumed to result in pulmonary vein stenosis at the age of 6 months. Closure of atrial septal defect was associated with decreased heart size and improved pulmonary venous flow. However, recurrent life-threatening hemoptysis occurred during follow-up, Computed tomography scan demonstrated left pulmonary vein stenosis and extrinsic compression of the left bronchus by multiple soft tissue density-masses. Exploratory thoracotomy revealed single stenotic left pulmonary vein, and flat left main bronchus compressed by multiple hypertrophied lymph nodes, Unexpected endotrachial tube bleeding during left hilar dissection mandated to proceed to left pneumonectomy, The patient's postoperative course was uneventful. Follow-up chest roentgenography revealed acceptable left hydrothorax without mediastinal shifting, Nevertheless, a long-term follow-up is necessary.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.361-363
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• 2009

A 17-year-old male patient was referred with symptoms of dyspnea. Multi-detector computerized tomography (MDCT) and echocardiography evaluation revealed quadricuspid aortic and pulmonary valves, an atrial septal defect (ASD), and pulmonary stenosis. We closed the ASD using a bovine patch and performed a commissurotomy of the pulmonary valve. Quadricuspid semilunar valves are very rare congenital abnormalities that are reported to occur nine times more frequently in the pulmonic valve than in the aortic valve. According to the Hurwitz Roberts classification, the aortic valve was type A, and the pulmonic valve was type B. The aortic valve normal function, but the pulmonic valve was stenotic and had abnormal function.

• Journal of Chest Surgery
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• v.56 no.6
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• pp.452-455
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• 2023

Patients who have undergone mechanical valve replacement require anticoagulation therapy with warfarin to prevent thromboembolism. However, administering warfarin to pregnant patients increases their risk of warfarin embryopathy or central nervous system disorders. Consequently, safer alternatives, such as heparin or low-molecular-weight heparin injection, are substituted for warfarin. However, limited research has been conducted on this subject, with no large-scale studies and particularly few investigations involving multiparous patients. A patient who had previously undergone mechanical mitral valve replacement for atrial septal defect and mitral stenosis received anticoagulant therapy with enoxaparin during 2 pregnancies. Upon confirmation of pregnancy, warfarin was replaced with subcutaneously injected enoxaparin with a dosage of 1 mg/kg at 12-hour intervals. The enoxaparin dosage was controlled using an anti-factor Xa assay, with a target range of 0.3-0.7 IU/mL. Intravenous heparin injections were administered starting 3 days prior to the expected delivery date and were continued until delivery, after which warfarin was resumed. No complications were observed during the deliveries.

• Journal of Chest Surgery
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• v.34 no.8
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• pp.626-629
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• 2001

Congenital polyvalvular disease is a connective tissue disorder affecting more than one heart valve with variable involvement of the entire valvular and subvalvular apparatus. It is frequently associated with the Trisomy 18 and trisomy 13-15 or ventricular septal defect and patent ductus arteriosus. We present an isolated case of congenital polyvalvular disease in a new born baby with a review of the pertinent literatures, which has not been described in Korea. The mass was discovered as a right atrial mass in the prenatal ultrasonography and it was thought to be either a hematoma or a myxoma in the preoperative echocardiography. Microscopic examination of the surgically resected mass showed irregular thickening, nodulation, and additional features of calcification and ossification in the valvular connective tissue on the body of anterior and septal leaflet of tricuspid valve. Congenital polyvalvular disease should be included in the differential diagnosis in cases showing valvular calcification or ossification in the fetal echocardiography.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.499-502
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• 2007

Left ventricular inflow obstruction can be caused by a persistent left superior vena cava (SVC) and a dilated coronary sinus. A 31-day-old male infant with secondum atrial septal defect (ASD) and bilateral SVC underwent an operation for treating his uncontrollable congestive heart failure. The preoperative 2-dimensional echocardiography showed a normally sized mitral valve shrouded by a dilated coronary sinus. The operation consisted of pericardial patch closure of the ASD, coronary sinus unroofing and left SVC transfer to the right atrial auricle. The postoperative course was complicated by persistent chylothorax, which was controlled by thoracic duct ligation, He was discharged to home at the postoperative day 39. He has been followed up for 9 months and has displayed normal development.

• Journal of Yeungnam Medical Science
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• v.13 no.2
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• pp.225-233
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• 1996

From August 1992 to July 1996, 63 consecutive patients underwent coronary artery bypass surgery. The mean age of these patient was 57 years(range form 30 to 71years). There were 44 men and 19 women. Preoperative 12 patients had stable angina pectoris and 23 patients were unstable angina pectoris. 8 patients had previous myocardial infarctation history and emergency or urgent myocardial revascularization were performed in 9 cases. In the risk factors of coronary atherosclerosis, 25 patients(40%) were hypercholesterolemia, 38 patients(60%) have smoking history and 19 patients(30%) have hypertension history. In the patterns of disease, 9 patients were single vessel disease, 18 patients were two vessele disease and 33 patients were three vessel disease. We performed total 284 distal anastomosis(mean 3.5 anastomosis per patient) and performed one case of ascending aorta graft interposition, two cases of mitral valve replacement, one case of aortic valve replacement, one case of ventricular septal defect repair and one case of atrial septal defect repair and the mean aortic cross clamp time was 115.3 minutes. The common complications were arrhythmia(7cases), wound infection(5cases), perioperative myocardial infarction(4cases), reoperation for bleeding control(4cases) and stroke(4cases). There were six hospital deaths due to low cardiac output syndrome, ventricular arrhythmia and respiratory failure. In the evaluation of operative risk factors, preoperative intravenous nitroglycerin requirement and prolonged aortic cross clamp tirne(>2hours) were found to be predective factor of morbidity and old age(>65years) was found to be predective factor of mortality.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.4
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• pp.200-204
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• 2006

Purpose: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique. Materials and Methods: We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions. Results: The mean Qp/Qs was $1.83{\pm}0.50$ by radionuclide, and $1.74{\pm}0.51$ by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.51, 0.74, 0.96, 1.57, and 1.50, respectively. Conclusion: There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.