• 보건행정학회지
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• 제13권4호
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• pp.115-130
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• 2003

Reperfusion delay in patients with acute myocardial infarction leads to increased morbidity and mortality. We sought to measure the rates of reperfusion delay and to identify factors associated with reperfusion delay after arrival to hospitals. We included 360 patients who had acute myocardial infarction with ST-elevation or left bundle branch block on electrocardiogram and received reperfusion therapy from the three participating academic medical centers from 1997 to 2000. Through retrospective chart review, we collected data about time to reperfusion therapy, patient and hospital factors potentially associated with reperfusion delay. Factors independently associated with reperfusion delay were determined by logistic regression analysis. Median door­to­needle time was 60.0 minutes, and median door­to­balloon time was 102.5 minutes. According to recommendation of the American College of Cardiology/American Heart Association Guidelines, 226 out of 264(85.6％) of thrombolytic patients and 43 out of 96(44.8％) percutaneous transluminal coronary angioplasty(PTCA) patients experienced reperfusion delay. The significant factors associated with delay were type of reperfusion therapy, patient factors including hypertension and delayed symptom onset to presentation(>4 hours), and hospital factors including nocturnal presentation(6pm∼8am), weekend, and an individual hospital. A significant proportion of patients experienced reperfusion delay. The identified predictors of reperfusion delay may help design a hospital system to reduce the delay in reperfusion therapy

• Journal of Chest Surgery
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• 제21권4호
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• pp.630-640
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• 1988

We clinically evaluated 222 cases of ventricular septal defect which we experienced at Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital between July 1981 and March 1988. These patients were occupied 46.2% of all congenital heart disease operated on its same period. Of 222 cases, 132 patients were male and 90 patients were female. Their age distribution ranged from 8 months to 34 years of age and their mean age was 10.3 years. Among these patients, 86 patients had associated cardiac anomalies, which were patent foramen ovale 43 cases[19.5%], Atrial septal defect 18 cases[8.1%], patent ductus arteriosus 8 cases[3.6%], aortic insufficiency 7 cases[3.2%], infundibular pulmonary stenosis 5 cases[2.3%] and etc. There was statistically significant correlationship between VSD size and Qp/Qs, Rp/Rs, Pp/Ps respectively. All cases were operated under cardiopulmonary bypass and 157 patients[70.7%] would be corrected through right atrial approach. 158 patients[71.2%] underwent closure of ventricular septal defect with primary closure and the remained patients[28.8%] with patch closure. In anatomical classification by Kirklin, type I constituted 23.4%, type II 73.4%, type III 0.5%, type I and type II 1.4%, and type II and type III 1.4%. Important postoperative EGG changes were noted in 57 cases[25.7%] and incomplete right bundle branch block was most common[12.6%]. 54 patients[24.3%] developed minor and major postoperative complications and 9 patients died of several complications and overall operative mortality was 4.1%.

• 대한임상독성학회지
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• 제2권1호
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• pp.7-11
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• 2004

Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.

• 대한핵의학회지
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• 제28권1호
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• pp.44-51
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• 1994

연구배경 : 정상적인 자극전도계를 통한 좌심실과 우심실의 전기적 활성은 거의 동시에 일어나지만 심실내에 자극전도 장애가 있는 경우 비정상적인 수축이 있게 된다. 이러한 변화는 자극전달의 속도가 빠르고 복잡하여 정량화 할 수 없었다. 이에 심실내 전도장애가 있는 환자를 대상으로 방사성동위원소 심장풀스캔(radionuclide gated blood pool scan, GBPS)을 이용한 위상분석(phase image analysis)을 통하여 비정상적인 수축정도를 정량화하고자 하였다. 방법 : 심실내 전도장애 환자 및 조기수축증후군환자에서 방사능동위원소 심장풀스캔을 이용하여 심전도상 전도장애를 보인 환자를 대상으로 좌심실 구혈률, 위상각, 위상각의 표준편차, 전체반값폭, 위상각의 범위를 측정하였으며 비정상적으로 수축하는 과정을 위상영상분석을 통하여 심실의 비정상적으로 수축하는 과정을 비교 분석하였다. 결과 : 좌각블록환자에서는 위상각의 포준편차, 전체 반값폭, 위상각의 범위는 정상대조군에 비하여 유의한 차이를 보였으나 우각블록환자에서는 대조군과 차이가 없었다. WPW 증후군환자에서는 위상각의 표준편차와 위상각의 범위는 유의하게 증가하였고 전체반값폭은 정상대조군에 비하여 차이가 없었다. 정상심전도를 보인 환자에서는 위상각의 지연없이 좌심실과 우심실을 거의 동시에 심장수축을 유발하는 것을 관찰한 반면 좌각블록을 가진 환자에서는 RV에 비하여 늦은 LV의 phase을 보였고, 우각블록을 가진 환자에서는 LV에 비하여 늦은 RV phase을 보였다. 또한 WPW 증후군환자의 77%에서 Kent bundle의 위치를 영상분석으로 추정할 수 있었다. 결론 : 이상의 결과로 GBPS의 위상영상분석은 심전도장애 및 조기수축증후군 환자에서 위상영상을 통하여 심장의 활성화 과정을 알아볼 수 있었으며 위상영상히스토그램을 통하여 이를 정량화하여 심실내 전기적 활성의 비동시성 여부를 추적관찰 할 수 있는 비관혈적검사임을 확인하였다.

• Korean Circulation Journal
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• 제52권12호
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• pp.865-875
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• 2022

Background and Objectives: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure. However, in pediatric and congenital heart disease (CHD) patients, current adult indications cannot be directly applied because of heterogeneity in anatomy and diagnosis. Therefore, CRT responses and clinical outcomes in these patients were investigated to derive possible candidates for CRT. Methods: This study retrospectively analyzed 16 pediatric and CHD patients who underwent CRT implantation at a single center in early (0.7±0.2 year) and late (4.7±0.3 years) follow-up period after CRT. Results: The median age at CRT implantation was 2.5 (0.3-37.2) years, and median follow-up duration was 6.3 (0.1-13.6) years. Thirteen had non-transvenous CRT. Two had congenital complete atrioventricular (AV) block with previous right ventricular pacing, 5 had dilated cardiomyopathy (DCM) with left bundle branch block, and 9 had CHD. The mean ejection fraction of the systemic ventricle increased from 28.1±10.0% to 44.3±21.0% (p=0.003) in early and 51.8±16.3% (p=0.012) in late outcome. The mean functional class improved from 3.1±0.9 to 1.8±1.1 after CRT (p=0.003). Twelve patients (75%) showed improvement in ventricular function or functional class after CRT. Proportion of responders differed between patients without CHD (2/2 patients with complete AV block and 5/5 with DCM, 100%) and those with CHD (5/9, 56%), although statistical significance was not reached (p=0.088). Conclusions: CRT improved ventricular function and functional status according to the underlying condition in pediatric and CHD patients. However, further large and longer-term studies are needed to establish the guideline for the patient selection of CRT in these patients.

• Journal of Chest Surgery
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• 제22권4호
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• pp.620-629
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• 1989

A clinical analysis of 138 cases of ventricular septal defect operated on from 1983 to June 1988 at the department of Thoracic and Cardiovascular Surgery, School of Medicine, Chung-nam National University was done. The following results were obtained. 1. The VSD were 27.6 % and 41.0 % respectively of 500 open heart surgery cases and 334 congenital heart disease. 2. The range of age when the VSD was repaired was 3 months to 45 years, the mean age was 10.4 years and the 53.6 % of patients were under 7 years. The sex ratio was 6:4 in males favor. 3. The two common symptoms were frequent upper respiratory infection and dyspnea whose frequency was 62.5 % and 58.7% respectively. 4. 52% of the patients was below 25 percentile of the standard body weight. 5. The most common chest PA findings were cardiomegaly and increased pulmonary vascularity. 6. On anatomical classification, perimembranous type was most common [65.5%], subpulmonary arterial type was 27.6 %, perimembranous plus subpulmonary arterial type was 3.4 % multiple VSD was 0.8 % and LV-RA defect was 2.6 %. 7. Associated cardiac anomalies were founded in 39 cases [35.5 %] and PDA and aortic valve prolapse were most common associated anomalies and extracardiac anomalies were founded in 6.7 % of patients. 8. Mean extracorporeal circulation time was 68 min. and mean aortic cross-clamping time was 42 min. 9. The postoperative complications developed in 26 % of patients and the most common one was minor wound infection. 10. Right bundle branch block developed in 54.8% of the patients who had right ventriculotomy, 40.0% of the patients who had right atriotomy and 10.5% of the patients who had pulmonary arteriotomy. 11. The overall operative mortality was 5.1 % and the operative mortality of the patients who body weigh under 10 Kg was 23.8%.

• Journal of Cardiovascular Imaging
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• 제30권4호
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• pp.307-319
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• 2022

BACKGROUND: Current guidelines indicate electrical dyssynchrony as the major criteria for selecting patients for cardiac resynchronization therapy, and 25-35% of patients exhibit unfavorable responses to cardiac resynchronization therapy (CRT). We aimed to evaluate different cardiac mechanical dyssynchrony parameters in heart failure patients using current echo-Doppler modalities and we analyzed their association with electrical dyssynchrony. METHODS: The study included 120 heart failure with reduced ejection fraction (HFrEF) who underwent assessments for left ventricular mechanical dyssynchrony (LVMD) and interventricular mechanical dyssynchrony (IVMD). RESULTS: Patients were classified according to QRS duration: group I with QRS < 120 ms, group II with QRS 120-149 ms, and group III with QRS ≥ 150 ms. Group III had significantly higher IVMD, LVMD indices, TS-SD speckle-tracking echocardiography (STE) 12 segments (standard deviation of time to peak longitudinal strain speckle tracking echocardiography in 12 LV-segments), and LVMD score compared with group I and group II. Group II and group III were classified according to QRS morphology into left bundle branch block (LBBB) and non-LBBB subgroups. LVMD score, TS-SD 12 TDI, and TS-SD 12 STE had good correlations with QRS duration. CONCLUSIONS: HFrEF patients with wide QRS duration (> 150 ms) had more evident LVMD compared with patients with narrow or intermediate QRS. Those patients with intermediate QRS duration (120-150 ms) had substantial LVMD assessed by both TDI and 2D STE, regardless of QRS morphology. Subsequently, we suggest that LVMD indices might be employed as additive criteria to predict CRT response in that patient subgroup. Electrical and mechanical dyssynchrony were strongly correlated in HFrEF patients.

• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.221-227
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• 1986

영남대학교 의과대학 흉부외과학교실에서는 1984년부터 1986년까지 총 99명의 심실중격 결손증 환자들을 수술 치험하였던 바 다음과 같은 결론을 얻었다. 1. 남여비는 1.2 : 1로 남자가 약간 많았다. 2. 연령분포는 다양하였으며 전체의 $\frac{2}{3}$가 3세에서 12세 사이였다. 3. 체중분포는 10kg미만이 13예이고 21kg이상이 44 예였다. 4. 입원시 주소는 잦은 상기로 감염증이 78예로 제일 많은 빈도를 보였다. 5. 심도자 검사상 폐 체동맥압비가 0.75이상인 경우가 6명, 폐 체 혈관 저항비가 0.5 이상인 경우는 0명, 폐 체 혈류량비가 3이상인 경우가 13명으로 대부분이 중등도의 병변을 보였다. 6. 동반된 심기형은 개방성 난원공, 폐동맥 협착증, 개방성 동맥관 등의 순이었다. 7. 심실중격 결손의 부위는 막변연 유입부 결손이 45예로 제일 많았으며 근육형은 1예로 없었다. 8. 술후 합병증은 완전 혹은 불완전 우각 차단증이 52예로 가장 많았다. 9. 술후 사망은 2예였으며 2%의 발생율을 보였다.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1180-1190
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• 1990

96 patients underwent cardiac valve replacement for valvular heart diseases consecutively between February 1986 to February 1990 in the Department of Thoracic and Cardiovascular Surgery of Yeungnam University Hospital. The follow up period was between 6 months and 4.5 years postoperatively[mean 23.4$\pm$13.1 months]. 75 cases got mitral valve replacement, 6 cases, aortic valve replacement, 15 cases, double valve replacement. 30[31.2%] patients were male and 66[68.8%] were female and the age ranged from 14 to 66 years old. Early hospital death within 30 days postoperation were 5 patients[5.2%], consisting of by low cardiac output in 2, infective endocarditis in 1, multiple organ failure with sepsis in 1 patient. There was no late postoperative death. Most common early postoperative complication was wound disruption [8.7%] and then low cardiac output, pneumothorax, pleural effusion in order. Most common late postoperative complications were minor bleeding episodes[8.7%] related to anticoagulant therapy which were consisted of frequent epistaxis in 3, gum bleeding in 2, hemorrhagic gastritis in 1, hypermenorrhea in 1, hematoma in right arm in 1 patient. Valve-related complications included valve thrombosis [1.6%/ patient-year], valve failure due to pannus formation[1.1% /patient-year], prosthetic valve endocarditis[1, 1%o/patient-year] and minor anticoagulant hemorrhage[4.4% /patient-year]. 5 cases of reoperations were performed in 4 patients due to valve failure and all of them were in the mitral positions[2.7% /patient-year]. Cardiothoracic ratios in the chest X-ray decreased at the 6th month and 1st year postoperation in all patients. But in New York Heart Association[NYHA] functional class IV, no change in cardiothoracic ratio was found between 6 months and 1 year postoperation. In the echocardiogram, the size of the cardiac chambers decreased, but ejection fraction increased postoperatively in each functional class. In the electrocardiogram, decreases were found in the incidence of atrial fibrillation, left atrial enlargement, left ventricular hypertrophy with right bundle branch block increasing postoperatively in each functional class. The actuarial survival rate was 98.4% for all patients, 98.7% for mitral valve replacement, 83.8% for aortic valve replacement, and 80% for double valve replacement at the end of a 4.5 year follow up period. Meanwhile the actuarial freedom rate was 91.5% for prosthetic valve endocarditis, 91.6% for thromboembolism, 89.0% for prosthetic valve failure and 83.7% for minor anticoagulant hemorrhage. Preoperative NYHA class III and IV were 75% of all patients, but 95% of all patients were up graded to NYHA class I and II postoperatively.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1184-1189
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• 1997

활로 4징증은 청색증이 있는 선천성 심장기형 중에서 가장 흔한 질환이다. 마산삼성병원 흉부외과에서는 1984년 4월부터 1993년 12월 까지 활로 4징증으로 완전교정을 받은 39례를 경험하였다. 그 관찰 결과는 다음과 같다. 남자가 14명, 여자가 25명이며 연령은 최소 2세에서 최고 36세로 평균 13.33$\pm$7.40세이었다. 심실중격결손증은 제 1형이 10례(25.6%), 제 2형이 19례(48.8%), 제 1형과 제 2형이 복합된 경우 10례 (25.6%)이었다. 우심실 유출로 폐쇄는 누두부와 폐동맥 판막이 함께 협착이 있는 경우가 19례(48.7%)로 가장 많고, 누두부 협착과 폐동맥 판막 및 판륜 협착이 함께 있는 경우 10례(25.6%), 누푸부 협착만 있는 경우 1례, 폐동맥 판막 협착만 있는 경우가 1례 있었다. 우심실 유출로 재건술은 첨포확장술이 33례(84.6%)에서 필요했고, 이중에 단일 판첨을 내재한 첨포를 사용한 2례를 포함하여 10례에서 경판륜 첨포확장술을 시행하였다. 수술후 36명의 생존자중 23례에서 2 dimensison 및 도플러 심에코를 시행하였다. 가장 흔한 합병증은 부정맥이었고 특히, 완전우각차단이 30 례(76.9%)에서 있었다. 수술 사망률은 7.7%이었으며, 사망원인은 저심박출증이었다.