• Journal of Chest Surgery
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• v.48 no.1
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• pp.25-32
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• 2015

Background: We evaluated operative outcomes after third or more cardiac operations for valvular heart disease, and analyzed whether pericardial coverage with artificial membrane is helpful for subsequent reoperation. Methods: From 2000 to 2012, 149 patients (male : female=70 : 79; mean age at operation, $57.0{\pm}11.3$ years) underwent their third to fifth operations for valvular heart disease. Early results were compared between patients who underwent their third operation (n=114) and those who underwent fourth or fifth operation (n=35). Outcomes were also compared between 71 patients who had their pericardium open during the previous operation and 27 patients who had artificial membrane coverage. Results: Intraoperative adverse events occurred in 22 patients (14.8%). Right atrium (n=6) and innominate vein (n=5) were most frequently injured. In-hospital mortality rate was 9.4%. Total cardiopulmonary bypass time ($225{\pm}77$ minutes vs. $287{\pm}134$ minutes, p=0.012) and the time required to prepare aortic cross clamp ($209{\pm}57$ minutes vs. $259{\pm}68$ minutes, p<0.001) increased as reoperations were repeated. However, intraoperative event rate (13.2% vs. 20.0%), in-hospital mortality (9.6% vs. 8.6%) and postoperative complications were not statistically different according to the number of previous operations. Pericardial closure using artificial membrane at previous operation was not beneficial in reducing intraoperative events (25.9% vs. 18.3%) and shortening operation time preparing aortic cross clamp ($248{\pm}64$ minutes vs. $225{\pm}59$ minutes) as compared to no-closure. Conclusion: Clinical outcomes of the third or more operations for valvular heart disease were acceptable in terms of intraoperative adverse events and in-hospital mortality rates. There were no differences in the incidence of intraoperative adverse events, early mortality and postoperative complications between third cardiac operation and fourth or more.

• Journal of Korean Biological Nursing Science
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• v.11 no.1
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• pp.68-76
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• 2009

Purpose: The purpose of this study was to evaluate the hemodynamic changes in degree and duration that occur during Valsalva maneuver (VM). Furthermore, we wanted to investigate the patterns and mechanisms of physiological hemodynamic control. Method: Thirty six healthy college students were recruited from Y university. Each participant was provided with written informed consent. Blood pressure (BP), heart rate (HR), cardiac output (CO) were continuously recorded using the Finometer. Result: During the phase I of VM, means of systolic and diastolic pressures were increased by 32.15% and 38.28%, respectively, compared with basal values. HR and CO were decreased by 9.91% and 13.01%, respectively. Immediately after the maneuver (phase III), systolic and diastolic pressures were decreased by 5.05% and 6.24%, respectively, compared with those obtained in the phase II. HR and CO were elevated by 13.33% and 11.93%, respectively, compared to the levels of earlier phases. BPs were represented with overshoot in the phase IV, and recovered by baseline values about 20 sec after VM. Conclusion: These results demonstrated that hemodynamic changes are variable in the event of VM even in healthy humans. It will be valuable to accumulate more quantitative hemodynamic information in special populations such as the elderly and the patients with cardiovascular problems.

• Proceedings of the KIEE Conference
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• 1999.07b
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• pp.994-996
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• 1999

In this paper, we proposed complex demodulation method(CDM) to visualize the instantaneous frequency change of LF component and HF component of HRV signals, which represent the dynamics of sympathetic and parasympathetic (vagal) tone, respectively. As we know the range of the center frequencies of each autonomic tones, we could apply complex demodulation method. To simulate the heart rate variability signal, the IFPM model was adopted for generation of simulated cardiac event series. Then, we can visualize and access the dynamic changes of LF and HF component of autonomic tones in the time-frequency domain.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.57-65
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• 1992

St.Jude Medical cardiac valve replacement was performed in 322 patients: 191 had mitral, 58 had aortic, 72 had double valve and 3 had tricuspid valve replacement. Motality rate in early period was 2.8%[9 patients]. The most common cause of early death was low cardic output syndrome. Follow up extended from 1 to 90 months[mean: 34 months] in 292 patients among 313 in all surviving patients [93.6%]. There were thrombolic complications in eighteen patients. The probability of free from thromboembolism at 5 yerars in MVR, AVR and DVR were 84.7%, 91.8% and 90.2% respectively. And also, actuarial event free rate at 5 years in MVR, AVR and DVR were 80.1%, 82.2%, and 81.4% respectively. There were fourteen late death during follow up period: six from thromboembolism, one from hemorrhage and the others from non valve related -or unknown complications. The acturial survival rate at 5 years were 93.1% in mitral, 92.1% in aortic and 97.1% in double valve replacement. In conclusion, the performance of the St. Jude Mecanical valve compares most favorably with other artificial valves. But it remains still hazards of mechanical prosthesis such as thromboembolism and anticoagulant related hemorrhage.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.464-469
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• 1986

Pulmonary atresia with intact ventricular septum, and with VSD were uncommon congenital anomalies with high mortality in the neonatal period. Those survivals depend on an adequate interatrial communication or interventricular communication and pulmonary flow via large aortopulmonary collateral including PDA. Recently we experienced surgical correction of 2 cases pulmonary atresia with intact ventricular septum and with VSD. On case 1, 10-years old male patient was confirmed as pulmonary valvular membranous atresia with intact ventricular septum combined with large functioning PFO and mild tricuspid incompetence. So we performed total correction under the E.C.C, that was PDA ligation, RVOT reconstruction with monocusp valved outflow patch [16mm], repair of tricuspid insufficiency and closure of PFO. Post-operative hemodynamic result was good and there was no event during hospital course. On case 2, 16-years old female patient was diagnosed as pulmonary atresia with VSD and PDA. MPA was absent, remained fibrous cord like remnant and type of VSD was subaortic defect [3cm by 3cm in the size]. PDA was located at the usual site. Under the E.C.C. VSD patch closure through the right ventriculotomy, anastomosis between the right ventricular outflow tract and the pulmonary bifurcated site with the extra-cardiac Hancock valved conduit [22cm] and PDA ligation were performed.

• Clinical and Experimental Pediatrics
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• v.64 no.11
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• pp.582-587
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• 2021

Background: Syncope is a common problem in children and adolescents. However, a large proportion of syncope cases have no underlying cause. Purpose: This study aimed to identify the factors affecting the severity of syncope using tissue Doppler imaging (TDI). Methods: This retrospective study included 61 children and adolescents with syncope who underwent echocardiography. The head-up-tilt test (HUT) was performed when there was a more severe syncopal event. We compared the echocardiographic findings between the execute HUT and nonexecute HUT, negative HUT result and positive HUT result, and normal electrocardiogram (ECG) and abnormal ECG groups. Data were analyzed using an unpaired t test post hoc analysis. Results: In the execute and nonexecute HUT groups, the odds ratios were 0.55 for medial E/E' (P=0.040) and 0.64 for lateral E/E' (P=0.049). Comparison of the results of the decreased, normal, and increased groups for lateral E/E' revealed a significant difference in the execution HUT and nonexecute HUT groups (overall, P=0.004; decreased vs. increased, P=0.003; normal vs. increased, P=0.050). Conclusion: Medial E/E' and lateral E/E' were decreased in patients with severe syncopal events. These findings suggest that the presence of left ventricular diastolic deterioration may cause hypoperfusion even in the absence of organic causes and, consequently, increase syncope severity and frequency. The TDI measured by echocardiography can be used as an index to predict syncope recurrence and/or severity.

• The Korean journal of internal medicine
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• v.33 no.6
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• pp.1039-1049
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• 2018

The populations of Asian countries are expected to age rapidly in the near future, with a dramatic increase in the number of heart failure (HF) patients also anticipated. The need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized in aging societies. However, palliative care and active treatment for HF are not mutually exclusive, and palliative care should be provided to reduce suffering occurring at any stage of symptomatic HF after the point of diagnosis. HF patients are at high risk of sudden cardiac death from the early stages of the disease onwards. The decision of whether to perform cardiopulmonary resuscitation in the event of an emergency is challenging, especially in elderly HF patients, because of the difficulty in accurately predicting the prognosis of the condition. Furthermore, advanced HF patients are often fitted with a device, and device deactivation at the end of life is a complicated process. Treatment strategies should thus be discussed by multi-disciplinary teams, including palliative experts, and should consider patient directives to address the problems discussed above. Open communication with the HF patient regarding the expected prognosis, course, and treatment options will serve to support the patient and aid in future planning.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.124-128
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• 2018

Background: Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. Patients with ASDs at high risk of cardiovascular complications undergo either surgical repair or percutaneous device closure. Case Report: We report the case of an 85-year-old male with unusual recurrent cerebral infarctions. The patient has undergone repair of secundum ASD 12 years ago. Evaluation by transesophageal echocardiography revealed a mobile mass at the patch repair site in the left atrium. The mass was surgically removed due to recurrent stroke during the anticoagulation. Conclusion: This case emphasizes the importance of regular cardiac checkup and the need to consider cardioembolic source as being part of the etiology of stroke recurrence, even if the event occurs many years after intracardiac shunt closures.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.153-168
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• 1998

Background: The existing data indicate that obstructive sleep apnea syndrome contributes to the development of cardiovascular dysfunction such as systemic hypertension and cardiac arrhythmias, and the cardiovascular dysfunction has a major effect on high long-term mortality rate in obstructive sleep apnea syndrome patients. To a large extent the various studies have helped to clarify the pathophysiology of obstructive sleep apnea, but many basic questions still remain unanswered. Methods: In this study, the influence of obstructive sleep apnea on systemic blood pressure, cardiac rhythm and urinary catecholamines concentration was evaluated. Over-night polysomnography, 24-hour ambulatory blood pressure and ECG monitoring, and measurement of urinary catecholamines, norepinephrine (UNE) and epinephrine (UEP), during waking and sleep were undertaken in obstructive sleep apnea syndrome patients group (OSAS, n=29) and control group (Control, n=25). Results: 1) In OSAS and Control, UNE and UEP concentrations during sleep were significantly lower than during waking (P<0.01). In UNE concentrations during sleep, OSAS showed higher levels compare to Control (P<0.05). 2) In OSAS, there was a increasing tendency of the number of non-dipper of nocturnal blood pressure compare to Control (P=0.089). 3) In both group (n=54), mean systolic blood pressure during waking and sleep showed significant correlation with polysomnographic data including apnea index (AI), apnea-hypopnea index (AHI), arterial oxygen saturation nadir ($SaO_2$ nadir) and degree of oxygen desaturation (DOD). And UNE concentrations during sleep were correlated with AI, AHI, $SaO_2$ nadir, DOD and mean diastolic blood pressure during sleep. 4) In OSAS with AI>20 (n==14), there was a significant difference of heart rates before, during and after apneic events (P<0.01), and these changes of heart rates were correlated with the duration of apnea (P<0.01). The difference of heart rates between apneic and postapneic period (${\Delta}HR$) was significantly correlated with the difference of arterial oxygen saturation between before and after apneic event (${\Delta}SaO_2$) (r=0.223, P<0.001). 5) There was no significant difference in the incidence of cardiac arrhythmias between OSAS and Control In Control, the incidence of ventricular ectopy during sleep was significantly lower than during waking. But in OSAS, there was no difference between during waking and sleep. Conclusion : These results suggested that recurrent hypoxia and arousals from sleep in patients with obstructive sleep apnea syndrome may increase sympathetic nervous system activity, and recurrent hypoxia and increased sympathetic nervous system activity could contribute to the development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac function.

• Korean Journal of Clinical Pharmacy
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• v.27 no.1
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• pp.15-21
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• 2017

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.