• Journal of Chest Surgery
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• v.23 no.6
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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.

• Radiation Oncology Journal
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• v.25 no.1
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• pp.26-33
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• 2007

[ $\underline{Purpose}$ ]: The aim of this study is to evaluate and compare the incidence and aspects of myocardial perfusion defects in patients who were subjected to either two-dimensional or three-dimensional simulation techniques for early left-sided breast cancer. The myocardial perfusion defects were determined from using single photon emitted computerized tomography (SPECT) myocardial perfusion images. $\underline{Materials\;and\;Methods}$: Between January 2002 and August 2003, 32 patients were enrolled in this study. The patients were diagnosed as having early (AJCC stage T1-T2N0M0) left-sided breast cancer and were treated with tangential irradiation after breast-conserving surgery and systemic chemotherapy. The patients were divided into two groups according to the type of simulation received: two-dimensional simulation using an X-ray fluoroscope simulator or three-dimensional simulation with a CT simulator. All patients underwent technetium-99m-sestamibi gated perfusion SPECT at least 3 years after radiotherapy. The incidence and area of myocardial perfusion defects were evaluated and were compared in the two groups, and at the same time left ventricular ejection fraction and cardiac wall motion were also analyzed. The cardiac volume included in the radiation fields was calculated and evaluated to check for a correlation between the amount of irradiated cardiac volume and aspects of myocardial perfusion defects. $\underline{Results}$: A myocardial perfusion defect was detected in 11 of 32 patients (34.4%). There were 7 (46.7%) perfusion defect cases in 15 patients who underwent the two-dimensional simulation technique and 4 (23.5%) patients with perfusion defects in the three-dimensional simulation group (p=0.0312). In 10 of 11 patients who had myocardial perfusion changes, the perfusion defects were observed in the cardiac apex. The left ventricular ejection fraction was within the normal range and cardiac wall motion was normal in all patients. The irradiated cardiac volume of patients in the three-dimensional simulation group was less than that of patients who received the two-dimensional simulation technique, but there was no statistical significance as compared to the incidence of perfusion defects. $\underline{Conclusion}$: Radiotherapy with a CT simulator (three-dimensional simulation technique) for early left-sided breast cancer may reduce the size of the irradiated cardiac volume and the incidence of myocardial perfusion defects. Further investigation and a longer follow-up duration are needed to analyze the relationship between myocardial perfusion defects and clinical ischemic heart disease.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.347-353
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• 2006

Background: Despite recent advances in surgical technique and perioperative care of total anomalous pulmonary venous return (TAPVR), post-repair pulmonary vein stenosis (PVS) remains as a serious complication. We thought that the most important factors of TAPVR repair to prevent PVS were good exposure, proper alignment, and sufficient stoma size. We analyzed our experience retrospectively. Material and Method: Between Jan. 1995 and Feb. 2005, we studied 74 patients diagnosed with TAPVR suitable for biventricular repair. Supra-cardiac type (n=41, 55.4%) was the most common. Mean CPB time, ACC time, and TCA (40.5%, 30/74) time were $92.1{\pm}25.9\;min,\;39.1{\pm}10.6\;min$, and $30.2{\pm}10.7\;min$, respectively. Mean follow-up duration was $41.4{\pm}29.1$ months and follow-up was possible in all patients. Result: The median age and body weight at operation were 28.5 days ($0{\sim}478$ days) and 3.4 kg $(1.4{\sim}9\;kg)$. Early mortality was 4.1% (3/74). Causes of death were pulmonary hypertensive crisis, sepsis, and sudden death. There was PR-PVS in 2 patients (early: 1, late: 1). Both patients were cardiac type TAPVR drained to coronary sinus. Re-operations were done but only one patient survived. Cumulative survival rate in 5 year and percent freedom from PVS were $94.5{\pm}2.7%\;and\;97.2{\pm}2.0%$, respectively. Conclusion: There was no PVS in patients who underwent extra-cardiac anatomosis between LA and CPVC. Therefore it could be said that our principle might be effective in preventing PR-PVS in patients suitable two-ventricle.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1038-1044
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• 1995

We have been used cryopreserved homograft valves for right ventricular outflow tract[RVOT reconstruction since November 1993. The homograft valves were harvested from the hearts of brain dead patients or hearts of transplant recipients. There were 12 male and 10 female patients. Their ages ranged from 5 months to 13 years[mean age,39.2 $\pm$ 37.4 months and the weight ranged from 5 to 48kg [mean weight, 13.7$\pm$ 9. l kg . The diagnoses included pulmonary atresia with ventricular septal defect [n=14 , tetralogy of Fallot[n=4 , truncus arteriosus[n=3 , and double outlet right ventricle with pulmonic stenosis[n=l .Monocuspid homograft patches were used for RVOT widening or REV[reparation l`etage ventriculaire operations in 4 patients. We also used homograft as valved conduits for RVOT reconstruction in 17 patients and left ventricular outflow tract reconstruction in anatomically corrected transposition in 1 patient. Among them size-reducing technique [converting a tricuspid valved conduit into a bicuspid valved conduit were applied to six patients for the correction of size mismatching. The mean follow-up period was 10.6 $\pm$ 5.4 months. There was one operative death[4.5% due to bleeding and one reoperation for removal of vegetation on the homograft leaflet. Postoperative echocardiography documented no significant homograft insufficiency and RVOT obstructions.In short-term, the homograft valves provide excellent hemodynamic characteristics, even though further studies are necessary to evaluate the long-term results.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1042-1045
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• 1999

Background: Recently, open heart surgerys using homograft are progressively increasing in complex cardiac anomalies, and even though the use of homograft tissues harvested from hearts of transplant recipients and brain-death patients are allowed and their use is increasing, the supply of homograft tissue is very limited. Material and Method: The large diameter homografts are difficult to apply directly for RVOT reconstruction of small neonatal and infant hearts due to the size mismatching. Therefore, were surgically down-sized the large diameter tricuspid homograft into bicuspid conduits by means of a longitudinal incision of the oversized homograft, excision of one cusp, and oversewing of the“Bicuspid homograft”wrapped around a Hega dilator of the appropriate size. Result: 3 patients(Male 1, Female 2: tetralogy of Fallot with pulmonary atresia), ranging in age from 5 months to 4 years and ranging in weight from 5.5Kg to 12.95Kg underwent reconstruction of the RVOT with bicuspid conduits obtained by appropriate tailoring from large-diameter homografts. The mean follow-up period was 4.3 months(range, 2 to 6 months). There were no complications related to the homograft tissues. Conclusion: In the short term follow-up, the bicuspid homografts provided good competence and excellent hemodynamics although a long term follow-up is needed to assess the functions of the bicuspid homografts in RVOT. We believe this technique may be a more effective alternative than the use of synthetic conduits when the use of an appropriate-sized homograft is not possible.

• Journal of Veterinary Clinics
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• v.34 no.3
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• pp.213-217
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• 2017

A 1-year and 8-month-old male, thoroughbred horse showed fever ($39.8^{\circ}C$), cardiac murmur, tachycardia up to 80 beats/min, anorexia, depression and lameness for about 2 months. The dead horse was referred to pathology laboratory at the College of Veterinary Medicine in Jeju National University. At necropsy, Severe protruding multiple rough cauliflower-like yellowish red nodules ranged $5{\sim}6{\times}2{\sim}3cm$ in size were attached on the mitral valve of the left heart. A yellowish red long stick-shaped thrombus $15{\times}3.5{\times}1.5cm$ in size was also present inside the right ventricle. Multifocal infarcts were scattered in the myocardium and renal cortex. Histopathologic examination revealed that morphologic diagnosis were vegetative endocarditis, thrombus in right ventricle, infarcts in myocardium and kidney, pulmonary congestion and edema, and splenic congestion. The isolated bacteria from vegetative lesions and thrombus were confirmed as Escherichia (E.) coli based on the bacterial culture and VITEK 2 system. Based on the gross and histopathologic features, and bacterial test, this case was diagnosed as vegetative endocarditis with thrombus formation associated by E. coli in a thoroughbred horse.

• Journal of the Korean Society for Aviation and Aeronautics
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• v.20 no.3
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• pp.63-67
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• 2012

Spaceflight induces a number of cardiovascular physiological alterations. To study adaptations to microgravity on Earth, the tail-suspended, hindlimb-unloaded rat model has been used to simulate the effects of microgravity. Despite the extensive use of this model to infer physiological adaptations of many organs to microgravity, little information has been obtained on the effect of tail suspension(TS) on cardiac adaptations in the rat. This study was aimed to investigate the effects of simulated microgravity on the rat myocardium using the TS model. Twenty-four male Sprague-Dawley rats were randomly assigned to 3 experimental groups(1, 7 and 14 days of TS) and a control group. A microscopic examination was performed to assess histopathological changes in the myocardial morphology. The hearts from the control group, the 1 day-TS rats and the 7 day-TS rats revealed no evident abnormalities in cardiomyocyte size and morphology. At day 14 of TS, in contrast, the ventricular cardiomyocytes appeared more separated from each other and were slightly smaller in size compared with those of the control group. Also seen were scattered areas exhibiting focal disorganization of muscle fibers and some degenerating cardiomyocytes, of which the nuclei had become pyknotic or disappeared. In this study, we demonstrated that the ventricular cardiomyocytes underwent degeneration and atrophy at the microscopic level during exposure to simulated microgravity in TS rats.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.18-24
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• 1986

The mean perfusion pressure produced by 20 different design and size of disposable aortic perfusion cannulas [size range: 18F to 20F] at flow rates of 1 to 5 L/min was compared. A roller pump with perfusion tubing 10mm in inner diameter was used with a mixture of 0.9% normal saline and 100% glycerin [mixing ratio of 6.72:13.28] to make the viscosity as normal blood in 20oC as the test solution. Line pressure in these cannulas at a flow rate of 3L/min ranged from 13.2$\pm$4.47 to 157$\pm$1 34 mmHg in a case of absence of resistance, and from 11.4$\pm$1.14 to 227.2$\pm$4.47 mmHg in a case of presence of resistances 14 cannulas had gradients of less than 100Hg at a flow rate of 3L/min and 9 cannulas less than 100mmHg at 4L/min. The following results were obtained from this experimental study: .1] A wide range of line pressure was observed in disposable aortic perfusion cannulas currently in clinical use; 2] Some cannulas currently used for cardiopulmonary bypass in adults generated excessive line pressure; 3] Both the material and design affect function, with some designs safer than others. Cardiac surgeons should base the choice of aortic perfusion cannula on the best performance and safest design available to avoid cannula-related problems during operation.

• The Korean Journal of Nuclear Medicine
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• v.7 no.2
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• pp.27-34
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• 1973

Pulmonary perfusion scan with radioactive $^{113m}In$-iron hydroxide particle was performed in the 25 cases of heart disease which had been diagnosed by cardiac catheterization prior to surgery from July, 1972 to July, 1973 at the Department of Radiology and Nuclear Medicine, Yonsei Medical College. It consists of 7 mitral stenosis, 2 mitral insufficiency, 1 aortic insufficiency, 3 atrial septal defect, 5 ventricular septal defect, 2 patent ductus arteriosus, 1 transposition of great vessel and 4 Tetralogy of Fallot. Findings of pulmonary perfusion scan in relation to hemodynamic data of cardiac catheterization were examined. 1) Out of 10 cases of acquired valvular heart disease, In 6 cases of mitral stenosis and 1 case of aortic insufficiency, radioactivity was increased at both upper lung. This finding is noted when pulmonary wedge or venous pressure was elevated above 22 mmHg and arterial systolic pressure above 33 mmHg. 2) Out of 15 cases of congenital heart disease. In almost all cases of atrial septal defect and ventricular septal defect except 2 cases, radioactivity was even at both entire lung. In 2 cases of patent ductus arteriosus, radioactivity was decreased especially at the left lung. It is observed that in acyanotic congenital heart disease, radioactivity of lung is not related with pulmonary arterial pressure. In 3 cases of Tetralogy of Fallot, radioactivity was even at both entire lung and in 2 of them, extrapulmonary radioactivity of liver or kidney which depends on size of defect and volume of right to left shunt reversible, was noted.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.3
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• pp.488-499
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• 1996

Diabetes mellitus revealed a chronic disorder of lipid, carbohydrate and protein metabolism characterized by insulin deficiency, and a striking tendency toward development of atherosclerosis, microangiopathy, nephropathy, neuropathy and recently cardiomyopathy etc. The mechanism of heart failure in patients with diabetic cardiomyopathy is not clear but diabetic cardiomyopathy usually occurs in persons with long standing diabetes. After diabetes induced in made Sprague- Dawley strain rats by injection of streptozotocin(60mg/kg), cardiac tissue with hematoxylin-eosin and Masson's trichrome stain was examined at 3 days, 1, 2, 4, 6 weeks later under light microscope. The results were obtained as follows : 1. In H&E stain of control group, myocardiac cells were shorter than skeletal muscle cell, which was branched out and connected each other at terminal with striation, intercalated disk and nucleus at center of cell. 2. In MT stain of control group, a few of collagen fibrile were seen at periva scular interstium, but wasn't seen between skeletal muscle fiber, and cardiac muscle was seen in various size. 3. In MT stain of experimental group, increased collagen fiber deposition at perivascular interstiums were seen periodically. 4. In MT stain of experimental group, increased collagen fiber deposition at interstitial matrix between perimyocardiac cells were seen at 3 day, 4 weeks and 6 weeks after DM induction. 5. In H&E stain of experimental group, partial degeneration of myocardiac cells was seen after 4 weeks of DM induction. From above results, streptozotocin induced diabetes mellitus increased collagen around perivascular and between intercellular matrix in heart.