• Journal of Chest Surgery
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• 제24권3호
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• pp.265-270
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• 1991

Since advent of the prosthetic cardiac valve replacement, much efforts for accurate assessing value function in-vivo have been attempted. To evaluate the postoperative functional and morphological status of the replaced cardiac valve prosthesis, 33 patients with valve replacement were studied by transthoracic and transesophageal 2-dimensional echocardiac imaging as well as by color Doppler flow velocity imaging. Twenty four patients had mitral valve replacement. 6 patients had aortic valve replacement and 3 patients had both mitral and aortic valve replacement. There were 34 mechanical and 2 biological prosthesis. Comparing to transthoracic echocardiography, transesophageal approach showed transvalvular regurgitant jet flow amid the prosthetic mitral valve ring during. systole and much clear visualization of cardiac chamber behind prosthesis which could give shadowing effect to ultrasound beam. According to the quantitative grading by the length and area of mitral regurgitant flow, 24 out of 27 mitral valves revealed mild degree regurgitation considered as physiological after prosthetic bileaflet valve replacement and the other 3 valves including 2 biological prosthesis had moderate degree regurgitation which was regarded as pathologic one. 2 cases of left atrial thromboses and 1 case of paravalvular leakage which were not visible by transthoracic approach were identified by transesophageal echocardiography in patients with mitral valve replacement and patients with aortic valve replacement respectively. We conclude that in patients with prosthetic mitral valve replacement, transesophageal 2-dimensional imaging with color Doppler can suggest reliable information beyond that available from the transthoracic access even though it gives patient some discomfort to proceed.

• Journal of Chest Surgery
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• 제53권2호
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• pp.64-72
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• 2020

Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.

• Korean Journal of Radiology
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• 제23권3호
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• pp.298-307
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• 2022

Objective: This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. Materials and Methods: A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50-61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via web-based review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss' kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). Results: Interobserver reliability (Fleiss' kappa) in each segment ranged 0.242-0.662 before the consensus and increased to 0.301-0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728-0.805 and 0.849-0.884; vascular territory, 0.756-0.902 and 0.852-0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. Conclusion: The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.

• Investigative Magnetic Resonance Imaging
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• 제16권1호
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• pp.47-54
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• 2012

목적: 백서 중간엽 줄기세포에 페리틴 유전자를 형질 도입시켜 생물학적 특성의 변화 유무를 평가하고, 자기공명영상에서 신호강도의 차이를 확인해보고자 하였다. 대상과 방법: 백서 중간엽 줄기세포에 렌티바이러스를 이용하여 사람유래 재조합 페리틴과 녹색형광단백질 유전자의 과발현을 유도하였다. 페리틴 유전자가 발현된 백서 중간엽 줄기세포의 증식성과 생존능을 분석하기 위해 MTT 어세이를 수행하였으며, 유세포 분석을 수행하여 중간엽 줄기세포의 표면 마커 발현을 평가하고, 세포 내 철 함량을 측정하고 프러시안 블루 염색을 시행하여 철 축적능력을 분석하였다. 세포 팬텀을 이용하여 9.4 T 자기공영영상 기기를 이용하여 검출가능성을 평가하였다. 결과: 페리틴과 녹색형광 유전자는 백서 중간엽 줄기세포에서 안정적으로 발현되었다. 페리틴 유전자의 과발현으로 인해 백서 중간엽 줄기세포의 생물학적 특성 (증식능력, 생존능, 표면마커)은 영향을 받지 않았다. 페리틴을 발현하는 중간엽 줄기세포에서 철의 축적능력이 증가된 것이 확인되었고, T2 이완 시간은 유의하게 감소하였다. 결론: 줄기세포 치료 연구에서 자기공명 리포터 유전자 페리틴은 자기공명영상법을 이용하여 중간엽 줄기세포를 비침습적으로 가시화 할 수 있고 이를 이용하여 생체추적이 가능할 것으로 기대된다.

• 한국방사선학회논문지
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• 제15권5호
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• pp.691-696
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• 2021

환자의 질병을 예방 및 치료를 위해서는 의료영상을 통한 병변의 해부학적 구조 파악은 중요한 과정중 하나이다. 하지만 스크린으로 통해 보여 지는 영상으로는 한계가 있으므로 3D 프린팅 기술을 이용하여 이를 극복하고자 하는 많은 연구가 진행 중이다. 이를 위해 본 연구는 실제 환자 영상데이터를 이용하여 3차원 심혈관 모델을 구현하였고, 이를 3D 프린터를 이용하여 출력하여 현재 종사하고 있는 의료전문가에게 유용성 테스트를 진행하였다. 유용성 평가 결과 총 5인이 실시한 설문을 리커트 척도로 변환하였을 때 모든 항목 평균값이 4.83점의 높은 결과를 나타내고, 교차분석 결과 x²(P)=10.000(0.265)의 수치로 모든 설문자간 동일하게 긍정적인 설문 결과를 나타냈다. 결과를 바탕으로 3D프린팅 기술이 의료기술 발전에 도움을 줄 것으로 기대한다.

• Korean Journal of Radiology
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• 제24권6호
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• pp.512-521
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• 2023

Objective: There is increasing recognition that left atrial (LA) strain can be a prognostic marker of various cardiac diseases. However, its prognostic value in acute myocarditis remains unclear. Therefore, this study aimed to evaluate whether cardiovascular magnetic resonance (CMR)-derived parameters of LA strain can predict outcomes in patients with acute myocarditis. Materials and Methods: We retrospectively analyzed the data of 47 consecutive patients (44.2 ± 18.3 years; 29 males) with acute myocarditis who underwent CMR in 13.5 ± 9.7 days (range, 0-31 days) of symptom onset. Various parameters, including feature-tracked CMR-derived LA strain, were measured using CMR. The composite endpoints included cardiac death, heart transplantation, implantable cardioverter-defibrillator or pacemaker implantation, rehospitalization following a cardiac event, atrial fibrillation, or embolic stroke. The Cox regression analysis was performed to identify associations between the variables derived from CMR and the composite endpoints. Results: After a median follow-up of 37 months, 20 of the 47 (42.6%) patients experienced the composite events. In the multivariable Cox regression analysis, LA reservoir and conduit strains were independent predictors of the composite endpoints, with an adjusted hazard ratio per 1% increase of 0.90 (95% confidence interval [CI], 0.84-0.96; P = 0.002) and 0.91 (95% CI, 0.84-0.98; P = 0.013), respectively. Conclusion: LA reservoir and conduit strains derived from CMR are independent predictors of adverse clinical outcomes in patients with acute myocarditis.

• Journal of Chest Surgery
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• 제41권3호
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• pp.360-362
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• 2008

대혈관전위 환자에서 동맥치환술 시행 시 관상동맥의 위치는 수술의 성적 및 환자의 예후에 매우 중요한 요소이다. 본 증례는 과거 대혈관전위로 동맥치환술을 시행 받았던 환자에서 발생한 관상동맥 압박에 대한 보고이다. 14세 남자 환자로 운동 시 협심증을 주소로 내원하였고, 영상학적 검사 결과 좌관상동맥 기시부가 대동맥과 폐동맥 사이에 위치하여 눌리고 있는 양상이어서 수술적 치료를 결정하였다. 수술은 좌관상동맥 기시부를 대동맥에서 버튼 절제한 후 좌외측으로 재이식하여 폐동맥에 눌리지 않도록 하였다. 수술 후 관상동맥의 대혈관에 의한 압박 소견은 사라졌으며 환자는 현재까지 합병증이나 증상 재발 없이 추적 관찰 중이다.

• Journal of Ginseng Research
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• 제45권6호
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• pp.726-733
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• 2021

Background: Panax notoginseng is a highly valued medicinal herb used widely in China and many Asian countries. Its root and rhizome have long been used for the treatment of cardiovascular and hematological diseases. Imaging the spatial distributions and dynamics of metabolites in heterogeneous plant tissues is significant for characterizing the metabolic networks of Panax notoginseng, and this will also provide a highly informative approach to understand the complex molecular changes in the processing of Panax notoginseng. Methods: Here, a high-sensitive MALDI-MS imaging method was developed and adopted to visualize the spatial distributions and spatiotemporal changes of metabolites in different botanical parts of Panax notoginseng. Results: A wide spectrum of metabolites including notoginsenosides, ginsenosides, amino acids, dencichine, gluconic acid, and low-molecular-weight organic acids were imaged in Panax notoginseng rhizome and root tissues for the first time. Moreover, the spatiotemporal alterations of metabolites during the steaming of Panax notoginseng root were also characterized in this study. And, a series of metabolites such as dencichine, arginine and glutamine that changed with the steaming of Panax notoginseng were successfully screened out and imaged. Conclusion: These spatially-resolved metabolite data not only enhance our understanding of the Panax notoginseng metabolic networks, but also provide direct evidence that a serious of metabolic alterations occurred during the steaming of Panax notoginseng.

• Journal of Trauma and Injury
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• 제33권4호
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• pp.207-218
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• 2020

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).

• Investigative Magnetic Resonance Imaging
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• 제25권4호
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• pp.332-337
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• 2021

Behçet's disease is a chronic inflammatory disorder involving vessels of various sizes and organs, including the skin, joints, gastrointestinal tract, lungs, and cardiovascular system. The etiology of Behçet's disease is unclear, and clinical diagnosis is important in the absence of definitive laboratory or pathological findings diagnostic of Behçet's disease. Cardiac involvement is rare but might present as endocarditis, myocarditis, pericarditis, or intracardiac thrombosis. This report presents a case of Behçet's disease involving the heart in a 22-year-old man with unusual manifestations of right ventricular fibrosis and intracardiac thrombosis. Cardiac magnetic resonance imaging revealed multiple intracardiac thrombi and delayed diffuse subendocardial enhancement involving the right ventricle. No peripheral eosinophilia was detected. Endomyocardial biopsy showed mixed inflammatory cell infiltrates. Based on the patient's clinical history of oral ulcer and arthritis, a diagnosis of Behçet's disease was made considering the clinical, radiological, and histological findings. Intracardiac thrombi and endomyocardial fibrosis are rare manifestations of Behçet's disease, and the diagnosis is often a clinical challenge. Early diagnosis is important for appropriate management. Behçet's disease should be considered in the differential diagnosis of patients with intracardiac thrombosis and endomyocardial fibrosis of the right chamber.