• Journal of Chest Surgery
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• v.43 no.1
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• pp.25-32
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• 2010

Background: Patients with vascular diseases commonly have coronary artery disease and associated cardiac problems. Therefore, their underlying heart diseases may be induced or exacerbated after vascular surgery. The effectiveness of SPECT imaging, which is a relatively simple and non-invasive imaging modality, for assessing these underlying heart diseases is still controversial. This study was performed to evaluate the clinical effect of tests and treatment based on SPECT imaging prior to vascular surgery on the development of post-operation cardiac complications. Material and Method: Sixty three patients who were treated at Inje University Pusan Paik Hospital between April 2004 and September 2007 and who underwent adenosine infusion technetium-99m (Tc-99m) tetrofosmin SPECT imaging prior to vascular surgery were selected for this study and we retrospectively reviewed their records. Result: The sensitivity and specificity of detecting a perfusion defect on SPECT to predict the development of cardiac complications was relatively low at 41.2% and 52.2%, respectively. However when coronary angiographies were done on the patients with abnormal SPECT and this was followed by aggressive treatment such as coronary artery intervention and coronary artery bypass grafting based on the angiography results, there was a tendency for lower cardiac complication rates. Conclusion: SPECT imaging shows low effectiveness as a screening test for predicting cardiac complications after vascular surgery.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1083-1091
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• 1997

This study was purposed to assess the result of coronary artery bypass graft surgery by analyzing and comparing the pre and postoperative myocardial perfusion state quantitatively by using myocardial SPECT. Twenty patients who received coronary artery bypass graft surgery since 1993 underwent both preoperative and postoperative myocardial SPECT and the result were analyzed. The mean age was 56.4$\pm$9.0 years, and the patients were composed of thirteen males and seven females. For quantitative analysis, we used polar maps of SPECT generated by Cedars-Sin i Medical Center program and we calculated perfusion scores, ischemic myocardial area ratios and reperfusion scores from polar maps. Preoperative mean stressfrest perfusion score was 7.3$\pm$ 1.117.7$\pm$ 1.0 and postoperative score was 8.1 $\pm$ 1 118.3$\pm$ 1.1. Preoperative mean stress ischemic myocardial area ratio was 0.32$\pm$0.2 and postoperative ratio was 0.15 $\pm$0.1. Postoperative mean perfusion score was significantly increased but, on the other hand, mean ischemic myocardial area ratio was significantly decreased as compared with preoperative values(p<0.01). Preoperative mean perfusion score of patients with postoperative roper(usion score more than 1.5 was significantly higher(p<0.01) than that of patients with postoperative reperfusion score less than 1.5. Preoperative perfusion scores of coronary artery territories that had fixed perfusion defect at myocardial SPECT were significantly low(4.3 $\pm$0.514.6$\pm$0.6, stresslrest), nevertheless it proved quantitatively that there was improvement in myocardial perfusion after surgery by showing improved perfusion scores postoperatively. In conclusion, myocardial SPECT is useful method for quantitative analysis of the myocardial perfusion state after coronary artery bypass grafting surgery.

• Annals of Laboratory Medicine
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• v.38 no.6
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• pp.538-544
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• 2018

Background: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. Methods: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. Results: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P =0.005). Conclusions: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.22-27
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• 2009

Background: Coronary artery bypass grafting (CABG) is the standard surgical treatment for coronary artery disease. Although there are many clinical reviews of the long term results after CABG in the Western countries, not many such studies have been done for Korea. Therefore, we reviewed the long term clinical results for the patients who underwent CABG at our hospital. Material and Method: We retrospectively reviewed the medical records of 342 patients who underwent CABG at our hospital from February 1984 to December 2006, which is when CABG was first performed in our institution. A total of 286 patients (83.6%) were able to be followed-up, and the mean follow-up period was $75.7{\pm}46.1$ months. Result: The early mortality rate was 5.6%, and late mortality rate was 23.1%. The one-year survival rate, the five-year survival rate, the ten-year survival rate and the fifteen-year survival rate were 91.5%, 82.1%, 60.7% and 50.0%, respectively. The survival rate was significantly lower for the patients over the age of 60 (p=0.002) and for those with diabetes mellitus (p=0.000), hypertension (p=0.002), multivessel disease (p=0.006) and left ventricular dysfunction (p=0.015). No significant difference was observed between the genders. Multivariate analysis showed that the statistically significant risk factors were diabetes mellitus (p=0.001), age (p=0.005) and those cases for which the left internal thoracic artery was not used (p=0.037). Conclusion: CABG is the effective method of treatment for coronary artery disease. Therefore, active usage of the internal thoracic artery and appropriate medical treatment after surgery, and especially for diabetes mellitus patients, are mandatory for achieving good long-term survival.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.643-652
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• 2002

As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF＜40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.

• Journal of Chest Surgery
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• v.46 no.6
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• pp.457-460
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• 2013

Dynamic left ventricular (LV) outflow tract obstruction is a characteristic feature of hypertrophic cardiomyopathy; however, it can also occur in association with hyperdynamic LV contraction and/or changes in the cardiac loading condition, even in a structurally normal or near-normal heart. Here, we report a case of anemia-induced systolic anterior motion of the mitral valve and the resultant intraventricular obstruction in a patient who underwent coronary artery bypass grafting and suffered from anemia associated with recurrent gastrointestinal bleeding.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.260-267
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• 1990

During a eight month period[from December, 1988 to July, 1989], a series of 35 adults undergoing redo-valve replacement or coronary artery bypass grafting was selected to an autotransfusion group[n=10] or a control group[n=25]. The Cell Saver System[Haemonetics Corp., Graintree, Mass] was employed for autotransfusion. With this system, all blood shed in the operative field before and after cardiopulmonary bypass and remained in cardiotomy reservoir after cardiopulmonary bypass was aspirated by means of a locally heparinized collecting system. After the salvaged blood was centrifuged, the resulting red cell concentrate subsequently reinfused. The patients receiving autologous blood required significantly less banked homologous blood than their controls[3213k1020 ml and 506051931 ml, respectively: p=0.001] There were no clinical infections in the autotransfusion group, although 40% of the cultures of processed blood were positive. And there was no apparent intergroup difference of the clinical and the hematologic and hemostatic laboratory findings. We conclude that autotransfusion using cell saver is effective for saving the homologous blood transfusion in cardiac surgery.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.922-924
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• 2004

A 55 year old male was admitted for dyspnea. The patient was diagnosed as acute myocardiac infarction, and coronary artery bypass grafting was performed with cardiopulmonary bypass. At postoperative day ＃1, Systemic Inflammatory Response Syndrome was developed with fever, leukocytosis, tachycardia, tachypnea and low systemic vascular resistance. The patient was recovered after being treated with high dose of (36 $\mug/min)$ norepinephrine, and was discharged.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.629-632
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• 2007

Most myocardial bridgings are found incidentally without symptoms, but myocardial bridging may induce symptoms such as angina, myocardial infarction, and ventricular arrythmia. In a patient who has symptoms despite of proper medication, stent insertion, supra-arterial myotomy or coronary artery bypass grafting have been applied without a definite guideline of treatment. We report two surgical cases of myocardial bridging with a review of the literature.

• Journal of Cardiovascular Imaging
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• v.31 no.1
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• pp.26-38
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• 2023

BACKGROUND: Dobutamine and adenosine stress cardiac magnetic resonance (CMR) imaging is relatively contraindicated in patients with moderate to severe aortic valve stenosis (AS). We aimed to determine the safety of dobutamine and adenosine stress CMR in patients with moderate to severe AS. METHODS: In this retrospective study patients with AS who underwent either dobutamine or adenosine stress CMR for exclusion of obstructive coronary artery disease were enrolled. We recorded clinical data, CMR and echocardiography findings, and complications as well as minor symptoms. Patients with AS were compared to matched individuals without AS. RESULTS: A total of 187 patients with AS were identified and compared to age-, gender- and body mass index-matched 187 patients without AS. No severe complications were reported in the study nor the control group. The reported frequency of non-severe complications and minor symptoms were similar between the study and the control groups. Nineteen patients with AS experienced non-severe complications or minor symptoms during dobutamine stress CMR compared to eighteen patients without AS (p = 0.855). One patient with AS and two patients without AS undergoing adenosine stress CMR experienced minor symptoms (p = 0.562). Four examinations were aborted because of chest pain, paroxysmal atrial fibrillation and third-degree atrioventricular block. Inducible ischaemia, prior coronary artery bypass grafting, prior stroke and age were associated with a higher incidence of complications and minor symptoms. CONCLUSIONS: Moderate to severe AS was not associated with complications during CMR stress test. The incidence of non-severe complications and minor symptoms was greater with dobutamine.