• Korean Journal of Radiology
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• v.24 no.7
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• pp.647-659
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• 2023

Objective: The study was conducted to investigate the effect of correct occlusion of the left atrial appendage (LAA) on intracardiac blood flow and thrombus formation in patients with atrial fibrillation (AF) using four-dimensional (4D) flow magnetic resonance imaging (MRI) and three-dimensional (3D)-printed phantoms. Materials and Methods: Three life-sized 3D-printed left atrium (LA) phantoms, including a pre-occlusion (i.e., before the occlusion procedure) model and correctly and incorrectly occluded post-procedural models, were constructed based on cardiac computed tomography images from an 86-year-old male with long-standing persistent AF. A custom-made closed-loop flow circuit was set up, and pulsatile simulated pulmonary venous flow was delivered by a pump. 4D flow MRI was performed using a 3T scanner, and the images were analyzed using MATLAB-based software (R2020b; Mathworks). Flow metrics associated with blood stasis and thrombogenicity, such as the volume of stasis defined by the velocity threshold ($\left|\vec{V}\right|$ < 3 cm/s), surface-and-time-averaged wall shear stress (WSS), and endothelial cell activation potential (ECAP), were analyzed and compared among the three LA phantom models. Results: Different spatial distributions, orientations, and magnitudes of LA flow were directly visualized within the three LA phantoms using 4D flow MRI. The time-averaged volume and its ratio to the corresponding entire volume of LA flow stasis were consistently reduced in the correctly occluded model (70.82 mL and 39.0%, respectively), followed by the incorrectly occluded (73.17 mL and 39.0%, respectively) and pre-occlusion (79.11 mL and 39.7%, respectively) models. The surfaceand-time-averaged WSS and ECAP were also lowest in the correctly occluded model (0.048 Pa and 4.004 Pa^-1, respectively), followed by the incorrectly occluded (0.059 Pa and 4.792 Pa^-1, respectively) and pre-occlusion (0.072 Pa and 5.861 Pa^-1, respectively) models. Conclusion: These findings suggest that a correctly occluded LAA leads to the greatest reduction in LA flow stasis and thrombogenicity, presenting a tentative procedural goal to maximize clinical benefits in patients with AF.

• Sim-seong Yeon-gu
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• v.28 no.2
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• pp.107-138
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• 2013

The purpose of this article is to awaken our colleagues to the culture and mind issues that have been forgotten or neglected by contemporary psychiatry under the prevalence of materialistic orientation. Cultural psychiatry too, though it has been contributed a great deal to widen the mental vision of psychiatry, has revealed several limitations in its approach. In the course of one sided search for culture specific factors in relation to mental health, conventional cultural psychiatry has neglected an effort to explore the common root underlying the different cultures and the common foundation of human mind. Cross sectional comparisons of the cultures alone have inevitably prevented the global considerations to culutre and mind in historical aspects and the dynamic interactions between mind and culture more in depth. The author suggested that the total view of mind and total approach of analytical psychology of C.G. Jung might be capable to replenish those limitations. Author explained the ways of C.G. Jung's observations and experiences of non-western culture and his concepts of culture and mind. The author demonstrated Jung's view of culture with the example of Filial Piety, Hyo, the Confucian moral norm which can be regarded as components of the collective consciousness though connected with archetypal patterns of behavior of intimacy between parent and child. In regard to the coexistence of multi-religious cultures in Korea the author made a proposal of 'culture spectrum' model for understanding value orientations of person in religious cultures. He identified in case of the Korean 4 types of cultural spectrums: Person with predominantly the Buddhist culture; with the Confucian; with the Shamanist; and with the Christian culture. The author also made an attempt to depict the dynamic interactions of different religious cultures in historical perspectives of Korea. Concepts of mind from the Eastern thoughts were reviewed in comparison with Jung's view of mind. The Dao of Lao Zi, One Mind by Wonhyo, the Korean Zen master from the 7th century, the Diagram of the Heaven's Decree by Toegye, a renowned Neo-Confucianist of Korea from the 16th century and his theory of Li-Ki, were explored and came to conclusion that they represent certainly the symbol of the Self in term of C.G. Jung. The goal of healing is 'the becoming whole person'. Becoming whole person means bringing the person as an individual to live not only within the specific culture but also to live in the world beyond the culture which is deeply rooted in the primordial foundation of human mind.