• Journal of Chest Surgery
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• 제12권3호
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제13권3호
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• pp.243-249
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• 1980

Truncus ateriosus is one of the cyanotic congenital heart disease. The incidence is relatively uncommon, as 0.4% of totoal congenital heart disease. Embryologically the defect is due to a lack of partitioning of the embryonic truncus and conus during the first few weeks of fetal life. The ventricular septal defect is invariable present. A single arterial vessel arises from the heart and supplies blood to the aorta, the lung, and the coronary arteries. In 1949, collett and Edwards classified this defect according to anatomic variation to four major types, such as type I, II, III, and IV. Type IV is defined that pulmonary arteries are absent, and the pulmonary arterial supply arises from the descending thoracic aorta. This patients often have a continuous murmur head particularly well in the interscapular area. No effective surgical treatment is available. We have experienced one case of truncus arteriosus, type IV of Collett and Edwards in the Department of Thoracic and Cardiovascular Surgery, Kyungbook National University Hospital. This patient was 10 year-old girl. The chief complaints were cyanosis and dyspnea on exertion since birth. She was admitted at this hospital on April 16, 1980. The continous machinery murmur was heard loudest at the interscapular area. The chest X-ray films revealed cardiomegaly with an increase in pulmonaryvascular markings. The pulmonary secotr was significantly concave. No filling of pulmonary arteries noticed by the right ventriculogram. There was possible biventricular hypertrophy in EKG. The echocardiogram showed that the demension of the aortic root was larger than normal and minimal increase of the left ventricular internal dimension. The cardiac catheterization data was obtained by use of the great saphenus vein approach. The systolic pressure of the right ventricular outflow tract was 80 mmHg and was similar to that of the aorta. The oxygen saturation data revealed the evidence of the left to right shunt at the level of ventricular septum. The patient was operated and the diagnosis was confirmed as trucus arteriosus, type IV. No effective surgical interventins were performed.

• Journal of Chest Surgery
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• 제20권3호
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• pp.610-618
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• 1987

A 23-y-o male patient was suffered from intermittent fainting and dyspnea on exertion [NYHA Class IIIIV]. 2-D - Echocardiogram and cardiac catheterization with cineangiogram showed typical IHSS findings those were asymmetrical septal hypertrophy [ASH], systolic anterior motion of anterior mitral leaflet [SAM] which induced mild mitral regurgitation [Seller Grade I/IV] and pressure gradient about 60 mmHg between left ventricle and the aorta. Medical treatment with 8-adrenergic blockade [propranolol] and Ca" channel antagonist [Verapamil] had no response. So, we performed trans-aortic ventricular septal myotomy and mymectomy. Resected rectangular muscle bar was 1 Cm x 1 Cm x 4.5 Cm. Post-operative pressure gradient between the left ventricle and the aorta was less than 10 mmHg and SAM. was disappeared with decreased mitral regurgitation grade. Post-operative course was smooth and his symptoms and signs were free without any medication during 12 months follow-up.w-up.

• 한국임상수의학회지
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• 제21권3호
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• pp.314-318
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• 2004

A 7-month-old 8.2 kg female Siberian Husky with history of exercise intolerance, delayed growth, and tachypnea was presented to Veterinary Medical Teaching Hospital, Kyungpook National University. A holosystolic murmur was identified in cardiac ausculation. In electrocardiography, thoracic radiographs, and ultrasonography, a right axis deviation, enlarged right ventricle, stenotic main pulmonary artery, large ventricular septal defect, marked right ventricle hypertrophy, and overriding aorta with dilation were identified. The color Doppler examination showed the left-to-right shunting of blood via interventricular septal defect and the blood flow streams converging from the right and left ventricles into the aorta. The dog was diagnosed as tetralogy of Fallot. The current state of the dog is well-tolerated without any specific medication.

• 한국임상수의학회지
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• 제33권4호
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• pp.221-224
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• 2016

An 8 month-old male Maltese (weighing 2.0 kg) was referred with loud heart murmur at routine physical exam in local animal clinic. Electrocardiogram found left ventricular hypertrophy pattern (4.5 mV R-wave). Diagnostic imaging studies revealed the elongation of left ventricle (LV) with classic triple bumps on the main pulmonary artery, aorta and left atrium on the ventrodorsal view of radiograph. Echocardiography revealed patent ductus arteriosus (PDA) duct and continuous turbulent shunt flow (maximal velocity 4.83 m/s) between the aorta and pulmonary artery with left to right direction. The PDA in this dog was successfully closed through femoral vein (transvenous approach) using a 5 mm Amplatz$^{(R)}$ Canine Duct Occluder. To the best of author's knowledge, this is the first case of PDA occlusion treated with Amplatz Canine Duct Occluder through femoral vein.

• Journal of Chest Surgery
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• 제40권8호
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• pp.552-557
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• 2007

배경: B-type natriuretic peptide (BNP)는 심실 심근 세포에서 생성되는 심장 호르몬이며, 울혈성 심부전, 심실비대증, 심근염, 심장이식 후 거부반응 때 증가하는 것으로 알려져 있다. 본 연구에서는 심장이식 후 거부 반응의 예측 인자로서의 BNP의 역할에 대해 조사하였다. 대상 및 방법: 심장이식을 받은 10명의 환자를 대상으로 하여 2004년 1월부터 2005년 8월까지 BNP측정값, 심내막 생검을 통한 거부반응, 혈역학적 지표, 심초음파 검사 결과 등을 조사하였으며, 57예의 BNP 측정값의 중간값인 290 pg/mL를 기준으로 하여 Low BNP (n=28, $BNP{\le}290$ pg/mL)군, High BNP (n=29, BNP>290 pg/mL)군으로 나누어 거부반응의 정도, 좌심실구혈률, 삼첨판막 폐쇄 부전, 좌심실비대, 폐동맥쐐기압, 평균 폐동맥압, 우심방압을 후향적으로 비교 분석하였다. 결과: BNP값의 차이에 따른 양 군 간심내막생검에 따른 거부반응의 정도, 좌심실구혈률, 삼첨판막 폐쇄 부전, 좌심실비대, 우심방압은 통계학적으로 유의한 차이가 없었다(p>0.05). 그러나, High BNP군에서 폐동맥쐐기압, 평균 폐동맥압이 Low BNP군보다 높았으며(p<0.05), BNP 측정값은 폐동맥쐐기압과 의미 있는 양의 상관관계를 보였다(r=0.590, p<0.001). BNP 측정값 620 pg/mL를 기준으로 했을때, 폐동맥쐐기압은 83.3%의 민감도와 91.1%의 특이도를 보이며 12 mmHg보다 높은 값을 보였다(AUC: $0.900{\pm}0.045$, p<0.001). 결론: 심장이식 후 BNP 측정값은 거부반응의 정도와 의미 있는 상관관계를 보이지는 않았으나, 심실의 이완기 불능 상태를 평가하는 유용한 지표가 될 수 있다.

• 한국임상수의학회지
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• 제29권5호
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• pp.404-407
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• 2012

3년령 암컷 잡종개(체중 5.3 kg)가 실신, 운동불내성, 의기소침, 기면 등의 증상으로 강원대학교 동물병원에 내원하였다. 진단검사상 적혈구증가증이 관찰되고, 흉부방사선 검사상 심한 우심종대 패턴이 관찰되었으며, 심초음파상우-좌 단락의 심방중격 결손증, 심한 폐동맥 협착증(~5 m/s of peak velocity)과 우심실 비대소견이 관찰되었다. 환자는 진단영상학적 소견을 근거로 팔로삼징(trilogy of Fallot)으로 진단되었다. 환자의 임상증상을 안정화시키기 위해 diltiazem과 enalapril을 투여하였고 일주일에 한번씩 정맥사혈을 실시하고 있다. 본 증례는 국내에서 최초로 보고되는 팔로삼징의 증례이다.

• Journal of Chest Surgery
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• 제56권5호
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• pp.295-303
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• 2023

Background: The use of Adriamycin (ADR), also known as doxorubicin, as a chemotherapy agent is limited by its detrimental adverse effects, especially cardiotoxicity. Recent studies have emphasized the crucial role of angiotensin II (Ang-II) in the development of ADR-induced cardiomyopathy. This study aimed to explore the potential cardioprotective effects of losartan in a rat model of ADR-induced cardiomyopathy. Methods: Male Sprague-Dawley rats were randomly divided into 3 groups: a control group (group C), an ADR-treated group (ADR 5 mg/kg/wk for 3 weeks via intraperitoneal injections; group A), and co-treatment of ADR with losartan group (same dose of ADR and losartan; 10 mg/kg/day per oral for 3 weeks; group L). Western blot analysis was conducted to demonstrate changes in brain natriuretic peptide, collagen 1, tumor necrosis factor (TNF)-α, interleukin-6, matrix metalloproteinase (MMP)-2, B-cell leukemia/lymphoma (Bcl)-2, Bcl-2-associated X (Bax), and caspase-3 protein expression levels in left ventricular (LV) tissues from each group. Results: Losartan administration reduced LV hypertrophy, collagen content, and the expression of pro-inflammatory factors TNF-α and MMP-2 in LV tissue. In addition, losartan led to a decrease in the expression of the pro-apoptotic proteins Bax and caspase-3 and an increase in the expression of the anti-apoptotic protein Bcl-2. Moreover, losartan treatment induced a reduction in the apoptotic area compared to group A. Conclusion: In an ADR-induced cardiomyopathy rat model, co-administration of ADR with losartan presented cardioprotective effects by attenuating LV hypertrophy, pro-inflammatory factors, and apoptosis in LV tissue.

• Journal of Chest Surgery
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• 제11권1호
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• pp.81-84
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• 1978

A 15 years Old girl was admitted with chief complaints of intermittent claudication of lower extremity, dizziness, and headache for 5 years. On admission, malignant hypertension was noted in the upper part of body [190-150/120-110] but femoral & dorsalis pedis pulse could not palpate. Once she had experienced C. V. A. due to hypertension of upper part, about years ago. On auscultation, systolic murmur was audible along the left sternal border. E.C.G. Showed left ventricular hypertrophy pattern, and others within normal limit. Retrograde aortography demonstrated diffuse narrowing of entire thoracic aorta with underdeveloped lower abdominal aorta [below the renal artery] & both common lilac artery, and rich collaterals, but normally visualized greater arteries in the aortic arch. On left posterolasteral thoracotomy, entire descending thoracic aorta revealed marked narrowing with mild perivascular adhesion, but no mediastinal pleura adhesion. These findings suggest as congenital type of atypical coarctation in the entire thoracic aorta with mild secondary change. But histopathology was showed the findings of chronic non-specific aortitis, later. Dacron by pass graft was performed with end to side anastomosis between graft and aortic wall. After operation, all her preoperative symptoms & signs were disappeared, and discharged with good general condition.

• Journal of Chest Surgery
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• 제39권9호
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• pp.659-667
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• 2006

배경: 저산소증, 공기색전증, monocrotaline 약물 주입 등에 의해 혈관 내막의 손상을 일으켜 폐동맥내세포외간질 단백질 합성을 활성화시키고 혈관의 중막비후나 신생내막의 형성을 일으키는 혈관개조(vascular remodeling) 실험이 활발하게 진행되고 있다. 본 연구는 폐정맥을 폐쇄시킨 후 변화된 혈류에 의해 폐장이 어떻게 반응하는지 확인하고자 동물실험을 실시하였다. 대상 및 방법: $352{\pm}18g$의 흰쥐(n=10)를 이용하여 ketamine 근육내 주사로 마취하여 정중흉골절개술을 시행하고 심장을 노출시킨 후 우측 폐정맥을 크립을 이용하여 폐쇄하였으며, 15일 후 폐동맥압, 좌심실과 심실중격 대비 우심실 무게비(RV/LV+Sweight ratio), 말초 폐동맥의 외측지름대비 벽두께비(percent wall thickness (%WT)) 등을 측정하여 대조군(n=5)과 비교하였다. 결과: 폐정맥 폐쇄군의 폐동맥압은 38{\pm}12 mmHg로 대조군의 $13{\pm}4mmHg$에 비해 의의 있게 증가되었다(p<0.05). 좌심실과 심실중격 대비 우심실 무게비는 대조군의 $0.35{\pm}0.04$에 비해 $0.52{\pm}0.07$로 통계적으로 유의한 우심실 비대 소견을 보였고(p<0.05), 말초 폐동맥의 외측지름대비 벽두께비는 폐쇄군이 $22.4{\pm}6.7%$로 대조군의 $6.7{\pm}3.4%$에 비해 증가되었다(p<0.05). 결론: 한쪽 폐의 폐정맥 폐쇄는 폐동맥고혈압, 우심실 비대, 말초 폐동맥의 중막 비후 소견을 유도하였다. 이는 폐동맥 혈관개조의 병리학적 특성을 나타내는 것으로 일측 폐정맥을 폐쇄하는 경우 반대측 폐장의 폐혈류량 증가뿐만 아니라 혈관개조를 유발하는 내막의 손상을 동반함을 알 수 있었다.