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Effects of Activation Regimens of Recipient Cytoplasm, Culture Condition of Donor Embryos and Size of Blastomeres on Development of Reconstituted Bovine Embryos (수핵 난자의 활성화 방법과 공핵 수정란의 배양체계 및 할구의 크기가 소 핵이식 수정란의 발달에 미치는 영향)

  • 심보웅;조성근;이효종;박충생;최상용
    • Korean Journal of Animal Reproduction
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    • v.22 no.4
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    • pp.425-435
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    • 1998
  • To improve the efficiency of nuclear transplantation in bovine, in this study the development in vitro of nuclear transferred (NT) embryos was compared by different activation regimens of the enucleated oocytes. The effect of developmental stage and culture system of donor nuclei on fusion and development in vitro of NT embryos were also evaluated. Oocytes were collected from Hanwoo ovaries obtained from slaughterhouse and matured in Ham's F-10 supplemented with hormones. After 20~22 h maturation, the oocytes were vortexed to be free from cumulus cells and subsequently their nucleus and the first polar body were removed. Enucleated oocytes were divided into 3 groups for activation; the oocytes of group I were activated with ionomycin for 5 min and subsequently incubated in 6-dimetylarninopurine (DMAP) for 4 h, Those of group II were treated with DMAP for 4 h at 39 h after onset of in vitro maturation (IVM) and those of group III were kept in room temperature ($25^{\circ}C$) for 3 h at 39 h after onset of IVM. After in vitro fertilization (IVF) the embryos for muclear donor were cultured either by group culture (20 embryos /50 ${mu}ell$ drop) or individually (1 embryo /50 ${mu}ell$ drop) for 4 day and 5 day. At day 4 and 5 after IVF, blastomeres were separated in calcium-magnesium free medium, and then classified into small (day 5: $\leq$ 38 ${\mu}{\textrm}{m}$, day 4: $\leq$ 46 ${\mu}{\textrm}{m}$) and large (day 5 : $\geq$ 38 ${\mu}{\textrm}{m}$, day 4 ; $\geq$ 46 ${\mu}{\textrm}{m}$). The separated blastomeres were replaced into enucleated and activated recipient cytoplasm. The blastomere-oocyte complexes were fused by electrically. The NT embryos were cultured in TCM-199 containing 10% FCS in 39$^{\circ}C$, 5% $CO_2$ incubator for 7 day. The results obtained were summarized as follows; There were no differences in fusion and development to blastocyst between groups as group I (68%, 10%), group II (75%, 14%) and group III (73%, 9%), respectively. However, the cell number in blastocyst of NT embryos in group III were significantly fewer than in the other groups (P<0.05). No differences in fusion and development to blastocyst were found between individual or group cultured and between small or large blastomeres of day 4 and day 5 donor embryos. From these results, it was concluded that the combination of ionomycin and DMAP, or treatment of DMAP at 39 h after onset of IVM were useful for the efficient of production of NT bovine embryos, and the individual cultured embryos could be simply used as donor nuclei for NT bovine embryo.

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Effect of Mixed Sowing Ratios Between Whole Crop Barley with Hooded Type and Forage Pea on the Forage Yield and Quality (삼차망 청보리와 사료용 완두의 혼파재배가 수량 및 사료가치에 미치는 영향)

  • Ju, Jung-Il;Park, Jong-Min;Lee, Jung-Jun;Kim, Chang-Ho;Koo, Han-Mo;Oh, Tae-Seok;Lee, Hyo-Won
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.29 no.3
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    • pp.171-178
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    • 2009
  • The study was conducted to clarify the mixed seeding rate of whole crop barley with hood type and forage pea for using of forage crops and to compare the forage yield and quality. At a mixed seeding rate between the whole crop barley (WCB) and forage pea, The heading date and plant height of WCB were not a difference according to mixed seeding rate of forage pea. The tillers of the WCB were a decrease and plant of the forage pea were a increase according to increased seeding rate of forage pea. The lodging index of the WCB was a appearance with distribution of $0{\sim}3$, The lodging index of WCB with a 20kg/10a seeding rate of a only WCB without seeding of the forage pea was 3. The overwintering rate of forage pea was a appearance more than 90% at all treatment. The plant height of forage pea was a increase according to increased seeding rate of forage pea at 14 kg/10a and 20 kg/10a plots of WCB. At a mixed seeding between the WCB and forage pea, The fresh weight was a increase according to increased seeding rate of forage pea and was a appearance more than 3,000 kg at all treatment plot. But the dry matter weight was decrease according to increased seeding rates of forage pea. The dry matter weight of 20 kg/10a seeding rate of a only WCB without seeding of the forage pea showed the most amount with 1,266 kg. The crude protein (CP) content was a tendency to increase according to increased seeding rates of forage pea. But, the relative feed value (RFV) was a tendency to decrease according to increased seeding rate of forage pea. The highest RFV was 183.8 at 14 kg/10a seeding rate of a only WCB without seeding of the forage pea. The acid detergent fiber (ADF) and neutral detergent fiber (NDF) were a increase according to increased seeding rate of forage pea at 14 kg/10a and 20 kg/10a plots of WCB. The highest content of ADF and NDF were 23.9% and 46.3% at mixed seeding rate of 20 kg/10a of WCB with 10 kg/10a of forage pea, respectively. The highest sum of standardized score by fresh weight, dry matter weight, CP, ADF, NDF and RFV was 2.309 at mixed seeding rate of 20 kg/10a of WCB with 7.5 kg/10a of forage pea. The optimum mixed seeding rate was a considered judgment in the order of mixed seeding rate of 20 kg/10a of WCB with 7.5 kg/10a of forage pea, mixed seeding rate of 20 kg/10a of WCB with 5.0 kg/10a of forage pea.

Effects of Application of Fermented Swine Manure with Additional Nitrogen Fertilizer on Productivity of Corn and Leaching of Nitrogen and Phosphorous in Corn Cultivation Soil (돈분발효 퇴액비 시용과 첨가적인 질소비료 시용이 옥수수의 생산성과 질소 및 인의 용탈에 미치는 영향)

  • Choi, Ki-Choon;Jo, Nam-Chul;Jung, Min-Woong;Yook, Wan-Bang
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.30 no.1
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    • pp.15-24
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    • 2010
  • This study was conducted to investigate the effects of swine manure (SM) application with additional nitrogen (N) fertilizer on productivity of corn and environmental pollution in com cultivation soil. The experiment was conformed in lysimeter which was constructed with 30 cm diameter, and 100 cm height. Swine manures used in this study were the compost of swine manure fermented with sawdust (SMFWS) and soft rice hulls treated with high temperature and high pressure (SRH), and swine slurry (SS). The application rates of the additional N, as urea, with swine manure were 50 and 100 kgN/ha on each plot. This study was arranged in completely randomized design with three replication. DM yields in SM treatments with mineral N were increased significantly compared to those in SM treatment without mineral N (zero-mineral N) (P<0.05) and increased as the rate of mineral N application increased (P<0.05). DM yields in SMFWS and SS treatments with mineral 100 kgN/ha showed trends similar to those of chemical fertilizer (control) but higher than those of 50 kg N/ha. DM yields tended to be higher in SMFWS and SS treatments than in SRH treatment. Total N contents in SMFWS, SRH and SS treatments with mineral N were increased, compared with SM treatment without mineral N. N contents in SM treatments with mineral N were lower than those of chemical fertilizer treatment, but N content of chemical fertilizer treatment showed trends similar to that of SS treatments with mineral 100 kgN/ha. $NO_3$-N concentration in SM treatments with mineral N were increased significantly, compared to those in SM treatment without mineral N and in chemical fertilizer (P<0.05). $NH_4$-N concentrations in SMFWS and SS treatments with mineral 100 kgN/ha showed trends similar to those of chemical fertilizer, but higher than those of 50 kg N/ha. $PO_4$-P concentration in SM treatments with mineral N were increased significantly, compared to those in SM treatment without mineral N (P<0.05). $PO_4$-P concentration in chemical fertilizer treatment showed trends similar to that of SS treatments with mineral 100 kgN/ha. The concentrations of $NO_3$-N $NH_4$-N and $PO_4$-P increased as the rate of mineral N application increased (P<0.05). The concentrations of $NO_3$-N $NH_4$-N and $PO_4$-P were highly elevated in the concentrated rainy season in the early stage among experimental period. The maximum $NO_3$-N $NH_4$-N and $PO_4$-P concentrations in the leaching water were 3.46 mg/L, 1.11 mg/L and 0.14 mg/L, respectively.

The comparison of lesion localization methods in breast lymphoscintigraphy (Breast lymphoscintigraphy 검사 시 체표윤곽을 나타내는 방법의 비교)

  • Yeon, Joon ho;Hong, Gun chul;Kim, Soo yung;Choi, Sung wook
    • The Korean Journal of Nuclear Medicine Technology
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    • v.19 no.2
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    • pp.74-80
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    • 2015
  • Purpose Breast lymphoscintigraphy is an important technique to present for body surface precisely, which shows a lymph node metastasis of malignant tumors at an early stage and is performed before and after surgery in patients with breast cancer. In this study, we evaluated several methods of body outline imaging to present exact location of lesions, as well as compared respective exposure doses. Materials and Methods RANDO phantom and SYMBIA T-16 were used for obtaining imaging. A lesion and an injection site were created by inserting a point source of 0.11 MBq on the axillary sentinel lymph node and 37 MBq on the right breast, respectively. The first method for acquiring the image was used by drawing the body surface of phantom for 30 sec using $Na^{99m}TcO_4$ as a point source. The second, the image was acquired with $^{57}Co$ flood source for 30 seconds on the rear side and the left side of the phantom, the image as the third method was obtained using a syringe filled with 37 MBq of $Na^{99m}TcO_4$ in 10 ml of saline, and as the fourth, we used a photon energy and scatter energy of $^{99m}Tc$ emitting from phantom without any addition radiation exposure. Finally, the image was fused the scout image and the basal image of SPECT/CT using MATLAB$^{(R)}$ program. Anterior and lateral images were acquired for 3 min, and radiation exposure was measured by the personal exposure dosimeter. We conducted preference of 10 images from nuclear medicine doctors by the survey. Results TBR values of anterior and right image in the first to fifth method were 334.9 and 117.2 ($1^{st}$), 266.1 and 124.4 ($2^{nd}$), 117.4 and 99.6 ($3^{rd}$), 3.2 and 7.6 ($4^{th}$), and 565.6 and 141.8 ($5^{th}$). And also exposure doses of these method were 2, 2, 2, 0, and $30{\mu}Sv$, respectively. Among five methods, the fifth method showed the highest TBR value as well as exposure dose, where as the fourth method showed the lowest TBR value and exposure dose. As a result, the last method ($5^{th}$) is the best method and the fourth method is the worst method in this study. Conclusion Scout method of SPECT/CT can be useful that provides the best values of TBR and the best score of survey result. Even though personal exposure dose when patients take scout of SPECT/CT was higher than another scan, it was slight level comparison to 1 mSv as the dose limit to non-radiation workers. If the scout is possible to less than 80 kV, exposure dose can be reduced, and also useful lesion localization provided.

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The Evaluation of Attenuation Difference and SUV According to Arm Position in Whole Body PET/CT (전신 PET/CT 검사에서 팔의 위치에 따른 감약 정도와 SUV 변화 평가)

  • Kwak, In-Suk;Lee, Hyuk;Choi, Sung-Wook;Suk, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.21-25
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    • 2010
  • Purpose: For better PET imaging with accuracy the transmission scanning is inevitably required for attenuation correction. The attenuation is affected by condition of acquisition and patient position, consequently quantitative accuracy may be decreased in emission scan imaging. In this paper, the present study aims at providing the measurement for attenuation varying with the positions of the patient's arm in whole body PET/CT, further performing the comparative analysis over its SUV changes. Materials and Methods: NEMA 1994 PET phantom was filled with $^{18}F$-FDG and the concentration ratio of insert cylinder and background water fit to 4:1. Phantom images were acquired through emission scanning for 4min after conducting transmission scanning by using CT. In an attempt to acquire image at the state that the arm of the patient was positioned at the lower of ahead, image was acquired in away that two pieces of Teflon inserts were used additionally by fixing phantoms at both sides of phantom. The acquired imaged at a were reconstructed by applying the iterative reconstruction method (iteration: 2, subset: 28) as well as attenuation correction using the CT, and then VOI was drawn on each image plane so as to measure CT number and SUV and comparatively analyze axial uniformity (A.U=Standard deviation/Average SUV) of PET images. Results: It was found from the above phantom test that, when comparing two cases of whether Teflon insert was fixed or removed, the CT number of cylinder increased from -5.76 HU to 0 HU, while SUV decreased from 24.64 to 24.29 and A.U from 0.064 to 0.052. And the CT number of background water was identified to increase from -6.14 HU to -0.43 HU, whereas SUV decreased from 6.3 to 5.6 and A.U also decreased from 0.12 to 0.10. In addition, as for the patient image, CT number was verified to increase from 53.09 HU to 58.31 HU and SUV decreased from 24.96 to 21.81 when the patient's arm was positioned over the head rather than when it was lowered. Conclusion: When arms up protocol was applied, the SUV of phantom and patient image was decreased by 1.4% and 9.2% respectively. With the present study it was concluded that in case of PET/CT scanning against the whole body of a patient the position of patient's arm was not so much significant. Especially, the scanning under the condition that the arm is raised over to the head gives rise to more probability that the patient is likely to move due to long scanning time that causes the increase of uptake of $^{18}F$-FDG of brown fat at the shoulder part together with increased pain imposing to the shoulder and discomfort to a patient. As regarding consideration all of such factors, it could be rationally drawn that PET/CT scanning could be made with the arm of the subject lowered.

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A Study on the Individual Radiation Exposure of Medical Facility Nuclear Workers by Job (의료기관 핵의학 종사자의 직무 별 개인피폭선량에 관한 연구)

  • Kang, Chun-Goo;Oh, Ki-Baek;Park, Hoon-Hee;Oh, Shin-Hyun;Park, Min-Soo;Kim, Jung-Yul;Lee, Jin-Kyu;Na, Soo-Kyung;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.9-16
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    • 2010
  • Purpose: With increasing medical use of radiation and radioactive isotopes, there is a need to better manage the risk of radiation exposure. This study aims to grasp and analyze the individual radiation exposure situations of radiation-related workers in a medical facility by specific job, in order to instill awareness of radiation danger and to assist in safety and radiation exposure management for such workers. Materials and Methods: 1 January 2007 to 31 December 2009 to work in medical institutions are classified as radiation workers Nuclear personal radiation dosimeter regularly, continuously administered survey of 40 workers in three years of occupation to target, Imaging Unit beautifully, age, dose sector, job function-related tasks to identify the average annual dose for a deep dose, respectively, were analyzed. The frequency analysis and ANOVA analysis was performed. Results: Imaging Unit beautifully three years the annual dose PET and PET/CT in the work room 11.06~12.62 mSv dose showed the highest, gamma camera injection room 11.72 mSv with a higher average annual dose of occupation by the clinical technicians 8.92 mSv the highest, radiological 7.50 mSv, a nurse 2.61 mSv, the researchers 0.69 mSv, received 0.48 mSv, 0.35 mSv doctors orderly, and detail work employed the average annual dose of the PET and PET/CT work is 12.09 mSv showed the highest radiation dose, gamma camera injection work the 11.72 mSv, gamma camera imaging work 4.92 mSv, treatment and safety management and 2.98 mSv, a nurse working 2.96 mSv, management of 1.72 mSv, work image analysis 0.92 mSv, reading task 0.54 mSv, with receiving 0.51 mSv, 0.29 mSv research work, respectively. Dose sector average annual dose of the study subjects, 15 people (37.5%) than the 1 mSv dose distribution and 5 people (12.5%) and 1.01~5.0 mSv with the dose distribution was less than, 5.01~10.0 mSv in the 14 people (35.0%), 10.01~20.0 mSv in the 6 people (15.0%) of the distribution were analyzed. The average annual dose according to age in occupations that radiological workers 25~34 years old have the highest average of 8.69 mSv dose showed the average annual dose of tenure of 5~9 years in jobs radiation workers in the 9.5 mSv The average was the highest dose. Conclusion: These results suggest that medical radiation workers working in Nuclear Medicine radiation safety management of the majority of the current were carried out in the effectiveness, depending on job characteristics has been found that many differences. However, this requires efforts to minimize radiation exposure, and systematic training for them and for reasonable radiation exposure management system is needed.

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A Clinical Study of Acute Poststreptococcal Glomerulonephritis with Nephrotic Syndrome (신증후군을 동반한 연쇄상구균 감염후 급성사구체신염의 임상적 고찰)

  • Moon Sang-Ae;Yook Jin-Won;Kim Ji-Hong;Lee Jae-Seung;Jeong Hyun-Joo;Kim Pyung-Kil
    • Childhood Kidney Diseases
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    • v.3 no.2
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    • pp.123-129
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    • 1999
  • Purpose: Acute poststreptococcal glomerulonephritis(APSGN) is a renal disease which is characterized by glomerular proliferation and inflammatory changes due to immune reaction. Although the 95% of patients with APSGN seems to recover fully and present as benign course, the remaining patients show poor prognosis. Therefore comparative retrograde study between APSGN with and without nephrotic syndrome was done to find out the any prognostic indicator to predict the outcome in patients with APSGN. Methods: We had retrospectively analyzed seventy-one patients who were diagnosed as APSGN clinically from Mar.1989 to Feb.1999 in Yonsei university medical center. Sixty-four of the patients was APSGN without nephrotic syndrome(Group A) and seven patients were in APSGN with nephrotic syndrome(Group B). Results: Patients who were diagnosed as APSGN with nephrotic syndrome were seven(9.9%) out of seventy-one. In the comparative study, sex ratio was 1:1 in group A and 1.9: 1 in group B, onset mean age was $8.9{\pm}2.6$ in group A and $8.8{\pm}2.6$ in group B. Following clinical profiles were compared but there were no significant difference between these two groups: WBC count($9413{\pm}2964\;vs\;9368{\pm}2650(/mm^3)$), hemoglobin($10.6{\pm}1.2\;vs\;10.0{\pm}0.9(gm/dL)$), ASO($746.1{\pm}640.7\;vs\;614.9{\pm}475.9(IU/ml)$), $C_3(20.1{\pm}17.0\;vs\;16.9{\pm}13.1(mg/dL)$), $C_4(22.8{\pm}9.5\;vs\;22.6{\pm}6.9(mg/dL)$), BUN($25.8{\pm}26.1\;vs\;28.1{\pm}14.5(mg/dL)$), creatinin($0.8{\pm}0.3\;vs\;0.8{\pm}0.3(mg/dL)$), $C_{cr}(80.6{\pm}28.8{\pm}62.4{\pm}31.4(ml/min/1.73\;m^2$)), the duration of edma, gross hematuria, and hypertension. However, we found that there were a significant difference in the duration of proteinuria($1.95{\pm}2.27\;vs\;13.3{\pm}21.1(months)$)(P<0.05), decreased $C_3$ duration($1.9{\pm}2.9\;vs\;7.3{\pm}5.0(weeks)$)(P<0.05) and especially it was proloned according to the amount of early urine protein excretion. Conclusion: Our study showed markedly prolonged duration of proteinuria and decreased $C_3$ duration in patients with APSGN with nephrotic syndrome. We were not able to find the definite prognostic factor that will guide the outcome of patients with APSGN accompaning nephrotic syndrome, but above findings seemed to represent as a relative indication of the outcome of the disease. All patients recovered completely and we did not experience any cases that progressed into the renal failure.

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A Clinical Study of Hospitalized Infants 28 to 90 Days of Age with Fever without Source (원인 없는 열로 입원한 생후 28일에서 90일 사이 영아들에 대한 임상적 고찰)

  • Rye, Min Hyuk;Noh, Yn Il;Lee, Seong Hun;Lee, Sun Young;Hur, Nam Jin;Lee, Dong Jin
    • Pediatric Infection and Vaccine
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    • v.8 no.2
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    • pp.191-198
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    • 2001
  • Purpose : The purpose of this study was to investigate clinical features of hospitalized infants 28~90 days of age with fever without source and to analyze those of young febrile infants using risk criteria for serious bacterial infection. Methods : The clinical features of 131 infants 28~90 days of age admitted to the Ulsan Dong-Kang General Hospital Pediatric Department because of fever(temperature ${\geq}38^{\circ}C$ rectally) without source, from January 2000 to December 2000, were investigated by retrospective chart review. The clinical features of 131 febrile infants were analyzed using Rochester criteria. Results : Among 131 cases, there were 60 cases(45.8%) of urinary tract infection, 33 cases (25.2%) of aseptic meningitis, 2 cases(1.5%) of bacteremia and 36 cases(27.5%) of no specific diagnosis. Among 131 cases, there were 57 cases(43.5%) in low risk group and 74 cases(56.5%) in not low risk one by Rochester criteria. A significant difference in the incidence of urinary tract infection, aseptic meningitis and no specific diagnosis was not found between both groups. Male to female ratio was 1.8 : 1. Sex ratio between both groups was not significantly different. Most febrile infant were noted in spring(35.1%) and the summer(36.7%). The peak incidence of aseptic meningitis was noted in May and June. The fever subsided mostly within 48~72 hours after administering antimicrobial agents(61.8~83.2%). A significant difference in duration of fever after administering antimicrobial agents was not found between both groups. Conclusion : A selected group of low risk infants 28~90 days of age with fever without source can be managed as outpatients provided that a thorough initial evaluation is performed, that parents can reliably monitor their infant closely at home and that careful follow up can be assured. Because bag collected specimens were more likely to yield indeterminate urine culture result, a suprapubic or catheter obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants 28~90 days of age. The further prospective study on evaluation and management of young febrile infant should be performed in our hospital.

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A Study on Urinary Cadmium Concentration and Renal Indices of Inhabitant in an Abandoned Mine Area (폐광지성(廢鑛地城) 주민(住民)의 요중(尿中) 카드뮴 농도(濃度)와 현기능평가(賢機能評價))

  • Park, Jung-Duck;Park, Chan-Byung;Choi, Byung-Sun;Kang, Eun-Yong;Hong, Yeon-Pyo;Chang, Im-Won;Chun, Byung-Yeol;Yeh, Min-Hae
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.3 s.62
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    • pp.424-439
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    • 1998
  • Urinary cadmium is used as a sensitive indicator for internal Cd dose, and increased excretion of $N-acetyl-\beta-D-glucosaminidase(NAG)$, $\beta_2-microglobulin(MG)$ and total protein are useful indices for renal dysfunction by chronic exposure to Cd. The target group was 184 inhabitant(82 men and 102 women) in an abandoned mine area known as exposure to low level Cd. The control group was took 160 individuals(64 men and 96 women) in Cd not-exposed area. Urinary Cd concentration was significantly higher in the target group than the control. The geometric mean of urinary Cd for male was $2.56{\mu}g/\ell,\;2.80{\mu}g/g$ creatinine and $2.50{\mu}g/S.G.$ in the target group and $1.19{\mu}g/\ell,\;1.36{\mu}g/g$ creatinine and $1.17{\mu}g/S.G.$ in the control. For female $2.69{\mu}g/\ell,\;3.94{\mu}g/g$ creatinine and $2.63{\mu}g/S.G.$ in the target group and $1.27{\mu}g/\ell,\;1.97{\mu}g/g$ creatinine and $1.25{\mu}g/S.G.$ in the control, respectively. In addition, urinary Cd of the target group had affected by the period of residence and dietary habit for the rice and the vegetables from the target area. These findings suggest the chronic exposure to Cd of the target population. Mean excretion of urinary NAG, $\beta_2-MG$ and total protein were not significant between two groups. In the target group, urinary NAG activity and total protein were significantly correlated with urinary Cd, but $\beta_2-MG$ was not related. Urinary excretion of NAG, $\beta_2-MG$ and total protein were significantly increased in $10\leqq$ than in <2 of urinary Cd level. In $2\sim10$ group of urinary Cd level, the excretion of NAG significantly increased while not showed for $\beta_2-MG$. In present study, urinary excretion of NAG was relatively sensitive than $\beta_2-MG$ in chronic exposure population to low level Cd.

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Risk Factor Analysis and Surgical Indications for Pulmonary Artery Banding (폐동맥 밴딩의 위험인자 분석과 수술적응중)

  • Lee Jeong Ryul;Choi Chang Hyu;Min Sun Kyung;Kim Woong Han;Kim Yong Jin;Rho Joon Ryang;Bae Eun Jung;Noh Chung I1;Yun Yong Soo
    • Journal of Chest Surgery
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    • v.38 no.8 s.253
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    • pp.538-544
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    • 2005
  • Background: Pulmonary artery banding (PAB) is an initial palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. We proved the usefulness of PAB through retrospective investigation of the surgical indication and risk analysis retrospectively. Material and Method: One hundred and fifty four consecutive patients (99 males and 55 females) who underwent PAB between January 1986 and December 2003 were included. We analysed the risk factors for early mortality and actuarial survival rate. Mean age was $2.5\pm12.8\;(0.2\sim92.7)$ months and mean weight was $4.5\pm2.7\;(0.9\sim18.0)\;kg$. Preoperative diagnosis included functional single ventricle $(88,\;57.1\%)$, double outlet right ventricle $(22,\;14.2\%)$, transposition of the great arteries $(26,\;16.8\%)$, and atrioventricular septal defect $(11,\;7.1\%)$. Coarctation of the aorta or interrupted aortic arch $(32,\;20.7\%)$, subaortic stenosis $(13,\;8.4\%)$ and total anomalous pulmonary venous connection $(13,\;8.4\%)$ were associated. Result: The overall early mortality was $22.1\%\;(34\;of\;154)$, The recent series from 1996 include patients with lower age $(3.8\pm15.9\;vs.\;1.5\pm12.7,\;p=0.04)$ and lower body weight $(4.8\pm3.1\;vs.\;4.0\pm2.7,\;p=0.02)$. The early mortality was lower in the recent group $(17.5\%;\;16/75)$ than the earlier group $(28.5\%;\;18/45)$. Aortic arch anomaly (p=0.004), subaortic stenosis (p=0.004), operation for subaortic stenosis (p=0.007), and cardiopulmonary bypass (p=0.007) were proven to be risk factors for early death in univariate analysis, while time of surgery (<1996) (p=0.026) was the only significant risk factor in multivariate analysis. The mean time interval from PAB to the second-stage operation was $12.8\pm10.9$ months. Among 96 patients who survived PAB, 40 patients completed Fontan operation, 21 patients underwent bidirectional cavopulmonary shunt, and 35 patients underwent biventricular repair including 25 arterial switch operations. Median follow-up was $40.1\pm48.9$ months. Overall survival rates at 1 year, 5 years and 10 years were $81.2\%\;65.0\%,\;and\;63.5\%$ respectively. Conclusion: Although it improved in recent series, early mortality was still high despite the advances in perioperative management. As for conventional indications, early primary repair may be more beneficial. However, PA banding still has a role in the initial palliative step in selective groups.