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The Role of Tumor Necrosis Factor-$\alpha$ and Interleukin-$1{\beta}$ as Predictable Markers for Development of Adult Respiratory Distress Syndrome in Septic Syndrome (패혈증 증후군환자에서 성인성 호흡곤란 증후군 발생의 예측 지표서의 혈중 Tumor Necrosis Factor-$\alpha$와 Interleukin-$1{\beta}$에 관한 연구)

  • Koh, Youn-Suck;Jang, Yun-Hae;Kim, Woo-Sung;Lee, Jae-Dam;Oh, Soon-Hwan;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.5
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    • pp.452-461
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    • 1994
  • Background: Tumor necrosis factor(TNF)-$\alpha$ and Interleukin(lL)-$1{\beta}$ are thought to play a major role in the pathogenesis of the septic syndrome, which is frequently associated with adult respiratory distress syndrome(ARDS). In spite of many reports for the role of TNF-$\alpha$ in the pathogenesis of ARDS, including human studies, it has been reported that TNF-$\alpha$ is not sensitive and specific marker for impending ARDS. But there is a possibility that the results were affected by the diversity of pathogenetic mechanisms leading to the ARDS because of various underlying disorders of the study group in the previous reports. The purpose of the present study was to evaluate the roles of TNF-$\alpha$ and IL-$1{\beta}$ as a predictable marker for development of ARDS in the patients with septic syndrome, in which the pathogenesis is believed to be mainly cytokine-mediated. Methods: Thirty-six patients of the septic syndrome hospitalized in the intensive care units of the Asan Medical Center were studied. Sixteens suffered from ARDS, whereas the remaining 20 were at the risk of developing ARDS(acute hypoxemic respiratory failure, AHRF). In all patients venous blood samples were collected in heparin-coated tubes at the time of enrollment, at 24 and 72 h thereafter. TNF-$\alpha$ and IL-$1{\beta}$ was measured by an enzyme-linked immunosorbent assay (ELISA). All data are expressed as median with interquartile range. Results: 1) Plama TNF-$\alpha$ levels: Plasma TNF-$\beta$ levels were less than 10pg/mL, which is lowest detection value of the kit used in this study within the range of the $mean{\pm}2SD$, in all of the normal controls, 8 of 16 subjects of ARDS and in 8 in 20 subjects of AHRF. Plasma TNF-$\alpha$ levels from patients with ARDS were 10.26pg/mL(median; <10-16.99pg/mL, interquartile range) and not different from those of patients at AHRF(10.82, <10-20.38pg/mL). There was also no significant difference between pre-ARDS(<10, <10-15.32pg/mL) and ARDS(<10, <10-10.22pg/mL). TNF-$\alpha$ levels were significantly greater in the patients with shock than the patients without shock(12.53pg/mL vs. <10pg/mL) (p<0.01). There was no statistical significance between survivors(<10, <10-12.92pg/mL) and nonsurvivors(11.80, <10-20.8pg/mL) (P=0.28) in the plasma TNF-$\alpha$ levels. 2) Plasma IL-$1{\beta}$ levels: Plasma IL-$1{\beta}$ levels were less than 0.3ng/mL, which is the lowest detection value of the kit used in this study, in one of each patients group. There was no significant difference in IL-$1{\beta}$ levels of the ARDS(2.22, 1.37-8.01ng/mL) and of the AHRF(2.13, 0.83-5.29ng/mL). There was also no significant difference between pre-ARDS(2.53, <0.3-8.34ngfmL) and ARDS(5.35, 0.66-11.51ng/mL), and between patients with septic shock and patients without shock (2.51, 1.28-8.34 vs 1.46, 0.15-2.13ng/mL). Plasma IL-$1{\beta}$ levels were significantly different between survivors(1.37, 0.4-2.36ng/mL) and nonsurvivors(2.84, 1.46-8.34ng/mL). Conclusion: Plasma TNF-$\alpha$ and IL-$1{\beta}$ level are not a predictable marker for development of ARDS. But TNF-$\alpha$ is a marker for shock in septic syndrome. These result could not exclude a possibility of pathophysiologic roles of TNF-$\alpha$ and IL-$1{\beta}$ in acute lung injury because these cytokine could be locally produced and exert its effects within the lungs.

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Mechanical Characteristics of the Rift, Grain and Hardway Planes in Jurassic Granites, Korea (쥬라기 화강암류에서 발달된 1번 면, 2번 면 및 3번 면의 역학적 특성)

  • Park, Deok-Won
    • Korean Journal of Mineralogy and Petrology
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    • v.33 no.3
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    • pp.273-291
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    • 2020
  • The strength characteristics of the three orthogonal splitting planes, known as rift, grain and hardway planes in granite quarries, were examined. R, G and H specimens were obtained from the block samples of Jurassic granites in Geochang and Hapcheon areas. The directions of the long axes of these three specimens are perpendicular to each of the three planes. First, The chart, showing the scaling characteristics of three graphs related to the uniaxial compressive strengths of R, G and H specimens, were made. The graphs for the three specimens, along with the increase of strength, are arranged in the order of H < G < R. The angles of inclination of the graphs for the three specimens, suggesting the degree of uniformity of the texture within the specimen, were compared. The above angles for H specimens(θH, 24.0°~37.3°) are the lowest among the three specimens. Second, the scaling characteristics related to the three graphs of RG, GH and RH specimens, representing a combination of the mean compressive strengths of the two specimens, were derived. These three graphs, taking the various N-shaped forms, are arranged in the order of GH < RH < RG. Third, the correlation chart between the strength difference(Δσt) and the angle of inclination(θ) was made. The above two parameters show the correlation of the exponential function with an exponent(λ) of -0.003. In both granites, the angle of inclination(θRH) of the RH-graph is the lowest. Fourth, the six types of charts, showing the correlations among the three kinds of compressive strengths for the three specimens and the five parameters for the two sets of microcracks aligned parallel to the compressive load applied to each specimen, were made. From these charts for Geochang and Hapcheon granites, the mean value(0.877) of the correlation coefficients(R2) for total density(Lt), along with the frequency(N, 0.872) and density(ρ, 0.874), is the highest. In addition, the mean values(0.829) of correlation coefficients associated with the mean compressive strengths are more higher than the minimum(0.768) and maximum(0.804) compression strengths of three specimens. Fifth, the distributional characteristics of the Brazilian tensile strengths measured in directions parallel to the above two sets of microcracks in the three specimens from Geochang granite were derived. From the related chart, the three graphs for these tensile strengths corresponding to the R, G and H specimens show an order of H(R1+G1) < G(R2+H1) < R(R1+G1). The order of arrangement of the three graphs for the tensile strengths and that for the compressive strengths are mutually consistent. Therefore, the compressive strengths of the three specimens are proportional to the three types of tensile strengths. Sixth, the values of correlation coefficients, among the three tensile strengths corresponding to each cumulative number(N=1~10) from the above three graphs and the five parameters corresponding to each graph, were derived. The mean values of correlation coefficients for each parameter from the 10 correlation charts increase in the order of density(0.763) < total length(0.817) < frequency(0.839) < mean length(Lm, 0.901) ≤ median length(Lmed, 0.903). Seventh, the correlation charts among the compressive strengths and tensile strengths for the three specimens were made. The above correlation charts were divided into nine types based on the three kinds of compressive strengths and the five groups(A~E) of tensile strengths. From the related charts, as the tensile strength increases with the mean and maximum compressive strengths excluding the minimum compressive strength, the value of correlation coefficient increases rapidly.

Clinical Analysis of Influenza in Children and Rapid Antigen Detection Test on First Half of the Year 2004 in Busan (2004 상반기 부산 지역에서 유행한 인플루엔자의 임상 역학적 분석 및 인플루엔자 진단에 있어서의 신속 항원 검사법)

  • Choi, So Young;Lee, Na Young;Kim, Sung Mi;Kim, Gil Heun;Jung, Jin Hwa;Choi, Im Jung;Cho, Kyung Soon
    • Pediatric Infection and Vaccine
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    • v.11 no.2
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    • pp.158-169
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    • 2004
  • Purpose : Although influenza is one of the most important cause of acute respiratory tract infections in children, virus isolation is not popular and there are only a few clinical studies on influenza and diagnostic methods. We evaluated the epidemiological and clinical features of influenza in children and rapid antigen detection test(QuickVue influenza test) on fist half of the year 2004 in Busan. Methods : From January 2004 to June 2004, throat swab and nasal secretion were obtained and cultured for the isolation of influenza virus and tested by rapid antigen detection test(QuickVue influenza test) in children with suspected influenza infections. The medical records of patients with influenza virus infection were reviewed retrospectively. Results : Influenza viruses were isolated in 79(17.2%) out of 621 patients examined. Influenza virus was isolated mainly from March to April 2004. The ratio of male and female with influenza virus infection was 1.2 : 1 with median age of 4 years 6month. The most common clinical diagnosis of influenza virus infection was bronchitis. There was no difference between influenza A and B infection in clinical diagnosis and symptoms. All patients recovered without severe complication. The sensitivity obtained for rapid antigen detection test (QuickVue influenza test) was 93.6% and the specificity was 80.2%, the positive predictive value 40.8%, the negative predictive value 98.8%. Conclusion : With rapid antigen detection test, it is possible early detection of influenza in children. reduction in use of antimicrobial agent and early use of antiviral agent.

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Preoperative Evaluation for the Prediction of Postoperative Mortality and Morbidity in Lung Cancer Candidates with Impaired Lung Function (폐기능이 저하된 폐암환자에서 폐절제술후 합병증의 예측 인자 평가에 관한 전향적 연구)

  • Perk, Jeong-Woong;Jeong, Sung-Whan;Nam, Gui-Hyun;Suh, Gee-Young;Kim, Ho-Cheol;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.1
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    • pp.14-23
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    • 2000
  • Background: The evaluation of candidates for successful lung resection is important. Our study was conducted to determine the preoperative predictors of postoperative mortality and morbidity in lung cancer patients with impaired lung function. Method; Between October 1, 1995 and August 31, 1997, 36 lung resection candidates for lung cancer with $FEV_1$ of less than 2L or 60% of predicted value were included prospectively. Age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness were considered as systemic potential predictors for successful lung resection. Smoking history, presence of pneumonia, dyspnea scale(l to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test were also included for the analysis. In addition, predicted postoperative(ppo) pulmonary factors such as ppo-$FEV_1$ ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-$FEV_1%{\times}$ppo-DLco% and ppo-maximal $O_2$ uptake($VO_2$max) were also measured. Results: There were 31 men and 5 women with the median age of 65 years(range, 44 to 82) and a mean $FEV_1$ of $1.78{\pm}0.06L$. Pneumonectomy was performed in 14 patients, bilobectomy in 8, lobectomy in 14. Pulmonary complications developed in 10 patients; cardiac complications in 3, other complications(empyema, air leak, bleeding) in 4. Twelve patients were managed in the intensive care unit for more than 48 hours. Two patients died within 30 days after operation. The ppo-$VO_2$max was less than 10 ml/kg/min in these two patients. MVV was the only predictor for the pulmonary complications. However, there was no predictor for the post operative death in this study. Conclusions: Based on the results, MVV was the useful predictor for postoperative pulmonary complications in lung cancer resection candidates with impaired lung function In addition, ppo-$VO_2$max value less than 10 ml/kg/min was associated with postoperative death, so exercise pulmonary function test could be useful as preoperative test. But further studies are needed to validate this result.

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Status and Change in Chemical Properties of Polytunnel Soil in Korea from 2000 to 2012

  • Kang, Seong Soo;Roh, Ahn Sung;Choi, Seung Chul;Kim, Young Sang;Kim, Hyun Ju;Choi, Moon Tae;Ahn, Byoung Gu;Kim, Hee Kwon;Park, Sang Jo;Lee, Young Han;Yang, Sang Ho;Ryu, Jong Soo;Sohn, Yeon Gyu;Kim, Myeong Sook;Kong, Myung Suk;Lee, Chang Hoon;Lee, Deog Bae;Kim, Yoo Hak
    • Korean Journal of Soil Science and Fertilizer
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    • v.46 no.6
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    • pp.641-646
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    • 2013
  • Chemical properties of agricultural soils in Korea have been investigated at four-year interval in order of paddy, polytunnel, upland, and orchard soils since 1999; polytunnel soils were investigated over the whole country in 2000, 2004, 2008, and 2012. Polytunnel soils were taken from the surface (0-15 cm) and subsurface (15-30 cm) at 2,651, 1,274, 1,374 and 1,374 sites in all provinces of South Korea. One hundred sampling sites located in more than 400 m altitude were additionally investigated in 2008 and 2012. Average of soil chemical properties in 2012 except Jeju province were 6.6 for pH, 3.2 dS $m^{-1}$ for EC, 37 g $kg^{-1}$ for organic matter (OM), 1,049 mg $kg^{-1}$ for available (Avail.) phosphate, 1.58 $cmol_c\;kg^{-1}$ for exchangeable (Exch.) K, 10.6 $cmol_c\;kg^{-1}$ for Exch. Ca, and 3.3 $cmol_c\;kg^{-1}$ for Exch. Mg. Except pH, averages of all chemical properties exceeded the upper limit of optimal range. The median values except pH showed a lower value than the averages. The pH, OM and Exch. Ca had slightly increased from 6.3 to 6.6, from 34 to 37 g $kg^{-1}$, and from 7.7 in 2000 to 10.6 $cmol_c\;kg^{-1}$ in 2012, respectively. The order of sample ratios exceeding the optimal range were Avail. $P_2O_5$ (83%) > Exch. Ca (80%) > Exch. K (70%) > Exch. Mg (65%) > EC (55%) > OM (48%) > pH (29%) in 2012. The order of sample ratios below the optimal range was OM (25%) > Exch. K (25%) > pH (20%), Exch. Mg and Avail. $P_2O_5$ (9%) > Exch. Ca (6%) in 2012. The excessive proportion of pH, Exch. Ca, Exch. Mg and OM slightly increased, while the insufficient proportion of those decreased. Approximately 55% of polytunnel soils exceeding EC 2 dS $m^{-1}$ was evaluated with salt accumulated soils having the risk of growth disorder of crops. Nutrient contents in polytunnel soils in Korea showed high level especially Avail. $P_2O_5$ and Exch. cations. Therefore, recommended fertilization based on soil testing or plant testing is needed for soil nutrient management.

Evaluation of Fish Acute Toxicity and Preliminary Risk Assessment of Plant Extracts, Sophora, Neem and Derris (유기농업자재 고삼, 님 및 데리스 추출물의 어류에 대한 독성과 위해성 평가)

  • Park, Kyung-Hun;Oh, Jin-A;Paik, Min-Kyoung;Son, Mi-Yeon;Lim, Joung-Taek;Jin, Jung-hwa;Hong, Soonsung;Cho, Nam-jun;Han, Sang-Gyun;Kim, Byung-Seok
    • The Korean Journal of Pesticide Science
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    • v.19 no.3
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    • pp.255-263
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    • 2015
  • Promoting the organic farming, much of the plant extracts used for controlling pests and fungi have been imported from China, India and Myanmar. But, it is so worrisome that aquatic animals such as muddy loach inhabiting in paddy field and common carps in river exposed to the pests and fungi likely be harmed. This study was conducted in order to evaluate the risks of aquatic animals influenced by the three plant extracts, i.e. Sophora flavescens, Azadirachta indica and Derris elliptica. The toxicities of common carp (Cyprinus Carpio), muddy loach (Misgurnus anguillicaudatus) and PEC (Predicted environmental concentration) exposed to the three plant extracts were estimated by the typical spray volume method. Risks were determined by the toxicity value as 48-hr $LC_{50}$ (Lethal concentration, median) or NOEC (No observed effect concentration) into PEC. 48-hr $LC_{50}$ of Common carp and NOEC by Sophora flavescens extracts was 7.9 and 6.2 mg/L, 26.8 and 21.8 mg/L by Azadirachta indica extracts and 47.0 and < 24.0 mg/L by Derris elliptica extracts, respectively. 48-hr $LC_{50}$ of Muddy loach and NOEC by Sophora flavescens extracts was 16.9 and 10.0 mg/L, 35.6 and 30.0 mg/L by Azadirachta indica extracts, and 73.9 and < 40 mg/L by Derris elliptica extracts, respectively. Therefore, acute toxicities of the three plant extracts for aquatic animals were proved to be very low level. PEC of Sophora flavescens extracts in paddy, drainage and river water was 68.0~3.0, 11.33~0.50 and 3.0~0.0018 mg/L, respectively. TER of Sophora flavescens extracts in the three water was 0.2~5.6, 1.5~33.8 and 2.6~4388.9, respectively. PEC of Azadirachta indica extracts in paddy, drainage and river water was 90.9~1.2, 15.2~0.2 and 4.8~0.00075 mg/L, respectively. TER of Azadirachta indica extracts in the three water was 0.4~29.7, 2.3~178.0 and 4.5~35733.3, respectively. PEC of Derris elliptica extracts in river water was 0.0063 mg/L. TER of Derris elliptica extracts in river water was 5222~15667.

Contrast-Enhanced Magnetic Resonance Angiography for Evaluation of the Steno-occlusive Disease of the Supraaortic Arteries: Comparison with Computed Tomography Angiography and Digital Subtraction Angiography (조영증강 자기공명 혈관조영술을 이용한 대동맥궁 위 혈관의 협착 및 페쇄 질환 평가: 전산화 단층 혈관조영술 및 디지털 감산혈관조영술과의 비교)

  • Jeh, Su-Kyung;Kim, Bum-Soo;Jung, So-Lyung;Ahn, Kook-Jin;Shin, Yong-Sam;Lee, Kwan-Sung;Kim, Young-In;Lee, Kwang-Soo
    • Investigative Magnetic Resonance Imaging
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    • v.13 no.2
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    • pp.152-160
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    • 2009
  • Purpose : To intra-individually compare diagnostic accuracy of high-resolution contrast-enhanced magnetic resonance angiography (CE-MRA) with computed tomography angiography (CTA) and digital subtraction angiography (DSA) for the assessment of supraaortic steno-occlusive disease. Materials and Methods : Twenty-eight patients (20 men, 8 women, 53-79 years of age) underwent supraaortic CE-MRA, CTA and DSA. CE-MRA was performed on two 1.5T MR scanners (voxel dimension: $0.66{\times}0.66{\times}1.1$ or $1.2\;mm^3$), and CTA on 64-slice CT scanners (voxel dimension: $0.42{\times}0.42{\times}0.63\;mm^3$). All the three examinations were completed within 40 days (median 19 days; range 1-40 days). Retrospective evaluation and measurement of diameter of 6 extracranial and 9 intracranial arterial segments was done by 2 experienced radiologists. Results: A total of 420 arterial segments were examined by CE-MRA, CTA and DSA. On DSA, 34 stenoocclusive lesions were noted at extracranial (n= 19) and intracranial (n = 15) vessels. For extracranial stenosis greater than 70%, sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were 94.7%, 98.7%, 90.0% and 99.3% on CE-MRA, and 94.7%, 99.3%, 94.7% and 99.3% on CTA. For intracranial stenosis greater than 50%, sensitivity; specificity, PPV and NPV were 93.3%, 98.3%, 77.8%and 99.6% on CE-MRA, and 86.7%, 97.9%, 72.2% and 99.1 % on CTA, with DSA as the standard of reference. Conclusion : Supraaortic CE-MRA is as reliable as CTA in depicting the arterial stenosis, and is effective in screening of significant stenosis of both extracranial and intracranial arterial stenosis.

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The Study on Acute and Subacute Toxicity and Sarcoma-180 Anti-cancer Effects of Triglii Semen Herbal-acupuncture (파두약침(巴豆藥鍼)의 급성(急性) 아급성(亞急性) 독성실험(毒性實驗) 및 Sarcoma-180 항암효과(抗癌效果)에 관(關)한 실험적(實驗的) 연구(硏究))

  • Yoo, Chang-Kil;Kwon, Ki-Rok;Yu, Byeong-Gil
    • Journal of Pharmacopuncture
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    • v.5 no.1 s.8
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    • pp.27-42
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    • 2002
  • Objective: The purpose of this study was to investigate the acute and subacute toxicity and sarcoma- 180 anti-cancer effects of Herbal acupuncture with Triglii Semen in mice and rats. Method: Balble mice were injected intraperitoneally with Triglii semen Herbal acupuncture for $LD_{50}$ and acute toxicity test. Sprague Dawley rats were injected intraperitoneally with Triglii semen Herbal acupuncture for subacute toxicity test. The Triglii semen Herbal acupuncture was injected on Chung-wan(CV12) of mice with S-180 cancer cell line. Results: 1. In acute toxicity test, the $LD_{50}$ value was $7.49{\times}10^3$ml, 0.30ml/kg.2. The body weights of mice treated with Triglii semen Herbal acupuncture increased during the acute toxicity test. 3. In acute toxicity test of serum biochenrical values of mice, total protein was decreased in treatment groups I, 2 and 3, albunrin was decreased in treatment groups 2 and 3 compared to the control group. GOT was increased in treatment group I and Alk. Phosphatase was increased in treatment groups 1,2 and 3 compared to the normal group(p<0.05). 4.ln subacute toxicity test, severe tissue injury was found in lung and liver. 5. In subacute toxicity test, the body weight was decreased in treatment groups I and 2 compared to the normal group and the weight of liver. lung and kidney were increased in treatment groups 1, 2 and 3 compared to the normal group.(p<0.05) 6. In subacute toxicity test, RBC, HGB and HCT were decreased in treatment groups 1 and 2 compared to the normal group. MCV was increased in treatment group1 compared to the normal group, MCH was increased in treatment groups 1 and 2 compared to the control group in complete blood count test.(p<0.05) 7. In subacute toxicity test, total protein was decreased in treatment groups 1 and 2 compared to the nonnal group, BUN was increased in treatment groups 1 and 2 compared to the nonnal group, creatinine and uric acid were decreased in treatment groups 1 and 2 compared to the normal group, glucose was increased in treatment group 2 compared to the nonnal group, triglycelide was decreased in treatment groups I and 2 compared to the normal group, total cholesterol was increased in treatment groups 1 and 2 compared to the control group. GOT was decreased in treatment group 2 compared to the normal and control group, AIk. Phosphatase was increased in treatment group 1 compared to the normal and control group.(p<0.05) 8. Median survival time was 17days in treatment group 2 for S- 180 cancer cell treated with Triglii semen Herbal acupuncture. 9. Natural killer cell activity was insignificant for S-180 cell treated with Triglii semen Herbal acupuncture.(p<0.05) 10. lnterieukin-2 productivity was decreased for S-180 cell treated with Triglii semen Herbal acupuncture compared to the normal and control group.(p<0.05) Conclusion: According to the results, we can conclude Herbal-acupuncture with Triglii semen caused toxicity, and caused no effects in S-180 cancer cell.

A Study on Evaluating Solute Excretion in the Normal Neonate (정상 신생아에서 용질배설 측정 의의에 관한 연구)

  • Choi Jeong Hoon;Kim Mi Kyung;Yoo Kee Hwan;Hong Young Sook;Lee Joo Won;Kim Soon Kyum
    • Childhood Kidney Diseases
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    • v.4 no.1
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    • pp.6-10
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    • 2000
  • Purpose: To evaluate whether the urinary creatinine concentration is a reliable reference value to standardize urinary solute excretion in a spot urine sample during the first week of life. Methods: Spontaneously voided urine specimens were obtained in 49 healthy full term neonates, and in 33 healthy older children with the median ages of $5.7{\pm}4.3$ years, two urine samples were available with an interval of 2 to 3 days. Urine creatinine concentration was determined by the Jaffe test(CoBAS, Integra, Roche, Swiss). Uurine osmolality was determined by the freezing point depression test(Multi-osmette, Precision, USA). Results: Mean urinary creatinine and osmolality values of the first urine samples were not significantly different with the second urine samples in each group. Mean urinary creatinine and osmolality values in neonates were significantly different from the older children of the each urine sample(P<0.01). In neonates, the mean of the urinary oreatinine/osmolality ratios was higher than that of the older children(P<0.01). The urinary creatinine and the creatinine/osmolality values of the first urine samples were closely correlated with those of the second samples in both two groups(P<0.001). Conclusion: The urinary creatinine concentration during the first day of life is relatively stable, even when corrected for urinary osmolality The urinary creatinine and the urinary creatinine/osmolality ratio, therefore, can be used to standardize the urinary excretion of solutes in the neonate.

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The Ross Procedure in Pediatric Patients: 10 Years Experience at the Asan Medical Center (소아 환자에서 Ross 수술 성적 보고: 아산병원 10년 경험)

  • Kim, Hee-Jung;Seo, Dong-Man;Yun, Tae-Jin;Park, Jeong-Jun;Park, In-Sook;Kim, Young-Hwue;Ko, Jae-Kon
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.305-310
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    • 2009
  • Background: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. Material and Method: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: $0.5\sim14.0$). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8$\sim$138.2 months). We reviewed the echocardiographic data with focusing on the, auto-graft dysfunction and reoperation. Result: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from $1.6{\pm}1.7/0.9{\pm}1.7$ at preoperation to $1.8{\pm}1.6$(p=0.64)/$2.2{\pm}0.9$ (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency. Conclusion: Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Vet reoperation due to allograft dysfunction was a major concern.