• Journal of Chest Surgery
• /
• 제56권5호
• /
• pp.359-361
• /
• 2023

Coronary ostium obstruction due to dislodgement of the prosthetic valve is a rare and life-threatening complication, and particular caution is required for sutureless aortic valve replacement (AVR) with concomitant valvular surgery. In general, coronary artery bypass surgery is performed when coronary ostium obstruction occurs after AVR, but other options may need to be considered in some cases. Herein, we present a case of coronary artery occlusion in an 82-year-old female patient who had undergone AVR and mitral valve replacement for aortic valve stenosis and mitral valve stenosis at the age of 77 years. A hybrid procedure involving redo AVR and percutaneous coronary intervention after left main coronary ostium endarterectomy was performed. To summarize, we present a case of hybrid AVR in a patient with coronary artery obstruction after AVR that was successfully managed using this method.

• 한국임상수의학회지
• /
• 제25권3호
• /
• pp.195-199
• /
• 2008

A 2-year-old female Maltese dog was referred with primary complaints of exercise intolerance and abnormal heart sound. Clinical and diagnostic investigation revealed split S2 and S4 gallop in the cardiac auscultation, tall P wave and left anterior fascicular block in the electrocardiogram, left atrial enlargement on the thoracic radiography, ostium primum atrial septal defect and cleft of the anterior leaflet of the mitral valve on the echocardiography. Based on those findings, the dog was diagnosed as the partial atrioventricular canal defect. Since the dog showed mild exercise intolerance, enalapril and furosemide were prescribed.

• Journal of Chest Surgery
• /
• 제23권1호
• /
• pp.41-48
• /
• 1990

Thirteen patients underwent repair of atrioventricular septal defect [AVSD] from January 1980 to July 1989 at Kyungpook National University Hospital. Two patients had complete AVSD [Rastelli type A] and eleven patients had partial AVSD [ostium primum atrial septal defect and cleft of anterior mitral leaflet]. In all the patients of partial AVSD, atrial septal defect was closed with Dacron patch and the mitral cleft was approximated with interrupted simple sutures. In one patient of complete AVSD, one patch technique was used to close the atrial and ventricular septal defect, and in the other patient of complete AVSD, two patch technique was used. In six patients, there were associated anomalies; four had isolated ostium secundum ASD, two had patent foramen ovale. Postoperative complete A-V block was noted in a patient of partial AVSD, but it was returned to 1st degree A-V block 30 months later and in another case of partial AVSD, severe congestive heart failure [NYHA functional class IV] due to residual mitral insufficiency was developed postoperatively, but this patient was recovered to the state of functional class I after receiving mitral valve replacement. There was one hospital death [8 %] resulting from low cardiac output.

• Journal of Chest Surgery
• /
• 제29권6호
• /
• pp.646-650
• /
• 1996

Aortic composite valve graft를 이식하는 술식에서 관상동맥을 문항하는 방법에 따라 그 단점과 합병증을 가지고 있다. 종래에 주로 이용되었던 방법과 달리, composite graf 문합부의 긴장을 줄여 출혈을 최소화하고 만기에 발생할 수 있는 가성 대동맥류를 방지할 수 있는 술식을 서술하고자 한다. 저자들은 심한 대동맥판 폐쇄부전이 합병된 급성 대동맥 박리 (DeBakey Type I)를 가진 40세 남자에서 composite graft의 이식과본변형술식을시행했다 본술식에서 좌관상동맥구에 직경 10mm의 인조혈관을문합하고 그 원위부를 composite gray떼 문합하였으며 우 관상동맥 단추편은 composite graf떼 직접 문합하였다. 이 방법으로 판륜 가까이에 위치한 좌관상동맥구를 과도한 긴장없이 composite gray에 쉽게 부착할 수 있어서 술후 출혈 및 가성동맥류의 발생을 최소화할 수 있을것으로 사료된다.

• 한국컴퓨터그래픽스학회논문지
• /
• 제23권1호
• /
• pp.49-55
• /
• 2017

심장 CT 혈관 조영 영상은 심혈관의 전체 해부학 구조를 3D 로 보여줄 뿐 아니라 병변의 정보를 제공하기 때문에 관상동맥 질환 진단 및 치료에 많이 사용되고 있다. 하지만 영상의 방대한 크기로 인해 수동으로 정보를 추출하는 데는 한계가 있어 자동으로 심혈관을 정확하게 추출하는 연구들이 활발히 진행되고 있다. 심혈관 자동 추출 알고리즘을 개발하는데 있어 심혈관의 시작점인 상행대동맥의 심문을 검출하는 방법은 필수적인 부분이다. 본 논문에서는 심혈관의 시작점인 심문을 분할하는 방법을 제안한다. 첫째, 상행대동맥의 크기와 위치를 고려한 허프변환으로 대동맥 초기영역을 검출한다. 둘째, 초기영역을 기반으로 탐색범위를 줄일 수 있도록 관심 볼륨 영역을 설정한다. 셋째, 지오데식 활성외곽선 모델을 기반으로 정제된 대동맥 영역을 검출한다. 마지막으로 검출된 대동맥 영역에서 심문을 분할한다. 제안방법의 평가를 위해 20 개의 심장 CT 혈관 조영 영상에서 전문가가 수동으로 표기한 시작점과 비교 분석하였다. 실험 결과 제안방법을 통해 시작점이 제대로 추출 됨을 확인할 수 있었다.

• Journal of Chest Surgery
• /
• 제15권2호
• /
• pp.250-253
• /
• 1982

A persistent left superior vena cava draining into the left atrium associated with atresia of the coronary sinus-ostium, ASD, and PDA is a rare congenital anomaly. The patient was a 4 year-old female whose complaints were frequent URI and exertional dyspnea. The congenital heart anomaly was suspected at 2 months of her age. Chest films showed cardiomegaly [C-T ratio, 75%]. EKG, Echocardiography, cardiac catheterization and angiocardiography were performed. Open heart surgery was done under impression of LV-RA shunt, bilateral superior vena cavae, and ASD. At the time of operation, huge LA and RA, inferior vena caval defect of a secundum type ASD [1.5 x 3cm in diameter], absence of innominate vein, atresia of the coronary sinus-ostium, and persistent LSVC draining into LA were noted. Direct suture closure of ASD and ligation of LSVC were done. The patient`s postoperative course was somewhat eventful: systolic murmur at apex remained. Four months after the operation, congestive heart failure attacked a few times. PDA that was overlooked at the time of open heart surgery was detected through postoperative cardiac catheterization in.4 months later. Emergent operation for closure of PDA was performed on the day of recatheterization. After that, patient`s heart failure was easily controlled without any notable problem.

• Journal of Chest Surgery
• /
• 제8권2호
• /
• pp.81-88
• /
• 1975

Up to October 31, 1975, 34 cases of atrial septal defect, secundum type, operated in this department, were presented. This is 23.2% of all congenital heart diseases, operated utilizing cardiopulmonary bypass, in this department during this period [34 out of 146]. Out of 34 cases, 32 cases are pure ostium secundum type and one case is sinus venosus and another one is ostium secundum type with partial anomalous pulmonary venous drainage. Six cases of endocardial cushion defect and 3 cases of trilogy of Fallot are excluded in this report. All 34 cases are repaired under direct vision utilizing extracorporeal circulation. Among 34 cases of atrial septal defect, 16 cases are male, and 18 cases are female. Their ages range between 3 to 48 years, but over 59% of the cases are below the ages of 20 years. Thirty-two cases are repaired by direct sutures while 2 cases are repaired with Teflon patches. The average perfusion time is 30 minutes; the shortest 12 and the longest 81 minutes. The number of the defect is single in 31 cases, double in 2 cases, triple in one case. But the associated defect except the main defect are so small as can be closed by simple direct suture. The size of the defect is average $12cm^2$; the smallest 0.7 and the largest $25cm^2$. The surgical mortality is 2 cases [5.6%] and other cases are found to be excellent in the follow up studies.

• Journal of Chest Surgery
• /
• 제30권10호
• /
• pp.986-990
• /
• 1997

23례의 환자에서 1989년 12월부터 1996년 12월까지 우전측방흉부절개술(RALT; right anterolateral thorncotomy)을 이용하여 선천성 심장병을 수술하였다. 22례에서 심방중격결손증(단순난원공형 13례, 하대정맥부 위로 확대된 저위형 쩨, 후방확대형 쎄, 정맥동형 1례, 일차공형 떼)이었고, 떼에서 심실중격결손증이었다. 우전측방흉부절개술(RALI)과 관련된 수술중 사망률이나 후기이환율은 없었다. 우전측방흉부절개술(RALI)은 선택된 환자에서(특히 여자) 정중흉골절개술에 비해 안전하고 효과적인 방법으로 생각되며, 추적관찰시 미용의 측면에서 결과는 매우 좋았다.

• Korean Journal of Radiology
• /
• 제23권2호
• /
• pp.172-179
• /
• 2022

Objective: We aimed to evaluate the ostium of right coronary artery of anomalous origin from the left coronary sinus (AORL) with an interarterial course throughout the cardiac cycle on CT and analyze the clinical significance of the ostial findings. Materials and Methods: From January 2011 to December 2015, 68 patients (41 male, 57.3 ± 12.1 years) with AORL with an interarterial course and retrospective cardiac CT data were included. AORL was classified as high or low ostial location based on the pulmonary annulus in the diastolic and systolic phases on cardiac CT. In addition, the height, width, height/width ratio, area, and angle of the ostium were measured in both cardiac phases. After cardiac CT, patients were followed until December 31, 2020 for major adverse cardiac events (MACE). Clinical and CT characteristics associated with MACE were explored using Cox regression analysis. Results: During a median follow-up period of 2071 days (interquartile range, 1180.5-2747.3 days), 13 patients experienced MACE (19.1%, 13/68). Seven (10.3%, 7/68) had the ostial location change from high in the diastolic phase to low in the systolic phase. In the univariable analysis, younger age (hazard ratio [HR] = 0.918, p < 0.001), high ostial location (HR = 4.008, p = 0.036), larger height/width ratio (HR = 5.621, p = 0.049), and smaller ostial angle (HR = 0.846, p = 0.048) in the systolic phase were significant predictors of MACE. In multivariable cox regression analysis, younger age (adjusted HR = 0.917, p = 0.002) and high ostial location in the systolic phase (adjusted HR = 4.345, p = 0.026) were independent predictors of MACE. Conclusion: The ostial location of AORL with an interarterial course can change during the cardiac cycle, and high ostial location in the systolic phase was an independent predictor of MACE.

• 한국임상수의학회지
• /
• 제17권1호
• /
• pp.173-177
• /
• 2000

A 3-year-old male Tosa was presented the severe dyspnea, emaciation and dehy dration. By echocardiograpy, right ventricle was found to be a mobile mass dynamically occluding the right ostium atrioventriculare in the systolic phase. At necropsy, 14 days after ultrasonography multiple tumor masses of various size were observed in the heart base, right ventricular lumen, myocardium, lung and liver. Histopathologically, the tumor cells, arranged in sheets or nests, were diagnosed as metastatic intracavitary cardiac aortic body tumor