• Nuclear Medicine and Molecular Imaging
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• v.40 no.4
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• pp.200-204
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• 2006

Purpose: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique. Materials and Methods: We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions. Results: The mean Qp/Qs was $1.83{\pm}0.50$ by radionuclide, and $1.74{\pm}0.51$ by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.51, 0.74, 0.96, 1.57, and 1.50, respectively. Conclusion: There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.

• Korean Journal of Veterinary Research
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• v.56 no.4
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• pp.209-213
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• 2016

This study evaluated several known echocardiographic markers related to the assessment of severity in dogs with patent ductus arteriosus (PDA) after the closure of ductus arteriosus (DA). Forty-two dogs with patent ductus arteriosus were enrolled in this study. Evaluated echocardiographic markers were left atrial to aortic root ratio, left ventricular end-diastolic dimension to aortic root ratio, indexed left ventricular end-diastolic and end-systolic dimensions, end-diastolic and end systolic volume index, pulmonic flow to systemic flow (Qp/Qs) ratio, velocities of pulmonary regurgitant and systolic jets, pulmonary flow profiles and the presence of mitral regurgitation. Those markers were evaluated before, 1 day, and 30 days after the closure of DA. Statistically significant changes in some echocardiographic markers (i.e., Qp/Qs) were observed. Although several studies in human and dogs have evaluated the clinical outcome of PDA occlusion using several echocardiographic markers, this study has firstly evaluated all echocardiographic markers known to be useful for assessing the clinical outcome of PDA occlusion in human, and has demonstrated that those markers including the Qp/Qs and pulmonary flow profiles were useful in evaluating of clinical outcome of PDA in dogs and the reduction of LA and LV preload after ductal closure could dramatically reduce after successful ductal occlusion of PDA in dogs.

• The Korean Journal of Nuclear Medicine
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• v.21 no.2
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• pp.155-165
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• 1987

The noninvasive nature of the radionuclide angiocardiography provided a useful approach for the evaluation of left-to-right cardiac shunts (LRCS). While the qualitative information can be obtained by inspection of serial radionuclide angiocardiograms, the quantitative information of radionuclide angiocardiography can be obtained by the analysis-of time-activity curves using advanced computer system. The count ratios method and pulmonary-to-systemic flow ratio (QP/QS) by gamma variate fit method were used to evaluate the accuracy of detection and localization of LRCS. One hundred and ten time-activity curves were analyzed. There were 46 LRCS (atrial septal defects 11, ventricular septal defects 22, patent ductus arteriosus 13) and 64 normal subjects. By computer analysis of time-activity curves of the right atrium, ventricle and the lungs separately, the count ratios modified by adding the mean cardiac transit time were calculated in each anatomic site. In normal subjects the mean count ratios in the right atrium, ventricle and lungs were 0.24 on average. In atrial septal defects, the count ratios were high in the right atrium, ventricle and lungs, whereas in ventricular septal defects the count ratios were higher only in the right ventricle and lungs. Patent ductus arteriosus showed normal count ratios in the heart but high count ratios were obtained in the lungs. Thus, this count ratios method could be separated normal from those with intra cardiac or extracardiac shunts, and moreover, with this method the localization of the shunt level was possible in LRCS. Another method that could differentiate the intracardiac shunts from extracardiac shunts was measuring QP/QS in the left and right lungs. In patent ductus arteriosus, the left lung QP/QS was higher than those of the right lung, whereas in atrial septal defects and ventricular septal defects QP/QS ratios were equal in both lungs. From this study, it was found that by measuring QP/QS separately in the lungs, intracardiac shunt could be differenciated from extracardiac shunts.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.268-273
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• 1977

During the period from March, 1963, to November, 1977, forty-eight patients with secundum type atrial septal defects have undergone surgical repair using cardiopulmonary bypass with a pump oxygenator at the Seoul National University Hospital. Twenty-six [55 percent] of the patients were females and Twenty-two [45 percent] were males. The patients varied in age from 3 years to 51 years. We have divided secundum defects into three types. These are: 1] the high defect; 2] Ovale type defect; and 3] low defect including the defect in the area of the coronary sinus. An ovale type defect was present in forty-one cases [85 percent]. Partial anomalous pulmonary venous connections were present in two patients in the high defect group. All of the forty-eight patients had had right heart catheterization before operation. The pulmonary to systemic flow ratio [Qp/Qs] was determined in our 38 patients. The Qp/Qs was less than 1.5/1 in only five of the 38 patients. Among the 33 patients with moderate and severe left-to-right shunts [Qp/Qs 1.6-3.5/1], the systolic pulmonary artery pressures. ranged from 30 to 80 mm Hg. Large left-to-right shunts [Qp/Qs>3.6/1] were present in 13 patients. The postoperative complications occurred in 13 patients [27. 1 percent]. Postoperative wound infections were the most frequent complications being present in 6 patients [12.5%]. Forty-six of the patients with secundum atrial septal defects survived surgical repair of their defects. Thus the hospital mortality of surgery was 4.2 percent. The causes of death in the early postoperative period were: 1] low cardiac output syndrome related to severe pulmonary hypertension in one case; and 2] postoperative several bleeding in one case.

• The Korean Journal of Nuclear Medicine
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• v.20 no.1
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• pp.85-91
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• 1986

In detecting, localizing and quantitating cardiac shunts, radionulide angiocardiography has been known to be a simple and safe method compared with oxymetry method. To ascertain the availability of the results obtained by radionuclide angiocardiography for the evaluation of patients with cardiac shunt, author compared the Qp/Qs ratios(pulmonary to systemic flow ratios) obtained by radionuclide angiocardiography with the results of oximetry method in 40 patients with left to right shunt, and also compared the results of radionuclide angiocardiography examined before and after shunt operation in 8 patients. The results were as follows: 1) Of the 161 patients examined radionuclide angiocardiography, 98 were thought to have cardiac shunts: right to left shunt id 27, left to right shunt in 71. Of the 71 patients who had left to right shunt, 40 who were examined with both radionuclide angiocardiography and oxymetry had following congenital heart disease: VSD in 21, ASD in 9 and PDA in 10. 2) Comparison of Qp/Qs ratios obtained during radionuclide angiocardiography and oxymetry revealed good correlation (linear regression analysis yielded correlation coefficient of 0.80) in 32 patients whose Qp/Qs ratio obtained during oxymetry were below 3.0, but very poor correlation in 8 patients whose Qp/Qs ratios were above 3.0 3) Radionuclide angiocardiography is a relatively safe and simple method in postoperative evaluation of patients with cardiac shunt.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.157-164
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• 1985

Our series comprised 68 patients of ventricular septal defect who underwent open heart surgery at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, from January, 1980 to September, 1984. Of the 68 patients, 47 patients were male [69.1%] and 21 patients were female [30.9%]. Their age ranged from 3 years to 27 years, and the mean age was 10.1 years. Upon Kirklin`s anatomical classification, type I constituted 29.4%, type II 69.1%, type III 1.5%, and type IV 1%. The cardiac anomalies associated with ventricular septal defect were 21 in all; 5 PS, 4 Aortic insufficiency, 2 ASD, 4 Patent foramen ovale, and 1 Patent ductus arteriosus. Upon the data of cardiac catheterization, most of the patients had Qp/Qs of 1.4-1.8, Pp/Ps of 0.25 or less and Rp/Rs of 0.25 or less. There was no significant correlationship between the rate of operative complication & mortality and the increase of Qp/Qs, Pp/Ps, and Rp/Rs. The values of Qp/Qs, Pp/Ps and Rp/Rs were correspondingly increased according to increment of the defect size. 20 patients developed postoperative complications, such as 4 acute respiratory failure, 3 reexploration due to massive bleeding, 1 low cardiac output, 1 patch detachment, and 2 air embolism. Operative mortality rate was 7.4% [5 cases] among 68 patients.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.430-437
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• 1990

We clinically evaluated 121 cases of ventricular septal defect which we operated from April, 1986 to December, 1989 at Inha General Hospital, Seong-Nam, Department of Thoracic and Cardiovascular Surgery, College of Medicine, Inha University. These patients were occupied 54.8% of all congenital heart diseases operated on its same period. Of the 121 patients, 63 patients were male[52.1%] and 58 patients were female[47.9i]. The two most common symptoms were frequent upper respiratory infection and dyspnea on exertion. By Kirklin s anatomical classification, type I constituted 34.7%, type II 61.98%, type III 0.03% and type IV not occupied. Associated cardiac anomalies were found in 34 cases, and PDA was most common associated anomaly, occupied in 22 cases. On the cardiac catheterization data, there were statistically significant correlation between VSD size[cm2 /BSAm2] and systolic pulmonary arterial pressure[sPAP], pulmonary to systemic flow ratio[Qp/Qs] & pulmonary to systemic pressure ratio[Pp/Ps] respectively, Type II [r=0.53, p<0.01] was more correlated than type I [r=0.49, p<0.05] between VSD size and Qp /Qs. We could not found the correlationship between age and Qp/Qs [Type I; r=0.16, Type II; r=-0.15] All cases were operated under cardiopulmonary bypass and 58 cases[46.3%] were operated through the right atrial approach, and 34 cases[28.1%] through the pulmonary arterial approach. Operative mortality rate was 4.13%[5 cases].

• Journal of the Korean Geophysical Society
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• v.9 no.3
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• pp.199-207
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• 2006

Fukuoka earthquake on March 20, 2005 showed the potential hazard of large events out of S. Korea. From the viewpoint of seismic hazard, seismic amplitude decrease Q-1 is very important. Related to the crustal cracks induced by the earthquakes, the value of Q-1- high Q-1 regions are more attenuating than low Q-1 regions - shows a correlation with seismic activity; relatively higher values of Q-1 have been observed in seismically active areas than in stable areas. For the southeastern and central S. Korea, we first simultaneously estimated QP-1 and QS-1 by applying the extended coda-normalization method to KIGAM and KNUE network data. Estimated QP-1 and QS-1 values are 0.009 f-1.05 and 0.004 f-0.70 for southeastern S. Korea and 0.003 f -0.54 and 0.003 f -0.42 for central S. Korea, respectively. These values agree with those of seismically inactive regions such as shield. The low QLg-1 value, 0.0018f -0.54 was also obtained by the coda normalization method. In addition, we studied QLg-1 by applying the source pair/receiver pair (SPRP) method to both domestic and far-regional events. The obtained QLg-1 for all Fc is less than 0.002, which is reasonable value for a seismically inactive region.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.238-242
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• 1986

The prognosis of patients with VSD and pulmonary hypertension is at least partially related to the reversibility of pulmonary hypertension after surgery. To predict postoperative pulmonary arterial pressure, immediate postbypass values were compared with preoperative hemodynamic data in 18 surgically closed VSD patients aged 6 to 80 months. The following results were obtained. 2] There was a good correlation between preoperative PP/PS and postoperative PP/PS in patients aged over 24 months [r=0.685, p<0.05], and in patients whose QP/QS were over 2.0 [r=0.686, p<0.01]. 3] There was also a good correlation between pump time and postoperative PP in total patients [r=0.697, p<0.005]. 4] Direct correlations were found between preoperative PP/PS and immediate postbypass PP/PS in patients aged over 24 months and in patients whose QP/QS>2.0, but the effect of CPB would participate in some degree. So it may be necessary to reevaluate their relationship after the effect of CPB have been disappeared.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.241-250
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• 1987

We scrutinized the preoperative electrocardiographic and hemodynamic findings in adult atrial septal defects older than 15 years, and then followed up the postoperative electrocardiographic changes sequentially. In preoperative electrocardiographs, the mean PR interval [0.17 sec] was prolonged than normal adults [M;0.13,F;0.15], and the mean QRS axis [93.1*] was deviated to rightward than normal [M;63.7*,F;64.4*], and 122 cases of all 159 patients [77.8%] were in RAD quadrant. The QRS morphology was classified into three groups; a] crista supraventricularis hypertrophy, 25 cases, b] right ventricular outflow tract hypertrophy, 89 cases, c] right ventricular hypertrophy, 44 cases, and normal rs pattern, 1 case. Comparing the QP/QS, Pp/Ps, Rp/Rs in these three groups, Qp/Qs increased a] 2.65 to b] 2.97 and decreased b] 2.97 to c] 2.55, Pp/Ps increased a] 0.27 to b] 0.35 to c] 0.44, and Rp/Rs increased a] 0.1 to b] 0.14 to c] 0.2. In comparing the atrial fibrillation with sinus rhythm, the patient`s mean age was increased [26.4 to 45.7], the mean Qp/Qs was decreased [2.97 to 2.7], the mean Pp/Ps was increased [0.35 to 0.46], the mean Rp/Rs increased [0.14 to 0.2], and the QRS morphology was RVOT hypertrophy;7 cases, RVH;2 cases in all 11 cases. Therefore, the atrial fibrillation was appeared in progressed status. Increasing the mean pulmonary arterial pressure, size of the R` wave in Vl lead increased, and the QRS morphology tended to become severe patterns. Postoperatively, the PR interval shortened and QRS axis tended to normal axis quadrant, and size of R` wave decreased sequentially, atrial fibrillation disappeared in 4 cases. Conclusively, by use of the conventional surface electrocardiography, we could anticipate the hemodynamic changes and the prognosis at outpatient department.