• Journal of Broadcast Engineering
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• v.24 no.4
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• pp.592-601
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• 2019

For coronary procedures, X-ray angiogram images are useful for diagnosing and assisting procedures. It is challenging to accurately segment a coronary artery using only a single segmentation model in 2D X-ray images due to a complex structure of three-dimensional coronary artery, especially from phenomenon of vessels being broken in the middle or end of coronary artery. In order to solve these problems, the initial segmentation is performed using an existing single model, and the candidate regions for the sophisticate correction is estimated based on the initial segment, and the local patch-based correction is performed in the candidate regions. Through this research, not only the broken coronary arteries are re-connected, but also the distal part of coronary artery that is very thin is additionally correctly found. Further, the performance can be much improved by combining the proposed correction method with any existing coronary artery segmentation method. In this paper, the U-net, a fully convolutional network was chosen as a segmentation method and the proposed correction method was combined with U-net to demonstrate a significant improvement in performance through X-ray images from several patients.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.994-1000
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• 1995

Thirty patients with ischemic heart disease underwent coronary artery bypass grafting [CABG from 1985 through 1994. There were 16 males and 14 females whose age ranged from 41 to 72 years old. Preoperative diagnoses were unstable angina in 13 of patients, stable angina in 8, postmyocardial infarction state in 7, and state of failed percutaneous transluminal coronary angioplasty [ PTCA in 2. The patterns of disease were single vessel involvement [ 17cases , double vessel involvement [ 7 cases , triple vessel involvement [ 3 cases , Lt main lesion including Lt. ostial lesion [ 3 cases . Saphenous vein grafts were used in 27/30 patients [ 90% , and internal mammary artery grafts were used in 6/30 patients [ 20% . The hospital mortality was 13.3% and all survivors were asymptomatic and improved over their preoperative status.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.588-593
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• 1988

We experienced a case of interrupted aortic arch[Type A] associated with PDA, VSD, mitral regurgitation and single coronary artery. The patient was 7 years old boy, who showed congestive heart failure[NYHA functional class III]. One stage total correction was performed under profound hypothermia with total circulatory arrest. Aortic continuity was established using PDA with anterior wall of main pulmonary artery flap. VSD was closed with Dacron patch and mitral regurgitation repaired by Reed`s annuloplasty method. The postoperative cardiac catheterization revealed no pressure gradient between ascending aorta and descending aorta, decreased pulmonary artery pressure and trivial residual shunt[Qp/Qs: 1.28]. The aortogram showed good continuity of the aorta without narrowing of the anastomotic site. During the period of 1 year follow up, heart failure symptoms were nearly subsided.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.271-275
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• 1993

In this country, the number of patients with coronary artery disease is progressively increasing with the change of life style and improvement of the diagnostic procedures. In addition, the medically invasive procedure for treating ischemic heart disease was rapidly developed and the surgical patients have more complex and multiple lesions and more surgical risks. Fifty three patients with ischemic heart disease underwent coronary bypass grafting [CABG] for recent 24 months. Twenty patients had three-vessel disease, 17 patients two-vessel disease, and 2 patients single-vessel disease. The average number of distal anastomoses was 3.3 per patient with the range of I to 6 grafts. Forty-one patients [77.4 %] had preoperative left ventricular ejection fraction of 50 % or more and 14 patients[26.4%] had a significant left main coronary lesion. Saphenous vein grafts were employed in 52/53 patients [98.1%] and internal mammary grafts, which were anastomosed to left anterior descending artery, in 38/53 patients[71.7%]. Two patients, whom percutaneous transluminal coronary angioplasty failed for, underwent emergency CABG with only saphenous vein grafts and both patients survived.The hospital mortality was 1.9 % and there was no late death. Perioperative myocardial infarction occurred in 1.9%. All survivors were asymptomatic[in 83% of the patients] and/or improved over their preoperative status. Twenty-nine patients were included in blood conservation group and 21 patients [72.4 %] underwent CABG without any homologous blood transfusion. Our early result of coronary bypass grafting was comparable to that which was reported in other coronary surgery units.

• Korean Circulation Journal
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• v.52 no.2
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• pp.150-161
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• 2022

Background and Objectives: Studies evaluating the nature of ischemic burden of chronic total occlusion (CTO) vessels are still lacking. Methods: A total of 165 patients with single vessel CTO >2.5 mm in an epicardial coronary artery who underwent single photon emission computed tomography (SPECT) were enrolled in the study. Ischemic burden was calculated with the use of semi-quantitative SPECT analysis, and was defined as the summed difference score (SDS) divided by the maximal limit of the score (=SDS/68). Results: The mean age of the participants was 59.5 years and the CTO of the left anterior descending coronary artery (LAD), left circumplex coronary artery (LCX), and right coronary artery (RCA) accounted for 93 (56.4%), 18 (10.9%), and 54 (32.7%) patients, respectively. The median ischemic burden of the total population was 8.8%, and it was highest in the LAD CTO (10.3%) compared with the LCX (5.9%) and RCA CTO (5.9%, p<0.001). High-ischemic burden (ischemic burden >10%) was observed in 66 patients (40.0%), and in 47 patients (50.5%) of the LAD CTO. Ischemic burden was different according to the CTO location only in LAD CTO. The statistically significant predictors for high-ischemic burden were hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO location, and de novo CTO. Japanese-CTO score and Rentrop scale collateral grade were not associated with high-ischemic burden. Conclusions: Only 40% of patients with single vessel CTO had ischemic burden >10%. For CTO vessels, measurement of ischemic burden using SPECT prior to revascularization may be helpful in identifying beneficial subjects.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.274-280
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• 1979

A case of successful surgical correction of double-outlet right ventricle with situs inversus, dextrocardia, subaortic ventricular septal defect, and pulmonic stenosis is described. The great vessels were normally related but in mirror-image arrangement. Another coronary artery anomaly, single origin of coronary artery and a large anomalous coronary artery coursed across the right ventricular outflow tract, was accompanied. Intracardiac repair with a Dacron tunnel conduit and extracardiac jumping graft with a valved conduit gave an excellent result.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.453-463
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• 1995

During 42 month period 91 consecutive patient underwent coronary artery bypass surgery. The mean age of these patient was 57 years [range from 28 to 78 years . There were 57 men and 34 women. The preoperative risk factors that include beyond the 50 % of total patients were male sex, obesity, hypo-high-density lipoproteinemia, smoking, hypercholesterolemia, hyper-low-density lipoproteinemia, hypertriglyceridemia and hypertension. Preoperatively 27 patients had stable angina pectoris and 39 patients of unstable angina pectoris. Twenty five patients had previous myocardial infarction history. The patterns of disease were 8 patients of single vessel involvement, 18 patients of double vessel involvement, 54 patients of triple vessel involvement and 11 patients of left main coronary artery disease. Fifty five patients were in Canadian Cardiovascular Society functional class III. Myocardial revascularization was performed under emergency conditions in 5 patients. Nine percent of patients had previous PTCA history. We performed 16 cases of sequential anastomosis, internal mammary artery harvest in 86 percent of total patients and total 284 distal anastomoses[mean 3.1 anastomosis per patient . The mean ACC time was 60.5 minutes and ECC time was mean 110 minutes. The combined surgeries were 16 cases of endarterectomy, 2 cases of LV aneurysmectomy, 1 case of Bentall operation, 1 case of repair of sinus of Valsalva, 1 case of ligation of coronary AV fistula and 1 case of excision of breast mass. The most common complication was wound infection[12 cases, 13 % . There was one hospital death due to postoperative respiratory failure and low output syndrome in patient with postinfarction VSD, LV aneurysm. Postoperative 88 patients were in Functional class I or II. The 99mTc-MIBI myocardial perfusion scan that used as evaluation of postoperative state was well correlated with patient`s symptoms instead of some disadvantages.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.8-14
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• 2018

Background: Minimally invasive direct coronary artery bypass grafting (MIDCAB) has the advantage of allowing arterial grafting on the left anterior descending artery without a sternotomy incision. We present our single-center clinical experience of 66 consecutive patients. Methods: All patients underwent MIDCAB through a left anterior small thoracotomy between August 2007 and July 2015. Preoperative, intraoperative, postoperative and follow-up data - including major adverse cardiovascular and cerebrovascular events (MACCE), graft patency, and the need for re-intervention - were collected. Results: The mean age of the patients was $69.4{\pm}11.1years$ and 73% were male. There was no conversion to an on-pump procedure or a sternotomy incision. The 30-day mortality rate was 1.5%. There were no cases of stroke, although 2 patients had to be re-explored for bleeding, and 81.8% were extubated in the operating room or on the day of surgery. The median stay in the intensive care u nit and in the hospital were 1.5 and 9.6 days, respectively. The median follow-up period was 11 months, with a 5-year overall survival rate of $85.3%{\pm}0.09%$ and a 5-year MACCE-free survival rate of $72.8%{\pm}0.1%$. Of the 66 patients, 32 patients with 36 grafts underwent a postoperative graft patency study with computed tomography angiography or coronary angiography, and 88.9% of the grafts were patent at $9.7{\pm}10.8months$ postoperatively. Conclusion: MIDCAB is a safe procedure with low postoperative morbidity and mortality and favorable mid-term MACCE-free survival.

• Journal of Chest Surgery
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• v.52 no.3
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• pp.155-161
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• 2019

Background: Coronary artery bypass grafting (CABG) is being offered increasingly frequently to octogenarians. However, old age is known to be an independent risk factor in CABG. The aim of this study was to compare the outcomes of off-pump coronary artery bypass (OPCAB) between octogenarians and septuagenarians. Methods: We retrospectively reviewed the data of 1,289 consecutive patients aged ${\geq}70years$ who underwent OPCAB at a single institution between 2001 and 2016. We compared the outcomes of 115 octogenarians and 1,174 septuagenarians. Using propensity score matching, based on preoperative clinical characteristics, 114 octogenarians were matched with 338 septuagenarians. Results: Propensity score analysis revealed that the incidence of acute kidney injury (14.9% vs. 7.9%, p=0.028) and respiratory complications (8.8% vs. 4.2%, p=0.040) was significantly higher in octogenarians. The early mortality rate (2.6% vs. 1.0%, p=0.240) and 1-year survival rate (89.5% vs. 94.4%, p=0.097) were not statistically significant between the groups. However, the 5-year survival rate (67.3% vs. 79.9%, p<0.001) was significantly lower in octogenarians. Previous myocardial infarction and a left ventricular ejection fraction ${\leq}35%$ were associated with a poor 1-year survival rate. Conclusion: Early and 1-year outcomes of OPCAB in octogenarians were tolerable when compared with those in septuagenarians. OPCAB could be a suitable option for octogenarians.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.774-776
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• 2009

A 57-year-old man with dyspnea was transferred to our institution. Echocardiography demonstrated grade III aortic valve regurgitation with a bicuspid aortic valve. The preoperative coronary angiography showed a left single nary artery. Replacement of the aortic valve was performed. Ventricular fibrillation developed during weaning patient of cardiopulmonary bypass after aortotomy repair. An anomalous origin of the coronary arteries is an incidental finding. However, in patients who are undergoing aortic valve replacement, a can significantly complicate the procedure. If this is present, then it is imperative that the clearly identified and the required procedure should be modified to avoid injury to these.