• Journal of Chest Surgery
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• v.34 no.9
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• pp.692-697
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• 2001

Background: The left main coronary artery surgical angioplasty has become the choice of surgical procedure in isolated LM disease. We have performed 22 cases of LMCA surgical angioplasy since 1996. We report the immediate and long term result of the surgical angioplasty with their postoperative angiography. Material and Method: Between July 1994 and October 2000, 22 patients(11 men and 11 women) were subjected to surgical patch angioplasty of the LMCA, 1 patient had an additional angioplasty performed on the proximal right coronary artery. The LMCA was approached anteriorly with or without transection of the main pulmonary artery(21 cases), and in a patient who had undergone an aortic valve replacement, LMCA was approached superiorly with transection of the ascending aorta. Additional grafting was required in 5 cases. The on-lay patch was used with autologous pericardium in 6 cases and bovine pericardium in 16 cases. Result: There was no operative mortality. There was 30~50% stenosis of the anastomosis site in 3 cases at the postop. coronary angiography. Coronary angiography was reperformed in 5 cases between 5th months and 15th months postoperatively. There was 40~60% stenosis of the anastomosis site in 2 cases. There was one death at 42nd months postoperatively but the cause was unknown. No patient complained of angina with a mean follow up of 48.$\pm$22.5 months. Conclusion: There were only several coronary angiographic results in long term follow-up but we had relatively good clinical results for LMCA surgical angioplasty in the immediate and long term. The excellence of LMCA surgical angioplasty needs the result of the long term follow-up.

• Journal of Chest Surgery
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• v.33 no.10
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• pp.777-784
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• 2000

Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. Material and Method: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. Result: After surgical correction peak aortic gradient fell from 58.4${\pm}$17.6, to 23.7${\pm}$17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6${\pm}$24.3 to 143.7${\pm}$27.1 mmHg and from 1.78${\pm}$0.4 to 1.76${\pm}$0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10${\pm}$0.2, to 1.27${\pm}$0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2${\pm}$24.9 to 57.1${\pm}$27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. Conclusion ; We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.

• The Korean Journal of Physiology and Pharmacology
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• v.24 no.4
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• pp.339-348
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• 2020

We aimed to characterize the participation of rapid non-genomic and delayed non-genomic/genomic or genomic mechanisms in vasoactive effects to triiodothyronine (T3), emphasizing functional analysis of the involvement of these mechanisms in the genesis of nitric oxide (NO) of endothelial or muscular origin. Influences of in vitro and in vivo T3 treatments on contractile and relaxant responsiveness of isolated rat aortas were studied. In vivo T3-treatment was 500 ㎍·kg^-1·d^-1, subcutaneous injection, for 1 (T3_1d) and 3 (T3_3d) days. In experiments with endothelium-intact aortic rings contracted with phenylephrine, increasing concentrations of T3 did not alter contractility. Likewise, in vitro T3 did not modify relaxant responses induced by acetylcholine or sodium nitroprusside (SNP) nor contractile responses elicited by phenylephrine or angiotensin II in endothelium-intact aortas. Concentration-response curves (CRCs) to acetylcholine and SNP in endothelium-intact aortic rings from T3_1d and T3_3d rats were unmodified. T3_3d, but not T3_1d, treatment diminished CRCs to phenylephrine in endothelium-intact aortic rings. CRCs to phenylephrine remained significantly depressed in both endothelium-denuded and endothelium-intact, nitric oxide synthase inhibitor-treated, aortas of T3_3d rats. In endothelium-denuded aortas of T3_3d rats, CRCs to angiotensin II, and high K⁺ contractures, were decreased. Thus, in vitro T3 neither modified phenylephrine-induced active tonus nor CRCs to relaxant and contractile agonists in endothelium-intact aortas, discarding rapid non-genomic actions of this hormone in smooth muscle and endothelial cells. Otherwise, T3_3d-treatment inhibited aortic smooth muscle capacity to contract, but not to relax, in an endothelium- and NO-independent manner. This effect may be mediated by delayed non-genomic/genomic or genomic mechanisms.

• Journal of Physiology & Pathology in Korean Medicine
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• v.30 no.2
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• pp.95-100
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• 2016

The aim of the present study is to investigate the hypotensive effect of Mantidis ootheca (WMO), Rosa laevigata (WIC), and Imperata cylindrica (WRL) in renovascular hypertension rats. Experimental hypertension model is 2-kidney and 1-clip (2K1C) induced rats. 2K1C rats were treated with WMO, WIC, and WRL at dose of 100 mg/kg/day orally for 3 weeks, respectively. Treatment groups with WMO, WIC, and WRL significantly lowered blood pressure. Interestingly, WMO, WIC, and WRL ameliorated endothelium-dependent and independent vascular relaxation in the phenylephrine-precontracted thoracic aorta in hypertension models. In addition, 2K1C-induced hypertension model increased plasma renin activity, however, WMO, WIC, and WRL attenuated those activities. These results suggest that WMO, WIC, and WRL ameliorates vascular dysfunction in 2K1C-induced hypertension models via the regulation of nitric oxide and renin-angiotensin-aldosterone system.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.177-186
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• 1994

Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.This report was performed to compare the clinical efficacy and safety of 10 % pentastarch[Pentaspan , group I] for plasma volume expansion after open heart surgery with that of 5% albumin[Plasmanate, group II]. There were no statistically significant differences between the group I [n=18] and group II [n:19] in the preoperative parameters [age, sex, body weight] and operative parameters[bypass time, aorta cross clamping time]. During the first 24 hours after arrival of the patient in the surgical intensive care unit, colloid solution [500--1000 ml] was infused to maintain left atrial pressure of more than 8 mmHg, or cardiac index of 2.0 L/min/M2 of more. In results, there were 3 complications of hypotension immediately after infusion of 5 % albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10 % pentastarch solution. Hemodynamic responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure[mean 1.8 versus 0.7 mmHg, p< 0.05] and right atrial pressure [mean 2.2 versus 1.7 mmHg, p < 0.05] was observed during infusion of the first 500 ml. There were no significant differences in any of the measured respiratory parameters[PaO2, intrapulmonary shunt, and effective lung compliance]. Homodilution with colloid significantly reduced hemoglobin [mean 1.2 versus 0.8 gm/dl], and serum protein and albumin level[total protein;4.8$\pm$ 0.5 versus 5.2 $\pm$0.5 gm/dl, p < 0.05: albumin: 3.2 $\pm$0.4 versus 3.6 $\pm$0.6 gm/dl, p < 0.05] by 6:00 AM on 1 day postoperatively, however there were no significant differences on 7 day postoperatively. The mean serum colloid osmotic pressure and osmolarity was similar in both group.There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of chest tube output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5 % albumin solution with no adverse effects on coagulation. Also 10 % pentastarch is less expensive than 5 % albumin and it would appeare to be a reasonable first choice for plasma volume expansion.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.171-176
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• 1996

From March, 1983 to June, 1994, twenty-two patients underwent coronary artery and combined operations. The ages of the patients ranged from 42 years to 72 years (mean 60.4$\pm$8.2 years). There were 17 male and 5 female patients. The left ventricular (LV) ejection fraction ranged from 25% to 65% (mean 46.9$\pm$14.2%). Nine patients had mechanical complication of myocardial infarction (MI), of which 5 were LV aneurysm, 3 ventricular septal defect and 1 mitral regurgitation. Nine patients had rheumatic valvular heart disease of whom 7 with aortic valve disease and 2 with mitral valve disease. Two other patients had left atrial thrombi, only one with atrial septal defect a d another with aneurysm of ascending aorta. An average of 2.1$\pm$1.0 bypasses was done, ranging from one to four. There were 3 postoperative complications; 2 perioperative MI and 1 leg wound infection. Among complicated patients, mortality was 1 patient (4.5%) due to low cardiac output syndrome after perioperative MI. With 3 to 136 months follow-up (mean 41.1$\pm$40.2 months), late mortality was 1 patient due to cerebral vascular accident. Among long-term survivors, all patients are in New York Heart Association functional class I or II. Although the number of patients was small, our surgical results were favorable. Therefore we think that coronary revascularization combined with heart operation does not increase the operative risk when associated coronary artery disease is present, and it reduces the occurrence of late death.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.678-683
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• 2006

Both bronchial leiomyoma and pulmonary sequestration are rare conditions, and to the best of our knowledge there are no reports of the two conditions coexisting. We report a female patient with bronchial leiomyoma with acquired pulmonary sequestration who presented with dyspnea, cough and purulent sputum. The patient had been treated for pneumonia at a local medical clinic. but was transferred to our clinic beacausr there was no clinical improvement. A 3-D computed tomography scan revealed a 1.5 cm sized mass near the distal portion of the left main bronchus and an anomalous artery arising from the aorta. The patient showed clinical improvement after a left lower lobectomy and a ligation of the anomalous artery.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.441-446
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• 2001

Background: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. Methods: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. Results: Tidal volume increased from 143.3$\pm$51.3 ml to 272.3$\pm$87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7$\pm$4.0 mmHg to -10.5$\pm$4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1+2.5 mmHg to 1.2$\pm$4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3$\pm$6.7cmH$_{2}$O to 20.0$\pm$5.3 cmH$_{2}$O. Conclusion: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1342-1346
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• 1996

A right thoracotomy was used for the reoperation or mitral valve of 15 patients who had previously undergone a cardiac operation through a median sternotomy. In our experience. this approach provided dn excellent exposure of the nlitral valve and easy cannulations of both cavie with minimal dissection, ilvoiding any damage of cardiac and major vessels during re-sternotomy Arterial cannulation was performed in the ascending aorta in 13 patients And in the femoral artery in 2 patients. In earlier cases, venous cannulation was done in the SVC And IVC through the right atrium and snared. In later cases, this could be done without snaginly of both cavae or by placing a silgle light-angled catheter into the right atrium. Crystalloid cardioplegic solution was infused for myocardial protection. Hypothermia was controlled at 20\ulcorner$25^{\circ}C$. For defibrillation, internal paddles were used In one patient while sterilized external paddles were used in 10 patients. In the remaining four patients. however. the heart beat spontaneously The respirator could be weaned within 48 hours alter the operation and no pulmonary complication was observed. One out of the 15 patients expired due to sudden attack of ventricular tarchycardid developed ten days after the operation, but the rest of the patients were discharged with good condition.

• Journal of Veterinary Clinics
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• v.38 no.3
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• pp.163-168
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• 2021

A 6-year-old, spayed female, Maltese dog with tachypnea and dry cough was presented to Gyeongsang National University Veterinary Medical Teaching hospital. On physical examination, its respiration rate was 132 per minute. Decreased partial pressure of oxygen, partial pressure of carbon dioxide, and hyperlactatemia were found on arterial blood gas analysis. Its diastolic blood pressure was 80 mmHg. Auscultation revealed arrhythmia. Electrocardiogram revealed P pulmonale, P mitrale, and ventricular premature complexes. Thoracic radiographs revealed mild enlargement of both atrium and moderate enlargement of the left ventricular. There was also a moderate alveolar pattern in the right and caudal part of the left cranial lung lobe. Two-dimensional echocardiography showed enlargement of generalized four chambers without remarkable findings of valvular degeneration. M-mode echocardiography showed decreased left ventricular fractional shortening and enlarged left ventricular internal diameter at both end-systolic and end-diastolic. Color-flow Doppler imaging revealed eccentric turbulent flow starting below the left ventricular outflow tract and extending into the left atrium during systole. Spectral Doppler recordings revealed a high velocity flow through the mitral, tricuspid, aorta, and pulmonic regurgitation. Restrictive transmitral flow revealed high E-wave velocity, short E-wave deceleration time, and reduced A-wave velocity. There was also low ejection velocity thorough left ventricular out tract flow. Based on echocardiographic examination, dilated cardiomyopathy was the tentative diagnosis. The dog was medicated with inotropes, angiotensin converting enzyme inhibitor, and diuretics. At the 10-day following-up, the dog died suddenly. This report describes echocardiographic diagnosis and prognosis of dilated cardiomyopathy rarely reported in small breed dogs.