• Journal of Chest Surgery
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• 제17권2호
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• pp.231-243
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• 1984

Despite its known limitation in the diagnostic value, the electrocardiography is one of the most common and routine examinations in the management of the patients with cardiac problems. The clinical results of 291 patients who underwent isolated mitral valve replacement from October 1978 to June 1983 were already reported. Their electrocardiograms were studied to assess the value of electrocardiographic examination in following the patients after valve replacement. The patients were divided into 5 groups beforehand according to the types of valve lesion on the bases of preoperative diagnosis and operative findings: Groups I: stenosis, I1: stenosis-dominant mixed, II1: equally mixed, IV: insufficiency-dominant mixed, and V: insufficiency. Their preoperative cardiac rhythm was sinus in 39.2% and atrial fibrillation in 59.1% of the patients. Seventy-three [42.4%] of the patients with atrial fibrillation gained sinus rhythm after operation, occurring in 67 from the day of surgery, and 42 returned to atrial fibrillation while 37 kept sinus rhythm at the follow-up end [mean follow-up period, 13.4\ulcorner1.4 months]. The P waves on the electrocardiograms of the preoperative sinus rhythm in 114 patients were normal in 5.3% and the findings of left atrial enlargement in 94.7% of the cases. They were normal in 42.1% and the findings of left atrial enlargement in 57.9% of the 140 patients with sinus rhythm at the follow-up. The preoperative major chamber enlargement was the right ventricle in Group I while it was the left ventricle in Group V, and it was in-between in Groups II-IV. The postoperative regression of the findings in ventricular enlargement was statistically significant only in Groups I and V. These results may suggest the importance of the serial electrocardiograms in following the patients with mitral valve replacement on the bases of outpatient. The electrocardiographic follow-up data were presented in patients with suspected or proved tissue valve failures.

• Journal of Chest Surgery
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• 제16권1호
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• pp.55-64
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• 1983

A hundred and eleven patients of mitral valvular heart disease, who were operated at Seoul National University Hospital, were analysed with echocardiogram before and after operation during the period from November 1979 to February 1982. Twenty-eight patients had mitral stenosis and eighty-three mitral regurgitation. In patients with mitral stenosis, right ventricular end-diastolic volume was in normal range at preoperative and postoperative period. But the left ventricular end-systolic volume was slightly increased preoperatively to 35.4mm and decreased to 33.5mm on immediate postoperative period and 32.5mm after a year later. The left ventricular end-diastolic volume was 50.5mm preoperatively and fell to 46.8mm postoperatively. Ejection fraction was normal preoperatively and postoperatively without changes. Left atrial size fell significantly from 50ram to 37.6mm at the time of late follow-up study. With mitral regurgitation, right ventricular end-diastolic volume was also normal preoperatively and postoperatively. The left ventricular end-systolic volume was increased to 41.9mm and decreased to 31.6mm postoperatively with statistic significance. Left ventricular end-diastolic volume fell from 58.5mm to 45.7mm significantly at the time of late follow-up period. Ejection fraction was also within normal range and had no changes postoperatively. Left atrial size fell from 54.8mm to 45.5mm on a year later [ p value less than 0.01 ]. When atrial fibrillation, the left atrial dimension was increased as 54.9mm compared with 46.8mm of no atrial fibrillation patients.

• Journal of Chest Surgery
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• 제46권2호
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• pp.93-97
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• 2013

Background: Minimally invasive cardiac surgery has emerged as an alternative to conventional open surgery. This report reviews our experience with atrial septal defect using the da VinciTM surgical robot system. Materials and Methods: This retrospective study included 50 consecutive patients who underwent atrial septal defect repair using the da VinciTM surgical robot system between October 2007 and May 2011. Among these, 13 patients (26%) were approached through a totally endoscopic approach and the others by mini-thoracotomy. Nineteen patients had concomitant procedures including tricuspid annuloplasty (n=10), mitral valvuloplasty (n=9), and maze procedure (n=4). The mean follow-up duration was $16.9{\pm}10.4$ months. Results: No remnant interatrial shunt was detected by intraoperative or postoperative echocardiography. The atrial septal defects were mainly repaired by Gore-Tex patch closure (80%). There was no operative mortality or serious surgical complications. The aortic cross clamping time and cardiopulmonary bypass time were $74.1{\pm}32.2$ and $157.6{\pm}49.7$ minutes, respectively. The postoperative hospital stay was $5.5{\pm}3.3$ days. Conclusion: The atrial septal defect repair with concomitant procedures like mitral valve repair or tricuspid valve repair using the da VinciTM system is a feasible method. In addition, in selected patients, complete port access can be helpful for better cosmetic results and less musculoskeletal injury.

• 대한약리학회지
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• 제12권2호
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• pp.13-19
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• 1976

A fluid extract of Zizyphi Semen was employed in this experiment. The cardiac effects of Zizyphi Semen were examined on isolated rabbits atria and heart in situ of anesthetized cats and rabbits. The adrenergic blocking activity and refractory period of cardiac muscle were measured after administration of this drug. In rabbits and cats the antiarrhythmic action of Zizyphi Semen on atrial and ventricular arrhythmias produced by epinephrine or ouabain was examined. The results were following: 1. Zizyphi Semen produced a decrease in rate and contractile amplitude of the isolated rabbit atria and had a week blocking effect on epinephrine acceleration of atrial movement. 2. Zizyphi Semen effectively abolished the spontaneous arrhythmia occurring in the isolated rabbit atria ana the atrial arrhythmia induced by ouabain. 3. Zizyphi Semen produced a marked prolongation of the refractory period in isolated atrial muscle of rabbit. 4. Zizyphi Semen prevented the induction of ventricular arrhythmia arising from excessive dose of epinephrine in anesthetized rabbits and cats. 5. With regard to the ventricular arrhythmia induced by a continuous infusion of ouabain, Zizyphi Semen exerted suppressive effect and produced a marked prolongation of cardiac arrest time in anesthetized rabbits and cats. From the above results, it may be concluded that Zizyphi Semen is effective against atrial and ventricular arrhythmias. The antiarrhythmic effect of this drug may be the result of direct myocardial depressive and partially adrenergic beta receptor blocking activities including prolongation of the refractory period of cardiac muscle.

• The Korean Journal of Physiology
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• 제24권1호
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• pp.115-121
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• 1990

Pentobarbital 마취한 정상혈압 및 신성 고혈압 흰쥐에서 calcium channel 봉쇄 약물 nifedipine과 atrial natriuretic peptide(ANP)의 상호작용을 조사하였다. 정상혈압 흰쥐에서 nifedipine$(1.0\;{\mu}g/kg/min)$ 또는 ANP(60 ng/kg/min)의 주입은 각각 유의하게 혈압을 내렸으며 두 약물의 동시 주입시에 개별적으로 주입하였을 때보다 그 혈압내림의 정도가 더욱 컸다. Nifedipine은 단독 주입하였을 때에 신기능에 유의한 영향을 미치지 않았으나 ANP와 동시에 주입하였을 때에는 ANP의 요량 및 Na 배설 증가 효과를 항진시켰다. 한편 고혈압 흰쥐에서도 ANP의 혈압내림효과와 신장효과는 nifedipine과 함께 주입하였을 때에 더 컸다. 적출 흉부대동맥 표본을 phenylephrine으로 미리 수축시킨 후 ANP를 첨가하면 용량의존 이완반응을 보였고 nifedipine 존재하에서 더 예민하였다. 이상의 실험결과는 calcium channel 봉쇄약물이 ANP의 혈압내림효과를 항진시킴을 보인 것이며 그 기전으로 요중 배설 증가 및 혈관이완효과 증가 등이 관여함을 시사하였다.

• The Korean Journal of Physiology
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• 제22권2호
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• pp.219-230
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• 1988

The effect of glycine, structurally the most simple amino acid was investigated on the electrophysiological characteristics of the isolated superfused atrial muscle and sinus node cells of the rabbit heart. Superfusion of the sinus node cell with glycine solution (3, 5 and 8 mM) produced concentration-dependent increments of OS (overshoot potential) and MDP (maximum diastolic potential). Generally action potential amplitude increased as a result of greater increment of OS than that of MDP. The changes in action potential of the sinus node cell peaked in $7{\sim}10{\;}minutes$ after onset of superfusioin. On the contrary to the response to intravenously administered glycine, the rate of spontaneous firing of sinus node cell was invariably increased following superfusion with glycine. Action potential duration manifested as $APD_{60}$ (time to 60% repolarization) was significantly shortened by glycine. And the electrophysiological effects of glycine on the atrial muscle cell were similar to that on the sinus node cells. The results of present study suggest that glycine can exert direct effects on the atrial muscle and sinus node cells of the rabbit heart.

• Journal of Chest Surgery
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• 제20권2호
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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.

• The Korean Journal of Physiology
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• 제26권1호
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• pp.27-35
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• 1992

We used the whole cell patch clamp technique to examine the ionic basis for the tail current after depolarizing pulse in single atrial myocytes of the rabbit. We recorded the tail currents during various repolarizations after short depolarizing pulse from a holding potential of -70 mV. The potassium currents were blocked by external 4-aminopyridine and replacement of internal potassium with cesium. The current was reversed to the outward direction above +10 mV. High concentrations of intracellular calcium buffer inhibited the activation of the current. Diltiazem and ryanodine blocked it too. These data suggest that the current is activated by intracellular calcium released from sarcoplasmic reticulumn. When the internal chloride concentration was increased, the inward tail current was increased. The current was partially blocked by the anion transport blocker niflumic acid. The current voltage curve of the niflumic acid sensitive current component shows outward rectification and is well fitted to the current voltage curve of the theoretically predicted chloride current calculated from the constant field equation. The currents recorded in rabbit atrial myocytes, with the method showing isolated outward Na Ca exchange current in ventricular cells of the guinea pig, suggested that chloride conductance could be activated with the activation of Na/ca exchange current. From the above results it is concluded that a chloride sensitive component which is activated by intracellular calcium contributes to tail currents in rabbit atrial cells.

• The Korean Journal of Physiology and Pharmacology
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• 제20권1호
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• pp.111-117
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• 2016

Vagal nerve activity has been known to play a crucial role in the induction and maintenance of atrial fibrillation (AF). However, it is unclear how the distribution and concentration of local acetylcholine (ACh) promotes AF. In this study, we investigated the effect of the spatial distribution and concentration of ACh on fibrillation patterns in an in silico human atrial model. A human atrial action potential model with an ACh-dependent $K^+$ current ($I_{KAch}$) was used to examine the effect of vagal activation. A simulation of cardiac wave dynamics was performed in a realistic 3D model of the atrium. A model of the ganglionated plexus (GP) and nerve was developed based on the "octopus hypothesis". The pattern of cardiac wave dynamics was examined by applying vagal activation to the GP areas or randomly. AF inducibility in the octopus hypothesis-based GP and nerve model was tested. The effect of the ACh concentration level was also examined. In the single cell simulation, an increase in the ACh concentration shortened $APD_{90}$ and increased the maximal slope of the restitution curve. In the 3D simulation, a random distribution of vagal activation promoted wavebreaks while ACh secretion limited to the GP areas did not induce a noticeable change in wave dynamics. The octopus hypothesis-based model of the GP and nerve exhibited AF inducibility at higher ACh concentrations. In conclusion, a 3D in silico model of the GP and parasympathetic nerve based on the octopus model exhibited higher AF inducibility with higher ACh concentrations.

• The Korean Journal of Physiology and Pharmacology
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• 제12권5호
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• pp.267-274
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• 2008

Since first discovered in chick skeletal muscles, stretch-activated channels (SACs) have been proposed as a probable mechano-transducer of the mechanical stimulus at the cellular level. Channel properties have been studied in both the single-channel and the whole-cell level. There is growing evidence to indicate that major stretch-induced changes in electrical activity are mediated by activation of these channels. We aimed to investigate the mechanism of stretch-induced automaticity by exploiting a recent mathematical model of rat atrial myocytes which had been established to reproduce cellular activities such as the action potential, $Ca^{2+}$ transients, and contractile force. The incorporation of SACs into the mathematical model, based on experimental results, successfully reproduced the repetitive firing of spontaneous action potentials by stretch. The induced automaticity was composed of two phases. The early phase was driven by increased background conductance of voltage-gated $Na^+$ channel, whereas the later phase was driven by the reverse-mode operation of $Na^+/Ca^{2+}$ exchange current secondary to the accumulation of $Na^+$ and $Ca^{2+}$ through SACs. These results of simulation successfully demonstrate how the SACs can induce automaticity in a single atrial myocyte which may act as a focus to initiate and maintain atrial fibrillation in concert with other arrhythmogenic changes in the heart.