• Title/Summary/Keyword: cardiac safety

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Endovascular Aortic Balloon Clamping for Various Heart Disease (대동맥 내 풍선 차단법을 이용한 여러 가지 심장수술)

  • Choi, Jin-Ho;Park, Pyo-Won
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.61-67
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    • 2008
  • Background: Conventional ascending aortic cross clamping is often limited. This study was carried out to evaluate the safety and efficacy of an endovascular aortic clamping technique with an intraaortic balloon catheter. Material and Method: From April 2004 to January 2007, surgery with endoaortic clamping was performed in seven patients. A retrograde access perfusion (RAP) catheter was used in six patients and a Pruitt's balloon catheter in two patients. The indication for the operation was a retrosternal pseudoaneurysm of the aortic root in six patients, diffuse calcification of the ascending aorta with aortic regurgitation in 2 patients and an atrial septal defect in one patient. Five patients had at least two prior cardiac surgeries. Result: Successful insertion of the catheter and endoaortic clamping was achieved in all patients. Conclusion: The endovascular aortic clamping technique with a balloon catheter was a useful alternative method for patients in whom conventional cardiac surgery was limited.

Behavioral and cardiac responses in mature horses exposed to a novel object

  • Lee, Kyung Eun;Kim, Joon Gyu;Lee, Hang;Kim, Byung Sun
    • Journal of Animal Science and Technology
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    • v.63 no.3
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    • pp.651-661
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    • 2021
  • This study aimed to investigate whether breed, sex, and age affected temperament differently (more or less neophobic) in mature horses during a novel object test. The study included Jeju crossbred (n = 12, age = 9.42 ± 4.57 y), Thoroughbred (n = 15, age = 10.73 ± 3.09 y), and Warmblood horses (n = 12, age = 13.08 ± 3.55 y) with the females (n = 22, age = 11.36 ± 4.24 y) and geldings (n = 17, age = 10.65 ± 3.66 y). Jeju crossbreds (Jeju horse × Thoroughbred) are valuable considering their popular usage in Korea, but limited studies have explored temperament of Jeju crossbred horses. A trained experimenter touched the left side of the neck with a white plastic bag (novel object). The test ended when the horse stopped escape response and heart rate (HR) dropped to baseline. Behavioral score and escape duration were measured as behavioral variables. Multiple variables related to HR and heart rate variability (HRV) were measured to reflect emotional state. These included basal HR (BHR), maximum HR (MHR), delay to reach maximum heart rate (Time to MHR), standard deviation of beat-to-beat intervals (SDNN), root mean square of successive differences (RMSSD), and ratio of low to high frequency components of a continuous series of heartbeats (LF/HF). Statistics revealed that Thoroughbreds had significantly higher behavioral scores, and lower RMSSD than Jeju crossbreds (p < 0.05), suggesting greater excitement and fear to the novel object in Thoroughbreds. None of the behavioral or cardiac parameters exhibited sex differences (p < 0.05). Age was negatively correlated with SDNN and RMSSD (p < 0.05), indicating that older horses felt more anxiety to the novelty than younger horses. Thoroughbreds and females had distinct correlations between behavioral and HRV variables in comparison with other groups (p < 0.05), implying that escape duration might be a good indicator of stress, especially in these two groups. These results are expected to improve equine welfare, safety and utility, by providing insights into the temperament of particular horse groups, to better match reactivity levels with specific functions.

Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: Is FFR-Guided Strategy Still Valuable?

  • Doosup Shin;Tae-Min Rhee;Seung Hun Lee ;Joo Myung Lee
    • Korean Circulation Journal
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    • v.52 no.4
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    • pp.280-287
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    • 2022
  • Several studies have shown the benefit of complete revascularization (CR) over culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevated myocardial infarction (STEMI) and multivessel disease (MVD). Nevertheless, optimal strategy to select targets for non-culprit PCI has not been clarified. In this paper, we critically discuss and compare the safety and efficacy of different strategies for CR in patients with STEMI and MVD using a Bayesian network meta-analysis including all previous randomized controlled trials (RCTs). In Bayesian network meta-analysis of 13 RCTs, culprit-only PCI was associated with higher risk of major adverse cardiac events (MACE), compared with angiography-guided or fractional flow reserve (FFR)-guided CR strategies. However, there was no significant difference between angiography-guided and FFR-guided CR strategies in the risk of MACE and its individual components including all-cause death, cardiac death, myocardial infarction (MI), and revascularization. These evidence support that both angiography-guided and FFR-guided complete revascularization strategies would be reasonable treatment option in patients with STEMI and MVD. If the non-culprit lesion is severe on visual assessment, angiography-guided PCI can be considered. If the non-culprit lesion is intermediate in severity or unclear based on visual assessment, FFR-guided strategy can be used as a reliable and objective tool, providing similar benefits with less stents compared with an angiography-guided strategy. Further RCT is needed to evaluate direct comparison between angiography-guided and FFR-guided CR strategies in patients with STEMI and MVD. Ongoing FRAME-AMI trial (NCT02715518) will provide more evidence regarding this issue.

Automatic Determination of Pacing Threshold by Surface ECG Morphology (ECG 형태에 의한 자동화된 pacing 문턱 전압 결정에 관한 연구)

  • Kim, J.;Huh, W.
    • Journal of Biomedical Engineering Research
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    • v.22 no.3
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    • pp.269-273
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    • 2001
  • Proper determination of pacing threshold is important for patient safety and pacemaker longevity. In general, cardiac muscle contractions caused by pacing pulses are verified by observing the morphology of surface ECG displayed on a monitor. In this study, a method of automatic pacing threshold determination based on morphological difference between intrinsic and paced ECGs was developed. First, characteristics of intrinsic ECG and paced ECG were analyzed in time and frequency domain and a proper discrimination parameter was extracted. Then, the automatic capture verification method based on the parameter was developed and applied to 23 pacemaker patients. The selected parameter was the area of ventricular depolarization wave during 80ms after pacing stimulus. It was found that the method was reliable and effective in identifying paced ECG and, thereby, determing a proper pacing threshold.

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Comprehensive understanding of atrial septal defects by imaging studies for successful transcatheter closure

  • Song, Jinyoung
    • Clinical and Experimental Pediatrics
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    • v.57 no.7
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    • pp.297-303
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    • 2014
  • Transcatheter closure of atrial septal defects has become a popular procedure. The availability of a preprocedural imaging study is crucial for a safe and successful closure. Both the anatomy and morphology of the defect should be precisely evaluated before the procedure. Three-dimensional (3D) echocardiography and cardiac computed tomography are helpful for understanding the morphology of a defect, which is important because different defect morphologies could variously impact the results. During the procedure, real-time 3D echocardiography can be used to guide an accurate closure. The safety and efficiency of transcatheter closures of atrial septal defects could be improved through the use of detailed imaging studies.

The Clinical Study of Ketamine HC1 on Oral Surgery (구강외과 영역에 있어서 Ketamine HC1의 임상적 고찰)

  • Cho, Byoung-Uk
    • The Journal of the Korean dental association
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    • v.11 no.1
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    • pp.45-52
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    • 1973
  • Ketamine HC1(Phencyclidine derivative) is a white, crystalline substance with melting point 259℃. It is soluble in water to a 20% clear, colorless solution. a 10% aqueous solution has a pH 3.5. The chemical structure is 2-(O-chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride. It is a rapid acting, nonhypnotic, nonbarbiturate drug with a wide safety margin. The author used the anesthetic ketamine hydrochloride for oral surgery procedure in 16 patients(2 to 33 years). Anesthesia was achieved with a single intramuscular injection by introduction of manufacture. Result obtained as follows : 1. It was easily administered. 2. Onset time was rapid and duration was short. 3. The mild cardiac stimulation resulted in moderate increase in the blood pressure and pulse. 4. There was no significant respiratory depression. 5. The airway can be maintained without artificial support or endotracheal intubation. 6. All protective reflex maintained, which was important in oral surgery. 7. The best results were achieved in pediatric patients than adults.

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Aortic and Pulmograft Transplantation Utilizing Cryopreservation (초저온 냉동보관법을 이용한 동종판막 이식술에 대한 연구)

  • Song, Myeong-Geun;Lee, Dong-Sun
    • Journal of Chest Surgery
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    • v.23 no.4
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    • pp.622-639
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    • 1990
  • The use of aortic valve homograft has been developed since 1962 when Ross and Barratt - Boyes independently replaced a diseased aortic valve with an orthotopically inserted homograft valve. And also surgical treatment of complex congenital cardiac malformations utilizing homograft extracardiac conduit has been tried with better result than any other prosthetic material. The present study was undertaken to clarify the safety tissue viability, sterility, after following our protocol of procurement of heart, dissection of aortic and pulmonic homograft, sterilization, cryopreservation, thawing and dilution, and transplantation on experimental animal, sheep. Tissue viability of valve and great artery was assessed by tissue culture. Sterility was evaluated by bacterial and fungal culture. The method used was proven no deleterious effect on the integrity of the valve. Tissue culture of valve tissue before, and after cryopreservation process resulted that active fibroblast growth was observed from homograft sterilized with antibiotics. And culture of the transplanted homograft from sacrificed animal showed active fibroblast growth. Pathologic examination of implanted valve tissue from sacrificed sheep showed mild calcification and minor change, but there were moderate and severe calcification of wall of great arteries.

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The effects of high $CO_2$ concentration on the cardiorespiratory function in the yellowtail and the flounder (방어 및 넙치의 심혈관 기능에 미치는 고이산화탄소의 영향)

  • Lee, Kyoung-Seon
    • Proceedings of KOSOMES biannual meeting
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    • 2007.05a
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    • pp.97-99
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    • 2007
  • 대기중 이산화탄소 농도상승을 억제하기 위하여 $CO_2$를 해양에 처리하는 방안이 제안되고 있으며 해양생태계 및 해양생물에 대한 생물학적 영향에 대한 검토가 신중하게 검토되어야 할 것으로 생각된다. 본 연구에서는 고농도의 이산화탄소 환경에서 천해어종인 방어 및 넙치의 심혈관계 반용을 비교 검토하였다. 5% $CO_2$ 환경에서 방어는 8시간 이내에, 넙치는 48 시간 이내에 100% 폐사하였으며, 넙치는 혈액 pH가 회복하였음에도 불구하고 폐사하는 경향이었다. 방어의 cardiac output (심박출량)은 stroke volume (박동량)의 변화에 의해서 영향을 받으며, 넙치는 heart rate (심박수)의 변화가 심박출량의 변화에 큰 영향을 끼치는 것으로 나타났다.

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Aortic Stenosis: New Insights in Diagnosis, Treatment, and Prevention

  • Saki Ito;Jae K. Oh
    • Korean Circulation Journal
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    • v.52 no.10
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    • pp.721-736
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    • 2022
  • Aortic stenosis (AS) is one of the most common valvular heart diseases and the number of patients with AS is expected to increase globally as the older population is growing fast. Since the majority of patients are elderly, AS is no longer a simple valvular heart disease of left ventricular outflow obstruction but is accompanied by other cardiac and comorbid conditions. Because of the significant variations of the disease, identifying patients at high risk and even earlier detection of patients with AS before developing symptomatic severe AS is becoming increasingly important. With the proven of efficacy and safety of transcatheter aortic valve replacement (TAVR) in the severe AS population, there is a growing interest in applying TAVR in those with less than severe AS. A medical therapy to reduce or prevent the progression in AS is actively investigated by several randomized control trials. In this review, we will summarize the most recent findings in AS and discuss potential future management strategies of patients with AS.

Comparison of Clopidogrel versus Cilostazol in Coronary Artery Stenting (관상동맥 스텐트 삽입술 후 Clopidogrel과 Cilostazol의 비교)

  • Song, In-Sook;Choi, Seung-Ki;Oh, Jung-Mi
    • Korean Journal of Clinical Pharmacy
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    • v.15 no.2
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    • pp.105-117
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    • 2005
  • Following intracoronary stenting, antiplatelet therapy lead to greater protection from thrombotic complication. A few data are available about the effect of clopidogrel versus cilostazol, an antiplatelet commonly used after intracoronary stenting. To evaluate the efficacy and safety of clopidogrel plus aspirin compared with those of cilostazol plus aspirin in coronary stenting and to evaluate the efficacy of clopidogrel loading dose prior to coronary stealing in clopidogrel group. Data were retrospectively collected from medical charts of patients who had undergone coronary stenting and received either clopidogrel with or without loading 300 mg followed by 75 mg/d (n=58), or 200 mg/d cilostazol(n=72) for 1 year, between January 2000 and May 2002. All patients in both groups received aspirin 200 mg/d throughout the study. The primary endpoints at 7, 30, 180 and 365 days after stealing were the composite of death, Myocardial Infarction, stroke, angina, and revascularization in the intent to treat population and restenosis at follow up angiography. The secondary endpoints were the incidence of bleeding complications at 7, 30, and 365 days, and durg adverse effects at 365 days after stenting. At 180 and 365 days after stenting, the combined primary endpoints were significantly reduced in clopidogrel plus aspirin group (relative risk 0.39; 95% CI 0.17 to 0.92; p=0.021, RR 0.43; 95% CI 0.22 to 0.84; p=0.0085, respectively). However, the combined primary endpoints were not significantly different between the two groups at 7 and 30 days (p:1.00, p=0.79, respectively). Angiographic restenosis rate was 14.3% in clopidogrel plus aspirin uoup and 32.1% in cilostazol plus aspirin group (p=0.19). 300mg of clopidogrel loading dose did not significantly reduce the combined primary endpoints at 30 days after stenting (RR 0.14; 95% CI 0.01 to 2.65; p=0.23). The rate of bleeding complications and drug adverse effects were not different between the two groups. In patients undergoing intracoronary stenting, clopidogrel plus aspirin therapy is more beneficial than cilostazol plus aspirin in reducing major adverse cardiac events with similar rate of bleeding complication. A loading dose of clopidogrel did not lead to a statistically significant reduction in major adverse cardiac events.

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