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Changes in Right Ventricular Volume, Volume Load, and Function Measured with Cardiac Computed Tomography over the Entire Time Course of Tetralogy of Fallot

  • Hyun Woo Goo
    • Korean Journal of Radiology
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    • v.20 no.6
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    • pp.956-966
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    • 2019
  • Objective: To characterize the changes in right ventricular (RV) volume, volume load, and function measured with cardiac computed tomography (CT) over the entire time course of tetralogy of Fallot (TOF). Materials and Methods: In 374 patients with TOF, the ventricular volume, ventricular function, and RV volume load were measured with cardiac CT preoperatively (stage 1), after palliative operation (stage 2), after total surgical repair (stage 3), or after pulmonary valve replacement (PVR) (stage 4). The CT-measured variables were compared among the four stages. After total surgical repair, the postoperative duration (POD) and the CT-measured variables were correlated with each other. In addition, the demographic and CT-measured variables in the early postoperative groups were compared with those in the late postoperative and the preoperative group. Results: Significantly different CT-based measures were found between stages 1 and 3 (indexed RV end-diastolic volume [EDV], 63.6 ± 15.2 mL/m2 vs. 147.0 ± 38.5 mL/m2 and indexed stroke volume (SV) difference, 7.7 ± 10.3 mL/m2 vs. 32.2 ± 16.4 mL/m2; p < 0.001), and between stages 2 and 3 (indexed RV EDV, 72.4 ± 19.7 mL/m2 vs. 147.0 ± 38.5 mL/m2 and indexed SV difference, 5.7 ± 13.1 mL/m2 vs. 32.2 ± 16.4 mL/m2; p < 0.001). After PVR, the effect of RV volume load (i.e., indexed SV difference) was reduced from 32.2 mL/m2 to 1.7 mL/m2. Positive (0.2 to 0.8) or negative (-0.2 to -0.4) correlations were found among the CT-based measures except between the RV ejection fraction (EF) and the RV volume load parameters. With increasing POD, an early rapid increase was followed by a slow increase and a plateau in the indexed ventricular volumes and the RV volume load parameters. Compared with the preoperative data, larger ventricular volumes and lower EFs were observed in the early postoperative period. Conclusion: Cardiac CT can be used to characterize RV volume, volume load, and function over the entire time course of TOF.

A Comparative Study regarding Health Condition and Work Stress of Nurses Working in Cancer Ward and General Ward (암병동간호사와 일반병동간호사의 건강상태와 직무스트레스 비교 연구)

  • Kim, Hyun-Sook
    • Asian Oncology Nursing
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    • v.1 no.2
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    • pp.191-203
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    • 2001
  • The health of a nurse is very important because her mental and physical health can influence toward nursing patients directly, Especially, Cancer patients are growing annually. Also, terminal cancer patients' nursing and dead place are increasingly using hospital and the period of nursing for cancer patients are increasing. Nursing for cancer patients are different with acute disease. Therefore, I analysed comparing nurses' health working in cancer and general ward so that nurses working at cancer ward could be developed as a professional nurse, and I wanted to establish the foundation of nursing administration and reasonable manpower management to supply good quality of nursing to patients. In my research, I selected 117 nurses working in cancer ward and 134 nurses working in general word to analyse the stress rate and nurse's health comparing nurses working in general ward and cancer ward. The survey was conducted of nurses working in cancer ward nurses in 2 university hospitals, nurses working in a cancer hospital, and general ward nurses working in 3 public hospital. Also, the data was collected from Sep. 13, 2001 to Sep. 28, 2001. As health measuring tool, I used Cornell Medical Index(CMI) which are developed to fit Koreans by Ko Ungrin and Park Hang-bas (1980) using Cornell Medical Services which were designed by Weiser, Brosman, Mittelman, Wechler, Wolff in Cornell University(1945). As working stress measuring tool, I used Questionaries which were designed by Kim Mae-ja and Ku Mi-ok(1984) and then developed by Bae In-sook(1996). For managing the data, I used frequency, percentage, ${\chi}^2$ verification, t-test, and F-test (ANOVA). And in the case of significant data(p<.05). I did Duncan's test for post verification. The mutual relation between health condition and working stress rate have been conducted using Pearson's Correlation Coefficient. Followings are the results of my research. 1. Two groups showed significant differency at age after testing homogeneous character between two groups (${\chi}^2$ =9.919, p=.007). 2. Comparing two group's health condition, cancer ward(average 19.35${\pm}$18.34) were higher than general ward(14.42${\pm}$10.59) and showed statistical significant differency(p=.009). And, comparing two group's mental condition, cancer ward(9.00${\pm}$9.79) were higher than general ward(7.13${\pm}$6.35) and statistically no differency. 3. After comparing two group's working stress rate, the rate of cancer ward nurse's working stress(3.36${\pm}$.50) is higher than general ward nurse (3.32${\pm}$.48). There are no significant differency. However, in the detailed verification test, there were significant differency at inappropriate compensation (t=3.254, p=.001) and medication issue (t=2.170, p=.031). 4. After comparing health condition at general points, physical health condition showed significant differency at age(p=.020), the number of children (p=.015), religion (p=.015), position(p=.005), career(p=.008), working satisfaction(p=.003), activity after office hour(p=.045); and mental health condition showed significant differency at position(p=.010), career (p=.017), working satisfaction (p=.003). 5. After comparing the working stress rate according to general points, there were significant differency at working satisfaction (F=5.285, p=.006), predicted nursing(F=3.822, p=.023). 6. At the relation of health condition and working stress rate between two groups. physical and mental condition showed significant relation with working stress rate. i.e, if a nurse's health condition is not good, she are feeling much more stress than others. After considering all the factors in my research, I found that the health condition and stress rate of cancer ward nurses is much higher than general ward nurses. Considering that cancer ward nurses is necessary to care for increasing cancer patients with mental and physical nursing, the less stress for cancer ward nurses is very important to develop nursing quality and working efficiency by keeping good health condition, specializing cancer ward nurses. Therefore, we need following studies to find the factors which are effecting to cancer ward nurses' health and specialization. Also, we need to improve managing working condition to decrease working stress by improving working condition.

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