• Clinical and Experimental Pediatrics
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• v.56 no.6
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• pp.235-241
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• 2013

Repair of tetralogy of Fallot (TOF) has shown excellent outcomes. However it leaves varying degrees of residual hemodynamic impairment, with severe pulmonary stenosis (PS) and free pulmonary regurgitation (PR) at both ends of the spectrum. Since the 1980s, studies evaluating late outcomes after TOF repair revealed the adverse impacts of residual chronic PR on RV volume and function; thus, a turnaround of operational strategies has occurred from aggressive RV outflow tract (RVOT) reconstruction for complete relief of RVOT obstruction to conservative RVOT reconstruction for limiting PR. This transformation has raised the question of how much residual PS after conservative RVOT reconstruction is acceptable. Besides, as pulmonary valve replacement (PVR) increases in patients with RV deterioration from residual PR, there is concern regarding when it should be performed. Regarding residual PS, several studies revealed that PS in addition to PR was associated with less PR and a small RV volume. This suggests that PS combined with PR makes RV diastolic property to protect against dilatation through RV hypertrophy and supports conservative RVOT enlargement despite residual PS. Also, several studies have revealed the pre-PVR threshold of RV parameters for the normalization of RV volume and function after PVR, and based on these results, the indications for PVR have been revised. Although there is no established strategy, better understanding of RV mechanics, development of new surgical and interventional techniques, and evidence for the effect of PVR on RV reverse remodeling and its late outcome will aid us to optimize the management of TOF.

• The Korean Journal of Nuclear Medicine
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• v.19 no.2
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• pp.43-50
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• 1985

With the improvement of hemodialysis, the course of the disease in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (early and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis. 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe due to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

• Journal of Biomedical Engineering Research
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• v.23 no.4
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• pp.281-286
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• 2002

In this study, blood flow in a carotid artery supplying blood to the human's brain has been numerically simulated to find out how the blood flow affects the genesis and the growth of atherosclerosis and arterial thrombosis. Velocity Profiles and hemodynamic parameters have been investigated for the carotid arteries with three different stenoses under physiological flow condition. Blood has been treated as Newtonian and non-Newtonian fluid. To model the shear thinning properties of blood for non-Newtonian fluid, the Carreau-Yasuda model has been employed. The result shows that the wall shear stress(WSS) increases with the development of stenosis and that the wall shear stress in Newtonian fluid is highly evaluated compared with that in non-Newtonian Fluid. Oscillatory shear index has been employed to identify the time-averaged reattachment point and this point is located farther from the stenosis for Newtonian fluid than for non-Newtonian fluid The wall shear stress gradient(WSSG) along the wall has been estimated to be very high around the stenosis region when stenosis is developed much and the WSSG peak value of Newtonian fluid is higher than that of non-Newtonian fluid.

• Journal of Biomedical Engineering Research
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• v.18 no.1
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• pp.25-36
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• 1997

To regulate cardiac output of the Total Artificial Heart(TAH) physiologically, the hemodynamic information must be toed back to the controller. So far, our group has developed an automatic cardiac output control algorithm using the motor current waveform, It is, however difficult to detect the preload level such as a filling status of ventricular inflow and the variation of atrial pressures within normal physiologic range(0-15 mmHg) by analyzing the motor current which simultaneously reflects the afterload effect. On the other hin4 the interventricular volume pressure(IVP) which is not influenced by arterload but by preload is a good information source for the estimation of preload states. In order to find the relationship between preload and IVP waveform, we set up the artificial heart system on the Donovan type mock circulatory system and measured the IVP waveform, right and left atrial pressures, inflow and outflow waveforms and the signals represented the information of moving actuator's position. We shows the feasibility of estimating the hemodynamic changes of inflow by using IVP waveform. fife found that the negative peak value of IVP waveform is linearly related to atrial pressures. And we also found that we could use the time to reach the negative peak in IVP waveform, the time to open outflow valve, the area enclosed IVP waveform as unfu parameters to estimate blood filling volume of diastole ventricle. The suggested method has advantages of avoiding thrombogenesis, bacterial niche formation and increasing longterm reliability of sensor by avoiding direct contact to blood.

• Tuberculosis and Respiratory Diseases
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• v.48 no.6
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• pp.964-972
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• 2000

We report three patients with pulmonary hypertension in Takayasu's arteritis, who showed long-term favorable response, clinically and hemodynamically, to the nitric oxide donor, molsidomine. In these patients, the inhaled nitric oxide was effective in reducing pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) as was shown in the acute vasodilator response test using the invasive hemodynamic monitoring. Molsidomine (single oral dose of 4 mg) was also effective in reducing PAP and PVR in the acute test, but nifedipine was not. With 4 mg of molsidomine three times daily, their dyspnea, exercise capacity and hemodynamic parameters were improved. These favorable responses have lasted during the 1st and 3rd month follow-up in all patients.

• International Journal of Vascular Biomedical Engineering
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• v.2 no.2
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• pp.16-26
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• 2004

The object of this study is to develop a mathematical model of the hemodialysis system including the mechanism of solute kinetics, water exchange and also cardiovascular dynamics. The cardiovascular system model used in this study simulates the short-term transient and steady-state hemodynamic responses such as hypotension and disequilibrium syndrome (which are main complications to hemodialysis patients) during hemodialysis. It consists of a 12 lumped-parameter representation of the cardiovascular circulation connected to set-point models of the arterial baroreflexes, a kinetic model (hemodialysis system model) with 3 compartmental body fluids and 2 compartmental solutes. We formulate mathematically this model in terms of an electric analog model. All resistors and most capacitors are assumed to be linear. The control mechanisms are mediated by the information detected from arterial pressoreceptors, and they work on systemic arterial resistance, heart rate, and systemic venous unstressed volume. The hemodialysis model includes the dynamics of urea, creatinine, sodium and potassium in the intracellular and extracellular pools as well as fluid balance equations for the intracellular, interstitial, and plasma volumes. Model parameters are largely based on literature values. We have presented the results on the simulations performed by changing some model parameters with respect to their basal values. In each case, the percentage changes of each compartmental pressure, heart rate (HR), total systemic resistance (TSR), ventricular compliance, zero pressure filling volume and solute concentration profiles are represented during hemodialysis.

• Journal of Veterinary Science
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• v.21 no.1
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• pp.6.1-6.12
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• 2020

Currently, the optimal resuscitation fluid remains debatable. Therefore, in the present study, we designed a trometamol-balanced solution (TBS) for use as a resuscitation fluid for hemorrhagic shock. Hemorrhagic shock was induced in 18 male Wistar-Kyoto rats, which were assigned to normal saline (NS), Ringer's solution (RS), and TBS groups. During the hemorrhagic state, their hemodynamic parameters were recorded using an Abbott i-STAT analyzer with the CG4+ cartridge (for pH, pressure of carbon dioxide, pressure of oxygen, total carbon dioxide, bicarbonate, base excess, oxygen saturation, and lactate), the CG6+ cartridge (for sodium, potassium, chloride, blood glucose, blood urea nitrogen, hematocrit, and hemoglobin), and enzyme-linked immunosorbent assay kits (calcium, magnesium, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, and albumin). Similar trends were found for the parameters of biochemistries, electrolytes, and blood gas, and they revealed no significant changes after blood withdrawal-induced hemorrhagic shock. However, the TBS group showed more effective ability to correct metabolic acidosis than the NS and RS groups. TBS was a feasible and safe resuscitation solution in this study and may be an alternative to NS and RS for resuscitation in hemorrhagic shock patients without liver damage.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.7 no.2
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• pp.256-270
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• 2000

Invasive hemodynamic monitoring has become a valuable assessment parameters in critical care nursing in patients undergoing open heart surgery patients. During cardiac surgery, the Swan Ganz catheter is placed in the pulmonary artery. Critical care nurses routinely obtain cardiac output, cardiac index, and pulmonary arterial pressure in these patients. Traditionally, patients are positioned flat and supine for cardiac output measurement. Numerous studies have dealt with the effects of changing position on the hemodynamic variables. However, there are a few studies dealing with patients who undergo cardiac surgery in Korea. Thus, the purpose of this study was to determine the effects of changing position on cardiac output, PAP, CVP, BP, HR and discomfort in patients after cardiac surgery. A sample of 21 adults who had CABG and/or valve replacement with Swan Ganz catheters in place was studied. The data were collected in the cardiac ICU of a university hospital in Seoul during the period from July 28, 1999 to August 30. 1999. In this study, the independent variable is patient position in the supine, 30 degree, and 45 degree angles. Dependent variables are C.O., C.I., CVP, PAP, MAP, HR and patients' perceived discomforts. Subject discomfort was measured subjectively by visual analogue scale. Other hemodynamic data where collected by the thermodilution method and by direct measurement. The data were analyzed by percentile, t-test, ANOVA, Linear regression analysis using SPSS-/WIN program. The results are as follows : 1) Changes in cardiac output were absent in different angle positions, 0, 30. 45 degrees(F=.070, P=.932). Changes in cardiac index were absent in different angle positions, 0. 30, 45 degrees(P>.05). 2) Changes in central venous pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 3) PAP had no change in different angle 0, 30, 45 degree positions; systolic PAP(P>.05), diastolic PAP(P>.05). 4) Changes in systolic blood pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 5) Changes in heart rates were absent in different angle positions, 0, 30, 45 degree(P>.05). 6) Patients' perceived discomfort was absent in different angle positions, 0, 30, 45 degree(p<.05). In conclusion, critical care nurses can measure C.O., C.I., PAP, BP, & CVP in cardiac surgery patients at 30 degree or 45 degree positions. This can improve the patients' comfort.

• Journal of Biomedical Engineering Research
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• v.25 no.6
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• pp.497-503
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• 2004

Numerical simulation of blood flow has been conducted based on real vessel geometries generated front DICOM medical images of abdominal and iliac bifurcated arteries of a healthy man. A program was developed to read cross sectional images of the three dimensional arteries and smoothly extract boundary coordinates of vessels. Commercial programs were employed for mesh generation and flow simulation. Pressures, velocities, and flow distributions were found to lie within normal physiological ranges. Peak velocity measured in the iliac artery by ultrasound was 20% smaller than that obtained by simulation. The trend of velocity variation in a cardiac cycle was fairly similar between the simulation and the ultrasonic measurements. Simulation based on real vessel geometry of individual patient provides information on pressure, velocity, and its distribution in the diseased arteries or arteries to be surgically treated. The results of simulation may help surgeons to better understand hemodynamic status and surgical need of the patient by revealing variation of the hemodynamic parameters. Futhermore, they may serve as basic data for surgical treatment of arteries. This research is expected to develop to a program in the future that early diagnose atherosclerosis by showing distribution of a hemodynamic index closely related to atherosclerosis in arteries.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.217-224
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• 1986

Using an isolated rat heart preparation under both aerobic and ischemic condition, we observed the myocardial protective effect of verapamil cardioplegia. Isolated working hearts were subjected to global ischemia at 25oC. Before ischemic arrest, rat hearts were treated with cold potassium cardioplegic solution [K=30 mEq/L] in control group and cold potassium cardioplegic solution added with verapamil [1 mg/L] in other group. After 30 min. of ischemia, hemodynamic parameters and creatine kinase leakage in coronary effluent were observed. Verapamil group exhibited greater percent of recovery in aortic pressure [p<0.01], aortic flow [p<0.01], and stroke volume [p<0.05]. Although there were no significant difference in creatine kinase leakage and the percent recovery of cardiac output between verapamil and control group, verapamil group showed better myocardial function. But the time to recover regular sinus rhythm was significantly [p<0.001] prolonged in verapamil group.