• Journal of Chest Surgery
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• 제41권4호
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• pp.476-479
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• 2008

심실 중격 결손과 폐동맥 협착을 동반한 완전 대혈관 전위를 갖는 환자에서 기존의 Rastelli수술법의 만족스럽지 않은 장기 결과가 보고되는 반면, 최근 들어 대동맥 전위술은 이 질환에서 유용한 수술방법으로 보고되고 있다. 본 증례는 우심실 유입부로 연장된 막성주위형 심실중격결손과 폐동맥 협착을 동반한 완전 대혈관 전위로 진단되어 과거에 체폐단락술을 받았던 2세 남자 환아(체중 9.6 kg)에서 우심실에서 분리한 대동맥 근부를 후방의 좌심실쪽으로 전위시켜 좌심실 유출로 재건술을 시행하고, 판막 도관을 이용하여 우심실 유출로 재건술을 시행하였다. 수술 후 시행한 심초음파 검사에서 양호한 혈역학적 소견을 보여 문헌 고찰과 함께 증례 보고를 한다.

• 대한핵의학회지
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• 제14권1호
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• pp.29-36
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• 1980

Most of clinical morbidity in cardiology are associated with abnormalities of the left ventricle. Several methods have been developed to measure the left ventricular function, including cardiac catheterization with cineangiography, echocardiography, and systolic time interval. But these methods have many limitations. ECG gated cardiac blood pool scan provides a safe, noninvasive, repeatable method for determining the left ventricular function. Utilizing the cardiac blood pool scan, we measured the left ventricular function in 165 cardiac patients, and in 26 normal subject. 1. Left ventricular ejection fractions were measured by cardiac blood pool scan, and compared in 20 patients with that measured by x-ray cineangiography. Correlation coefficient was 0.885. 2. Ejection fractions were classified by funtional class made in New York Heart Association. Ejection fractions well represented the functional status. 3. Ejection fractions decreased in cardiomyopathy ($20.1{\pm}4.8%$) and ischemic heart disease ($34.4{\pm}16.7%$). Impaired ejection fractions in myocardial infarction were associated with the extent of infarction. 4. Regional left ventricular wall motion was evaluated from the end-diastolic and end-systolic images. In cardiomyopathy diffuse hypokinesia was noted and in myocardial infarction akinesia was noted on the infarcted areas.

• Journal of Chest Surgery
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• 제39권2호
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• pp.145-149
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• 2006

폐동맥 협착과 심실 중격 결손을 동반한 대혈관 전위를 갖는 환자들에 대한 수술은 Rastelli 수술법이나 Lecornpte 수술법이 전통적으로 시행되어 왔으나, 심실 내 터널에 의한 뒤틀린 좌심실 유출로와 부자연스러운 우심실 유출로에 의해 장기 성적은 만족스럽지 않다. 이에 대한 대안으로 저자들은 이 기형으로 진단된 3세 환아(체중 9.6 kg)에서 반회전 동맥간 전환술(half-turned truncal switch operation)을 시행하였다. 술 후 심초음파 검사에서 좌심실유출로와 우심실유출로가 곧고 넓게 형성되어 향후 좋은 장기 결과가 기대된다.

• 약학회지
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• 제55권3호
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• pp.247-250
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• 2011

An increase in ventricular pressure can alter cardiac excitation and contraction. Recent report has demonstrated that fluid pressure (FP) suppresses L-type $Ca^{2+}$ current with acceleration of the current inactivation in ventricular myocytes. Since the L-type $Ca^{2+}$ channels known to be regulated by intracellular pH ($pH_i$), this study was designed to explore whether pressurized fluid flow affects pHi in isolated rat ventricular myocytes. A flow of pressurized (~16 dyne/$cm^2$) fluid, identical to that bathing the myocytes, was applied onto single myocytes, and intracellular $H^+$ concentration was monitored using confocal $H^+$ imaging. FP significantly decreased $pH_i$ by $0.07{\pm}0.01$ pH units (n=16, P<0.01). Intracellular acidosis enhances the activity of $Na^+-H^+$ exchanger (NHE). Therefore, we examined if the NHE activity is increased by FP using the NHE inhibitor, HOE642. Although HOE642 did not alter $pH_i$ in control conditions, it decreased $pH_i$ in cells pre-exposed to FP, suggesting enhancement of NHE activity by FP. In addition, FP-induced intracellular acidosis was larger in cells pre-treated with HOE642 than in cells under the control conditions. These results suggest that FP induces intracellular acidosis and that NHE may contribute to extrude $H^+$ during the FP-induced acidosis in rat ventricular myocytes.

• Journal of Chest Surgery
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• 제57권2호
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• pp.184-194
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• 2024

Background: Left ventricular assist devices (LVADs) are widely employed as a therapeutic option for end-stage heart failure. We evaluated the outcomes associated with centrifugal-flow LVAD implantation, comparing 2 device models: the Heartmate 3 (HM3) and the Heartware Ventricular Assist Device (HVAD). Methods: Data were collected from patients who underwent LVAD implantation between June 1, 2015 and December 31, 2022. We analyzed overall survival, first rehospitalization, and early, late, and LVAD-related complications. Results: In total, 74 patients underwent LVAD implantation, with 42 receiving the HM3 and 32 the HVAD. A mild Interagency Registry for Mechanically Assisted Circulatory Support score was more common among HM3 than HVAD recipients (p=0.006), and patients receiving the HM3 exhibited lower rates of preoperative ventilator use (p=0.010) and extracorporeal membrane oxygenation (p=0.039). The overall early mortality rate was 5.4% (4 of 74 patients), with no significant difference between groups. Regarding early right ventricular (RV) failure, HM3 implantation was associated with a lower rate (13 of 42 [31.0%]) than HVAD implantation (18 of 32 [56.2%], p=0.051). The median rehospitalization-free period was longer for HM3 recipients (16.9 months) than HVAD recipients (5.3 months, p=0.013). Furthermore, HM3 recipients displayed a lower incidence of late hemorrhagic stroke (p=0.016). In the multivariable analysis, preoperative use of continuous renal replacement therapy (odds ratio, 22.31; p=0.002) was the only significant predictor of postoperative RV failure. Conclusion: The LVAD models (HM3 and HVAD) demonstrated comparable overall survival rates. However, the HM3 was associated with a lower risk of late hemorrhagic stroke.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.570-576
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• 2016

Objective : Elevated cell counts and protein levels in cerebrospinal fluid (CSF) result from disease activity in patients with leptomeningeal carcinomatosis (LMC). Previous studies evaluated the use of CSF profiles to monitor a treatment response or predict prognosis. CSF profiles vary, however, according to the sampling site and the patient's systemic condition. We compared lumbar and ventricular CSF profiles collected before intraventricular chemotherapy for LMC and evaluated the association of these profiles with patients' systemic factors and LMC disease activity. Methods : CSF profiles were retrospectively collected from 228 patients who underwent Ommaya reservoir insertion for intraventricular chemotherapy after a diagnosis of LMC. Lumbar samples taken via lumbar puncture were used for the diagnosis, and ventricular samples were obtained later at the time of Ommaya reservoir insertion. LMC disease activity was defined as the presence of LMC-related symptoms such as increased intracranial pressure, hydrocephalus, cranial neuropathy, and cauda equina syndrome. Results : Cell counts (median : 8 vs. 1 cells/mL) and protein levels (median : 68 vs. 17 mg/dL) significantly higher in lumbar CSF than in ventricular CSF (p<0.001). Among the evaluated systemic factors, concomitant brain metastasis and previous radiation were significantly correlated with higher protein levels in the lumbar CSF (p=0.01 and <0.001, respectively). Among the LMC disease activity, patients presenting with hydrocephalus or cauda equina syndrome showed higher lumbar CSF protein level compared with that in patients without those symptoms (p=0.049 and p<0.001, respectively). The lumbar CSF cell count was significantly lower in patients with cranial neuropathy (p=0.046). The ventricular CSF cell counts and protein levels showed no correlation with LMC symptoms. Carcinoembryonic antigen (CEA), which was measured from ventricular CSF after the diagnosis in 109 patients, showed a significant association with the presence of hydrocephalus (p=0.01). Conclusion : The protein level in lumbar CSF indicated the localized disease activity of hydrocephalus and cauda equina syndrome. In the ventricular CSF, only the CEA level reflected the presence of hydrocephalus. We suggest using more specific biomarkers for the evaluation of ventricular CSF to monitor disease activity and treatment response.

• Journal of Chest Surgery
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• 제29권1호
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• pp.32-37
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• 1996

본 서울중앙병원에서는 1991년 5월에서 1995년 9월까지 심근경색후 합병된 심실중격결손증 7례 환자의 수술을 시행 하였다. 남자환자가 2명, 여자환자가 5명 이었으며, 평균연령은 65세 (범위 : 54~76)였다. 심실중격결손의 위치는 전중격 결손이 6명이 었으며, 전후중격 경계부 심실중격결손이 1명 있었다. 모든 환자에서 술전 심초음파와 심혈관조영술을 시행하여 심실기능과 관상동맥 병변의 위치를 파악하였다. 수술은 심근괴사후 평균 24 $\pm$ 12일 후에 시행하였다. 좌심실 심근괴사 조직을 통하여 Teflon patch로 봉합하였고, 추가적인 수술로 3명 환자에서는 관상동맥 우회 술을 시행하였고, 5명 환자에서 심실류 제거술을 시행하였으며, 1명 환자에서 좌심실혈전 제거술을 시행하였다. 심실중격결손의 봉합시 중격근육전층을 통하여 interuptted pledget 봉합함으로써 심실중격 결손 재발을 막으려고 노력하였으며, 수술후 합병증으로는 폐렴 1명, 좌측대퇴부 피부괴사 1명이 있었다. 조기 사망률은 없었고 외국으로 이민간 1명을 제외하고 6명 모두 수술후 3개월에서 63개월 사이(평균28개월)에 추적 조사상 합병증이나 사망 없이 NYHA I-II상태로 생활하고 있다.

• 대한한방소아과학회지
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• 제24권3호
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• pp.106-120
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• 2010

Objectives: Sanjointang has been clinically used much for treating sleeplessness. However, the effects of Sanjointang in artificial sleep deprivation situations are not known. The purpose of this study is to evaluate the heart rate, left ventricular systolic pressure, left ventricular diastolic pressure, +dp/dt maximum, -dp/dt maximum, and -dp/dt / +dp/dt ratio which are related to the hemodynamic functions of the heart by using sleep-deprived Sparague-Dawley rats, in order to clarify the impact of Sanjointang on hemodynamic functions of the heart of sleep deprived rats. Methods: Eighteen hearts were removed from the male Sparague-Dawley rats weighting about 180g were perfused by the Langendorff technique with modified 37 Krebs-Henseleit's buffer solution at a constant perfusion pressure (60mmHg). They were randomly assigned to one of the following three groups, 1) Normal group (those which did not have sleep deprivation and received normal saline administration), 2) Control group (sleep deprived and normal saline administered), 3) Sample group (sleep deprived and Sanjointang was administered). Control and sample groups rats were deprived 96 hours of sleep by using the modified multiple platform technique. Heart rate, left ventricular systolic pressure, left ventricular diastolic pressure, +dp/dt maximum, -dp/dt maximum, -dp/dt / +dp/dt ratio were evaluated at baseline after the administration of either normal saline or Sanjointang. Results: The heart rate and -dp/dt / +dp/dt ratio was significantly decreased in rats with 96 hours of sleep deprived significantly decreased. The change in the heart rate after administering Sanjointang did not show any significant difference. The left ventricular systolic pressure of the removed heart significantly decreased due to Sanjointang administration, while the left ventricular diastolic pressure significantly increased (p<0.05). The +dp/dt maximum and -dp/dt maximum both significantly decreased in the removed heart after administering Sanjointang. (p<0.05). There was no significant difference observed in the -dp/dt / +dp/dt ratio after administering Sanjointang. Conclusions: According to the results above, sleep deprivation significantly decreases heart rate and -dp/dt / +dp/dt ratio. This is considered as a result of exhaustion due to accumulation of fatigue. Meanwhile, Sanjointang reduced left ventricular systolic pressure and raised left ventricular diastolic pressure, and relieved the contractility and relaxation of the myocardium. Consequently, this reduces the burden of the heart and creates a relatively stabilized heart condition similar to a sleeping condition.

• 대한수의학회지
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• 제37권3호
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• pp.669-685
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• 1997

The present study was performed to evaluate the effects of xylazine and tiletamine + zolazepam on echocardiograms before and after experimental myocardial infarctions in clinically normal dogs taken preliminary examinations related to cardiac function. The results are as follows. With xylazine administration, left ventricle end-diastolic dimension, left ventricle end-systolic dimension, left atrium/aorta, ejection time and velocity of circumferential fiber shortening increased and mitral valve CD slope, % delta D decreased(p<0.01). In tiletamine+zolazepam administered group, interventricular septum amplitude(p<0.01), mitral valve DE slope(p<0.05) and ejection time(p<0.01) decreased and left atrium/aorta, ejection time also decreased compared with xylazine group(p<0.01). In 48 hours after experimental myocardial infarction group, anterior aortic wall amplitude decreased compared with control, xylazine, tiletamine + zolazepam group, respectively(p<0.01). Posterior aortic wall amplitude decreased compared with control(p<0.01). Left ventricle end systolic dimension increased compared with control and tiletamine + zolazepam group, respectively(p<0.01). Left ventricular posterior wall end systolic dimension decreased compared with control(p<0.01). Left ventricular posterior wall amplitude decreased compared with control and tiletamine+zolazepam group(p<0.01). Left atrium/aorta decreased compared with xylazine group(p<0.01). % thickening left ventricular posterior wall decreased compared with control(p<0.05). % delta D decreased compared with control and tiletamine+zolazepam group(p<0.01). Ejection time decreased compared with xylazine(p<0.01). Velocity of circumferential fiber shortening increased compared with control and tiletamine + zolazepam group(p<0.01). With xylazine administration 48 hours after experimental myocardial infarction, anterior aortic wall amplitude, posterior aortic wall amplitude decreased compared with control(p<0.01). Left ventricle end-diastolic dimension increased compared with control(p<0.01). Left ventricle end-systolic dimension increased compared with control and tiletamine + zolazepam group, respectively(p<0.01). Left ventricular posterior wall end-systolic dimension and left ventricular posterior wall end-diastolic dimension decreased compared with control(p<0.01). Left atrium/aorta decreased compared with xylazine group(p<0.01). % thickening left ventricular posterior. wall(p<0.05) and % delta D(p<0.01) decreased compared with control. Velocity of circumferential fiber shortening increased compared with tiletamine + zolazepam group(p<0.01). With tiletamine + zolazepam administration 48 hours after experimental myocardial infarction, anterior aortic wall amplitude decreased compared with control, xylazine and tiletamine+zolazepam group, respectively(p<0.01). Posterior aortic wall amplitude decreased compared with control(p<0.01). Left ventricle end-systolic dimension increased compared with control and tiletamine+zolazepam group(p<0.01). Left ventricular posterior wall end-systolic dimension, left ventricular posterior wall end-diastolic dimension and interventricular septum amplitude decreased compared with control(p<0.01). Left atrium/aorta decreased compared with xylazine group(p<0.01). % delta D decreased compared with control and tiletamine + zolazepam group(p<0.01). Ejection time decreased compared with xylazine group and velocity of circumferential fiber shortening increased compared withtiletamine+zolazepam group(p<0.01). Conclusively, echocardiography was proved to be a useful, diagnostic, non-invasive and simple method for establishing the diagnosis of myocardial infarction and evaluating the effects of drug on cardiac function before and after myocardial infarction.

• Journal of Chest Surgery
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• 제32권2호
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• pp.124-129
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• 1999

배경: 심실 중격 결손으로 인한 좌우 단락은 폐정맥 환류의 증가로 인한 좌심방 및 좌심실의 비대를 유발할 뿐만 아니라, 폐동맥압이나 폐혈관 저항을 증가 시키므로 우심실의 후부하에 간접적인 영향을 미친다. 따라서 폐동맥 고혈압을 추정하는 하나의 지표로 사용되고 있는 우심실 수축기 시간 간격의 변화를 추적하여 우심실 부하의 변화 정도를 확인하고, 이를 심실 중격 결손 환아의 술 후 관리 지침에 반영하고자 본 연구를 시도하였다. 대상 및 방법: 1995년 1월부터 1996년 12월까지 영남대학교 의과대학 부속병원에서 다른 심기형이나 증후군을 동반하지 않은 단순형 심실중격결손으로 진단받고, 봉합술을 전후하여 어떠한 전신 질환이나 합병증을 동반하지 않은 12명을 대상으로, M-mode 및Doppler 심초음파도를 이용하여 봉합술 전, 술후 3개월 그리고 술후 6개월에서 1년 사이(평균9.5$\pm$1.8개월)의 심박수, 좌심방/대동맥 내경비(LA/Ao), 우심실 박출 전기(right ventricular pre-ejection period : RVPEP)와 우심실 박출 기간(right ventricular ejection time : RVET)을 구하여 그 비(RVPEP/RVET)의 변화를 알아 보았다. 결과:심박수는 술후 실시한 두 차례의 검사에서 유의한 감소를 보였다(137.1$\pm$13.7 vs 114.4$\pm$21.1 and 104.1$\pm$10.2, p<0.01). 좌심방/대동맥 내경비는 술후 실시한 두 차례의 검사에서 유의한 감소를 보였다(1.71$\pm$0.32 vs 1.47$\pm$0.33 and 1.390.23, p<0.05). RVPEP/RVET는 술후 두 차례의 검사에서 유의한 감소를 보였으며(0.38$\pm$0.09 vs 0.32$\pm$0.08 and 0.29$\pm$0.09, p<0.01) 각각을 심박수로 교정한 RVPEP/RVET는 술후 3개월에는 유의한 감소를 보이지 않았으나 술후 6개월에서 1년 사이에는 유의한 감소를 보였다(0.32$\pm$0.03 vs 0.30$\pm$0.05 and 0.28$\pm$0.06, p<0.05). 결론: 심실중격결손으로 인한 좌우 단락은 폐동맥압의 증가를 유발하여 우심실의 후부하에 영향을 미친다는 사실을 우심실 수축기 시간 간격의 변화를 통하여 간접적으로 확인할 수 있었으며, 우심실의 과부하 상태가 수술적 교정 직후부터 정상으로 회복되기 시작하나, 단순형 심실중격결손이라 할지라도 술후 6개월 이상까지 지속되는 것을 확인할 수 있었다.