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Left Ventricular Outflow Tract Obstruction Caused by Accessory Mitral Valve Tissue in a Child -A case report- (소아에서 부승모판막(Accessoy Mitral Valve Tissue)에 의한 좌심실 유출로 협착 - 1예 보고 -)

  • Lee, Chung-Eun;Lee, Sang-Ho;Choi, Jun-Young;Yang, Jun-Ho
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.363-365
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    • 2008
  • Accessory mitral valve tissue is a very rare congenital cardiac malformation and it is an uncommon cause of left Ventricular outflow tract obstruction(LVOTO). The pathogenetic mechanism of subaortic obstruction is thought to be systolic ballooning of the abnormal valve tissue into LVOT. We are reporting a case of an accessory mitral valve tissue that was associated with LVOTO, and this was completely relieved after trans-aortic surgical excision of the accessory tissue.

Truncus Arteriosus, Type IV -one case report- (동맥간증 제 IV형 -1예 보고-)

  • 이종태
    • Journal of Chest Surgery
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    • v.13 no.3
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    • pp.243-249
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    • 1980
  • Truncus ateriosus is one of the cyanotic congenital heart disease. The incidence is relatively uncommon, as 0.4% of totoal congenital heart disease. Embryologically the defect is due to a lack of partitioning of the embryonic truncus and conus during the first few weeks of fetal life. The ventricular septal defect is invariable present. A single arterial vessel arises from the heart and supplies blood to the aorta, the lung, and the coronary arteries. In 1949, collett and Edwards classified this defect according to anatomic variation to four major types, such as type I, II, III, and IV. Type IV is defined that pulmonary arteries are absent, and the pulmonary arterial supply arises from the descending thoracic aorta. This patients often have a continuous murmur head particularly well in the interscapular area. No effective surgical treatment is available. We have experienced one case of truncus arteriosus, type IV of Collett and Edwards in the Department of Thoracic and Cardiovascular Surgery, Kyungbook National University Hospital. This patient was 10 year-old girl. The chief complaints were cyanosis and dyspnea on exertion since birth. She was admitted at this hospital on April 16, 1980. The continous machinery murmur was heard loudest at the interscapular area. The chest X-ray films revealed cardiomegaly with an increase in pulmonaryvascular markings. The pulmonary secotr was significantly concave. No filling of pulmonary arteries noticed by the right ventriculogram. There was possible biventricular hypertrophy in EKG. The echocardiogram showed that the demension of the aortic root was larger than normal and minimal increase of the left ventricular internal dimension. The cardiac catheterization data was obtained by use of the great saphenus vein approach. The systolic pressure of the right ventricular outflow tract was 80 mmHg and was similar to that of the aorta. The oxygen saturation data revealed the evidence of the left to right shunt at the level of ventricular septum. The patient was operated and the diagnosis was confirmed as trucus arteriosus, type IV. No effective surgical interventins were performed.

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Surgical Correction of Partial Atrioventricular Canal: One Case Report (부분방실관의 교정수술 치험 1예)

  • 이철범
    • Journal of Chest Surgery
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    • v.14 no.1
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    • pp.49-59
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    • 1981
  • This is one case report of surgically treated partial atrioventricular canal. The 22 year-old male patient had no definitive history of frequent respiratory infection and cyanosis in his early childhood. Since his age of 7 years, dyspnea was manifested on exertion. First appearance of congestive heart failure was at his age of 16 years old. The physical examination revealed that the neck veins were distended and heaving of precordium. A thrill was palpable on the left 3rd-4th intercostal space extending from the sternal border toward the apex and Grade IV/VI systolic ejection murmur was audible on it. Neither cyanosis nor clubbing was noted. Liver was palpable about 5 finger breadths. Chest X-ray revealed increased pulmonary vascularity and severe cardiomegaly (C-T ratio = 74%). EKG revealed LAD, clockwise rotation, LVH and trifascicular block. Echocardiogram showed paradoxical ventricular septal movement, narrowed left ventricular outflow tract and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted in large left to right shunt (Qp : Qs = 5.7: 1), ASD and moderate pulfllonary hypertension. Finally, left ventriculogram revealed typical goose neck appearance of left ventrlcalar outflow tract. On Oct. 10, 1980, open heart surgery was performed. Operative findings were: 1. Large primum defect ($6{\times}5$ Cm in diameter) 2. Cleft on the anterior leaflet of mitral valve. 3. The upper portion of ventricular septum was descent but no interventricular communication. 4. Downward attachment of the atrioventricular valves on the ventricular muscular septum. 5. Medium sized secumdum defect ($2{\times}1$ Cm in diameter). The cleft was repaired with 4 interrupted sutures. The primum defect was closed with Teflon patch and the secundum defect was closed with direct suture closure. Postoperatively atrial flutter-fibrillation in EKG and Grade U/VI apical systolic murmur were found. The postoperative course was uneventful and discharged on 29th postoperative day in good general conditions.

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One-stage Repair of Interrupted Aortic Arch with Ventricular Septal Defect and Valvular Aortic Stenosis - A case report- (심실 중격 결손과 대동맥 판 협착을 가진 대동맥 궁 단절의 일차 완전 교정술 -1예 보고-)

  • Cho, Joon-Yong;Jeong, Young-Kyun;Lee, Jong-Tae;Kim, Kyu-Tae;Chang, Bong-Hyun
    • Journal of Chest Surgery
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    • v.38 no.12 s.257
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    • pp.856-859
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    • 2005
  • A male neonate was referred to our hospital with facial cyanosis and tachypnea at 19 days of age. Two-dimensional echocardiography showed type B interrupted aortic arch, posterior malalignment ventricular septal defect and valvular aortic stenosis. A new surgical repair was done with biventricular repair and neo-aortic arch reconstruction. Left ventricular outflow track (LVOT) was consisted of aortic valve and pulmonic valve. Right ventricular outflow (RVOT) track was reconstructed with extracardiac conduit. Postoperative two-dimensional echocardiography showed no stenosis and turbulency flow on LVOT and RVOT.

Electrocardiographic Findings in School Children (국민학생 및 중학생의 심전도 소견)

  • Jun, Jin-Gon;Kim, Jeong-Lan;Park, Jae-Hong
    • Journal of Yeungnam Medical Science
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    • v.4 no.2
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    • pp.23-27
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    • 1987
  • Mass electrocardiographic (ECG) examination was performed on 13,801 children (male 7,526 and female 6,275) of elementary and middle school in Taegu from May 1. 1986. to April 30. 1987. We read their ECG according to the "Pediatric Electrocardiography." The results were as following; The Incidence of ECG abnormality was 1.05%(male 1.3% and female 0.75%). Fifty eight children (0.42%) had atrial and ventricular hypertrophy; two right atrial hypertrophy, five left atrial hypertrophy, thirty five fight ventricular hypertrophy and sixteen left ventricular hypertrophy respectively. Ectopic beats occurred in 25 children (0.18%) ; They were atrial in 12 children, ventricular in 8 children and junctional in 5 children. There were 62 children (0.45%) of conduction disturbance ; They were first degree atrioventricular (A-V) block in 21 children, type I second degree A-V block in 1 child, A-V dissociation in 1 child, right bundle branch block in 36 children, left bundle branch block in 1 child and WPW syndrome in 2 children. Nonspecific ST, T changes and sinus tachycardia were found in 3 and one children respectively.

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Diagnostic Usefulness of N-Terminal Probrain-type Natriuretic Peptide to Detect Congestive Heart Failure Patients (울혈성 심부전 환자에서 N-Terminal Probrain-type Natriuretic Peptide의 진단적 유용성)

  • Son, Gye-Sung
    • Korean Journal of Clinical Laboratory Science
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    • v.37 no.2
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    • pp.88-95
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    • 2005
  • Even though the echocardiograph has been recognized as the method of choice among various diagnostic tools to detect congestive heart failure (CHF), there were some limitations in relation to the consumption of time, labor and process. We analyzed results of N-terminal probrain-type natriuretic peptide (NT-proBNP) and various parameters of the echocardiographic findings to clarify the diagnostic usefulness of NT-proBNP in detecting patients with CHF. We analyzed the sera from total of 242 cases from in-patients and out-patients, which were requested from the cardiovascular section of department of Internal Medicine at Chungnam National University Hospital from March 2003 to May 2004. The procedures were performed in order as shown below; sampling, NT-proBNP analysis, data acquisition and data analysis. All data including personal information and echocardiographic findings ware acquired by medical record review. When classifying the study population into six groups according to the degree of left ventricular ejection fraction (LVEF), the serum level of NT-proBNP was higher in the group with 51-60% of LVEF (P=0.023). There were low correlation between the serum level of NT-proBNP and various parameters of the echocardiographic findings with LVESD (r=0.1513), LVEDD (r=0.0831), LVEF (r=0.2035), IVST (r=0.03) and LVPWT (r=0.0728), respectively. When comparing NT-proBNP with atrial and/or ventricular enlargement, the patient group with both left atrial and left ventricular enlargement (p=0.186) or only left atrial (p=0.105) or only left ventricular enlargement (p=0.256) showed higher level of NT-proBNP without statistical significance than patient group with no enlargement. Searching the optimal cutoff of the serum level of NT-proBNP, the sensitivity (98.9%) and the specificity (100%) was highest at the cutoff of 300 pg/mL than any other cutoffs. These findings suggested that the analysis of NT-proBNP in serum might detect the patients with CHF earlier than with the echocardiograph, especially in patients with asymptomatic or mild symptomatic CHF. In conclusion, NT-proBNP test was proved to be clinically useful to diagnose CHF patients.

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The Use of Rapid Ventricular Pacing to Facilitate Stent Graft Deployment in the Distal Aortic Arch (빠른 심실유도를 이용한 흉부대동맥류의 혈관 내 스텐트 그라프트 치료)

  • Kong, Joon-Hyuk;Koo, Yang-Hee;Lee, Yoon-Ji;Hur, Jin;Kim, Duk-Sil;Kim, Sung-Wan
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.769-773
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    • 2010
  • Systemic hypotension has been traditionally used to facilitate deployment of thoracic stent grafts. Decreasing blood pressure with vasodilating agents further increases cardiac output and, consequently, the cardiac output-mediated windsock effect during deployment. Use of rapid ventricular pacing reduces the windsock effect during stent graft deployment and allows the graft to appose to the aortic wall under zero cardiac output, thus minimizing aortic wall shear stress. In this case we report the use of transvenous rapid ventricular pacing, a safe and reproducible technique to allow precise deployment of a Valiant Captivia stent graft in the distal thoracic arch for a saccular thoracic aneurysm.

Left Ventricular Assist Device Implantation via Dual Left Thoracotomy in an Adult Patient with Congenitally Corrected Transposition of the Great Arteries

  • Kim, Shin;Cho, Yang-Hyun;Park, Pyo Won;Lee, Young Tak;Jun, Tae-Gook;Kim, Wook Sung;Sung, Kiick;Yang, Ji-Hyuk;Chung, Suryeun
    • Journal of Chest Surgery
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    • v.53 no.5
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    • pp.306-309
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    • 2020
  • A 59-year-old man presented for possible durable ventricular assist device (VAD) implantation. He had previously been diagnosed with congenitally corrected transposition of the great arteries, a ventricular septal defect, an atrial septal defect, pulmonary valve stenosis, and aortic valve regurgitation. In the previous 22 years, he had undergone palliative cardiac surgery 3 times. VAD implantation as a bridge to transplantation was planned. Owing to severe adhesions, mesocardia, a left ascending aorta, and moderate aortic regurgitation, we performed VAD implantation and aortic valve closure via a dual left thoracotomy and partial sternotomy.

Premature Ventricular Contraction Classification through R Peak Pattern and RR Interval based on Optimal R Wave Detection (최적 R파 검출 기반의 R피크 패턴과 RR간격을 통한 조기심실수축 분류)

  • Cho, Ik-sung;Kwon, Hyeog-soong
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.22 no.2
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    • pp.233-242
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    • 2018
  • Previous works for detecting arrhythmia have mostly used nonlinear method such as artificial neural network, fuzzy theory, support vector machine to increase classification accuracy. Most methods require higher computational cost and larger processing time. Therefore it is necessary to design efficient algorithm that classifies PVC(premature ventricular contraction) and decreases computational cost by accurately detecting feature point based on only R peak through optimal R wave. For this purpose, we detected R wave through optimal threshold value and extracted RR interval and R peak pattern from noise-free ECG signal through the preprocessing method. Also, we classified PVC in realtime through RR interval and R peak pattern. The performance of R wave detection and PVC classification is evaluated by using 9 record of MIT-BIH arrhythmia database that included over 30. The achieved scores indicate the average of 99.02% in R wave detection and the rate of 94.85% in PVC classification.