• Journal of Chest Surgery
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• v.30 no.5
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• pp.486-492
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• 1997

We r viewed a policy of primary surgical closure of large ventricular septal defects in small infants. Sixty-three infants met criteria for inclusion in the study, and were divided into two groups based on age: group 1 infants aged less than 5 months(n = 31), and group 2 infants aged 5 months or more(n = 32). Both groups had similar variation in ventricular septal defect location(paramembranous versus muscular), and showed no significant difference in left to right shunt and in ratio of systemic and pulmonary vascualr resistance. Three early deaths(9.7%) occurred in group 1, but no death(0%) in group 2. The causes of death were preoperative cardiac arrest and cerebral injury followed by postoperative respiratory insufficiency in two patients, and preoperative tracheomalacia followed by laryngeal edema and respiratory arrest in one Two patients in group 1 showed postoperative low cardiac output syndrome(6.5% in group 1 versus 0% in group 2). There was no late death during the follow-up per od in both groups. No surviving patients had postoperative patch leakage, or required a second operation. These results indicate that primary surgical closure of large ventricular septal defects, if logical perioperative care is accompanied, can be saefly performed in small infants aged less than 5 months with low postoperative mortality or morbidity rates.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.885-890
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• 1997

Patients with coronary artery disease and depressed ventricular function have better longterm benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from truly 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction < 40%, n=24) and Normal EF group(Ejection fraction $\geq$ 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EP group. The left internal thoracic artery was used less frequently in Low EP group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33olo in Normal EP group, but without s atistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit.

• Clinical and Experimental Pediatrics
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• v.54 no.8
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• pp.340-344
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• 2011

Purpose: Brain natriuretic peptide (BNP) has been considered a biochemical marker for myocarditis in Kawasaki disease. We performed this study to determine its quantitative significance. Methods: We attempted to correlate log-transformed BNP concentrations (log-BNP) and clinical, laboratory, and echocardiographic variables in 81 children with Kawasaki disease. Stepwise multiple linear regression analysis was used to determine the variables independently associated with log-BNP concentration. Results: Serum C-reactive protein level (P<0.0001), serum alanine aminotransferase concentration (P =0.0032), white blood cell count (P=0.0030), and left ventricular mass index (P=0.0024) were positively related with log-BNP, and hemoglobin level (P<0.0001), serum albumin level (P<0.0001), $Na^+$ concentrations (P<0.0001), left ventricular fractional shortening (P=0.0080), and peak early diastolic tissue velocity of the left ventricular basal lateral segment (P=0.0045) were negatively related to the log-BNP concentration. Multiple regression analysis showed that serum albumin concentration ($R_2$=0.31, P=0.0098) and left ventricular mass index ($R_2$=0.09, P=0.0004) were significantly associated with the log-BNP concentration. Conclusion: Elevated BNP levels during the acute phase of Kawasaki disease may be attributable to cardiac dysfunction associated with the increase in left ventricular mass, and log-BNP concentration may be a quantitative biochemical marker of myocarditis in Kawasaki disease.

• Journal of Preventive Medicine and Public Health
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• v.31 no.2 s.61
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• pp.183-198
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• 1998

In order to determine the prevalence rate and find out the sexual difference of abnormal electrocardiographic findings manifested by computerized EKG, which is equipped with auto-analyzing function, a total of 2,083 electrocardiograms that were taken from population over 20 years-old from October 1996 to February 1997 were studied according to their age, gender and blood pressure. 1. Using the electrocardiography with auto-analyzing function, 33 kinds of abnormal findings were manifested. The prevalence rate of abnormal findings was 52.8% in male and 43.7% in female. Among them, the most common finding was sinus brady-cardia found in 17.6% of male and 15.4% of female. Left ventricular hypertrophy by voltage criteria, minimal voltage of left ventricular hypertrophy, left axis deviation and atrial fibrillation were more common in male than in female statistically. Both of nospecific T wave and ST segment abnormality were more common in female than in male statistically. 2. Thirty-three kinds of abnormal findings were manifested. They revealed one abnormal finding alone or combined with some other ones making 128 kinds of abnormal finding. The most common abnormal finiding that manifested alone was right axis deviation (100%), then myocardial ischemia (95.7%) the next. The most common abnormal finding that complexed with other abnormal findings were left anterior fascicular block(percentage of single manifestation, 26.2%) and nonspecific T wave abnormality(percentage of single manifestation; 32.9%). Also, combination of sinus bradycardia and minimal voltage of left ventricular hypertrophy, and combination of sinus bradycardia and left ventricular hypertrophy were included in 25th sequences of abnormal findings. 3. The prevalence rate of abnormal electrocardiographic findings were higher in older group, hypertensive group, and the group of higher systolic or diastolic pressure in both sexes. 4. Abnormal findings that commonly manifested with sinus bradycardia were voltage criteria or minimal voltage of left ventricular hypertrophy(38.6%): sinus arrhythmia(10.5%): nonspecific T wave or ST segment abnormality(18.4%) and first degree AV block(7.2%) in descending order. 5. The most common site which manifested myocardial ischemia was posterior and inferior wall with equal percentage of 23.4%. And then anterior wall(19.1%), and antero-lateral wall and septum with equal percentage of 10.6% was noted in descending order.

• The Journal of Internal Korean Medicine
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• v.37 no.5
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• pp.796-805
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• 2016

Objective: To examine the effects of Gagam-Samryoungbeakchul-san (加減 蔘苓白朮散) on a premature ventricular contraction patient with dizziness and chest discomfort. Methods: A patient diagnosed with premature ventricular contraction was treated with herbal medicine and acupuncture. The period of admission was 15 days, and we measured the electrocardiogram before and after treatment. We evaluated the improvement in symptoms by Global Assessment (G/A), and checked the pulse rate by oximetry three times a day. We estimated the efficacy of treatment by analyzing the relationship between the average pulse rate and symptoms. Results: After Gagam-Samryoungbeakchul-san treatment and acupuncture therapy, the average pulse rate increased from 36.5 to 58. This increase in average pulse rate was accompanied by a reduction in dizziness of 40%, chest discomfort of 30%, and frequency of bigeminy in the electrocardiogram. Conclusions: This case report confirmed the effectiveness of Gagam-Samryoungbeakchul-san on premature ventricular contraction, but further study is warranted.

• Journal of Chest Surgery
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• v.33 no.6
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• pp.476-486
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• 2000

Background: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. Material and method: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). Result: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. Conclusion: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05$\leq$Z-value of T-value of T-valve$\leq$2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve$\leq$4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.190-194
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• 2010

Purpose : To investigate the nature of deviant voice physiology in preoperative children with congenital heart disease. Methods : Ninety-four children with congenital heart disease were enrolled. Their cries and related acoustic variables (fundamental frequency, duration, noise to harmonic ratio, jitter and shimmer) were analyzed using a multi-dimensional voice program. Results : The average fundamental frequency showed a significant decrease in patent ductus arteriosus, ventricular septal defect, and tetralogy of Fallot, except in atrial septal defect and pulmonary stenosis. The length of the analyzed sample (duration) did not show a significant difference when compared with the control group. There was a significant increase in jitter percent in ventricular septal defect, patent ductus arteriosus, and atrial septal defect. There was an increase in shimmer in ventricular septal defect, patent ductus arteriosus, and atrial septal defect. The noise-to-harmonic ratio increased in ventricular septal defect, patent ductus arteriosus, and atrial septal defect but there was no significant difference in pulmonary stenosis and tetralogy of Fallot. While analyzing acoustic variables, the voice change was significantly higher, especially in patent ductus arteriosus followed by ventricular septal defect and atrial septal defect. Most of these acoustic variables were deviant in left-to-right shunt lesions in congenital heart disease, especially in patent ductus artriosus. Conclusion : The results of the voice change analysis of preoperative children with congenital heart disease revealed that the acoustic variables differed by each congenital heart disease. Moreover, the acoustic variables were prominently deviant in congenital heart disease with left-to-right shunts.

• Korean Journal of Veterinary Research
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• v.47 no.1
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• pp.7-17
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• 2007

The left main descending artery (LMDA) of left coronary artery (LCA) in rats runs around the left side of conus arteriosus after arising from the aortic sinus and descends to the apex of heart with branching several branches into the wall of left ventricle (LV). The ligation site of LMDA for myocardial infarction (MI) is the 2~4 mm from LCA origin, between the pulmonary trunk and left auricle. The characteristics that rat heart has no interventricular groove on the surface and its coronary arteries run intramyocardially with branching several branches give the difficulty in surgery for MI which resulted in expected size. This study was aimed to elucidate the branching patterns of the left coronary artery for analysis of MI size and for giving the basic data to producing small MI intentionally in 2 male species that are widely used, Sprague-Dowley (SD) and Wistar-Kyoto (WKY), in the world. Red latex casting was followed by the microdissection in 27 and 28 hearts of SD and WKY male rats, respectively. The branching patterns of LMDA were classified into 3 major types and others based on the left ventricular branches (L). The Type I, Type II, Type III and others are shown in 55.6%, 22.2%, 14.8%, and 7.4% in SD, 60.7%, 10.7%, 7.1%, and 21.5% in WKY, respectively. The branching number of the first left ventricular branch (L1) that are distribute the upper one third of LV was 1.2~1.5, and its branching sites were ranging 0.9~2.1 ᒠfrom LCA origin. L2, the second left ventricular branch distributing middle one third of LV, was the number of 1.2~1.4 and branching out ranging 5.1~5.7 mm. L3, the third left ventricular branch of LMDA distributing lower one third of LV, was the number of 1~1.5 and branching out ranging 7.0~9.3 mm from LCA origin. The common branch of L1 and L2 was branched from LMDA with the number of 1.1, and its site was located in the distance of mean of 1.5 mm and 2.8 mm in SD and WKY, respectively. The common branch of L2 and L3 was branched from LMDA with the number of 1, and its site was located in the distance of mean of 7.2 mm and 2.9 mm in SD and WKY, respectively. The right ventricular branches (R) of LMDA were short and branched in irregularly compared with L. The number of 1~4 of R were branched from LMDA. With regarding to the distribution area of L and the ligation site for MI, moderate MI (25~35% of LV) might be resulted in 70.4% and 60.7% in SD and WKY rats. Small MI might be produced intentionally if the ligation would be located at the 4~6 mm from LCA origin in the left side of LMDA. These data wold be helpful to expect the size of MI and to reproduce of small MI, intentionally, in rat hearts.

• Journal of Veterinary Clinics
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• v.32 no.2
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• pp.162-167
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• 2015

Tei-index has been reported as one of reliable echocardiographic factors for evaluating cardiac function in human and small animals. In this study, Tei-index were measured and evaluated with other echocardiographic parameters in normal thirteen beagle dogs and thirty-one dogs with mitral valve degeneration. Normal range of Tei index with tissue Doppler obtained at septum and left ventricular free wall was $0.58{\pm}0.07$ and $0.60{\pm}0.07$, respectively. The values between septum and left ventricular free wall did not show significant difference. Tissue Doppler derived tei index showed better reproducibility and significantly lower values than the results obtained by pulsed wave Doppler. Tei index obtained in either method increased with the progression of clinical signs. Therefore, the increase of Tei index in dogs with mitral regurgitation is thought to be an useful factor reflecting left ventricular dysfunction.

• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.52-61
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• 1994

Background : The demand for refinement in noninvasive and quantitative assessment of left ventricular (LV) function is increasing. Purpose : To assess normal values of left ventricular functional parameters during both systole and diastole by scintigraphic method using computerized triple-head gamma camera and to evaluate correlations between these parameters. Methods : ECG gated blood pool scan with $^{99m}Tc$-Human serum albumin was performed in 94 normal Korean subjects. Ejection fraction (EF), systolic parameters [peak emptying rate (PER), average emptying rate (AER), time to peak emptying rate (TPER)], and diastolic parameters [peak filling rate (PFR), average filling rate (AFR), time to peak filling rate (TPFR)] were obtained by analysis of LV time-activity curve, the correlation of these parameters to the age and sex, and the correlation between these parameters were evaluated. Results : 1) Mean value of ejection fraction in study subjects was $59.6{\pm}5.25%$ and showed no significant correlation to age (r=-0.08) and sex but showed most pronounced correlation to PFR (r=0.46, p<0.001), PER (r=0.41, p<0.001), AFR (r=0.34, p<0.001) and AER (r=0.28, p<0.01). 2) Mean values of systolic parameters were as follows: $PER=3.22{\pm}0.50$ end-diastolic volume/sec, $AER=2.22{\pm}0.45$ end-diastolic volume/sec, $TPER=103.5{\pm}29.30$ msec. They showed no significant correlation to age and sex. 3) Mean values of diastolic parameters were as follows: $PFR=2.71{\pm}0.51$ end-diastolic volume/sec, $AFR=1.83{\pm}0.44$ end-diastolic volume/sec, $TPFR=132.1{\pm}33.45$ msec. They showed strong correlation to age (r=0.70, -0.64, 0.37, p<0.001). Conclusions : Left ventricular functional parameters in normal Korean subjects were obtained reliably by computerized scintigraphic method and may be applied to the evaluation of cardiac function in diseased patients.