• Journal of Chest Surgery
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• 제12권3호
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• pp.183-190
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• 1979

A 23-year-old male patient complained dyspnea on exertion and orthopnea since December 1977. On examination, he was tall and slender. There was grade IV/VI to-and-fro murmur on the left sternal border especially on Erb`s point. The liver was descended 2 fingers breadth below right costal margin. There were no signs of Marfan`s syndrome. Echocardiography demonstrated partial closure of aortic valve and dilated aortic root with enlargement of ascending aorta. Left heart cardiac catheterization revealed moderately elevated pulmonary wedge pressure and right ventricular pressure. The left ventricular end diastolic pressure was markedly elevated to 26 mmHg. On aortography, the aortic regurgitation was severe and it was belonged to angiographically Grade IV. The aortic valve was replaced with Carpentier-Edwards valve without excision and replacement of ascending aorta, under the impression of rheumatic valvular heart disease. After closure of aortotomy, blood pressure was transiently elevated and bleeding from the site of inserting air vent needle of ascending aorta was developed. The bleeding was not controlled by any means. On postmortem microscopic study, the histologic changes were strikingly limited to the ascending aorta from the region of the aortic valve ring.

• 한국임상수의학회지
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• 제32권4호
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• pp.343-346
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• 2015

4년령의 중성화된 수컷 Dachshund가 만성적인 호흡곤란 및 청색증을 주증으로 내원하였다. 혈액검사에서 헤마토크리트 79.7%의 심각한 적혈구증가증이 확인되었다. 흉부 방사선 영상에서는 경도의 우심 종대가 관찰되었다. 심초음파 검사에서 좌심실유출로 대동맥판막 근위부에서 큰 심실 중격 결손이 확인되었으며, 도플러 검사에서 이 결손을 통한 우-좌 션트가 확인되었으며 조영 심초음파를 통하여 최종적으로 확진되었다. 이러한 진단적 결과 및 환자의 임상증상을 바탕으로 환자는 우-좌 단락 심실 중격 결손증으로 진단되었다. 사혈 및 산소 공급을 실시하였으나 환자는 내원 다음날 집에서 사망하였다. 본 증례보고에서는 심초음파를 통한 우-좌 단락 심실 중격 결손증의 진단을 서술하였다.

• Korean Journal of Radiology
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• 제22권10호
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• pp.1619-1627
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• 2021

Objective: This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). Materials and Methods: This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. Results: The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m² for PA, 75.9 ± 14.3 mL/m² for EH, and 77.3 ± 12.8 mL/m² for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m² for PA, 30.7 ± 8.1 mL/m² for EH, and 29.5 ± 7.0 mL/m² for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m² for PA, 56.9 ± 12.1 g/m² for EH, and 44.1 ± 8.9 g/m² for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosterone-to-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. Conclusion: Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.

• Journal of Chest Surgery
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• 제17권2호
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• pp.231-243
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• 1984

Despite its known limitation in the diagnostic value, the electrocardiography is one of the most common and routine examinations in the management of the patients with cardiac problems. The clinical results of 291 patients who underwent isolated mitral valve replacement from October 1978 to June 1983 were already reported. Their electrocardiograms were studied to assess the value of electrocardiographic examination in following the patients after valve replacement. The patients were divided into 5 groups beforehand according to the types of valve lesion on the bases of preoperative diagnosis and operative findings: Groups I: stenosis, I1: stenosis-dominant mixed, II1: equally mixed, IV: insufficiency-dominant mixed, and V: insufficiency. Their preoperative cardiac rhythm was sinus in 39.2% and atrial fibrillation in 59.1% of the patients. Seventy-three [42.4%] of the patients with atrial fibrillation gained sinus rhythm after operation, occurring in 67 from the day of surgery, and 42 returned to atrial fibrillation while 37 kept sinus rhythm at the follow-up end [mean follow-up period, 13.4\ulcorner1.4 months]. The P waves on the electrocardiograms of the preoperative sinus rhythm in 114 patients were normal in 5.3% and the findings of left atrial enlargement in 94.7% of the cases. They were normal in 42.1% and the findings of left atrial enlargement in 57.9% of the 140 patients with sinus rhythm at the follow-up. The preoperative major chamber enlargement was the right ventricle in Group I while it was the left ventricle in Group V, and it was in-between in Groups II-IV. The postoperative regression of the findings in ventricular enlargement was statistically significant only in Groups I and V. These results may suggest the importance of the serial electrocardiograms in following the patients with mitral valve replacement on the bases of outpatient. The electrocardiographic follow-up data were presented in patients with suspected or proved tissue valve failures.

• Journal of Chest Surgery
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• 제33권4호
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• pp.285-289
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• 2000

Background: For AVR using conventional prosthetic valves in adult patients with a narrow aortic root, aortic root enlargement is necessary to reduce postoperative pressure gradient across the aortic valve (ΔP). An evaluation of early and mid-term results of aortic root enlargement with AVR and echocardiographic follow up of ΔP and left ventricular function was performed. Method: From Aug. 1991 to Feb. 1998, eighteen patients aged 17 to 59 years(mean, 38$\pm$12 years) underwent Manouguian procedure with AVR. Aortic annular circumstance was enlarged 10.0mm to 18.0mm(mean, 12.6$\pm$6.3mm). Eight patients(44.0%) had NYHA class III status before operation, and seven cases of them underwent concomitant MVR. Valve pathology was ASr in 6 cases, AS in 4 cases, nd ASr+MSr in 8 cases. Replaced valve size was 21mm in 8 cases and 23 mm in 10 cases, and St. Jude Medical mechanical valve was used in 10 cases and Carbomedics in 8 cases. Result: Follow-up duration was 6 to 57 months (mean, 26$\pm$18 months), and total follow-up was 287 patient-year. There were one hospital death and one late death, therefore, actuarial survival rate was 85.7% at 56 months. Peak ΔP wad decreased significantly at postoperative mid-term period as 13$\pm$5mmHg, compared with thepreoperative one (42$\pm$8mmHg) (p<0.01). LVM(gm/$m^2$) was also diminished as 35.8%(115$\pm$36gm/$m^2$)at postoperative mid-term period, compared with preoperative one (179$\pm$56gm/$m^2$)(p<0.05). Conclusion: There were no specific complications related to the procedure. And we could have adequate enlargement of aortic annulus to suitable prosthetic valve that have no effect of patient-prosthese mismatch.

• 대한수의학회지
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• 제43권2호
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• pp.307-310
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• 2003

An atrial septal defect (ASD) is congenital heart disease with a communication between the atria, which allows blood to shoot from the atrium with pressure. A 3-month-old female Miniature Schunauzer was referred to the Veterinary Teaching Hospital of Konkuk University for the evaluation of systolic heart murmur. At presentation, the mucous membrane was cyanotic. On physical examination, an ejection-type systolic murmur was auscultated at the pulmonic area. In addition, thoracic radiography showed enlargement of main pulmonary artery and right atrial/ventricular enlargement. Echocardiography revealed dilated right atrium and atrial septal defect. However, mitral and tricuspid valve were still intact and well tolerating. The presence of an ASD was confirmed by identifying flow across the defect with color Doppler imaging. Doppler echocardiography provides a means of non-invasive documentation and quantification of ASD. Complete blood count and serum chemistry were not remarkable. Although large defect was confirmed between the two atrium, the patient did not show any obvious clinical signs of heart failure at this time.

• Investigative Magnetic Resonance Imaging
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• 제12권1호
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• pp.40-48
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• 2008

목적: 개정 도씨 술식과 승모판 고리성형을 동시에 시행한 후 심실의 형태와 기능의 초기 변화를 자기공명영상을 이용하여 평가하고자 하였다. 대상 및 방법: 총 21명의 확장성 심부전 환자를 대상으로 하여 8명에서 개정 도씨 술식을, 6명에서 승모판 고리성형을, 7명에서 두 수술을 동시에 시행하였다. 영화 자기공명영상을 이용하여 수술 전과 후에 좌심실의 형태와 기능을 평가하였다. 좌심실의 이완기말 용적과 수축기말 용적, 장축과 단축의 길이를 측정하고 이로부터 좌심실의 일회박출량, 박출률, 구형지수를 계산하여 구하였다. 이렇게 구해진 인자들을 분석하고 술식이 서로 다른 3군에서 어떻게 다른지 비교하고 두 수술을 동시에 시행할 때의 효과를 해석하였다. 결과: 자기공명영상은 수술 전 $12\;{\pm}\;15$ 일 (범위 1-58 일)과 수술 후 $38\;{\pm}\;50$ 일 (범위 7- 231 일)에 시행하였다. 두 수술을 동시에 시행한 군에서 다른 군에 비하여 수술 전 좌심실의 확장이 더 심하였고 수축력이 더 감소되어 있었다. 수술 후, 좌심실의 이완기말 용적과 수축기말 용적은 수술 형태와 관계없이 모든 환자에서 유의하게 감소하였다. 박출률은 개정 도씨 술식을 받은 환자 군에서만 유의하게 증가하였다 (25.4% to 40.7%). 구형지수는 개정 도씨 술식을 받은 환자에서는 증가하였고 승모판 고리성형을 받은 환자에서는 감소하였다 (0.65 to 0.78 vs. 0.75 to 0.65). 두 수술을 동시에 시행한 환자에서는 유의한 구형지수의 변화가 없었다. 결론: 개정 도씨 술식과 승모판 고리성형을 동시에 시행받은 확장성 심부전 환자에서 좌심실의 형태와 기능의 초기 변화는 좌심실 용적과 일회박출량의 현저한 저하이다. 승모판 고리성형에 의한 구형지수의 감소는 개정 도씨술식에 의한 구형지수의 증가에 의해 상쇄되어 좌심실의 형태는 변하지 않는다. 두 수술을 동시에 시행한 후 좌심실 박출률의 향상은 조기에 일어나지 않는다.

• Journal of Chest Surgery
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• 제21권4호
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• pp.649-655
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• 1988

One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2008년도 춘계학술대회
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• pp.107-107
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• 2008

• 대한수의학회지
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• 제47권4호
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• pp.461-467
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• 2007

A 6-year-old female Maltese dog (body weight 2.0 kg) was referred to the Veterinary Teaching Hospital, Kangwon National University with primary complaints including exercise intolerance and heart murmur. Based on clinical and diagnostic findings including grade V/VI left basal continuous murmur, bounding femoral pulsation, left ventricular enlargement pattern in electrocardiogram, cardiomegaly with aortic bulging on the thoracic radiography, and shunt flow between aorta and pulmonary artery on the echocardiography, the dog was diagnosed as the left-to-right patent ductus arteriosus. The patent ductus arteriosus was successfully treated by lodging a single embolization coil with transjugular approach.