• Journal of Chest Surgery
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• 제17권3호
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• pp.362-370
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• 1984

The term corrected transposition of great arteries [hereafter referred to as corrected TGA] of the heart in which there is both a discordant atrio-ventricular relationship and transposition of the great vessels. Usually situs solitus is present, while the ventricles are inverted showing an l -loop. The great vessels are transposed and in the l-position so that the pulmonary artery arises from the right-sided morphological left ventricle and the anteriorly l- transposed aorta arises from the left-sided morphological right ventricle yielding an SLL pattern. In the majority of cases, associated lesions are common. The most frequent are ventricular septal defect, obstruction to the pulmonary outflow tract, tricuspid valve incompetence and atrio-ventricular conduction abnormalities. In the rare cases, no associated conditions are present and hemodynamic pathways are normal. In the report, we present one case of a 20 year-old male having corrected TGA associated with severe tricuspid valve incompetence, was corrected by tricuspid valve replacement, directly developed a supra-ventricular tachycardia but was controlled by calcium-entry blocker, verapamil, successfully.

• 센서학회지
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• 제22권5호
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• pp.338-345
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• 2013

Premature ventricular contractions are the most common of all arrhythmias and may cause more serious situation like ventricular fibrillation and ventricular tachycardia in some patients. Therefore, the detection of this arrhythmia becomes crucial in the early diagnosis and the prevention of possible life threatening cardiac diseases. Most methods for detecting arrhythmia require pp interval, or the diversity of P wave morphology, but they are difficult to detect the p wave signal because of various noise types. Thus, it is necessary to use noise-free R wave. So, the new approach for the detection of PVC is presented based on the rhythm analysis and the beat matching in this paper. For this purpose, we removed baseline wandering of low frequency band and made summed signals that are composed of two high frequency bands including the frequency component of QRS complex using the wavelet filter. And then we designed R wave detection algorithm using the adaptive threshold and window through RR interval. Also, we developed algorithm to classify PVC using RR interval. The performance of R wave and PVC detection is evaluated by using MIT-BIH arrhythmia database. The achieved scores indicate average detection rate of 99.76%, sensitivity of 99.30% and specificity of 98.66%; accuracy respectively for R wave and PVC detection.

• Korean Circulation Journal
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• 제53권4호
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• pp.239-250
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• 2023

Background and Objectives: Brugada syndrome (BrS) is an inherited arrhythmia syndrome that presents as sudden cardiac death (SCD) without structural heart disease. One of the mechanisms of SCD has been suggested to be related to the uneven dispersion of transient outward potassium current (I_to) channels between the epicardium and endocardium, thus inducing ventricular tachyarrhythmia. Artemisinin is widely used as an antimalarial drug. Its antiarrhythmic effect, which includes suppression of I_to channels, has been previously reported. We investigated the effect of artemisinin on the suppression of electrocardiographic manifestations in a canine experimental model of BrS. Methods: Transmural pseudo-electrocardiograms and epicardial/endocardial transmembrane action potentials (APs) were recorded from coronary-perfused canine right ventricular wedge preparations (n=8). To mimic the BrS phenotypes, acetylcholine (3 μM), calcium channel blocker verapamil (1 μM), and I_to agonist NS5806 (6-10 μM) were used. Artemisinin (100-150 μM) was then perfused to ameliorate the ventricular tachyarrhythmia in the BrS models. Results: The provocation agents induced prominent J waves in all the models on the pseudo-electrocardiograms. The epicardial AP dome was attenuated. Ventricular tachyarrhythmia was induced in six out of 8 preparations. Artemisinin suppressed ventricular tachyarrhythmia in all 6 of these preparations and recovered the AP dome of the right ventricular epicardium in all preparations (n=8). J wave areas and epicardial notch indexes were also significantly decreased after artemisinin perfusion. Conclusions: Our findings suggest that artemisinin has an antiarrhythmic effect on wedge preparation models of BrS. It might work by inhibition of potassium channels including I_to channels, subsequently suppressing ventricular tachycardia/ventricular fibrillation.

• Journal of Chest Surgery
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• 제32권1호
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• pp.53-57
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• 1999

저자들은 심장수술 후 발생한 심정지로 심폐소생술을 시행한 신생아에서 성공적인 체외막산소화 장치(ECMO)사용 1례를 경험하였다. 환자는 울혈성 심부전과 폐동맥 고혈압을 가졌던 4.4kg의 35일된 남아로 술중에 특별한 문제없이 심실중격결손증을 첨포봉합법으로 봉합하였다. 심장 중환자실에서의 술후 경과는 junctional ectopic tachycardia (JET)가 나타나기 전까지 약 5시간 동안은 특별한 문제가 없었다. junctional ectopic tachycardia (JET)가 나타난 후 50분경과한 뒤 갑작스러운 서맥이 나타나면서 수축기 혈압이 50mmHg로 하강하여 곧 흉골절개 봉합부(sternotomy incision)를 열고 심폐소생술을 바로 시행하였으며 심폐소생술을 시행한 지 4시간 후에 상행대동맥에 동맥관을 그리고 정맥관은 우심방이에 삽관하여 체외막산소화 장치를 시작하였다. 환자의 혈액동력학은 체외막산소화 동안 안정적이었으며, 시작 후 38.5시간 만에 중지하였다. 흉골지연봉합을 시도하였고, 환자는 수술 후 7일째 인공호흡기를 제거했으며, 신경학적 합병증없이 수술 후 21일째 퇴원하였다.

• Journal of Chest Surgery
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• 제29권6호
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• pp.639-645
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• 1996

14세 남자환자로 최근 3년간 반복된 심계항진을 주소로 내원하였다. 환자는 8년전에 TOF로 진단받고 완전교정수술을 받았다. 수술 전 심도자 검사에서 우폐동맥폐쇄와 그에 따른 우심실압력상승을 보였고 전기 생 리학검사에서는 우심실유출로의 중격부위 에서 기 원하는 회귀성 심실빈맥으로 진단되 었다 한 개의 양극성 전극을 이용한 심실외막전기도검사에서 심실빈맥의 회귀성회로는 첩포 원위부 좌측 의 심실중격쪽 심근에서 가장 빨리 나타나 시계방향으로 청포주위를 돌아 우심실유출로 우측 심근을 활 성화시키는 것으로 나타났다. 또한 64채널 심장전기도시스템을 이용한 심실심외막전기도 검사에서는 우심실유출로의 첩 포주위를 )20 msec 주기로 시계반대방향으로 회귀하는 심실빈맥을 관찰할 수도 있었 다. 수술은 우심실유출로의 첩포와 섬유화된 조직을 제거하고 우심실유출로 상연에서 폐동맥 판막륜까지 절개를 하여 회귀성 회로가 차단되도록 하였다. 폐동맥 판막륜과 심실중격사이 에는 회귀성 회로가 완전히 차단되도록 냉동병소를 만들었다. 우폐동맥이 발달되지 않아 우폐동맥재건술은 하지 못하였다. 수술후 전기생리학 검사에서는 더 이상심 퓟窄팀\ulcorner유발되지 않았다. 본 증례에서는 TOF완전교정수술후 우심실유출로 첩포와 일부 우심실 심근주위에 slow conduction지 대가 형성되고 이것에 의한 macro-reentry심실빈맥이 발생한 것으로 생각된다. 약물로서 치료되지 않을 때는 catheter ablation이나 외과적 절제를 고려해야 한다. 외과적 절제를 할 때에는 우심실유출로와 폐동 맥 판막륜사이의 심근조직손상을 최소화하면서 우심실유출로재건을 하는것이 중요하다.성 거부반응 1례, 크기불일치 에 의한 만성 이식부전증이 1례, 천식 발작에 의한 호흡부전이 1례, 지주막하출혈 1례, 체액 성 거부반응이 의심되는 경우가 1례 였다. 이상의 단기간성적을 통해 심장이식분야에서 더욱 발전을 요하며, 특히 이식공여자 및 수혜자의 선택 이나 술후 감염관리 및 체 액성거부반응치료 등에서 더욱 진전이 있어야 하겠다.07m', 동맥 혈 산소포화도는 83.0$\pm$3.8 % 이었다. 우폐동맥의 지름은 9.0$\pm$ 1.5 mm, 좌폐동맥의 지름은 7.7 $\pm$2.Omm, 폐동맥 지수는 197.3$\pm$57.1 mm2/m2, McGoon 비는 1.76$\pm$0.32 였다 수술후 전 환자에서 폐동맥 압력을 측정하였으며 평균 폐동맥 압은 12.8 $\pm$3.6mmHg이 었다. 환자의 성장에 따라 폐동맥의 지름도 증가하였으나 폐동맥 지수나 McGoon비는 증가하지 않았다. 또한 환자의 나이, 술후 동맥혈내 산소포화도의 증가 정도, 혈관 성형술 여부, 수술후 심도자 및 혈큰조 영술까지의 기간 등은 수술후의 폐동맥 지수의 증가에 영향을미치지 못하였으며 단지 수술전의 폐동맥 의 크기가 매우 작을 경우(McGoon 비 1.2 미만)에는 폐동맥 지수가 유의한 증가를 보였는데 이는 수술 \ulcorner 동반된 폐동맥 성형술등의 영향이 있었음을 감안하여야 할 것으로 생각되었다. 한편 수술전 폐동맥 크기에 대한 지표로서 폐동맥 지수(PAI)와 McGoon 비(MGR)와는 다음과 같은 유의한 상관관계가 있 음을 알 수 있었다

• International Journal of Fuzzy Logic and Intelligent Systems
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• 제11권3호
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• pp.204-210
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• 2011

This paper proposes a fuzzy support vector machine ($FSVM_n$) pattern classifier to classify the arrhythmia patterns of an electrocardiograph (ECG). The $FSVM_n$ is a pattern classifier which combines n-dimensional fuzzy membership functions with a slack variable of SVM. To evaluate the performance of the proposed classifier, the MIT/BIH ECG database, which is a standard database for evaluating arrhythmia detection, was used. The pattern classification experiment showed that, when classifying ECG into four patterns - NSR, VT, VF, and NSR, VT, and VF classification rate resulted in 99.42%, 99.00%, and 99.79%, respectively. As a result, the $FSVM_n$ shows better pattern classification performance than the existing SVM and FSVM algorithms.

• Journal of Chest Surgery
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• 제48권1호
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• pp.67-69
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• 2015

This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers' volume. There was no evidence of myxoma recurrence. The most probable cause of the patient's heart failure was considered to be tachycardia-induced cardiomyopathy.

• 대한임상독성학회지
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• 제5권1호
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• pp.67-70
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• 2007

Aconitum is an extremely dangerous plant that contains various toxic diterpenoid alkaloids, primarily concentrated in the roots. We report a case of acute intoxication of a 60-year-old man admitted to our emergency department after ingestion of a large amount of homemade aconitine decoction. At presentation about one hour after intake, the patient was unconscious and electrocardiographic analysis showed a ventricular tachycardia/fibrillation. Several times defibrillation was applied and antiarrhythmic agents were administered, but the patient still exhibited a refractory ventricular fibrillation and failed to return to spontaneous circulation. Sustained cardiopulmonary resuscitation finally produced a pulsatile cardiac rhythm at two hours after intake. The patient was discharged from our hospital on day 8. The authors stress that clinicians must be aware of the possible occurrence of life-threatening ventricular arrhythmia in cases of aconitine intoxication and be prepared to persist with prolonged CPR as necessary.

• Journal of Chest Surgery
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• 제28권5호
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• pp.491-494
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• 1995

A fibroma arising in the right ventricle outflow tract of a 14 month-old infant was successfully removed. The patient was first seen because of shortness of breath and tachycardia. Pertinent clinical and laboratory findings included a grade II/VI systolic murmur, blood pressure of 120/60 mmHg, slight cardiomegaly on chest X-ray, a mass obstructing the outflow tract of the right ventricle on echocardiography and magnetic resonance imaging. On october 30,1992, under cardiopulmonary bypass, a 4cm x 3cm x 3cm tumor was resected from the right ventricular outflow tract, together with a portion of the ventricular wall. Histologically, it was diagnosis as a fibroma. The patient was sent home on the 6th postoperative day following an uneventful recovery form the operation. Although cardiac fibroma is the second most common cardiac tumor in infancy and childhood, it is usually found in the left ventricle and one arising in the right ventricle is considered rare. Although it is a benign tumor, it could produce a severe cardiac dysfunction and even sudden death, depending on its size and location. With the advance in diagnostic techniques and operative management, there is a renewed interest in the early detection and operative removal of these tumors. The case herein presented is the first such case successfully managed and reported in the Korean literature.

• 융합신호처리학회논문지
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• 제23권2호
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• pp.62-69
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• 2022

의료현장에서는 최근 디지털 헬스케어의 중요성이 대두되면서, 다양한 형태의 생체신호 측정 관련 연구가 활발히 진행되고 있다. 생체신호 중 가장 중요한 신호로 심전도를 들 수 있으며, 특히 부정맥 환자에 있어 심전도 신호의 연속 모니터링은 매우 중요하다. 부정맥은 동결절(sinus node), 동빈맥(sinus tachycardia), 심방조기수축(atrial premature beat, APB), 심실세동 (ventricular fibrillation) 등으로 그 발병원에 따른 형태가 다양하며, 발병 이후의 예후가 좋지 않으므로 일상 중 연속 모니터링은 부정맥의 조기 진단과 치료방향 설정에서 매우 중요하다. 부정맥 환자의 심전도 신호는 매우 불안정하며, 부정맥을 자동 검출하기 위한 주요 특징점으로 작용하는 정확한 R-peak 포인트의 검출이 어렵다. 본 연구에서는 연속 측정하는 홀터 심전도 모니터링 기기와 분석용 소프트웨어를 개발하였으며, 부정맥 데이터베이스를 통해 심전도 신호의 R-peak 효용성을 확인하였다. 향후 연구에서는 다양한 발병원인으로 인한 부정맥의 형태적 구분 및 예측을 위한 알고리즘과 임상 데이터에 근거한 유효성 검증에 관한 추가 연구가 필요하다.