Results of Balloon Angioplasty in Patients with Coarction of the Aorta

Purpose : This study was undertaken to analyze and compare the effects of percutaneous balloon angioplasty(BAP) on postoperative re-coarctation and native coarctation of the aorta(CoA) and to thereby contribute to the development of treatment methods for CoA. Methods : The subjects in this study were 21 children who had undergone BAP from Jan. 1996 to Dec. 2000 in the Division of Yonsei Pediatric Cardiology. The relation between factors such as pressure and diameter changes across the coarctation segment together with hemodynamic and morphologic variables of children with postoperative re-coarctation and native CoA was analyzed through retrospective study of medical records. Results : Among the 21 cases, 11 children showed a decreased pressure gradient across the coarctation segment of less than 20 mmHg(average:11±5 mmHg) after BAP was performed. In postoperative re-coarctation, the pressure gradient across the coarctation segment significantly fell from 56±21(30-90) mmHg to 20±13(0-50) mmHg(P<0.001) after BAP, while in native CoA, the pressure gradient decreased from 57±13(40-70) mmHg to 22±14(10-40) rnmHg(P<0.001) after BAP. The diameter of the narrowest coarctation segment was significantly increased in native CoA and postoperative re-coarctation after BAP. The factor that most affected our results was the ratio of isthmic/descending aortic dimension showing an inverse relationship between the ratio of isthmic/descending aortic dimension and pressure gradient after BAP( r =-0.473, P=0.030). Complications included one case of femoral artery stenosis, one case of femoral artery interruption, and one case in which seizure occurred two days after BAP due to cerebral thrombosis. Conclusion : We conclude that BAP is an effective treatment modality in postoperative recoarctation and native CoA.ope

Morphologic Changes of the Pulmonary Arteries after Stent Implantation on Branch Pulmonary Artery Stenosis- Impact of Pulmonary Insufficiency -

Purpose: Intravascular stent implantation for the treatment of postoperative branch pulmonary artery(PA) stenosis has been used successfully. However, the cross sectional area of contralateral branch PA does not regress in spite of the successful dilation of the stenotic branch PA after stent implantation. We analyzed the morphologic and hemodynamic factors on the size of branch PA after successful stent implantation. Methods: The subjects in our study were 23 children who had undergone stent implantation from Jan. 1995 to Jul. 2002 in Division of Yonsei Pediatric Cardiology. We evaluated the cross sectional area index(CSAI) of branch PA before and after stent implantation at follow-up catheterization. We also investigated factors such as residual pulmonary stenosis, pulmonary regurgitation(PR), systolic pressure of right ventricle, and lung perfusion scan. Results: The CSAI of RPA without stenosis changed from mean 238±17 ㎟/BSA to mean 249±20 ㎟/BSA(P=0.47), but didn't regress. The CSAI of the PLA with stenosis was increased effectively by stent implantation from the mean 102±12 ㎟/BSA to mean 125±11 ㎟/BSA(P<0.05). At follow up after stent implantation, the CSAI of PA is correlated with the residual PR fraction after stent implantation. Conclusion: In a group with increased residual PR, CSAI of RPA was found to be significantly increased between the pre- and post-stage of stent implantation. So, we suspect that the pulmonary regurgitation remaining after post-stages of stent implantation. So, we suspect that the pulmonary regurgitation remaining after right ventricle outlet tract(RVOT) dilatation surgery is correlated with the increase in CSAI of RPAope

Postoperative Progress and Influencing Factors in Patients after Rastelli Procedure

Purpose : We have performed an analysis on patients who received Rastelli operation in our institute and reviewed their progress postoperatively. Various factors with suspected relationship to the outcome have been considered to help in future treatment and follow-up. Methods : We analyzed retrospectively 43 patients who either received Rastelli operation in Yonsei University Cardiovascular Center from March 1995 to April 1997 or who received post-procedural cardiac catheterization and follow-up echocardiography in the out-patient department after the procedure. Results : No statistically valid relationships were found between the age of the patient, their body weight, preoperative pulmonary arterial index and pressure, presence of pulmonary branchial stenosis and postoperative results. Cases with atrioventricular concordance showed lower age and body weight, and discordant cases exhibited lower ejection fraction 3 days postoperatively. Upon follow up, lower NYHA score was seen in patients with severe residual stenosis. In the group that received cardiac catheterization after the procedure, residual stenosis and right ventricular pressure measurement in echocardiography showed good correlation with the catheterization data. Conclusion : In cases where conduit insertions of the right ventricular outflow tract are required to achieve total correction in complex cardiac deformity, early operation does not seem to provide a clear risk to the patient. In patients with atrioventricular discordance, careful postoperative observation of the ventricular function seems to be needed. Also, echocardiography appears to be a sound method in follow-up of patients after the correctional procedure.ope

Mid-term Result of the Transcatheter Occlusion of Patent Ductus Arteriosus with Duct-Occlud Device and Procedure-Related Problems

Purpose : We will present our mid-term result of transcatheter closure of PDA with Duct-Occlud device(pfm. AG. Germany) after 12 months follow up and report the problems during the procedure. Methods : In total 154 patients, the Duct-Occlud devices were inserted in our institute from March, 1996 to August, 2002. Three types of Duct-Occlud device, i.e standard, reinforced, reinforced reverse cone coil were used. Echocardiographic examination was performed at 1, 6, 12 months after procedure. Results : The echocardiographic closure rate was 96% after 12 months. The rates of residual shunt in the standard coil, the reverse cone coil, and the reinforced reverse cone group were 8%, 4% and 3% respectively. In PDA with diameter less than 4 mm, the closure rate was up to 98% while in large PDA with more than 4 mm, it was 72% after 12 months. Embolization of the inserted coils had occurred in 5 cases with successful retrieval using snare catheter. The rupture of the core wire during the procedure and distortion of the original coil shape had occurred in 4 cases. Conclusion : The transcatheter occlusion with Duct Occlud is safe and effective method for small to moderate sized PDA less than 4 mm. The minimum diameter of the PDA seems to be the predictor of residual shunt. Further refinement of the device to overcome the procedure-related problems seems to be needed.ope

Conversion of Total Atrio-pulmonary Connection to Total Cavo-pulmonary Connection -Review of Indications and Hemodynamic Characteristics-

Purpose : Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. Methods : Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization 11? months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. Results : There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range : 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was 18.0?.6 mmHg, but baffle pressure, corresponding to right atrial pressure decreased to 14.8?.6 mmHg after TCPC. The size of the pulmonary arteries did not regress after TCPC. Conclusion : The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.ope

Morphologic Change of Pulmonary Arteries and Right Ventricular Outflow Tract after Total Correction of Tetralogy of Fallot : Risk Factors for Pulmonary Artery Junctional Stenosis

Background and Objectives: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. Methods: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.1±19.8 months, follow-up duration after operation 13.9±5.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. Results: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=0.776, p<0.01) and post-operative RVEDP(r=0.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade Ⅱ of residual PI than grade Ⅲ∼Ⅳ. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(pressure gradient, ㎜Hg)=5.43+16.24×[false aneurysmal change of RVOT]+14.13×[RVOT patch enlargement to LPA] + 16.89×PDA. Conclusion: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.ope

Medico-Surgical Cooperative Treatment of Pulmonary Atresia with Intact Ventricular Septum

Purpose : The actual clinical examples of co-appliance of catheter intervention with surgical procedures in the treatment of pulmonary atresia with an intact ventricular septum(PA/IVS) which we have experienced in our institution are here shown, and the anatomical and hemodynamical profiles between each method is compared. Methods : Medical records of 33 patients with PA/IVS who underwent various treatment from January, 1995 to December, 2000 were reviewed for a retrograde study. Results : In three out of 10 patients who underwent percutaneous balloon pulmonary valvotomy (PPV), residual pulmonary stenosis were observed in their out patient department(OPD) follow-ups, eventually necessitatig balloon pulmonary valvuloplasty(BPV). One out of three patients exhibited deterioration of tricuspid regurgitation after BPV, requiring surgical tricuspid annuloplasty(TAP). Two out of the seven patients who received primarily surgical right ventricle outlet tract(RVOT) repair without any systemic-pulmonary shunt or intervention needed additional intervention employing cardiac catheterization after operation. Two patients received interventional catheterization before surgical RVOT repair. In five out of 11 cases of Fontan type operation, coil embolization of collateral circulation was done before total cavo-pulmonary connection(TCPC), and in three cases, interventional catheterization was needed after TCPC. Conclusion : Both medical and surgical treatment modalities are widely used in management of PA/IVS patients, and recent results prove that medico-surgical cooperative treatment is essential.ope

Role of T-Cell and T-cell Subsets Alteration in Childhood Minimal Change Nephrotic Syndrome

의학과/석사[영문] [한글] 지난 수년간 신증후군의 병인론으로 면역학적 요인이 관여한다는 사실이 밝혀졌다. 특 히 최근에는 미세변화 신증후군 환아에서 T-임파구 및 그 아집단인 보조 T-임파구와 억제 T-임파구를 측정한 연구결과가 많이 발표되고 있지만, 연구자마다 일치된 소견을 나타내 지 않고 있다. 이에 본 연구자는 미세변화 신증후군 환아에서 T-임파구 및 그 아집단을 측정하여, 임 상경과에 따른 T-임파구와 아집단의 변화를 관찰하여 비교분석 하였다. 1987년 1월부터 1989년 12월까지 만 3년간 연세대학교 의과대학 영동 세브란스병원 소 아과에 미세변화 신증후군으로 입원한 52례의 환아를 대상으로 하였으며, 활동기 및 관해 기에 immunomicrobead를 사용한 Bio-Rad사의 Quantigen**TM T & B cell assay 및 Quantig en**TM T^^4 /T^^8 cell surface marker assay를 사용하여 T-임파구 및 아집단을 측정하 였다. 말초 혈액 총 임파구와 T-임파구는 활동기 및 관해기에 대조군과 비교시 유의한 차이가 없었다. 보조 T-임파구와 억제 T-임파구의 수 및 백분율도 대조군과 비교시 유의한 차이 를 보이지는 않았지만, 보조 T-임파구와 억제 T-임파구의 비율은 활동기에 1.19±0.07로 관해기의 0.99±0.06과 비교시 활동기에 의의있게 증가하였고, 대조군의 1.04±0.15와 비 교시도 의의있는 증가를 보였다(p<0.05). 스테로이드 반응군(37례)의 경우 보조 T-임파구 와 억제 T-임파구는 활동기 및 관해기 사이에 유의한 차이가 없었다. 그러나 보조 T-임파 구와 억제 T-임파구의 비는 활동기에 1.26±0.09로 관해기의 1.01±0.06과 비교시 의의있 게 증가되어 있었다(p<0.05). 이를 대조군과 비교시에도 활동기에 의의있게 증가되었다. 반면에 저항군(15례)에서는 의의있는 증감을 관찰할 수 없었다. 이상의 결과를 종합하여 볼때 미세변화 신증후군의 발병기전은 T-임파구 아집단의 복합 적인 변화와 관계가 있을 것으로 사료되며, 스테로이드 반응성 여부를 예측하는 데도 보 조 T-임파구 및 억제 T-임파구의 비율을 측정함으로써 그 예측지표로 이용할 수 있으리라 사료된다. Role of T-cell and T-cell Subsets Alteration in Childhood Minimal Chenge Nephrotic Syndrome Jong Kyun Lee Department of Medical Science The Graduate School Yonsei University (Directed by Professor Pyung-Kil Kim M.D., Ph.D.) An immunological factor in the pathogenesis of minimal change nephrotic syndrome(MCNS) has been suggested for several years. In an attempt to investigate the pathogenic role of lymphocyte subsets in childhood MCNS, we studied 52 children with MCNS in acute nephrotic phase and 34 children in remission phase who were admitted at Young-dong Severance Hospital from January, 1987 to December, 1989. There was no significant change in the total lymphocyte count and its subsets(T-cell and B-cell). When T-cell subsets(helper T-cell and suppressor T-cell) were tested, there was no significant change in acute nephrotic phase and remission phase compared with control group. But the helper T-cell / suppressor T-cell ratio was 1.19±0.07 in acute nephrotic phase and 0.99±0.06 in remission phase, revealing that the ratios were significantly increased in acute nephrotic phase rather than in remission phase. An interesting result was observed in steroid-sensitive group which showed significant increase of the helper T-cell/suppressor T-cell ratio in acute nephrotic phase (1.26±0.09), when compared with remission phase (1.01±0.06) and control group (1.04±0.15) respectively. There was no significant change in steroid-resistant group, which suggested that an increase in the ratio can predict the responsiveness to steroid in MCNS patients. From the above results, an immunological factor is thought to be involved in the pathogenesis of MCNS. However in order to obtain a further understanding of the pathogenic role of T-cell subsets, longitudinal and functional tests should be performed because of the heterogeneity in immunogenesis of MCNS.restrictio

차세대 배선 공정의 초등각 은(Ag) 전해도금을 위한 씨앗층의 영향 및 유·무기 가속제의 영향 연구

학위논문(석사)--서울대학교 대학원 :화학생물공학부,2006.Maste

건강 검진자에서 초음파를 이용한 담석의 유병률 및 위험 요소

학위논문(석사)--서울대학교 대학원 :의학과 내과학전공,1996.Maste