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만성 비판막성 심방세동의 전기적 심율동전환후 장기 추적관찰 성적
전성희(Seong Hee Jeon),현민수(Min Su Hyon),이상훈(Sang Hoon Lee),조성제(Sung Je Cho),고경환(Kyung Whan Ko),윤재형(Jae Hyung Yoon),이수금(Su Geum Lee),김명아(Myung A Kim),박성훈(Seong Hoon Park) 대한내과학회 1999 대한내과학회지 Vol.56 No.4
N/A Objectives : We performed a prospective observation for the patients with chronic nonvalvular atrial fibrillation who underwent electrical cardioversion after failed pharmacological cardioversion with amiodarone. The aim of this study was to look at the immediate sinus conversion rate, the maintenance rate of sinus rhythm at long-term follow-up, and the clinical and echocardiographic parameters that influence on the rate of immediate sinus conversion and maintenance of sinus rhythm. At simultaneously, we intended to evaluate the efficacy of electrical cardioversion for the patients with chronic nonvalvular atrial fibrillation. Methods : After anticoagulation therapy with coumadine for four weeks before cardioversion, we tried pharmacological cardioversion with amiodarone first. Failed cases included in this study. The direct current cardioversion was performed under transesophageal echocardiography monitoring to exclude the left atrial thrombus and to measure various echocardiographic parameters. After successful sinus cardioversion, we prescribed amiodarone with maintenance doses and coumadine at least 4 weeks. Transthoracic echocardiography was performed before cardioversion and one day, one month, 3 months, 6 months, and 9 months after sinus conversion. The minimum duration of atrial fibrillation was one month before the trial of pharmacological cardioversion. Results : 1) The total number of patients was forty three (male : 28, female : 15, average age : 60±9). The initial success rate of sinus conversion was 88 %. 2) The maintenance rate of sinus rhythm with maintenance dose of amiodarone was 52 % after 9 months follow-up. 3) The direct current cardioversion was performed to 10 patients among 17 patients who recurred atrial fibrillation after sinus conversion. Among 10 patients, 5 patients of them were converted to sinus rhythm and maintained sinus rhythm after 9 months follow-up. 4) The initial success rate of sinus conversion was significantly higher in patients with lone atrial fibrillation compared with those patients with other associated heart disease (100 % vs. 83 %, p < 0.05), but the long-term maintenance rate of sinus rhythm was not influenced by the presence of associated disease. 5) The duration of atrial fibrillation before cardioversion was shorter in patients who were naintained sinus rhythm than that of those who were recurred atrial fibrillation. 6) The initial energy requirement at sinus conversion was lower in the patients who were maintained sinus rhythm than that of those who were recurred atrial fibrillation at 9 months follow-up. Conclusions : Direct current cardioversion was an effective treatment modality for patients with chronic nonvalvular atrial fibrillation after failure of pharmacological cardioversion with amiodarone.
흉부 방사선 치료후 완전방실차단증과 양측 관동맥구 협착증을 보인 1예
고경환,김정경,이수금,윤재형,조성제,이상훈,홍석근,현민수,황흥곤,김명아,박성훈 대한내과학회 1997 대한내과학회지 Vol.53 No.3S
We have experienced a case of radiation-induced coronary biostial stenosis presented with recurrent syncopal attack, which was confirmed by coronary angiography and pathologic findings. A 60 year-old woman was admitted with the symptoms of recurrent syncopal attack. She had a history of radiation therapy of the chest for lung neoplasm 15 years ago. Initial electrocardiogram showed transient high-degree A-V block followed by third-degree atrioventricular block which was associated with syncope. Echocardiography revealed mild aortic regurgitation without left ventricular dysfunction. The coronary angiogram revealed biostial stenosis of coronary arteries. Initial cardiac symptom subsided after temporary pacemaker implantation. She had a coronary bypass graft surgery on both coronary arteries using saphenous vein. Biopsy findings showed mild fibrosis with intimal thickening of coronary artery.
심장 이식 후에 발생한 침윤성 폐 Aspergillosis 2 예
김희정,박성훈,홍석근,현민수,고경환,윤재형,이수금,오미혜,김명아,박국양 대한내과학회 1997 대한내과학회지 Vol.53 No.2
Case 1: A 39-year-old man underwent orthotopic heart transplantation on November 1994 for dilated cardiomyopathy. His postoperative course was unevenful and medications included daily cyclosporin A, Immuran and prednisone. On December 13.1994, he developed cough and sore throat. Chest radiographs revealed multiple patch growing lesions. Sputum fungus culture revealed Aspergillus Fumigatus. The patient was treated with daily infusion of amphotericin B. He remains well without evidence of relapse of Aspergillus, Case 2: This 39-year-old man had undergone orthotopic heart transplantation on November 16 1994 for dilated cardiomyopathy. In December 7.1994. he developed recurrent syncope. Chest radiographs revealed fungus ball like lesion on right lung field. On open lung biopsy and wedge resection of the mass was performed. Aspergillosis and CMV infection was demonstrated in the biopsy specimen. The patient was treated with conventional amphotericin B therapy for over 7weeks and Ganciclovir for over 2weeks. At the end of therapy chest X-ray showed only small residual scar in the area of previous mass.