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윤덕형,최현희,홍경순,김형수,한상진 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Subject: The purpose of this study is the evaluation of prognostic factors in patients treated with extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock and/or refractory ventricular tachyarrhythmia (VT) as a complication of acute myocardial infarction (AMI). Method: From January 2006 to December 2009, the patients admitted to Chuncheon Sacred Heart Hospital, Hallym University and treated with ECMO for refractory cardiogenic shock or refractory VT as a complication of AMI were enrolled. We retrospectively analyzed prognostic factors for weaning from ECMO. Result: A total of 17 patients (39.5%) of the 43 enrolled patients were successfully weaned from ECMO. DM is more prevalent in patients failed to be weaned ECMO. Among the laboratory data at admission, the patients failed to be weaned ECMO had higher level of BUN (25.0±12.0 vs. 17.2±4.9 mg/dL, p=0.007), Troponin-I (56.6±103.2 vs. 8.7 ±25.9 ng/dL, p=0.051), CK-MB (134.5±234.0 vs. 39.3±108.6 ng/mL, p=0.047), and myoglobin (3401.2±8199.3 vs. 354.4±591.0 ng/mL, p=0.013) and had lower level of pH (7.07±0.15 vs. 7.21±0.18, p=0.005), bicarbonate (9.6±2.7 vs. 14.3±4.6 mmol/L, p<0.001), and base-excess (-20.5±4.5 vs. -13.3±7.3 mmol/L, p=0.001) than the patients succeed to be weaned ECMO. The patients who received cardiopulmonary resuscitation (CPR) at the initiation of ECMO showed lower weaning rate than the patients who didn``t (29.0% vs. 66.7%, p=0.037). Conclusion: At the initiation of ECMO, elevated BUN and cardiac enzymes, and decreased pH, bicarbonate, and base excess were associated with weaning failure. After initiation of ECMO, elevated levels of peak creatinine and peak myoglobin were associated with weaning failure. Receiving CPR at the initiation of ECMO is poor prognostic factor of weaning from ECMO in patients with AMI.
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Tako-Tsubo Cardiomyopathy by Transient Dynamic Left Midventricular Obstruction
홍경욱,박대균,최현희,김성은,윤덕형,이준희,한규록,오동진 대한심장학회 2009 Korean Circulation Journal Vol.39 No.1
A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient, who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function, severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely. There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy. A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient, who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function, severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely. There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy.
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A Case of Suspected Danon Disease Presenting as a Hypertrophic Cardiomyopathy
박소연,오동진,박대균,최현희,윤덕형,김성은,이준희,한규록 한국심초음파학회 2009 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.17 No.1
Danon disease is characterized clinically by the triad of cardiomyopathy, myopathy and mental retardation. It was originally reported as a lysosomal glycogen storage disease with normal acid maltase by Danon. Danon disease results from mutations in lysosome associated membrane protein-2 (LAMP-2) gene. The LAMP-2 gene is located on Xq24-25. We report a case of suspected Danon disease in patient who had hypertrophic cardiomyopathy and mental retardation along with abnormal findings in electromyography. Danon disease is characterized clinically by the triad of cardiomyopathy, myopathy and mental retardation. It was originally reported as a lysosomal glycogen storage disease with normal acid maltase by Danon. Danon disease results from mutations in lysosome associated membrane protein-2 (LAMP-2) gene. The LAMP-2 gene is located on Xq24-25. We report a case of suspected Danon disease in patient who had hypertrophic cardiomyopathy and mental retardation along with abnormal findings in electromyography.
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증례 : 순환기 ; 우좌 단락 없이 관상동맥 색전증과 폐동맥색전증이 동시에 발생한 1예
이민영 ( Min Young Lee ),윤덕형 ( Duck Hyoung Yoon ),이찬우 ( Chan Woo Lee ),박규태 ( Kyu Tae Park ),유명신 ( Myeong Shin Ryu ),최현희 ( Hyun Hee Choi ),홍경순 ( Kyung Soon Hong ) 대한내과학회 2011 대한내과학회지 Vol.81 No.4
본 증례는 급성 심근경색으로 내원한 환자의 혈관조영술에서 좌주관상동맥류와 함께 관상동맥 혈전색전이 확인되었던 환자로 관동맥 재관류 치료 후에도 증상 및 징후의 호전이 없고 심초음파 검사에서 폐색전증이 의심되는 소견이 관찰되었으며, 흉부 컴퓨터 단층촬영에서 폐색전증이 발견되었다. 이 환자는 응고장애나 다른 검사에서 특이사항이 없었으며 경흉부 심초음파 하모닉 영상에서 우좌 단락을 시사하는 소견은 보이지 않았다. 우좌 단락 없이 관상동맥과 폐동맥에 동시에 색전증이 발생된 증례로 현재까지 보고된 바가없어 문헌고찰과 함께 보고하는 바이다. A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient`s coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt. (Korean J Med 2011;81:496-501)
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Myopericarditis in a Korean Young Male With Systemic Lupus Erythematosus
박규태,홍경순,한상진,윤덕형,최현희,이민영,류명신,이찬우 대한심장학회 2011 Korean Circulation Journal Vol.41 No.6
Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.
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김성은,박대균,최현희,윤덕형,한규록,오동진,홍경순,이준희 대한심장학회 2009 Korean Circulation Journal Vol.39 No.9
Background and Objectives: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. Subjects and Methods: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. Results: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. Conclusion: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE. Background and Objectives: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. Subjects and Methods: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. Results: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. Conclusion: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
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정-정맥 체외막형산소화요법을 이용한 급성호흡부전의 치료
김형수 ( Hyoung Soo Kim ),한상진 ( Sang Jin Han ),홍경순 ( Kyung Soon Hong ),윤덕형 ( Duck Hyoung Yoon ),이창률 ( Chang Youl Lee ),이명구 ( Myung Goo Lee ),홍원기 ( Won Ki Hong ),이순희 ( Sun Hee Lee ),김건일 ( Kun Il Kim ),이희성 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.2
Background: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. Methods: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a PaO2/FiO2 ratio <100 mm Hg on FiO2 of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. EBS(R), Bio-pump(R), and Centrifugal Rotaflow pump(R) were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. Results: Five of the 7 patients were male and the mean age was 46.3±18.3. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was 17.3±13.7 days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. Conclusion: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.
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