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      • S-상 심실중격의 임상적 고찰

        이동민,장경식,양종태,장대용,김종오,서영욱,고영엽,홍순표 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.1

        Background: The sigmoid septum described an anatomical variation in the contour of the left ventricular outlet. It is related to degenerative change with aging. We observed clinical significance of sigmoid septum in Korean. Methods: Echocardiographic examination was performed in 434 patients. Sigmoid septum is defined as discrete bulging of the proximal interventricular septum with that thickness is greater than 1.3cm or the thickness is grater 1.5 times than adjacent mid interventricular septum in apical 3 chamber view. Result: The incidence of patient with sigmoid septum(septum patient) is 24.8% (male 8.4%, female 16.3%) . The incidence increases with age and is more common in women. The patients with sigmoid septum were compared with targeted groups, there was no significant difference in blood pressure between them, but in height and weight, the former were lower. (p<001, p<03). In the patients with sigmoid septum, weight and the surface area of a body have an opposite correlation with increase of age (p<03, r=-0.34) (p<04, r=-0.31) , but no decrease of height was found according to age increase (p=0.47, r=-0.11) The main reason patients with sigmoid septum ask echocardiolography and its clinical symptoms were abnormal results of previous electrocardiography and/or usual chest pain. Compared with control group, interventricular septal thickness is larger in septum patients (p<001). The thickness of interventricular septum located in subaortic left ventricular outflow tract is 1.6±0.3cm. There is another web like structure that continued from interventricualr septum to anterior free wall of left ventricle and the width is 1.6±0.4cm. A sign of insignificant obstruction due to left ventricular outflow was observed from three sigmoid septum patients. Conculusion: Septum patient is largely found in older age group and the body weight and body surface area are lower than control group. The body weight and body surface area are opposite correlation with age. So sigmoid septum is considered as structural change by weight reduction with aging. It is assumed that septum patients are related with asymptomatic ischemia because they have more abnormal ECG finding such as T wave inversion on precordial leads or standard leads, nonspecific ST-T change, LBBB etc. Sigmoid septum is not only proximal interventricular septal bludging but also another web like structure continuing to anterior wall of left ventricle.

      • 관상동맥 풍선성형술 후 발생한 관상동맥 박리의 초기 조영술적 고찰

        고영엽,강지인,장재혁,강민정,정중화,장경식,홍순표 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

        Background and Objectives: Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease (CAD). Althouth it has numerous benefits, intimal tear or dissection, serious and potentially life-threatening complications of plain old balloon angioplasty (POBA) can occur. The aim of this study was to assess the implications of coronary dissections after ballon angioplasty. Methods: 78 consecutive patients (age, 62 +/- 11 years; 46 men, 32 women) identified to two groups as having with or without dissection (dissection (D) group or non-dissection (ND) grouP) underwent balloon angioplsty for CAD were studied. All patients with dissection could be managed by successful stent implantation to rescue the artery. The morbidity of ischemic complication and mortality were evaluated for 30days after PCI. Results: Coronary dissection developed 44 lesions (38%) in 31 patients out of 117 lesions in 78 patients after POBA and a good final angiographic result was obtained in all patients with dissection, Significant correlates of a development of dissection were the lesion morphology of ACC/AHA type B and C (P<0.05). There were no significant correlations of clinical pictures, whether POBA in single vessel disease or in multivessel disease, diameter stenosis before POBA, and balloon/coronary artery diameter ratio. Morphologic feature of dissection was type A in 15 (34%), type B in 13(30%), type C in 12 (27%), and type D in 4 (9%). After PCI, there was no ischemic complication or death related coronary dissection during follow-up period for 30days. Conclusions: Coronary dissection after angioplasty occurred in 44 lesions (38%) out of 117 lesions of 78 consecutive patients underwent POBA. Coronary dissection after POBA significantly correlated with the severity of lesion morphology. Coronary stenting is effective in the management of acute coronary dissections after angioplasty.

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