심근경색증 환자에서 간헐파도플러 심초음파검사에 의한 심실확장기능에 관한 연구

조승연(Seung Yun Cho),박승정(Seung Jung Park),백경권(Kyung Kwon Paik),정익모(Ik Mo Chung),박성삼(Sung Sam Park),심원흠(Won Heum Shim),김성순(Sung Sun Kim),이웅구(Woong Ku Lee) 대한내과학회 1988 대한내과학회지 Vol.35 No.4

N/A Inflow characteristics of left and right ventricular filling were assessed in 33 patients with myocardial infarction and 20 normal subjects by pulsed doppler echocardiography. The presence of left and right ventricular diastolic functional change in accordance to the infarct location, serial change of left and right ventricular diastolic function in patients with acute myocardial infarction, and correlation between left ventricular end-diastolic pressure and pulsed doppler echocardiographic incices of left ventricular diastolic function were assessed. Patients with myocardial infarction were subdivided into two groups, the anterior infarct group(20 patients) and the inferior infarct group(13 patients), according to the site of the involved myocardium. Serial doppler echocardiograms were perfarmed three times, within 3 days after onset(lst phase), after about 12 days (2nd phase), and after 4 weeks (3rd phase). 1) Concerning the left ventricular diastolic function, A/E in the anterior infarct group(1.04±0.18) and inferior infarct group(1.07±0.23) was greater than in that of the control group(0.64+0.10)(p<0.05) The corrected isovolumic relaxation time in the anterior infarct group(2.34±0.60 √ms and inferior infarct group(2. 43±0.70 √ms) was longer than in that of the control (1.83±0.31 ms) (p<0.05). The 0.33 area fraction and E area fraction in the anterior infarct group(45±7%, 55±5%, respectively) and inferior infarct group(43+9 53±8%, respectively) were less than in those of the control group(59±9%, 67±5%, respectively) (p< 0.05, p<0.05, respectively) and A area fraction in the anterior infarct group (43±6%) and inferior infarct group(47±8%) was greater than that in the control group(36±7%) (p<0.05). 2) In the right ventricular side, A/E in anterior infarct group(0.86±0.23) and inferior infarct group(1.01±0.16) was greater than in that of contol group(0.62±0.10) (p<0.05), peak A velocity in inferior infarct group(0.44±0.09 m/s) was higher than in those of anterior infarct group(0.36±0.10 m/s) and control group(0,28±0.05 m/s) (p<0.05), 0.33 area fraction and E area fraction in anterior infarct group(43±7%, 52±10%, respectively) and inferior infarct group(42±9%, 50±10%, repectively) were lesser than in those of control group(56±9%, 63±7%) (p<0.05, p<0.05, respectively), and A area fraction in anterior infarct group(48±10%) and inferior infarct group(49±9%) was greater than in that of control group(36±7%) (p<0.05). 3) Serial left ventricular pulsed doppler echocardiogram in 12 patients with acute myocardial infarction showed follwoing results. A/E in phaae 2(0,86±0,17) and phase 3(0.83±0.21) was lesser than in that of phase 1(1.07±0.22) (p<0,05), 0,33 area fraction and E area fraction in phase 2(53±10%, 59±8%, respectively) and phase 3(55±9%, 59±7%, respectively) were greater than in those of phase 1(43±8%, 49±9 respectively) (p<0,05, p<0,05, respectively), A area fraction in phase 2(39±8%) and phase 3(39±8%) was lesser than in phase 1(49±11%) (p<0,05), and these variables were not changed between phase 2 and phase 3. 4) Serial right ventricular pulsed doppler echocardiogram in 12 patients with acute myocardial infarction showed following results, A in phase 2 (0.35±0.10 m/s) and phase 3(0,31+0,06 m/s) was lower than in that of phase 1(0,46±0.09 m/s) (p<0.05), A/E in phase 2(0.92±0.26) and phase 3(0,78±0.18) was lesser than in that of phase 1(1.10±0.16) (p<0.05, p<0.01, respectively), 0,33 area fraction and E area fraction in phase 2(53±10%, 47±9%, respectively) and phase 3(53±8%, 42±9%, respectively) were greater than in those of phase 1(41±10%, 49±8%, respectively) (p<0.05, p<0.05, respectively), and A area fraction in phase 2(47±9%) and phase 3(42±9%) was lesser than in that of phase 1(50±7%) (p<0.05), 5) Left ventricular end diastolic pressure had a signi1icant high correlation with A/E (r=0,76, p=0.01), with 0.08 area fraction (r=0,71, p=0,02), and with E area fraction

경피적 내심근 생검술의 임상 경험

심원흠(Won Heum Shim),김성순(Sung Soon Kim),탁승제(Seung Jae Tahk),박승정(Seung Jung Park),백경권(Kyung Kwon Paik),정익모(Ik Mo Chung),조승연(Seung Yun Cho),이웅구(Woong Ku Lee) 대한내과학회 1988 대한내과학회지 Vol.35 No.6

N/A In 1962, Sakakibara and Konno reported doing endomyocardial biopsies in patients using a cartheter inserted into the right ventricle from a systemic vein. The right ventricular aspect of the ventricular septum was the portion of heart of heart biopsied, Although biopsy is not yet applicable in all cases of myocardial disease, many investigators have found this procedure valuable in specific circumstances, including cardiac allograft rejection, adriamycin-induced cardiomypathy and myocarditis. With this technique diagnoses can be made for various disorders including cardiac amyloidosis, sarcoidosis, hemochromatosis and endomyocardial fibrosis. Endomyocardial biopsy was done in 16 cases which consisted of dilated cardiomyopathy in 9(56.3%) cases, unexplained heart failure in 3(18.8%) cases, ventricular tachycardia in 3 cases and angina with normal coronary angiogram with thallium defects in 1 case. The route of entry of the biopsy porceps was through the right internal jugular vein in 12(75%) cases and right femoral vein in 4(25%) cases. There were no cases of left heart biopsy. There were no serious complications. The number of biopsy samples per patient was 2-7 pieces and these samples were examined by light microscope or electromicroscope or were used for special purposes such as culture or biochemical study. The biopsy yields were 100% and the material was satisfactory for pathologic study. A modified King's bioptome was selected for use in all cases. In conclusion, although of limited value from a diagnostic standpoint, the biopsy is safe and is likely to provide the most asistance as a research tool in the biochemical study of cardiomyopathy.

승모판협착증 환자에서의 경피적 풍선학장 판막성형술

박승정(Seung Jung Park),심원흠(Won Heum Shim),조승연(Seung Yun Cho),이웅구(Woong Ky Lee),김성순(Sung Soon Kim),탁승재(Seung Jea Tahk),백경권(Kyung Kwon Paik),정익모(Ik Mo Chung) 대한내과학회 1988 대한내과학회지 Vol.35 No.1

N/A Percutaneous mitral balloon valvuloplasty (PMV) using the double-balloon technique was performed in 28 symptomatic patients with mitral stenosis who were candidates for mitral valve commissurotomy. There were 21 women and 7 men with a mean age 38±10 years (range 23 to 57). PMV in 28 patients with moderate to severe mitral stenosis (including 3 with a fluoroscopic calcified valve) resulted in an increase mitral valve area (0.9±0.2 to 2.2±0,7cm, p<0.0001) by Gorlin`s formula, and a decrease in mean diastolic mitral pressure gradient (16.8±5.7 to 6.1±3.9mmHg, p<0.0001), and mean left atrial pressure (23.6±6.7 to 11.7±5.8mmHg, p<0. 0001). And also cardiac output increased (4.8±1.0 to 5. 8±1.5L/min, p<0.005) and mean pulmonary artery pressure decreased (32±12 to 24±9mmHg, p<0.05). Mitral regurgitation developed or increased in severity after PMV in 15 (53.6%) patients, grade 3mitral regurgitation in 2 and no mitral regurgitation in 12 patients. Oxymetric studies performed immediately after PMV demonstrated a small left-to-right shunt (pulmonary-to-systemic blood flow ratios>1.5) through the interatrial communication in 4 patients. Follow up echocardiography showed improvement in mitral valve area by 2-D and Doppler pressure half-time (0.9±0.2 to 1.8±0.5 and 0.8±0.2 to 1.7±0.4 cm, p<0.0001), increase of mitral EF slope (13±7 to 37±17mm/ sec, p<0.0001) and decrease peak E mitral velocity (209±32 to 142±32cm/sec, p<0.0001). Transient cerebral embolic phenomenon just after PMV was observed in 1 patient and cerebral embolic infarction with hemorrhage requiring surgery developed in 1 patient. PMV using the double-balloon technique is safe and effective procedure to relieve mitral valve obstruction and could be an alternative to surgical mitral commissurotomy in selected patients with mitral stenosis.

성인의 대동맥찬협착증에서의 경피적 풍선성형술

조승연,심원흠,박승정,김성순,이웅구,정익모,탁승제 대한내과학회 1988 대한내과학회지 Vol.35 No.4

Percutaneous aortic balloon valvuloplasty (PAV) has recently been proposed as a palliative procedure for treating nonsurgical candidates or high risk patients with calcific aortic stenosis. PAV vas carrried out with a 15×2 bifoil balloon in a 63-year-old woman suffering from syncope, angina and heart failure. The transvalvular systolic pressue gradient (peak to peak 40 mmHg) had almost completely disappeared at the end of the procedure without complications. The aortic valve area increased from 0.6 to 1.6cm² by Gorlin's formula and an increased valve opening was confirmed by angiography and echocardigraphy. PAV is recommended as a simple pailiative proccdure to aortic vale replacement in symptomatic adult aortic stenosis patients.

관동맥 우회로술을 받은 환자에서의 경피적 이식혈관 확장성형술

조승연,심원흠,박승정,이웅구,백경권,정익모 대한내과학회 1988 대한내과학회지 Vol.35 No.3

The number of patients uodergoiog coronary artery bypass surgery is increasing each year. In most cases, this surgery is palliative because there is a subsequent progression of narrowing of both the native arteries and the bypass graft. Therefore, many patients develop angina or myocardial infarction some years after the operation, To avoid repeart surgery, percutaneous transluminal dilatation of the saphenous vein bypass graft is performed in many centers and now angioplasty of the coronary artery graft appears to be a feasible and efficacious procedure with a low complication rate. The technique is a satisfactory alternative to repeat surgery in selected patients. In this report, we present a case of a successful percutaneous transluminal dilatation of a saphenous vein bypass graft in a patient with prior coronary bypass surgery.