심포지움 : 심방세동의 치료

조정휘 ( Chung Whee Choue ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

연속파형 Doppler 초음파도를 이용한 우심실 수축기압의 측정 : 심도자술로 측정한 우심실압과의 비교 관찰

박원도(Won Do Park),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1988 대한내과학회지 Vol.35 No.3

N/A To predict right ventricular systolic pressure with great accuracy in patients with Doppler-detected tricuspid regurgitation, we tested thirty-two patients with a wide spectrum of cardiac lesions. The results were as follows; 1) 27 of the 32 patients had Doppler-detectable tricuspid regurgitation. 2) The correlation between Doppler-estimated and catheter-measured right ventricular systolic pressure was significant, (r=0.80, p<0.005). 3) There was a linear correlation between Doppler gradient alone (not adding right atrial pressure) and catheter-measured right ventricular systolic pressure(r=0.79, p<0.005). Continuous wave Doppler echocardiogaphy is an accurate noninvasive technique for the estimation of right ventricular systolic pressure in patients with a wide spectrum of cardiac lesions. This yielded information compatible with that obtained upon catherization.

관상동맥 질환 환자에서 관상동맥내 Acetycholine 유발검사의 임상적 의의에 관한 연구

강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jeung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Backgroand: Coronary vasoconstriction plays an improtant role in the pathogenesis of coronary artery disease. It has been known that acetylcholine (Ach) dilate normal vessels by releasing an endothelium- derived relaxing factor (EDRF), but when the endothelium is removed or dysfunctional, the vasodilator response is replaced by vasoconstriction resulting from the direct effects of this agent on vascular smooth mulscle. Methods: To evaluate the effects of intracoronary injection of Ach, 42 patients (27 males, 15 females; age range, 32~70 years) who had a history of chest pain were studied by using biplane cineangiography. Twentytwo patients had angiographically normal coronary arteries (Group I) and 20 patients had significant coronary artery disease (Group II). Results: Coronary artery vasoconstriction was induced in 11 patients (50%) of Group I, and in 14 patients (70%) of Group II by intracoronary injection of Ach. The site of vasoconstiction induced by Ach was more frequent in right coronary artery (23 patients out of 25 patients) than in left coronary artery. The levels of plasma total cholesterol in the patients with coronary vasoconstriction (GroupIB: 191.8±23.9 mg/dl, GroupIIB: 208.6±34.2mg/dl) were higher than those who without coronary vasoconstriction (154.5±35.9 mg/ dl)(p?0.01). Conclusion: These results suggest that vasoconstriction of coronary artery are induced easily by intracoronary injection of Ach and more frequent observed in right coronary artery, Intracoronary injection of Ach may be helpful in the evaluation of the patients with atypical chest pain and in the early detection of the patients with coronary artery atherosclerosis

심근경색에서 측부순환 유무에 따른 99mTc-MIBI 심근 SPECT 소견

김덕윤(Deog Yoon Kim),양형인(Hyung In Yang),강홍선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae),김재만(Jae Man Kim),나득영(Deug Young Na),박은경(Eun 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A The coronary collateral vessels have revealed their significance in terms of reduction of infarct size, preservation left ventricular function, and prevention of left ventricular aneurysm in patients with myocardial infarction. The purpose of this study were to evaluated the relation between collateral circulation and 99mTc-MIBI Heart SPECT in patient with acute myocardial infarction and their clinical significance. The fifty six MI patients with antegrade TIMI perfusion grade 0 and 1 were studied. The pat#ients #were classified into two groups; Group I inclueded 30 patients with grade 2, 3 Collateral flow. Group II inclueded 26 patients with grade 0, 1 Collateral flow. Collateral filling were graded from 0 to 3; 0- none, 1- Filling of side branch only, 2- Partial filling of the epicardial segment, 3- Complete filling of epicardial segment. Clinical variables, left ventricular function, 99mTc-MIBI Heart SPECT were analyzed with angiographic finding. Results were following: 1) Collateral visualization was found to be greater in patient with invoivement of right coronary artery (RCA). The callateral development site of infarct related artery was RCA 15 cases, left anterior descending artery (LAD) 10 cases, left circumflex artery (LCX) 5 cases, and the collateral circulation from LAD to RCA was 13 cases (40.6%). 2) There was a tendency to be decreased in peak CK activity with group I . 3) The presence of good collateral channels was more frequently 99mTc-MIBI reversible perfusion defect (83.4% vs 15.3%, p<0.05). 4) No differences af left ventrieular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), ejection fraction (EF) were noted between group I and group II. The presence of good collateral channels did affect the frequency of occurrence of 99mTc-MlBI reversible perfusion defect.

승모판 협착증 환자에 있어서 좌심방내 Spontaneous Echo Contrast 에 관한 연구 - 경흉부 및 정식도 심초음파도의 비교관찰 -

신선영(Sun Young Sin),윤창상(Chang Sang Yoon),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1994 대한내과학회지 Vol.46 No.2

N/A Objectives: Left atrial thrombus (LAT) has been known as a major cause of systemic arteria1 embolization in patients with mitral stenosis. This study was undertaken to compare the diagnostic efficacy of transthoracic echocardiography (TTE) with that of transesophageal echocardiography (TTE) in the detection of LAT, Additionally, we assessed the prevalence and clinical significance of left atrial SEC and the factors related to its presence in patients with mitral stenosis. Methods; The study group comprised 33consecutive patients who had mitral stenosis (MS) or mitral stenoinsufficiency, 26patients of them had atrial fibrillation (AF), 7patients had sinus rhythm. Among them, 14cases had systemic embolization. All patients were studied with transthoracic and transesophageal echocardiography. We measured left atrial dimension (LAD), mitral valve area (MVA), ejection fraction (EF), severity of mitral regurgitation, and examined the presence and location of LAT and SEC by TTE and TEE. Cardiac rhythm, history of systemic cmbolization were collected by review of the patients hospital records. Results: 1) TTE revealed left atrial SEC in only 1patient. In contrast, left atrial SEC clould be detected in 25patients by TEE. In 8patients, LAT were diagnosed by TTE, whereas detected 14cases of LAT by TEE. The difference between two methods was statistically significant (p<0 05). 2) The patients with LAT had significantly highter prevalence of SEC and AF, lower EF, lower frequency of severe mitral regurgitation than in patients without LAT (p<0 05). But, MVA and LAD were not significantly different between two groups. 3) Patients with SEC had significaotly higher frequency of AF and history of systemic embolization, more severe stenosis of MVA, lower frequency of severe mitral regurgitation than in patients without SEC (p<0, 05). But LAD and EF were not significantly different between two groups. 4) LAT or systemic embolization, or both were found in 20 of 25patients (80%) with SEC. Whereas, only 1 of 8patients (13%) without SEC had a history of arterial embolization (p<0,01), and no patient without SEC was found to have thrombus within the left atrium, Conclusion: This results suggested that TEE was more sensitive to detect left atrial SEC and LAT than TTE, and left atrial SEC was strong predictor for thrombus formation and systemic embolization in patients with mitral stenosis.

심방중격 결손중에서 경흉부 및 경식도 심초음파도의 비교

김양수(Yang Soo Kim),김성훈(Sung Hoon Kim),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1994 대한내과학회지 Vol.46 No.3

N/A Objectives: Transthoracic two-dimensional echocardiography and conventional Doppler color flow mapping studies have been to used in patients with congenital cardiac defect. However, the transthoracic approach is of limited value in patients with poor acoustic window, Recently transesophageal echocardiography provides high quality images of structure because of close proximity. The purpose of this study is the usefulness of transesophageal echocardiography compared with transthoracic echocardiogrphy in the diagnosis and assessment of the shunt volume in patients with atrial septal defect. Method: 13 patients with atrial septal defect documented at cardiac catheterization or surgery were evaluated. The study group consisted of 7 men and 6 women aged 15 to 59 years. Two-dimensional transthoracic echocardiogrphy with Doppler color flow mapping assessed the morphology and shunt of atrial septum. The size of atrial septal defect and the shunt volume across the defect were estimated by using the tranesophageal echocardiography. Results: 1) Transthoracic echocardiography identified 9 of 13 patients with and atrial septal defect (69%), whereas transesophageal echocardiography identified 13 of 13 patients and the diagnostic sensitivity was 100%. 2) Transesophageal echocardiography identified the site and size of defect correctly compared with operative findings (r=0.73, p<0.05). 3) The shunt flow volume by transesophageal echocardiography was compared with pulmonary to systemic blood flow ratios (Qp/Qs) by cardiac catheterization. The net shunt flow volume by transesophageal echocardiography and shunt flow ratio cardiac catheterization correlatie well (r=0.88, p<0.001). Conclusion: Transesophageal echocardiography was better and more usuful than transthoracic echocardiography in the diagnosis and in the assessment of shunt volume in the patients of atrial septal defect. However further studies with large number of patients and using the biplane or multiplane TEE will be required to determine the exact status of this the technique in assessment of shunt.

우리나라 뇌졸중의 최근 10 년간 변화 양상에 대한 연구

송일한(Il Han Song),오동환(Dong Hwan Oh),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kuen Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hwa Bae) 대한내과학회 1992 대한내과학회지 Vol.43 No.5

N/A Background: Stroke is well known one of the major causes of death in adults. In the incidence of type of stroke, the cerebral infarction occured more frequently than the cerebral hemorrhage in the Western, but the incidence varies with the individual clinical studies in Korea. We expect that there is changing pattern in the incidence of type of stroke during the recent 10 years in Korea. Methods: To investigate the changing pattern of stroke during the recent 10 years, 1304 patients with stroke who underwent the computerized tomographic scanning were evaluated for the type of stroke, the sex and age distribution, the underlying diseases and the location. Group I included 450 pateints with stroke who admitted from January 1978 to October 1981, at department of internal medicine, Kyung Hee University Hospital. Group II included S54 patients with stroke who admitted from January 1989 to December 1989. Results: Cerebral hemorrhage was the most frequent type of stroke in group I, but cerebral infarction in group II. Male was more prevalent than female in cerebral hemorrhage and cerebal infarction in both groups. The subarachnoid hemorrhage more frequently occurred in female than in male. It was a tendency to increase the frequency in females in group II including all types of stroke. Cerebral hemorrhage occurred most frequently in sixth decade in both groups, but cerebral infarction occurred most frequently in sixth decade in group I and seventh decade in group II. In both groups, hypertension was the most frequent associated disease. The proportion of diabetes mellitus and heart diseases increased in group II than group I. The level of serum total cholesterol in patients with cerebral infarction was higher than those with cerebral hemorrhage in group II. In cerebral infarction, the most frequent lesion site was lobal area. In cerebral hemorrhage, basal ganglia was the most frequent lesion site, the second was thalamus and then subcortical area. Conclusions: These results suggest that the cerebral infarction is the most frequent type in the stroke in Korea recently due to increased population with old age, increased incidence of diabetes mellitus and heart diseases, the adequate control of hypertension and changes of life style and diets.

고혈압환자에 있어 심초음파로 측정한 좌심방확대의 의의

이석권(Suk Kwon Lee),어완규(Wan Kyu Eo),최철준(Chul Joon Choi),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1990 대한내과학회지 Vol.39 No.2

N/A To access the hypothesis that left atrial enlargement as measured by echocardiography is the earliest sign of cardiac dysfunction in patients with systemic hypertension alone, we underwent M-mode echocardiography in 13 normal controls and 31 hypertensive patients who have neither quantitative evidence of left ventricular hypertrophy by noninvasive techniques, nor other causes of left atrial enlargement, such as coronary artery or valvular hart disease. The results were as follows: 1) There were no significant differences in left ventricular end-systolic and end-diastolic dimension, left ventricular mass, ejection fraction, or fractional shortening. 2) The left atrial dimension in the hypertensive patients (1.98±0.51cm) was significantly higher than normal control (3.27±0.46 cm) (p<0.05). 3) The left artial index was also higher in the hyper-tensive patients, 1.99±0.36cm/m² versus 2.42±0.39cm/m² (p<0.05), and the left atrial-to-aortic root dimension ratio was significantly higher in the hypertensive group, 1.10±0.14 versus 1.37±0.39 (p<0.05). The above results suggest that echocardiographic left atrial enlargement may be an early sign of hypertensive heart disease in patients with no other discernible causes of left atrial enlargement.

새 방법에 의한 승모판협착중에서의 승모판구 면적측정에 관한 연구

배종화(Jong Hoa Bae),최철준(Chul Joon Choi),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),정충화(Chong Hwa Jung) 대한내과학회 1990 대한내과학회지 Vol.39 No.1

N/A A new formula (ED-MVA) was derived from the study of fluid dynamics, that the flow volume is proportional to orifice area, velocity of flow, and which shows period required by the flow. The mitral inflow volume can be obtained by estimating the stroke volume (SV) by Teichholz's method from M-mode echocardiogram of the left ventricle, and the mean diastolic velocity (MDV) and diastolic filling period (DFP) by mitral inflow continuous-wave Doppler echocardiogram, respectively. Therefore, the new Echo/Doppler method is MVA= SV/MDV×DFP. We compared this new method to other methods in 28 patients with severe mitral stenosis. The following results were obtained: 1) MVAs of 28 patients with mitral stenosis were determined as follows: Cath-MVA=0.967±0.289cm² 2DE-MVA=1.202±0.519 cm², PHT-MVA=1.006±0.364 cm², and ED-MVA=0.976±0.279cm² 2) ED-MVA of these 28 cases correlated well at a coefficient of 0.867 than with PHT-MVA (r=0.513) or 2DE-MVA (r=0.513) in comparison with Cath-MVA, 3) Excluding four patients with mitral regurgitation, the ED-MVA of 24 patients with isolated mitral stenosis showed a better correlation with r=0.944 than with PHT-MVA (r=0.642) or 2DE-MVA (r=0.637) in comparison with Cath-MVA. Therefore, new Echo/Doppler method was a useful noninvasive method in the estimation of mitral valve area with simplicity and accuracy.

급성 하벽심근경색증에 동반된 ST 절의 상호 하강 ( V₁ - V₃ ) 에 대한 연구

류혜영(Hyae Young Lew),윤용선(Yong Sun Yun),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Wha Bae) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Background: Reciprocal ST-segment depression in precordial leads is a common finding in acute inferior myocardial infarction. The responsible mechanism and the significance of this finding, however, are still controversial. Methods: From January 1991 to December 1994, 38 patients with acute inferior myocardial infarction were treated at the Department of Internal Medicine in Kyung Hee University Hospital. Clinical characteristics, serial electrocardiograms, and angiographic findings of coronary artery and left ventriculography, echocardiography were reviewed. Reciprocal ST-segment depression was defined as ST-segment depression≥1.0mm in two or more adjacent precordial leads(V₁-V₃) in patients with acute inferior myocardial infarction showing ST-segment elevation in II, III, aVF. Coronary angiography and echocardiography were performed within 24 hours from admission. In this study, angiographic distribution score was used to define the perfusion territory causing inferior ischemia. Results : 1) The summation of ST-segment elevation in II, III, aVF leads was significantly more higher in group H than group A (P<0.05). 2) However, the angiographic distribution score, peak CK levels, in-hospital complications and ejection fraction showed no difference between two groups (P>0.05). 3) There were no evidence of anterior wall motion abnormality in two groups. Conclusions: Our results suggest that the S'I'- segment depression on the precordial leads in acute myocardial infarction can be explained mainly by benign reciprocal electrical change.