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류마티스성 승모판 협착증의 치료를 위한 경피적 승모판 성형술의 치료성적
김성은,조흥근,박성훈,박시훈 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.4
연구목적 : 류마티스성 승모판 협착증에 대한 유용한 치료법인 경피적 승모판 성형술의 본원의 단기 치료 성적을 알아보고자 하였다. 방법: 1993년 10월에서 1999년 4월까지의 이대목동병원에 내원한 류마티스성 승모판 협착증 환자 21명에서 투시조명 하에 경피적 승모판 성형술을 시행하였다. 시술전에 경흥부심초음파와 경식도초음파가 시행되었고, 시술후에는 경흉부초음파를 사용하여 혈역학적, 임상학적 변화를 비교하였다. 연구대상의 거의 모두가 NYHA class Ⅱ에 속했고, 5명이 심방세동을 가지고 있었으며, 모두 심초음파점수가 8이하였다. 좌심방에 혈전이 있는 경우로 혈전을 용해시킨 후 시술한 경우가 2예였다. 결과 : 경피적 승모판 성형술 이후의 평균 승모판구면적은 시술전의 1.16±0.36㎠에서 2.06±0.33㎠로 증가되었다. 경승모판 이완기 평균 압력차는 시술전 11.60±5.54mmHg에서 시술 후 4.93±2.53mmHg(p<0.001). 좌심방 크기는 46.41±14.66mm에서 42.03±15.01mm로(p=0.042), 그리고 심박출량은 4.21±1.25L/min에서 6.88±9.57L/min로(p<0.0001) 의미있는 호전을 보였다. 3도 이상의 심한 승모관폐쇄부전이나 심각한 시술후 합병증은 없었다. 결론 : 본원에서 약 6년간 시행된 경피적 승모판 성형술는 그 사례가 적고 시술전 예상되는 난이도 면에서 특이한 것은 없었지만, 시술후 합병증이 거의 발견되지 않았으며 혈역학적 측정상에서도 성공적인 시술을 보여주었다. 승모판구면적에 따른 시술후 단기내 호전의 정도는 거의 예측할 수 없었으나, 심초음파점수는 모두가 8점이하로 높은 성공율의 조건을 제공하였다. Objective : Percutaneous mitral valvuloplasty(PMV) became a treatment modality or mitral stenosis because of its low morbidity, short hospital stay, and low cost. We reviewed clinical and hemodynamic results after PMV for the patients with mitral stenosis in Ewha Womans University Mokdong hospital. Methods : We compared the results of echocardiographic, hemodynamic, and clinical parameters before and after PMV. PMV was performed under fluoroscopic guidance in 21 patients(M:4, F:17, mean age 43±12 years) with mitral stenosis from October 1993 to April 1999. Transesophageal echocardiography(TEE) and Transthoracic echocardiography(TTE) were performed for the evaluation of mitral valve, chamber size, and the presence of left atrial thrombus before procedures. TIE was also used for follow-up evaluation. On presentation, all patients showed at least NYHA class Ⅱ. Five patients had atrial fibrillation. Two patients with thrombus in the left atrium were included to study group after thrombolytic treatment with coumadin. Echo-score of our patients was not greater than 8. Results : Mean mitral valve area(MVA) by 2 dimensional or Doppler echocardiography was increased from 1.16±0.36㎠ before PMV to 2.06±0.33㎠ after PMV. There were marked improvements in transmitral gradients(11.60±5.54mmHg before PMV vs 4.93±2.53mmHg after PMV, p<0.001), left atrial dimension(46.41±14.66mm vs 42.03±15.01mm, p=0.042), and cardiac output(4.21±1.25L/min vs 6.88±9.57L/min, p<0.0001) following PMV, Severe(≥GⅢ) mitral insufficiency or severe postprocedural complications were not noted. This suggested that all procedure was successful. Conclusion : The Procedural success rate of PMV in Ewha Womans University Mokdong hospital was 100%. Low echo score of our patients might explain this high procedural success rate. Long-term-follow-up is warranted in the near future.
황민규,김화정,김도연,신정은,김태희,박수영,남준식,박성훈,조흥근 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.2
Heat stoke is a life-threatening syndrome of multi-organ dysfunction caused by elevated body temperature. Reported mortality rate range from 17-70 percent. The heat stoke victim's circulatory pattern id defined low peripheral vascular resistance and high circulatory demand of other conditions involving tissue injury such as trauma or sepsis. Owing to either to direct thermal injury of the myocardium or to increased pulmonary vascular resistance, the heart may not meet the elevated circulatory demand. Heat stoke induced cardiomyopathy is diagnosed by pathlogy, EKG abnormality, LDH isoenzyme, echocardiography. Therapy was two purpose : rapid reduction of body temporature and support of the cardiovascular system. We experienced a case of heat stoke induced cardiomyopathy in a 21 year-old male who had been observed for 1 years. The Left Ventricular End-Diastolic Diameter(LVEDD) was 65㎜, Ejection fraction(EF) was 35% initially and LVEDD was decreased 58㎜, EF was 60% after 9 months. We report a case of heat stoke induced cardiomyopathy with brief review of literature