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작은 기계 판막을 이용한 대도액 판막 치환술 후 판막 전후 압력차
황경환,박계현,차대원,전태국,박표원,채헌,Hwang, Kyung-Hwan,Park, Kay-Hyun,Cha, Dae-Won,Jun, Tae-Gook,Park, Pyo-Won,Chae, Hurn 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.2
background: The prognosis after an aortic valve replacment can be affected significantly by the transprosthetic pressure gradient which is determined mainly by the size of the patients body and the prosthesis used. We analyzed the hemodynamic feature of two relatively new prosthese the ATS and the evensized Medtronic-Hall(M-H) valves by measuring the transprosthetic pressure gradient in the cases where small sizes (23mm or smaller) were used. Material and method: There were 94 patients who received whom aortic valve replacement with prosthesis smaller than 23 mm from October 1994 to June 1998. In these patients the transprosthetic pressure gradient clalculated from the pressure half time during postoperative Dopper echocardiographic examination was compared between the prostheses of different sizes. The body surface area of each patient was also taken into consideration. result: The mean pressure gradient and body surface area in each group were 21.7$\pm$10.2 mmHg and 1.52$\pm$0.14m2 in ATS 19mm 11.4$\pm$6.5 mmHg and 1,57$\pm$0.20m2 in M-H 20mm 15.2$\pm$6.3 mmHg and 1.54$\pm$0.13m2 in ATS 21mm 9.3$\pm$2.5 mmHg and 1.63 $\pm$0.14m2 in M-H 22 mm and 12.9$\pm$5.3 mmHg and 1.69$\pm$0.13m2 in ATS 23mm. Conclusion: The 19mm ATS prosthesis showed significant trasprosthetic pressure gradient which is similar to the values previously reported with other bileaflet prosthesesm Close follow-up was needed in terms of exercise capacity and change in left ventiricular geometry. In patients with small aortic valve annulus the 20mm M-H valve is recomendable as an alternative to 19mm bileaflet valves because it has less pressure gradient with similar outer diameter.
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손대원,박동영,이효석,김정룡,김진,김병관,차성덕,유철규 대한내과학회 1997 대한내과학회지 Vol.53 No.2
The hepatopulmonary syndrome is defined as the triad of liver disease, an increased alveolar-arterial gradient while breathing room air, and evidence of intrapulmonary dilatation. Other cardiopulmonary abnormalities(such as pleural effusion or decreased lung volumes) are common and may coexist in patients with the hepatopulmonary syndrome. An abnormal dilatation of intrapulmonary capillaries is evidenced by Tc 99m-MAA perfusion scan, contrast-enhanced echocardiography, and pulmonary angiography. We have experienced a case of hepatopulmonary syndrome in a 67 year old woman with liver cirrhosis who complained of severe dyspnea and cyanosis. Her arterial blood gas analysis (ABGA) showed severe hypoxemia(PaO₂ 59mmHg), suggesting the hepatopulmonary syndrome, which was confirmed with the contrast-enhanced echocardiography. It showed delayed opacification of left side chambers during agitated saline injection', thus, intrapulmonary shunt was confirmed. So we report a case of hepatopulmonary syndrome with a review of literature.
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