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승모판 협착증 환자에서의 경피적 풍선판막성형술 및 판막대치술의 치료 효과
성인환(In Whan Seong),박승정(Seung Jung Park),박성욱(Seong Wook Park),김재중(Jae Joong Kim),이종구(Jong Koo Lee) 대한내과학회 1991 대한내과학회지 Vol.40 No.4
N/A To assess the efficacy of mitral balloon valvuloplasty (PMV) and mitral valve replacement (MVR) in patients with mitral stenosis, PMV or MVR was performed in 73 patients (male 28, female 44, mean age 42±12 yrs) between September 1989 and August 1990. Atrial fibrillation was found in 33. PMV could be performed in 68 (93%) out of 73 patients and MVR in only 5 (7%). PMV using the Inoue balloon technique was in 35 and double balloon technique in 33, and 63(93%) out of 68 PMV were be technically successful. After PMV, the mitral valve area MVA increased from 0.9±0.2 to 1.9±0.3 ㎠(p<0.0001). The mean mitral diastolic gradient decreased from 16. 6±28.0 to 5.6±3.1 mmHg (p<0.0001), the mean left atrial pressure and mean pulmonary artery pressure significantly decreased from 25±8, 32±13 to 14±5, 25±10 mmHg, respectively (p <0.001), and pulmonary vascular resistance decreased from 299±318 to 271±217 dynes sec/cm5. The cardiac output increased from 3.5±0.9 to 4.0±1.1L/min (p<0 01). Technical failures included inability to cross the mitral valve in 2, Inoue balloon deflation failure in the left atrium in 2, inability to fix the guide wire into the left ventricle in 1, and 1 death due to hemorrhagic myocardial infarction after surgical removal of the undeflated Inoue balloon. Complications included severe mitral regurgitation Grade 4/4 in 1, creation of left-to right shunt (Qp/Qs>1.2) in 12(19%), cerebral embolism in I, bleeding requiring transfusion in 1, but no cardiac tamponade in our series. MVR was performed in only 5 patients, and the reason of MVR was heavily thickened and/or calcified mitral valvular or subvalvular structure (echo-score>12) in 3, visible thrombus in the left artium in 1, and mitral valve vegetation in 1. MVA after MVR by Doppler echocardiogram increased from 0.6±0.1 to 2±0.5㎠ (p<0. 001), which was significantly greater than that of post- PMV (p<0.01).
관동맥 조영상 정상소견을 보인 환자에서 관동맥내 아세틸콜린 주사에 의한 관동맥 조영 소견의 변화
박성욱(Seong Wook Park),박승정(Seung Jung Park),김재중(Jae Joong Kim),성인환(In Whan Seong),김상위(Sang We Kim),이종구(Jong Koo Lee) 대한내과학회 1991 대한내과학회지 Vol.40 No.5
N/A The effect of an intracoronary injection of acetylcholine (A1, 20 ug; A2, 50 ug; A3, 100 ug) on the coronary artrial diameter was examined by coronary arteriography in 29 adult patients (16 men, 13 women), aged 19 to 70 years (mean 49), with normal or near normal coronary arteriographic findings. The Luminal diameter of each coronary arterial segment after each dose of acetylcholine (Ach) was compared with the diameters before Ach injection. After injection of 20 to 100 ug of Ach into the left and right coronary arteries, a significant diffuse narrowing occurred in all segments of the left and right coronary artery except for the left main stem, with more narrowing to increased doses of Ach (A1:-1.39%, A2: -7.2%, A3:-9.6% compared with control). The change in the luminal diameter after injection of 100 μg of Ach was an initial constrictive response followed by gradual dilatation, and the peak constriction occurred in 1 min after injection of Ach (1 min, -15%.2 min., -9. 6%: 3min., -2.8%: 4 min., -2.8%: 5min., 3%). These results indicate that Ach invariably induces coronary vasoconstriction in adult patients with normal or near normal coronary arteries, and the peak constrictive response occurs in 1 minute after injection of Ach. The vosoconstrictive response to Ach may reflect the endothelial dysfunction associated with early atherosclerosis, which is not evident by coronary arteriography.
좌심실 보조장치를 이용한 전격성 심근염의 치료 - 1례 보고 -
강신광,박상순,나명훈,유재현,임승평,이영,성인환,Kang, Shin-Kwang,Park, Sang-Soon,Na, Myung-Hoon,Yu, Jae-Hyeon,Lim, Seung-Pyung,Lee, Young,Seong, In-Whan 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.6
17세 여자 고등학교 학생이 전흉부 동통을 주소로 입원하였다. 약물 치료와 대동맥내 풍선 펌프에도 불구하고 폐부종과 순환 허탈이 악화되었다. 급성 전격성 심근염 추정 진단 하에 좌심실 보조장치를 설치하였다. 유입구 도관은 유방하 좌전개흉술로 좌심이를 통하여 좌심방에 삽입하였고, 좌심이의 일부를 조직검사를 위해 떼어냈다. 유출구 도관은 좌측 대퇴 동맥에 PTFE도관을 간치시켜 삽입하였다. 체외순환 158시간 후 심초음파에서 좌심실의 운동성이 거의 정상으로 회복되었고, 좌심실 보조장치를 성공적으로 이탈할 수 있었다. 면역화학 검사와 중화 항체 검사에서 콕사키바이러스가 확인되었다. 환자는 입원 23일 째 아무런 심부전 증상없이 퇴원하였다. A 17 year-old high school girl was admitted for anterior chest pain. Pulmonary edema and circulatory collapse progressed in spite of the medical treatment and intra-aortic balloon pump. Left ventricular assist device(LVAD, Bio-Pump, Medtronic Bio-Med, USA) was instituted under the impression of acute fulminant myocarditis. The inlet cannula was inserted in the left atrium(LA) via left submammary anterior thoracotomy. Biopsy was taken from left atrial appendage. The outlet cannula inserted to the left femoral artery using PTFE cuff. After 158 hours of extracorporeal circulation, LVAD was able to be weaned successfully with nearly normalized LV motion on echocardiogram, Coxsakievirus was identified with immunochemistry and serum neutralization test. She was discharged without any heart failure symptoms after 23 days of hopitalization.
불안정형 협심증의 임상 및 간동맥 조영상의 특성과 그에 따른 치료법
임채만(Chae Man Im),박승정(Sung Jung Park),김재중(Jae Joong Kim),성인환(In Hwan Seong),박성욱(Seong Wook Park),이종구(Jong Koo Lee) 대한내과학회 1991 대한내과학회지 Vol.41 No.4
N/A The pathophysiology of unstable angina is known to be in continuum with acute myocardial infarction, and its treatment requires timely intervention using haparin iv, thrombolysis, and/or percutaneous transluminal coronary angioplasty, or bypass graft along with conventional measures. We analyzed the clinical and angiographic findings of 72patients with unstable angina and the treatments performed on them and compared the results with those of 50patients with stable angina to know differences existing between the 2groups. The results were as follows; 1) There were no statistical differences in clinical characteristics, including coronary risk factors between patients with unstable angina vs patients with stable angina (p>0.05). 2) Multivessel and left main diseases were more prevalent in patients with unstable angina (61% and 13%, respectively) compared to patients with stable angina (34% and 4%, respectively)(p<0.05). 3) Type B2 (42% and C (34%) lesions were more common in patients with unstable angina, while type A (23%) and B1 (32%) lesions were more common in patients with stable angina (p<0.05). 4) Most unstable patients (94%) were initially stabilized by medical treatment only, but the probability requiring surgical treatment (CABG) was significantly higher in patients with unstabe angina than in patients with stable angina (25% vs 6%)(p<0.05). Unstable angina has more complex coronary lesions and is precipitated frequently by platelet aggregation or thrombus associated with rupture of the atheromatous plaque. Most unstable angina could be stabilized with medical treatment only. However if chest pain does not remit by 48hours after medical therapy, more aggessive modalities such as thrombolysis, PTCA or CABG seem to be justified.
김현숙 ( Hyun Sook Kim ),이재환 ( Jae Hwan Lee ),성인환 ( In Whan Seong ),이승환 ( Seung Whan Lee ),이경석 ( Kyoung Suk Rhee ),김원호 ( Won Ho Kim ),고재기 ( Jae Ki Ko ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1
Objectives: Paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) are more effective than bare-metal stent for reducing restenosis. However, it is not known whether there are differences between PES and SES in terms of safety and efficacy in the setting of ST-elecation myocardial infarction (STEMI). Methods and Results: Acute STEMI patients (n=231) undergoing primary stenting were randomly assigned to PES (n=115) or SES (n=116) treatment. Primary end point was in-segment late loss at 6 months. Secondary end points were 6-month angiographic restenosis and major adverse cardiac events (MACE) at 9 months. At 6 months, in-segment late loss was higher in the PES than the SES group (0.33±0.70 vs. 0.05±0.40mm, respectively, p<0.001). During 9-month follow-up, 14 (6.1%) patients were died (9 in PES, 5 in SES group). Nine-month TLR (7.8% vs. 2.6%, p=0.09) and MACE (15.7% vs. 6.9%, p= NS) tended to be lower in SES group than PES group. Conclusions: Both PES and SES implantation was safe, and both showed favorable clinical outcomes in STEMI patients undergoing primary angioplasty. SES appeared to be superior to PES in preventing neointimal hyperplasia.
최웅림 ( Uhng Lim Choi ),이선화 ( Sun Hwa Lee ),박재형 ( Jae Hyeong Park ),성석우 ( Seok Woo Seong ),김준형 ( Jun Hyung Kim ),이재환 ( Jae Hwan Lee ),최시완 ( Si Wan Choi ),정진옥 ( Jin Ok Jeong ),성인환 ( In Whan Seong ),이경석 ( 대한내과학회 2012 대한내과학회지 Vol.83 No.1
목적: 판막 질환으로 수술적 치료를 시행받는 환자들에서 유의한 관상동맥 질환의 유무를 확인하는 것은 동시에 관상 동맥우회술을 시행함으로써 향후의 재개흉술 및 이로 인한 합병증의 예방에 중요하다. 국내의 허혈성 심질환의 빈도는 서구에 비해 낮으나 어떤 환자군에서 관상동맥 조영술을 시행하여야 하는지에 대한 기초 통계자료는 없는 실정이다. 이에 저자들은 국내에서 판막 질환으로 개흉 술을 시행 받는 환자들을 대상으로 하여 관상동맥 조영술의 시행유무 및 유의한 관상동맥 질환의 유병률에 대해 연구하였다. 방법: 2005년 1월부터 2011년 6월까지 충남대학교 병원 및 전북대학교 병원 심장내과와 흉부외과에서 유의한 판막 질환으로 개흉 술을 시행 받은 성인 환자들을 대상으로 후향적 분석을 하였다. 급성 대동맥 박리 증이나 외상으로 인해 응급수술을 시행 받은 경우 및 관상동맥 협착증으로 관상동맥 우회로 술을 시행 받으면서 동시에 판막 질환을 수술한 경우는 제외하였다. 결과: 연구 기간 동안 총 431명의 환자(평균나이 58 ± 13세, 남자 204명)가 연구에 등록되었다. 질환 별로 보면 승모 판막 질환은 241명에서 관찰되었고, 대동맥판 질환은 230명에서 관찰되었다. 관상동맥 조영 술을 시행 받은 환자는 297명(68.9%)으로 이 중 36명(12.1%)에서 유의한 협착증이 관찰되었고, 32명에서 관상동맥 우회로 술이 판막 수술과 동시에 시행되었다. 다변 량 분석결과 관상동맥의 유의한 협착은 65세 이상의 고령 [Odd ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], 심혈관계 위험인자가 많은 경우(≥3) (OR =3.002, 95% CI = 1.386-6.503, p = 0.005) 및 대동맥협착증(OR= 2.763, 95% CI = 1.269-6.013, p = 0.010)과 유의하게 연관되었다. 결론: 한국에서 판막 질환으로 수술적 치료를 시행 받는 성인 환자에서 유의한 관상동맥 질환의 빈도는 12.1%로 주로 고령, 대동맥판막 협착증 및 많은 수의 심혈관계 위험인자를 가진 환자에서 높게 나타났다. Background/Aims: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. Methods: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. Results: During the study period, a total of 431 patients (58 ± 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (≥ 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (≥ 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). Conclusions: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.
심포지움,특별강연 및 일반연제 발표 : 혈액 투석환자에서 발생한 중심정맥 협착의 경피적 풍선성형술 및 스텐트 삽입술
강민규 ( Kang Min Gyu ),이상주 ( Lee Sang Ju ),박기현 ( Park Gi Hyeon ),장윤경 ( Jang Yun Gyeong ),양종오 ( Yang Jong O ),구영선 ( Gu Yeong Seon ),황평주 ( Hwang Pyeong Ju ),성인환 ( Seong In Hwan ),이강욱 ( Lee Gang Ug ),신영태 ( 대한신장학회 2000 춘계학술대회 초록집 Vol.19 No.2
장윤경 ( Jang Yun Gyeong ),최대은 ( Choe Dae Eun ),양종오 ( Yang Jong O ),구영선 ( Gu Yeong Seon ),강민규 ( Kang Min Gyu ),황평주 ( Hwang Pyeong Ju ),성인환 ( Seong In Hwan ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6
Thrombosis is one of the important complications of nephrotic syndrome. Still, the mechanism of thrombosis of nephrotic syndrome is under debate, but the presence of hypercoagulable state in nephrotic syndrome is regarded as the principal contributing factor to that. Venous thrombosis in nephrotic syndrome has been increasingly reported, but arterial thrombosis is relatively rare and has been reported mainly in nephrotic children. Authors experienced a 35-year old male patient with frequently relapsing nephrotic syndrome of focal segmental glomerulosclerosis, who complained sudden onset of claudication, cold sensation, numbness and cyanosis of right lower extremity. A diagnosis of thrombosis in right common iliac artery and thromboses in septal and distal branch of left anterior descending coronary artery was made by arterial angiography. The patient fully recovered after emergent thrombectomy and anticoagulation therapy.