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양측 장골동맥협착을 동반한 환자에서 경대퇴동맥 접근법을 통한 경피적 대동맥판막 삽입술
이동준 ( Dong Jun Lee ),고영국 ( Young Guk Ko ),심지영 ( Ji Young Shim ),장병철 ( Myeong Ki Hong ),곽영란 ( Byung Chul Chang ),홍명기 ( Young Ran Kwak ),장양수 ( Yang Soo Jang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2
본 환자는 수술의 고위험군인 중증 대동맥판협착 환자이며 TAVI를 시행하려 하였으나 말초혈관 질환, 관상동맥 우회술 과거력, 중증의 석회화된 대동맥 등의 접근경로상의 문제로 접근이 용이하지 않은 환자였다. 이러한 환자에서 스텐트가 삽입된 장골동맥 협착병변에 경피적 혈관 성형술을 시행 후 성공적으로 TAVI를 시행할 수 있었다. 모든 환자에서 가능한 접근경로에 대한 세심한 평가가 필요하며 이에 따른 적절한 접근경로의 선택 및 시술이 중요하다. Transcatheter aortic valve implantation (TAVI) is an alternative treatment modality for surgical aortic valve replacement in patients at high surgical risk. Transfemoral access is not feasible in many cases with unfavorable iliofemoral anatomy or severe peripheral arterial disease (PAD). Elderly patients with severe aortic valve stenosis have a higher prevalence of PAD due to atherosclerotic degenerative changes in the large and small vessels. Transsubclavian, transapical, and direct access to the ascending aorta by thoracotomy are alternative routes for the TAVI procedure. In this case, we describe a patient with a previous coronary artery bypass graft and bilateral iliac artery stenosis who successfully underwent TAVI using a CoreValve® by transfemoral approach after balloon angioplasty of iliac artery stenosis. (Korean J Med 2013;85:188-193)
신동맥에 접한 복부대동맥류에서 굴뚝형 이식편을 이용한 혈관내 치료
김다래 ( Da Rae Kim ),고영국 ( Young Guk Ko ),이도연 ( Do Yun Lee ),최동훈 ( Dong Hoon Choi ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2
An endovascular repair of an abdominal aortic aneurysm (AAA) is technically less invasive than open surgery, but gives results as effective as open surgery if the anatomy is adequate. Unfortunately, 20-30% of AAA patients are not suitable for endovascular repair because they lack a sufficient proximal landing zone. In an effort to broaden the applicability of endovascular repair, the chimney technique has been introduced. This refers to deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, creating a conduit that runs outside the main aortic endograft into the aortic branches. We report the case of a 75-year-old male with a juxtarenal abdominal aortic aneurysm and multiple comorbidities who was treated successfully with an endovascular aneurysm repair using a chimney graft. (Korean J Med 2014;86:213-217)
버거 병에서 내막하 박리 혈관성형술(Subintimal angioplasty)을 시행한
윤종찬 ( Jong Chan Youn ),고영국 ( Young Guk Ko ),김종윤 ( Jong Yoon Kim ),김준형 ( Joon Hyung Kim ),최동훈 ( Dong Hoon Choi ),장양수 ( Yang Soo Jang ),심원흠 ( Won Heum Shim ) 대한내과학회 2006 대한내과학회지 Vol.71 No.4
A 27-year-old male was admitted with a three week history of pain and gangrenous changes of his first to fourth right foot toes. Clinical, laboratory and angiographic findings were consistent with Buerger`s disease. The patient was treated by subintimal balloon angioplasty of the right anterior tibial artery. The percutaneous subintimal angioplasty was successful, and the patient symptoms and the ankle brachial index was improved. The value of subintimal angioplasty in limb-threatening ischemia in Buerger`s disease, has not been established but this case illustrates a role for subintimal angioplasty in acute ischemia.(Korean J Med 71:420-425, 2006)
지민철,박세진,최재영,고영국,김명수,김지홍,신재일,Ji, Min-Chul,Park, Se-Jin,Choi, Jae-Young,Ko, Young-Guk,Kim, Myoung-Soo,Kim, Ji-Hong,Shin, Jae-Il Korean Society of Pediatric Nephrology 2010 Childhood kidney diseases Vol.14 No.2
신성 고혈압은 신동맥의 협착 혹은 폐색으로 인해 유발되는 전신성 고혈압이다. 최근에는 신동맥의 재개통을 위해 PTRA가 선호되고 있지만, 복잡한 경우에 있어서는 신 자가이식이 대안적인 치료방법으로서 시행되어 왔다. 저자들은 심각한 고혈압 증상을 보인 14세 남자 환아를 PTRA 및 신 자가이식을 시행하여 성공적으로 치료하였기에 보고하는 바이다. 도플러 초음파 검사와 CT 혈관조영술상 우측 신동맥 기시부에서 약간의 좁아짐과 다발적인 측부순환을 동반한 좌측 신동맥 기시부의 완전폐색이 확인되었다. 우측 신동맥 협착의 치료를 위해 PTRA와 스텐트 삽입술을 시행하였으나 좌측 신동맥은 완전폐색으로 인해 시술이 불가능하여 좌측 신장을 절제한 후 동측 장골와에 자가이식하였다. 수술 후 시행한 도플러 초음파 검사와 MAG-3 신주사 검사상 신혈류와 신기능은 정상이었다. 혈압은 정상화되었으며 항고혈압제 투여도 점차 중단하였다. 임상적인 특성을 고려할 때 신성 고혈압의 원인은 섬유근성 형성이상으로 생각되었다. 결론적으로 신 자가이식은 혈관내 중재적 시술이 실패하였거나 불가능한 경우에 선택할 수 있는 치료방법이다. Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.
권혁찬,김기웅,이용호,김진목,임현균,박용기,정남식,고영국,정보영,김진배,조정래,Kwon, H.,Kim, K.,Lee, Y.H.,Kim, J.M.,Lim, H.K.,Park, Y.K.,Chung, N.,Ko, Y.G.,Joung, B.,Kim, J.B.,Cho, J.R. 한국초전도학회 2007 Progress in superconductivity Vol.9 No.1
Myocardial ischemia causes heterogeneity of ventricular repolarization and sometimes produces changes of the ST-T wave in ECG. Therefore, morphological changes of ST-T waveform in ECG have a clinical significance in diagnosing myocardial ischemia. In this study, we investigated the ST-T changes caused by myocardial ischemia in magnetocardiography (MCG). We analyzed MCG patterns of biphasic T, ST segment deviations from baseline, main current angle of $T_{peak}$ and $T_{peak}$ dispersion in 300 CAD patients without ST elevation in ECG, 122 symptomatic patients and 48 normal subjects. MCGs were recorded by multichannel SQUID system in a magnetically shielded room. As results, we found that appearances of the abnormality were strongly correlated with the severity of myocardial ischemia. Also we found that the percentage of the patients showing MCG changes were higher than those in ECG. These results show that morphological changes of ST-T waveform in MCG can be used as a marker of myocardial ischemia.
권혁찬,김기웅,김진목,이용호,김태은,임현균,박용기,고영국,정남식,Kwon, H.,Kim, K.,Kim, J.M.,Lee, Y.H.,Kim, T.E.,Lim, H.K.,Park, Y.K.,Ko, Y.G.,Chung, N. 한국초전도학회 2006 Progress in superconductivity Vol.8 No.1
Magnetocardiography(MCG) has been proposed as a novel and non-invasive diagnostic tool for the detection of cardiac electrical abnormality associated with myocardial ischemia. In our previous study, we have proposed a new classification method of MCG parameters, based on the different populations of the parameters between coronary artery disease(CAD) patients, symptomatic patients and healthy volunteers. We used four parameters, representing the directional changes of the electrical activity in the period of an R-ST-T interval. In patients with chest pain and without ST-segment elevation, who were selected consecutively from all patients admitted to the hospital in 2004, the patients with CAD could be classified with a higher sensitivity than conventional methods, showing that the proposed method can be useful for the diagnosis of CAD with MCG. In this study, we examined the validity of the algorithm with the prior probability distribution in diagnosis of new patients admitted to the hospital in 2005. In the results, presence of CAD could be found with sensitivity and specificity of 81.3% and 71.4%, respectively, in patients with chest pain and non-diagnostic ECG findings.
권혁찬,김기웅,김진목,이용호,김태은,임현균,박용기,고영국,정남식,Kwon, H.,Kim, K.,Kim, J.M.,Lee, Y.H.,Kim, T.E.,Lim, H.K.,Park, Y.K.,Ko, Y.G.,Chung, N. 한국초전도학회 2006 Progress in superconductivity Vol.8 No.1
In emergency rooms, patients with acute chest pain should be diagnosed as quickly as possible with higher diagnostic accuracy for an appropriate therapy to the patients with acute coronary syndrome or for avoiding unnecessary hospital admissions. At present, electrocardiography(ECG) and biochemical markers are generally used to detect myocardial infarction and coronary angiography is used as a gold standard to reveal the degree of narrowing of coronary artery. Magnetocardiography(MCG) has been proposed as a novel and non-invasive diagnostic tool fur the detection of cardiac electrical abnormality associated with myocardial ischemia. In this study, we examined whether the MCG can be used fur the detection of coronary artery disease(CAD) in patients, who were admitted to the emergency room with acute chest pain. MCG was recorded from 36 patients admitted to the emergency room with suspected acute coronary syndrome. The MCG recordings were obtained using a 64-channel SQUID MCG system in a magnetically shielded room. In result, presence of CAD could be found with a sensitivity of 88.2 % in patients with acute chest pain without 57 elevation in ECG, demonstrating a possible use in the emergency room to screen CAD patients.
Classification of magnetocardiographic maps in coronary artery disease diagnosis
권혁찬,김기웅,김진목,이용호,김태은,임현균,고영국,정남식,Kwon H.,Kim K.,Kim J. M.,Lee Y. H.,Kim T. E.,Lim H. K.,Ko Y. G.,Chung N. The Korean Superconductivity Society 2005 Progress in superconductivity Vol.7 No.1
The diagnostic management of patients with chest pain remains a clinical challenge. Magnetocardiography (MCG) has been proposed as a new non-invasive method for detection of myocardial ischemia. To date, however, MCG technique is not intensively introduced for clinical use. One of the main reasons might be the absence of statistically valid and diagnostically clean criteria, which can determine the presence of certain heart disease. In this work, we suggested a new method to classify the diagnostic value of MCG for the detection of coronary artery disease (CAD) in patients with chest pain. MCG was recorded for three groups (healthy subjects and patients without and with CAD) by means of the 64 channel SQUID gradiometer system installed at a hospital. Using four parameters, which were found to be significantly different between groups, we evaluated a probability, in which parameters can be classified into each group based on the distribution function of the parameter in each group. For all parameters, sum of probabilities was compared between groups to determine the presence of CAD. Our classification method shows that the MCG can be a useful tool to predict the presence of CAD with sensitivity and specificity of higher than $80\%$ each.