Volumetric Severity Assessment of Ebstein Anomaly Using Three-Dimensional Cardiac CT: A Feasibility Study

Goo Hyun Woo 아시아심장혈관영상의학회 2019 Cardiovascular Imaging Asia Vol.3 No.3

Objective: The purpose of this study was to demonstrate the feasibility of using cardiac CT to perform volumetric severity assessment of the Ebstein anomaly. Materials and Methods: Six children with Ebstein anomaly were included. We used cardiac CT to measure the delineated tricuspid valve, streak artifacts, and contrast enhancement heterogeneity. Cardiac CT data were used to quantify the volumes of all of the cardiac chambers, including the atrial and functional right ventricle (RV). In addition, the functional RV (fRV) fraction, fRV/left ventricle (LV) volume ratio, and total right/left-volume index were calculated. The volume-based CT severity index was compared using area-based echocardiographic and CT severity indices. Results: All of the patients had grade 3 or 4 extent of delineation of the malformed tricuspid valve and streak artifacts. In one case, the right atrium had image noise [126.7 Hounsfield units (HU)] that was >50 HU, while all others demonstrated image noise <50 HU. This image quality was appropriate to make all of the volumetric measurements. The RV volumes were enlarged in 83.3% (5/6) of the cases. The fRV fraction was 60.8–61.5%. The fRV/LV volume ratio and total right/left-volume index were 2.0±1.4 and 3.5±1.5, respectively. There was a smaller difference (0.2±0.1) between the area-based and volume-based CT severity indices than there was in other comparisons. These parameters also had a higher concordance rate (83.3%, 5/6) in the severity grades. Conclusion: Volumetric severity assessment using cardiac CT is feasible in Ebstein anomaly, and may be useful to characterize the disease’s diverse phenotypes.

무체외순환 관상동맥 우회로술을 받는 환자에서 Magnesium 정주가 좌심실박출작업량지수에 미치는 영향

김태균 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.3

Background: The administration of magnesium provides cellular protection during ischemia, improves the contractile response of the stunned myocardium, increases the threshold for the electrical excitation of myocardial cells, presents arrhythmia, and reduces the level of reperfusion injury. It also causes a decrease in peripheral vascular resistance in association with a secondary increase in the cardiac index and improves the left ventricular stroke work index. The aim of this study was to verify characteristic effects of magnesium infusion during off pump coronary artery bypass grafting (OPCAB). Methods: In a prospective double-blind trial, 17 patients undergoing OPCAB were randomly assigned to receive intravenous magnesium sulfate (n = 9) or a placebo (n = 8). The mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), heart rate (HR), cardiac index (CI), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVSWI), systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were measured. Results: MAP, PCWP, HR, CI, LWSWI, RVSWI, SVR, and PVR using the thermodilution method were not significantly different in both groups. Post operative arrhythmia occurred in 1 out of 9 patients after the administration of magnesium and in 1 out of 8 patients after infusing the placebo. Conclusions: The administration of magnesium does not affect the increase in LVSWI during OPCAB and does not decrease the incidence of post operative arrhythmia in the operating room period.

임상연구 : 관상동맥 우회술 시 Propofol과 Fentanyl 마취에서 술중 각성 유무 판단을 위한 Bispectral Index의 유용성

김수창 ( Soo Chang Kim ),김정수 ( Chung Su Kim ),조현성 ( Hyun Sung Cho ),이상민 ( Sang Min Lee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.3

Difference in Serum Iron, Cardiac, and Biochemical Indices between Alcoholic and Non-alcoholic Fatty Liver

Cheol-Yu Kim(김철유),Seong-Min Moon(문성민),Kyung-Yae Hyun(현경예),Dae-Sik Kim(김대식),Seok-Cheol Choi(최석철) 한국생명과학회 2009 생명과학회지 Vol.19 No.2

비록 음주가 간손상을 일으키는 지방간의 원인이 되긴 하나 다른 인자들 역시 지방간의 원인이 된다. 우리는 알코올성 지방간(알코올군) 및 비알코올성 지방간 남성(비알코올군)에 있어 철 표지자, 심장표지자, 그리고 생화학적 표지자의 변화와 차이를 연구하였다. 알코올군이 비알코올군 보다 신체지수, 수축기 및 확장기 혈압, 좌우안압이 유의하게 더 높았다. 또한 혈색소 농도, 적혈구 용적률, 평균 적혈구 혈색소량, 평균 적혈구혈색소 농도, 단구 수 역시 알코올군이 비알코올군 보다 유의하게 더 높았다. 생화학적 지수인 alanine aminotransferase, γ-glutamyltranspeptidase, 총콜레스테롤, 중성지방, 저밀도콜레스테롤, 혈당, 크레아티닌, 요산 등도 알코올군이 비알코올군 보다 유의하게 높았고, 철 지수인 철, 총철결합능, 페리틴 농도 역시 알코올군이 의미있게 더 높았다. 이러한 결과들은 장기적인 알코올 기인성 지방간이 비음주 지방간에 비해 혈청 철농도, 심혈관 표지자, 그리고 생화학적 표지자들을 더 상승시키며, 이는 심혈관 질환 및 대사성 증후군과 같은 성인병에 노출될 가능성이 보다 높을 수 있음을 시사하고 있다. Although alcohol drinking may cause fatty liver to induce hepatocytic injury, other factors lead to it. We designed this study to investigate the differences in serum iron, cardiac, and biochemical indices in men with fatty liver and the difference between alcohol drinkers (Alcohol group) and non-drinkers (Non-alcohol group). The alcohol group had higher body indices than the non-alcohol group. Systolic and diastolic blood pressure (SBP and DBP), and right and left intraocular pressure in the alcohol group were higher than those in the non-alcohol group. Hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and monocyte counts were higher in the alcohol group than in the non-alcohol group. Alanine aminotransferase, γ-glutamyltranspeptidase, total cholesterol, triglyceride, low-density lipoprotein cholesterol, glucose, creatinine, uric acid, iron, total iron binding capacity, and ferritin levels in the alcohol group were greater than those in the non-alcohol group. The present data reveals that alcohol-induced fatty liver has more elevated level of iron indices than in non-alcohol fatty liver as well as biochemical and cardiac indices, indicating that alcohol-induced fatty liver may cause possibility of adult diseases including cardiovascular disease and metabolic syndrome.

開心術 患者의 術後 早期 右心臟 指數 및 血行動態에 關한 硏究

禹鍾守,丁晃奎 인제대학교 1986 仁濟醫學 Vol.7 No.1

저자들은 1985년 1월부터 9월까지 총 67례의 심장수술환자를 술전 Swan-Ganz Catheter을 이용하여 심장지수를 측정하고 술중, 술후 변화에 관하여 연구 관찰하였다. Nowadays the prognosis of open heart surgery is very much improved than before beginning era owing to progression of the technique of cardiopulmonary bypass, myocardial protection during operation and surgery technique. However, till now, remain many problems in the care of the postcardiac surgery patient whose heart was damaged in various aspect by exposure in special environment, so called ''operation.'' Here, author studied the right ventricular index and allied hemodynamic changes in early postcardiac surgery patient attempting to achieve more qualified postoperative care and early evaluation of postoperative improvement. The results study were summarized as follows: 1.In the preoperative examination of ASD, VSD and TOF the right ventricular indices were 4.5 ± 0.72 in ASD, 4.26±1.15 in VSD and 1.95±0.07 in TOF. In these findings, above normal ranges of ASD and VSD mean more or less left to right shunt but too much decreased TOF value means the shunt is only in the balanced level. The echocardiographic findings in various lesion of mitral valve before operation show decreased level of cardiac indices 2.23±7.97 in MS valve area less than 1.0 cm2 and 2.67±0.15 in the other valvar lesions. 2.In ASD patients the cardiac index before operation was 4.5 ± 0.72 and 36 hours after operation it decreased to the lowest level 2.6±0.67 and then increased in 72 hours to 3.0±0.56, 66.7% level of before operation (p<0.01). 3.Before surgery of VSD, the cardiac index was 4.26 ± 1.15 and in 48 hours after surgery it decreased to the lowest level 3.18±0.64 and in 72 hours it increased to 3.19±0.62, 74.9% level of before operation (p<0.01). 4.In TOF surgery, before operation the cardiac index was 1.95 ± 0.07 and 1 hour after operation it decreased lowest level after operation to 2.6±0.1 and then steadily increased till 72 hours to 3.3±0.26 but this finding didn't have any statistical significance . 5.In valve surgery patients, the cardiac index of before operation was in low normal limit 2.4±0.54 but in 6 hours after operation it increased to the lowest level after operation 2.45±0.29 and then steadily increased in 72 hours to 3.56±0.36, 145.30% level of before operation (p<0.01). 6.After surgery of VSD and valve disease there was no regular changes of cardiac indices with statistical significance in various time sequence according to the time length of cardiopulmonary bypass but in both esions the more lower level hypothermia during operation brought the lower level cardiac indices in the early postoperative period (p<0.05).

A Study on the Effect of Heart rate based Left Ventricular Global Function on the Time of Contrast Enhancement

서충범(Choong-Beom Seo),남태현(Tae-Hyun Nam),채희창(Hee-Chang Chae),김성관(Seong-Gwan Kim),서은희(Eun-Hee Seo),대창민(Chang-Min Dae) 대한CT영상기술학회 2021 대한CT영상기술학회지 Vol.23 No.1

목적: 심장 기능 지표와 조영 증강 시간 간의 일정한 상관관계가 성립하는지 알아보고 이를 통해 심장의 기능에 따른 예상 조영 증강 시간을 구하고자 하였다. 대상 및 방법: 심장 기능 평가의 적정성을 확인하기 위해 팬텀 연구를 선행하였다. 임상 연구로 CCTA를 시행한 273명의 환자들을 대상으로 조영제 주입 속도에 따라 두 그룹으로 나누어 다양한 심장 기능을 측정하고 조영 증강 시간를 비교하는 후향적 연구를 진행하였다. 심장 기능 지표는 심박동수, 심박출량, 심장박출지수, 초당 심장박출지수, 좌심실 구혈률, 심박동수에 따른 초당 좌심실 구혈률을 사용하였다. 결과: 팬텀 연구에서 ECG 동조 관전류 변조로 측정한 용적의 변화율은 0.1 % 이하로 심장 기능 측정의 적정성을 확인하였다. 후향적 연구 결과 심장의 기능을 나타내는 지표들 중 심박동수에 따른 초당 좌심실 구혈률이 조영 증강 시간과 명확한 음의 상관관계(P<0.01)를 나타내고 가장 높은 신뢰도를 나타냈다. 이를 통해 조영 증강 시간과의 상관관계에서 회귀식을 통해 예상 조영 증강 시간을 도출하였으나 회귀식은 성립하지 않았다. 결론: 조영 증강 시간과 심박동수에 따른 초당 좌심실 구혈률은 명확한 상관관계를 가지나 다양한 인자의 복합적인 상호작용으로 이루어지는 조영 증강 시간을 심장의 기능만으로 예측할 수는 없었다. 추후 체내 순환 인자들의 영향에 대한 연구가 지속된다면 환자의 상태를 기반으로 한 조영 증강 검사가 가능할 것으로 사료된다. Purpose: It was intended to find out whether a constant correlation between the cardiac function and the contrast enhancement time was established and to obtain the estimated contrast enhancement time according to the cardiac function. Material and Method: A phantom study was preceded to verify the adequacy of cardiac function evaluation. A retrospective study of 273 patients who performed CCTA was conducted to measure cardiac function and compare contrast enhancement time. Cardiac functional indicators used Heart Rate, Cardiac Output, Cardiac Index, Cardiac Index per second, Left Ventricular Ejection Fraction, and Left Ventricular Ejection Fraction per second based on heart rate. Results: In the phantom study, the change rate of volume measured by ECG based tube current modulation was less than 0.1%. A retrospective study found the Left Ventricular Ejection Fraction per second based on heart rate showed a clear negative correlation with contrast enhancement time (P<0.01) and the highest reliability. Through this, the expected contrast enhancement time was derived from the regression equation in correlation with the contrast enhancement time, but the regression equation was not established. Conclusions: The contrast enhancement time and Left Ventricular Ejection Fraction per second based on heart rate were clearly correlated, but the contrast enhancement time, which consists of the complex interactions of various factors, could not be predicted by the cardiac function alone. If the study of the effects of circulating factors in the body continues, it is believed that contrast enhanced CT based on the patient s condition will be possible.

실험연구 : 출혈성 쇼크에서 Phenylephrine이 심장작업수행능력과 심근산소균형에 미치는 영향

황병현 ( Byung Hyun Hwang ),홍성진 ( Sung Jin Hong ),전순신 ( Soon Shin Jeon ),최진환 ( Jin Hwan Choi ),이해진 ( Hae Jin Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5

Background: The issue of using phenylephrine in hemorrhagic shock treatment has been controversial because it is known that phenylephrine improves the tissue perfusion by increasing arterial blood pressure but deteriorates the myocardium by increasing afterload and decreasing myocardial oxygen delivery via coronary vasoconstriction. This study was aimed to assess the effects of phenylephrine on hemodynamic variables, cardiac performance, and myocardial oxygen balance in resuscitation from hemorrhagic shock. Methods: Twenty anesthetized dogs were randomly divided into phenylephrine group and control group. After inducing hemorrhagic shock, resuscitation was done with phenylephrine and 0.9% normal saline respectively. We measured hemodynamic indices, blood gas parameter and cardiac enzymes which indicate myocardial demage. Results: In both groups, cardiac output and hemodynamic indices improved. In phenylephrine group, the systemic oxygen delivery and consumption was much higher and the myocardial oxygen extraction ratio was maintained at the lower level than the control group. In addition, the CK-MB was higher at the early phase of resuscitation and the troponin T was also higher than the control group during the whole period of resuscitation. Creatine kinase-MB increased during early resuscitation in phenylephrine group but kept decreasing after that and there`s no difference between two groups. Troponin T was higher in the phenylephrine group after resuscitation. Conclusions: We concluded that phenylephrine improves myocardial oxygen balance and contractility without serious myocardial demage during resuscitation from hemorrhagic shock. (Korean J Anesthesiol 2007; 52: 571~7)

Potential Association of Triglyceride Glucose Index with Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus Patients

Md. Akbar,Uma Bhandari,,Anwar Habib,Razi Ahmad 대한의학회 2017 Journal of Korean medical science Vol.32 No.7

Cardiac autonomic neuropathy (CAN) is a common and most neglected complication of diabetes, estimated to be roughly 8% in recently diagnosed patients and greater than 50% in patients with chronic disease history. The insulin resistance (IR) itself is bidirectionally associated with increased risk of type 2 diabetes mellitus (T2DM) and CAN is a predisposing factor. The primary objective of the present study was aimed to find a correlation of triglyceride glucose index (TyG index) in CAN patients along with the prevalence of CAN in T2DM patients as a secondary objective. This prevalence study was conducted on 202 patients visiting the diabetic clinic of Hamdard Institute of Medical Sciences and Research, Jamia Hamdard (HIMSR) teaching hospital in New Delhi, India who fulfilled the inclusion criteria. The Ewings autonomic function test was used for diagnosis of CAN. TyG index was calculated for patients based on fasting levels of glucose and triglyceride. The CAN was diagnosed in 62 participants out of 202 T2DM patients (overall prevalence 30.7%). The mean ± standard deviation (SD) for TyG index was 10.3 ± 0.2 and 9.5 ± 0.2 in CAN positive, T2DM patients, respectively. The difference of TyG index, in CAN positive and T2DM patients, was highly significant (P < 0.001). Further correlation analysis was performed to find an association of TyG index, duration, and age with patient groups. TyG index showed a positive correlation with heart rate during deep breathing (HRD), heart rate variation during standing (HRS), blood pressure (BP) response to handgrip and BP response to standing. Our finding highlights the TyG index, low-cost IR index, might be useful as an alternative tool for the early screening of patients at a high risk of diabetic neuropathy.

Effect to Prostaglandin E₁on Heterotopic Cardiac Allografts in Rate

Yoo, Seung Jin,Hur, Eun,Lee, Yong Kak,Koh, Yong Bok CATHOLIC MEDICAL CENTER 1987 Bulletin of the Clinical Research Institute Vol.15 No.1

Organ allograft rejection is characterized by cellular infiltration of the organ, reduction in blood flow and intravascular coagulation, resulting out graft organ filure. Factors that mediate vasoconstriction and platelet aggregation have not been clearly identified, but recent works have pointed to a role for the prostaglandin-thromboxane system in the pathogenesis of acute rejection. Authors' experiment was attempted to investigate the effect of prostaglandin E_1, analogue of prostaeyclin, on heterotopic allocardiac grafts in rats. Experimental rats were divided into three groups; cardiac allograft without treatment, (control group), cardiac allograft with cyclosporin A (CsA group, 5mg/kg/day intramuscularly) and cardiac allograft with prostaglandin E_1, (PGE_1, group, 1mg/kg/day intraperitoneally). All experimental rats were observed for 7 days because most of cardiac allograft without treatment cease beat within 7 days after transplantation. 1. Nine out of 10 control and 2 out of 10 PGE_1 rats ceased beats within postransplant 7th day, but all cardiac allografts of CsA group were beating during experimental period. 2. Lymphocyte stimulation indices of control group on 3rd posttransplant day were significantly higher than those of CsA and PGE_1 group (P < 0.05). The indices of PGE_1 group were rather higher than that of CsA group but there was no statstical significance. Lymphocyte stimulation indices of CsA group oil 7th posttransplant day were significantly lower than those of PGEI and control group (P< 0.05). The values of PGE_1, group were higher than CsA group, but lower than control group. 3. There were severe and various pathological changes consistent with rejection reaction in control group, followed by CsA goup, than PGE_1 group. The degree of interstitial edema and myocardial necrosis was less in CsA group. The finding of intravascular thromboiss was minimum in PGE_1 group comparing with the other two groups. In summary, authors found that PCE_1 exerted beneficial effect on rat cardiac allograft rejection probably through anti-thromboxane action and alteration of T-lymphocyte immune- modulation by PGE_1 -

Development of New Cardiac Deformity Indexes for Pectus Excavatum on Computed Tomography: Feasibility for Pre- and Post-Operative Evaluation

Miyoung Kim,이기열,박형주,김희영,강은영,오유환,서보경,Bo Kyung Je,Eun Jung Choi 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.3

Purpose: The aim of this study was to evaluate new cardiac deformity indexes (CDIs) for diagnosis of pectus excavatum as well as morphological assessment of heart on computed tomography (CT). Materials and Methods: We retrospectively evaluated the CT images of the control group (n=200), and the pectus excavatum before and after correction groups (n=178), and calculated the CDIs; cardiac compression index (CCI), and cardiac asymmetry index (CAI). We also calculated chest wall compression index (CWCI) and asymmetry index (CWAI) on the axial images. We performed logistic regression analysis using each index and age as predictor variables. Results: The CDIs (CCI and CAI) were significant (p < 0.05) in the diagnosis of pectus excavatum, regardless of age (p = 0.4033, p = 0.8113). The CWCI and CWAI were significant (p < 0.05) and significantly affected by age (p < 0.05). If we selected 1.82 as the cutoff of the CCI, the sensitivity and specificity were 99.4% and 98%, respectively. The following cutoffs and the sensitivity and specificity were obtained: 1.15 for the CAI gave 94.4% and 94.5%, 3.05 for the CWCI gave 92.1% and 92%, and 1 for the CWAI gave 62.4% and 65%, respectively. The CCI after repair improved from 2.83 ± 0.84 to 1.84 ± 0.33, while the CWCI improved from 4.49 ± 1.61 to 2.57 ± 0.44. Conclusion: CDIs such as the CCI and CAI may be potentially useful to detect and estimate repair for pectus excavatum.