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현민수(Min Su Hyon),강덕현(Duk Hyun Kang),고광곤(Kwang Kon Koh),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Sik Choi),서정돈(Jung Don Seo),이영우(Young Woo Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.5
N/A We reviewed the patients who were diagnosed as infective endocarditis from January 1984 to September 1988, The total number of patients was one hundred and sixteen. Seventy-six were male and forty were female. The mean age was 37.5 years. Rheumatic heart disease was the most common predisposing heart disease with fifty-five cases l47.4%), followed by congenitai heart disease with eighteen cases (15.5%), prosthetic valve endocarditis with sixteen (18.8%) and cardiac pacemaker with one case. Culture was positive in sixty-eight cases (58.6%). Alpha hemolytic streptococci were the most commonly isolated micrroorganisms (51.5%), followed by S. aureus (16.2%). Fungus was also isolated (1case). Vegetations were found in seventy-nine cases an echocardiographic examination (68.1%). These were found more frequently on the aortic valve (48.1%) than on the mitral valve (32.9%). Fifty-nine cases (50.8%) developed congestive heart failure and twenty-seven cases (23.3%) had embolic complications. Out of 116 patients, 27 died and the overall mortality was 23.3%. Main causes of death were congestive heart failure and embolic complications. Surgical traeatment was performed in thirty-nine patients (33.6%). Operation was indicated more frequently in patients with prosthetic valve endocarditis ar in patients with vegetation.
승모판협착증에서 운동능력을 결정하는 혈역학적인 인자 ; Exercise Doppler Echocardiography 를 이용한 연구
송재관(Jae Kwan Song),강덕현(Duk Hyun Kang),이철환(Cheol Hwan Lee),이상곤(Sang Gon Lee),정상식(Sang Sig Cheong),홍명기(Myeong Ki Hong),김재중(Jae Joong Kim),박성욱(Seong Wook Park),박승정(Seung Jung Park),이종구(Jong Koo Lee) 대한내과학회 1996 대한내과학회지 Vol.51 No.5
N/A Objectives: Objective assessment of degree of functional impairment in patients with valvular heart disease is crucial in the clinical decision-making. The present study was designed to examine the use of formal exercise testing in the evaluation of mitral stenosis (MS) ancl to determine hemodynamic factors associated with exercise tolerance in patients with MS. Methods: In 37 patients with MS (26 females, age of 51±10yrs), Doppler measurement of transmitral gradient (MG) and pressure gradient between right ventricle and atrium using turbulent jets of tricuspid regurgitation (PGTR) was performed before and immediately after maximum symptom-limited treadmill exercise (EX) according to Bruce protocol. Results: Mean mitral valve area (MVA) was 0.97±0.33㎠ (0.5-1.9) and number of patients with severe MS (MVA<1.0㎠) were 25/37. TR was present in 35/37 at rest and immediately after EX, PGTR could be measured in 86% (32/37). Mean EX time was 422±188 sec (112-760) and MG increased from 11±5 to 27±10mmHg (p<0.001) and PGTR form 31±13 to 61±30mmHg (p<0.001). Using a linear regression, factors associated with prolonged EX time were male gender, increased mobility of leaflet, low MG, small pre- and post-EX TR jets, low pre-and post-EX PGI'R, and appropriate increase of heart rate during EX; among them, low post-EX PGTR (p=0.000) and heart rate increase with EX (p=0.005) were the significant independent factors. In patients with tight MS with average MVA of 0.8±0.15㎠, the range of PGTR increase with EX was from 10 to 100mmHg. Patients with post-EX PGTR more than 60mmHg had larger jets of TR at rest, and higher basal MG and pre-EX PGTR compared to the others. Conclusion: Exercise Doppler echocardiography is technically simple and an important addition to the noninvasive evaluation of patients with MS. Increase of PGTR with EX rather than MVA at rest per se is the important determining factors for EX capacity in patients with MS, and it can be predicted by severity of TR at rest and pre-EX PGTR.
증례 : 대동맥 벽내혈종에서 발생한 국소 대동맥 박리증 치료를 위한 Stent-graft 삽입 1예
이명준 ( Myung Zoon Yi ),안정민 ( Jung Min An ),한송이 ( Song Yi Han ),강덕현 ( Duk Hyun Kang ),윤현기 ( Hyun Gi Yun ),송재관 ( Jae Kwan Song ) 대한내과학회 2006 대한내과학회지 Vol.71 No.2
Aortic intramural hematoma, a variant form of classic aortic dissection, has been accepted as an increasingly recognized and potentially fatal entity of acute aortic syndrome. Although favorable clinical course and resorption of hematoma has been reported with medical treatment, it can progress to development of typical aortic dissection in a localized aortic segment. The standard treatment option for this lesion has not been established. We report a case of a 50 year-old male who developed localized aortic dissection during medical treatment for distal aortic intramural hematoma and was successfully treated with a stent-graft.(Korean J Med 71:203-207, 2006)
김민규(Min Kyu Kim),송재관(Jae Kwan Song),강덕현(Duk Hyun Kang),이재환(Jae Hwan Lee),조윤행(Yoon Haeng Cho),박경하(Kyoung Ha Park),고관호(Kwan Ho Ko),윤영진(Young Jin Yoon),김재중(Jae Joong Kim),박성욱(Seong Wook Park),박승정(Seung J 대한내과학회 2000 대한내과학회지 Vol.58 No.1
N/A Background : We sought to analyze the recent trends and clinical outcomes of infective endocarditis in Korea using newly proposed diagnostic criteria, Duke criteria, for this potentially life-threatening disease. Methods : Retrospective analysis of medical records including echocardiographic data, blood culture and operation records was done for 156 patients (male 103) with clinical diagnosis of infective endocarditis at Asan Medical Center from 1989 to January 1998. Results : One hundred eighteen patients (75%) fulfilled the criteria for definite group (Group I) in Duke criteria, whereas 38 patients (25%) for possible group (Group II). Mean age was 48±16 years. Although valvular heart disease was the most common underlying heart disease (49/156, 31%), in more than half (84/156, 54%) infective endocarditis was the first clinical presentation without previous medical history of any cardiac disease. Surgical intervention was required in 69 patients (44%), and the frequency of surgery during hospital course did not show any difference in Group I versus Group II (44% vs. 45%). Overall mortality was 17%, and did not show any difference in Group I versus Group II. Surgical mortality was 12% (8/69), which was not significantly different form mortality with medical treatment (21%, 18/87). Among 98 survivors in Group I, 84 patients (86%) were followed for average 34±24 months (0.5∼98 months). Five-year survival and event-free survival rate were 85±7 % and 57±8 % respectively. Conclusion : Recently the mean age of patients with infective endocarditis increased dramatically, and infective endocarditis could be an initial clinical presentation without any previous medical history of cardiac disease in many patients. Surgical intervention was needed in considerable numbers of patients and infective endocarditis still shows relatively high mortality. There were no significant different clinical features in Group I and II.(Korean J Med 58:28-38, 2000)
좌심방이 혈전을 동반한 승모판 협착증 환자에서 풍선판막성형술 : 경구항응고 요법과 경식도 초음파의 역할
정상식(Sang Sig Cheong),박승정(Seung Jung Park),송재관(Jae Kwan Song),홍명기(Myeong Ki Hong),강덕현(Duk Hyun Kang),김재중(Jae Joong Kim),박성욱(Seong Wook Park),이종구(Jong Koo Lee) 대한내과학회 1996 대한내과학회지 Vol.50 No.6
N/A Objectives: The presence of left atrial thrombi is believed to be a contraindication to balloon dilatation in mitral stenosis. The purpose of this study is to determine whether balloon valvuloplasty is possible in mitral stenosis patients with left atrial thrombi after oral anticoagulation therapy and to evaluate the evolution of left atrial thrombi with oral anticoagulation by transesophageal echocardiography. Methods: Prospective oral anticoagulation with warfarin has been started in tight mitral stenosis with left atrial thrombi. Regular follow up has been performed by transesophageal echocardiography to determine whether the left atrial appendage thrombi are resolved. Percutaneous balloon valvuloplasty has been performed after resolution of left atrial appendage thrombi with oral anticoagulation. Results: Fourteen patients were included in this study period. Nine patients(64%) had been performed balloon valvuloplasty after average 8month oral anticoagulation. Mitral valve replacement had been performed in 3(21%) patients due to renal embolism, menorrhagia and no change of left atrial appendage thrombi. There are two cases in decreasing thrombi size with oral anticoagulation, Conculsion: Left atrial appendage thrombi in mitral stenosis could be resolved in a high proportion after oral anticoagulation treatment, which has been followed by transesophageal echocardiography. Percutaneous mitral halloon valvuloplasty could be safe and effective treatment modality despite of the presence of left atrial appendge thrombi after oral anticoagulation therapy.