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The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery
손관협,신대희,변경민,한혜진,조수진,송영빈,김준형,온영근,김준수 대한심장학회 2009 Korean Circulation Journal Vol.39 No.3
Background and Objectives: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. Subjects and Methods: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. Results: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. Conclusion: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates. Background and Objectives: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. Subjects and Methods: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. Results: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. Conclusion: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.
하대정맥 중절과 다비장증을 동반한 좌이성체에서 대동맥축착 1예
손관협,변경민,한혜진,김학진,최진오,이상철,박승우 한국심초음파학회 2007 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.15 No.1
A 27-year-old female visited outpatient clinic for the evaluation of palpitation and dyspnea on exertion. Echocardiographic examination including transthoracic and transesophageal echocardiography revealed coarctation of aorta, bicuspid aortic valve, mitral valve prolapse, and sealed-up ventricular septal defect. Further evaluation with computed tomography angiography revealed another combined congenital anomaly of left isomerism with polysplenism and interrupted inferior vena cava and pulmonary embolism with deep vein thrombosis. After corrective surgery for the coarctation, she received anticoagulation therapy for the treatment and the secondary prevention of pulmonary embolism.
손관협,양정훈,최승혁,송영빈,한주용,최진호,권현철,이상훈 대한의학회 2014 Journal of Korean medical science Vol.29 No.11
We aimed to investigate that complete revascularization (CR) would be associated with adecreased mortality in patients with multivessel disease (MVD) and reduced left ventricularejection fraction (LVEF). We enrolled a total of 263 patients with MVD and LVEF < 50%who had undergone percutaneous coronary intervention with drug-eluting stent betweenMarch 2003 and December 2010. We compared major adverse cardiac and cerebrovascularaccident (MACCE) including all-cause death, myocardial infarction, any revascularization,and cerebrovascular accident between CR and incomplete revascularization (IR). CR wasachieved in 150 patients. During median follow-up of 40 months, MACCE occurred in 52(34.7%) patients in the CR group versus 51 (45.1%) patients in the IR group (P = 0.06). After a Cox regression model with inverse-probability-of-treatment-weighting usingpropensity score, the incidence of MACCE of the CR group were lower than those of the IRgroup (34.7% vs. 45.1%; adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI],0.44-0.95, P = 0.03). The rate of all-cause death was significantly lower in patients withCR than in those with IR (adjusted HR, 0.48; 95% CI, 0.29-0.80, P < 0.01). In conclusion,the achievement of CR with drug-eluting stent reduces long-term MACCE in patients withMVD and reduced LVEF.
한혜진,최진오,손관협,변경민,김윤정,최진호,박승우 한국심초음파학회 2008 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.16 No.4
A 69-year-old man was admitted to undergo percutaneous coronary intervention (PCI) for chronic total occlusion of right coronary artery. He had diabetes mellitus, stable angina pectoris. Diagnostic coronary angiography demonstrated proximal total occlusion of right coronary artery. PCI was failed due to failure of balloon passage. Echocardiography was performed after PCI and thickened epicardial tissue at right atrioventricular groove was noted. It was highly echogenic and localized along the course of mid right coronary artery. In following echocardiogram after 12 days, the size of echogenic mass was decreased from 3.4 cm×2.6 cm to 1.7 cm×0.7 cm and we could conclude it was right coronary artery hematoma associated with PCI. A 69-year-old man was admitted to undergo percutaneous coronary intervention (PCI) for chronic total occlusion of right coronary artery. He had diabetes mellitus, stable angina pectoris. Diagnostic coronary angiography demonstrated proximal total occlusion of right coronary artery. PCI was failed due to failure of balloon passage. Echocardiography was performed after PCI and thickened epicardial tissue at right atrioventricular groove was noted. It was highly echogenic and localized along the course of mid right coronary artery. In following echocardiogram after 12 days, the size of echogenic mass was decreased from 3.4 cm×2.6 cm to 1.7 cm×0.7 cm and we could conclude it was right coronary artery hematoma associated with PCI.