Chin ; Humans ; Polyethylene ; Transplants

PURPOSE: To assess the regional wall motion of the left ventricle in patients with diastolic overloaded lesions of congenital heart diseases with centerline analysis and radial method. METHODS: This study included 96 children with congenital heart diseases admitted to Kyungpook National University Hospital from January 1998 to December 2002 who received left ventriculograms. The evaluation of the regional wall motion of the left ventricle was done on review mode of 30-degree elongated right anterior oblique projection of left ventriculogram by using cardiac analysis program of the DXC Hiline Digital System(GER, Paris, France). RESULTS: Compared with the control group, the left ventricular regional wall motions of patients with right ventricular diastolic overload were significantly decreased at the anterolateral portion and increased at the diaphragmatic portion with the centerline analysis method, but no differences were noted with the radial method. CONCLUSION: We confirmed left ventricular regional wall motion abnormalities in patients with right ventricular diastolic overload lesions of congenital heart diseases with the centerline method in spite of normal ejection fraction.
Child* ; Gyeongsangbuk-do ; Heart Diseases ; Heart Ventricles* ; Humans

Animals ; Bone Marrow ; Bone Regeneration ; Bone Transplantation ; Cartilage ; Cell Culture Techniques ; Fibrin Tissue Adhesive ; Lifting ; Mesenchymal Stromal Cells ; Osteogenesis ; Rabbits ; Stem Cells ; Tendons ; Tissue Engineering ; Transplants

PURPOSE: The major cause of cardiac dysfunction, after open heart surgery for congenital heart disease, is perioperative myocardial injury. Cardiac troponin I is found only within the myocardial cell, so it can be used as a biochemical marker of the myocardial injury. We performed this study to evaluate the worth of cardiac troponin I as a biochemical marker reflecting the extent of perioperative myocardial injury and recovery. METHODS: Thirty-four patients who had undergone elective open heart surgery of congenital heart disease(CHD) from April to July 2001 were enrolled in this study. We measured types of CHD, serial cardiac troponin I(baseline 1 day before operation, postoperative day 1, 2, 3, 7), duration of cardiopulmonary bypass(CPB), aortic cross clamping(ACC), intubation and postoperative hospital stay. RESULTS: Compared with the baseline before operation, there was a significant, increase of cardiac troponin I on the postoperative day 1 and a significant gradual decrease on the day 2, 3, 7. The levels of cardiac troponin I were the highest in the transposition of great artery(TGA) repair on the postoperative day 1 and high in the tetralogy of Fallot(TOF), atioventricular septal defect (AVSD), ventricular septal defect(VSD) and atrial septal defect(ASD) repair with decreasing sequence. The longer duration of CPB, ACC and intubation, the higher of cardiac troponin I, but there were no significant correlations between cardiac troponin I levels and duration of hospital stay. CONCLUSION: Because there was significant increases or decreases of cardiac troponin I according to the perioperative time and types of the congenital heart disease, it is a worthy biochemical marker which reflects the extent of perioperative myocardial injury and recovery after open heart surgery.
Biomarkers ; Heart Defects, Congenital ; Heart* ; Humans ; Intubation ; Length of Stay ; Thoracic Surgery* ; Troponin I* ; Troponin*

Exercise testing with Thallium imaging is widely used for the noninvasive evaluation of patients suspected of having coronary artery disease. However, many patients referred for stress testing connot exercise adequately for either physical or psychological reasons, and as a result may have nondiagnostic or suboptimal test results. Intravenous dipyridamole in conjunction with Thallium imaging is as effective alternative method without exercise. But, myocardial imaging using the standard scintillation camera technique(planner view) is hampered by superposition of proximal & distal cardial walls and by the segmental nature of myocardial ischemia. For this reason, Single Photon Emission Computed Tomography(SPECT) reslut in high specificity & sensitivity rates for the detection of coronar artery disease compared with conventional technique. So we performed dipyridamole Th-201 myocardial scintigraphy on 25 subjects who have suspicious angina or myocardial infarction instead of exercise Th-201 myocardial scintigraphy, and compared SPECT view with conventional plannar view. The results obtained are as follows : 1) T1-201 scintigraphic findings in 17 patients with suspicious angina were as follows ; redistribution defect was seen in 4 cases in plannar view and 13 cases in SPECT view. 2) T1-201 scintigraphic findings in 8 patients with myocardial infarction were as follows ; in planner view, perfusion defect was seen in all cases and 1 cases of them, redistribution defect was accompained, and in SPECT view, perfusion defect was seen in all cases and 6 cases of them, redistribution defect was accompained. 3) During dipyridamole infusion, the mean systolic & diatolic pressure decreased from 133+/-22.7/86+/-13.5 to 121+/-23.9/78+/-13.1mmHg and the heart rate increased from 68+/-12.4 to 84+/-12.4beats/min. 4) Adverse effects of dipyridamole were noted in 14(56%) of the subjects, but in 12 of these, the symptoms were mild in severity and subsided spontanously. To summarize, Dipyridamole-201 myocardial imaging is a useful and test for coronary artery disease, and the new tomographic technique, SPECT view, is more useful than the conventional plannar view.
Arteries ; Coronary Artery Disease ; Dipyridamole* ; Exercise Test ; Gamma Cameras ; Heart Rate ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Perfusion Imaging ; Perfusion Imaging* ; Perfusion* ; Sensitivity and Specificity ; Thallium* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. MATERIALS AND METHODS: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. RESULTS: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. CONCLUSION: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.
Amputation ; Discrimination (Psychology) ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Joints ; Male ; Nails ; Range of Motion, Articular ; Thumb ; Toes ; Transplants

Cephalometry ; Dentofacial Deformities ; Esthetics ; Humans ; Lip ; Nose ; Orthognathic Surgery ; Osteotomy ; Strikes, Employee

PURPOSE: To understand morphologic and hemodynamic variations in patients with pulmonary atresia with intact ventricular septum(PA/IVS), and to decide the best treatment modalities, we measured right ventricular volume, inflow, and outflow valvular annulus size in these patients and compared them with those of normal newborns. METHODS: Eight patients with PA/IVS diagnosed by echocardiography from January to December 2001 were enrolled in this study. Among the total eight patients, five were male and three were female. The mean age of patients was 6.9 days(1-34 days), and the mean body weight was 3,343 gm (2,970-4,000 gm). Ten fullterm newborn infants with sepsis or hyperbilirubinemia without heart disease were enrolled as a control group. Echocardiographic and Doppler studies using Acuson Aspen (7Mh probe) were recorded on super-VHS videotape and later on, with review mode. We measured volumes of right and left ventricles, aortic, pulmonic, mitral and tricuspid valvular annulus sizes using an installed program, and then these parameters were compared with those of the control group. RESULTS: Mean Z-value of tricuspid valvular annulus in PA/IVS was -3.69+/-2.80(-8.4--0.45), and tricuspid/mitral valvular annulus size ratio 0.68+/-0.15(0.43--0.84). The more the tricuspid/mitral valvular annulus size ratio, the more Z-value of tricuspid valvular annulus(P=0.003, r=0.885). Those patients who underwent pulmonary valvuloplasty(balloon or surgical) had a tendency toward larger volume of the right ventricle, more Z-value of pulmonic and tricuspid valvular annulus, and more tricuspid/mitral valvular annulus size ratio than those patients who underwent a shunt operation. CONCLUSION: Compared to a measurement of the volume of the right ventricle, measurements of tricuspid/mitral valvular annulus size ratio and Z-value of tricuspid valvular annulus may be easier and better parameters to decide the treatment method and to predict prognosis in PA/IVS patients.
Body Weight ; Echocardiography* ; Female ; Heart Diseases ; Heart Ventricles ; Hemodynamics ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Male ; Prognosis ; Pulmonary Atresia* ; Sepsis ; Videotape Recording

PURPOSE: This study was undertaken to learn the usefulness, cost-effectiveness and safety of intraoperative transesophageal echocardiography(ITEE) during open heart surgery for congenital heart diseases. METHODS: The usefulness and safety of ITEE were assessed in 254 patients who underwent open heart surgery for congenital heart diseases from January 1, 2001 to June 30, 2003, with retrospective chart reviews and a simple relative cost analysis. RESULTS: Among 254 open heart surgery patients, ITEE was not performed in 47 cases. The majority of cases were atrial septal defect(15 cases, 32%), ventricular septal defect(16 cases, 34%), ASD and VSD(three cases, 6.4%). In the other five smaller babies(weight range 2.7-3.1 kg), the ITEE probes couldn't pass the patient's esophagus. In 207 cases, ITEE were performed without any major complications. Residual abnormalities were identified by ITEE in six cases(2.9%), requiring surgical revisions : four cases with right ventricular outflow tract pressure gradient, one case of residual mitral regurgitation and one case of residual aortic stenosis and supravalvular pulmonary stenosis. If these six cases had not directly returned to bypass for surgical revision of the initial repair at the same operation, the additional fee of reoperation after leaving operation room were estimated to be won47,496,346(won7,916.057 per patient). In contrast, the costs of performing ITEE in all open heart surgical patients(207 patients) stood to total won82,800,000(won400,000 per patient). CONCLUSION: ITEE was not considered to be a beneficial diagnostic modality in terms of cost effectiveness in this study. But, the routine use of ITEE during most open heart surgery for congenial heart defects may be warranted as it produces no major complication, improves postoperative care, and comforts surgeon's feelings.
Aortic Valve Stenosis ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Echocardiography, Transesophageal* ; Esophagus ; Fees and Charges ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Mitral Valve Insufficiency ; Postoperative Care ; Pulmonary Valve Stenosis ; Reoperation ; Retrospective Studies ; Thoracic Surgery

PURPOSE: Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. METHODS: From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. RESULTS: Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times (P<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer (P<0.05), the mortality rate was not significantly different among the 2 groups. CONCLUSION: Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.
Accelerated Idioventricular Rhythm ; Arrhythmias, Cardiac ; Arteries ; Body Weight ; Cardiopulmonary Bypass ; Child ; Heart ; Heart Diseases ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Retrospective Studies ; Risk Factors ; Tachycardia, Ectopic Junctional ; Thoracic Surgery ; Ventilators, Mechanical