No abstract available.
Aortic Coarctation* ; Stents*

Transcatheter closure of atrial septal defects has become a popular procedure. The availability of a preprocedural imaging study is crucial for a safe and successful closure. Both the anatomy and morphology of the defect should be precisely evaluated before the procedure. Three-dimensional (3D) echocardiography and cardiac computed tomography are helpful for understanding the morphology of a defect, which is important because different defect morphologies could variously impact the results. During the procedure, real-time 3D echocardiography can be used to guide an accurate closure. The safety and efficiency of transcatheter closures of atrial septal defects could be improved through the use of detailed imaging studies.
Echocardiography ; Echocardiography, Three-Dimensional ; Heart Septal Defects, Atrial* ; Tomography Scanners, X-Ray Computed ; Vascular Access Devices

Ventricular septal defects (VSDs) are the most common kind of congenital heart disease and, if indicated, surgical closure has been accepted as a gold-standard treatment. However, as lessinvasive methods are preferred, percutaneous device closure has been developed. After the first VSD closure was performed percutaneously by Lock in 1988, both techniques and devices have developed consistently. A perventricular approach for closure of muscular VSD in small patients and the closure of perimembranous VSD using off-label devices are key remarkable developments. Even though the Amplatzer membranous VSD occluder (Abbott) could not be approved for use due to the high complete atrioventricular conduction block rate, other new devices have shown good results for closure of perimembranous VSDs. However, the transcatheter technique is slightly complicated to perform, and concerns about conduction problems after VSD closure with devices remain. There have been a few reports demonstrating successful closure of subarterial-type VSDs with Amplatzer devices, but long-term issues involving aortic valve damage have not been explored yet. In conclusion, transcatheter VSD closure should be accepted as being as effective and safe as surgery but should only be performed by experienced persons and in specialized institutes because the procedure is complex and requires different techniques. To avoid serious complications, identifying appropriate patient candidates for device closure before the procedure is very important.

PURPOSE: Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease. MATERIALS AND METHODS: Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected. RESULTS: The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2+/-6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs. CONCLUSION: The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.
Child ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Occlusion ; Coronary Vessels* ; Humans ; Methods ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Perfusion* ; Transplants

Purpose: In this study, we examined change in the number of cataract surgeries from 2013 to 2018, since the implementation of institutional changes in 2012, and the introduction of diagnosis-related groups (DRGs) and a gradual reduction in selective-medical expenses from 2014. Methods: Based on data from the main surgery statistical yearbook provided by the Korea National Health Insurance Service (KNHIS), we extracted the number of cataract surgeries nationwide by year from 2013 to 2018. Data were divided by sex, age, regions, and level of healthcare providers in an effort to understand changes that occurred in the number of cataract surgeries and the reasons for these changes. Statistical analysis was carried out using joint point regression. Results: The total number of cataract surgeries per 100,000 people increased by 32.9% over the six-year period, with an annual average increase of 5.9%. Females (58.0-59.2%) had more cataract surgeries than males (40.8-42.0%). Additionally, the number of cataract surgeries per 100,000 people rose over the six-year time frame for those aged under 40 years, and for those in their 40s, 50s, and 60s. In terms of regions and patients’ residence, urban areas such as Seoul, Pusan, and Daegu showed an increase in surgeries performed; most provinces, however, with the exception of Jeju Island, indicated a relative decline in cataract surgeries. There was no difference in the number of cataract surgeries performed over the six-year period in terms of the level of healthcare providers. Conclusions The number of cataract surgeries per 100,000 people rose over the six-year period between 2013 and 2018. By region, an increasing trend was observed in urban areas; however, the level of the healthcare providers did not appear to have an effect on the number of cataract surgeries performed.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the balloon occlusive diameter (BOD) of non-circular defects in the transcatheter closure of atrial septal defect (ASD). SUBJECTS AND METHODS: A total of 67 patients who had undergone transcatheter closure of an ASD were reviewed retrospectively. A non-circular defect was defined as the ratio of the short diameter to the long diameter of the defect on the en-face image less than 0.75. The BOD was compared with the long diameter of the defect and then compared between the two groups. RESULTS: There were 22 patients with circular defects and 45 patients with non-circular defects. The difference in BOD measuring from the long diameter of the defect was quite different between the two groups and significantly smaller in non-circular morphology (0.1+/-4.0 vs. 2.3+/-2.1, p=0.006). The difference in BOD measurement from the long diameter of ASD showed a positive correlation with the ratio of the short diameter to the long diameter of ASD (b/a) (r2=0.102, p=0.008). In the non-circular morphology of ASD, the difference in BOD measured from the long diameter had a significant negative correlation with the long diameter of ASD (r2=0.230, p=0.001), whereas in circular ASD, no significant correlation was found between the difference in BOD and the long diameter of ASD (p=0.201). CONCLUSION: The BOD compared with the long diameter measured from three-dimensional transesophageal echocardiography was smaller in non-circular ASD than in circular ASD. This difference was much smaller in non-circular ASD with a large long diameter.
Balloon Occlusion ; Echocardiography, Transesophageal ; Echocardiography, Three-Dimensional ; Heart Septal Defects, Atrial* ; Humans ; Retrospective Studies ; Septal Occluder Device*

BACKGROUND AND OBJECTIVES: While the off-label use of implantable medical devices for treating congenital heart disease is not uncommon, the present conditions and outcomes of their off-label use have rarely been described. Therefore, this study evaluated the prevalence and results of using implantable devices off-label to treat congenital heart disease at a single institute. SUBJECTS AND METHODS: This was a retrospective study based on the medical records of catheter-based interventions for congenital heart disease performed from July 1, 1995 to June 1, 2015. The inclusion criterion was the off-label use of an implantable device. Patient demographic data, procedural success, and follow-up status regarding late complications were investigated, and the results of the off-label use of each device were compared. RESULTS: Off-label use occurred in 144 of 1730 interventions with device implantation, accounting for 8.3% of the interventions. The median patient age and mean body weight were 51.0 months and 16.3 kg, respectively. Immediate and late failures were found in 9 cases, and 3 cases of mortality were not directly related to the devices used. The overall success rate was 93.8%. There were no long-term complications of the off-label use of occlusion devices. No procedural failures resulted from stent implantation, but one case of stent malposition and two cases of stent fracture were identified after procedure completion. CONCLUSION: In general, the off-label use of implantable devices for treating congenital heart disease is safe and effective.
Body Weight ; Follow-Up Studies ; Heart Defects, Congenital* ; Humans ; Medical Records ; Mortality ; Off-Label Use* ; Prevalence ; Retrospective Studies ; Stents

PURPOSE: For the successful completion of transcatheter closure of atrial septal defects with the Amplatzer septal occluder, shape of the defects should be considered prior to selecting the device. The purpose of this study is to evaluate the results of a transcatheter closure of oval shaped atrial septal defect. MATERIALS AND METHODS: From November 2009 until November 2011, cardiac computed tomography was performed on 69 patients who needed a transcatheter closure of atrial septal defect. We defined an oval shaped atrial septal defect as the ratio of the shortest diameter to the longest diameter < or =0.75 measured using computed tomography. A trans-thoracic echocardiogram was performed one day after and six months after. RESULTS: The transcatheter closure of atrial septal defect was performed successfully in 24 patients in the ovoid group and 45 patients in the circular group. There were no serious complications in both groups and the complete closure rate at 6 months later was 92.3% in the ovoid group and 93.1% in the circular group (p>0.05). The differences between the device size to the longest diameter of the defect and the ratios of the device size to the longest diameter were significantly smaller in the ovoid group (1.8+/-2.8 vs. 3.7+/-2.6 and 1.1+/-0.1 vs. 1.2+/-0.2). CONCLUSION: Transcatheter closure of an oval shaped atrial septal defect was found to be safe with the smaller Amplatzer septal occluder device when compared with circular atrial septal defects.
Echocardiography ; Heart Septal Defects, Atrial/pathology/*surgery ; Humans ; Middle Aged ; Postoperative Complications ; Republic of Korea ; Retrospective Studies ; Septal Occluder Device/*adverse effects ; Tomography, X-Ray Computed ; Treatment Outcome

Brugada syndrome is a rare channelopathy associated with the SCN5A gene that causes fatal ventricular arrhythmias. This case of Brugada syndrome, in which ventricular tachycardia (VT) was provoked by high fever, is the first report in a Korean child. The boy had retinoblastoma of his left eye diagnosed at 16 months of age. After chemotherapy, he contracted a catheter-related infection with a high fever up to 41degrees C leading to monomorphic VT. This was characterized as having right bundle branch block morphology, superior axis deviation, and a heart rate of 212/min. Direct current cardioversion recovered the VT to sinus rhythm after a lack of response to amiodarone and lidocaine. A second attack of VT that was not controlled by cardioversion, however, responded to lidocaine. The baseline electrocardiogram showed a long PR interval and QRS duration, and the patient's grandfather had a history of Brugada syndrome. A mutation in SCN5A was identified in this patient, his father, and his grandfather. The patient was treated with quinidine and followed up for 1 year.
Amiodarone ; Arrhythmias, Cardiac ; Axis, Cervical Vertebra ; Brugada Syndrome* ; Bundle-Branch Block ; Catheter-Related Infections ; Channelopathies ; Child ; Drug Therapy ; Electric Countershock ; Electrocardiography ; Fathers ; Fever ; Heart Rate ; Humans ; Lidocaine ; Male ; Quinidine ; Retinoblastoma ; Tachycardia, Ventricular*

A healthy 8 year old boy was referred to our hospital because of cardiomegaly on the chest X ray. No cardiac murmur was detected on chest examination and normal sinus rhythm was checked by electrocardiogram. The 2-D echocardiogram showed a huge dilated right atrium and a normal tricuspid valve and right ventricle. The findings of cardiac angiogram and MRI was compatible with the isolated giant right atrial aneurysm. For the prevention of atrial arrhythmia and thromboembolism, he underwent successful surgical reduction of the right atrium and cryoablation and the follow-up X ray showed no cardiomegaly.
Aneurysm* ; Arrhythmias, Cardiac ; Cardiomegaly ; Child ; Cryosurgery ; Electrocardiography ; Follow-Up Studies ; Heart Atria ; Heart Murmurs ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Male ; Thorax ; Thromboembolism ; Tricuspid Valve