OBJECTIVE: To assess the visualization rate and size of the cavum septum pellucidum (CSP) by transabdominal sonography in normal fetuses in the second and third trimesters of pregnancy. METHODS: The CSP was prospectively researched and measured using an axial transventricular plane in 308 consecutive uncomplicated singleton pregnancies between 15 and 41 weeks of gestation. RESULTS: The CSP was seen in 42.5% of cases at 15 weeks, 84.78% at 16-17 weeks, 100% at 18-37 weeks and 81.25% at 38-41 weeks. Compared to biparietal diameter (BPD), the visualization rate was 35.29% between 31 and 32 mm, 47.8% between 33 and 34 mm, 84% between 35 and 43 mm, 100% between 44 and 88 mm and 87.5% between 89 and 101 mm. Mean CSP width was 5.5+/-1.7 mm (range 2-9 mm). The CSP width was increased with gestational age and BPD, but with a slight decrease around term. CONCLUSION: In normal fetuses the CSP should always be visualized between 18 and 37 weeks, or with a BPD of 44-88 mm. Failure to observe the CSP in this interval, or possibly the presence of a large CSP, may indicate abnormal cerebral development and warrant further investigation. Conversely, absence of the CSP prior to 18 weeks, or later than 37 weeks, is a normal finding.
Female ; Fetus* ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy* ; Prospective Studies ; Septum Pellucidum*

BACKGROUND: Significant aortic stenosis of various underlying etiologies presents with similar clinical characteristics and is usually treated with aortic valve replacement. We performed a clinical study to evaluate the clinical characteristics, changes of echocardiographic parameters before and after aortic valve replacement in adult aortic stenosis patients. METHODS: From January 1991 through December 1995, 159 patients underwent aortic valve replacement at Sejong General Hospital. Sixty-two cases(39%) of those patients were pure or predominant aortic stenosis. We observed the clinical characteristics, etiology, operative procedure, perioperative complication and mortality, And we observed the changes of echocardiographic parameters such as mean and peak pressure gradients at aortic valve, ejection fraction, systolic and diastolic left ventricular internal dimensions, left ventricular wall thickness, left ventricular mass index retospectively at preoperative and postoperative periods regularly within 1 month, 1 yr, 3 yrs after operation(mean follow up period : 16 months, 1-36 months). RESULTS: 1) The age of patients ranged from 31 to 71 years(mean 55+/-11), and 60%(37 cases) of them were men. 2) Regarding underlying heart disease, the most common etiology of aortic stenosis was rheumatic valvular heart disease(32 cases, 52%), followed by congenital bicuspid aortic valve(16 cases, 25%) and degenerative change(14 cases,23%). 3) 44 cases(77%) of the patients had dyspnea,12 cases(19%) had chest pain, and 5 cases(8%) had history of syncope at the time of operation. Asymptomatic patient was only 1 case. 4) Seven patients(11%) had associated coronary artery disease, and only 1 case(about 2%) underwent concomitant coronary bypass surgery. 5) Post-operative complications which developed within 1 month were bleedings(8 cases, 13%), arrhythmias(7 cases, 11%) and infections(4 cases, 6%). After 1 month, bleedings related with anticoagulation were most common(7 cases, 11%). Other complications were hemolytic anemia(1 case), and aortic dissection(1 case). There was one surgery related mortality(2%) which happened during operatin due to myocardial ischemia. 6) The size of implanted prosthetic valves ranged from 19 to 25mm(mean 22+/-2mm). Larger valves(23-25mm) showed lower peak(p=0.839) and mean pressure gradients(p=0.019) than smaller valves(19-21mm). 7) We observed that peak and mean pressure gradient, left ventricular internal dimension, and left ventricular mass index had decreased significantly after aortic valve replacement. 8) The average preoperative functional class(2.3) had improved significantly at 1 month after surgery(1.2), and 1 year after surgery(1.0). CONCLUSIONS: In our series, the most common etiology of aortic stenosis was rheumatic valvular disease(52%). The incidence of combined coronary artery disease was 11%, lower than other reports. And only 1 case(2%) underwent concomitant coronary artey bypass graft surgery. The average size of implanted valves was 22mm, and the larger size had lower transaortic peak and mean pressure gradients after operation. The most common perioperative complication was bleeding and mortality rate was about 2%. Echocardiography was useful for evaluation of postoperative changes, such as transaortic peak and mean pressure gradient, left ventricular internal dimension and left ventricular mass index.
Adult* ; Aortic Valve Stenosis* ; Aortic Valve* ; Bicuspid ; Chest Pain ; Coronary Artery Disease ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Diseases ; Hemorrhage ; Hospitals, General ; Humans ; Incidence ; Male ; Mortality ; Myocardial Ischemia ; Postoperative Period ; Surgical Procedures, Operative ; Syncope ; Transplants

From March, 1992 to March, 1996, a total of 279 patients underwent coronary bypass surgery at the Sejong General Hospital, Puchon. We selected 22 patients with severe left ventricular(LV) dysfunction from them. The criteria were the presence of global or segmental abnormalities of left ventricular contraction and LV ejection fraction(EF) less than 35% based on biplane LV angiography by planimetry method. The mean age of 17 male and 5 female patients was 60+/-5.6years(range:47~73 years). All had the anginas, which were Canadian class II in 6, class III in 12 and class IV in 4. All patients except one had the history of previous myocardial infarction more than once. Seven of them had the symptoms and signs of congestive heart failure, such as dyspnea on excertion and increased pulmonary vascular markings. Their mean LVEF was 29.4+/-4 5%(range : 18~35%) and mean LV end-diastolic pressure was 18.7 +/-8. 2mmHg(range:10~42mmHg). 21 patients had 3 vessel-disease and 1 had 2 vessel-disease. Complete revascularization was tried with the use of 16 internal mammary arteries and 60 sapheuous veins and 3 radial arteries grafts. The mean number of distal anastomosis was 3.5+/-1.1. Concomitantly, one mitral valvuloplasty and annuloplasty was performed in the patient with moderate mitral regurtigation. The hospital mortality was 4.5%. During the follow-up, there were 3 late deaths. Of 18 survivors, 2 patients were lost in follow-up 24 and 27 month respectively after operation and the remaining 16 patients have bcen followed up with an average of 30.4 +/-13.4 months.15 patients had improvement with respect to angina but 8 patients still have the continuing or progressing heart failure. The 1-year, 2-year and 3-year actuarial survival rate was 85.2, 69.1, 46.1%, respectively. This study indicates that coronary artery bypass sur ery can be performed in the patients with severe LV dysfunction at acceptable risk but does not greatly contribute to the improvement of congestive heart failure.
Angiography ; Coronary Artery Bypass ; Dyspnea ; Female ; Follow-Up Studies ; Gyeonggi-do ; Heart Failure ; Hospital Mortality ; Hospitals, General ; Humans ; Male ; Mammary Arteries ; Myocardial Infarction ; Radial Artery ; Survival Rate ; Survivors ; Transplants ; Veins ; Ventricular Dysfunction, Left*

The radial artery as a graft for myocardial revascularization was introduced by Carpentier et al. in the early 1970s. Mid-term results were unfortunately discouraging, and the clinical experience with this graft was interrupted. At the end of the 1980s, these authors reproposed the same arterial conduit with more satisfying results, because of improved technique and pharmacological management of the graft. Between October 1994 and July 1995, 36 patients underwent myocardial revascularization with a radial artery graft in Sejong General Hospital. Left internal mammary artery was concomitantly used as a pedicled graft in 34 patients. Fifteen patients(42%) had a complete arterial graft revascularization. A total of 123 distal anastomoses were performed(average 3.4 per patient), including 36 left internal mammary artery grafts(two sequential in 2 patients), and 23 saphenous vein grafts. The remaining 64 distal anastomoses were performed with radial artery grafts (mean 1.8 per patient). The radial arteries were anastomosed to the circumflex(n=38), diagonal( n=18), right coronary(n=6), and left anterior descending coronary artery(n=2). The percentage of radial artery graft anastomoses(64) to the total anastomoses(123) was 52%. The radial artery was used as a single graft in 10 patients, as a sequential graft in 25 patients, and two grafts in 1 patient. Twenty patients underwent associated procedures : coronary endarterectomy(14), coronary artery patch angioplasty(4), mitral valve repair(1), and repair of ventricular septal rupture(1). One patient died of low cardiac output syndrome and the others had no perioperative myocardial infarction. There are no ischemic and functional complications in the arm or hand after removal of the radial artery. Only 1 patient required reexploration of the arm, for the hematoma evacuation, and 2 patients complained transient thumb dysesthesia of the side of the havested arm. This dysesthesia improved within one month. Postoperative angiographic controls were obtained in 11 patients(31%) postoperative 79 to 210 days(mean 126 days). The patency rate were as follows : left internal mammary artery(100%), saphenous vein(100%), and radial artery(95%). We concluded that the radial artery is useful alternative graft, but long term clinical and angiographic studies are required to dertermine whether wider application is warranted.
Arm ; Cardiac Output, Low ; Coronary Artery Bypass* ; Coronary Vessels* ; Hand ; Hematoma ; Hospitals, General ; Humans ; Mammary Arteries ; Mitral Valve ; Myocardial Infarction ; Myocardial Revascularization ; Paresthesia ; Radial Artery ; Saphenous Vein ; Thumb ; Transplants

Congenital tracheal stenosis is very rare, but it leads to life threatening obstruction in infancy and childhood. Recently, we experienced two cases of congenital tracheal stenosis, involving half of the distal trachea. We adopted slide tracheoplasty procedure proposed by Peter Goldstraw. Tracheoplasty was performed by dividing the stenosis at midpoint, incising the proximal and distal narrow segments vertically on opposite anterior and posterior surfaces, and sliding these together. On case 1, the patient is now doing well. On case 2, the patient succumbed due to anastomotic disruption at postoperative day 4.
Constriction, Pathologic ; Humans ; Trachea ; Tracheal Stenosis*

Understanding of the surgical anatomy of patients with double outlet right ventricle (DORV) is important in the planning of biventricular repair. From May 1995 to September 1996, 7 patients underwent biventricular repair for DORV with remote ventricular septal defect. There were 5 males and 2 females. Age at operation varied from 2 to 9 years(mean 3.4+/-2.7years). Preoperative diagnostic assessment was made by two-dimensional echocardiography and cardiac catheterization. Ventricular septal defect was perimembranous inlet type in all patients. Associated cardiac anomalies were pulmonary atresia in two, pulmonary stenosis in five and tricuspid chordae attachment to conal septum in five. The operations were performed intraventricular repair and pulmonary enlargement in two, REV operation in two, and Rastelli operation in three. There was no early postoperative deaths and complications. The follow-up period was from 1 month to 18months, averaging 10+/-6.1 months. In the past,we considered the Fontan operation indicative as primary choice when DORV was associated with abnormal tricuspid chordal attachment to the conal septum,but now we believe that biventricular repair is feasible for those cases by making conal flap or reattachment method. Biventricular repair has theoretic advantages because it estabilishes normal anatomy and physiology,and it was concluded that the precise preoperative evaluation using both echocardiography and cardiac catheterization was essential to the successful surgery.
Bays ; Cardiac Catheterization ; Cardiac Catheters ; Double Outlet Right Ventricle* ; Echocardiography ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart Septal Defects, Ventricular* ; Humans ; Male ; Pulmonary Atresia ; Pulmonary Valve Stenosis

Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending (LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours (mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.
Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Hospitals, General ; Humans ; Mammary Arteries ; Myocardial Revascularization ; Radial Artery ; Saphenous Vein ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Thoracoscopes ; Thoracotomy ; Transplants

In small children with left ventricular outflow tract obstruction, a few methods of surgical treatment could be considrred. The pulmonary autogrart provides a promising options for aortic valve replacement as part of the aortoventriculoplasty procedure in children. We report a successfully treated congenital aortic stcnoinsufricicncy with severe left ventricular dysfunction in an early infant with the aortoventriculoplasty using thc pulmonary autograft (the Ross-Konno procedure).
Aortic Valve ; Autografts* ; Child ; Dronabinol ; Humans ; Infant ; Transplantation, Autologous ; Ventricular Dysfunction, Left ; Ventricular Outflow Obstruction

Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a rare and complex lesion in which great morphologic variability exists regarding the sources of pulmonary blood flow. We report a case of this disease with no true central pulmonary arteries in a 9-month-old-boy successfully treated by one-stage complete unifocalization and repair from a midline sternotomy approach.
Heart Septal Defects, Ventricular* ; Pulmonary Artery ; Pulmonary Atresia* ; Sternotomy