Bucheon, South Korea
Bucheon, South Korea

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Hahn J.-Y.,Sungkyunkwan University | Song Y.B.,Sungkyunkwan University | Kim E.K.,Sungkyunkwan University | Yu C.W.,Seoul National University | And 14 more authors.
Circulation | Year: 2013

BACKGROUND - : Ischemic postconditioning has been reported to reduce infarct size in patients with ST-segment-elevation myocardial infarction. However, cardioprotective effects of postconditioning have not been demonstrated in a large-scale trial. METHODS AND RESULTS - : We performed a multicenter, prospective, randomized, open-label, blinded end-point trial. A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction within 12 hours after symptom onset were randomly assigned to the postconditioning group or to the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow as follows: The angioplasty balloon was positioned at the culprit lesion and inflated 4 times for 1 minute with low-pressure (<6 atm) inflations, each separated by 1 minute of deflation. The primary end point was complete ST-segment resolution (percentage resolution of ST-segment elevation >70%) measured at 30 minutes after PCI. Complete ST-segment resolution occurred in 40.5% of patients in the postconditioning group and 41.5% of patients in the conventional PCI group (absolute difference, -1.0%; 95% confidence interval, -8.4 to 6.4; P=0.79). The rate of myocardial blush grade of 0 or 1 and the rate of major adverse cardiac events (a composite of death, myocardial infarction, severe heart failure, or stent thrombosis) at 30 days did not differ significantly between the postconditioning group and the conventional PCI group (17.2% versus 22.4% [P=0.20] and 4.3% versus 3.7% [P=0.70], respectively). CONCLUSION - : Ischemic postconditioning did not improve myocardial reperfusion in patients with ST-segment-elevation myocardial infarction undergoing primary PCI with current standard practice. CLINICAL TRIAL REGISTRATION - : URL: http://clinicaltrials.gov. Unique identifier: NCT00942500. © 2013 American Heart Association, Inc.

Lee C.,Sejong General Hospital | Kim S.H.,Seoul National University | Choi S.-H.,Seoul National University | Kim Y.J.,Seoul National University
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: Glutaraldehdye (GA)-fixed xenografts are widely used in cardiovascular surgery. The objective of this study was to evaluate the anticalcification effect of glycine treatment and high-concentration GA fixation in organic solvent on GA-fixed bovine pericardium, and to evaluate the possible synergistic effect of combined treatment. Methods: Bovine pericardial tissues were divided into four groups according to the methods of treatment. Group 1 consisted of tissues fixed with 0.5% GA (control), group 2 fixed with 0.5% GA and post-treated with glycine, group 3 fixed with 2% GA in organic solvent (65% ethanol+5% octanol), and group 4 fixed with 2% GA in organic solvent and post-treated with glycine. The material characteristics of the treated tissues were assessed by amino acid analysis, thermal stability test, uniaxial mechanical test and light microscopy. The tissues were subcutaneously implanted into 4-week-old rats for 8 weeks, and the calcium contents of the explanted tissues were measured. Results: Differently treated tissues resulted in no significant alterations in material characteristics and morphology as assessed by amino acid analysis, thermal stability test, uniaxial mechanical test, and light microscopy. Median calcium contents of groups 1, 2, 3, and 4 were 80.5μgmg-1, 1.0μgmg-1, 0.5μgmg-1 and 1.7μgmg-1, respectively. The calcium contents of groups 2, 3 and 4 were all significantly lower than that of group 1 (p<0.05). Conclusions: Post-fixation treatment with glycine, high-concentration GA fixation in organic solvent and combined treatment of these all strongly prevented calcification of GA-fixed bovine pericardium in rat subcutaneous implantation model. © 2010 European Association for Cardio-Thoracic Surgery.

Park C.S.,Sejong General Hospital | Lee J.R.,Seoul National University | Lim H.-G.,Seoul National University | Kim W.-H.,Seoul National University | Kim Y.J.,Seoul National University
European Journal of Cardio-thoracic Surgery | Year: 2010

Objective: The objective of this study was to evaluate the long-term outcome of total repair for tetralogy of Fallot. Methods: Between April 1986 and December 2007, a total of 734 patients underwent total repair for tetralogy of Fallot. There were 444 males and 290 females. The median age and weight were 17.2 months (0.4-329.6 months) and 9.5. kg (2.6-53.5. kg). The median follow-up duration was 150.2 months (1.9-356.2 months). Results: There were 27 early deaths (3.7%) and 13 late deaths. A longer cardiopulmonary bypass time and the use of total circulatory arrest were risk factors for early death. The overall survival rate was 94.8%, 92.8% and 92.8% at 10, 20 and 25 years, respectively. The presence of pulmonary atresia was a risk factor for long-term survival. Re-operation or re-intervention was required in 224 patients (31.7%). The most common causes of re-operation or re-intervention were pulmonary regurgitation in 109 patients and branch pulmonary artery stenosis in 127 patients. Freedom from re-operation or re-intervention rate was 81.5%, 68.9% and 46.6% at 5, 10 and 20 years, respectively. Reconstruction of the right ventricular outflow tract with other than non-trans-annular repair and branch pulmonary arterioplasty at the time of total repair were the risk factors for late re-operation or re-intervention. The use of a monocusp patch was not associated with early mortality or re-operation. At the latest follow-up, most patients were in the New York Heart Association functional class 1 or 2. Conclusions: The long-term outcome of total repair for tetralogy of Fallot was satisfactory. A longer cardiopulmonary bypass time and the use of deep hypothermic circulatory arrest were associated with early mortality. The patients with pulmonary atresia have poorer late survival. Preservation of the pulmonary annulus can reduce the re-operation rate. A small pulmonary artery that requires augmentation may increase the risk of re-operation. The use of a monocusp in patients who underwent trans-annular repair has no benefit for early survival, the postoperative recovery and avoidance of re-operation. Age was not a risk factor for early mortality and re-operation. © 2010.

Relief of right ventricular (RV) outflow tract obstruction in tetralogy of Fallot or similar physiology often results in pulmonary regurgitation (PR). The resultant chronic volume overload can lead to RV dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias and sudden death. Although pulmonary valve replacement (PVR) can lead to improvement in the functional class and a substantial decrease or normalization of RV volumes, the optimal timing of FVR is not well defined. Benefits of PVR have to be weighed against the risks of this procedure including subsequent reoperation. This article reviews the pathophysiology of chronic PR, evidence-based benefits and risks of PVR, options for valve substitute, and optimal timing of PVR in patients with chronic PR after relief of RV outflow tract obstruction. Copyright © 2012 The Korean Society of Cardiology.

Background and Objective Estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes. In this study, we investigated the longitudinal relationships of the two markers with mortality, vascular events and functional outcomes in a stroke cohort. Methods A total of 295 patients with acute ischemic stroke were prospectively recruited in a single center between May 2012 and February 2015. Renal dysfunction was defined as a decreased eGFR (<60 mL/min/1.73 m2 ) or albuminuria (urine albumin-to-creatinine ratio ?30 mg/g). Good functional outcome at 6 months was defined as a modified Rankin scale score ô 2, and the occurrence of major vascular events (stroke, acute coronary syndrome or peripheral artery occlusion) or death was monitored. The associations between renal dysfunction and mortality, major vascular events, and 6-month functional outcome were evaluated by the Cox proportional hazards model and logistic regression analysis. Unadjusted and adjusted hazards ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were obtained. A Kaplan-Meier survival curve for composite adverse events (major vascular events or death) was also computed according to the presence or absence of albuminuria. Results Albuminuria, not eGFR, was significantly associated with mortality (P = 0.028; HR 2.15; 95% CI 1.09-4.25) and major vascular events (P = 0.044; HR 2.24; 95% CI 1.02-4.94) in the multivariate Cox proportional hazards models adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history, initial National Institutes of Health Stroke Scale (NIHSS) score and eGFR. In addition, albuminuria was negatively associated with 6-month functional outcome in the multivariate logistic regression analysis adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history and eGFR (P = 0.001; OR 0.36; 95% CI 0.20-0.65), but the association disappeared when NIHSS score was additionally adjusted (P = 0.519; OR 0.79; 95% CI 0.39-1.60). Furthermore, the patients with albuminuria had a significantly higher rate of composite adverse events than the patients without albuminuria (P < 0.001 by log-rank test). Conclusions Albuminuria seems a more useful clinical indicator than eGFR in evaluating the risk of adverse outcomes including further vascular events and death in patients with ischemic stroke. © 2016 Lee, Lee. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Lee C.,Sejong General Hospital | Kim S.-J.,Sejong General Hospital | Kim Y.M.,Sejong General Hospital
Annals of Thoracic Surgery | Year: 2010

A fetal echocardiogram revealed a large right ventricular mass. After birth, the infant had pulmonary blood flow obstruction with cyanosis. The size and characteristics of the tumor prevented resection. The patient underwent placement of a systemic-to-pulmonary shunt as another alternative. This palliation allowed discharge from the hospital and provided good relief for the cyanosis until the tumor became resectable. The pathologic examination revealed a cardiac fibroma. © 2010 The Society of Thoracic Surgeons.

Lee S.-J.,Sejong General Hospital | Kim J.-H.,Sejong General Hospital | Na C.-Y.,Sejong General Hospital | Oh S.-S.,Sejong General Hospital
Cerebrovascular Diseases | Year: 2012

Background: Cardiac myxomas are rare but are the most common cardiac tumors. This study is based on our clinical experience with cardiac myxomas over a period of 11 years at Sejong General Hospital. We focused on the embolic complications of patients with cardiac myxoma. Methods: We retrospectively reviewed the medical records of 59 consecutive patients with cardiac myxoma who were treated between January 2000 and March 2011. The myxomas were divided into two types: type 1, with an irregular or villous surface and a soft consistency, and type 2, with a smooth surface and a compact consistency. The 59 investigated patients were classified into the embolic group and the non-embolic group. Results: Cardiac obstructive symptoms, embolic events and constitutional symptoms were observed in 37 (62.7%), 13 (22.0%) and 10 (16.9%) patients, respectively. When the embolic and non-embolic groups were compared, there were no significant differences in vascular risk factors, the ejection fraction, the left atrial diameter or the tumor size. However, type 1 myxomas were significantly more frequent in the embolic group (p = 0.009 by Fisher's exact test). A binary logistic regression analysis showed that type 1 pathology alone was independently associated with myxoma-related embolism (p = 0.008; odds ratio 10.056; 95% confidence interval 1.828-55.337). There were no operative deaths in any of the 59 patients studied. Among the 13 patients with embolism, 11 (84.6%) had brain infarcts. The main patterns of the lesions were multiple lesions (8 out of 11 patients, 72.7%) and lesions in the middle cerebral artery territories (7 out of 11 patients, 63.6%). The other 2 patients were found to have occlusion of the left central retinal artery and left external iliac artery. Additionally, incidental cerebral aneurysms were found in the latter case. There was no recurrence of myxoma or myxoma-related symptoms in the 53 patients receiving outpatient management during the follow-up period (range 2 months to 11 years). Conclusions: The embolic potential of myxoma was associated with an irregular surface pathology but not with vascular risk factors. Echocardiography should be performed in patients with embolic events, especially when cerebral infarcts with multiple territorial lesions are detected. Surgical resection is a relatively safe and curative procedure for cardiac myxoma. Copyright © 2012 S. Karger AG, Basel.

Kim T.-H.,Sejong General Hospital | Shim W.-H.,Sejong General Hospital
Catheterization and Cardiovascular Interventions | Year: 2014

The "Preclose technique" using a perclose device has recently become widely used in various percutaneous procedures requiring a large access sheath. However, the post-procedural application of the perclose™ to the large sheath arteriotomy is more challenging because of the risk of bleeding and difficulty of device application. This report introduces a novel post-procedural closing technique of large 22 Fr arterial sheath access using perclose devices. © 2013 Wiley Periodicals, Inc.

Kwak J.G.,Sejong General Hospital | Lee C.-H.,Sejong General Hospital | Lee C.,Sejong General Hospital | Park C.S.,Sejong General Hospital
Annals of Thoracic Surgery | Year: 2011

Background. We changed our surgical strategy for pulmonary atresia with ventricular septal defect from shunt operation to early total correction as an initial procedure since 2004. The objective of this study was to compare the surgical outcomes of shunt and early total correction. Methods. From 1997 to 2008, 47 patients with pulmonary atresia with ventricular septal defect and no major aortopulmonary collateral arteries who underwent surgical correction were enrolled in this retrospective study. Twenty-nine patients underwent palliative shunt operation (group S) and 18 patients underwent early total correction (group T). The patients in group T were younger than that of group S (23.2 ± 12.6 vs 40.1 ± 23.3 days; p = 0.008). Results. There were 3 operative mortalities in group S and 1 operative mortality in group T. Four interstage deaths in group S and 1 late death in group T occurred. There was no difference in the overall survival rate between the 2 groups (p = 0.3). The reoperation rate was higher in group S (p < 0.0001) and the reintervention rate was higher in group T (p = 0.006). The ventilator support time (5.5 ± 5.1 vs 4.2 ± 5.6 days; p = 0.016) and intensive care unit stay (20.3 ± 25.5 vs 15.5 ± 16.0 days; p = 0.233) were longer in group T. The preoperative age, body weight, and pulmonary artery size were not associated with the prolonged ventilator support time in group T. The patients who had received preoperative ventilator care showed tendency of prolonged postoperative ventilator support time (p = 0.004). Conclusions. The midterm results of early total correction for pulmonary atresia with ventricular septal defect are acceptable. Despite a difficult postoperative course, there was no difference in the mortality compared with shunt operation. Although the reintervention rate was higher in the early total correction group, we were able to avoid interstage mortalities that occurred in the shunt group, and we reduced the reoperation rate in the early total correction group. © 2011 The Society of Thoracic Surgeons.

Lee C.,Sejong General Hospital | Kim Y.M.,Sejong General Hospital | Lee C.-H.,Sejong General Hospital | Kwak J.G.,Sejong General Hospital | And 6 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The objectives of this study were to evaluate outcomes of pulmonary valve replacement (PVR) in patients with chronic pulmonary regurgitation (PR) and to better define the optimal timing of PVR. Background: Although PVR is effective in reducing right ventricular (RV) volume overload in patients with chronic PR, the optimal timing of PVR is not well defined. Methods: A total of 170 patients who underwent PVR between January 1998 and March 2011 for chronic PR were retrospectively analyzed. To define the optimal timing of PVR, pre-operative and post-operative cardiac magnetic resonance imaging (MRI) data (n = 67) were analyzed. Results: The median age at the time of PVR was 16.7 years. Follow-up completeness was 95%, and the median follow-up duration was 5.9 years. Overall and event-free survival at 10 years was 98% and 70%, respectively. Post-operative MRI showed significant reduction in RV volumes and significant improvement in biventricular function. Receiver-operating characteristic curve analysis revealed a cutoff value of 168 ml/m 2 for non-normalization of RV end-diastolic volume index (EDVI) and 80 ml/m 2 for RV end-systolic volume index (ESVI). Cutoff values for optimal outcome (normalized RV volumes and function) were 163 ml/m 2 for RV EDVI and 80 ml/m 2 for RV ESVI. Higher pre-operative RV ESVI was identified as a sole independent risk factor for suboptimal outcome. Conclusions: Midterm outcomes of PVR in patients with chronic PR were acceptable. PVR should be considered before RV EDVI exceeds 163 ml/m 2 or RV ESVI exceeds 80 ml/m 2, with more attention to RV ESVI. © 2012 American College of Cardiology Foundation.

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