Publications by authors named "Sung Uk Kwon"

26 Publications

  • Page 1 of 1

Elective Laparoscopic Cholecystectomy Is Better than Conservative Treatment in Elderly Patients with Acute Cholecystitis After Percutaneous Transhepatic Gallbladder Drainage.

J Gastrointest Surg 2021 Jun 25. Epub 2021 Jun 25.

Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea.

Background: It is unclear whether cholecystectomy is beneficial after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis (AC).

Methods: This single-center, retrospective study included 202 patients aged >80 years with AC without common bile duct (CBD) stones who underwent PTGBD between January 2010 and December 2019.

Results: One hundred and forty-two patients underwent elective laparoscopic cholecystectomy (ELC), and 60 underwent conservative treatment, specifically PTGBD removal (PTGBD-R) in 36 patients and PTGBD maintained (PTGBD-M) in 24 patients. The postoperative major complication (POMC) rate in the ELC group was 8.5%. The cumulative incidence for recurrence of biliary events (BE) in the PTGBD-R group was 22.2%. The cumulative incidence for PTGBD-related complication in the PTGBD-M group was 70.8%. Mortality after initial treatment was not significantly different between the three groups (2.8% vs. 2.8% vs. 8.3%, p=0.381). In multivariate analysis, a Charlson age comorbidity index ≥6 and body mass index ≤19 were significant risk factors for POMC after ELC, and a closed cystic duct was a significant risk factor for recurrent BE after PTGBD-R.

Conclusion: ELC is recommended in AC after PTGBD for selected patients aged >80 years without CBD stones due to the high recurrence rate of BE after PTGBD-R and the difficulty associated with PTGBD-M.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11605-021-05067-1DOI Listing
June 2021

Comparison of in-hospital outcomes of patients with vs. without ischaemic cardiomyopathy undergoing veno-arterial-extracorporeal membrane oxygenation.

ESC Heart Fail 2021 Jun 18. Epub 2021 Jun 18.

Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.

Aims: This study aimed to investigate differences in baseline and treatment characteristics, and in-hospital mortality according to the aetiologies of cardiogenic shock in patients undergoing veno-arterial-extracorporeal membrane oxygenation (VA-ECMO).

Methods And Results: The RESCUE registry is a multicentre, observational cohort that includes 1247 patients with cardiogenic shock from 12 centres. A total of 496 patients requiring VA-ECMO were finally selected, and the study population was stratified by cardiogenic shock aetiology [ischaemic cardiomyopathy (ICM, n = 342) and non-ICM (NICM, n = 154)]. The primary outcome of interest was in-hospital mortality. Sensitivity analyses including propensity-score matching adjustments were performed. Mean age of the entire population was 61.8 ± 14.2, and 30.8% were women. There were significant differences in baseline characteristics; notable differences included the older age of patients with ICM (65.1 ± 13.7 vs. 58.2 ± 13.8, P < 0.001), preponderance of males [258 (75.4%) vs. 85 (55.2%), P < 0.001], and higher prevalence of diabetes mellitus [140 (40.9%) vs. 39 (25.3%), P = 0.001] compared with patients in the NICM aetiology group. Patients with ischaemic cardiogenic shock were more likely to have longer shock duration before VA-ECMO implantation (518.7 ± 941.4 min vs. 292.4 ± 707.8 min, P = 0.003) and were less likely to undergo distal limb perfusion than those with NICM [108 (31.6%) vs. 79 (51.3%), P < 0.001]. In-hospital mortality in the overall cohort was 52.2%; patients with ICM had a higher unadjusted risk of in-hospital mortality [203 (59.4%) vs. 56 (36.4%); unadjusted hazard ratio, 2.295; 95% confidence interval, 1.698-3.100; P < 0.001]. There were no significant differences in the primary outcome between the two aetiologies following propensity-score matching multiple adjustments (adjusted hazard ratio, 1.265; 95% confidence interval, 0.840-1.906; P = 0.260).

Conclusions: Results of the current study indicated among patients with cardiogenic shock undergoing VA-ECMO, ischaemic aetiology does not seem to impact in-hospital mortality. These findings underline that early initiation and appropriate treatment strategies of VA-ECMO for patients with ICM shock are required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ehf2.13481DOI Listing
June 2021

Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock: Results From the RESCUE Registry.

Circ Heart Fail 2021 Jun 15;14(6):e008141. Epub 2021 Jun 15.

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center (J.H.Y., K.H.C., T.K.P., J.M.L., Y.B.S., J.-Y.H., S.-H.C., H.-C.G.), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS.

Methods: The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality.

Results: In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89-3.94], <0.001), body mass index <25 kg/m (OR, 1.52 [95% CI, 1.08-2.16], =0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44-3.23], <0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54-4.95], <0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88-5.95], <0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16-4.63], <0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07-2.24], =0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25-2.76], =0.002) were independent predictors for in-hospital mortality.

Conclusions: The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.008141DOI Listing
June 2021

Differential Prognostic Implications of Vasoactive Inotropic Score for Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock According to Use of Mechanical Circulatory Support.

Crit Care Med 2021 May;49(5):770-780

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Objectives: To identify whether the prognostic implications of Vasoactive Inotropic Score according to use of mechanical circulatory support differ in the treatment of acute myocardial infarction complicated by cardiogenic shock.

Design: A multicenter retrospective and prospective observational cohort study.

Setting/patient: The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy registry includes 1,247 patients with cardiogenic shock from 12 centers in Korea. A total of 836 patients with acute myocardial infarction complicated by cardiogenic shock were finally selected, and the study population was stratified by quartiles of Vasoactive Inotropic Score (< 10, 10-30, 30-90, and > 90) for the present study.

Interventions: None.

Measurements And Main Results: Primary endpoint was in-hospital mortality and secondary endpoint was follow-up mortality. Among the study population, 326 patients (39.0%) received medical treatment alone, 218 (26.1%) received intra-aortic balloon pump, and 292 (34.9%) received extracorporeal membrane oxygenation. In-hospital mortality occurred in 305 patients (36.5%) and was significantly higher in patients with higher Vasoactive Inotropic Score (15.6%, 20.8%, 40.2%, and 67.3%, for < 10, 10-30, 30-90, and > 90; p < 0.001). Vasoactive Inotropic Score showed better ability to predict in-hospital mortality in acute myocardial infarction patients with cardiogenic shock who received medical treatment alone (area under the curve: 0.797; 95% CI, 0.728-0.865) than in those who received intra-aortic balloon pump (area under the curve, 0.704; 95% CI, 0.625-0.783) or extracorporeal membrane oxygenation (area under the curve, 0.644; 95% CI, 0.580-0.709). The best cutoff value of Vasoactive Inotropic Score for the prediction of in-hospital mortality also differed according to the use of mechanical circulatory support (16.5, 40.1, and 84.0 for medical treatment alone, intra-aortic balloon pump, and extracorporeal membrane oxygenation, respectively). There was a significant interaction between Vasoactive Inotropic Score as a continuous value and the use of mechanical circulatory support including intra-aortic balloon pump (interaction-p = 0.006) and extracorporeal membrane oxygenation (interaction-p < 0.001) for all-cause mortality during follow-up.

Conclusions: High Vasoactive Inotropic Score was associated with significantly higher in-hospital and follow-up mortality in patients with acute myocardial infarction complicated by cardiogenic shock. The predictive value of Vasoactive Inotropic Score for mortality was significantly higher in acute myocardial infarction patients with cardiogenic shock treated by medical treatment alone than in those treated by mechanical circulatory support such as intra-aortic balloon pump or extracorporeal membrane oxygenation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000004815DOI Listing
May 2021

Fatal Simultaneous Multi-organ Failure Following Pembrolizumab Treatment for Refractory Thymoma.

Clin Lung Cancer 2020 03 19;21(2):e74-e77. Epub 2019 Oct 19.

Department of Cardiology, Ilsan Paik Hospital, Inje University, College of Medicine, Goyang, Korea. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cllc.2019.10.008DOI Listing
March 2020

Isolated metastasis of hepatocellular carcinoma in the right ventricle: A case report.

Medicine (Baltimore) 2016 Dec;95(51):e5544

Division of Cardiovascular Medicine, Department of Medicine Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.

Metastatic hepatocellular carcinoma (HCC) of the right ventricle is very rare and difficult to diagnosis.A 79-year-old man who underwent right hemi-hepatectomy for HCC was admitted to our hospital for chest pain, severe dyspnea, and orthopnea. The echocardiogram showed a tumor located in the right ventricle. A biopsy was obtained, and histopathological findings confirmed metastatic HCC. Palliative resection of the tumor was performed.There is no standard treatment for metastatic HCC into the right ventricle. Thus, treatment should be individualized to the patient, and a multidisciplinary approach should be used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000005544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5181814PMC
December 2016

Valsartan 160 mg/Amlodipine 5 mg Combination Therapy versus Amlodipine 10 mg in Hypertensive Patients with Inadequate Response to Amlodipine 5 mg Monotherapy.

Korean Circ J 2016 Mar 21;46(2):222-8. Epub 2016 Mar 21.

Division of Cardiology, Department of Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background And Objectives: When monotherapy is inadequate for blood pressure control, the next step is either to continue monotherapy in increased doses or to add another antihypertensive agent. However, direct comparison of double-dose monotherapy versus combination therapy has rarely been done. The objective of this study is to compare 10 mg of amlodipine with an amlodipine/valsartan 5/160 mg combination in patients whose blood pressure control is inadequate with amlodipine 5 mg.

Subjects And Methods: This study was conducted as a multicenter, open-label, randomized controlled trial. Men and women aged 20-80 who were diagnosed as having hypertension, who had been on amlodipine 5 mg monotherapy for at least 4 weeks, and whose daytime mean systolic blood pressure (SBP) ≥135 mmHg or diastolic blood pressure (DBP) ≥85 mmHg on 24-hour ambulatory blood pressure monitoring (ABPM) were randomized to amlodipine (A) 10 mg or amlodipine/valsartan (AV) 5/160 mg group. Follow-up 24-hour ABPM was done at 8 weeks after randomization.

Results: Baseline clinical characteristics did not differ between the 2 groups. Ambulatory blood pressure reduction was significantly greater in the AV group compared with the A group (daytime mean SBP change: -14±11 vs. -9±9 mmHg, p<0.001, 24-hour mean SBP change: -13±10 vs. -8±8 mmHg, p<0.0001). Drug-related adverse events also did not differ significantly (A:AV, 6.5 vs. 4.5 %, p=0.56).

Conclusion: Amlodipine/valsartan 5/160 mg combination was more efficacious than amlodipine 10 mg in hypertensive patients in whom monotherapy of amlodipine 5 mg had failed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2016.46.2.222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805567PMC
March 2016

Clinical Relevance of Poststent Fractional Flow Reserve After Drug-Eluting Stent Implantation.

J Invasive Cardiol 2015 Aug;27(8):346-51

Seoul National University College of Medicine, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea. or

Background: The prognostic value of poststent fractional flow reserve (FFR) has not been clearly defined in patients with drug-eluting stent (DES) implantation. This study sought to evaluate the association between FFR and clinical outcomes after DES implantation with intravascular ultrasound (IVUS) assistance.

Methods: A total of 115 lesions (107 patients) with FFR measurement after IVUS-assisted DES implantation were enrolled. Poststent angiographic and IVUS parameters were compared with FFR values. Clinical outcomes were assessed by target vessel failure (TVF), defined as a composite of target vessel revascularization, death, or non-fatal myocardial infarction attributed to the target vessel.

Results: Mean poststent FFR was 0.92 ± 0.04. Minimal stent area by IVUS had a positive correlation with poststent FFR (r = 0.36; P<.01). Poststent FFR ≥0.89 was a physiologic cut-off value for 1-year TVF-free survival. The best cut-off value of minimal stent area to define poststent FFR ≥0.89 was >5.4 mm² (sensitivity, 63.2%; specificity, 90.0%). At 3-year follow-up, lesions with poststent FFR ≥0.89 had a better TVF-free survival rate than those with poststent FFR <0.89 (89.3% vs 61.1%, P =.03).

Conclusion: Poststent FFR can be a useful predictor for long-term clinical outcomes after DES implantation and relevant to IVUS minimal stent area.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2015

Clinical implications of T-wave inversion in an asymptomatic population undergoing annual medical screening (from the Korean Air Forces Electrocardiogram Screening).

Am J Cardiol 2014 May 12;113(9):1561-6. Epub 2014 Feb 12.

Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea.

This study aimed to determine prevalence, differentiate underlying causes, and identify the benign group in subjects with asymptomatic T-wave inversion (TWI). We retrospectively read 12-lead electrocardiograms from 3,929 consecutive asymptomatic men in the air force (3,929 participants, mean age 39.3 ± 8.7 years) who underwent medical screening at the Aerospace Medical Center, Korea, from September 2010 to August 2012. TWIs other than in right precordial leads (V1 and V2) were present in 23 men (0.6%). All subjects with persistent TWI for 1 year (n = 18) underwent additional study, with the exception of 1 patient who refused further evaluation. Of 17 subjects with investigated persistent TWI, 8 (47.1%) had an apically displaced papillary muscle, 5 (29.4%) exhibited idiopathic TWI, 3 (17.6%) had apical hypertrophic cardiomyopathy, and 1 (5.9%) had Maron type 2 hypertrophic cardiomyopathy with dynamic left ventricular outflow obstruction. The depth of TWI was significantly shallow in the benign group (idiopathic TWI, 1.6 ± 0.5 mm) compared with potentially nonbenign group (the others; 5.5 ± 3.3 mm, p = 0.021). Lateral lead TWI was significantly correlated with potentially nonbenign group (46% vs 0%, p = 0.049). In conclusion, asymptomatic TWI is not rare (0.6%), even in a healthy population such as Korean Air Force society, and at least 29.4% of subjects with TWI are considered to belong to the benign group that does not require aggressive evaluation and criteria of TWI ≤2 mm other than lateral leads without co-morbidity could help to distinguish the benign group from the potentially nonbenign group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2014.02.008DOI Listing
May 2014

Presence of plaques predicts worse outcomes in multi-detector computed tomography in patients with stable chest pain syndrome.

Int J Cardiol 2014 May 21;173(3):570-2. Epub 2014 Mar 21.

Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States; Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2014.03.118DOI Listing
May 2014

Diagnostic value of coronary CT angiography in comparison with invasive coronary angiography and intravascular ultrasound in patients with intermediate coronary artery stenosis: results from the prospective multicentre FIGURE-OUT (Functional Imaging criteria for GUiding REview of invasive coronary angiOgraphy, intravascular Ultrasound, and coronary computed Tomographic angiography) study.

Eur Heart J Cardiovasc Imaging 2014 Aug 9;15(8):870-7. Epub 2014 Feb 9.

Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.

Aims: The anatomical criteria for the diagnosis of ischaemia referenced by fractional flow reserve (FFR) from non-invasive coronary computed tomographic angiography (CCTA), invasive coronary angiography (ICA), and intravascular ultrasound (IVUS) have not been evaluated contemporarily in a large-scale study. The aim of this study was to assess the diagnostic value of CCTA compared with ICA and IVUS in patients with intermediate coronary stenosis.

Methods And Results: CCTA, ICA, IVUS, and FFR were performed in 181 coronary lesions with intermediate severity. Minimal lumen diameter (MLD) and per cent diameter stenosis (%DS) were determined by CCTA and ICA, whereas minimal lumen area (MLA) was determined by CCTA and IVUS. Inducible ischaemia was defined by FFR ≤ 0.80. Diagnostic performances from non-invasive and invasive methods were compared. FFR ≤ 0.80 was observed in 49 (27.1%) lesions. CCTA MLD was smaller than ICA MLD (1.3 ± 0.5 vs. 1.5 ± 0.4 mm, P < 0.001), CCTA %DS was higher than ICA %DS (54.0 ± 14.0 vs. 50.3 ± 12.8%, P < 0.001), and CCTA MLA was smaller than IVUS MLA (2.2 ± 1.2 vs. 3.2 ± 1.2 mm(2), P < 0.001). This trend was consistent irrespective of lesion location, lesion severity, and plaque characteristics. For the determination of ischaemia, diagnostic performance of CCTA %DS was lower than ICA %DS [area under the curve (AUC) 0.657 vs. 0.765, P = 0.04], and that of CCTA MLA was lower than IVUS MLA (AUC 0.712 vs. 0.801, P = 0.03).

Conclusion: Anatomical criteria for the diagnosis of ischaemia-producing coronary stenosis differ by non-invasive and invasive methods. Compared with invasive methods, CCTA presents overestimation in assessing lesion severity and lower diagnostic performance in assessing ischaemia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjci/jeu009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110885PMC
August 2014

The role of large animal studies in cardiac regenerative therapy concise review of translational stem cell research.

Korean Circ J 2013 Aug;43(8):511-8

Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA. ; Vision 21 Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Korea.

Animal models have long been developed for cardiovascular research. These animal models have been helpful in understanding disease, discovering potential therapeutics, and predicting efficacy. Despite many efforts, however, translational study has been underestimated. Recently, investigations have identified stem cell treatment as a potentially promising cell therapy for regenerative medicine, largely because of the stem cell's ability to differentiate into many functional cell types. Stem cells promise a new era of cell-based therapy for salvaging the heart. However, stem cells have the potential risk of tumor formation. These properties of stem cells are considered a major concern over the efficacy of cell therapy. The translational/preclinical study of stem cells is essential but only at the beginning stages. What types of heart disease are indicated for stem cell therapy, what type of stem cell, what type of animal model, how do we deliver stem cells, and how do we improve heart function? These may be the key issues that the settlement of which would facilitate the transition of stem cell research from bench to bedside. In this review article, we discuss state-of-the-art technology in stem cell therapies for cardiovascular diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2013.43.8.511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772295PMC
August 2013

Familial occurrence of atrioventricular nodal reentrant tachycardia in a mother and her son.

Korean Circ J 2012 Oct 31;42(10):718-21. Epub 2012 Oct 31.

Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.

Atrioventricular nodal reentrant tachycardia (AVNRT), caused by a reentry circuit involving fast and slow atrioventricular nodal pathways, is one of the most common types of paroxysmal supraventricular tachycardias. While familial Wolff-Parkinson-White syndrome has been well recognized, familial AVNRT has been rarely reported. We report a familial occurrence of AVNRT in a mother and her son, who were symptomatic and successfully treated with radiofrequency catheter ablation of slow pathway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2012.42.10.718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493812PMC
October 2012

A rare case of aortic valve myxoma: easy to confuse with papillary fibroelastoma.

Korean Circ J 2012 Apr 26;42(4):281-3. Epub 2012 Apr 26.

Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.

Myxoma of the aortic valve is an exceedingly uncommon condition. In this article, we report the case of a 72-year-old man with myxoma arising from the aortic valve. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2012.42.4.281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341427PMC
April 2012

Late-onset postpneumonectomy empyema presenting as right-sided heart failure: extrinsic right atrial compression.

Korean Circ J 2012 Apr 26;42(4):274-7. Epub 2012 Apr 26.

Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.

Although it is rare, the right atrium can be encroached on by abnormal mediastinal structures, including aortic aneurysms, carcinomas, hepatic cysts and diaphragmatic paralysis. Extrinsic compression of the right atrium causes significant hemodynamic compromise and can lead to fatal outcomes. We describe the case of a 66-year old man with a past history of pulmonary tuberculosis that had undergone right pneumonectomy 40 years previously. He then presented with signs and symptoms of right-sided heart failure. These new signs and symptoms were recognized to be secondary to extrinsic compression of the right atrium, which was due to late-onset postpneumonectomy empyema, and the signs and symptoms were successfully relieved by performing open drainage of the empyema.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2012.42.4.274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341425PMC
April 2012

Tricuspid valvular myxoma: unusual case of tricuspid valve myxoma mimicking thrombus after pulmonary artery embolectomy and tricuspid annuloplasty in pulmonary thromboembolism patient.

J Cardiovasc Ultrasound 2011 Dec 27;19(4):207-10. Epub 2011 Dec 27.

Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea.

A 55-year-old man with massive pulmonary thromboembolism underwent thrombolysis, pulmonary artery embolectomy and tricuspid annuloplasty. Nine months later, a mobile echogenic intra-cardiac mass was found in the tricuspid valve. Because the patient had undergone annuloplasty, thrombosis was suspected as the most likely diagnosis and thrombolytic therapy was instituted. However, the size of the cardiac mass did not change and after surgical excision the mass was found to be a myxoma. Cardiac valvular tumors are uncommon and when they occur they are usually slow growing fibroelastomas. In this case, the rapid growing cardiac myxoma on the tricuspid valve was found after the occurrence of pulmonary thromboembolism. To our knowledge, this is first reported case of tricuspid valve myxoma in Korea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4250/jcu.2011.19.4.207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259547PMC
December 2011

Stenting of the Left Main Coronary Artery in a Patient With Takayasu's Arteritis.

Korean Circ J 2011 Jan 31;41(1):34-7. Epub 2011 Jan 31.

Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University, Ilsan Paik Hospital, Goyang, Korea.

Management of Takayasu's arteritis of the left main coronary artery (LMCA) is difficult because of the possibility of restenosis. Clinically significant stenotic lesions must be considered anatomical correlation. Many studies have reported that the management of stenotic lesions of the LMCA with endoluminal stenting and balloon angioplasty and de-novo stenting is safe and effective for patients with Takayasu's arteritis. We report the case of a patient with Takayasu's arteritis of the LMCA. The patient had undergone two consecutive percutaneous coronary interventions because of recurrent restenosis of in-stent lesions, and eventually underwent coronary artery bypass graft (CABG) surgery for myocardial infarction in the same lesion. We suggested treatment with CABG because the pathophysiology of Takayasu's arteritis is different from that of atherosclerotic stenosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2011.41.1.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040401PMC
January 2011

The Management of Cardiovascular Abnormalities in Patient With LEOPARD Syndrome.

Korean Circ J 2010 Jul 26;40(7):339-42. Epub 2010 Jul 26.

Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.

LEOPARD syndrome (LS) is a rare hereditary disorder in Asian countries. This syndrome consists of multiple systemic abnormalities. In particular, characteristic cardiovascular effects in LS may include variable clinical manifestations from benign to life-threatening courses. The cardiac effects of this syndrome consist of left ventricular hypertrophy (LVH), pulmonary stenosis (PS), coronary artery dilatation and electrocardiogram(ECG) abnormalities. Since there are few LS patients who have undergone a complete cardiovascular evaluation, the nature and clinical prognosis of cardiovascular abnormalities in this syndrome remain uncertain. Also, there have been few reports on therapeutic strategies for cardiovascular abnormalities in LS. Here we describe a case of LS who presented with multiple cardiovascular problems and underwent successful surgical and medical treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4070/kcj.2010.40.7.339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910291PMC
July 2010

The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism.

Korean J Intern Med 2009 Jun 8;24(2):123-7. Epub 2009 Jun 8.

Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan-gu, Goyang, Korea.

Background/aims: Many prognostic models have been developed to help physicians make medical decisions on treating patients with pulmonary embolism. Among these models, the Pulmonary Embolism Severity Index (PESI) has been shown to be a successful risk stratification tool for patients with acute pulmonary embolism. The PESI, however, had not been applied to patients with pulmonary embolism in Korea.

Methods: The patients included in this study were diagnosed by computed tomography at Inje University's Ilsan Paik Hospital between December 1999 and March 2007. Risk stratification for the patients was performed using the PESI. The mortality rate was calculated according to each PESI risk class.

Results: Of the 90 patients enrolled in this study, ten were assigned to PESI class I, 29 to PESI class II, 22 to PESI class III, eight to PESI class IV, and ten to PESI class V. The mortality rate after 30 days in each class was 0, 10.3, 9.1, 0, and 50% (p=0.0016), respectively, whereas the respective hospital mortality rate was 4.8, 13.8, 13.6, 12.5, and 50% (p=0.0065). The overall mortality was 9.5, 27.6, 31.8, 50.0, and 60%, respectively (p=0.0019). The mortality rate was significantly associated with the PESI class.

Conclusions: The PESI class was found to be significantly correlated with the 30-day mortality rate, hospital mortality, and overall mortality. Our data indicate that the PESI can be used to predict the prognosis of patients with pulmonary embolism and in making medical decisions regarding the treatment of patients with pulmonary embolism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3904/kjim.2009.24.2.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698620PMC
June 2009

Preoperative and postoperative evaluation of multiple giant coronary aneurysms by the use of coronary CT angiography with 64-MDCT: a case of multiple giant coronary aneurysms treated with aneurysmectomy and coronary artery bypass surgery.

Yonsei Med J 2009 Feb 24;50(1):160-3. Epub 2009 Feb 24.

Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

A coronary artery aneurysm is an uncommon disorder and is seen as a characteristic dilatation of a localized portion of the coronary artery. Clinical manifestation of a coronary artery aneurysm varies from an asymptomatic presentation to sudden death of a patient. Although coronary aneurysms are typically diagnosed by the use of coronary angiography, a new generation of coronary 64-slice multidetector computed tomography (64-MDCT) scanners have successfully been used for evaluating this abnormality in a noninvasive manner. In the present case, we performed coronary 64-MDCT scanning preoperatively and postoperatively on a patient with multiple giant coronary aneurysms. The use of coronary 64-MDCT may provide an evaluation technique not only for diagnosis but also for follow-up after surgery for this condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3349/ymj.2009.50.1.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649873PMC
February 2009

Coronary stent fracture: detection with 64-section multidetector CT angiography in patients and in vitro.

Radiology 2008 Dec;249(3):810-9

Department of Diagnostic Radiology, Inje University Ilsanpaik Hospital, 2240 Daewha-dong, Goyang-si, Gyunggi-do 411-706, Korea.

Purpose: To evaluate 64-section multidetector coronary computed tomographic (CT) angiography for the depiction of coronary stent fracture in patients and in vitro.

Materials And Methods: This retrospective study was approved by the institutional review board, and informed patient consent was waived. The coronary CT angiograms obtained in 371 consecutive patients (268 men, 103 women; mean age, 62.9 years) with 545 stents were reviewed. All patients with stent fractures underwent conventional coronary angiography and/or fluoroscopy as part of their medical care. In phantom studies, magnified radiographs of three types of drug-eluting stents in their fully expanded, maximally bent, and unrolled states were obtained. CT angiography and fluoroscopy of a water phantom that contained two drug-eluting stents--Cypher and Taxus devices--with four fractures each were performed, and two radiologists blinded to the fracture information evaluated the images.

Results: Twenty-four stents with fractures were identified. Eighteen fractured stents (13 Cypher, four Taxus, one S670) in 14 patients were detected with CT angiography; six (33%; two Cypher, four Taxus) of these 18 stents in five (36%) patients were not detected on conventional angiograms at the initial readings. Six fractured stents showed significant (>50%) recurrent in-stent stenosis. Of 58 arteries with overlapping stent placements, eight (14%) had fractures involving 11 stents. In the in vitro studies, 57 stent fractures (31 Cypher, 26 Taxus) were detected with CT angiography and 38 (18 Cypher, 20 Taxus) were detected with fluoroscopy.

Conclusion: Coronary CT angiography depicts stent fractures in patients and phantoms, even those fractures that are not clearly depicted by conventional angiography.

Supplemental Material: http://radiology.rsnajnls.org/cgi/content/full/249/3/810/DC1.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2493088035DOI Listing
December 2008

Comparison of vessel geometry in bifurcation between normal and diseased segments: intravascular ultrasound analysis.

Atherosclerosis 2008 Dec 29;201(2):326-31. Epub 2008 Feb 29.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Seoul, Republic of Korea.

Objective: To investigate the geometry in bifurcation using intravascular ultrasound (IVUS) analysis.

Methods: We performed quantitative three-dimensional IVUS analysis of 31 true bifurcation lesions and 30 angiographically normal bifurcation segments including the main and side branches as well as parent vessel.

Results: The external elastic membrane (EEM) area changed significantly according to distance from bifurcation in the parent vessel and main branches of the lesion group while there was no significant change in the EEM area in the normal group. Vessel size of bifurcation segments obeyed the principle of minimum work (Murray's law). The cube of the mean EEM diameter of parent vessel nearly equaled the sum of the cubes of the mean EEM diameters of main and side branches (95.5 +/- 38.9 mm(3) versus 90.7 +/- 36.1 mm(3) for the lesion group and 93.4 +/- 49.6 mm(3) versus 85.3 +/- 47.3 mm(3) for the normal group). However, the deviation from the optimal relationship of lumen size was noted more frequently in bifurcation lesion than normal bifurcation segments (71% versus 43%, P=0.03).

Conclusions: The EEM pattern may differ between bifurcation lesions and normal bifurcating segments. Although human coronary artery system obeys the principle of minimum work, the geometry may deviate from the optimal relationship in bifurcation lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.atherosclerosis.2008.02.021DOI Listing
December 2008

Spontaneous closure of iatrogenic coronary artery fistula to left ventricle after septal myectomy for hypertrophic obstructive cardiomyopathy.

J Korean Med Sci 2006 Dec;21(6):1111-4

Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Cases of iatrogenic coronary artery fistulas draining into the left ventricle after surgical myectomy for hypertrophic obstructive cardiomyopathy have been published as sporadic reports. However, its management scheme and prognosis are not clear because of the low incidence. A 46-yr-old woman was hospitalized for evaluation of chest pain and shortness of breath for 3 months. Transthoracic echocardiographic examination showed typical hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 71 mmHg across the left ventricular outflow tract. The patient underwent surgical septal myectomy. Postoperative color Doppler imaging revealed a diastolic blood flow from the interventricular septal myocardium to the left ventricular cavity, i.e. iatrogenic coronary artery fistula to the left ventricle. Ten days later, the fistula closed spontaneously which was diagnosed by transthoracic echocardiography and confirmed by coronary angiography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721939PMC
http://dx.doi.org/10.3346/jkms.2006.21.6.1111DOI Listing
December 2006

Amount of left ventricular hypertrophy determines the plasma N-terminal pro-brain natriuretic peptide level in patients with hypertrophic cardiomyopathy and normal left ventricular ejection fraction.

Clin Cardiol 2006 Apr;29(4):155-60

Department of Medicine, Cardiac and Vascular Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is increased in patients with hypertrophic cardiomyopathy (HCM); however, the determinants of NT-proBNP level have not been clarified in HCM.

Hypothesis: This study was performed to determine the relationship between NT-proBNP levels and various echocardiographic variables of patients with HCM and normal left ventricular ejection fraction (LVEF).

Methods: We assessed plasma NT-proBNP levels and echocardiographic variables of 36 patients (19 men, 58 +/- 14 years) with HCM and an LVEF of > or = 55%. Echocardiographic variables measured were LV wall thickness, end-diastolic LV internal dimension (LVIDd) and volume (LVEDV), LV mass, and LV mass index (LV mass/body surface area, LVMI). Left ventricular outflow tract pressure gradient, transmitral E and A velocities, deceleration time (DT) of the transmitral E wave, and septal annular E' velocity were measured by Doppler technique. The relationship between echocardiographic variables and plasma NT-proBNP level was analyzed.

Results: The plasma NT-proBNP level was 775.2 +/- 994.2 pg/ml (range 33.1-4729.0 pg/ml). It showed positive correlations with LV end-diastolic septal thickness (r = 0.39, p = 0.010) and LVMI (r = 0.27, p = 0.050), while it revealed negative correlations with LVIDd (r = -0.44, p = 0.004), LVEDV (r = -0.44, p = 0.004) and DT(r = -0.31,p = 0.034). The NT-proBNP level was higher in the patients with than in those without LV diastolic dysfunction (p = 0.033) and was independently related to LVIDd (p = 0.001), LVMI (p = 0.006) and DT (p = 0.031) by multivariate analysis.

Conclusion: In patients with HCM and normal LVEF, the amount of LV hypertrophy and LV diastolic dysfunction may exert a significant role in determining plasma NT-proBNP level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/clc.4960290406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6654112PMC
April 2006

Prevalence and clinical implications of Staphylococcus aureus with a vancomycin MIC of 4 microg/ml in Korea.

Microb Drug Resist 2006 ;12(1):33-8

Department of Microbiology, National Institute of Health, Seoul 122-701, Republic of Korea.

In addition to vancomycin-intermediate Staphylococcus aureus (VISA), S. aureus with a vancomycin MIC of 4 microg/ml has been reported to be the cause of therapeutic failure. This study was designed to determine the prevalence of methicillin-resistant S. aureus (MRSA) with a vancomycin MIC of 4 microg/ml and to clarify the clinical characteristics of infections caused by these isolates. During the 8-week period from April to May, 2001, 27 hospitals participated in a nationwide surveillance program for VISA and vancomycin-resistant S. aureus (VRSA) in Korea. After screening on brain-heart infusion agar containing 4 microg/ml of vancomycin as previously described, 100 isolates with confluent growth were tested. The medical records of the patients involved were reviewed. Even though VISA or VRSA was not detected among 3,756 MRSA isolates, 18 (0.5%) had a vancomycin MIC of 4 microg/ml. The infections in 12 of these patients, excluding 5 that were colonized, were 8 chronic osteomyelitis, 1 surgical site infection, 1 pneumonia, 1 intra-abdominal infection, and 1 catheter-related infection. Although 11 cases were exposed to glycopeptides for a long time (median 56 days), the site of infection became culture-negative in only 1 case. Two patients died of their S. aureus infections. MRSA with a vancomycin MIC of 4 microg/ml was rare. Chronic osteomyelitis was the most common type of infection, and prolonged exposure to glycopeptides was associated with reduced susceptibility to vancomycin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/mdr.2006.12.33DOI Listing
May 2006

Successful whole blood exchange by apheresis in a patient with acute cyclosporine intoxication without long-term sequelae.

J Heart Lung Transplant 2006 Apr 8;25(4):483-5. Epub 2006 Feb 8.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Acute cyclosporine A (CsA) intoxication after organ transplantation may occur during the changeover from one form of drug to another, or from miscalculation of dosage. Sometimes, it may cause severe hepatotoxicity, nephrotoxicity and neurotoxicity. However, the therapeutic plasma exchange for the CsA intoxication was not established. Here, we present a case of very severe CsA intoxication after cardiac transplantation who recovered from intoxication without long-term sequelae via whole blood exchange; therapeutic erythrocytapheresis followed by total plasma exchange.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healun.2005.11.440DOI Listing
April 2006
-->