• Journal of Chest Surgery
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• v.21 no.5
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• pp.828-841
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• 1988

To predict the postoperative hemodynamic status of right ventricle preoperatively, a retrospective analysis was undertaken to determine the influence of pulmonary artery size on postoperative right ventricular pressure in 32 consecutive patients with tetralogy of Fallot who underwent total correction between July, 1987 to June, 1988 at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. We have related the ratio of the postrepair peak systolic pressure in the right ventricle and the systemic systolic arterial pressure[PRV/Ao] to the preoperative cineangiographic measurement of pulmonary arterial tree, expressed as pulmonary artery index[PAI], the ratio of diameter of the right pulmonary artery to diameter of ascending aorta[r.PA/A.Ao], the ratio of right and left pulmonary artery to diameter of descending aorta[r.I.PA/D.Ao] There was tendency that the postrepair PRV/Ao seems to be related to the preoperative diameter of right and left pulmonary artery, but there were no statistically significant correlation with PAI, r.PA/A.Ao, r.l.PA/D. Ao to the ratio of the postoperative peak systolic right ventricular pressure and systemic systolic arterial pressure[PRV/Ao]. There was tendency to decrease the postoperative right ventricular pressure[PRV/Ao] about 11.2%[P < 0.025] within several hours than immediately after repair, but after then, there was no change of right ventricular pressure[PRV/Ao] significantly. There was good correlation of pressure change between the immediate and late postrepair right ventricular pressure[48 hour], and the derived linear regression line was; y=0.68534 0.1994[r=0.57294, P < 0.001]. There was no operative death due to residual high right ventricular pressure[PRV/Ao >0.75] related to hypoplastic pulmonary arterial development, thus we expect, for symptomatic patients even infants, that complete repair can be attempted when the pulmonary artery index[PAI] is over 108mm2/BSA, RPA/AAo is over 0.35, RPA LPA/D. Ao is over 1.36.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1045-1048
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• 1995

Pulmonary atresia with VSD is uncommon congenital anomaly with high mortality in neonatal period.Recently we experienced surgical correction of pulmonary atresia with VSD. The case was 2 month old male patient diagnosed as pulmonary atresia with VSD and PDA. Atretic pulmonary artery segment from Rt ventricular infundibulum to pulmonary artery was lcm in length. The pulmonary trunk tapered toward Right ventricular infundibulum and resulted in blind pouch with diameter of lmm. The left pulmonary artery was stenosed at just proximal and distal part to which PDA was connected. Total correction was undertaken which consisted of PDA ligation, dacron patch closure of VSD, establishment of continuity between right ventricle and pulmonary artery with autogenous pericardium. Postoperative systolic fight ventricular pressure and left ventricular pressure ratio was 0.7. In patient with pulmonary atresia with VSD it is advisable to perform a corrective operation, whenever the size and anatomy of pulmonary artery are acceptable for it.

• YAKHAK HOEJI
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• v.43 no.4
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• pp.487-493
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• 1999

Effects of Ginkgo biloba extract (EGb 761) on the anti-pulmonary hypertensive action of enalapril were evaluated in rats. Pulmonary hypertension was induced by monocrotaline treatment (60mg/kg, i.p.) in normotensive rats. In the systolic pulmonary artery pressure, the control group was 33$\pm$2 mmHg, comparing to the normal group of 19$\pm$1 mmHg. That of enalapril group(20mg/kg/day, p.o.) was 26$\pm$2 mmHg. In the isolated lung preparation, acetylcholine, which was endothelium dependent vasodilator, induced the decrease of pulmonary artery perfusion pressure(-2.0$\pm$0.7 mmHg) in normal group, but the increase of that of 3.4$\pm$0.6 and 3.0$\pm$0.9 mmHg in control and enalapril group, respectively. And that of the combined group was -0.5$\pm$0.2 mmHg. In the isolated pulmonary artery, acetylcholine(10-5M) induced the relaxation of 65$\pm$6% in normal group, but 15 and 8% in control and enalapril group, respectively. And that of the combined group was resulted 55$\pm$2%. These results suggested that co-administration of Ginkgo biloba extract(EGb 761) potentiated the anti-pulmonary hypertensive effects of enalapril through the increase of pulmonary vasodilation due to the protection of endothelial cell by antioxidant action of Ginkgo biloba extract (EGb 761).

• Journal of Veterinary Clinics
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• v.37 no.4
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• pp.185-190
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• 2020

This retrospective, echocardiographic study using 144 dogs with clear systolic tricuspid regurgitation on Doppler echocardiography was performed to determine the diagnostic value of the systolic tricuspid regurgitation velocity/pulmonary artery flow velocity time integral to predict the Doppler estimates of dogs with tricuspid regurgitation pressure gradient compared with other cardiac indices of pulmonary hypertension, and to investigate a cutoff value to select patients with a potentially poor outcome. The systolic tricuspid regurgitation velocity/pulmonary artery flow velocity time integral increased significantly as the severity of pulmonary hypertension increased and had a correlation coefficient that was analogous to those of other conventional cardiac indices. A cutoff value greater 1.65 provided the best-balanced sensitivity (84%) and specificity (80%) in determining patients with a poor prognosis. In conclusion, the systolic tricuspid regurgitation velocity/pulmonary artery flow velocity time integral is readily obtained using routine echocardiography and could provide a non-invasive, novel, and supplementary index for evaluating dogs with pulmonary hypertension as useful prognostic criteria, particularly in those with advanced pulmonary hypertension.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.944-950
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• 1989

Children with congenital cardiac defects associated with high pulmonary artery pressure may die despite accurate surgery. Postoperative mortality and morbidity have been attributed to acute rises in pulmonary artery pressure and resistance. Acute pulmonary hypertensive crisis is defined as a paroxysmal event in which pulmonary arterial systolic pressure rises to or above systemic levels followed by a rapid fall in systemic pressure and a minor pulmonary hypertensive event is defined as an acute rise in pulmonary arterial pressure to more than 80 % of systemic levels but without a fall in systemic pressure. From Oct. 1988 to Jul. 1989, we experienced 23 patients who showed many pulmonary hypertensive crises after operation in the Department of Thoracic and Cardiovascular Surgery, Seoul National University Children\ulcorner Hospital. Their preoperative PAP/SAPs were 53 to 123 %[mean 93.3%] and diagnoses were VSD[7], TAPVR[5], TGA[4], AVSD[3], MS[1], DORV[1], Truncus arteriosus[1], and AP window[l]. There were 9 deaths among 23 patients and they showed many pulmonary hypertensive crisis episodes during postoperative intensive care, which was managed by sedation, hyperventilation, oxygen, and acidosis correction and which decreased after using tolazoline. In view of our experience, we recommend that pulmonary artery pressure should be monitored in congenital heart defected patient with preoperative pulmonary hypertension to confirm and to manage the pulmonary hypertensive crisis accurately and using tolazoline is helpful in the treatment of pulmonary hypertensive crisis.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.780-785
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• 1987

Pulmonary atresia with VSD is uncommon congenital anomaly with high mortality in neonatal period. Recently we experienced surgical correction of 2 cases of pulmonary atresia with VSD. The first case was 7-year old female patient and diagnosed as pulmonary atresia with VSD combined PDA. So, total correction was undertaken which consisted of PDA ligation, patch repair of VSD, transannular enlargement of RVOT with woven Dacron vascular graft, and closure of PFO. Postoperative systemic Rt. ventricular and radial artery pressure ratio was 0.44 and her postoperative course was uneventful. The second case was 6-year old male patient diagnosed as pulmonary atresia with VSD and large systemic-pulmonary collateral arteries. There were two large systemic-pulmonary collaterals, one was simply controlled by ligation, but the other was considered to supply Rt. upper lung. So end to side anastomosis was performed to the RVOT patch. Postoperative systolic Rt. ventricular and radial artery pressure ratio was 0.54. During the follow up period he showed clinical picture of Rt. heart failure, which is relatively well controlled with anticongestive therapy.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.241-249
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• 1977

Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.230-240
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• 1977

Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

• Asian-Australasian Journal of Animal Sciences
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• v.20 no.10
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• pp.1503-1509
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• 2007

Endothelin-1 (ET-1) is an important factor in regulation of cardiovascular tone in humans and mammals, but the biological function of ET-1 in the avian vascular system has not been determined. The purpose of this study was to characterize the role of endogenous ET-1 in the vascular system of poultry by investigating the effect of endothelin A receptor ($ET_AR$) antagonist BQ123 on the femoral artery pressure (FAP) and the pulmonary artery pressure (PAP) in broiler chickens. First, we found that plasma and lung homogenate ET-1 levels were both increased with age over the seven weeks life cyccle of broiler chickens. Second, 60 min after intravenous injection, BQ123 ($0.4{\mu}g\;kg^{-1}$ and $2.0{\mu}g\;kg^{-1}$, respectively) induced a significant reduction in FAP and PAP (p<0.05). Third, chronic infusion of BQ123 ($2.0{\mu}g\;kg^{-1}$ each time, two times a day) into abdominal cavities led to significant decrease in systolic pressure of the femoral (p<0.05) and pulmonary arteries (p<0.01) in broiler chickens at 7 and 14 days after treatment. Taken together, the $ET_AR$ antagonist BQ123 lead to a significant reduction of FAP and PAP, which suggests that endogenous ET-1 may be involved in the maintenance and regulation of systemic and pulmonary pressure in broiler chickens.

• Journal of Chest Surgery
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• v.15 no.1
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• pp.61-66
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• 1982

The present study was performed to evaluate hemodynamic effects on the pericardial patch graft for stenosis of right ventricle outflow tract in 19 patients of tetralogy of Fallot. The stenosis of right ventricle outflow tract was associated with or without pulmonary annular nar-rowing, pulmonary valvular stenosis, and hypoplastic narrowing of pulmonary artery. Total correction of tetralogy of Fallot was performed under cardiopulmonary bypass with moderate hypothermia and cardioplegic cardiac arrest. Ventricular septal defects were closed with Teflon patch graft. The chamber pressures in the heart were measured before and after a total correction of tetralogy of Fallot. The data of pressure measurement and the results of postoperative observation of pericardial patch were as followings: 1. Systolic and diastolic pressure of right ventricle was decreased after operation from $96.0{\pm}14.7/10.0{\pm}14.4mmHg$ to $61.0{\pm}13.1/8.0{\pm}9.3mmHg$. 2. Systolic and diastolic pressure of pulmonary artery was increased after operation from $18.0{\pm}5.6/10.0{\pm}5.5mmHg$ to $31.0{\pm}10.7/14.0{\pm}4.9mmHg$. 3. Preoperative pressure gradient between right ventricle and pulmonary artery was decreased immediately after operation from 78.0mmHg to 30.0mmHg. 4. It was observed that excellent widening effects of right ventricle outflow tract was resulted from pericardial patch graft. 5. No postoperative bleeding from pericardial patch graft was observed. 6. Aneurysm formation of pericardial patch was not be observed during 1 to 6 years postoperative periods.