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Biomedical subjects

K J Chung

Publications and source records attributed to K J Chung.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Pterional approach to the basilar artery aneurysm--with special reference to the accessibility via optic-carotid triangle].

There have been known two routes in pterional approach to the distal basilar artery aneurysms: one is via the space between the optic nerve and internal carotid artery (optic-carotid triangle: OCT) and the other is lateral to the ICA (retrocarotid approach: RCA). Although the approach via OCT has several advantages of its own, it had been considered to be used in very limited cases. Since we successfully clipped the aneurysms via OCT in 4 cases out of 12 (33%), neuroradiological findings observed in these 4 cases are analyzed and reported. Measurements were made in the following items on the carotid angiogram of the cases operated via OCT (OCT group) and RCA (RCA group): the distance of ICA bifurcation from midline (D), height of ICA bifurcation from the base line between anterior and posterior clinoid processes (H). Although these two values seemed higher in OCT group than those in RCA group, no significant difference was found. The product of D and H (D X H) was observed to be significantly higher in OCT group than in RCA group. The value of D X H is considered one of the indicators of the size of OCT and is proved to be useful to judge whether approach via OCT is applicable or not. Values of D X H obtained from cases with aneurysm increase with age. Regression line calculated between age and D X H value suggests that more than half of the patients over 45 years of age should have space in OCT wide enough to apply clips to the aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Two-dimensional Doppler color flow mapping for detecting atrial and ventricular septal defects. Studies in an animal model and in the clinical setting.

In experimental studies in six dogs as well as in clinical studies in eleven patients with atrial septal defect and 27 patients with ventricular septal defect, the diagnostic usefulness of color Doppler echocardiography in detection of small septal defects and multiple defects was analyzed. The study showed that atrial or ventricular septal defects with a size of 2.5 to 3 mm or more, which eluded detection with two-dimensional echocardiography, were easily identified with the color Doppler method. Additionally, multiple defects were reliably demonstrated. In atrial septal defects, according to the results of this study, the shunt area in the color Doppler image enables a semiquantitative estimation of the shunt volume.

Adolescent↗
PubMed1986

The treatment of Kawasaki syndrome with intravenous gamma globulin.

We compared the efficacy of intravenous gamma globulin plus aspirin with that of aspirin alone in reducing the frequency of coronary-artery abnormalities in children with acute Kawasaki syndrome in a multicenter, randomized trial. Children randomly assigned to the gamma globulin group received intravenous gamma globulin, 400 mg per kilogram of body weight per day, for four consecutive days; both treatment groups received aspirin, 100 mg per kilogram per day, through the 14th day of illness, then 3 to 5 mg per kilogram per day. Two-dimensional echocardiograms were interpreted blindly and independently by two or more readers. Two weeks after enrollment, coronary-artery abnormalities were present in 18 of 78 children (23 percent) in the aspirin group, as compared with 6 of 75 (8 percent) in the gamma globulin group (P = 0.01). Seven weeks after enrollment, abnormalities were present in 14 of 79 children (18 percent) in the aspirin group and in 3 of 79 (4 percent) in the gamma globulin group (P = 0.005). No child had serious adverse effects from receiving gamma globulin. We conclude that high-dose intravenous gamma globulin is safe and effective in reducing the prevalence of coronary-artery abnormalities when administered early in the course of Kawasaki syndrome.

Aneurysm↗
PubMed1986

Real-time Doppler color flow mapping for detection of patent ductus arteriosus.

In this study, ultrasound Doppler color flow mapping systems were utilized to examine flow in the pulmonary artery in 31 premature and term infants (aged 4 hours to 9 months) with patent ductus arteriosus accompanying respiratory distress syndrome, as an isolated lesion, or with patent ductus in association with other cyanotic or acyanotic congenital heart disorders. The flow mapping patterns were compared with those of a control population of 15 infants who did not have patent ductus arteriosus. In unconstricted ductus arteriosus, the flow from the aorta into the pulmonary artery was detected in late systole and early diastole and was distributed along the superior leftward lateral wall of the main pulmonary artery from the origin of the left pulmonary artery back in a proximal direction toward the pulmonary valve. In constricted patent ductus arteriosus, or especially in a ductus in association with cyanotic heart disease, the position of the ductal shunt in the pulmonary artery was more variable, often directed centrally or medially. Waveform spectral Doppler sampling could be performed in specific positions guided by the Doppler flow map to verify the phasic characteristics of the ductal shunt on spectral and audio outputs. Shunts through a very small patent ductus arteriosus were routinely detected in this group of infants, and right to left ductal shunts could also be verified by the Doppler flow mapping technique. This study suggests substantial promise for real-time two-dimensional Doppler echocardiographic flow mapping for evaluation of patent ductus arteriosus in infants.

Blood Flow Velocity↗
PubMed1985

Ventricular tachycardia in children without heart disease.

To assess the natural history of ventricular tachycardia (VT) in children without heart disease, the clinical course of 26 children, aged 1 day to 15 years at initial detection, was reviewed. Symptoms related to the rhythm were present in 8 children at some time during their course of follow-up. Evaluation included echocardiogram (19 patients), Holter monitoring (22 patients), graded treadmill exercise testing (16 patients) and invasive electrophysiology (4 patients). Exercise induced or exacerbated VT in 9 patients, but suppressed rhythm in 7. Ten patients were never treated. Of the remaining 16 treated patients, therapy was discontinued in 10 on the basis of the electrocardiographic or Holter monitor recordings. Six continued to receive therapy without complications. There were no known deaths over a period of 1 month to 34 years (mean 59 months, median 42 months). Although 2 patients have been lost to follow-up, based on our findings and a review of the reported cases of VT in children to date, after undergoing complete noninvasive cardiac evaluation symptomatic patients should be treated and studied with invasive electrophysiology if antiarrhythmic control is inadequate. The rate of VT or age at onset are not predictive of outcome in asymptomatic patients. As a group, these patients do not appear to benefit from therapy, but warrant follow-up since deaths have been reported in untreated asymptomatic patients.

Adolescent↗
PubMed1985

Digital subtraction angiography in patients with transposition of the great arteries after surgical repair.

Digital subtraction angiography was used for postoperative evaluation of seven patients who underwent the Senning procedure for repair of d-transposition of the great arteries. Their ages ranged from 2.5 to 3 years. The patients were premedicated with methohexital (25 mg/kg rectally), and 0.3 to 0.4 ml/kg of diatrizoate was injected into a peripheral vein through a plastic needle. Images were obtained on a Technicare DR-960 or Diasonics DA 100 digital angiographic unit at four frames per second using 256 X 256 matrix and a 6 inch (15.24 cm) field size. In all patients, the venous systems, cardiac chambers and great arteries were well visualized. Two patients had obstruction of the superior vena cava with a dilated azygos vein draining into the inferior vena cava. One patient had severe obstruction of the left pulmonary artery. Digital subtraction angiography is safe and easy to perform and appears to be a valuable alternative method for evaluating patients after surgical repair of transposition of the great arteries. The small amount of contrast material required and the low radiation dose make it attractive for use in children.

Arterial Occlusive Diseases↗
PubMed1984

Combined discrete subaortic stenosis and ventricular septal defect in infants and children.

Eight patients, aged 1 to 8 years, with discrete subaortic stenosis (DSS) and ventricular septal defect (VSD) were studied by 2-dimensional (2-D) and M-mode echocardiography. Initial cardiac catheterization and angiocardiography showed VSD and other associated cardiac lesions, including coarctation of the aorta and patent ductus arteriosus. None had evidence of DSS. Six patients underwent surgical repair of the associated lesions, but none required closure of the VSD. Ultimately, 6 patients had spontaneous closure of VSD, and 2 had a residual small VSD. Subsequent serial echocardiography showed evidence of subaortic membrane, prompting repeat cardiac catheterization, which confirmed moderate to severe peak systolic pressure gradients between the left ventricle and ascending aorta. Surgical resection of the membrane was performed in 5 patients. Thus, in patients with small or spontaneously closed VSDs, DSS may develop. Evaluation of the left ventricular outflow tract area is recommended in patients with small or closed VSD in whom a significant heart murmur or electrocardiographic abnormality remains.

Abnormalities, Multiple↗
PubMed1984

Myocardial ischemia during intravenous DSA in patients with cardiac disease.

A prospective study was performed for 48 patients who had histories of angina and were referred for digital subtraction angiography (DSA). Cardiac disease was graded according to the American Heart Association (AHA) functional classification system. Each patient received 2-5 injections of 40-ml diatrizoate meglumine and diatrizoate sodium (Renografin-76, Angiovist-370, or MD-76) at 15 ml per second in the superior vena cava. Of the 28 patients in functional Classes I or II (no or slight limitation of activity), 11% had angina and 32% had definite ischemic ECG changes after the DSA injections. Of the 19 patients in functional Class III (marked limitation of activity), 63% had angina, and 58% had definite ischemic ECG changes after the injections. One patient in functional Class IV (total disability) developed ventricular fibrillation after the second injection. These observed cardiac effects following bolus injections of hypertonic ionic contrast media indicate that special precautions are necessary when performing intravenous DSA examinations on this group of high risk patients.

Aged↗
PubMed1982

Cardiac and coronary arterial involvement in infants and children from New England with mucocutaneous lymph node syndrome (Kawasaki disease). Angiocardiographic-echocardiographic correlations.

Forty-four patients, aged 6 months to 11 years, meeting the clinical criteria for mucocutaneous lymph node syndrome (Kawasaki disease) were studied from March 1980 to March 1981. A protocol was designed for evaluation of cardiac involvement including electrocardiogram, chest X-ray film, cardiac enzyme determinations and M mode and two dimensional echocardiograms. Aspirin was given during the acute febrile period as an anti-inflammatory agent in a dosage of 100 mg/kg per day; followed by 30 mg/kg per day for 10 weeks or longer if platelet counts were elevated. Angiocardiography was performed in 38 patients. Twenty-one patients (48 percent) showed abnormal M mode echocardiographic findings (flat or greatly decreased ventricular septal motion, pericardial effusion or decreased left ventricular function) during the acute febrile stage. Coronary artery disease developed in seven patients, all of whom had abnormal M mode echocardiographic abnormalities in the acute stage. Five patients had coronary aneurysms and two patients had dilated coronary arteries. Two dimensional echocardiograms identified coronary arterial lesions accurately if present proximally but failed to detect aneurysms beyond 1.5 cm from the aortic root. The study shows that serial M mode and two dimensional echocardiograms provide sufficient information to rule out cardiac involvement in Kawasaki disease. Echocardiograms should be obtained every 3 to 4 days during the acute febrile stage because all patients with coronary artery disease detected with angiography had abnormal echocardiographic findings during that period.

Angiocardiography↗
PubMed1980

Transfemoral snaring of broken catheters from the right heart in small infants.

Successful retrieval of embolized central venous catheter fragments from the right heart was accomplished in two small infants weighing 2100 and 4050 Gm respectively. The catheters had been broken off at the site of entry into the vein and migrated to right atrium. A 5F end-hole Cook catheter with 0.018 inch diameter, 125 cm long Curry snaring wire with flexible mid-segment was successfully utilized through the femoral vein percutaneously to remove the foreign body without complication.

Cardiac Catheterization↗
PubMed1980

Management of infective endocarditis using echocardiography.

Serial echocardiograms of five children who had infective endocarditis were analyzed and correlated with the clinical course. Vegetations were visualized initially on M-mode in four and on two-dimensional echocardiograms in all patients. The appearance of the vegetation was unexpected in one. More accurate anatomic localization of the vegetation was possible using two-dimensional echography. Four of the five patients died despite vigorous medical treatment and valve replacement in two. Complete resolution of the vegetation was documented for the first time in a child following medical therapy. This study suggests that echocardiography plays an important role in the diagnosis of endocarditis, allows objective follow-up of the size of the vegetations and their effects on valve function, and, therefore, may prove helpful in the management of these patients.

Adolescent↗
PubMed1978

Congenital partial eventration of the left diaphragm.

Two unusual cases of congenital partial eventration of the left diaphragm in young infants are described. In both cases the entity appeared as a space occupying lesion in the left anterior chest and was initially thought to represent pericardial cyst, mediastinal tumor, or cardiac enlargement. The left lobe of the liver occupied the eventration in both cases; one was proven at surgery, and the other was documented with a radionuclide liver scan. The radiographic features of eventration are discussed and the role of radionuclide liver scanning in infants with chest masses is emphasized.

Diaphragmatic Eventration↗
PubMed1977

Intrapulmonary steal complicating repair of tetralogy of Fallot.

A patient with total occlusion of the distal right pulmonary artery secondary to the performance of a Waterston shunt is reported. A nearly fatal intrapulmonary steal occurred at the time of corrective operation when an attempt was made to revascularize both pulmonary arteries.

Arterial Occlusive Diseases↗
PubMed1977

Recent results after repair of atrioventricular canal.

Tweleve patients with the complete form of persistent atrioventricular (AV) canal were operated upon at the University of Wisconsin between May, 1972, and November, 1975. The technique originally described by Rastelli and his associates was used. All 12 patients are asymptomatic and well, with no hospital or late deaths. Postoperative cardiac catheterization in 8 patients showed a return to near normal dynamics, with minimal residual mitral insufficiency. Half of these children had type A and half type C malformations; both types could be repaired without the need for valve replacement. Since 3 of these patients were less than 2 years of age, we now feel that complete repair of the AV canal can be undertaken in children between 12 and 18 months of age for optimal management.

Adolescent↗