폐동맥협착증에서풍선판막성형술후심실재분극의변화

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1 Original Articles Korean Circulation J 2001;313: 폐동맥협착증에서풍선판막성형술후심실재분극의변화 고재곤 윤소영 김영휘 박인숙 Changes in Ventricular Repolarization after Balloon Valvuloplasty in Patients with Pulmonary Stenosis Jae Kon Ko, MD, So Young Yoon, MD, Young Hwee Kim, MD and In Sook Park, MD Division of Pediatric Cardiology, Asan Medical Center, Medical College University of Ulsan, Seoul, Korea ABSTRACT BackgroundAlterations in ventricular loading conditions lead to changes in action potential duration via mechanoelectrical feedback. A decrease in load immediately leads to the prolongation of repolarization. QT interval and QT dispersion were measured in order to determine the long-term effect of changes in ventricular systolic load on the ventricular repolarization. MethodCorrected QT interval and QT dispersion were measured in 26 patients before and 36 months after valvuloplasty for pulmonary stenosis. In order to determine the effect of ventricular load on ventricular repolarization, patients were divided in 2 groupsgroup 1 was those patients with a decrease in the right ventricular systolic pressure greater than 30 mmhg and Group 2 was those patients with a less than 30 mmhg decrease. ResultsCorrected QT interval msec vs msec, p0.05 and QT dispersion msec vs msec, p0.05 were increased significantly only in Group 1 after valvuloplasty. ConclusionIt suggested that mechanoelectrical interactions are operative for long duration in humans that changes in ventricular load after successful pulmonary valvuloplasty showed a long-term effect on ventricular repolarization. Korean Circulation J 2001;313: KEY WORDSPulmonary stenosis QT interval QT dispersion Ventricular repolarizarion Mechanoelectrical feedback. 서 론 341

2 대상및방법 342 결과 대상환자 우심실의압력변화가심실재분극에미치는영향 Korean Circulation J 2001;313:

3 Table 1. Electrocardiographic data before and after balloon valvuloplasty in patients with pulmonary stenosis n26 pre-balloon msec post-balloon msec p-value QTc p0.05 QTd p0.05 QTcd p0.05 JTc p0.05 JTd p0.05 JTcd p0.05 QTccorrected QT interval, QTdQT dispersion, QTcdcorrected QT dispersion, JTccorrected JT interval, JTdJT dispersion, JTcdcorrected JT dispersion Fig. 2. Changes of QTd between before and after balloon pulmonary valvuloplasty. Gr1patients with right n16, Gr2patients with right ventricular pressure change of less than 30 mmhg n10. Fig. 1. Changes of QTc between before and after balloon pulmonary valvuloplasty. Gr1patients with right n16, Gr2patients with right ventricular pressure change of less than 30 mmhg n10. Fig. 3. Changes of JTc between before and after balloon pulmonary valvuloplasty. Gr1patients with right n16, Gr2patients with right ventricular pressure change of less than 30 mmhg n10. 고 찰 343

4 Fig. 4. Changes of JTd between before and after balloon pulmonary valvuloplasty. Gr1patients with right n16, Gr2patients with right ventricular pressure change of less than 30 mmhg n Korean Circulation J 2001;313:

5 요약 연구목적 : 345

6 대상및방법 : 결과 : 결론 : 중심단어 REFERENCES 1) Rome JJ. Balloon pulmonary valvuloplasty. Pediatr Cardiol ) Levine JH, Guarnieri T, Kadish AH, White RI, Calkins H, Kan JS. Changes in myocardial repolarization in patients under-going balloon valvuloplasty for congenital pulmonary stenosis Evidence for contraction-excitation feedback in humans. Circualtion ) Lerman BB. Mechanoelectrical feedback Maturation of a concept. J Cardiovasc Electrophysiol ) Tsai CH, Lee TM, Su SF. Regression of ventricular repolarization inhogeneity after aortic valve replacement in patients with aortic stenosis. Int J Cardiol ) Darbar D, Cherry CJ, Kerins DM. QT dispersion is reduced after valve replacement in patients with aortic stenosis. Heart ) Martin GR, Stanger P. Transient prolongation of the QTc interval after balloon valvuloplasty and angioplasty in children. Am J Cardiol ) Taggart P, Sutton PM, Treasure T, Lab M, O Brien W, Runnall M, et al. Monophasic action potentials at discontinuation of cardiopulmonary bypass Evidence for contraction-excitation feed-back in man. Circualtion ) Taggart P, Sutton PMI. Cardiac mechanoelectric feedback in man Clinical relevance. Prog Biophys Mol Biol ) MacFarlane PW. Measurement of QT dispersion. Heart ) Malik M, Camm AJ. Mystery of QTc interval dispersion. Am J Cardiol ) Zabel M, Portnoy S, Franz MR. Effect of sustained load on dispersion of ventricular repolarization and conduction time in the isolated intact rabbit heart. J Cardiovasc Electrophysiol ) Tomaselli GF, Marban E. Electrophysiological remodeling in hypertrophy and heart failure. Cardiovasc Res ) Krayenbuehl HP, Hess OM, Monrad ES, Schneider J, Mall G, Turina M. Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation Korean Circulation J 2001;313: