Original Articles Korean Circulation J 1998;28 4 : 상심실성빈맥환자에서관상정맥동의형태비교 현대우 김윤년 박소영 한성욱 허승호 김기식 김권배 Coronary Sinus Morphology in Patients with

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1 Original Articles Korean Circulation J 1998;284: 상심실성빈맥환자에서관상정맥동의형태비교 현대우 김윤년 박소영 한성욱 허승호 김기식 김권배 Coronary Sinus Morphology in Patients with Supraventricular Tachycardia Dae-Woo Hyun, MD, Yoon-Nyun Kim, MD, So-Young Park, MD, Seung-Ho Hur, MD, Seong-Wook Han, MD, Kee-Sik Kim, MD and Kwon-Bae Kim, MD Division of Cardiology, Department of Internal Medicine, School of Medicine Keimyung University, Taegu, Korea ABSTRACT BackgroundCoronary sinus catheterization is important in electrophysiological studies. However the morphologic feature of the coronary sinus and its significance in patients with supraventricular tachycardia SVT have not been determined. During diagnostic electrophysiological studies, coronary sinus catheterization was easier in patients with atrioventricular nodal reentry tachycardia AVNRT than in patients with atrioventricular reentry tachycardia AVRT. Therefore, we studied coronary sinus morphology in patients with SVT and compared AVNRT and AVRT patients. MethodsThe size and shape of the coronary sinus were measured in 13 patients who underwent retrograde coronary sinus venogram during electrophysiologic study between May and June The diagnosis was 7 cases of AVNRT, 2 of Wolff-Parkinson-White syndrome and 4 of concealed bypass tracts mean age, 40 yearsmale vs female, ResultsThe mean coronary sinus ostial diameter was mmfor AVNRT, it was mm, and for AVRT it was mm in left anterior oblique projection p The mean coronary sinus-to-spine angle was AVNRT and AVRT in anterior posterior projection p ConclusionThe coronary sinus ostial diameter of AVNRT patients was significantly larger than that of AVRT patients. This finding may have important implications for arrythmia pathogenesis in such patients. Korean Circulation J 1998;284: KEY WORDSCoronary sinus AVNRT AVRT. 서 론 620

빈맥환자에서 방실회귀성 빈맥환자보다 쉽게 도자가 관상정맥동구의 각도는 좌전측면에서는 척추체전연 관상정맥동으로 위치함을 경험할 수 있다. 이에 연구자 과 관상정맥동구사이의 각도를 측정하였고 전후면에서 는 상심실성 빈맥환자에서 관상정맥동의 형태와 방실 는 척추체중심선과 관상정맥동구사이의 각도를 측정하 결절회귀성 빈맥과 방실회귀성 빈맥환자에서 관상정맥 였다.

통계처리는 Window용 SPSS(statistical pa- 대상 및 방법 대 상 1996년 5 6월동안 계명의대 순환기내과에서 전기 생리 심장검사를 시행한 환자중 13명의 상심실성 빈맥 환자를 대상으로 하였고 이들은 방실결절회귀성 빈맥 7명, 불현성 우회로성 빈맥 4명, WPW증후군 2명이었 다.

2 빈맥환자에서 방실회귀성 빈맥환자보다 쉽게 도자가 관상정맥동구의 각도는 좌전측면에서는 척추체전연 관상정맥동으로 위치함을 경험할 수 있다. 이에 연구자 과 관상정맥동구사이의 각도를 측정하였고 전후면에서 는 상심실성 빈맥환자에서 관상정맥동의 형태와 방실 는 척추체중심선과 관상정맥동구사이의 각도를 측정하 결절회귀성 빈맥과 방실회귀성 빈맥환자에서 관상정맥 였다. 관상정맥동분지의 각도는 분지에서의 관상정맥동 동의 형태 차이에 대해 비교 분석하였다. 수직선과 분지사이의 각도를 측정하였다(Figs. 1, 2 and 3). 통계처리는 Window용 SPSS(statistical pa- 대상 및 방법 대 상 1996년 5 6월동안 계명의대 순환기내과에서 전기 생리 심장검사를 시행한 환자중 13명의 상심실성 빈맥 환자를 대상으로 하였고 이들은 방실결절회귀성 빈맥 7명, 불현성 우회로성 빈맥 4명, WPW증후군 2명이었 다. 이들의 평균연령은 40±17(20 61)세였고 남녀 비는 1 1.2(6명 7명)였다. 이들 모두 도자절제술을 시행하였고 불현성 우회로성 빈맥 1명을 제외하고는 Fig. 1. Schematic diagram of coronary sinus-spine angle measurement at anterior posterior(a) and left anterior oblique(b) projections. (1) angle of coronary sinus-spine, (2) angle of branch, (3) diameter of coronary sinus ostium. 모두 도자절제를 성공하였다(Table 1). 방 법 대상환자에서 전기생리검사중에 좌측쇄골하정맥접근 으로 7F Daig Coronary Sinus Catheter(모델명, Daig ResponseTM )를 투시영상하에 관상정맥동에 위치케 하였다. 혈관조영은 앙와위에서 중호기에 수동 으로 조영제를 주입하여 좌전측면과 전후면 두방면에 서 활동혈관필름에 기록후 분석을 시행하였다. 관상정맥동구 직경은 조영제가 흘러나오는 외곽선과 관상정맥동이 우심방으로 들어오는 장축에서 측정하였 으며 각각 5, 10, 20, 30, 40 mm거리의 간격으로 관상 정맥동의 직경을 측정하였다. 관상정맥동 각분지의 수 Fig. 2. Left anterior oblique projection of coronary sinus angiogram in a patient with atrioventricular nodal reentry tachycardia. 와 직경, 관상정맥동구와의 거리를 측정하여 기록하였 다. 모든 거리와 직경의 측정은 7F Daig Coronary Sinus Catheter의 실제직경을 혈관조영필름상에 관상 정맥동구가 가장잘 보이는 정지영상상에 배율로 환산 하여 측정하였다. Table 1. Characteristics of study patients Sex(M F) AVNRT AVRT(CBT+WPW) Total Age 42±19 36±16 40±17 AVNRT Atrioventricular nodal reentry tachycardia AVRT Atrioventricular reentry tachycardia CBT Concealed bypass tract WPW Wolff-Parkinson-White syndrome Fig. 3. Anterior posterior projection of coronary sinus angiogram in a patient with atrioventricular reentry tachycardia. 621

3 관상정맥동의직경 결 Fig. 4. Diagram comparing the mean measurement of the left anterior oblique projection of the coronary sinus for patients with atrioventricular nodal reentry tachycardia AV NRT and atrioventricular reentry tachycarida AVRT. 과 관상정맥동의분지 관상정맥동구와척추와의각도 Table 2. Mean measurements of AVNRT and AVRT patients in two agiographic projections of the coronary sinus Ostium 5 mm 10 mm 20 mm 30 mm 40 mm LAO AVNRT * * AVRT * * Mean AP AVNRT * AVRT * Mean AVNRTatrioventricular nodal reentry tachycardia AVRTatrioventricular reentry tachycardia LAOleft anterior oblique projection APanteroposterior projection Results are meansd expressed in min. *p Korean Circulation J 1998;284:

4 Table 3. Mean measurements of AVNRT and AVRT patients in two angiographic projections of the coronary sinus venous tributaries First branch Second branch Distance Diameter Angle Distance Diameter Angle LAO AVNRT * AVRT * Mean AP AVNRT AVRT Mean AVNRTatrioventricular nodal reentry tachycardia AVRTatrioventricular reentry tachycardia LAOleft anterior oblique projection APanteroposterior projection Results are meansd expressed in mm or degree. *p0.05 Table 4. Relation of the coronary sinus ostium to the spine 방실결절 LAO 고 안 AP AVNRT * AVRT * Mean AVNRTatrioventricular nodal reentry tachycardia AVRTatrioventricular reentry tachycadia LAOleft anterior oblique projection APanteroposterior projection Results are meansd expressed in degree *p0.05 관상정맥동의확장과방실결절회귀성빈맥과의관계 623

5 관상정맥동의형태이상 624 요약 연구배경 : 방법 : 결과 : 결론 : Korean Circulation J 1998;284:

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Original Articles Korean Circulation J 1998;28 9 : WPW 증후군환자에서성공적인전극도자절제술후재분극이상 배장호 1 김윤년 1 한성욱 1 현대우 1 신이철 1 김기식 1 김권배 1 이상민 2 Repolarizatio

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