Development of an Enzyme-linked Immunosorbent Assay Using Vitellin for Vitellogenin Measurement in the Pale Chub, Zacco platypus

OBJECTIVES: Fish vitellogenin (VTG) is produced in the female liver during oogenesis through the estradiol cycle and produced in the male liver by endocrine disrupting chemicals (EDCs) such as alkylphenols. In this study, we propose that the VTG concentration in the pale chub could be detected using monoclonal antibodies and polyclonal antibodies against vitellin (Vn) in a VTG enzyme-linked immunosorbent assay (ELISA) system. METHODS: Monoclonal antibodies and polyclonal antibodies were produced using the Vn extracted from the matured ovum of the ovary. The VTG was extracted from the plasma of the male pale chub. The Vn and VTG were confirmed by measuring the molecular weight of their proteins using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and the specificity of the antibodies was checked through western blotting methods. The assay system was validated with respect to optimal assay concentrations, specificity, recovery, and intra- and inter-assay variations. RESULTS: The Vn consisted of two protein bands with apparent molecular weights of 64 and 37 kDa. The SDS-PAGE indicated protein weights of 146 and 77 kDa in the VTG. The assay range was 15.6 ng/mL to 2,000 ng/mL, and the value of the intra- and inter-assay variations were within 10.0% and 14.7%, respectively. The recovery rate was 99.5+/-5.5%. CONCLUSIONS: A sandwich ELISA was developed that could be used to qualify the VTG of pale chub in screening for EDCs. Pale chub is an ideal species for observing estrogen activity in the environment because of its extensive habitat and extensive food chain. The ELISA developed here would be more favorable than those for other species for determining the effect of long-term food chain accumulation of EDCs in aquatic environments.

Effects of Water Chemistry on Aggregation and Soil Adsorption of Silver Nanoparticles

OBJECTIVES: In this study, we investigated the influence of ionic strength and natural organic matter (NOM) on aggregation and soil adsorption of citrate-coated silver nanoparticles (AgNPs). METHODS: Time-resolved dynamic light scattering measurements and batch adsorption experiments were used to study their aggregation and soil adsorption behaviors, respectively. RESULTS: The aggregation rate of AgNPs increased with increasing ionic strength and decreasing NOM concentration. At higher ionic strength, the AgNPs were unstable, and thus tended to be adsorbed to the soil, while increased NOM concentration hindered soil adsorption. To understand the varying behaviors of AgNPs depending on the environmental factors, particle zeta potentials were also measured as a function of ionic strength and NOM concentration. The magnitude of particle zeta potential became more negative with decreasing ionic strength and increasing NOM concentration. These results imply that the aggregation and soil adsorption behavior of AgNPs were mainly controlled by electrical double-layer repulsion consistent with the Derjaguin-Landau-Verwey-Overbeek theory. CONCLUSIONS: This study found that the aggregation and soil adsorption behavior of AgNPs are closely associated with environmental factors such as ionic strength and NOM and suggested that assessing the environmental fate and transport of nanoparticles requires a thorough understanding of particle-particle interaction mechanisms.

Toxicity Assessment of Titanium (IV) Oxide Nanoparticles Using Daphnia magna (Water Flea)

OBJECTIVES: Titanium dioxide (TiO2), a common nanoparticle widely used in industrial production, is one of nano-sized materials. The purpose of this study was to determine the acute and chronic toxicity of TiO2 using different size and various concentrations on Daphnia magna. METHODS: In the acute toxicity test, four concentrations (0, 0.5, 4, and 8 mM) for TiO2 with 250 or 500 nm and five concentrations (0, 0.25, 0.5, 0.75, and 1 mM) for TiO2 with 21 nm were selected to analyze the toxic effect to three groups of ten daphnia neonates over 96 hours. In addition, to better understand their toxicity, chronic toxicity was examined over 21 days using 0, 1, and 10 mM for each type of TiO2. RESULTS: Our results showed that all organisms died before the reproduction time at a concentration of 10 mM of TiO2. In addition, the exposure of anatase (21 nm) particles were more toxic to D. magna, comparing with that of anatase (250 nm) and rutile (500 nm) particles. CONCLUSIONS: This study indicated that TiO2 had adverse impacts on the survival, growth and reproduction of D. magna after the 21days exposure. In addition, the number of test organisms that were able to reproduce neonates gradually were reduced as the size of TiO2 tested was decreased.

Effect of saline irrigation used in combination with antimicrobial agents on salivary bacterial counts

INTRODUCTION: The aim of the present study was to investigate the effect of mechanical irrigation in combination with mouthwash of antimicrobial agents on salivary bacterial counts. MATERIALS AND METHODS: This study was performed with a randomized study employing a panel of 40 healthy volunteers (20 males and 20 females) between the age of 26 and 32 years. Volunteers were randomly put in one of four treatment groups. In the first group, 0.2 mL of non-stimulatory saliva was collected from every subjective person. Then, saliva was collected after rinsing with chlorhexidine (CHX) for 1 minute. In the second group, non-stimulatory saliva was collected, and then saliva was collected after rinsing with CHX and irrigation with saline. In the third and fourth groups, the same procedures as the first and second groups were performed with povidone iodine (PVI) instead of CHX. All of these samples were cultured for 48 hours aerobically. The reduction rates of colony-forming units (CFU) were calculated for each group. The reduction rate between each group was tested statistically using student t-test. RESULTS: Using CHX in combination with saline irrigation showed a significant decrease of the salivary bacterial CFU when compared with only using CHX.(P0.01) CONCLUSION: It was concluded that the CHX or PVI used with saline irrigation made the salivary bacterial counts reduced more than when CHX or PVI was used alone as an oral antiseptic agent.

Clinical Characteristics and Prognosis of Lung Cancer Patients Admitted to the Medical Intensive Care Unit at a University Hospital / 결핵및호흡기질환

BACKGROUND: The management of patients with lung cancer has improved recently, and many of them will require admission to the medical intensive care unit (MICU). The aim of this study was to examine the clinical characteristics and to identify risk factors for mortality in patients with lung cancer admitted to the MICU. METHODS: We conducted retrospective analysis on 88 patients with lung cancer admitted to the MICU between April 2004 and March 2008. RESULTS: Of the 88 patients (mean age, 66 years), 71 patients (80.7%) had non-small cell lung cancer and 17 patients (19.3%) had small cell lung cancer. Distant metastasis were present in 79 patients (89.8%). The main reasons for MICU admission were acute respiratory failure (77.3%), sepsis (11.4%), and central nervous system dysfunction (4.5%). Mechanical ventilation was used in 54 patients (61.4%). Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of MICU stay, need for mechanical ventilation, source of MICU admission were correlated with MICU mortality. The type of lung cancer and metastasis were not predictive factors of death in MICU. CONCLUSION: Most common reason for ICU admission was acute respiratory failure. Mortality rate of lung cancer patients admitted to the MICU was 65.9%. APACHE II score, length of ICU stay, need for mechanical ventilation, source of MICU admission were predicted factors of death in the MICU.

The Occlusal Force and EMG Change after BSSRO

BSSRO is most frequently operated among orthognathic surgery techniques for repairment of maxillofacial deformities. In case of patients with maxillofacial asymmetry accompanying mandibular protrusion who are operated by BSSRO, this study considers the recovering time for masticatory force of each tooth and Masseteric EMG and the adequate time enabling normal occlusion. The patients who are operated with BSSRO under general anesthesia in Dankook Dental Hospital, Department of OMS are selected for this study. The control group is devided into 2. 26 patients with facial asymmetry accompanying mandibular protrusion are selected for group 1 and their maximum voluntary bite force and masseteric EMG are measured. Group 2 is formed by volunteers with healthy dentition who are measured maximum bite force and masseteric EMG on both sides of the mouth. At the week of 3rd, 5th, 7th, 9th and 11th, Mann-Whitney U test is carried on for statistical analysis and the result is as follows. 1. Patients with mandibular protrusion showed apparently low maximum bite force and masseteric EMG than patients with normal occlusion. 2. In comparison with control group 1, Occlusal force is regained in incisors and canines at the 9th week and in premolars and molars, 11th week and masseteric EMG is regained at 11th week. 3. Comparing to normal occlusal patients, no recovery could be found in experimental group in every parts of the mouth.

Giant Coronary Aneurysm with Stenosis and Thrombus Formation due to Kawasaki Disease: Treatment with Graft Stent

Kawasaki disease is an acute systemic vasculitis of unknown origin. Coronary aneurysm or ectasia is one of the most serious complications of Kawasaki disease. The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm. Percutaneous balloon angioplasty, rotational ablation, directional coronary artherectomy, stent insertion and coronary artery bypass graft can be used to treat coronary artery stenosis or occlusion. We describe a 6-year old boy who had an episode of Kawasaki disease with giant coronary artery aneurysm diagnosed at the age of 3 years. Surveillance echocardiogram showed giant coronary aneurysm with stenosis and large mural thrombus in the proximal portion of left main coronary artery. So we inserted two polytetrafluoroethylene(PTFE) covered graft stent without complication.

Acute Epididymo-orchitis in Newborn Infant

Acute scrotum in newborn infants is unusual and it is even more unusual with infectious origin. The causes of acute scrotum in newborn infants include hydrocele, testicular torsion, torsion of an appendix testis, epididymo-orchitis, meconium peritonitis, testicular tumor, scrotal hematoma and reducible or incarcerated inguinal hernia. Because of lack of typical symptoms and signs, the correct diagnosis of surgical emergencies such as testicular torsion and incarcerated inguinal hernia are often delayed. Recently, color Doppler ultrasonography and testicular scans are being used for differential diagnosis of acute scrotum, although the latter is often technically unsatisfactory due to small size of the testicles in newborn infants. We report a seven day-old male infant with acute scrotum who was diagnosed as acute epididymo-orchitis by color Doppler ultrasonography, and saved from unnecessary surgical interventions. Although color Doppler ultrasonography can not give diagnostic clue for acute scrotum, it can reduce the need for explorative surgery.

Mid-term Result of the Transcatheter Occlusion of Patent Ductus Arteriosus with Duct-Occlud Device and Procedure-Related Problems / 소아과

PURPOSE: We will present our mid-term result of transcatheter closure of PDA with Duct-Occlud device(pfm. AG. Germany) after 12 months follow up and report the problems during the procedure. METHODS: In total 154 patients, the Duct-Occlud devices were inserted in our institute from March, 1996 to August, 2002. Three types of Duct-Occlud device, i.e standard, reinforced, reinforced reverse cone coil were used. Echocardiographic examination was performed at 1, 6, 12 months after procedure. RESULTS: The echocardiographic closure rate was 96% after 12 months. The rates of residual shunt in the standard coil, the reverse cone coil, and the reinforced reverse cone group were 8%, 4% and 3% respectively. In PDA with diameter less than 4 mm, the closure rate was up to 98% while in large PDA with more than 4 mm, it was 72% after 12 months. Embolization of the inserted coils had occurred in 5 cases with successful retrieval using snare catheter. The rupture of the core wire during the procedure and distortion of the original coil shape had occurred in 4 cases. CONCLUSION: The transcatheter occlusion with Duct Occlud is safe and effective method for small to moderate sized PDA less than 4 mm. The minimum diameter of the PDA seems to be the predictor of residual shunt. Further refinement of the device to overcome the procedure-related problems seems to be needed.

Comparison of Infundibular Septal Malalignment in Isolated Ventricular Septal Defect and inTetralogy of Fallot and Relationship between the Degree of Infundibular Septal Malalignment and the Peak Velocity of the Right Ventricular Outflow Tract

No Abstract available.

Natural Course of Secundum Atrial Septal Defect Diagnosed within 3 Months after Birth

No Abstract available.

The Natural Course and Size Change of Atrial Septal Defect Secundum

PURPOSE: This study was performed to follow the natural course and size change of isolated atrial septal defect(ASD) secundum. METHODS: Among the newly diagnosed with ASD secundum at the division of pediatric cardiology in Yonsei cardiovascular hospital from January 1996 to December 2000, 89 patients with pure ASD secundum were checked by the serial echocardiographic evaluation to measure the size change. RESULTS: There was a statistical difference(P8 mm) and the group of smaller defect (< or = 8 mm). There was also a statistical difference(P<0.05) in the rate of spontaneous closure and size change of the defect between the group of younger than three years of age and the group of older than three years of age. The initial size of the defect and change of size were the significant influencing factors in the rate of spontaneous closing of ASD. In the group of patients who have persistent ASD, the size of defect showed a tendency of increasing size of defect with the age(P<0.005); however in the correction of these values by the body surface area of each patients, there was no statistical difference. CONCLUSION: The possibility of spontaneous closure of pure ASD secundum was higher in the group of patients who have smaller defect and who were younger. The ASD secundum that did not have spontaneous closure showed an increase in size with the growth of the patients; however when this size was corrected by the body surface area, there was no statistical difference. The closure of the defect was at 26.2 months of age so close follow-up of the patients is important.

Medico-Surgical Cooperative Treatment of Pulmonary Atresia with Intact Ventricular Septum

PURPOSE: The actual clinical examples of co-appliance of catheter intervention with surgical procedures in the treatment of pulmonary atresia with an intact ventricular septum(PA/IVS) which we have experienced in our institution are here shown, and the anatomical and hemodynamical profiles between each method is compared. METHODS: Medical records of 33 patients with PA/IVS who underwent various treatment from January, 1995 to December, 2000 were reviewed for a retrograde study. RESULTS: In three out of 10 patients who underwent percutaneous balloon pulmonary valvotomy (PPV), residual pulmonary stenosis were observed in their out patient department(OPD) follow-ups, eventually necessitatig balloon pulmonary valvuloplasty(BPV). One out of three patients exhibited deterioration of tricuspid regurgitation after BPV, requiring surgical tricuspid annuloplasty(TAP). Two out of the seven patients who received primarily surgical right ventricle outlet tract(RVOT) repair without any systemic-pulmonary shunt or intervention needed additional intervention employing cardiac catheterization after operation. Two patients received interventional catheterization before surgical RVOT repair. In five out of 11 cases of Fontan type operation, coil embolization of collateral circulation was done before total cavo-pulmonary connection(TCPC), and in three cases, interventional catheterization was needed after TCPC. CONCLUSION: Both medical and surgical treatment modalities are widely used in management of PA/IVS patients, and recent results prove that medico-surgical cooperative treatment is essential.

Postoperative Progress and Influencing Factors in Patients after Rastelli Procedure

PURPOSE: We have performed an analysis on patients who received Rastelli operation in our institute and reviewed their progress postoperatively. Various factors with suspected relationship to the outcome have been considered to help in future treatment and follow-up. METHODS: We analyzed retrospectively 43 patients who either received Rastelli operation in Yonsei University Cardiovascular Center from March 1995 to April 1997 or who received post-procedural cardiac catheterization and follow-up echocardiography in the out-patient department after the procedure. RESULTS: No statistically valid relationships were found between the age of the patient, their body weight, preoperative pulmonary arterial index and pressure, presence of pulmonary branchial stenosis and postoperative results. Cases with atrioventricular concordance showed lower age and body weight, and discordant cases exhibited lower ejection fraction 3 days postoperatively. Upon follow up, lower NYHA score was seen in patients with severe residual stenosis. In the group that received cardiac catheterization after the procedure, residual stenosis and right ventricular pressure measurement in echocardiography showed good correlation with the catheterization data. CONCLUSION: In cases where conduit insertions of the right ventricular outflow tract are required to achieve total correction in complex cardiac deformity, early operation does not seem to provide a clear risk to the patient. In patients with atrioventricular discordance, careful postoperative observation of the ventricular function seems to be needed. Also, echocardiography appears to be a sound method in follow-up of patients after the correctional procedure.

Morphologic Changes of the Pulmonary Arteries after Stent Implantation on Branch Pulmonary Artery Stenosis: Impact of Pulmonary Insufficiency

PURPOSE: Intravascular stent implantation for the treatment of postoperative branch pulmonary artery(PA) stenosis has been used successfully. However, the cross sectional area of contralateral branch PA does not regress in spite of the successful dilation of the stenotic branch PA after stent implantation. We analyzed the morphologic and hemodynamic factors on the size of branch PA after successful stent implantation. METHODS: The subjects in our study were 23 children who had undergone stent implantaion from Jan. 1995 to Jul. 2002 in the Division of Yonsei Pediatric Cardiology. We evaluated the cross sectional area index(CSAI) of branch PA before and after stent implantation at follow-up catheterization. We also investigated factors such as residual pulmonary stenosis, pulmonary regurgitation(PR), systolic pressure of right ventricle, and lung perfusion scan. RESULTS: The CSAI of the RPA without stenosis changed from mean 238+/-17 mm2/BSA to mean 249+/-20 mm2/BSA(P=0.47), but didn't regress. The CSAI of the LPA with stenosis was increased effectively by stent implantation from the mean 102+/-12 mm2/BSA to mean 125+/-11 mm2/BSA(P< 0.05). At follow up after stent implantation, the CSAI of PA is correlated with the residual PR fraction after stent implantation. CONCLUSION: In a group with increased residual PR, CSAI of RPA was found to be significantly increased between the pre- and post-stages of stent implantation. So, we suspect that the pulmonary regurgitation remaining after right ventricle outlet tract(RVOT) dilatation surgery is correlated with the increase in CSAI of RPA.

The Influence of the Preoperative Chronic Cyanosis on the Cardiac Troponin I in the Pediatric Cardiac Operation

PURPOSE: The purpose of this study was to evaluate the perioperative myocardial damage in pediatric congenital heart disease with the cardiac specific protein of cardiac troponin I(cTpn-I). METHODS: All 25 pediatric patients who were diagnosed with tetralogy of Fallot or double outlet right ventricle were classified as group A(acyanotic, SaO2 >90%), group B(mildly cyanotic, SaO2 >80-90%) and group C(moderately cyanotic, SaO2 <80%). The control group D was consisted of 10 patients with ventricular septal defects who were operated in the same period. We measured preoperative hemoglobin, preoperative and postoperative(24 and 72 hour) arterial oxygen saturation, cTpn-I and creatine kinase(CK-MB). RESULTS: Total 25 patients were subdivided into 6 of group A, 12 of group B and 7 of group C. The concentrations of preoperative cTpn-I were 0.23+/-0.12 ng/mL in group A, 0.25+/-0.12 ng/mL in group B, 0.26+/-0.13 ng/mL in group C. And the concentrations of cTpn-I in postoperative 24 hour were 10.04+/-5.28 ng/mL in group A, 12.50+/-6.86 ng/mL in group B, 12.55+/-9.90 ng/mL in group C. Which revealed cTpn-I in group C was higher than that of the another less cyanotic groups. In addition, the concentration of cTpn-I of group C in postoperative 72 hour was higher than any other groups. The concentration of cTpn-I in postoperative 72 hour was statistically correlated with that in postoperative 24 hour and preoperative arterial oxygen saturation(P=0.001). CONCLUSION: Preoperative chronic cyanosis can influence on the postoperative concentration of cTpn-I in pediatric cardiac patients, which means impairment on the postoperative myocardial recovery.

Epidemiologic Study of Kawasaki Disease in Korea, 1997-1999: Comparison with Previous Studies During 1991-1996

We performed a retrospective epidemiologic survey on Kawasaki disease (KD) from 1997 to 1999 in Korea. We sent a questionnaire to 111 training hospitals, and summarized the data from 50 hospitals that responded. Data from a total of 3,862 cases were collected, which showed no difference in annual incidence and a seasonal predilection for summer. The male-to-female ratio was 1.51:1, and the mean age was 29.7 months. The prevalence of sibling cases was 0.26%, and the rate of recurrent cases was 2.3%. The proportion of patients with KD among total hospitalized pediatric patients was 1.19% in average, showing a significant difference according to the regions. Coronary arterial (CA) abnormalities were detected by echocardiography in 19.8% of cases (737/3,723) including dilatations in 601 cases (16.1%) and aneurysms in 191 cases (5.1%). Data from total 8,251 cases in the 1990s including the cases in the present study, in Korea showed a mean age of patients 28.9 months, male-to-female ratio 1.6:1, seasonal predilection for summer, prevalence of sibling cases 0.24%, rate of recurrent cases 2.3%, incidence of CA abnormalities 21.0%, and incidence of CA aneurysms 5.2%, with statistically significant decreasing trends in the male-to-female ratio and the rate of CA abnormalities.

Study of Neonatal Cardiac Catheterization for Over the Last 10 Years

PURPOSE: The neonatal cardiac catheterization and angiogram for transcatheter therapy are still essential methods in congenital heart disease, so we reviewed our experience with neonatal cardiac catheterization over 10 years at a single institution. METHODS: A retrospective review of all 139 neonatal catheterizations from January 1991 to December 2000 at Sejong Heart Institution was performed. The purpose of the catheterizations, ages, body weights and the complications by the exam was surveyed. RESULTS:The mean age of our 139 patients was 14.9 days and the mean body weight was 3.3 kg. As for the diagnosis : TGA in 49 patients, PAIVS in 26 patients, DORV in 14 patients, PS in 14 patients, PAVSD in 11 patients. For the cardiac catheterization, general anesthesia was performed in 65% of total and fluoroscopy time was 20.1+/-14.5 minutes during cardiac catheterization. In the interventional cardiac catheterization which was 75% of the total, the age and body weight were statistically the same but the irradiation time was longer than the diagnostic catheterization(P=0.001). There were 48 cases of atrial septostomy, 16 cases of balloon pulmonary valvuloplasty and 25 cases of transcatheter pulmonary valvotomy. Complications of cardiac catheterization were found in 16.3%, but there was no difference between interventional catheterization and diagnostic catheterization. CONCLUSION: Therapeutic cardiac catheterization in neonates is a relatively safe and effective method in congenital heart disease.

Histologic Changes of Pulmonary Arteries in Congenital Heart Disease with Left-to-Right Shunt (Part 1): Correlated with Preoperative Pulmonary Hemodynamics. Emphasizing the Significance of Pulmonary Arterial Concentration

The hemodynamic findings related to the histologic changes in the small pulmonary arteries in congenital heart disease were analyzed with a left-to-right shunt. A lung biopsy was performed during the repair because of pulmonary arterial (PA) hypertension (mean PA pressure > or = 15 mmHg) in 38 patients. There were 13 patients whose age ranged from 2 years to 25 years old. A preoperative cardiac catheterization was performed to locate the site of the defect and to determine the preoperative hemodynamic findings. Among them, 29 patients had pulmonary vascular resistance (PVR) > 2.5 unit/m2. The lung biopsy specimens were investigated microscopically for the Heath- Edward grade, morphometric analysis of medial wall thickness (MWT) and the rate of the decrease in the pulmonary arteriolar concentration (PAC) obtained by the alvoelo-arterial ratio divided by patients' age. All patients were in the Heath-Edward grade I to III (29 patients in grade I). This grade correlated with the MWT, but did not correlate with a decrease in the PAC. The MWT and the rate of the decrease in the PAC did not accompany each other, but either one had the tendency dominate the pattern in individual patients. The MWT had a close correlation with the mean PA pressure and PVR, and an even closer correlation in patients with a high PVR and those older than 2 years of age. The rate of the decreased in the PAC showed a weak correlation with the shunt volume in patients over 2 years of age or with a large shunt. In the high flow group (PVR 2.0, n=14) the MWT was significantly thinner and the rate of the decrease in the PAC was significantly higher than the high resistance group (PVR > 2.5 unit/m2, Qp/Qs2 < 2.0, n=13). The rate of the decrease in the PAC correlated with the patients' age, but the MWT did not. The lung biopsy results in patients who had both left-to-right shunts and pulmonary hypertension showed that the rate of the decrease in the PAC was weakly related to the shunt volume and the MWT was related to the PA pressure and PVR. Either an increased MWT or the rate of the decrease in the PAC tended to dominate. These phenomena were prominent in patients older than 2 in whom a wide range of individual variations were noted in the morphometric pattern. The medial hypertrophy and the rate of the decrease in the PAC may be induced by different stimuli or that medial hypertrophy may play a role in preventing PAC decrease.

Conversion of Total Atrio-pulmonary Connection to Total Cavo-pulmonary Connection-Review of Indications and Hemodynamic Characteristics-

PURPOSE: Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. METHODS: Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization 11+/-3 months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. RESULTS: There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range: 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was 18.0+/-3.6 mmHg, but baffle pressure, corresponding to right atrial pressure decreased to 14.8+/-3.6 mmHg after TCPC. The size of the pulmonary arteries did not regress after TCPC. CONCLUSION: The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.