Massive endobronchial hemorrhage after a successful pulmonary thromboendarterectomy is a rare but catastrophic complication. We experienced this complication in a patient with chronic pulmonary embolism, but it was managed successfully using extracorporeal membrane oxygenation and differential ventilation.
Endarterectomy* ; Extracorporeal Membrane Oxygenation ; Hemorrhage* ; Humans ; Pulmonary Embolism* ; Ventilation

No abstract available.
Phenylketonurias*

No abstract available.
Child* ; Humans ; Infant*

Repair of the aortic valve has received considerably less attention than repair of the mitral or tricuspid valves. Reasons for this may include the greater incidence of stenosis in the aortic valve relative to insufficiency, the degenerative processes that lead to valvular dysfunction reducing the number of potentially repairable valves, and the presence of a wider variety of valve substitutes with lower thromboembolic potential and greater longevity than for the mitral position. Furthermore, the functional structure and redundancy of the mitral and tricuspid valves may be more amenable to plastic techniques. Most surgeons treat all aortic valve pathology with a replacement. In part, this management strategy is justified by the excellent long-term results with available prostheses. Since valve replacement in the younger adult has the inherent problems associated with anticoagulation and/or prosthesis durability, repair, if durable, has the potential for a good solution in this patient population. We reviewed the surgical indications, techniques, clinical results, and current status of aortic valve repair.
Adult ; Aortic Valve Insufficiency ; Aortic Valve* ; Constriction, Pathologic ; Humans ; Incidence ; Longevity ; Pathology ; Plastics ; Prostheses and Implants ; Prosthesis Failure ; Tricuspid Valve

Repair of the aortic valve has received considerably less attention than repair of the mitral or tricuspid valves. Reasons for this may include the greater incidence of stenosis in the aortic valve relative to insufficiency, the degenerative processes that lead to valvular dysfunction reducing the number of potentially repairable valves, and the presence of a wider variety of valve substitutes with lower thromboembolic potential and greater longevity than for the mitral position. Furthermore, the functional structure and redundancy of the mitral and tricuspid valves may be more amenable to plastic techniques. Most surgeons treat all aortic valve pathology with a replacement. In part, this management strategy is justified by the excellent long-term results with available prostheses. Since valve replacement in the younger adult has the inherent problems associated with anticoagulation and/or prosthesis durability, repair, if durable, has the potential for a good solution in this patient population. We reviewed the surgical indications, techniques, clinical results, and current status of aortic valve repair.
Adult ; Aortic Valve Insufficiency ; Aortic Valve* ; Constriction, Pathologic ; Humans ; Incidence ; Longevity ; Pathology ; Plastics ; Prostheses and Implants ; Prosthesis Failure ; Tricuspid Valve

Xanthogranulomatous pyelonephritis is an uncommon form of chronic bacterial infection of the kidney that may occur at any age but is most often seen in middle-aged or older women. Xanthogranulomatous pyelonephritis in children is very rare. We report a 2-year-4-month-old male hospitalized with complaints of palpable abdominal mass. Excretory urography, abdominal sonogram, abdominal computed tomogram showed hydronephrosis with right renal stones and ureteropelvic junction obstruction. It was treated with right nephrectomy. Pathologic findings revealed xanthogranulomatous pyelonephritis postoperatively. This case is a xanthogranulomatous pyelonephritis occurred in the most youngest age in Korean literatures.
Bacterial Infections ; Child* ; Female ; Humans ; Hydronephrosis ; Kidney ; Male ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous* ; Urography

Ehlers-Danlos syndrome type IV(the arterial-ecchymotic type) which has skin fragility, easy bruisability, and j oint hyperextensibility is occasionally combined with large vessel involve-ment and spontaneous catastrophic bleeding. As even a small inj ury can cause profound vascular tearing and damage, surgical management is hazardous and often unrewarding. We report a successful surgical treatment of an acute type A aortic dissection associated with Ehlers-Danlos syndrome.
Ehlers-Danlos Syndrome* ; Hemorrhage ; Skin

BACKGROUND: We assessed the efficacy of intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery. MATERIAL AND METHOD: We studied seven hundred ninety-six patients who underwent off-pump coronary artery bypass between January 2000 and December 2006. The patient were divided into group I (n=39), which received intraoperative intra-aortic balloon pump therapy, and group II (n=757), which did not receive intraoperative intra-aortic balloon pump therapy. RESULT: There were no differences in the operative mortalities (2.6%, 1/39 vs 0.8%, 6/757; p=0.195) and morbidities such as atrial fibrillation (p=0.691), stroke (p=0.908) and mediastinitis (p=0.781) between the 2 groups, although the ventilator support time, the length of the intensive care unit stay and the length of the hospital stay were longer in group I than in group II (p<0.05). Multivariate analysis failed to prove that group I was a high risk group for operative mortality (p=0.549). There were 3 intraoperative intra-aortic balloon pump-related complications in group I (7.9%). However, no longer complications occurred after 2003, when the surgeons began using a smaller sized 8 F catheter that was inserted using a sheathless technique. CONCLUSION: Intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery can be performed safely and it showed comparable clinical results to that of not using intraoperative intra-aortic balloon pump therapy.
Atrial Fibrillation ; Catheters ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Hemodynamics ; Humans ; Intensive Care Units ; Length of Stay ; Mediastinitis ; Multivariate Analysis ; Stroke ; Ventilators, Mechanical

Background: Atrial fibrillation (AF) is a significant contributor to cardioembolic stroke, with the left atrial appendage (LAA) often being the principal source of thrombus. Given the substantial impact of stroke on patient quality of life, and its potential life-threatening nature, stroke prevention is paramount in the management of AF. Nonvitamin K oral anticoagulants (NOACs) or vitamin K antagonists are typically the first line of treatment to prevent strokes caused by AF. However, for patients unable to tolerate oral anticoagulants, alternatives such as percutaneous LAA closure (LAAC) or surgical LAAC might be considered.Main body The most widely used percutaneous LAAC methods are the AMPLATZER Amulet and WATCHMAN devices. Registry studies have shown promising results for both devices, with low ischemic stroke rates in patients undergoing LAAC (Reddy in J Am Coll Cardiol 70(24):2964–75, 2017, Holmes in J Am Coll Cardiol 64(1):1–12, 2014).However, catheter-based LAAC has some limitations, such as a risk of device-related thrombus and the need for antithrombotic medication to facilitate device endothelialization Mesnier (Circ Cardiovasc Interv 16(5):e012812, 2023.). Surgical LAAC is being considered as a method that can complement the shortcomings of percutaneous LAAC. In the past, surgical LAAC was performed either by LAA resection or internal obliteration during open-heart surgery, but it was not widely used as a standalone treatment due to its high invasiveness. More recently, the development of a new clip device allows for LAAC via thoracoscopy, eliminating the need for cardiopulmonary bypass.Moreover, its safety and efficacy profiles surpass those of previous LAAC. Conclusion The recent surgical LAAC devices have not only demonstrated high success rates but also shown low invasiveness. It becomes a feasible treatment alternative for non-valvular AF patients who experience NOAC failure or have a high bleeding risk with oral anticoagulants.

Atrial fibrillation (AF) is a leading cause of cardioembolic stroke, which is often fatal or disabling. Prevention of stroke is crucial in AF management, and anticoagulation with non-vitamin K oral anticoagulants (NOACs) is the mainstay of AF management for stroke prevention. Because NOAC prescriptions have been surging worldwide, the development of acute ischemic stroke in patients with AF who receive NOAC treatment is an increasingly important issue in clinical practice. Moreover, these patients show a high risk of recurrence, with more than a 50% higher risk, than do patients with AF and no prior anticoagulation therapy. Careful evaluation is mandatory to determine possible causes of ischemic stroke during NOAC therapy. Differentiation of AF-unrelated stroke and demonstration of combined cardiac disease/systemic coagulopathy are important in these patients and may provide improved results in their treatment. In addition, ensuring appropriate dosing and good adherence to NOAC treatment is important. Cardioembolism, despite sufficient anticoagulation and no other causes, is the most common and challenging complication because switching to anticoagulants or adding antiplatelets to the treatment regimen does not reduce the risk of recurrent stroke, and there are no guidelines for this specific situation. This review article aimed to present the most updated data on the prevalence, causes, and secondary prevention strategies, specifically focusing on non-pharmacological approaches, together with relevant cases of AF in patients who developed ischemic stroke on NOAC therapy.