Although outcomes of neonatal cardiac surgery have dramatically improved in the last two decades, low body weight still constitutes an important risk factor for morbidity and mortality. In particular, cardiac surgery in neonates with very low birth weight (< or =1.5 kg) is carried out with greater risk because most organ systems are immature. We report here on a successful case of early one-stage total repair of coarctation of the aorta and a ventricular septal defect in a 1,480 gram neonate.
Aortic Coarctation ; Body Weight ; Heart Septal Defects, Ventricular ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight ; Risk Factors ; Thoracic Surgery

Implanting a pacemaker is the most often used intervention for treating bradycardia. The most commonly used pacemaker is the intracardiac pacemaker, yet it can have many complications. An infected pacemaker can spread to systemic infection and the condition of the patient can quickly get worse, so if an infected pacemaker is suspected, then the pacemaker must be removed. Apart from the use of interventional methods such as a loop or a weight, we can take a more aggressive approach by using extracorporeal circulation for removal of the pacemaker. We report here on two cases in which extracorporeal circulation was used to remove the infected pacemakers.
Bradycardia ; Cardiopulmonary Bypass ; Extracorporeal Circulation ; Humans

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Rastelli repair has been considered the procedure of choice for surgically repairing transposition of the great arteries combined with ventricular septal defect and pulmonary stenosis. However, the long term results have been less than optimal and these patients who ungo this procedure can eventually display conduit obstruction, left ventricular outflow tract obstruction and arrhythmias. Many new procedures are now available and they are technically challenging for making a more normal anatomic repair. In our hospital, two patients who had a TGA with VSD and PS have been repaired with a Half Turned Truncal Switch Operation and a Lecompte maneuver in 2003 and 2006, respectively. We report on our two experiences with performing a Half Turned Truncal Switch Operation, and we discuss the changes of the biventricular outflow tract.
Arrhythmias, Cardiac ; Arteries ; Heart Septal Defects, Ventricular ; Humans ; Pulmonary Valve Stenosis ; Transposition of Great Vessels

BACKGROUND: Remarkable progress has recently been made in achieving successful early repair of congenital heart disease with using cardiopulmonary bypass in the neonatal period. The aim of this study is to evaluate our short-term outcomes for performing neonatal cardiac surgery under extracorporeal circulation. MATERIAL AND METHOD: Fifty five neonates underwent open heart surgery from February 2002 to December 2007. The mean ages and body weight was 13.5 days and 3.2 kg, respectively. The diagnoses of the patients were transposition of the great arteries (14), total anomalous pulmonary venous connection (7), large ventricular septal defect (VSD) (7), coarctation of the aorta with VSD (6), interrupted aortic arch (5) and others (16). RESULT: Six patients had difficulties being weaned from extracorporeal circulation. Four patients left the operating room with an open sternum. Low cardiac output syndrome and acute renal insufficiency were observed in 3 patients each, respectively. Post-operative complications were observed in 27 patients (49.1%). The postoperative mortality was 12.7% (7 patients); 5 patients experienced early hospital death and 2 experienced late death (2). CONCLUSION: In our hospital, early surgical repair with extracorporeal circulation in neonates was feasible with tolerable mortality. Further follow-up is required to establish the long-term survival and complications.
Acute Kidney Injury ; Aorta, Thoracic ; Aortic Coarctation ; Arteries ; Body Weight ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Extracorporeal Circulation ; Follow-Up Studies ; Heart ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Infant, Newborn ; Operating Rooms ; Sternum ; Thoracic Surgery

Thoracoabdominal aortic aneurysm (TAAA) involving the roots of the celiac, superior mesenteric and both renal arteries is a rare, but potentially lethal disease. The overall postoperative mortality rate is high even when the intact TAAA is electively repaired. Furthermore, the postoperative complications are often serious and they include acute renal failure, paraplegia, respiratory distress and intestinal ischemia. The inclusion technique using a visceral-aortic patch (VAP) is considered the gold standard method for visceral artery revascularization for the treatment of TAAA. However, the inclusion technique is not feasible for patients with Marfan syndrome or for those patients with inappropriate anatomy for VAP. In such cases, separate visceral revascularization is a useful alternative and this may decrease the visceral ischemic time. Herein we report on 3 cases of TAAA, and the patients all underwent successful separate visceral revascularization, including one patient with Marfan syndrome.
Acute Kidney Injury ; Aortic Aneurysm, Thoracic ; Arteries ; Humans ; Ischemia ; Marfan Syndrome ; Paraplegia ; Postoperative Complications ; Renal Artery

The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.
Aorta, Thoracic* ; Aortic Aneurysm, Thoracic ; Blood Vessel Prosthesis* ; Endovascular Procedures ; Polyethylene Terephthalates* ; Rupture* ; Stents* ; Thoracotomy ; Transplants*