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

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

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*

PURPOSE: Placement of an arteriovenous fistula (AVF) before initiation of chronic hemodialysis (HD) is recommended to avoid the use of a dialysis catheter. However, many patients use temporary catheter at the start of HD for many reasons. We conducted a study to examine the reasons for use of temporary catheter instead of AVF at initial HD therapy. METHODS: We investigated 61 chronic renal failure (CRF) patients who started HD from January 2001 to August 2004 at Daegu Fatima Hospital. Fourty one of them used temporary catheter (catheter group) and 20 used AVF (AVF group) at initial HD. The causes of CRF, clinical presentation at initial HD, reasons that required start of HD and reasons for use of temporary catheter were investigated. RESULTS: The reasons that required start of HD were dyspnea (23), uremic symptoms (11), severe edema (4) and metabolic abnormalities (3) in catheter group and uremic symptoms (8), progression of CRF with minimal uremic symptoms (8) in AVF group. Those causes of unpreparedness of AVF in catheter group were delayed referral (12), rapid progression of CRF (12), unawareness of CRF (10), and noncompliance (7). The systolic and diastolic blood pressure were higher in catheter group than AVF group (171.3+/-33.5 vs 146.0+/-18.0 mmHg, 94.0+/-18.5 vs 80.6+/-10.8 mmHg, respectively). Serum albumin level was lower (3.0+/-0.6 vs 3.4+/-0.7 g/dL) and serum phosphorus level was higher (6.8+/-1.9 vs 5.7+/-1.7 mg/dL) in catheter group. CONCLUSION: To avoid temporary vascular catheter, early diagnosis of CRF, early referral to nephrologist and preparation of AVF is essential.
Arteriovenous Fistula* ; Blood Pressure ; Catheters* ; Daegu ; Dialysis ; Dyspnea ; Early Diagnosis ; Edema ; Humans ; Kidney Failure, Chronic ; Phosphorus ; Referral and Consultation ; Renal Dialysis* ; Serum Albumin ; Vascular Access Devices

PURPOSE: To analyze abnormal ventricular activation in childhood congenital heart disease induced by postoperative changes in ventricular volume and pressure and ventricular scar formation using signal-averaged electrocardiography (SAECG). METHODS: Fifty-two patients who had undergone open heart surgery (OHS) were enrolled. Patients were divided into the following 3 groups: right ventricular volume overload (atrial septal defect, group1), left ventricular volume overload (ventricular septal defect, group2), and right ventricular pressure overload (tetralogy of Fallot, group 3). The patients were monitored by standard 12-lead ECG and SAECG before and 2 months after the operation. QRS duration, QT and QTc intervals, filtered QRS (f-QRS), high frequency low amplitude potential (HFLA), and root mean square (RMS) voltage in the terminal 40 ms of SAECG were determined. RESULTS: In the preoperative period, group1 showed significant increase in QRS (P=0.011) compared to those of the other 2 groups. In the postoperative period, group3 showed significant increase in the QTc interval (P=0.004) compared to those in the other 2 groups. SAECG parameters showed no significant differences among the groups in the pre- or postoperative period. Of the 52 patients, 12 (23%) in the preoperative period and 21 (40%) in the postoperative period had at least 1 SAECG abnormality. The prevalence of SAECG abnormalities was significantly higher in the postoperative group 2 and group 3 (preoperative: 20% versus postoperative: 28%, P<0.001, preoperative: 14% versus postoperative: 64%, P<0.001, respectively). CONCLUSION: Abnormal SAECG patterns may be attributed to postoperative scars, OHS itself, and/or ventricular overload.
Cicatrix ; Electrocardiography ; Heart ; Heart Diseases ; Humans ; Postoperative Period ; Preoperative Period ; Prevalence ; Thoracic Surgery ; Ventricular Pressure

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

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.
Aged ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Female ; Hematoma/*diagnosis/*surgery ; Humans ; Magnetic Resonance Imaging ; *Pulmonary Artery ; Thromboembolism/diagnosis ; Tomography, X-Ray Computed

Pulmonary hypoplasia is an entity of pulmonary agenesis. Pulmonary agenesis is a rare congenital anomaly, usually diagnosed soon after birth. It is commonly associated with other anomalies, mainly of the cardiovascular systems. Although it may hasten the death of a child, sometimes it is compatible with normal growth. We report a right lateral thoracotomy approach for mitral valve repair in a young woman with pulmonary hypoplasia, in whom preoperative computed tomography showed severe right side shifting of the mediastinum and total collapse of the right lung.
Cardiovascular System ; Child ; Female ; Humans ; Lung ; Mediastinum ; Mitral Valve* ; Parturition ; Thoracotomy

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