No abstract available.
Myxoma* ; Pulmonary Artery*

Pericardial cysts are reported by some authors, but epicardial cysts are extremely rare. We report one case of epicardial cyst that was detected incidentally and was removed successfully. Furthermore, unusually, pathological examinations confirmed that the cyst wall was looked like a vessel wall.
Glycosaminoglycans ; Heart Ventricles ; Mediastinal Cyst

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.
Aged ; Chungcheongnam-do ; Female ; Heart Arrest, Induced* ; Humans ; Mitral Valve* ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for critically ill patients. Although ECMO is becoming more common, hemorrhagic and thromboembolic complications remain the major causes of death in patients undergoing ECMO treatments. These complications commence upon blood contact with artificial surfaces of the circuit, blood pump, and oxygenator system. Therefore, anticoagulation therapy is required in most cases to prevent these problems. Anticoagulation is more complicated in pediatric patients than in adults, and the foreign surface of ECMO only increases the complexity of systemic anticoagulation. In this review, we discuss the pathophysiology of coagulation, anticoagulants, and monitoring tools in pediatric patients receiving ECMO.
Adult ; Anticoagulants ; Cause of Death ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Pediatrics ; Salvage Therapy

BACKGROUND: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal outcomes are very common. The aim of this study was to evaluate titanium plate fixation as a treatment for sternal dehiscence following major cardiac surgery. MATERIALS AND METHODS: Between 2010 and 2012, 17 patients underwent sternal reconstruction using horizontal titanium plating for the treatment of post-cardiac-surgery sternal dehiscence. The plates were cut and shaped, and then were fixed to corresponding costal segments using 2-3 titanium screws per each side. RESULTS: The median age of our patients was 66 years (range, 50 to 78 years) and 9 were female. Indications for sternal reconstruction included aseptic sternal dehiscence in 3 patients and osteomyelitis in 14 patients including 6 patients who were diagnosed with mediastinitis. During the operation, sternal resection and autologous flap interposition were combined in 11 patients. One patient died due to sepsis. Two patients required additional soft tissue wound revisions. Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications. The postoperative course was uncomplicated in the other 13 patients. CONCLUSION: Titanium plate fixation that combines appropriate debridement and flap interposition is very effective for the treatment of sternal dehiscence following major cardiac surgery.
Debridement ; Female ; Humans ; Mediastinitis ; Osteomyelitis ; Reoperation ; Sepsis ; Sternum ; Thoracic Surgery ; Titanium ; Treatment Failure ; Wound Infection

BACKGROUND: Minimally invasive cardiac surgery has emerged as an alternative to conventional open surgery. This report reviews our experience with atrial septal defect using the da VinciTM surgical robot system. MATERIALS AND METHODS: This retrospective study included 50 consecutive patients who underwent atrial septal defect repair using the da VinciTM surgical robot system between October 2007 and May 2011. Among these, 13 patients (26%) were approached through a totally endoscopic approach and the others by mini-thoracotomy. Nineteen patients had concomitant procedures including tricuspid annuloplasty (n=10), mitral valvuloplasty (n=9), and maze procedure (n=4). The mean follow-up duration was 16.9+/-10.4 months. RESULTS: No remnant interatrial shunt was detected by intraoperative or postoperative echocardiography. The atrial septal defects were mainly repaired by Gore-Tex patch closure (80%). There was no operative mortality or serious surgical complications. The aortic cross clamping time and cardiopulmonary bypass time were 74.1+/-32.2 and 157.6+/-49.7 minutes, respectively. The postoperative hospital stay was 5.5+/-3.3 days. CONCLUSION: The atrial septal defect repair with concomitant procedures like mitral valve repair or tricuspid valve repair using the da VinciTM system is a feasible method. In addition, in selected patients, complete port access can be helpful for better cosmetic results and less musculoskeletal injury.
Cardiopulmonary Bypass ; Constriction ; Cosmetics ; Echocardiography ; Follow-Up Studies ; Heart Septal Defects ; Heart Septal Defects, Atrial ; Humans ; Length of Stay ; Mitral Valve ; Polytetrafluoroethylene ; Retrospective Studies ; Thoracic Surgery ; Tricuspid Valve

Endovascular stent grafting is regarded as a promising alternative approach to open surgical repair for treating various aortic diseases in high risk patients. We report here on a case of a 79-year-old female who underwent endovascular stent-graft insertion in the ascending aorta for treating a complicated ascending aortic rupture that occurred secondary to radiation necrosis during the treatment of recurrent breast cancer.
Aged ; Aorta ; Aortic Diseases ; Aortic Rupture ; Breast Neoplasms ; Female ; Humans ; Necrosis ; Stents ; Transplants

The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification.
Abscess ; Endocarditis* ; Humans ; Mitral Valve*

We have experienced five cases of atrial septal defect closure under complete port access using the da Vinci system. We used only six 8~12 mm ports without thoracotomy or sternotomy for operation.
Heart Septal Defects, Atrial ; Robotics ; Sternotomy ; Thoracotomy

BACKGROUND: The optimal timing of surgery for infective endocarditis complicated by embolic stroke is unclear. We compared early versus delayed surgery in these patients. MATERIALS AND METHODS: Between 1992 and 2007, 56 consecutive patients underwent open cardiac surgery for the treatment of infective endocarditis complicated by acute septic embolic stroke, 34 within 2 weeks (early group) and 22 more than 2 weeks (delayed group) after the onset of stroke. RESULTS: The mean age at time of surgery was 45.7+/-14.8 years. Stroke was ischemic in 42 patients and hemorrhagic in 14. Patients in the early group were more likely to have highly mobile, large (>1 cm in diameter) vegetation and less likely to have hemorrhagic infarction than those in the delayed group. There were two (3.7%) intraoperative deaths, both in the early group and attributed to neurologic aggravation. Among the 54 survivors, 4 (7.1%), that is, 2 in each group, showed neurologic aggravation. During a median follow-up of 61.7 months (range, 0.4~170.4 months), there were 5 late deaths. Overall 5-year neurologic aggravation-free survival rates were 79.1+/-7.0% in the early group and 90.9+/-6.1% in the delayed group (p=0.113). CONCLUSION: Outcomes of early operation for infective endocarditis in stroke patients were similar to those of the conventional approach. Early surgical intervention may be preferable for patients at high risk of life-threatening septic embolism.
Embolism ; Endocarditis ; Follow-Up Studies ; Humans ; Infarction ; Neurologic Manifestations ; Stroke ; Survival Rate ; Survivors ; Thoracic Surgery