It is difficult to perform Off-pump Coronary Artery Bypass Grafting(OPCAB) for the posterior vessels in patients with cardiomegaly and left ventricular dysfunction due to hemodynamic instability and poor exposure. Right heart supported OPCAB may facilitate posterior vessel approach during OPCAB in those patients, in addition to those advantages of avoiding cardiopulmonary bypass and aortic cannulation. We experienced 2 cases of right heart supported OPCAB for those patients with cardiomegaly and left ventricle dysfunction.
Cardiomegaly ; Cardiopulmonary Bypass ; Catheterization ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Heart Ventricles ; Heart* ; Hemodynamics ; Humans ; Surgical Procedures, Minimally Invasive ; Ventricular Dysfunction, Left

A two-month-old infant presented with coarctation of the aorta, severe left ventricular dysfunction, and moderate to severe mitral regurgitation. Through median sternotomy, the aortic arch was repaired under cardiopulmonary bypass and regional cerebral perfusion. The patient was postoperatively supported with a left ventricular assist device for five days. Left ventricular function gradually improved, eventually recovering with the concomitant regression of mitral regurgitation. Prompt surgical repair of coarctation of the aorta is indicated for patients with severe left ventricular dysfunction. A central approach for surgical repair with a back-up left ventricular assist device is a safe and effective treatment strategy for these patients.
Aorta, Thoracic ; Aortic Coarctation* ; Cardiopulmonary Bypass ; Heart Failure ; Heart-Assist Devices* ; Humans ; Infant* ; Mitral Valve Insufficiency ; Perfusion ; Sternotomy ; Ventricular Dysfunction, Left* ; Ventricular Function, Left

BACKGROUND: Since the first implanted in September 1997, the use of On-X prosthetic heart valve has been increasing around in the world. This study was designed to assess the feasibility, safety, and the postoperative hemodynamics with this new valve in clinical setting. MATERIAL AND METHOD: The current study was carried out on 52 patients undergoing aortic valve replacement with this prosthesis between April 1999 to August 2002 at Chonnam National University Hospital to evaluate the surgical results. 52% of the patients were male and the average age at implant was 50+/-13 years. The study followed the guidelines of the AATS/STS. Preoperatively, 32 (61.5%) patients were in NYHA functional class III or IV and 2 patients had previous aortic valve surgery. Concomitant cardiac surgery was performed in 71.1%. The implanted valve sizes were 19 mm in 13 patients, 21 mm in 26, 23 mm in 10 and 25 mm in 3, respectively. Mean follow-up was 16.6+/-10.5 months (1~39 months). Echocardiographic assessment was performed pre- and immediate postoperatively, as well as 3, 6, 12 months after surgery, evaluating pressure loss and regression of left ventricular hypertrophy. RESULT: Mean cardiopulmonary bypass time was 191+/-94.7 minutes with an aortic cross-clamp time of 142+/-51.7 minutes. There was no early and late mortality. Freedom from adverse events at 1 year in the study were as follows: thromboembolism, 95.6+/-6%; bleeding events, 90.2+/-4%; paravalvular leakage 92.3+/-4%; and overall valve-related morbidity at 1 year was 76.6+/-3%. There were no cases of valve thrombosis, prosthetic valve endocarditis and structural or non-structural failure. Left ventricular function at 12 months after surgery (EF=62.7+/-9.8%) revealed a statistically significant improvement compared to preoperative investigation (EF=55.8+/-15.9%, p=0.006). Left ventricular mass index was 247.3+/-122.3 g/m2 on preoperative echocardiographic study, but regressed to 155.5+/-58.2 g/m2 at postoperative 1 year (p=0.002). Over the follow-up period a further decrease of peak transvalvular gradients was observed in all patients: 62.5+/-38.0 mmHg on preoperative assessment, 18.2+/-6.8 mmHg at immediate postoperative period (p<0.0001), 7.6+/-5.09 mmHg (p<0.0001) at 6 month, 18.0+/-10.8 mmHg (p<0.0001) at 1 year. CONCLUSION: The On-X prosthetic heart valve performs satisfactorily in the first 1 year period. Clinical outcome by examining NYHA functional classification revealed especially good results. Effective regression of left ventricular hypertrophy and statistically significant decrease of transvalvular gradient were observed over the first year, but longer-term follow-up of this patient group is needed to establish the expected rates for late valve-related events as well as the long-term clinical efficacy of this valve.
Aortic Valve* ; Cardiopulmonary Bypass ; Classification ; Echocardiography ; Endocarditis ; Follow-Up Studies ; Freedom ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Hemodynamics ; Hemorrhage ; Humans ; Hypertrophy, Left Ventricular ; Jeollanam-do ; Male ; Mortality ; Postoperative Period ; Prostheses and Implants ; Thoracic Surgery ; Thromboembolism ; Thrombosis ; Ventricular Function, Left

BACKGROUNDAcute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery.

METHODSFrom January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class III or IV. Preoperative ejection fraction was 26% +/- 9%. The mean left ventricular, end diastolic diameter was (57.5 +/- 7.1) mm. The ventricular preoperative and postoperative performances were compared. chi2 test and Student's t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.

RESULTSHospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3 +/- 1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P < 0.001). The mean left ventricular, end diastolic diameter decreased significantly (P < 0.001).

CONCLUSIONSSurgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass ; Female ; Heart Aneurysm ; physiopathology ; surgery ; Heart Ventricles ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Stroke Volume ; Ventricular Dysfunction, Left

OBJECTIVE: To determine the use of septal plication with Dor or Cooley procedure for post infarction anterior and anterior-septal aneurysm of the left ventricle. METHODS: A total of 23 patients with post infarction anterior and anterior-septal aneurysm of the left ventricle underwent septal plication and Dor or Cooley procedure along with coronary artery bypass grafting concomitantly. Data of NYHA grading, left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) were recorded before the surgery, before discharge and 3 months after the surgery. RESULTS: Compared with the preoperative data, the NYHA grading before the discharge and 3 months after the surgery improved from 3.21 ± 0.62 to 1.72 ± 0.31 and 1.57 ± 0.23(P<0.05); LVEDVI decreased from (102.31 ± 18.71) mL/m² to (62.11 ± 6.21) mL/m² and (54.63 ± 4.54) mL/m² (P<0.05); LVESVI decreased from (69.32 ± 17.48) mL/m² to (30.23 ± 3.25)mL/m² and (28.34 ± 3.12) mL/m²; while LVEF increased from (32.92 ± 8.12)% to (48.78 ± 4.51)% and (50.52 ± 4.68)% (P<0.05), respectively. CONCLUSION Ventricular septal plication combined with Dor or Cooley procedure can remarkably improve the left heart function in patients with post infarction ventricular aneurysm.
Aged ; Coronary Artery Bypass ; methods ; Female ; Heart Aneurysm ; etiology ; surgery ; Heart Ventricles ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; Ventricular Function, Left ; physiology ; Ventricular Septum ; surgery

BACKGROUND: Heart transplantation is considerated for a selected certain group of complicated congenital heart disease in neonates because corrective surgery is very difficult and has high mortality. Precise planning of transplantation is necessary to adequately fit the donor heart to the recipient. MATERIAL AND METHOD: We have performed 4 neonatal pig heart transplantations to test the technical feasibility. Experiment 1: The transplantation was performed using the same technique as the adult heart transplantation. Experiment 2: The transplantation for hypoplastic left heart syndrome was simulated as we reconstructed the whole aortic arch with donor aorta. Experiment 3: The heart transplantation was done with radical pulmonary artery reconstruction. Experiment 4: The experiment was performed for a long term survival. RESULT: Preoperative planning was very important for adequate fitting. All animals could be weaned from cardiopulmonary bypass, however, two animals died due to bleeding at pulmonary artery and left atrium. CONCLUSION: We concluded that the neonatal heart transplantation can be applied in some complicated Further using animal model is mandatory.
Adult ; Animal Experimentation* ; Animals* ; Aorta ; Aorta, Thoracic ; Cardiopulmonary Bypass ; Heart Atria ; Heart Defects, Congenital* ; Heart Transplantation* ; Heart* ; Hemorrhage ; Humans ; Hypoplastic Left Heart Syndrome ; Infant, Newborn* ; Models, Animal ; Mortality ; Pulmonary Artery ; Tissue Donors

BACKGROUND AND OBJECTIVES: Prediction of the postoperative left ventricular (LV) function in valvular heart disease that will cause LV volume overloading, such as chronic mitral regurgitation (MR) and aortic regurgitation (AR), remains elusive. We sought to test if 2-dimensional peak negative longitudinal strain (LS2D) was useful for prediction of the postoperative LV function in relation to this disease entity. SUBJECTS AND METHODS: Newly developed speckle tracking imaging was performed preoperatively to measure the LS2D in 26 and 22 patients with MR and AR, respectively. A favorable response after the operation (FR) was defined according to the change in the LV ejection fraction (EF): 1) a LVEF > or =55% both pre- and post-operation, 2) a postoperative LVEF > or =55% with a pre-operative LVEF between <55 and > or =45%, or 3) an increase in the LVEF >10% with a pre-operative LVEF <45%. RESULTS: Follow-up echocardiography was performed at an average of 6.7+/-2.3 months after the operation. FR was confirmed in 36 patients (LVEF from 55.4+/-10.1 to 58.3+/-5.0%, p=0.06), with the remaining 12 showing an unfavorable response (LVEF from 52.5+/-7.6 to 45.1+/-5.4%, p<0.01). There was no significant difference in the baseline characteristics, including underlying etiologies, operation techniques, and cardiopulmonary bypass time, and LV volumes and EF between the two groups. The only difference was the LS2D, which was significantly larger in the FR group (-19.8+/-3.9 versus -16.2+/-2.9%, p<0.01). An LS2D of -18.3% could predict an unfavorable response of the LVEF following an operation, with a sensitivity and specificity of 75 and 75%, respectively. CONCLUSION: The preoperative LS2D is a useful predictor of the postoperative left ventricular function in AR and MR.
Aortic Valve Insufficiency ; Cardiopulmonary Bypass ; Echocardiography ; Follow-Up Studies ; Heart Valve Diseases* ; Humans ; Mitral Valve Insufficiency ; Sensitivity and Specificity ; Ventricular Function, Left

BACKGROUND: Left ventricular dysfuction is common in immediate postoperative periods after surgical correction of heart diseases with chronic left ventricular volume overload. We speculated postoperative changes of left ventricular volume and unction in patients with patent ductus osus(PDA) who had underwent surgical repair at ages older than 16 years. Factors influencing postoperative left ventricular volume and function were also analyzed. MATERIAL AND METHOD: From August 1989 to August 1999 thirty-siz adult patients with PDA 28 females and 8 males. were enrolled in this study. Their age ranged from 16 years to 57 years(mean :32 years). Types of surgical repair were division with primary closure in 22, division with patch closure in 6, internal obliteration using cardiopulmonary bypass in 4 and ligation in 4. Aortic clamping was combined during surgical repair in 22(61%) and cardiopulmonary bypass was used in 8(22%) Two-dimensional echocardiography studies were performed in 34(94%) preoperatively and in 25(66%) immediate postoperatively to assess postoperative changes of left ventricular internal dimensions. left ventricular volume and ejection fraction. Duration of postoperative follow-up ranged from 1 month to 99 months (mean:22 months) and 10 patients underwent 16 echocardiographic evaluation during this period. RESULT: Preoperative and postoperative left ventricular systolic dimensions(LVIDs) were 42+/-8.0mm and 42+/-8.3mm left ventricular diastolic dimensions(LVIDd) were 64+/-10.0mm and 56+/-7.4mm left ventricular end systolic volumes(LVESV) were 62+/-19cc (z=1.87+/-0.06) and 59+/-24cc(z=1.78+/-0.08) left ventricular end diastolic volumes(LVEDL) were 169+/-40cc(z-1.17+/-0.1) and 112+/-29cc(z=0.85+/-0.1) and ejection fractions(EF) were 66+/-6.7% and 48+/-12.6% respectively. There were statistically significant differences between preoperative and postoperative values in LVDIDd(p=0.001) LVEDV(p=0.001) and EF(p=0.0001) while no significant difference is LVIDs and LVESV. Postoperative depression of ejcection fraction was significantly related with z-score of preoperative LVESV and LVEDV by univariateanalysis while LVEDV only was significant risk factor for postoperative LV dysfunction by multiple regressioin analysis (deltaLVEF=-13.3-4.62xLVEDV(z), p=0.001) During the follow-up periods ejection fractions become normalized in all except one patients. CONCLUSION: Left ventricular function is usually deteriorated after the surgical correction of PDA in adult age and preoperative LVEDV is a major determinant of postoperative LV function.
Adult* ; Cardiopulmonary Bypass ; Constriction ; Depression ; Echocardiography ; Female ; Follow-Up Studies ; Heart Diseases ; Humans ; Ligation ; Male ; Postoperative Period ; Risk Factors ; Ventricular Function, Left

BACKGROUND: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. MATERIAL AND METHOD: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. RESULT: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. CONCLUSION: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.
Age Factors ; Aged ; Angioplasty ; Cause of Death ; Coronary Artery Bypass ; Heart* ; Humans ; Length of Stay ; Mortality ; Postoperative Complications ; Renal Insufficiency ; Risk Factors ; Survival Rate ; Survivors ; Ventilators, Mechanical ; Ventricular Function, Left

BACKGROUND: Previous reports present that the early results of coronary artery bypass grafting (CABG) has been improving with the accumulation of surgical experience. We conducted a retrospective analysis of the patients who received CABG to evaluate the recent results of CABG. MATERIAL AND METHOD: Between January 1996 and August 2001, 154 patients underwent CABG at Hanyang University Hospital. There were 47 patients(group I) who were operated between 1996 and 1998, and 107 patients(group II) who were operated thereafter. The preoperative diagnosis, operative procedure, mortality, and complications were analyzed retrospectively. RESULT: There were 35 males and 12 females in group I, and 78 males and 29 females in group II, which shows similar ratio of sexes between the two groups. The average age of patients for group I and group II was 55.9+/-6.2 years and 61.0+/-8.0 years, respectively, showing a significant increase in group II(p<0.05). The average left ventricular ejection fraction(LVEF) for group I and group II was 54.6+/-11.8% and 56.9+/-13.0%, respectively. The number of patients who had previous MI in group I and group II were 13 patients(27.7%) and 14 patients(13.1%), respectively, which shows a significant difference (p<0.05). All procedures were performed using the cardiopulmonary bypass(CPB) and moderate systemic hypothermia. Myocardial protection was achieved using intermittent hypothermic ischemia under ventricular fibrillation state or cold crystalloid cardioplegic solution for most of group I patients, whereas cold blood cardioplegic solution was used for group II patients. The mean CPB times for group I and group II were 149.2+/-48.7 minutes and 113.1+/-30.6 minutes, respectively. The mean aortic cross clamp times for group I and group II were 81.3+/-26.5 minutes 72.2+/-23.9 minutes, respectiely. These figures show that CPB and aortic cross clamp times were significantly reduced in group II(p<0.05). The use of the left internal thoracic artery(LITA) was increased from 42%(20/47) for group I to 81% (87/107) for group II. The mean number of grafts also significantly increased from 2.5+/-0.6 for group I to 3.0+/-1.1 for group II(p<0.05). Intra-aortic balloon pump(IABP) was applied in 7 cases in group I and 17 cases in group II. Of these, 28.6%(2/7) and 52.9%(9/17) were broadly applied preoperatively in patients with LVEF<40% or congestive heart failure. The operative mortalities for group I and II were 10.6%(5/47) and 0.9%(1/107), respectively, which shows significant decrease for group II(p<0.05). CONCLUSION: This report suggest that CABG using CPB can recently be performed more safely in virtue of the accumulation of surgical experience with reduction in CPB and aortic cross clamp times and improved surgical techniques and myocardial protection. And we think that the optimal treatment of patients with left ventricular dysfunction associated with congestive heart failure and the extended application of IABP, especially have contributed to the reduction of operative mortality and morbidity.
Cardioplegic Solutions ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Female ; Heart Failure ; Humans ; Hypothermia ; Ischemia ; Male ; Mortality ; Retrospective Studies ; Surgical Procedures, Operative ; Transplants ; Ventricular Dysfunction, Left ; Ventricular Fibrillation ; Virtues