BACKGROUND: In this study, we investigated the early time course of expression of the major histocompatibility (MHC) antigens, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), interleukin-6 and the histopathological changes in the coronary arteries of cardiac allografts exchanged between inbred mice strains that differ in one loci of class I major histocompatibility antigen (B10.BR to B10.A). MATERIAL AND METHOD: No immunosuppressive therapy was used. Both allografts and the hearts of the recipients were harvested at 7 (group 1, n=6), 15 (group 2, n=6), 21 (group 3, n=6), and 30 (group 4, n=6) days after transplantation. They were examined by immunohistochemistry, microscopy and morphometry. All allografts had contractions at the time of harvest. RESULT: A strong MHC class I antigen expression was present on the endothelial and medial cells of the coronary arteries in group 1 and remained unchanged in the rest of the groups. However, MHC class II reactivity was none or very little at any time. Mild to moderate ICAM-1 expression was observed on the endothelial cells, but not on the medial cells at any time by 30 days. VCAM-1 expression was strong both on the endothelial and medial cells at any time. Moderate degree expression of interleukin-6 was observed from 7 to 30 day specimens. Histopathologically, percentage of affected vessels (vessels with intimal thickening) was less than 10 % in 7 day group and increased up to 50 % at 30 days. Mean percent narrowing of the lumen of the affected vessels revealed less than 20 % at 7 days and 40 % at 30 days. The area occupied by tropomyosin positive cells in the intimal lesion, graded from 0 to 3, showed gradual increase but remained between grade 0 to 1 by 30 days. Medial integrity was also well preserved at any time. Moderate perivascular mononuclear cell infiltration was observed at 7 days and it was progressively increased upto 30 days. Recipients' heart revealed no positive immunopathologic findings. CONCLUSION: In this study, the early time course of progression of the transplantation vasculopathy was demonstrated in the murine heterotopic heart transplant model.
Allergy and Immunology ; Allografts ; Animals ; Atherosclerosis ; Coronary Vessels* ; Endothelial Cells ; Heart* ; Histocompatibility ; Histocompatibility Antigens ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; Mice* ; Microscopy ; Transplantation ; Tropomyosin ; Vascular Cell Adhesion Molecule-1

We evaluated CT findings of bronchial carcinoid and accuracy of preoperative pathological diagnosis according to two subtypes. The subjects were 10 cases (typical;5, atypical;5), confirmed by surgery and tissue pathology. Sputum cytology (n=10), percutaneous aspiration (n=1) and bronchoscopic biopsy (n=8) were performed, preoperatively. The CT findings were analysed according to two subtypes. Typical carcinoid shows central location in all, and bronchial lumens just proximal to tumor were widened in two, whereas atypical carcinoid presented as peripheral leison in two. Among central atypical carcinoid, two cases showed flat meniscus appearance of lumen. Remaining one showed diffuse wall thickening. Intratumoral low density by necrosis was noted in one. Both subtypes show contrast enhancement. For preoperative diagnosis, sputum cytology & percutaneous aspiration were not conclusive at all. As for bronchoscopic biopsy, only 3 cases were accurately diagnosed as typical carcinoid. Typical carcinoid presented as endobronchial mass in all, whereas atypical carcinoid presented in various appearance. In all atypical & some typical carcinoid were misdiagnosed as primary lung cancer, preoperatively. However, in typical carcinoid, conservative surgery was possible. In conclusion, if there is discrepancy between CT findings & preoperative pathological diagnosis, full understanding of CT findings of bronchial carcinoid is imperative to choose appropriate surgical modality.
Biopsy ; Carcinoid Tumor* ; Diagnosis* ; Lung Neoplasms ; Necrosis ; Pathology ; Sputum

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time ; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical center for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ration was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhage had brought about a high licidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade I-II, and also decreased the frequency of Grade III, but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment. 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.
Academic Medical Centers ; Blood Loss, Surgical ; Cause of Death ; Classification ; Consciousness ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive* ; Korea ; Middle Aged ; Mortality ; Neurosurgery ; Putamen ; Seasons

Objective: To evaluate the impact of surgical simulation training using a three-dimensional (3D)-printed model of tetralogy of Fallot (TOF) on surgical skill development. Materials and Methods: A life-size congenital heart disease model was printed using a Stratasys Object500 Connex2 printer from preoperative electrocardiography-gated CT scans of a 6-month-old patient with TOF with complex pulmonary stenosis.Eleven cardiothoracic surgeons independently evaluated the suitability of four 3D-printed models using composite Tango 27, 40, 50, and 60 in terms of palpation, resistance, extensibility, gap, cut-through ability, and reusability of. Among these, Tango 27 was selected as the final model. Six attendees (two junior cardiothoracic surgery residents, two senior residents, and two clinical fellows) independently performed simulation surgeries three times each. Surgical proficiency was evaluated by an experienced cardiothoracic surgeon on a 1–10 scale for each of the 10 surgical procedures. The times required for each surgical procedure were also measured. Results: In the simulation surgeries, six surgeons required a median of 34.4 (range 32.5–43.5) and 21.4 (17.9–192.7) minutes to apply the ventricular septal defect (VSD) and right ventricular outflow tract (RVOT) patches, respectively, on their first simulation surgery. These times had significantly reduced to 17.3 (16.2–29.5) and 13.6 (10.3–30.0) minutes, respectively, in the third simulation surgery (p = 0.03 and p = 0.01, respectively). The decreases in the median patch appliance time among the six surgeons were 16.2 (range 13.6–17.7) and 8.0 (1.8–170.3) minutes for the VSD and RVOT patches, respectively. Summing the scores for the 10 procedures showed that the attendees scored an average of 28.58 ± 7.89 points on the first simulation surgery and improved their average score to 67.33 ± 15.10 on the third simulation surgery (p = 0.008). Conclusion Inexperienced cardiothoracic surgeons improved their performance in terms of surgical proficiency and operation time during the experience of three simulation surgeries using a 3D-printed TOF model using Tango 27 composite.

Objective: To evaluate the impact of surgical simulation training using a three-dimensional (3D)-printed model of tetralogy of Fallot (TOF) on surgical skill development. Materials and Methods: A life-size congenital heart disease model was printed using a Stratasys Object500 Connex2 printer from preoperative electrocardiography-gated CT scans of a 6-month-old patient with TOF with complex pulmonary stenosis.Eleven cardiothoracic surgeons independently evaluated the suitability of four 3D-printed models using composite Tango 27, 40, 50, and 60 in terms of palpation, resistance, extensibility, gap, cut-through ability, and reusability of. Among these, Tango 27 was selected as the final model. Six attendees (two junior cardiothoracic surgery residents, two senior residents, and two clinical fellows) independently performed simulation surgeries three times each. Surgical proficiency was evaluated by an experienced cardiothoracic surgeon on a 1–10 scale for each of the 10 surgical procedures. The times required for each surgical procedure were also measured. Results: In the simulation surgeries, six surgeons required a median of 34.4 (range 32.5–43.5) and 21.4 (17.9–192.7) minutes to apply the ventricular septal defect (VSD) and right ventricular outflow tract (RVOT) patches, respectively, on their first simulation surgery. These times had significantly reduced to 17.3 (16.2–29.5) and 13.6 (10.3–30.0) minutes, respectively, in the third simulation surgery (p = 0.03 and p = 0.01, respectively). The decreases in the median patch appliance time among the six surgeons were 16.2 (range 13.6–17.7) and 8.0 (1.8–170.3) minutes for the VSD and RVOT patches, respectively. Summing the scores for the 10 procedures showed that the attendees scored an average of 28.58 ± 7.89 points on the first simulation surgery and improved their average score to 67.33 ± 15.10 on the third simulation surgery (p = 0.008). Conclusion Inexperienced cardiothoracic surgeons improved their performance in terms of surgical proficiency and operation time during the experience of three simulation surgeries using a 3D-printed TOF model using Tango 27 composite.

Percutaneous transcatheter closure of atrial septal defects as a therapeutic alternative in appropriate patients provides superior cosmetic results, is less invasive, and allows for shorter hospital stays. Unfortunately, however, such percutaneous procedures can be associated with catastrophic procedure complications that may require immediate surgical intervention. We report a case of aorta-to-right atrial fistula two months after transcatheter occlusion of an atrial septal defect by an Amplatzer septal occluder. Revealed by dyspnea, palpitation and hemolysis, this complication needed an emergency surgical operation. The fistula between the noncoronary Valsalva sinus of the aorta and the right atrium was repaired. The atrial septal defect was closed by patch. The cause of this serious complication appears to be erosion into the aorta by the right atrial disk.
Aorta* ; Dyspnea ; Emergencies ; Fistula* ; Heart Atria* ; Heart Septal Defects, Atrial* ; Hemolysis ; Humans ; Length of Stay ; Prostheses and Implants ; Septal Occluder Device ; Sinus of Valsalva

BACKGROUND: Bioprostheses for cardiovascular surgery have limitations in their use following as calicification. alpha-galactosidase epitope is known as a stimulant of immune response and then shows a progressing calcification. The objective of this study was to evaluate histologic characteristics and mechanical properties of decellularization and treated with alpha-galactosidase. MATERIALS AND METHODS: Bovine pericardial tissues were allocated into three groups: fixation only with glutaraldehyde, decellularization with sodium dodesyl sulfate and decellularization plus treatment with alpha-galactosidase. We confirmed immunohistological characteristics and mechanical properties as fatigue test, permeability test, compliance test, tensile strength (strain) test and thermal stability test. RESULTS: Decellularization and elimination of alpha-gal were confirmed through immunohistologic findings. Decellularization had decreased mechanical properties compared to fixation only group in permeability (before fatigue test p=0.02, after fatigue test p=0.034), compliance (after fatigue test p=0.041), and tensile strength test (p=0.00). The group of decellularization plus treatment with alpha-galactosidase had less desirable mechanical properties than the group of decellularization in concerns of permeability (before fatigue test p=0.043) and strain test (p=0.001). CONCLUSION: Favorable decellularization and elimination of alpha-gal were obtained in this study through immunohistologic findings. However, those treatment including decellularization and elimination of alpha-gal implied the decreased mechanical properties in specific ways. We need more study to complete appropriate ioprosthesis with decellularization and elimination of alpha-gal including favorable mechanical properties too.
alpha-Galactosidase ; Bioprosthesis ; Compliance ; Fatigue ; Glutaral ; Pericardium ; Permeability ; Sodium ; Sprains and Strains ; Tensile Strength

Idiopathic pulmonary arterial hypertension eventually leads to right-sided heart failure and sudden death. Its mortality rate in children is still high, despite improvements in pharmacological therapy, and therefore novel treatments are necessary. The Potts shunt, which creates an anastomosis between the left pulmonary artery and the descending aorta, has been proposed as a theoretically promising palliative surgical technique to decompress the right ventricle. We report the case of a 12-year-old girl with suprasystemic idiopathic pulmonary hypertension and right ventricular failure who underwent a Potts shunt for palliation with good short-term results.
Aorta, Thoracic ; Child ; Death, Sudden ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Mortality ; Pulmonary Artery

BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was 49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient. CONCLUSIONS: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.
Angina, Stable ; Angina, Unstable ; Arrhythmias, Cardiac ; Arteries ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Delirium ; Diagnosis ; Female ; Femoral Artery ; Gastroepiploic Artery ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Operating Rooms ; Postoperative Complications ; Radial Artery ; Reoperation ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Thromboembolism ; Transplants*

Purpose: The safety and efficacy of minimally invasive techniques in congenital heart surgery were tested in this study. Materal and method: Between July 1997 and November 1997, a total of 46 children were underwent minimally invasive cardiac operations at Seoul National University Children's Hospital. Age and body weight of the patients averaged 34.6+/-41.8 (Range: 1~148) months and 14.5+/-9.9 (Range: 3.0~40.0) kg, respectively. Twenty eight patients were male. Preoperative surgical indications included 15 atrial septal defects, 25 ventricular septal defects, 1 foreign body in aorta, 3 partial atrioventricular septal defects, 1 total anomalous pulmonary venous connection (cardiac type), and 1 tetralogy of Fallot. After creating a small lower midline skin incision starting as down as possible from the sternal notch, a vertical midline sternotomy extended from xyphoid process to the level of the second intercostal space, where one of the T-, J-, I-or inverted C-shaped lower lying mini-sternotomy was completed with a creation of unilateral right or bilateral trap door sternal opening. A conventional direct aortic and bicaval cannulation was routine. RESULT: A mean length of skin incision was 6.1+/-1.0 (range: 4.0~9.0) cm. A mean distance between the suprasternal notch and the upper most point of the skin incision was 4.0+/-1.1 (range: 2.0~7.0) cm. Mean cardiopulmonary bypass time, aortic cross-clamp time, and the operation time were 62.9+/-20.0 (range: 28~147), 29.8+/-12.8 (range: 11~79), and 161.1+/-34.5 (range: 100-250) minutes. A mean total amount of postoperative blood transfusion was 71.0+/-68.1 (range: 0~267) cc. All patients were extubated mean 11.3+/-13.8 (range: 1~73) hours after operation. A mean total amount of analgesics used was 0.8+/-1.8 (range: 0~9) mg of morphine. The mean duration of stay in intensive care unit and hospital stay were 35.0+/-32.2 (range: 10~194) hours and 6.2+/-2.0 (range: 3~11) days. There were no wound complications and hospital deaths. CONCLUSION: This short-term experience disclosed that the minimally invasive technique can be feasibly applied in a selected group of congenital heart disease as well as is cosmetically more attractive approach.
Analgesics ; Aorta ; Blood Transfusion ; Body Weight ; Cardiopulmonary Bypass ; Catheterization ; Child* ; Deception ; Foreign Bodies ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Morphine ; Seoul ; Skin ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Tetralogy of Fallot ; Thoracic Surgery* ; Wounds and Injuries