No abstract available.
Seoul*

Emergency surgical repair for acute traumatic aortic ruptures has been associated with a high peri-procedural mortality rate. Endovascular stent-grafting, as a less invasive procedure, has shown encouraging results. This report describes a patient with a short landing zone, who was treated by transposing the supra-aortic branch without sternotomy, followed by covered stent-grafting with an extended proximal bare portion to enhance fixation.
Acute Disease ; Aged ; Aortic Rupture/diagnosis/radiography/*surgery ; Female ; Humans ; Stents ; Sternotomy ; Subclavian Artery ; Surgical Procedures, Minimally Invasive ; Tomography, X-Ray Computed

A 23 years old single nulligravida woman underwent laparoscopic removal of a huge cystic adnexal mass that occupied her entire abdomen, giving the appearance of a full term pregnancy. After anesthesia, a vertical infra-umbilical incision, 1 cm long, was made and a telescope was introduced through the port to determine the status of the intra-abdomen and the surface contour of the mass. A needle tipped with a laparoscopic suction apparatus was inserted into the cyst through the infra-umbilical port, directly under the mass. Subsequently, 3, 200 ml of cystic fluid was aspirated without spillage. A huge cyst, reaching to the level of the xyphoid process was effectively excised through the operative laparoscopy after prelaparoscopic drainage. Operation time was 140 minutes and hospital stay was 2 days. There were no complications during hospital stay and after discharge. It seems the size of the cyst is not a criteria for the contraindication of laparoscopic surgery.
Abdomen ; Anesthesia ; Drainage ; Female ; Humans ; Laparoscopy ; Length of Stay ; Needles ; Ovarian Cysts* ; Pregnancy ; Suction ; Telescopes ; Young Adult

The authors report one case of akinetic mutism with obstructive hydrocephalus. The patient suffered from multiple shunt failures and shunt revision. After multiple shunt revision, the patient fell into an akinetic-mute state. She appeared awake but was no response to painful somatosensory, loud auditory or threatening visual stimuli and she required total nursing care. This behavioral syndrome was no response to shunt revision but we were able to successfully treat a case of akinetic mutism after combination theraphy of Bromocryptine and Ephedrine.
Akinetic Mutism* ; Bromocriptine* ; Ephedrine* ; Humans ; Hydrocephalus ; Nursing Care

Selection of a treatment modality for traumatized renal rupture depends on the renal injury grade, hemodynamic stability, combined organ injury, and the physician's experience. Treatment for renal injury tends to be conservative to maintain renal function and lessen the morbidity of surgery. If renal injuries were well-staged and selected by radiologic evaluation, hemodynamically stable patients with significant injuries (grades II through V) can usually be managed without surgical exploration. We report 3 cases of grade 4 renal injuries successfully treated with selective renal arterial embolization.
Emergencies ; Hemodynamics ; Hemorrhage ; Humans ; Rupture

OBJECTIVE: This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease. MATERIALS AND METHODS: From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes. RESULTS: The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65). CONCLUSION: Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.
*Aorta, Thoracic ; Aortic Diseases/mortality/*surgery ; Chi-Square Distribution ; Drainage ; Endovascular Procedures/*methods ; Female ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Survival Rate ; Thoracotomy ; Treatment Outcome

BACKGROUND: The choice between a bioprosthetic and a mechanical valve is an important decision in cardiac valve surgery, and the durability of the tissue valve is a major decision factor. We retrospectively evaluated the midterm results of bioprosthetic valve replacement in the mitral position. MATERIAL AND METHOD: The subjects were all patients who had undergone mitral bioprosthesis replacement between July 1989 and August 2007. Among the 216 patients, there were 236 surgical cases. The mean age was 63+/-15 years, and the male to female ratio was 1:3. We retrospectively analyzed hospital and outpatient records such that the total follow-up duration amounted to 760.2 patient-years, and the mean follow-up duration was 41.9+/-40.7 months (range 0~212 months). RESULT: Early death occurred in 18 patients (8.3%), and 13 of these underwent concomitant cardiac procedures. The survival rate after 5 years was 79.9+/-3.5%, and the survival rate after 8 years was 65.5+/-5.5%, while freedom from structural valve deterioration (SVD) was 96.2+/-2.2% at 5 years and 85.9+/-5.3% at 8 years. Freedom from reoperation was 96.0+/-1.7% at 5 years and 90.4+/-4.2% at 8 years, while freedom from reoperation for SVD was 98.1+/-1.2% at 5 years and 92.3+/-4.1% at 8 years. On multivariate analysis of preoperative risk factors, small valve size (between 25 mm and 27 mm) was a significant risk factor for reoperation, and low LV ejection fraction (<40%) was a significant risk factor for SVD and mortality. CONCLUSION: Survival and freedom from reoperation for SVD in mitral bioprosthesis replacement had acceptable midterm results, but freedom from SVD was relatively low. In particular, since SVD increased sharply at the eighth postoperative year, frequent follow-up and echocardiograms around that time will be helpful for the early detection of SVD. It will be necessary to conduct further studies involving long-term follow-up and more patients.
Bioprosthesis ; Female ; Follow-Up Studies ; Freedom ; Heart Valves ; Humans ; Male ; Multivariate Analysis ; Outpatients ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Risk Factors ; Survival Rate

Minimally invasive cardiac surgery using AESOP (Automated Endoscope System for Optimal Positioning) offers certain advantages such as better a cosmetic outcome, a shortened post operative recovery time and a shorten hospital stay, and these advantages are not achieved by conventional cardiac surgery. We report here on our first robot-assisted (AESOP) left minithoracotomy surgery in a 26 year-old female with a subarteral ventricular septal defect, and this might have been treated by median sternotomy before the development of AESOP.
Cosmetics ; Endoscopes ; Female ; Heart Septal Defects, Ventricular ; Humans ; Length of Stay ; Robotics ; Sternotomy ; Thoracic Surgery

BACKGROUND: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. MATERIAL AND METHOD: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echocardiograms to find potential preoperative risk factors. RESULT: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was 54.5+/-14.3 years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was 4.3+/-1.8 (range 1.1~8 cm) cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down to the mitral annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was 5.1+/-1.0 cm, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was 36.2+/-37.5 months, with recurrence reported in 2 (2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. CONCLUSION: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.
Diastole ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mitral Valve Stenosis ; Myxoma ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

Open heart surgery via right thoracotomy can be accomplished in atrial septal defects, and mitral valve diseases. Recently, thoracoscopic atrial septal defect closure, mitral valve repair, Maze operation, and minimal invasive direct coronary artery bypass (MIDCAB) are accomplished with AESOP 3000. However, there is no report of thoracoscopic aortic valve replacement in Korea. We report a successful thoracospic aortic valve replacement assisted with AESOP 3000 in a 31-year-old female patient.
Adult ; Aortic Valve* ; Coronary Artery Bypass ; Endoscopes* ; Female ; Heart Septal Defects, Atrial ; Humans ; Korea ; Mitral Valve ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery ; Thoracoscopy ; Thoracotomy