Even though some authors have reported on the advantages of early total correction of complex heart disease, for low birth weight premature neonates, most surgeons prefer a multi-step approach to early total correction due to the many problems, such as the technical problems, the cardiopulmonary bypass management and etc. 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 1,250 gram premature neonate.
Aortic Coarctation ; Cardiopulmonary Bypass ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Thoracic Surgery

OBJECTIVES: The aim of this study is to evaluate the short-term results and complications of treating the intertrochanteric fracture with bipolar hemiarthroplasty (BHA) in elderly population. METHODS: We retrospectively reviewed 31 unstable intertrochanteric fracture patients who were treated with BHA between January 2007 and August 2009 in older populations more than 65 years old. The 6 males and 25 females had a mean age of 79.8 years (range: 66-88) and a mean follow-up of 36.3 months (range: 24-55). We analyzed the radiological outcomes, functional recovery grade, using Jensen's social function score and Harris hip score (HHS), and complications. RESULTS: The average operation time and blood loss was 148.9 min (range, 110-215 min) and 455.2 mL (range, 200-1200 mL). Mean preoperative and postoperative hemoglobin (Hb) was 10.9 g/dL (range, 8.6-13.4 g/dL) and 10.5 g/dL (range, 5.1-14.1 g/dL) respectively. Average 1.3 pints of blood transfusion was performed. Ambulation with (or without) crutch was possible at mean 6.8 days postoperatively. The stability and alignment indices were adequate in all cases at final follow-up. On clinical results, the average HHS score, was changed from 79.7 points (range, 44-100) preoperatively to 73.0 points (range, 46-92) postoperatively, and the preoperative and postoperative Jensen's score was 1.8 (range, 1-3) and 2.1 (range, 1-4) respectively. CONCLUSIONS: The BHA is an acceptable alternative for unstable intertrochanteric fractures in older population.
Aged ; Blood Transfusion ; Butylated Hydroxyanisole ; Female ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hemoglobins ; Hip ; Hip Fractures ; Humans ; Male ; Retrospective Studies ; Walking

Recently, surgical outcomes of repair of tetralogy of Fallot (TOF) have improved. For patients with TOF older than 3 months, primary repair has been advocated regardless of symptoms. However, a surgical approach to symptomatic TOF in neonates or very young infants remains elusive. Traditionally, there have been two surgical options for these patients: primary repair versus an initial aortopulmonary shunt followed by repair. Early primary repair provides several advantages, including avoidance of shunt-related complications, early relief of hypoxia, promotion of normal lung development, avoidance of ventricular hypertrophy and fibrosis, and psychological comfort to the family. Because of advances in cardiopulmonary bypass techniques and accumulated experience in neonatal cardiac surgery, primary repair in neonates with TOF has been performed with excellent early outcomes (early mortality<5%), which may be superior to the outcomes of aortopulmonary shunting. A remaining question regarding surgical options is whether shunts can preserve the pulmonary valve annulus for TOF neonates with pulmonary stenosis. Symptomatic neonates and older infants have different anatomies of right ventricular outflow tract (RVOT) obstructions, which in neonates are nearly always caused by a hypoplastic pulmonary valve annulus instead of infundibular obstruction. Therefore, a shunt is less likely to preserve the pulmonary valve annulus than is primary repair. Primary repair of TOF can be performed safely in most symptomatic neonates. Patients who have had primary repair should be closely followed up to evaluate the RVOT pathology and right ventricular function.
Anoxia ; Cardiopulmonary Bypass ; Fibrosis ; Humans ; Hypertrophy ; Infant ; Infant, Newborn* ; Lung ; Pathology ; Pulmonary Atresia* ; Pulmonary Valve ; Pulmonary Valve Stenosis ; Tetralogy of Fallot* ; Thoracic Surgery ; Ventricular Function, Right

We report the case of a 17-year-old girl who presented with an indentation in the right ventricle caused by an incomplete pericardium on preoperative 3-dimensional reconstructed computed tomography. She was to undergo surgery for a partial atrioventricular septal defect and secundum atrial septal defect. Preoperative electrocardiography revealed occasional premature ventricular beats. We found the absence of the left side of the pericardium intraoperatively, and this absence caused strangulation of the diaphragmatic surface of the right ventricle. After correcting the lesion, the patient’s rhythm disturbances improved.
Adolescent ; Electrocardiography ; Female ; Heart Septal Defects, Atrial ; Heart Ventricles* ; Humans ; Pericardium* ; Ventricular Premature Complexes

Ebstein's anomaly is a complex congenital defect of the tricuspid valve and right ventricle. Various surgical methods to repair the regurgitant tricuspid valve have been reported, and most of them depend on monocuspidalization with using the anterior leaflet. We report here on our first experience with Ebstein's anomaly in a 31-year-old female patient who underwent cone reconstruction of the tricuspid valve with using three leaflets.
Adult ; Congenital Abnormalities ; Ebstein Anomaly ; Female ; Heart Ventricles ; Humans ; Tricuspid Valve

BACKGROUND: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. MATERIAL AND METHOD: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). RESULT: Mean age was 41+/-14 years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of 38+/-17 months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from 1.9+/-0.6 to 1.2+/-0.5 (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from 45+/-9 and 67+/-10 to 37+/-10 and 56+/-10, respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative (3.1+/-1.2) to post-bypass (0.9+/-0.7). However, the grade at last follow-up (1.7+/-1.1) was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. CONCLUSION: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.
Aortic Valve Insufficiency ; Aortic Valve* ; Bicuspid* ; Echocardiography ; Follow-Up Studies ; Freedom ; Heart ; Hospital Mortality ; Humans ; Male ; Medical Records ; Retrospective Studies ; Sutures

Background: Although the modified Blalock-Taussig shunt remains the mainstay method of palliation for augmenting pulmonary blood flow in various congenital heart diseases, the shunt must be carefully designed to achieve the best outcomes. This study investigated the effect of shunt configuration on pulmonary artery growth and growth discrepancy. Methods: Twenty patients with successful modified Blalock-Taussig shunt takedown were analyzed. Pulmonary artery and shunt characteristics were obtained using computed tomography scans. Differences in the baseline and follow-up diameter ratios and growth in the ipsilateral and contralateral arteries were calculated. The angle between the shunt and pulmonary artery, as well as the distance from the main pulmonary artery bifurcation, were measured. Correlations between pulmonary arteries and shunt configurations were analyzed. Results: The median interval time between shunt placement and takedown was 154.5 days (interquartile range, 113.25–276.25 days). Follow-up values of the ipsilateral-to-contralateral pulmonary artery diameter ratio showed no significant correlation with the shunt angle (ρ=0.429, p=0.126) or distance (ρ=0.110, p=0.645). The shunt angle and distance from the main pulmonary bifurcation showed no significant correlation (ρ=-0.373, p=0.189). Pulmonary artery growth was negatively correlated with shunt angle (ipsilateral, ρ=-0.565 and p=0.035; contralateral, ρ=-0.578 and p=0.030), but not with distance (ipsilateral, ρ=-0.065 and p=0.786; contralateral, ρ=-0.130 and p=0.586). Conclusion Shunt configuration had no significant effect on growth imbalance. The angle and distance of the shunt showed no significant correlation with each other. A more vertical shunt was associated with significant pulmonary artery growth. We suggest a more vertical graft design for improved pulmonary artery growth.

BACKGROUND: The aim of this study is to evaluate the long term results of creating various right ventricle to pulmonary artery conduits for treating complex congenital heart disease. MATERIAL AND METHOD: Between June 1986 and July 2006, we retrospectively reviewed 245 patients who underwent reconstruction of the right ventricular outflow tract with various kinds of conduits. 410 operations were done in 245 patients, the mean age at operation was 3.2+/-4.9 years (range: 7 days~45 years) and the mean body weight was 12.5+/-8.7 kg (range: 2.4~76.3 kg). RESULT: We used the following conduits: Polystan conduit, Shelhigh conduit, Carpenter-Edward conduit, Dacron graft with an artificial valve, valveless Gore Tex vascular graft, homograft and hand-made bovine or autologous pericardial conduit. The mean follow up duration was 6.3+/-5.2 years. Redo operation for RV-PA conduit dysfunction was performed in 131 patients, a second redo was done in 31 and a third redo was done in 3. The reoperation free rates were 67.3%, 48.5% and 39.4% for 5 years, 10 years and 15 years, respectively. The homograft showed the best durability, followed by the Dacron graft with artificial valve and the Carpentier-Edward conduit. The larger sized conduit showed better durability. CONCLUSION: The homograft showed lowest reoperation rate and a smaller size of conduit showed the highest reoperation rate. The reoperation rate for the RV-PA conduit was about 35% at 5 years, so it is mandatory to develop the more durable conduit for RV outflow.
Body Weight ; Follow-Up Studies ; Heart Diseases ; Heart Ventricles ; Humans ; Polyethylene Terephthalates ; Polytetrafluoroethylene ; Pulmonary Artery ; Pulmonary Atresia ; Reoperation ; Retrospective Studies ; Tetralogy of Fallot ; Transplantation, Homologous ; Transplants

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiography with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, hemopericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.
Aged ; Angiography ; Aorta ; Aorta, Thoracic ; Aortic Diseases ; Aortic Rupture ; Brachiocephalic Trunk ; Chest Pain ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Emergencies ; Female ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Mediastinum ; Natural History ; Nausea ; Pericardial Effusion ; Pleural Cavity ; Tunica Media ; Ulcer* ; Vomiting

BACKGROUND: In this study, the role and the surgical outcome of the modified Blalock-Taussig shunt in the treatment of the infants with cyanotic complex congenital heart diseases were investigated. MATERIAL AND METHOD: Over the last 12 years, 105 modified BT shunts were performed in 100 infants. Postoperative course, shunt patency rate, complications, mortality and its risk factors were reviewed restrospectively. RESULT: The mean age at operation was 43.0 36.6 days. Sex ratio was 60:40(M:F). The postoperative oxygen saturations were lowest after mean duration of 11 hours after the shunt procedure. The operative mortality was 8%(8) with 3 late deaths. Causes of operative death included failure of maintenance of minimum oxygenation during the procedure(2), immediate postoperative shunt occlusion(2), respiratory failure(2), low cardiac output due to heart failure and pericardial effusion(2) and sepsis(2). Late deaths resulted from acute cardiac arrest during the follow up cardiac catheterization, hypoxic myocardial failure, and arrhythmia. Year of surgery, shunt size, age at operation, and complexity of the anomalies were not the risk factors for mortality. Six month shunt patency rate was 97% and overall patency rate was 96%. Postoperative complications comprised of shunt occlusion(6), phrenic nerve palsy(3), and wound infection(2). CONCLUSION: We demonstrated that modified Blalock-Taussig shunt was a useful tool to palliate the infants with complex cyanotic heart disease in whom early complete repair was not feasible with acceptable mortality and patency rate. An adequate postoperative management and a meticulous surgical technique may be key factors for the better results.
Arrhythmias, Cardiac ; Blalock-Taussig Procedure* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output, Low ; Follow-Up Studies ; Heart Arrest ; Heart Diseases ; Heart Failure ; Humans ; Infant ; Mortality ; Oxygen ; Phrenic Nerve ; Postoperative Complications ; Risk Factors ; Sex Ratio ; Wounds and Injuries