No abstract available.
Truncus Arteriosus*

BACKGROUND: The purpose of writing this article is to get better clinical results and further clinical improvement based on subject to 110 cases of cardiac surgery which were performed and clinically analyzed. MATERIAL AND METHOD: Since January 1995, the patent ductus arteriosus surgery had started in our hospital. In February 1999, an open heart surgery had started and up to September 2000, total of 110 cases were performed as of double ligation of patent ductus arteriosus(10 cases) and open heart surgery(100 cases). RESULT: Among the patients, Korean-Chines was 74(67.3%) and Han-Chinese was 35(31.8%). Congenital heart disease was 95 cases and acquired valvular heart disease was 15 cases. 83 cases of acyanotic congenital heart disease consisted of ventricular septal defect(VSD) with associated anomaly(45 cases), atrial septal defect(ASD) with associated anomaly(20 cases), patent ductus arteriosus(PDA) with associated anomaly(11 cases), congenital aortic stenosis(5 cases), double chamber right ventricle(1 case) and Ebstein's anomaly(1 case). Among the 12 cases of cyanotic congenital heart disease, 11 cases of tetralogy of Fallot underwent total correction. Among the 15 cases of acquired valvular heart disease, valvular replacement(7 cases), double valve replacement(3 cases), mitral valve replacement(3 cases) and aortic valve replacement(1 case) were performed. And 8 cases of valvuloplasty were performed by using of commissurotomy, chordal plasty, plasty of papillary muscle, ring type annuloplasty, repair of leaflet. CONCLUSION: On congenital heart disease, short term results of surgery for acyanotic congenital heart disease was good. Among the cyanotic congenital heart disease, tetralogy of Fallot showed a little difference of recovery according to the surgery method so that further follow up observation was needed for long term result. On acquired valvular heart disease, especially. in terms of short term result of valvuloplasty, was relatively good, but further follow up observation was also needed for long term result. There wasn't any operative mortality.
Aortic Valve ; Ductus Arteriosus, Patent ; Heart Defects, Congenital ; Heart Valve Diseases ; Heart* ; Humans ; Ligation ; Mitral Valve ; Mortality ; Papillary Muscles ; Tetralogy of Fallot ; Thoracic Surgery* ; Writing

BACKGROUND: The washing of packed red blood cells could remove pro-inflammatory mediators,cell debris,and micro-particles contained in packed red blood cells,and the preci- rculation-ultrafiltration (recirculation and ultrafiltration of circuit itself before cardiopulmonary bypass)could attenuate the initial inflammatory reaction and remove the initial proinflam- mat ory medi at ors.Thi s st udy was performed t o eval uat e whet her the washing of packed red blood cells and precirculation-ultrafiltration can reduce the production of cytokines that have an important role in myocardial reperfusion injury.This study investigated the effects of washing the packed red blood cells and precirculation-ultrafiltration on the production of cytokines during and after cardiopulmonary bypass and open heart surgery. MATERIAL AND METHOD: Forty eight infants with VSD undergoing open heart surgery under cardiopulmonary bypass were randomized into control group (group C,n=12),washing group (group W,n=12), precirculation-ultrafiltration group (group F,n=12),and combined group(washing and precirculation-ultrafiltration,group WF,n=12).Blood samples were obtained before,during,and after the bypass to assess plasma level of tumor necrosis factor-alpha (TNF-alpha ),interleukin-6 (IL-6),and interleukin-8 (IL-8). RESULTS: Expressions of TNF-alpha were significantly reduced in combined group (group WF)compared with group C,group W,and group F(p < 0.05). Expression of IL-6 were significantly reduced in group W,group F,and group WF compared with group C (p < 0.05),but similar among group W,group F,and group WF (p=0.053).Expression of IL-8 were reduced in group W and group WF compared with group C (p < 0.05),but similar among group W,group F,and group WF (p=0.067). CONCLUSION: In conclusion,the washing of packed red blood cells and precirculation-ultrafiltration blunted the increase of TNF-alpha ,IL-6,and IL-8 during and after open heart surgery with cardiopulmonary bypass.However,the clinical benefits of these treatments remains unproven.
Blood Cells ; Cardiopulmonary Bypass ; Cytokines* ; Erythrocytes* ; Heart* ; Humans ; Infant ; Interleukin-6 ; Interleukin-8 ; Myocardial Reperfusion ; Plasma ; Thoracic Surgery* ; Tumor Necrosis Factor-alpha ; Ultrafiltration

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

BACKGROUND: The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. MATERIAL AND METHOD: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8+/-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1. RESULT: There were 3 early and late deaths respectively. Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1). In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. CONCLUSION: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However,more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class,Although the results were not satisfactory enough in all patients.
Arrhythmias, Cardiac ; Arteries ; Atrial Flutter ; Constriction, Pathologic ; Cryosurgery ; Follow-Up Studies ; Fontan Procedure* ; Humans ; Mortality ; Physiology ; Pneumonectomy ; Postoperative Complications ; Protein-Losing Enteropathies ; Pulmonary Veins ; Reoperation ; Thoracotomy

BACKGROUND: This study describes our surgical results of transventricular complete repair of tetralogy of Fallot in infants. MATERIAL AND METHOD: Eight hundred and forty children underwent complete repair of TOF between January 1990 and April 2002 in our institute. One hundred sixty infants of them were included to this survey. Mean age at repair was 8.1+/-2.6 months (3~12). Correction was accomplished through a short right ventriculotomy less than 30% of ventricular height in all patients. A transannular patch was necessary in 78 patients (49%). RESULT: There were four early deaths. There were no late deaths. Follow-up with mean duration of 66 months was completed in all survivors. All patients are currently in New York Heart Association functional class I or II. Twenty patients required late reoperations. Actuarial freedom from reoperation at 1 and 10 years were 94% and 87% respectively. Two-dimensional and Doppler echocardiographic follow-up studies showed good right ventricular function in all patients except three. CONCLUSION: Our results suggested that early complete repair of TOF yield the acceptable results with low mortality and morbidity. Transventricular repair of intracardiac pathology can be safely applied to these patient population, yielding good postoperative right ventricular function.
Child ; Echocardiography ; Follow-Up Studies ; Freedom ; Heart ; Humans ; Infant ; Mortality ; Pathology ; Reoperation ; Survivors ; Tetralogy of Fallot* ; Ventricular Function, Right

We investigated changes of the size of neoaortic annulus, root, and aortic anastomosis after arterial switch operation for complete transposition of the great arteries performed in infancy. A total of 23 patients were included in this study. Age ranged from 6 to 153 days. Body weight averaged 3.9+/-0.8kg and 17 patients were male. The preoperative angiocardiographic dimensions of the pulmonary annulus, the pulmonary root, and the sinotubular junction, standardized to the diameter of descending aorta at the level of diaphragm, were compared to the size of postoperative measurements of the neoaortic annulus, the neoaortic root, and the aortic anastomosis at a mean interval of 17.2+/-9.4 months. Mean dimensions of the neoaortic annulus and the neoaortic root were significantly increased postoperatively(n=23, annulus; p<0.01, root; p<0.01), however, those of the aortic anastomosis did not reveal significant change(n=23, p=0.06). There were no significant differences in changes of diameters of the neoaortic annulus, the root, and the aortic anastomosis between patients with(n=8) and without(n=15) postoperative neoaortic regurgitation(annulus; p=0.32, root; p=0.29, anastomosis; p=0.86). Postoperative dimensions of the neoaortic root and annulus between patients with ventricular septal defect(n=10) and without ventricular septal defect(n=13) were not significantly changed compared to the preoperative measurements(annulus; p=0.09, root; p=0.07) but mean diameters of the aortic anastomosis decreased significantly after operation in patients with ventricular septal defect(p=0.04). This study revealed that the site of the aortic anastomosis grows in proportion to patient's somatic growth after arterial switch operation. Although we could not demonstrate the relation between the aortic root dilatation and the postoperative neoaortic regurgitation in this study, a continuous close follow-up might be necessary to detect a possible progression of the aortic root dilatation and the resulting significant aortic valve regurgitation.
Aorta, Thoracic ; Aortic Valve ; Arteries ; Body Weight ; Diaphragm ; Dilatation ; Follow-Up Studies ; Humans ; Male