Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

BACKGROUND: There is a controversy regarding the pathogenesis and management principle of an acute intramural hematoma (IMH) of the aorta. Recent studies have reported intimal defects in many patients diagnosed with IMH, and suggested that intimal defects play important roles in the pathogenesis, progression of the pathology, and prognosis. MATERIAL AND METHOD: This study reviewed the preoperative and postoperative computed tomography (CT) scan images of 36 patients who underwent surgical treatment for Stanford type A acute IMH of the aorta. The surgical findings were also reviewed retrospectively from the medical records. RESULT: In 15 patients (41.7%), the findings suggestive of the intimal defects were found in the preoperative CT. During the operation, 26 patients (72.2%) were found to have small intimal defects in the ascending aorta or the arch, of which 13 patients (50.5%) did not have the CT findings suggestive of intimal defects. In 17 patients, the intimal defects were located in the aortic arch or distal ascending aorta, where a gross examination would have been impossible without total circulatory arrest. In all patients, the intimal defects identified were included in the resected aortic segment, or locally closed. Follow-up CT at 4 months or longer after surgery showed that the IMH in the descending aorta had disappeared or was markedly improved. CONCLUSION: Most patients undergoing surgical treatment for acute type A IMH had intimal defects. This suggests that a large proportion of IMH might have a similar pathogenic mechanism as classic dissection. Consequently, it is believed that those two entities of acute aortic syndrome should be treated using the same principles.
Aorta* ; Aorta, Thoracic ; Follow-Up Studies ; Hematoma* ; Humans ; Medical Records ; Pathology ; Prevalence* ; Prognosis ; Retrospective Studies

About 1,000 patients undergo aortic surgery annually in Korea. Unlike Western countries, emergency surgery for dissection or ruptured aneurysm is more frequent than elective cases. Because timely diagnosis and intervention are essential for improving the treatment outcome, medical professionals should be provided with accurate knowledge about the nature of the diseases and currently available treatment modalities along with their results. Aortic dissection is the most frequent among the acute aortic diseases. Although there is a wide variation in surgical results between hospitals, experienced centers are reporting early survival rates higher than 90% after a surgery for acute type A dissection. The majority of the patients with acute type B dissection can be treated medically. For those who have serious complications such as rupture or malperfusion, catheter-based intervention became a promising alternative to surgery. Aortic intramural hematoma and penetrating atherosclerotic ulcer are known to have better prognosis than dissection. However, treatment plans should be decided individually, because many of such lesions can progress into dissection or rupture. Because the result of surgery for ruptured degenerative aneurysm is poor, surveillance and timely intervention is of utmost importance. The mortality rate after elective aortic surgery has come into a satisfactory range; <10% for the thoracic and <5% for the abdominal aorta. Endovascular repair has been established as an effective treatment for the abdominal aortic aneurysm. However, its effectiveness and proper indications for thoracic aortic diseases are not fully determined. Refinement of device and combination with surgical repair (hybrid technique) will widen the indication of stent-grafting.
Aneurysm ; Aneurysm, Ruptured ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Diseases ; Emergencies ; Hematoma ; Humans ; Korea ; Prognosis ; Rupture ; Survival Rate ; Treatment Outcome ; Ulcer

BACKGROUND: This study was aimed to assess improvement in myocardial perfusion after TMR by measuring regional myocardial blood flow(RMBF) in porcine model of chronic myocardial ischemia. MATERIAL AND METHOD: Ameroid ring was placed around the proximal left circumflex coronary artery in fourteen pigs. After 4 weeks, the control group(7 pigs) underwent rethoracotomy only, and the TMR group(7 pigs) underwent Ho:YAG laser TMR at the circumflex territory. After another 4 weeks, the animals were sacrificed for the measurement of RMBF using colored microspheres. The ratio of RMBF between the circumflex territory and the interventricular septum was calculated and compared. RESULT: At 4 weeks after ameroid constriction, RMBF of the circumflex territory decreased to 46~89% of RMBF of the interventricular septum. In five of six animals in the TMR group, RMBF of the circumflex territory at 8 weeks after ameroid constriction was higher compared with RMBF at 4 weeks after ameroid constriction. However, the improvement was statistically significant only in two animals. In three of the four animals in the control group, RMBF of the circumflex territory also increased at 8 weeks compared with RMBF at 4 weeks. The degree of increase in RMBF was not different between the control and the TMR groups. CONCLUSION: In porcine model of chronic myocardial ischemia, the degree of increase in RMBF of the ischemic area after Ho:YAG TMR was not different from the increase by development of native collateral circulation. Perfusion of ischemic myocardium after TMR is not thought to improve to the degree that can be demonstrated by currently available method of assessment such as radioisotope myocardial scintigraphy.
Animals ; Collateral Circulation ; Constriction ; Coronary Artery Disease ; Coronary Vessels ; Laser Therapy ; Microspheres ; Myocardial Ischemia* ; Myocardial Perfusion Imaging ; Myocardial Revascularization ; Myocardium ; Perfusion ; Swine ; Transmyocardial Laser Revascularization*

The results of surgical bypass and endarterectomy in Takayasu's arteritis (TA) were reported to be poor compared to usual atherosclerosis patients. However, if ischemic symptoms due to occlusive disease were severe, surgical procedures were inevitable. We report surgical experience of 5 patients with TA. Five women (ranged from 26 to 58 yr) were operated between June 1998 and May 2004. Three patients showed occlusion of main branches of aortic arch and had symptoms of cerebral ischemia. One patient showed near total occlusion in the midabdominal aorta and had symptoms of orthopnea and uncontrolled hypertension. One patient showed total occlusion of abdominal aorta at the level of aortic bifurcation and had a symptom of severe claudication on both legs. Bypasses from the ascending aorta to the carotid artery were performed in 3 cases. Bypass from the thoracic aorta to the left common iliac artery was performed in one case and endarterectomy of abdominal aorta in one case. The ischemic symptoms related with arterial occlusion were resolved after surgery. And the symptoms of cardiac failure disappeared. The symptomatic TA frequently required arterial reconstruction. The symptomatic improvement and excellent mid-term patency could be expected after arterial reconstruction and endarterectomy.
Adult ; Endarterectomy, Carotid/methods ; Female ; Humans ; Middle Aged ; Migraine Disorders/etiology ; Postoperative Complications ; Takayasu's Arteritis/radiography/*surgery ; Treatment Outcome

We evaluated the feasibility and safety of this method by reviewing the early outcome of the patients who underwent coronary artery bypass grafting(CABG) utilizing parallel sequential anastomoses with saphenous vein grafts, comparing with the outcome of the patients revascularized with grafts having only single distal anastomosis. During the one-year period of 1995, a total of 79 patients underwent isolated CABG, among whom 39 patients with sequential vein grafts(sequential group) and 40 patients without sequential grafts(non-sequential group). There was no difference between the two groups in terms of preoperative status, except in the extent of the coronary disease; 87.2% of the sequential group and 45.0% of the non-sequential group had left main and/or triple vessel involvement. 318 distal coronary anastomoses were done; 198 for the sequential group(5.1/patient) and 120 for the non-sequential group(3.0/patient). In the sequential group, the mean durations of cardiopulmonary bypass and aortic clamp per one distal anastomosis were 33.5 and 21.1 minutes, respectively. In the non-sequential group, these were 41.8 and 22.7 minutes. There were two operative deaths, both in the non-sequential group. There was no difference in the incidence of postoperative complications including myocardial infarction. During the follow-up period(2 to 15 months), 8 patients(3 in the sequential and 5 in the non- sequential group) complained of residual or recurrent angina. Comparison of preoperative and postoperative 201Thallium myocardial perfusion scans in 30 patients showed improved or normal perfusion reserve in 83.3% of segments bypassed with sequential grafts and 82.5% of segments bypassed with non-sequential graft(s). These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft. These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Disease ; Coronary Stenosis ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Revascularization* ; Perfusion ; Postoperative Complications ; Saphenous Vein ; Transplants ; Veins

PURPOSE: Cardiopulmonary bypass (CPB) is one of the most fundamental and important subjects in cardiovascular surgery. Thus, it is insufficient to understand CPB through only traditional education methods as a comprehensive knowledge based on anatomy and physiology of the circulating system and surgical techniques is essential. The aim of this study was to develop a multimedia CPB teaching program for a more rewarding learning experience. METHODS: Among all teaching materials, text and picture-based lectures, movies on surgical procedures, and animations were chosen to be included in the teaching programs. Firstly, we made lecture notes and a powerpoint lecture with narration. Secondly, we made and edited movie files on surgical procedures, and incorporated sound in the movies. Thirdly, we developed animation files including all CPB procedures using flash 5.0. Finally we made a CD ROM and a web page for CPB and other basic surgical techniques. A basic wurgical procedures Self-test was also included. Questionnaires were given to medical students to evaluate the effectiveness and the ease of use of this program. RESULTS: The developed CPB educational program was distributed in a CD-ROM. An internet homepage (http: //surgery.chungbuk.ac.kr) for basic surgical procedures was constructed with the multimedia CPB lecture. The results of the questionnaires were positive, Proving the improved understanding of CPB. CONCLUSION: This multimedia education program on CPB not only can help medical students to easily understand the structures and principles involved in CPB, but also give indirect experience of this surgical procedure.
Cardiopulmonary Bypass* ; CD-ROM ; Education ; Humans ; Internet ; Learning ; Lectures ; Multimedia* ; Narration ; Physiology ; Reward ; Students, Medical ; Teaching Materials ; Surveys and Questionnaires

Suitability rate of endovascular aneurysm repair (EVAR) and the anatomic features causing unsuitability have not been well determined in Asian patients who have abdominal aortic aneurysm (AAA). In a single Korean center, a total of 191 patients with abdominal aortic aneurysm (maximal diameter > or = 4 cm) were identified. Aortoiliac morphologic characteristics in contrast-enhanced computed tomography images were retrospectively reviewed to determine suitability for EVAR with four FDA-approved stent-grafts. AAA was considered ideally suitable for EVAR in 46.6% of patients. The most frequent causes for unsuitability were common iliac artery (CIA) aneurysm (61.8%) and excessive neck angulation (52.9%). Problems such as small and/or short neck and small access were found in minor incidences. If CIA aneurysm is dealt by overstenting with sacrifice of internal iliac artery, suitability rate can increase to 65%. Larger aneurysms were more frequently unsuitable for EVAR and had more chance of having multiple unfavorable features. In conclusion, the overall feasibility rate for EVAR in Korean patients was not different from that in Western patients. However, considering the difference in the major causes of unsuitability, more attention has to be paid to neck angulation and CIA aneurysm to provide EVAR for more Korean patients especially who have large aneurysm.
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/*surgery ; *Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/*instrumentation ; Female ; Humans ; Iliac Aneurysm/surgery ; Iliac Artery ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; *Stents ; Tomography, Spiral Computed

BACKGROUND: We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. METHODS: Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. RESULTS: Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8+/-48.6 minutes and 126.1+/-22.6 minutes in mitral valve repair operations and 132.0+/-32.0 minutes and 76.1+/-23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3+/-43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. CONCLUSION: Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.
Aorta ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Heart Septal Defects, Atrial ; Hemorrhage ; Hospital Mortality ; Humans ; Length of Stay ; Mitral Valve ; Myxoma ; Operative Time ; Reoperation ; Robotics ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery*

A 70-year-old man was transferred to our center due to severe epigastric and back pain with the impression of a ruptured thoracic aortic aneurysm. Six months previously, he had undergone insertion of stent graft into the descending thoracic aorta at another hospital. The findings of the computed tomographic scan suggested a rapidly growing malignant mediastinal tumor rather than a ruptured aneurysm. Exploratory thoracotomy confirmed the diagnosis and the tumor was resected along with the portion of the aorta contained in it. This exemplary case should raise the concern against overzealous application of endovascular aortic repair.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Back Pain ; Diagnostic Errors ; Humans ; Sarcoma ; Stents ; Thoracotomy ; Transplants