Proximal coronary artery stenosis after direct coronary artery ostial perfusion is an infrequent but life-threatening complication. We had been experienced 3 cases of proximal coronary artery stenosis related to direct ostial perfusion since September, 2000. And now we report the cases.
Constriction, Pathologic ; Coronary Disease ; Coronary Stenosis* ; Coronary Vessels* ; Perfusion*

BACKGROUND: Myxoma makes up close to 50% of adult primary cardiac tumors, and this mainly occurs in the left atrium, and rarely in the right atrium or ventricle. The patients clinically present with symptoms of hemodynamic obstruction, embolization or constitutional changes. Diagnosis is currently established most appropriately with 2-D echocardiography. Surgical resection of myxoma is a safe and effective treatment. MATERIAL AND METHOD: We reviewed our clinical experience in the diagnosis and management of 57 cases of cardiac myxoma that were seen over a 20-year period from July 1984 to July 2004. RESULT: The mean age of the patients was 53.5+/-14.0 years (range: 12 to 76 years). There were 38 (67%) females and 19 (33%) males. The preoperative symptoms included dyspnea on exertion in 27 patients, palpitation in 4, chest pain in 9 and syncopal episode in 4. The diagnosis was made by echocardiography alone in 51, and by combination of echocardiography, CT and angiography in 6. The tumor attachment sites were the interatrial septum in 50, the mital valve annulus in 3 and the left atrial wall in cases. The tumor was excised successfully via biatriotomy in 33 (58%), left atriotomy in 15 (26%), the septal approach via right atriotomy in 3, Inverted T incision in 3 and the extended septal approach in 3. The follow-up time ranged from 1 to 229 months (mean follow-up: 84.0+/-71.3 months). There were no early and late deaths and no recurrence during the follow-up period except for follow-up loss in 5 patients. CONCLUSION: It's concluded that excision of cardiac myxoma is curative and the long-term survival is excellent. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Radical tumor excision may prevent recurrences.
Adult ; Angiography ; Chest Pain ; Death, Sudden, Cardiac ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Follow-Up Studies ; Heart Atria ; Heart Neoplasms ; Hemodynamics ; Humans ; Male ; Myxoma* ; Recurrence ; Syncope

A widened mediastinum is not always caused by aortic dissection, which is the default diagnosis among emergency physicians. Other acute aortic syndromes should be included in differential diagnosis, such as penetrating atherosclerotic ulcer (PAU), intraluminal hematoma, aneurismal leak, and traumatic transection. When an ulcerative lesion is found in the atherosclerotic aorta, especially the descending aorta of an elderly, PAU should be considered as the possible cause of widened mediastinum. We present a case of PAU, the diagnosis of which was delayed without the knowledge of PAU even though thoracic computed tomography showed widened mediastinum and suspious pericardial effusion.
Aged ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Rupture ; Chest Pain ; Diagnosis, Differential ; Emergencies ; Hematoma ; Humans ; Mediastinum ; Pericardial Effusion ; Ulcer

BACKGROUND: The effect of patient-prosthesis mismatch (PPM) on the clinical outcome following aortic valve replacement (AVR) remains controversial. This study compared the surgical outcomes of AVR between patients with a patient-prosthesis mismatch and those having undergone an aortic annular enlargement. MATERIAL AND METHOD: Six hundred and twenty seven adult patients, who underwent AVR with stented bioprosthetic or mechanical valves, between January 1996 and February 2006, were evaluated. PPM was defined as an indexed effective orifice area (iEOA) < or =0.85 cm2/m2, and severe if the iEOA < or =0.65 cm2/m2. PPM was present in 103 (16.4%, PPM group) patients, and severe in 11 (1.8%, SPPM group). During the period of the study, 21 patients underwent an AVR with annular enlargement (AE group). RESULT: The mean iEOA of the AE group was larger than that of the PPM group (0.95 vs. 0.76 cm2/m2, p=0.00). The AE group had longer CPB, ACC and operation times than the PPM group, and showed a tendency toward higher operative mortality (14.3% vs. 2.9%, p=0.06). The SPPM group had higher AV pressure gradients (peak/mean) than the AE group (72/45 mmHg vs. 38/25 mmHg, p=0.02/0.06) and suffered more AV related events (AV reoperation or severe aortic stenosis)(45.5% vs. 9.5%, p=0.03). LV masses were not regressed in the patients who experienced an AV related event. CONCLUSION: During AVR in patients with a small aortic annulus, annular enlargement should be carefully applied taking into account the high risk of operative mortality due to annular enlargement and co-morbidities of patients. Aortic annular enlargement; however, should be considered as an alternative method in patients expected to have a severe PPM after an AVR.
Adult ; Aortic Valve* ; Humans ; Mortality ; Prostheses and Implants ; Reoperation ; Stents

Infected vascular lesion, including aortic graft infection, is one of the most challenging fields in vascular surgery. The primary treatment objectives are to remove the infected graft material and to re-establish vascular continuity with an extra-anatomic bypass or in situ graft replacement. Despite significant progress in perioperative care and antimicrobial therapy, mortality and morbidity remain high. The great saphenous veins are gaining wide popularity as acceptable native vascular grafts, but in terms of flow capacity, their small caliber may be unsuitable for immediate replacement of arterial flow. Superficial femoral popliteal vein grafts are excellent conduits for infected aortic, peripheral arterial and central venous lesion, in terms of feasible harvesting, resistance to infection, serving immediate high postoperative flow and long-term durability. Surgery using the superficial femoral vein (SFV) graft is neither time-consuming nor dangerous. A delicate preoperative and intraoperative surgical plan is mandatory, and future studies regarding the long-term patency, appropriate clinical indication and safety issue of the SFV graft in peripheral vessel reconstruction are warranted.
Femoral Vein ; Glycosaminoglycans ; Perioperative Care ; Popliteal Vein ; Saphenous Vein ; Transplants ; Veins

BACKGROUND: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. MATERIAL AND METHOD: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months (13 days~38.1 months) and body weight was 5.0 kg (2.9~13.5 kg). Preoperative pressure gradients were 25.3+/-15.7 mmHg (10~60 mmHg). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6, another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. RESULT: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of 62.7+/-38.9 months (3.3~128.1 months). Kaplan-Meier estimated actuarial survival was 71.9%+/-9.3% at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. CONCLUSION: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.
Aorta ; Aorta, Thoracic ; Bays ; Body Weight ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Crisscross Heart ; Double Outlet Right Ventricle ; Echocardiography ; Follow-Up Studies ; Fontan Procedure ; Freedom ; Heart ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Mitral Valve Insufficiency ; Multivariate Analysis ; Parturition ; Pulmonary Artery ; Reoperation ; Retrospective Studies ; Risk Factors ; Vascular Resistance

BACKGROUND: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. MATERIAL AND METHOD: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. RESULT: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. CONCLUSION: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.
Adult ; Debridement* ; Endocarditis* ; Heart ; Hospital Mortality ; Humans ; Mortality* ; Preoperative Period ; Staphylococcal Infections

Most myocardial bridgings are found incidentally without symptoms, but myocardial bridging may induce symptoms such as angina, myocardial infarction, and ventricular arrythmia. In a patient who has symptoms despite of proper medication, stent insertion, supra-arterial myotomy or coronary artery bypass grafting have been applied without a definite guideline of treatment. We report two surgical cases of myocardial bridging with a review of the literature.
Arrhythmias, Cardiac ; Coronary Artery Bypass ; Humans ; Myocardial Bridging* ; Myocardial Infarction ; Stents

The incidence of the Buerger's disease is higher for the far-East Asian population that for western people, but the surgical outcomes have been documented to be unsatisfactory. So, more aggressive and multi-focused treatment modalities should be warranted such as stopping smoking or intravenous vasodilator infusion with surgery. We report here on a successful surgical case of intra-arterial direct infusion of Prostaglandin E1 concomitant with surgical bypass and lumbar sympathectomy to treat Buerger's disease.
Alprostadil ; Asian Continental Ancestry Group ; Humans ; Incidence ; Lower Extremity ; Smoke ; Smoking ; Sympathectomy ; Thromboangiitis Obliterans ; Transplants

A 75-year-old man who was diagnosed as having a fluid-filled giant bulla was treated with a modified Brompton technique due to his poor performance status. Percutaneous drainage, suction, and talc sclerotherapy through a Foley catheter can be good treatment options for patients with conditions that are too poor to allow surgical intervention, especially if there is adhesion between a giant bulla and parietal pleura. Talc can also be used safely when mixed with normal saline as a sclerosant.
Aged ; Blister ; Catheters ; Drainage ; Humans ; Pleura ; Sclerotherapy ; Suction ; Talc