BACKGROUND: Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches. METHODS: Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion. RESULTS: No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376). CONCLUSION: There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.
Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Hemorrhage ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Retrospective Studies ; Transplants

PURPOSE: Heart rate variability (HRV) is a tool used to measure autonomic nervous function; however, there is no evidence that it can be used to define sympathetic hyperactivity in men with lower urinary tract symptoms (LUTS). We suspected that LUTS would differ between sympathetic hyperactive and hypoactive patients. Therefore, we measured HRV and divided the LUTS patients into two groups, a sympathetic hyperactive group and a sympathetic hypoactive group according to the low frequency/high frequency (LF/HF) ratio and made clinical comparisons between the groups. METHODS: A total of 43 patients with symptomatic LUTS (International Prostate Symptom Score [IPSS] over 8) and 49 healthy volunteers were enrolled. No subjects had diseases that could affect the autonomic nervous system, such as diabetes or hypertension. Electrocardiographic signals were obtained from subjects in the resting state and HRV indexes were calculated with spectral analyses. We divided the LUTS patients into two groups by an LF/HF ratio of 1.9, which was the median value in the healthy volunteers, and compared the differences in clinical characteristics, IPSS, prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) results. The parameters were compared by independent sample t-test by use of SPSS ver. 19. RESULTS: There were no significant differences in age, serum PSA, or volume of the prostate between the 2 LUTS groups. However, analyzing IPSS questionnaires between two groups showed that there were significant differences in mean of Q2 score (frequency) and storage symptom score ([Q2+Q4+Q7]/3) (P<0.05). CONCLUSIONS: We suggest that an imbalance of autonomic nervous system activity may be a factor that evokes varieties of symptoms in men with LUTS. LUTS patients with hypoactive sympathetic tone may suffer from frequency and storage symptoms.
Autonomic Nervous System ; Electrocardiography ; Heart Rate ; Humans ; Hypertension ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.
Accidents, Traffic ; Adolescent ; Bronchi* ; Bronchial Diseases ; Chest Pain ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Pneumoperitoneum* ; Rupture* ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

We report a 72-year-old male with known myelodysplastic syndrome who presented to the emergency department with a 7-day history of fever and dyspnea. Echocardiography revealed a round echogenic mass 13×16 mm in size attached to the atrial side of the tricuspid valve. Considering the high risk of infective endocarditis in the patient with a low absolute neutrophil count (130/mm3), emergency surgery was performed. Intraoperatively, a single gelatinous neoplasm was resected, and subsequent reconstruction of the involved leaflet was accomplished using autologous pericardium. The tumor was pathologically confirmed as papillary fibroelastoma with no evidence of infective endocarditis. Papillary fibroelastoma is a rare cardiac neoplasm that occurs in either the mitral or aortic valves. Interestingly, a few cases of tricuspid valve papillary fibroelastoma have been reported so far. Similar echocardiographic findings between vegetation and tricuspid valve neoplasm make it difficult to distinguish these two disease entities.
Aged ; Aortic Valve ; Dyspnea ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Endocarditis ; Fever ; Gelatin ; Heart Neoplasms ; Humans ; Male ; Myelodysplastic Syndromes ; Neutropenia* ; Neutrophils ; Pericardium ; Tricuspid Valve

BACKGROUND: Extracorporeal life support (ECLS) in patients with hematologic malignancies is considered to have a poor prognosis. However, to date, there is only one case series reported in the literature. In this study, we compared the in-hospital survival of ECLS in patients with and without hematologic malignancies. METHODS: We reviewed a total of 66 patients who underwent ECLS for treatment of acute respiratory failure from January 2012 to December 2014. Of these patients, 22 (32%) were diagnosed with hematologic malignancies, and 13 (59%) underwent stem cell transplantation before ECLS. RESULTS: The in-hospital survival rate of patients with hematologic malignancies was 5% (1/22), while that of patients without malignancies was 26% (12/46). The number of platelet transfusions was significantly higher in patients with hematologic malignancies (9.69±7.55 vs. 3.12±3.42 units/day). Multivariate analysis showed that the presence of hematologic malignancies was a significant negative predictor of survival to discharge (odds ratio, 0.07; 95% confidence interval, 0.01–0.79); p=0.031). CONCLUSION: ECLS in patients with hematologic malignancies had a lower in-hospital survival rate, compared to patients without hematologic malignancies.
Extracorporeal Membrane Oxygenation ; Hematologic Neoplasms* ; Hematology ; Humans ; Multivariate Analysis ; Platelet Transfusion ; Prognosis ; Respiratory Insufficiency ; Stem Cell Transplantation ; Survival Rate

A 71-year-old male with known bronchiectasis and atrial fibrillation was admitted to Seoul St. Mary's Hospital with recurrent transient ischemic attack. Radiofrequency ablation was performed to resolve the patient's atrial fibrillation, but failed. However, a fistula between the left circumflex artery and the bilateral bronchial arteries was found on computed tomography. Fistula ligation and a left-side maze operation were planned due to his recurrent symptom of dizziness, and these procedures were successfully performed. After the operation, the fistula was completely divided and no recurrence of atrial fibrillation took place. A coronary-bronchial artery fistula is a rare anomaly, and can be safely treated by surgical repair.
Aged ; Arteries* ; Atrial Fibrillation ; Bronchial Arteries ; Bronchiectasis ; Catheter Ablation ; Coronary Artery Disease ; Dizziness ; Electrons* ; Fistula* ; Humans ; Ischemic Attack, Transient ; Ligation ; Male ; Myocardial Ischemia* ; Positron-Emission Tomography* ; Recurrence ; Seoul

No abstract available.
Evoked Potentials ; Humans ; Neural Conduction ; Poisoning*

We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.
Adult ; Atrial Septum/pathology/surgery ; Cardiomegaly/*etiology/radiography ; *Cardiopulmonary Bypass ; Female ; Heart Atria/pathology ; Heart Neoplasms/pathology/*surgery ; Humans ; Magnetic Resonance Imaging, Cine ; Neurilemmoma/*pathology/surgery ; *Printing, Three-Dimensional ; Sternotomy ; Treatment Outcome ; Vena Cava, Superior/pathology

BACKGROUND AND OBJECTIVES: Inflammation plays a central role in the development of neointimal hyperplasia. Due to its potent anti-inflammatory property, thalidomide is being re-evaluated in several clinical fields. Thus, we examined whether thalidomide affects neointimal overgrowth. MATERIALS AND METHODS: Male Sprague-Dawley rats, pretreated with thalidomide (100 mg/kg qd) for 3 days, underwent carotid artery angioplasty. Thalidomide administration was then continued for 2 weeks after injury. RESULTS: Compared with the control rats, the systemic inflammatory marker (serum TNF-alpha) reduced significantly in the thalidomide-treated rats at 3 and 14 days after injury (856+/-213 vs 449+/-68 pg/mL, p=0.001, day 3;129+/-34 vs 63+/-18 pg/mL, p=0.001, day 14). This effect was accompanied by marked decreases in the arterial macrophage infiltration and by attenuated expressions of TNF-alpha and bFGF in the arteries, which were measured as local tissue inflammatory indicators. The anti-proliferative effect of thalidomide was confirmed by a reduced number of PCNA-positive vascular smooth muscle cells in the arteries (43.1+/-2.9 vs 7.4+/-1.7 %, p<0.001, day14). Morphometric analysis 2 weeks after injury revealed that gains in the luminal area of the thalidomide-treated rats (0.17+/-0.04 vs 0.05+/-0.02 mm2, p=0.001) were due to the suppression of neointimal hyperplasia (neointima-to-media[N/M] ratio, 0.35+/-0.13 vs 1.26+/-0.29, p<0.001). Moreover, a strong positive correlation was observed between the serum TNF-alpha and the N/M ratio. CONCLUSION: Through its anti-inflammatory and anti-proliferative effect, thalidomide significantly inhibits neointimal hyperplasia. Therefore, thalidomide can be applied in various ways, for instance, as a new drug-eluting stent or as a systemic oral drug against restenosis.
Angioplasty ; Animals ; Arteries ; Carotid Arteries* ; Coronary Restenosis ; Cytokines ; Drug-Eluting Stents ; Humans ; Hyperplasia* ; Inflammation ; Macrophages ; Male ; Muscle, Smooth, Vascular ; Phenobarbital ; Rats* ; Rats, Sprague-Dawley ; Thalidomide* ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: Inflammation plays a central role in the development of neointimal hyperplasia. Due to its potent anti-inflammatory property, thalidomide is being re-evaluated in several clinical fields. Thus, we examined whether thalidomide affects neointimal overgrowth. MATERIALS AND METHODS: Male Sprague-Dawley rats, pretreated with thalidomide (100 mg/kg qd) for 3 days, underwent carotid artery angioplasty. Thalidomide administration was then continued for 2 weeks after injury. RESULTS: Compared with the control rats, the systemic inflammatory marker (serum TNF-alpha) reduced significantly in the thalidomide-treated rats at 3 and 14 days after injury (856+/-213 vs 449+/-68 pg/mL, p=0.001, day 3;129+/-34 vs 63+/-18 pg/mL, p=0.001, day 14). This effect was accompanied by marked decreases in the arterial macrophage infiltration and by attenuated expressions of TNF-alpha and bFGF in the arteries, which were measured as local tissue inflammatory indicators. The anti-proliferative effect of thalidomide was confirmed by a reduced number of PCNA-positive vascular smooth muscle cells in the arteries (43.1+/-2.9 vs 7.4+/-1.7 %, p<0.001, day14). Morphometric analysis 2 weeks after injury revealed that gains in the luminal area of the thalidomide-treated rats (0.17+/-0.04 vs 0.05+/-0.02 mm2, p=0.001) were due to the suppression of neointimal hyperplasia (neointima-to-media[N/M] ratio, 0.35+/-0.13 vs 1.26+/-0.29, p<0.001). Moreover, a strong positive correlation was observed between the serum TNF-alpha and the N/M ratio. CONCLUSION: Through its anti-inflammatory and anti-proliferative effect, thalidomide significantly inhibits neointimal hyperplasia. Therefore, thalidomide can be applied in various ways, for instance, as a new drug-eluting stent or as a systemic oral drug against restenosis.
Angioplasty ; Animals ; Arteries ; Carotid Arteries* ; Coronary Restenosis ; Cytokines ; Drug-Eluting Stents ; Humans ; Hyperplasia* ; Inflammation ; Macrophages ; Male ; Muscle, Smooth, Vascular ; Phenobarbital ; Rats* ; Rats, Sprague-Dawley ; Thalidomide* ; Tumor Necrosis Factor-alpha