To define the risk factors affecting the early major morbidity and mortality after multiple-valve operations, the preoperative, intraoperative and postoperative informations were retrospectively collected on 124 consecutive patients undergoing a multiple-valve operation between October 1985 and July 1996 at the department of Thoracic and Cardiovascular Surgery of Pusan Paik Hospital. The study population consists of 53 men and 71 women whose mean age was 37.9+/-11.5 (mean+/-SD) years. Using the New York Heart Association (NYHA) classification, 41 patients (33.1%) were in functional class II, 60 (48.4%) in class III, and 20 (16.1%) in class IV preoperatively. Seven patients (5.6%) had undergone previous cardiac operations. Atrial fibrillations were present in 76 patients (61.3%), a history of cerebral embolism in 5 (4.0%), and left atrial thrombus in 13 (10.5%). The overall early mortality rate and postoperative morbidity was 8.1% and 21.8% respectively. Among the 124 cases of multiple-valve operation, there were 57 (46.0%) of combined mitral valve replacement (MVR) and aortic valve replacement (AVR), 48 (38.7%) of combined MVR and tricuspid annuloplasty (TVA), 12 (9.7%) of combined MVR, AVR and TVA, 3 (2.4%) of combined MVR and aortic valvuloplasty, 2 (1.6%) of combined MVR and tricuspid valve replacement, and others. The patients were classified according to the postoperative outcomes; Group A (27 cases) included the patients who had early death or major morbidity such as low cardiac output syndrome, mediastinitis, cardiac rupture, ventricular arrhythmia, sepsis, and others; Group B (97 cases) included the patients who had the good postoperative outcomes. The patients were also classified into group of early death and survivor. In comparison of group A and group B, there were significant differences in aortic cross-clamping time (ACT, group A:153.4+/-42.4 minutes, group B:134.0+/-43.7 minutes, p=0.042), total bypass time (TBT, group A:187.4+/-65.5 minutes, group B:158.1+/-50.6 minutes, p=0.038), and NYHA functional class (I:33.3%, II:9.7%, III:20%, IV:50%, p=0.004). In comparison of early death (n=10) and survivor (n=114), there were significant differences in age (early death:45.2+/-8.7 years, survivor:37.2+/-11.6 years, p=0.036), sex (female:12.7%, male:1.9%, p=0.043), ACT (early death:167.1+/-38.4 minutes, survivor:135.7+/-43.7 minutes, p=0.030), and NYHA functional class (I:0%, II:4.9%, III:1.7%, IV:35%, p=0.001). In conclusion, the early major morbidity and mortality were influenced by the preoperative clinical status and therefore the earlier surgical intervention should be recommended whenever possible. Also, improved methods of myocardial protection and operative techniques may reduce the risk in patients with multiple-valve operation.
Aortic Valve ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Busan ; Cardiac Output, Low ; Classification ; Female ; Heart ; Heart Rupture ; Humans ; Intracranial Embolism ; Male ; Mediastinitis ; Mitral Valve ; Mortality* ; Retrospective Studies ; Risk Factors* ; Sepsis ; Survivors ; Thrombosis ; Tricuspid Valve

BACKGROUND: Pneumoconiosis is a parenchymal lung disease that results from the accumulation of coal dust in the lungs and the consequent tissue reaction. To evaluate the role of various personal factors in pneumoconosis and the significance of some serologic markers for assessing the disease activity related to pneumoconiosis, the Rheumatoid Factor(RF), α1-AT, C-Reactive Protein(CRT), ceruloplasmin and fibrinogen levels were measured. METHOD: All the patients were males, 45-76 years old, and the mean duration of coal dust exposure was 23.2 years. 51 patients were classified as having Simple Pneumoconiosis (SP), 59 had Progressive Massive Fibrosis (PMF). Fifty eight men with ages ranging from 26-70 years wer used as normal controls. The serum RF and CRT were titrated using an Autochemistry analyzer (HITACHI 7150 : Japan) and the α1-AT and ceruloplasmin levels were measured using a Nephelometer (Behring Nephelometer : Germany) and the fibrinogen levels were estimated by using and Autoanalyzer for hematologic coagulation. RESULT: There was a higher RF level in the SP, and PMF groups than in the control groups but there was no statistical difference. The CRP, α1-AT, and ceruloplasmin levels were also higher in the SP, and PMF groups. However, the fibrinogen concentration was within the normal ranges in both the SP and PMF groups. CONCLUSION: The CWP (Ed note : Define CWP) patients had significantly higher CRP, α1-AT, and ceruloplasmin levels compared to the control group. It is believed that these serologic changes could be used as a marker of the disease activity.
C-Reactive Protein ; Ceruloplasmin ; Coal* ; Dust ; Fibrinogen ; Fibrosis ; Humans ; Lung ; Lung Diseases ; Male ; Pneumoconiosis* ; Reference Values ; Rheumatoid Factor

BACKGROUND: The authors studied factors that affected operative mortality and clinical course by analysis of 98 patients who had underwent total correction of TOF at department of thoracic surgery, Pusan Paik hospital from Sept, 1985 to Aug, 1996 to predict the outcome of operation and improve the result of total correction. MATERIALS AND METHODS: To analyse the factors that affect operative mortality, patients were divided into two groups, non-survivor (group I) and survivor (group II), compared body surface area (BSA), aortic clamping time (ACT), total bypass time (TBT), preoperative PRV/LV, postoperative PRV/LV, operation method between them. These same patients were also divided into two groups, group A (non-survivor or severe complication group) and B (survivor and only mild complication group), comparing the same items. RESULTS: There were statistical differences between group I and II about postoperative PRV/LV as 0.67+/-0.13, 0.46+/-0.15. There were statistical differences between group A and B about postoperative PRV/LV as 0.62+/-0.12, 0.44+/-0.15. Transventricular cases were predominant in group A, transatrial cases in group B (p<0.01). CONCLUSIONS: We suggested that the operative results of TOF were better in cases of lower postoperative PRV/LV and transatrial approach.
Body Surface Area ; Busan ; Constriction ; Humans ; Mortality ; Survivors ; Tetralogy of Fallot* ; Thoracic Surgery

BACKGROUND: For AVR using conventional prosthetic valves in adult patients with a narrow aortic root, aortic root enlargement is necessary to reduce postoperative pressure gradient across the aortic valve (deltaP). An evaluation of early and mid-term results of aortic root enlargement with AVR and echocardiographic follow up of deltaP and left ventricular function was performed. METHOD: From Aug. 1991 to Feb. 1998, eighteen patients aged 17 to 59 years(mean, 38+/-12 years) underwent Manouguian procedure with AVR. Aortic annular circumstance was enlarged 10.0mm to 18.0mm(mean, 12.6+/-6.3mm). Eight patients(44.0%) had NYHA class III status before operation, and seven cases of them underwent concomitant MVR. Valve pathology was ASr in 6 cases, AS in 4 cases, nd ASr+MSr in 8 cases. Replaced valve size was 21mm in 8 cases and 23 mm in 10 cases, and St. Jude Medical mechanical valve was used in 10 cases and Carbomedics in 8 cases. RESULT: Follow-up duration was 6 to 57 months (mean, 26+/-18 months), and total follow-up was 287 patient-year. There were one hospital death and one late death, therefore, actuarial survival rate was 85.7% at 56 months. Peak deltaP wad decreased significantly at postoperative mid-term period as 13+/-5mmHg, compared with thepreoperative one (42+/-8mmHg) (p<0.01). LVM(gm/m(2)) was also diminished as 35.8%(115+/-36gm/m(2))at postoperative mid-term period, compared with preoperative one (179+/-56gm/m(2))(p<0.05). CONCLUSIONS: There were no specific complications related to the procedure. And we could have adequate enlargement of aortic annulus to suitable prosthetic valve that have no effect of patient-prosthese mismatch.
Adult ; Aortic Valve ; Echocardiography ; Follow-Up Studies ; Humans ; Pathology ; Survival Rate ; Ventricular Function, Left

BACKGROUND: Selective diagnostic blocks of the medial branches of the dorsal primary ramus are usually performed under the guidance of fluoroscopic or computed tomography. Recently, however, ultrasound guidance has been suggested as an alternative method. In this study, the distances between the vertebral structures were measured and compared with the values measured using magnetic resonance imaging (MRI) to assess the clinical feasibility of using ultrasound-guided block in Korean patients. METHODS: Five male and 15 female patients were enrolled in this study. The target point of the medial branch block in our study was the groove at the base of the superior articular process. We measured the depth from the skin to the target point at the transverse process (d-TP) and to the most superficial point of the superior articular process (d-AP). RESULTS: The d-TP and d-AP values measured under ultrasound guidance were concordant with the values measured using MRI. CONCLUSIONS: The images of the bony landmarks obtained under ultrasound examination could be useful for ultrasound-guided lumbar medial branch block.
Female ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Skin ; Ultrasonography ; Zygapophyseal Joint

In an attermpt to aviod the deleterious effects of cardiopulmonary by pass such as pulmonary complication neurologic complication and renal failure off-pump CABG has been rediscovered and developed. We experienced off-pump CABG in 2 cases with unstable angina complicated with COPD and report herein the cases with review of literature.
Angina, Unstable* ; Coronary Artery Bypass ; Pulmonary Disease, Chronic Obstructive* ; Renal Insufficiency

Hyperhidrosis is one of abnormalities in autonomic nervous system, it has been treated with dermatologic principles or thoracic sympathectomy via thoracotomy. But these techniques were rather ineffective or invasive. Recently, Video Assisted Thoracoscopic Surgery (VATS) is widely applided in thoracic surgical area, and palmar & axillary hyperhidrosis is not the exception. From August 1995 to February 1997, 52 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic sympathectomy with VATS in the department of thoracic & cardiovascular surgery, Inje university, Pusan Paik Hospital. There were 27 men and 25 women and the mean age was 22 years. Mean operating time was 172 min and unilateral sympathectomy via minithoracotomy was applied in one patient due to severe pleural adhesion. Mean postoperative hospital stay was 2.6 days. During mean 12.5 months follow-up, there was no recurrence of sweating in the both hands. Thirty patients (57.7%) complained moderate degree of compensatory sweating, but the discomfort was decreased in severity. 83.8% of all patients were satisfied with the result of operation.
Autonomic Nervous System ; Busan ; Female ; Follow-Up Studies ; Hand ; Humans ; Hyperhidrosis* ; Length of Stay ; Male ; Recurrence ; Sweat ; Sweating ; Sympathectomy* ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

A bronchogenic cyst is regarded as a developmental abnormality of the primitive foregut, which typically occurs in the mediastinum. The cystis normally diagnosed in relation to respiratory problems or recurrent infections in children. In adulthood, it is a rare pathology, and its diagnosis is usually incidental. Moreover, subdiaphragmatic and retroperitoneal locations are exceptionally rare. A 60-year old woman presented with an incidental left retroperitoneal mass that was suspected of being a non-functioning retroperitoneal tumor. After evaluating the general radiologic and endocrinologic work up for a retroperitoneal tumor, a laparoscopically complete resection was performed with primary repair of the attached diaphragm. The surgically resected cyst measured 7x5x5 cm and was filled with mucin material. Histologically, the cyst wall was lined by a ciliated pseudostratified or tall columnar epithelium without dysplastic changes. The diagnosis of a bronchogenic cyst in the retroperitoneum was confirmed. We present this case with a review of the relevant literature.
Bronchogenic Cyst ; Child ; Diaphragm ; Epithelium ; Female ; Humans ; Laparoscopy ; Mediastinum ; Mucins

BACKGROUND: There are several advantages to the ministernotomy approach. The skin incision is much smaller than the traditional median sternotomy incision. This approach allows the patients to return to normal life more quickly and provide them with good self-image. MATERIAL AND METHOD: From April to July 1998, we performed a ministernotomy via lower half sternum in 25 patients. There were 10 males(40%) and 15 females(60%) with a mean age of 30+/-16 years(range 3 to 55 years). The body surface area ranged from 0.58 to 1.9 m2(mean 1.5 to 0.4 m2). A vertical skin incision of 11cm in mean length was made in the midline over the sternum extending inferiorly from the third intercostal space. The sternum was divided vertically in the midline from the xyphoid process to the level of second intercostal space using a standard saw and then transversely to the left(n=17) or to both sides(n=4) of the second intercostal space using an oscillating saw. The sternum was divided vertically only in children (n=4). RESULT: The ministernotomy was used in 25 consecutive patients undergoing mitral valve replacement(n=10), repair of ventricular septal defect(n=4) and atrial septal defect(n=11). There was no significant complication related to ministernotomy. The mean ICU stay time 20 hours. Patient and family acceptance was very high. CONCLUSION: We concluded that minimally invasive cardiac surgery via ministernotomy can be done safely. These methods may benefit the patients with lesser discomfort, smaller incision, and earlier ICU discharge than the traditional incision.
Body Surface Area ; Child ; Humans ; Mitral Valve ; Skin ; Sternotomy* ; Sternum ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery*

BACKGROUND: To review the middle and long term results of aortic valve replacement(AVR) for 11 years, we surveyed and followed up the patients who underwent AVR. MATERIAL AND METHOD: Between Feb. 1986 and May 1997, 134 patients underwent AVR. The patients consisted of 71 men and 63 women whose mean age was 38.9 years, ranging from 17 to 70. RESULT: The concomitant operations were 62 mitral valve replacement(MVR), 14 MVR + tricuspid valve annuloplasty, 10 Cabrol operation, 16 aortic annulus widening, and so forth. We used 119 mechanical(75 St. Jude Medical, 38 CarboMedics, 6 Sorin) and 15 tissue (Carpentier-Edwards) valves. Early postoperative complications occurred in 35 cases; 9 congestive heart failure, 6 low cardiac output, 5 postoperative bleeding, 5 pleural effusion, and so forth. There were 13 early postoperative deaths(9.7%) due to low cardiac output(5), CHF (2), disseminated intravascular coagulopathy(2), and so forth. The cumulative total follow-up period was 452.7 patient-years with a mean of 3.4+/-3.1 years/patient. There were 9 cases of valve-related complications; anticoagulant-related bleeding(4), prosthetic valve endocarditis(2), thromboembolism(2) and prosthetic valve failure(1) occured at rate of 0.9, 0.4, 0.4, 0.2%/ pt-yr, respectively. Late valve-related death occurred in 3 cases(2.0%/pt-yr) associated with anticoagulant-related bleeding(2) and prosthetic valve endocarditis(1). CONCLUSION: Actuarial survival rate by Kaplan-Meier method was 91.0+/-4.3 % at 11 years.
Aortic Valve* ; Cardiac Output, Low ; Female ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mitral Valve ; Pleural Effusion ; Postoperative Complications ; Survival Rate ; Tricuspid Valve