Open heart surgery via right thoracotomy can be accomplished in atrial septal defects, and mitral valve diseases. Recently, thoracoscopic atrial septal defect closure, mitral valve repair, Maze operation, and minimal invasive direct coronary artery bypass (MIDCAB) are accomplished with AESOP 3000. However, there is no report of thoracoscopic aortic valve replacement in Korea. We report a successful thoracospic aortic valve replacement assisted with AESOP 3000 in a 31-year-old female patient.
Adult ; Aortic Valve* ; Coronary Artery Bypass ; Endoscopes* ; Female ; Heart Septal Defects, Atrial ; Humans ; Korea ; Mitral Valve ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery ; Thoracoscopy ; Thoracotomy

BACKGROUND: Mitral valve repair (MVP) is the optimal procedure for mitral regurgitation (MR), however, failure and subsequent reoperations are the limitations. The current study assessed the procedure in relation to the primary valve related causes of recurrent MR. MATERIAL AND METHOD: MR was treated in 493 patients undergoing MVP from January of 1994 to January of 2002. The causes of MR were degenerative (n=252, 51.5%), rheumatic (n=156, 31.6%), and others (n=85, 16.9%). Surgery comprised 446 ring annuloplasties (90.5%), 227 new chordae formations (46%), 125 quadriangular resections (25.3%), 28 chordae transfers (5.7%), and 8 Alfieri's stitches (1.6%). The mean follow up was 29.04+/-22.81 months. RESULT: There were 5 early (1.01%), and 5 late deaths (1.01%). The reoperation rate was 1.42%. There were 45 (9.1%) recurrent MR (grade III or IV). Of these, 24 were procedure related including incomplete repair (n=14), discordant new chordae length (n=8) and others (n=2). In 21 patients, the cause was valve related including rheumatic disease progression (n=10), recurrent chordae elongation or prolapse (n=5) and others (n=6). Severe MR was higher after incomplete repair (p <0.001), and valve related failure strongly correlated with rheumatic progression (p <0.05). CONCLUSION: Since completeness of operation is the prime risk factor that determine the repair durability, intra-operative assessment of the initial repair with trans-esophageal echocardiography is essential.
Echocardiography ; Follow-Up Studies ; Humans ; Mitral Valve ; Mitral Valve Insufficiency* ; Prolapse ; Reoperation ; Rheumatic Diseases ; Risk Factors

Brain delivery of macromolecular therapeutics (e.g., proteins) remains an unsolved problem because of the formidable blood-brain barrier (BBB). Although a direct pathway of nose-to-brain transfer provides an answer to circumventing the BBB and has already been intensively investigated for brain delivery of small drugs, new challenges arise for intranasal delivery of proteins because of their larger size and hydrophilicity. In order to overcome the barriers and take advantage of available pathways (e.g., epithelial tight junctions, uptake by olfactory neurons, transport into brain tissues, and intra-brain diffusion), a low molecular weight protamine (LMWP) cell-penetrating peptide was utilized to facilitate nose-to-brain transport. Cell-penetrating peptides (CPP) have been widely used to mediate macromolecular delivery through many kinds of biobarriers. Our results show that conjugates of LMWP-proteins are able to effectively penetrate into the brain after intranasal administration. The CPP-based intranasal method highlights a promising solution for protein therapy of brain diseases.