PURPOSE: To evaluate the clinical characteristics of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures and assess the surgical outcomes of a novel, closed intramedullary nailing surgical approach designed to minimize fixation failure. MATERIALS AND METHODS: Between May 2013 and April 2017, 31 patients with intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures treated with closed intramedullary nailing or long proximal femoral nail antirotation (PFNA) were enrolled in this study. Preoperative data included age, sex, injury severity score, body mass index, location of shaft fracture, injury mechanism, accompanying traumatic injury, walking ability before injury, and surgical timing. Perioperative outcomes, including follow-up period, types of intramedullary nails, number of blocking screws used, operation time, and blood loss were assessed. Radiologic outcomes, including union rate, time from surgery to union, and femoral shortening, and clinical outcomes, including hip flexion, walking ability, and Harris hip score were also evaluated. RESULTS: A total of 29 unions (93.5%) were achieved. The time to union was 16.8 months (range, 11–25 months) for hip fractures (15.7 weeks for intertrochanteric fractures and 21.7 weeks for subtrochanteric fractures) and 22.8 months for femoral shaft fractures. There were no significant differences in surgical outcomes between the two groups except for type of intramedullary nail. CONCLUSION: Closed intramedullary nailing in the treatment of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures may be a good surgical option. However, fixation of femoral shaft fractures might not be sufficient depending on the implant design.
Body Mass Index ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip ; Hip Fractures ; Humans ; Injury Severity Score ; Walking

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root (Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.
Adolescent ; Aorta ; Aorta, Thoracic ; Aortic Stenosis, Supravalvular* ; Aortic Valve* ; Arteries ; Brachiocephalic Trunk ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Vessels ; Humans ; Male ; Perfusion ; Williams Syndrome

BACKGROUND: The optimal therapeutic strategies for patients with coarctation of the aorta(CoA) and ventricular septal defect(VSD) remain controversial. This study was undertaken to determine the outcome and the need for reintervention following single-stage repair of coarctation with VSD in infants younger than 6 months. MATERIAL AND METHOD: Thirty three consecutive patients who underwent single-stage repair of CoA with VSD, from January 1995 to December 2000, at Sejong General Hospital were reviewed retrospectively. Mean age and body weight at repair were 54+/-37 days(12 days-171 days) and 3.9+/-1.1 kg(1.5~6 kg), respectively. The surgical repair of CoA was performed under deep hypothermic circulatory arrest(CA) in the early period of the study and under regional cerebral perfusion through a direct innominate arterial cannulation without CA in the later period. The technique used in the repair of the CoA was resection and extended end-to-end anastomosis(EEEA; n=16) and extended side-to-side anastomosis(ESSA; n=2) in the early period, and resection and extended end-to-side anastomosis(EESA; n=15) in the later period. The simultaneous closure of VSD was done with a Dacron patch(n=16) and autologous pericardium(n=17). Aortic arch hypoplasia was present in 29 patients(88%) and its types were distal(n=18), complete(n=5), and complex(n=6). RESULT: All procedures without CA were performed in 18 patients(55%) and repair of CoA without CA in 20 patients(61%). The total bypass and aortic crossclamp time were 163+/-68 minutes and 52+/-27 minutes, respectively, and the mean time used for CA was 27+/-11 minutes. There were four early postoperative deaths(12.1%). Twenty nine hospital survivors were followed up for a mean of 38+/-26 months(6 months-78 months) and recurrent coarctation has occurred in 5 patients(17.2%). Two patients underwent balloon aortic angioplasty for recurrent coarctation and the need for reoperation was not present. Actuarial freedom from recoarctation at 1 and 4 years were 85% and 78%, respectively. Actuarial freedom from recoarctation at 4 years was 92% after EESA and 77% after EEEA(p=NS). There was no late death. CONCLUSION: Single-stage repair of aortic coarctation and VSD using extended anastomosis can be performed with the acceptable operative mortality and provides adequate correction of coarctation and low risk of recoarctation.
Angioplasty ; Aorta, Thoracic ; Aortic Coarctation* ; Body Weight ; Catheterization ; Freedom ; Heart Septal Defects, Ventricular* ; Hospitals, General ; Humans ; Infant* ; Mortality ; Perfusion ; Polyethylene Terephthalates ; Reoperation ; Retrospective Studies ; Survivors

There have been few reports documenting the outcome of arterial swich operations(ASO) in selected patients with transposition of great arteries(TGA) and with left ventricular outflow tract obstruction(LVOTO). In the case of TGA with LVOTO, if the atrial septal defect(ASD) is large and the ventricular septal defect(VSD) is restricive, this deprives the left ventricle(LV) of approporiate preload and could lead to underdevelopment of the ventircular mass and lead poor LV performance after the arterial switch operation, dspite a high pressure in the LV preoperatively. Because an increase in the systolic ventricular pressure is not necessarily paralleled by an increase in ventricular mass, which is also essential for optimal ventricular performance after the operation. We report here a case of rapid LV training after ASO in TGA with unprepared LV (because of large ASD and restrictive VSD) despite a high pressure in the LV(due to LVOTO) preoperatively.
Heart Septal Defects, Ventricular* ; Humans ; Transposition of Great Vessels* ; Ventricular Pressure

BACKGROUND: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. MATERIAL AND METHOD: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. CONCLUSION: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.
Body Weight ; Cardiopulmonary Bypass ; Follow-Up Studies ; Heart Defects, Congenital ; Heart* ; Hemorrhage ; Humans ; Infant* ; Infant, Newborn ; Intensive Care Units ; Length of Stay ; Mortality ; Seizures ; Survival Rate ; Thoracic Surgery* ; Ventilators, Mechanical

We report one case of an 18-day-old female patient, weighing 3.4 kg, with severe cyanosis. The diagnosis was made with only transthoracic echocardiography, which revealed cor triatriatum with an atretic small opening of fibromuscular membrane, obstructive infracardiac total anomalous pulmonary venous drainage(TAPVD), severely restrictive interatrial communication, and scanty mitral inflow and aortic forward flow. The preoperative decision-making for biventricular repair was not easy due to collapsed left heart system caused by remarkably reduced blood flow. An emergent operation was performed due to severe cyanosis. All left heart structures were somewhat hypoplastic but thought to be adequate for systemic circulation. Biventricular repair was done without specific intraoperative problems. The postoperative course was uneventful. The patient has been doing well with no evidence of pulmonary vein stenosis or mitral regurgitation for 4 months after operation.
Constriction, Pathologic ; Cor Triatriatum* ; Cyanosis ; Diagnosis ; Drainage* ; Echocardiography ; Female ; Heart ; Humans ; Membranes ; Mitral Valve Insufficiency ; Pulmonary Veins

We report one case of an 18-day-old female patient, weighing 3.4 kg, with severe cyanosis. The diagnosis was made with only transthoracic echocardiography, which revealed cor triatriatum with an atretic small opening of fibromuscular membrane, obstructive infracardiac total anomalous pulmonary venous drainage(TAPVD), severely restrictive interatrial communication, and scanty mitral inflow and aortic forward flow. The preoperative decision-making for biventricular repair was not easy due to collapsed left heart system caused by remarkably reduced blood flow. An emergent operation was performed due to severe cyanosis. All left heart structures were somewhat hypoplastic but thought to be adequate for systemic circulation. Biventricular repair was done without specific intraoperative problems. The postoperative course was uneventful. The patient has been doing well with no evidence of pulmonary vein stenosis or mitral regurgitation for 4 months after operation.
Constriction, Pathologic ; Cor Triatriatum* ; Cyanosis ; Diagnosis ; Drainage* ; Echocardiography ; Female ; Heart ; Humans ; Membranes ; Mitral Valve Insufficiency ; Pulmonary Veins

Patients who have complex endocarditis with involvement of both the aortic and mitral valves and intervalvular fibrous skeleton are among the most difficult to treat and still have the highest surgical mortality and morbidity rates. We report one case of aortic and mitral valve replacement with reconstruction of the fibrous skeleton performed in a 55-year-old female patient who had an aortic annular abscess and both the aortic and mitral prosthetic valve endocarditis with destruction of the fibrous skeleton. Previously, she had undergone redo double valve replacement. Transesophageal echocardiogram showed the paravalvular defect at the noncoronary aortic sinus and abnormal sinus tract along the fibrous skeleton. Emergent operation was performed due to positive blood cultures of staphylococcus epidermidis and persistent sepsis despite appropriate antibiotic therapy. After aortotomy extended to the roof of left atrium, both prosthetic valves and destroyed fibrous skeleton were completely resected and the aortic annular abscess was debrided and closed with a bovine pericardial patch. Reconstructions of both aortic and mitral annuli and the fibrous skeleton were done by using two separate bovine pericardial patches in triangular shape and mechanical valves were implanted. Postoperatively, adequate antibiotic therapies were continued and the patient was discharged at the postoperative 72 days without evidence of recurrence of endocarditis. Transthoracic echocardiogram of the postoperative 8 months shows no paravalvular leakage or recurrence of endocarditis and the patient has been followed up with no symptom.
Abscess ; Endocarditis* ; Female ; Heart Atria ; Humans ; Middle Aged ; Mitral Valve* ; Mortality ; Recurrence ; Sepsis ; Sinus of Valsalva ; Skeleton* ; Staphylococcus epidermidis

BACKGROUND: Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. MATERIAL AND METHOD: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). RESULT: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well. CONCLUSION: Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results.
Angiography ; Arteries* ; Coronary Vessels ; Humans ; Mammary Arteries* ; Mortality ; Standard of Care ; Transplants*

BACKGROUND: With an increasing awareness of the limitations of both mechanical prostheses and bioprostheses, aortic valvuloplasty has gained attention as an alternative procedure for aortic valve disease. MATERIAL AND METHOD: Eight consecutive patients underwent aortic valvuloplasty caused by leaflet prolapse between June 1999 to June 2000. Mean age of the patients was 18.4+/- 12.6 year. Four paitents(50%) were male. Six patients had tricuspid valves and ventricular septal defect and two patients had bicuspid valves. The extent of aortic insufficiency was 3.5+/- 0.5 by preoperative Doppler echocardiography. The technique involved triangular resection of the free edge of the prolapsed leaflet, annular plication at the commissure, and resection of a raphe when present in bicuspid valves. RESULT: There was no in-hospital mortality or morbidity. Mean follow-up was complete at 11.9+/- 3.6months. There was no late mortality or morbidity. The amount of the severity of aortic insufficiency, as assessed by echocardiography preoperatively, postoperatively and at late follow-up was 3.5+/- 0.5, 0.6+/- 0.5 and 0.8+/- 0.6, respectively(p value = 0.01). There was one patient with grade 2/4 aortic insufficiency and in the other patients, grade 1/2 or trivial aortic insufficiency were detected with late echocardiograms. CONCLUSION: Triangular resection in the patients with aortic leaflet prolapse offers a good early clinical result, but long-term follow-up is necessary.
Aortic Valve ; Bioprosthesis ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Male ; Mitral Valve ; Mortality ; Prolapse ; Prostheses and Implants ; Tricuspid Valve