No abstract available.
Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip* ; Pulmonary Embolism*

Takayasu's arteritis is generally recognized as a chronic, idiopathic, inflammatory disease, which affects the aorta and the proximal portions of its major branches. We experienced a patient with Takayasu's arteritis who was presented with main pulmonary artery stenosis and right coronary ostial occlusion without involvement of aorta nor its major branches. She was managed with pulmonary arterioplasty and coronary artery bypass graft. This case emphasize that the disease cannot affect the aorta.
Aorta ; Constriction, Pathologic* ; Coronary Artery Bypass ; Coronary Vessels* ; Humans ; Pulmonary Artery* ; Takayasu Arteritis* ; Transplants

OBJECTIVE: Systemic embolism related with left atrial thrombi is a well known complication of percutaneous ballon valveloplasty of the mitral valve stenosis. The presence of left atrial thtombi is believed to be a contraindication to balloon valvuloplasty. The purpose of this study was to determine whether balloon valvuloplasty is possible in mitral stenosis patients with left atrial thrombi after oral anticoagulation therapy. METHODS: We studied 13 consecutive patients(12 : female, 1 : male, mean age : 44+/-11) who had mitral stenosis and left atrial appendage thrombi by serial transesophageal echocardiography before balloon valvuloplasty of the stenotic mitral valve from May 1995 to January 1997. We started oral anticoagulation in those 13 patients with mitral stenosis and left atrial appendage thrombi to keep the INR 2-3. Regular follow up was performed by transesophageal echocardiagraphy to determine whether the left atrial appendage thrombi are resolved. Patients underwent percutaneous balloon valvuloplasty after complete resolution of left atrial appendage thrombi. RESULTS: 9 patients(69.2%) underwent balloon valvuloplasty after complete resolution of left atrial appendage thrombi with oral anticoagulation for average 6 months. Two (15.4%) patients had normal sinus rhythm. Three patients had coronary A-V fistular due to neovascularization to left atrial appendage thrombi. In four patients, oral antiocoagulation failed to resolve the left atrial appendage thrombi and they underwent balloon valvuloplasty under TEE guide with special caution to avoid systemic embolization. There were no complications such as systemic embolization in those 4 patients. CONCLUSION: Left atrial appendage thrombi in mitral stenosis could be resolved in high proportion(69.2%) by oral anticoagulation therapy. Percutaneous mitral balloon valvuloplasty could be a safe and effective treatment modality despite of the presence of left atrial appendage thrombi after adequate oral anticoagulation therapy.
Atrial Appendage* ; Balloon Valvuloplasty ; Echocardiography, Transesophageal ; Embolism ; Female ; Follow-Up Studies ; Humans ; International Normalized Ratio ; Male ; Mitral Valve ; Mitral Valve Stenosis

OBJECTIVES:We performed a prospective observation for the patients with chronic nonvalvular atrial fibrillation who underwent electrical cardioversion after failed pharmacological cardioversion with amiodarone. The aim of this study was to look at the immediate sinus conversion rate, the maintenance rate of sinus rhythm at long-term follow-up, and the clinical and echocardiographic parameters that influence on the rate of immediate sinus conversion and maintenance of sinus rhythm. At simultaneously, we intended to evaluate the efficacy of electrical cardioversion for the patients with chronic nonvalvular atrial fibrillation. METHODS: After anticoagulation therapy with coumadine for four weeks before cardioversion, we tried pharmacological cardioversion with amiodarone first. Failed cases included in this study. The direct current cardioversion was performed under transesophageal echocardiography monitoring to exclude the left atrial thrombus and to measure various echocardiographic parameters. After successful sinus cardioversion, we prescribed amiodarone with maintenance doses and coumadine at least 4 weeks. Transthoracic echocardiography was performed before cardioversion and one day, one month, 3 months, 6 months, and 9 months after sinus conversion. The minimum duration of atrial fibrillation was one month before the trial of pharmacological cardioversion. RESULTS: 1) The total number of patients was forty three (male: 28, female: 15, average age: 60+/-9). The initial success rate of sinus conversion was 88 %. 2) The maintenance rate of sinus rhythm with maintenance dose of amiodarone was 52 % after 9 months follow-up. 3) The direct current cardioversion was performed to 10 patients among 17 patients who recurred atrial fibrillation after sinus conversion. Among 10 patients, 5 patients of them were converted to sinus rhythm and maintained sinus rhythm after 9 months follow-up. 4) The initial success rate of sinus conversion was significantly higher in patients with lone atrial fibrillation compared with those patients with other associated heart disease (100 % vs. 83 %, p < 0.05), but the long-term maintenance rate of sinus rhythm was not influenced by the presence of associated disease. 5) The duration of atrial fibrillation before cardioversion was shorter in patients who were naintained sinus rhythm than that of those who were recurred atrial fibrillation. 6) The initial energy requirement at sinus conversion was lower in the patients who were maintained sinus rhythm than that of those who were recurred atrial fibrillation at 9 months follow-up. CONCLUSIONS: Direct current cardioversion was an effective treatment modality for patients with chronic nonvalvular atrial fibrillation after failure of pharmacological cardioversion with amiodarone.
Amiodarone ; Atrial Fibrillation* ; Echocardiography ; Echocardiography, Transesophageal ; Electric Countershock* ; Female ; Follow-Up Studies* ; Heart Diseases ; Humans ; Prospective Studies ; Thrombosis ; Warfarin

Osteogenesis imperfecta is one of the groups of hereditary disorders of connective tissue which includes the Ehlers-Danlos syndrome, the Marfan syndrome, pseudoxanthoma elasticum, and Hurler syndrome. While cardiovascular involvement is associated with each of these disorders, it is least common in osteogenesis imperfecta and is overshadowed by the bony, ocular, otologic, cutaneous, and dental manifestations that are characteristic of the disorder. In evaluating patients with osteogenesis imperfecta, careful attention should be paid to cardiovascular findings and if valvular lesions are noted, patients should be instructed regarding the need for antibiotic prophylaxis for dental and surgical procedures. We report a case of osteogenesis imperfecta associated with aortic regurgitation.
Antibiotic Prophylaxis ; Aortic Valve Insufficiency* ; Connective Tissue ; Ehlers-Danlos Syndrome ; Humans ; Marfan Syndrome ; Mucopolysaccharidosis I ; Osteogenesis Imperfecta* ; Osteogenesis* ; Pseudoxanthoma Elasticum

Atrial septal aneurysm (ASA) was reported as a cause of unknown origin of central or peripheral thromboembolism with patent foramen ovale, aortic debris and spontaneous echo contrast. Especially the paradoxical right to left shunt via micro-fenestration on this sac may be the important cause of this embolism. We report a case of 39 year-old female patient who had atrial septal aneurysm with multiple renal infarction. Symptom was improved with aneurysmectomy and patch closure, then long term anticoagulation has been continued.
Adult ; Aneurysm* ; Embolism ; Female ; Foramen Ovale, Patent ; Humans ; Infarction* ; Thromboembolism

Rupture of the left ventricle is a dreadful complication after mitral valve replacement.It is infrequent but potentially lethal. We have experienced a case of sudden hemorrhagic shock immediately after arriving at intensive care unit postoperatively and revealed left ventricle rupture on resternotomy.The possible mechanism and surgical maneuver are reviewed and the preventive measures in aspect of anesthetic management are discussed.
Heart Ventricles ; Intensive Care Units ; Mitral Valve ; Rupture ; Shock, Hemorrhagic

BACKGROUND: The inflammatory response to cardiopulmonary bypass (CPB) surgery is believed to play an important role in the end organ dysfunction after open heart surgery. The effect of temperature on the post-bypass inflammatory response has been studied in normothermic and hypothermic patients. This study compared the influence on the systemic inflammatory response and postoperative morbidity in hypothermic cardiopulmonary bypass patients with those in patients in deep hypothermic circulatory arrest. METHODS: Fifty patients undergoing elective redo-valvular replacement or double valve replacement using a hypothermic cardiopulmonary bypass (26-28oC, H Group) and 9 patients undergoing an elective ascending aortic aneurysm replacement using deep hypothermic circulatory arrest (16oC, D Group) were prospectively investigated. The serum samples were collected to estimate the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha levels immediately after induction, 30 min after the initiation of the CPB, 30 min after weaning from the CPB, 2 hours after the CPB, 24 hours after the CPB. RESULTS: Patients preoperative and intraoperative characteristics (age, gender, aortic cross clamping time, cardiopulmonary bypass time) were not similar in the two groups. The serum level of IL-6 and TNF-alpha were also similar in the two groups. There were no statistical differences in the intubation time, ICU stay and oxygenation index (arterial PO2/inspired fraction of oxygen). There were also no statistical differences in the incidence of systemic inflammatory response syndrome and the APACHE II scores. CONCLUSIONS: Deep hypothermic circulatory arrest was not shown to produce a more profound inflammatory response or influence the postoperative morbidity than a hypothermic cardiopulmonary bypass.
Adult* ; Aortic Aneurysm ; APACHE ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced* ; Constriction ; Humans ; Incidence ; Interleukin-6 ; Interleukins ; Intubation ; Oxygen ; Prospective Studies ; Systemic Inflammatory Response Syndrome ; Thoracic Surgery* ; Tumor Necrosis Factor-alpha ; Weaning

PURPOSE: This study analyzed the tumor response, overall survival, progression free survival and related prognostic factors in patients with muscle invasive bladder cancer subjected to bladder preserving treatment. MATERIALS AND METHODS: Between August 1995 and June 2004, 37 patients with muscle invasive (transitional cell carcinoma, clinically stage T2-4) bladder cancer were enrolled for the treatment protocol of bladder preservation. There were 33 males and 4 females, and the median age was 67 years (range 38~86 years). Transurethral resection of the bladder (TURB) was performed in 17 patients who underwent complete resection. The median radiation dose administered was 64.8 Gy (range 55.8~67 Gy). The survival rate was calculated by the Kaplan-Meier method. RESULTS: An evaluation of the response rate was determined by abdomen-pelvic CT and cystoscopy at three months after radiotherapy. A complete response was seen in 17 patients (46%). The survival rate at three years was 54.7%, with 54 months of median survival (range 3~91 months). During the study, 17 patients died and 13 patients had died from bladder cancer. The progression free survival rate at three years was 37.2%. There were 24 patients (64.9%) who had disease recurrence: 16 patients (43.2%) had local recurrence, 6 patients (16.2%) had a distant recurrence, and 2 patients (5.4%) had both a local and distant recurrence. The survival rate (p=0.0009) and progression free survival rates (p=0.001) were statistically significant when compared to the response rate after radiotherapy. CONCLUSION: The availability of complete TURB and appropriate chemoradiotherapy were important predictors for bladder preservation and survival.
Chemoradiotherapy ; Clinical Protocols ; Cystoscopy ; Disease-Free Survival ; Female ; Humans ; Male ; Radiotherapy ; Recurrence ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Nafamostat mesilate (NM), a synthetic serine protease inhibitor, has anticoagulant and anti-inflammatory properties. The intracellular mediator and external anti-inflammatory external signal in the vascular wall have been reported to protect endothelial cells, in part due to nitric oxide (NO) production. This study was designed to examine whether NM exhibit endothelium dependent vascular relaxation through Akt/endothelial nitric oxide synthase (eNOS) activation and generation of NO. NM enhanced Akt/eNOS phosphorylation and NO production in a dose- and time-dependent manner in human umbilical vein endothelial cells (HUVECs) and aorta tissues obtained from rats treated with various concentrations of NM. NM concomitantly decreased arginase activity, which could increase the available arginine substrate for NO production. Moreover, we investigated whether NM increased NO bioavailability and decreased aortic relaxation response to an eNOS inhibitor in the aorta. These results suggest that NM increases NO generation via the Akt/eNOS signaling pathway, leading to endothelium-dependent vascular relaxation. Therefore, the vasorelaxing action of NM may contribute to the regulation of cardiovascular function.
Animals ; Aorta ; Arginase ; Arginine ; Biological Availability ; Endothelial Cells ; Endothelium ; Human Umbilical Vein Endothelial Cells ; Mesylates* ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type III ; Phosphorylation ; Rats ; Relaxation ; Serine Proteases ; Vasodilation*