BACKGROUND: The recent trend of an increasing number of patients with acute cardiogenic shock or chronic congestive heart failure following myocardial infarction, as well as the considerable number who can not be weaned from cardiopulmonary bypass after open heart surgery, call for immediate efforts to develop affordable ventricular assist devices that are suitable for the Korean physique. Recently, a pneumatic pulsatile ventricular assist device (VAD), named DKUH-75, has been developed by the Department of Biomedical Engineering, in collaboration with the Department of Thoracic and Cardiovascular Surgery of Dankook University College of Medicine. The feasibility of the DKUH-75 VAD was evaluated on the bases of common hemodynamic variables and echocardiographic measurements in pigs, which are subjected to an acute cardiogenic shock state following myocardial infarction, using a novel coronary artery ligation method employing the ischemic preconditioning concept. MATERIAL AND METHOD: Acute cardiogenic shock was induced in 10 Yorkshire Landrace Duroc strain pigs by ligating the left anterior descending coronary artery via an ischemic preconditioning process. The hemodynamic variables were monitored, with epicardial echocardiographic measurements performed before and one hour after the ligation. The DKUH-75 VAD was implanted into 5 pigs one hour after the onset of the shock. The hemodynamic variables and echocardiographic measurements were taken one hour after installation of the VAD. RESULT: The systolic, diastolic and mean systemic arterial pressures were significantly decreased in all the experimental animals one hour after the ligation. The systolic, diastolic and mean pulmonary arterial pressures were increased (Eds note: this completely contradicts the preceding statement? However, if you mean the non-experimental animals this should be stated?). The left ventricular end diastolic pressure (LVEDP) was increased, but the cardiac index decreased. An increase in the left ventricular end systolic dimension and decreases in the fractional shortening and ejection fraction were observed all animals one hour after the coronary artery ligation. In all 5 of the VAD implanted pigs, the systolic and mean systemic arterial pressures were increased, and the pulmonary arterial pressures decreased one hour after the implantation; the LVEDP decreased, but the cardiac index was significantly increased. In the echocardiographic measurements, the left ventricular end systolic dimension decreased after the implantation of the VAD, but the fractional shortening and ejection fraction significantly increased. CONCLUSION: Significant improvements in the hemodynamic variables and echocardiographic measurements were observed in the 5 VAD implanted animals one hour after installation, which had been subjected to an acute cardiogenic shock state by ligation of the coronary artery, indicating that the DKUH-75 VAD could help in the recovery of the myocardial function. This suggests that the DKUH-75 VAD is feasible in the short term in relation to an acute cardiogenic shock state due to myocardial infarction.
Animals ; Arterial Pressure ; Biomedical Engineering ; Blood Pressure ; Cardiopulmonary Bypass ; Cooperative Behavior ; Coronary Vessels ; Echocardiography ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Humans ; Ischemic Preconditioning ; Ligation ; Myocardial Infarction ; Shock ; Shock, Cardiogenic* ; Swine* ; Thoracic Surgery

BACKGROUND: Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. MATERIALS AND METHODS: Among trauma patients that had visited the hospital emergency room from January 2007 to December 2009, a retrospective study was conducted on 453 patients suffering from rib fracture due to blunt trauma. Rib fracture was classified according to location (left, right, and bilateral), and according to level (upper rib fracture [1-2nd rib], middle rib fracture [3-8th rib], and lower rib fracture [9-12th rib]). The researched data was statistically compared and analyzed to investigate the correlation between the location, level, and number of rib fracture and intra-abdominal organ injury. RESULTS: Motor vehicle injury was found to be the most common mechanism of injury with 208 cases (46%). Associated injuries accompanied with rib fracture were generated in 276 cases (61%). Intra-abdominal organ injury was discovered in 97 cases (21%). Liver injury was the most common intra-abdominal injury associated with rib fracture with 39 cases (40%), followed by spleen injury, with 23 cases (23%). Intra-abdominal injury according to level of rib fracture was presented as upper rib fracture in 11 cases (11%), middle rib fracture in 31 cases (32%), and lower rib fracture in 55 cases (57%), thus verifying that intra-abdominal injuries were commonly accompanied in lower rib fractures (p=0.03). In particular, significant increase of intra-abdominal injury was presented in fractures below the 8th rib (p=0.03). The number of intra-abdominal injuries requiring emergency operations was significantly higher in patients with more than 6 rib fractures (p=0.04). CONCLUSION: Intra-abdominal organ injury is more common in patients with lower rib fracture, especially fractures below the 8th rib. Intra-abdominal organ injuries generated in multiple rib fracture patients with more than 6 fractures significantly higher severity. These cases must be thoroughly inspected and carefully observed as there is possibility of emergency operation.
Abdomen ; Aluminum Hydroxide ; Carbonates ; Emergencies ; Humans ; Liver ; Motor Vehicles ; Prognosis ; Retrospective Studies ; Rib Fractures ; Ribs ; Spleen ; Stress, Psychological

PURPOSE: The recent rise in the number of patients visiting emergency rooms with acute cardiogenic shock underscores the need for immediate efforts to develop affordable circulatory assist devices. Recently, a pneumatic pulsatile ventricular assist device (VAD) named DKUH-75, has been developed by the authors. We evaluated the feasibility of the DKUH-75 VAD in pigs placed into an acute cardiogenic shock state following myocardial infarction through a novel coronary artery ligation method involving ischemic preconditioning. METHODS: Acute cardiogenic shock was induced in 5 YorkshirexLandracexDuroc pigs by ligating the left anterior descending coronary artery via the ischemic preconditioning process. Afterward, the DKUH-75 VAD was implanted one hour after the onset of shock. Hemodynamic variables, echocardiographic findings and the level of circulating catecholamine were ascertained one hour after VAD installation. RESULTS: Systolic and mean systemic arterial pressures were increased while pulmonary arterial pressure were decreased one hour after the VAD implantation. LVEDP decreased, and the cardiac index increased significantly. In echocardiographic findings, the left ventricular end systolic dimension decreased after VAD implantation, and the fractional shortening and the ejection fraction increased significantly. The level of circulating catecholamine was increased one hour after the coronary artery ligation and was decreased one hour after VAD implantation, but these trends did not reach a statistical significance. CONCLUSION: The DKUH-75 VAD may help in the recovery of myocardial function, and we postulate that early VAD installation can improve outcome for the cardiogenic shock patients in the emergency room by preventing further development of congestive heart failure. However, further experiments are needed in order to demonstrate the statistical significance of the observed results.
Animals ; Arterial Pressure ; Catecholamines ; Coronary Vessels ; Emergencies ; Heart Failure ; Heart-Assist Devices ; Hemodynamics ; Humans ; Ischemic Preconditioning ; Ligation ; Myocardial Infarction ; Shock ; Shock, Cardiogenic ; Swine

A 32 year-old man was transferred to our hospital due to blood-tinged sputum for 15 days. He had been treated at a private hospital for recurrent pneumonia. The chest X-ray showed an atelectasis on the right middle lobe. Computed tomography of the chest demonstrated a broncholith on right middle lobar bronchus with lobar atelectasis of the right middle lobe. We tried to remove the broncholith through fiberoptic bronchoscopy, but could not remove it. Therefore, we performed surgical removal of broncholith and the right middle lobectomy. The cause of broncholith was identified as actinomycosis by pathologic examination. The broncholith caused by actinomycosis is rare. We report a rare case of broncholithiasis with recurrent obstructive pneumonia caused by actinomycosis, which was treated by surgical operation.
Actinomycosis* ; Adult ; Bronchi ; Bronchoscopy ; Hospitals, Private ; Humans ; Pneumonia ; Pulmonary Atelectasis ; Sputum ; Thorax

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. MATERIAL AND METHOD: We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy. RESULT: The interval between symptom onset and hospitalization was 4.6+/-1.8 days (1~9 day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage. CONCLUSION: Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.
Anti-Bacterial Agents ; Cause of Death ; Debridement ; Drainage ; Early Diagnosis ; Hospitalization ; Humans ; Incidence ; Klebsiella ; Mediastinitis ; Multiple Organ Failure ; Necrosis ; Shock, Septic ; Staphylococcus ; Streptococcus ; Thoracotomy

It has been reported that the immune response due to alpha-Gal epitopes is an important factor in tissue valve failure. The elimination of the interaction between the natural anti-Gal antibodies and alpha-gal epitopes on the xenografts is a prerequisite to the success of xenografts in humans. Previously, we reported that the green coffee bean alpha-galactosidase could remove all alpha-Gal epitopes from cell surface of porcine aortic valve and pericardial tissue, but it has limitations on cost effectiveness. In this study we wanted to know whether the recently produced recombinant human alpha-galactosidase A has the same effective enzymatic activity as green coffee bean alpha-galactosidase in removing alpha-Gal epitopes from the same tissues. After treating fresh porcine aortic valve and pericardial tissue with recombinant alpha-galactosidase A, each sample was stained with Griffonia simplicifolia type I isolectin B4 indirect immunoperoxidase avidin-biotin technique. We then examined whether the alpha-Gal epitopes were reduced or abolished in each consecutive concentration of recombinant alpha-galactosidase A by comparing the degree of the Griffonia simplicifolia isolectin B4 staining. As a result, the recombinant alpha-galactosidase A could remove cell surface alpha-Gals on porcine aortic valve and pericardial tissue as effectively as green coffee bean alpha-galactosidase.
Adolescent ; Animals ; Aortic Valve/chemistry/cytology/*immunology ; Child ; Coffea/enzymology ; Epitopes/*immunology ; Heart Valve Prosthesis Implantation ; Humans ; Pericardium/chemistry/cytology/*immunology ; Recombinant Proteins/genetics/*immunology ; Swine ; Transplantation, Heterologous/immunology ; alpha-Galactosidase/genetics/*immunology

BACKGROUND: Recently, percutaneous cardiopulmonary support (PCPS) has been widely used to rescue patients in cardiogenic shock or cardiac arrest. However, patients with cardiopulmonary bypass (CPB) weaning failure during open heart surgery still have very poor outcomes after PCPS. We investigated clinical results and prognostic factors for patients who underwent PCPS during open heart surgery. MATERIAL AND METHOD: From January 2005 to December 2008, 10 patients with CPB weaning failure during open heart surgery underwent PCPS using the CAPIOX emergency bypass system (EBS(R), Terumo Inc, Tokyo, Japan). We retrospectively reviewed the medical records of those 10 patients. RESULT: The average age of the patients was 60.2+/-16.5 years (range, 19~77 years). The mean supporting time was 48.7+/-64.7 hours (range, 4~210 hours). Of the 10 patients, 6 (60%) were successfully weaned from the PCPS While 5 (50%) were able to be discharged from the hospital. Complications were noted in 5 patients (50%). In univariate analysis, long aortic cross clamp time during surgery, mediastinal bleeding during PCPS and high level of Troponin-I before PCPS were significant risk factors. All of the discharged patients are still surviving 34+/-8.6 months (range, 23~48 months) post-operatively. CONCLUSION: The use of PCPS for CPB weaning failure during open heart surgery can improve the prognosis. More experience and additional clinical studies are necessary to improve survival and decrease complications.
Cardiopulmonary Bypass ; Emergencies ; Extracorporeal Circulation ; Heart ; Heart Arrest ; Hemorrhage ; Humans ; Medical Records ; Prognosis ; Retrospective Studies ; Risk Factors ; Shock, Cardiogenic ; Thoracic Surgery ; Tokyo ; Troponin I ; Weaning

We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.
Angiography ; Cardiovascular Diseases ; Echocardiography ; Heart Septal Defects, Atrial ; Vascular Diseases ; Vena Cava, Superior

We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.
Angiography ; Cardiovascular Diseases ; Echocardiography ; Heart Septal Defects, Atrial ; Vascular Diseases ; Vena Cava, Superior

BACKGROUND: In order to develop the acute heart failure model for the animal experiment of the pneumatic ventricular assist device, we decided to use young pig whose coronary artery distribution is almost the same as humans and also very cheap in price. The purpose of this study is to develop stable, reproducible acute ischemic heart failure model in swine using coronary artery ligation method. MATERIAL AND METHOD: Five young pigs whose weights are the same as adult humans are under experiment. Each pig was under endotracheal intubation and connected to a mechanical ventilator. Through left lateral thoracotomy, we exposed the heart and induced ischemic heart failure by coronary artery ligation. The ligation began at the distal part of the left anterior descending coronary artery. After 5 minutes of initial ligation we reperfused the artery and then re-ligated. Before and after each ligation-reperfusion procedure we assessed the left ventricular end-diastolic pressure, arterial pressure, and cardiac index. We also measured left ventricular end-diastolic dimension, end-systolic dimension, fractional shortening, ejection fraction using intraoperative epicardial echocardiography. After appropriate heart failure was established with sequential (from distal part of LAD to proximal location) ligation-reperfusion-ligation procedure, we inserted the ventricular assist device and operated. RESULT: We established stable acute ischemic heart failure in 3 of 5 young pigs with this sequential ligation-reperfusion-ligation procedure, and could maintained 50% less ejection fraction before the procedure according to intraoperative epicardial echocardiography. We also observed no ventricular arrhythmia usually associated with simple coronary artery ligation in large animals and no cardiac arrest associated with ventricular arrhythmia or myocardial stunning. In pathologic specimen, we observed scattered ischemic myocardium in all around the ischemic field induced by coronary artery ligation. CONCLUSION: Under the concept of ischemic preconditioning, we developed safe and reproducible acute ischemic heart failure model in swine using sequential coronary artery ligation-reperfusion-ligation method.
Adult ; Animal Experimentation ; Animals ; Arrhythmias, Cardiac ; Arterial Pressure ; Arteries ; Coronary Vessels ; Echocardiography ; Heart Arrest ; Heart Failure* ; Heart* ; Heart-Assist Devices* ; Humans ; Intubation, Intratracheal ; Ischemic Preconditioning ; Ligation ; Models, Animal ; Myocardial Stunning ; Myocardium ; Swine* ; Thoracotomy ; Ventilators, Mechanical ; Weights and Measures