No abstract available.
Aorta*

No abstract available.
Aortic Rupture* ; Echocardiography, Transesophageal*

BACKGROUND: The present study was undertaken to assess the effectiveness of surgical repair as a method of treatment for rheumatic mitral regurgitation by comparing the results of mitral valvuloplasty(MVP) in rheumatic mitral regurgitation and degenerative mitral regurgitation. MATERIAL AND METHOD: Among the 184 MVP patients between January 1995 to December 1998, 49 Rheumatic mirtal regurgiation patients(Group I) and 72 degenerative mirtal regurgitation(Group II) patients were studied. The mean age in group I was 36.3+/-14.6(16-74) and in group II, 52.5+/-13.4(14-77) years. The total follow up duration was 72.2patient years for group I and 77.2 patient years for group II. The Echocardiography was performed preoperatively, at 6months and 1 year postoperatively, and then yearly thereafter in both groups. RESULT: Preoperatively, there were no hemodynamic differences between the two groups. The preoperative mitral regurgitation was 3.9+/-0.4 in group I and 3.9+/-0.3 in group II, but on follow up, both groups showed decrease of grade of regurgitation to 0.9+/-0.9 in group I and 0.8+/-0.7 in group II. The mitral valve area or the mean transmitral pressure gradient was not significantly different between the two groups. There was neither early nor late mortality in either group and the reoperation rate in group I was 1.4% per patient year and 2.6% per patient year in group II. The rate of thromboembolism in group I was 2.8% per patient year and 1.3% per patient year in group II. There was one bacterial endocarditis in group I. Statistical analysis of the data between the two groups failed to reveal any significant differences. CONCLUSION: Although the results of a long term follow up will be required, the current intermedite term study showed that repair was a viable option in the treatment of rheumatic mitral regurgitation.
Echocardiography ; Endocarditis, Bacterial ; Follow-Up Studies ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency* ; Mortality ; Reoperation ; Rheumatic Heart Disease ; Thromboembolism

BACKGROUND: The current study was undertaken to investigate the results of a modification in the conventional Maze III Procedure devised by the authors. The aim of the technical modification was in improving the left atrial contractility. MATERIAL AND METHOD: Between July 1997 and December 1998, 34 patients with chronic atrial fibrillation for more than 1 year duration underwent a modified Maze III procedure. The assessment of the left atrial function was made by various echocardiographic measurements and SA nodal recovery was evaluated by HRV Holter monitoring. RESULT: All 34 patients were in sinus rhythm. On echocardiography, right atrial contraction was detected in 32 patients(94.1%) and left atrial contraction in 33 patients(97.1%). The echocardiographic A wave at 1, 6, and 12 months or more were 50.5+/-31.5, 62.1+/-25.1, 66+/-20.6 cm/sec, respectively, and the E wave measurements at the same time points were 152+/-31.1, 134.4+/-35.2, 133+/-27.5 cm/sec. The corresponding A/E ratios were 0.32+/-0.13, 0.48+/-0.18, 0.5+/-0.15, showing a rising trend. Treadmill evaluation at 6 months showed a mean 82% increase in heart rate after excising, and the SDNN and SDANN upon HRV Holter at 1 and 3 months postoperatively were 65.3+/-28.1/87.8+/-27.2 ms, and 60.0+/-24.1/83.4+/-25.7 ms, respectively, showing a predoinant autonomic recovery in the parasympathetic system(PSDNN = 0.01, PSDANN =0.015). CONCLUSION: The results of our data suggest that the current modification in the conventional Maze III Procedure was efective in enhancing the postoperative left atrial contractility.
Atrial Fibrillation ; Atrial Function, Left* ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Rate ; Humans

BACKGROUND: B-type natriuretic peptide (BNP) is a cardiac hormone that is primarily synthesized by the ventricular cardiac myocytes. Increased plasma BNP levels have been observed in patients suffering with congestive heart failure, ventricular hypertrophy and myocaridits and also during heart transplantation rejection. We investigated the serum BNP level as a predictive marker for rejection after heart transplantation. MATERIAL AND METHOD: To test the usefulness of measuring the BNP level in cardiac transplant patients, consecutive blood samplings for BNP, right ventricular endomyocardial biopsies, hemodynamic measurements and transthoracic echocardiogram were all done in 10 such patients between January 2004 and August 2005 at the Department of Thoracic and Cardiovascular Surgery in Asan Medical Center. Two groups were identified with using the median value: the low BNP group (n=28, BNP: < or =290 pg/mL) and the high BNP group (n=29, BNP: >290 pg/mL). We retrospectively analyzed rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy, the pulmonary capillary wedge pressure and the right atrial pressure between the 2 groups. RESULT: There were no differences in age, gender, rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy and the right atrial pressure between the 2 groups (p>0.05). However, a higher pulmonary capillary wedge pressure and a higher mean pulmonary atrial pressure were observed in the high BNP group (p<0.05). Further, BNP has linear correlation with the pulmonary capillary wedge pressure (r=0.590, p<0.001). Using the cut-off value of 620 pg/mL, the BNP predicted a high PCWP (>12 mmHg) with a sensitivity of 83.3% and a specificity of 91.1% (AUC: 0.900+/-0.045, p<0.001). CONCLUSION: The BNP level after heart transplantation does not show any significant correlation with rejection, yet it might be a predictive marker of ventricular diastolic dysfunction.
Atrial Pressure ; Biopsy ; Chungcheongnam-do ; Heart Failure ; Heart Transplantation* ; Heart* ; Hemodynamics ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Myocytes, Cardiac ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Wedge Pressure ; Retrospective Studies ; Sensitivity and Specificity ; Tricuspid Valve Insufficiency

BACKGROUND: Heart transplantation is still the best therapy for end-stage heart disease. However, the longterm outcome among different institutions vary. The current series is an assessment of the important factors which determine prognosis. METHODS: Between November of 1992 and September of 2000, 85 heart transplantations were performed at our institution. The standard technique was used in the first 57 patients (group I) where as in the latter 28 patients (group II), the Bicaval technique was utilized. The mean waiting time was approximately 4.7 months, and the causes in decreasing order were Dilated cardiomyopathy (n=69), Ischemic cardiomyopathy (n=10), Hypertrophic cardiomyopathy and others (n=6). The mean follow up was about 31 months. The immunosuppressive protocol comprised cyclosporin, Azathioprine (AZA), and prednisone. Later changes included induction with IL-2 receptor monoclonal antibody and changing AZA to mycophenolate mofetil. RESULTS: The mean donor ischemic time was 95.8 28.3 mins and the implantation time was 59.3 7.6 mins. There was a higher incidence of significant TR in group I along with a greater postoperative pacing requirement. There were 35 postoperative complications of which infectious events were most common (26). Of these, only 3 were early infections and the rest occurred late postoperatively. There were a total of 8 mortalities of which only one occurred early postoperatively and among the 7 late deaths, 3 were medically related and 4 were related to social factors. Only 5% of the patients had graft vascular disease. The overall 1YSR was 92% and the 5 YSR was 85%. CONCLUSIONS: The superior long term results of this current series was attributable to strong early immunosuppression, a homogenous population, and very low incidence of CMV infection.
Azathioprine ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cyclosporine ; Follow-Up Studies ; Heart Diseases ; Heart Transplantation* ; Heart* ; Humans ; Immunosuppression ; Incidence ; Mortality ; Postoperative Complications ; Prednisone ; Prognosis ; Receptors, Interleukin-2 ; Retrospective Studies* ; Tissue Donors ; Transplants ; Vascular Diseases

BACKGROUND: Arbekacin was introduced to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. It is an aminoglycoside with proven in vitro activity against MRSA strains. Pharmacokinetic advantages such as concentration-dependant bactericidal activity, prolonged post-antibiotic effect are its feature of aminoglycoside like others. But there are only few clinical data of this new kind of antibiotics outside of Japan, the first country approved its use against MRSA infections. We studied the clinical and bacteriological efficacy and safety of arbekacin in the treatment of infections caused by MRSA. METHODS: During the period between December 2001 and October 2002, we prospectively enrolled 21 patients with culture proven MRSA infection and evaluated the clinical and bacteriological efficacy and adverse events of arbekacin. Patients were treated with arbekacin sulphate 100 mg intravenously twice daily for 14 days. RESULTS: Patients were included if they had signs and symptoms of active MRSA infection including bacteremia, soft tissue infection, urinary tract infection, pneumonia etc. A total of 21 patients with MRSA infection were enrolled. Four patients experienced adverse events; 3 nephrotoxicities, 1 hepatotoxicity. One of them with elevated creatinine was unable to continue the study. Efficacy were evaluated on 19 patients with duration of arbekacin longer than 9 days. A favorable bacteriological response (eradicated or presumed eradicated) occurred in 13 (68.5%) patients. CONCLUSION: Although this clinical study was limited in number and in proper randomization, arbekacin alone was less effective than combination therapy with glycopeptides for the treatment of MRSA infection. However, our limited data suggested the efficacy of arbekacin alone for the treatment which needs shorter duration. The combination treatment of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycosides. The combination therapy of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycoside.
Aminoglycosides ; Anti-Bacterial Agents ; Bacteremia ; Creatinine ; Glycopeptides ; Humans ; Japan ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Pneumonia ; Prospective Studies ; Random Allocation ; Soft Tissue Infections ; Urinary Tract Infections

Heart transplantation is now regarded as the treatment of choice for end-stage heart failure. To improve long-term results of the heart transplantation, we analyzed causes of death relative to time after transplantation. A total of 201 consecutive patients, 154 (76.6%) males, aged > or = 17 yr underwent heart transplantation between November 1992 and December 2008. Mean ages of recipients and donors were 42.8 +/- 12.4 and 29.8 +/- 9.6 yr, respectively. The bicaval anastomosis technique was used since 1999. Mean follow up duration was 6.5 +/- 4.4 yr. Two patients (1%) died in-hospital due to sepsis caused by infection. Late death occurred in 39 patients (19.4%) with the most common cause being sepsis due to infection. The 1-, 5-, and 10-yr survival rates in these patients were 95.5% +/- 1.5%, 86.9% +/- 2.6%, and 73.5% +/- 4.1%, respectively. The surgical results of heart transplantation in adults were excellent, with late mortality due primarily to infection, malignancy, and rejection. Cardiac deaths related to cardiac allograft vasculopathy were very rare.
Adult ; Anastomosis, Surgical/methods ; Female ; Follow-Up Studies ; Graft Rejection/mortality ; Heart Transplantation/*mortality ; Humans ; Immunosuppression/methods ; Infection/mortality ; Male ; Middle Aged ; Neoplasms/mortality ; Postoperative Complications/mortality/surgery ; Survival Rate ; Transplantation/*mortality ; Treatment Outcome

BACKGROUND: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. MATERIAL AND METHOD: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). RESULT: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4+/-1.7 and 11.2+/-17.7 days, in the BITA group, respectively and 2.8+/-2.7 and 9.7+/-7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9+/-0.7 was slightly higher in the BITA group compared to the SITA group, which was 3.1+/-0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. CONCLUSION: The results of the current data did not show a significant difference in patency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.
Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Humans ; Length of Stay ; Mammary Arteries* ; Myocardial Infarction ; Myocardial Revascularization ; Postoperative Period ; Reoperation ; Retrospective Studies ; Skeleton* ; Surgical Procedures, Minimally Invasive ; Transplants*

BACKGROUND: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. METHODS: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4+/-43.6 months. RESULTS: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). CONCLUSION: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.
Adult* ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart Failure ; Heart Transplantation* ; Heart* ; Heart-Lung Transplantation ; Hemorrhage ; Humans ; Incidence ; Kidney Transplantation ; Korea ; Length of Stay ; Lymphocele ; Mortality ; Pericardial Effusion ; Postoperative Complications* ; Renal Insufficiency ; Stroke ; Transplants ; Wound Infection