Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

BACKGROUND: The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. METHODS: Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. RESULTS: The mean follow-up duration was 13.4±6.5 months in the s-VATS group and 28.7±3.9 months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups. CONCLUSION: No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP.
Drainage ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Medical Records ; Operative Time ; Pneumothorax* ; Recurrence ; Retrospective Studies ; Survival Rate ; Thoracic Surgery, Video-Assisted*

Significant differences exist between neonatal and adult airways. Anesthetic management of the airway may be challenging in neonate and young infant with large neck mass because these patients are at risk for sudden complete airway occlusion resulting in hypoventilation and hypoxemia. We experienced a 30-day-old baby presented with large cystic hygroma on the left side of neck. This mass was infiltrated in pharynx and large enough to disturb swallowing and breathing, and was not reduced despite of sclero-therapy. Therefore he was decided to get surgical removal. During the gaseous induction with sevoflurane, spontaneous respiration was maintained because difficulty was encountered with intubation. Intraoperatively, the endotracheal tube was dislodged unexpectedly because vigorous surgical traction. Postoperatively the baby was extubated 2 day after operation, and suffered from transient facial nerve palsy and continuous discharge from surgical wound. He was administered ICU for a long time.
Adult ; Anoxia ; Deglutition ; Facial Nerve ; Humans ; Hypoventilation ; Infant ; Infant, Newborn ; Intubation ; Lymphangioma, Cystic ; Methyl Ethers ; Neck ; Paralysis ; Pharynx ; Respiration ; Traction

BACKGROUND: Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. METHODS: We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. RESULTS: In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. CONCLUSION: We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.
Endocarditis ; Heart Valves ; Humans ; Incidence ; Mitral Valve* ; Suture Techniques* ; Sutures ; Tricuspid Valve

Ascending aortic injury after blunt chest trauma is an emergency condition that requires urgent diagnosis and treatment. The authors report the case of a patient with traumatic ascending aortic injury who received ascending aorta replacement under cardiopulmonary bypass after failure of primary repair.

Patients with traumatic aortic rupture rarely reach the hospital alive. Even among those who arrive at the hospital alive, traumatic aortic rupture after high-speed motor vehicle accidents leads to a high in-hospital mortality rate and is associated with other major injuries. Here, we report a rare case of descending midthoracic aortic rupture with blunt diaphragmatic rupture. Successful management with emergency laparotomy after an immediate endovascular procedure resulted in a favorable prognosis in this case.

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.
Aneurysm* ; Embolization, Therapeutic ; Emergencies ; Emergency Service, Hospital ; Endovascular Procedures ; Gyeongsangbuk-do ; Hemothorax ; Humans ; Mammary Arteries* ; Middle Aged ; Neurofibromatosis 1 ; Resuscitation ; Rupture ; Thoracic Surgery, Video-Assisted