No abstract available.
Arrhythmias, Cardiac* ; Humans ; Mitral Valve*

No abstract available.

No abstract available.
Thoracic Surgery*

BACKGROUND: The femoral artery is the most common site of cannulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. MATERIAL AND METHOD: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. RESULT: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorter in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263 min and 49 min, respectively; p<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2% in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. CONCLUSION: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection. It enabled us to approach the patients with aortic arch pathology more aggressively.
Aneurysm, Dissecting ; Aorta, Thoracic ; Axillary Artery* ; Cardiopulmonary Bypass ; Catheterization* ; Catheters ; Femoral Artery ; Humans ; Incidence ; Length of Stay ; Median Nerve ; Mortality ; Pathology ; Retrospective Studies

BACKGROUND: The aortic arch replacement in an acute aortic dissection is technically demanding procedure that has a lot of postoperative morbidity and high mortality. The authors have applied several techniques of aortic arch replacement to overcome the risks of the procedure. Therefore we analysed the results of these techniques. MATERIAL AND METHOD: From March of 1996 to July of 2002, we performed 31 cases of the aortic arch replacement in the Stanford type A acute aortic dissection. There were 12 male and 19 female patients with 59.6+/-9.4 years of mean age. Among them 18 cases were treated with the hemiarch replacement and 13 cases with the total arch replacement. We approached the aortic arch through median sternotomy in all but 3 cases of Clamshell incision and applied the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The associated procedures were 2 Bentall's procedures, an axillobifemoral bypass, a femorofemoral bypass and a carotid artery bypass. RESULT: The postoperative morbidities were 8 acute renal failures, 3 CNS complications, 2 low cardiac output syndromes, 2 malperfusion syndromes, and 2 deep wound infections. There were 4 cases of early hospital mortality which were from an acute renal failure, a postoperative bleeding, a low cardiac output syndrome, and a reperfusion syndrome. There were 3 cases of late hospital mortality which were from an acute renal failure, and 2 multiorgan failures. So the total mortality rate was 22.5%. There were 4 cases of late mortality after the discharge, which were form 2 cases of distal anastomotic rupture and 2 cases of intracranial hemorrhage. CONCLUSION: The hemiarch replacement has relatively shorter operative time and lower hospital mortality but higher late mortality than the total arch replacement. The total arch replacement needs more technically demanding procedure.
Acute Kidney Injury ; Aorta, Thoracic* ; Cardiac Output, Low ; Carotid Arteries ; Circulatory Arrest, Deep Hypothermia Induced ; Female ; Hemorrhage ; Hospital Mortality ; Humans ; Intracranial Hemorrhages ; Male ; Mortality ; Operative Time ; Perfusion ; Reperfusion ; Rupture ; Sternotomy ; Wound Infection

BACKGROUND: Cryoablation and radiofrequency ablation have been used to treat the atrial fibrillation. Some reports insisted that the microwave ablation is a better method for a deep and extensive lesion. MATERIAL AND METHOD: From December 2001 to July 2002, we performed 8 microwave ablations in patients who needed mitral valve surgery (7 MVR, 1 MVR+AVR). There were 3 men and 5 women, and their mean age was 43.4+/-8.3 years and mean follow up period was 5.6+/-2.4 months respectively. The microwave was applied on endocardium or epicardium by LynxR (Afx, inc.) using a power of 45 watts for 25 seconds. We studied the left atrial dimension, the left atrial function and the sinus conversion with echocardiography and electrocardiography at three times; 1) before the operation, 2) immediately after the operation, and 3) 6 months after the operation. RESULT: There was no complication and no mortality. The mean aortic clamping time was 104.6+/-25.0 minutes, and the mean total bypass time was 130.5+/-28.7 minutes. The rate of sinus conversion was 75%, A wave across the mitral valve was a mean of 77.0+/-24.8 cm/sec, and the A/E was a mean of 0.46+/-0.17 at 5.6 months postoperatively. CONCLUSION: There was no difference in the early result of microwave ablation compared to other methods. The microwave ablation was an acceptable method due to its convenient application especially in beating heart.
Atrial Fibrillation* ; Atrial Function, Left ; Catheter Ablation ; Constriction ; Cryosurgery ; Echocardiography ; Electrocardiography ; Endocardium ; Female ; Follow-Up Studies ; Heart ; Humans ; Male ; Microwaves* ; Mitral Valve ; Mortality ; Pericardium

BACKGROUND: The St. Jude Medical prosthesis is one of the popularly used artificial prosthesis, therefore the National Medical Center reports the long-term clinical results of patients who underwent prosthetic valve replacement with St. Jude medical valve for 18 years. MATERIAL AND METHOD: Between January, 1984 and June, 2002, a series of 163 consecutive patients who had implanted St. Jude prosthesis at the National Medical Center were reviewed. Mean age was 42.9+/-15.1 years and male to female ratio was 69:94. The operative procedure comprised of 87 MVR, 30 AVR, 45 DVR, and 1 TVR. The reoperative procedure comprised of 21 MVR, 2 AVR, and 14 DVR. Follow-up rate was 96.9%, and cumulative follow-up was 823.8 patient-years. RESULT: Early mortality rate was 7.9% (13 patients), late mortality rate was 8.7% (13 patients) and late mortality due to valve related complication was 4.7% (7 patients). Actual survival rate at 10 and 18 years were 91.7+/-2.1% and 91.0+/-1.9%. Linearized incidence was as follows: thromboembolism, 1.09%/ patient-year; anticoagulant related hemorrhage, 0.36%/patient-year; valve thrombosis, 0.24%/patient-year; paravalvular leakage, 0.12%/patient-year; and prosthetic bacterial endocarditis, 0.12%/patient-year. Linearized incidence of over all valve related complication was 1.94%/patient-year. Freedom from valve related complication at 10 and 18 years were 89.1+/-3.3% and 88.4+/-3.9%. Freedom from valve related death at 10 and 18 years were 95.1+/-1.2% and 95.1+/-1.0%. Valve related complication was related the age of patient, especially anticoagulant related hemorrhage was more common in patients over 60 years of age. Valve related complication, death were higher in DVR than AVR or MVR, and valve related death was higher in reoperation. There was no relationship between valve related complication or death and implant valve or size. CONCLUSION: The long-term clinical results of patients implanted with St. Jude Mechanical prosthesis was quite satisfactory with a low incidence of valve related complication and mortality.
Endocarditis, Bacterial ; Female ; Follow-Up Studies ; Freedom ; Heart Valve Prosthesis ; Hemorrhage ; Humans ; Incidence ; Male ; Mortality ; Prostheses and Implants ; Reoperation ; Surgical Procedures, Operative ; Survival Rate ; Thromboembolism ; Thrombosis

BACKGROUND: The detection of circulating microemboli by transcranial Doppler ultrasonography (TCD) has the potential to select the patients with high risk for future symptomatic brain embolism. We prospectively evaluated the positive rate and the frequency of microembolic signals (MES) before and after the heart valve surgery (HVS). MATERIAL AND METHOD: Fifty in-patients with heart valve disease were enrolled in this study. Patients with history of previous stroke or heart valve surgery were excluded. Two unilateral TCD monitoring sessions were performed from middle cerebral artery for 1-hour, before and after HVS. RESULT: Mechanical Heart valves were implanted in 28 patients, tissue valves were implanted in 10 patients, and remaining 12 patients received mitral valve repair. Positive rate of MES was significantly increased after HVS (50%), compared to that of before HVS (8%, p=0.00). There was no relation between MES after HVS and intensity of anticoagulation, cardiac rhythm, patients' age, and history of hypertension. The positive rate of MES after implantation of mechanical heart valve (71.4%) was significantly higher than those after implantation of tissue valve or mitral valve plasty (p=0.002). CONCLUSION: Positive rate of MES was increased significantly after the implantation of HVS. The changes of MES in those with mechanical prosthesis may be related to the increased risk of embolism after HVS.
Embolism ; Heart Valve Diseases ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Humans ; Hypertension ; Intracranial Embolism ; Middle Cerebral Artery ; Mitral Valve ; Prospective Studies ; Prostheses and Implants ; Stroke ; Ultrasonography, Doppler, Transcranial

BACKGROUND: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure, we routinely performed off-pump total arterial coronary revascularization. MATERIAL AND METHOD: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. RESULT: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibbon A or B patency grading. CONCLUSION: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.
Cardiomegaly ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Gastroepiploic Artery ; Hemodynamics ; Hemorrhage ; Humans ; Myocardial Infarction ; Transplants ; Veins

BACKGROUND: It has been known that internal thoracic artery grafting has a better patency rate compare to other graft conduits in coronary revascularization. Better patency rates can be expected in more coronary arteries with the use of bilateral internal thoracic artery. However, there were some debates on the complications after the use of bilateral internal thoracic artery. The purpose of our study was to reveal the results of bilateral internal thoracic artery. MATERIAL AND METHOD: The 26 coronary artery bypass operations with bilateral internal thoracic artery were performed from July 2001 to May 2002. We compared the results of 8 diabetic patients to those of 18 non-diabetic patients. We compared the results of BITA (bilateral internal thoracic artery) group to those of SITA (single internal thoracic artery) group that were 20 patients and performed during same period. RESULT: There was no mortality. There was one wound complication in the diabetic group and one in the non-diabetic group. There were no significant differences in operation time, duration of mechanical ventilation, amount of bleeding, infusing duration of cardiotonics, and complication between two groups. There were no significant differences in results between the BITA group and the SITA group. CONCLUSION: There were no significant differences in early results between the BITA group and the SITA group, and there were no significant differences in results between the diabetic group and the non-diabetic group. We think coronary artery bypass grafting with the use of bilateral internal thoracic artery is considered in diabetic patients.
Cardiotonic Agents ; Coronary Artery Bypass ; Coronary Vessels ; Hemorrhage ; Humans ; Mammary Arteries* ; Mortality ; Respiration, Artificial ; Transplants ; Wounds and Injuries