BACKGROUND: There have been many reports of coronary angiographic findings aft er coronay bypass grafting,most of which are focused on the graft patency rate of the bypass conduits. However,postoperative angiography can provide numerous informations other than patency rates that are useful for establishing operative strategy. MATERIAL AND METHOD: We studied 73 patients in whom coronary angiography was done after more than 1 month of CABG.Mean interval from the operation to coronary angiography was 10.6 months and the reasons for coronary angiography follow up were residual or recurrent angina in 54 patients, abnormalities on myocardial perfusion scan or echocardiography in 13 patients,and for simple follow up in 6 patients. RESULT: Overall graft patency rate was 80.9% (internal thoracic artery 100%,saphenous vein 75.0%) in patients of simple follow up and 61.6% (internal thoracic artery 81.1%,saphenous vein 55.3%) in patients with ischemia. Progression of native coronary arterial disease proximal to the grafting site was found in 50 patients(68.5%). Among 201 coronary arterial branches that had not been completely occluded preoperatively, ninty five branches(47.3%)revealed progression of diameter stenosis by more than 20%on the follow up study. Among them,64 branches(31.8%)progressed to total occlusion.The incidence of disease progression was highter in the coronary arteries with patent grafts (57.5%)than in those with occluded grafts(36.3%)(p < 0.05). Comparing internal thoracic artery graft with saphenous vein graft, internal thoracic artery was superior to saphenous vein,not only in terms of patency(83.3% vs 56.6%), but also in terms of result of later percutaneous intervention success rate(100% vs 62%,p < 0.05). CONCLUSION: Due to the considerable incidence of progression of native coronary artery stenosis in the early postoperative periods, bypass grafting of a vessel with borderline stenosis,especially with vein graft,must be done prudently. And it was confirmed again that revascularization of left anterior descending artery is most important and that internal thoracic artery was superior to saphenous vein.
Angiography ; Arteries ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Disease Progression ; Echocardiography ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Mammary Arteries ; Perfusion ; Postoperative Period ; Saphenous Vein ; Thoracic Arteries ; Transplants ; Veins

Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

BACKGROUND: The prognosis after an aortic valve replacment can be affected significantly by the transprosthetic pressure gradient which is determined mainly by the size of the patients body and the prosthesis used. We analyzed the hemodynamic feature of two relatively new prosthese the ATS and the evensized Medtronic-Hall(M-H) valves by measuring the transprosthetic pressure gradient in the cases where small sizes (23mm or smaller) were used. MATERIAL AND METHOD: There were 94 patients who received whom aortic valve replacement with prosthesis smaller than 23 mm from October 1994 to June 1998. In these patients the transprosthetic pressure gradient clalculated from the pressure half time during postoperative Dopper echocardiographic examination was compared between the prostheses of different sizes. The body surface area of each patient was also taken into consideration. RESULT: The mean pressure gradient and body surface area in each group were 21.7+/-10.2 mmHg and 1.52+/-0.14m2 in ATS 19mm 11.4+/-6.5 mmHg and 1,57+/-0.20m2 in M-H 20mm 15.2+/-6.3 mmHg and 1.54+/-0.13m2 in ATS 21mm 9.3+/-2.5 mmHg and 1.63 +/-0.14m2 in M-H 22 mm and 12.9+/-5.3 mmHg and 1.69+/-0.13m2 in ATS 23mm. CONCLUSIONS: The 19mm ATS prosthesis showed significant trasprosthetic pressure gradient which is similar to the values previously reported with other bileaflet prosthesesm Close follow-up was needed in terms of exercise capacity and change in left ventiricular geometry. In patients with small aortic valve annulus the 20mm M-H valve is recomendable as an alternative to 19mm bileaflet valves because it has less pressure gradient with similar outer diameter.
Aortic Valve* ; Body Surface Area ; Echocardiography ; Follow-Up Studies ; Heart Valve Prosthesis ; Hemodynamics ; Humans ; Prognosis ; Prostheses and Implants*

BACKGROUND: The purpose of this study is to review the clinical course after the correction of noncomplicated ventricular septal defect and to analyze the morbidity and risk factors of postoperative complications and evaluate residual defect during the follow-up period. MATERIAL AND METHOD: From September 1994 to June 1998 24 patients(median age 10 months) underwent surgery under the diagnosis of ventricular septal defect. We made a retrospective review of the clinical records including the operation notes critical care unit records echocardiography results and the follow-up records. RESULT: There was no early mortality nd late mortality. There was no postoperative complete conduction block. Respiratory complication was the most common complication. The body weight age type of ventricular septal defect associated anomalies and operative procedure were not related to the incidence of complications. residual ventricular septal defects aortic valve regurgitation and tricuspid valve regurgitation were insignificant in postoperative hemodynamics, CONCLUSIONS: Correction of the noncomplicated ventricular septal defect was done without mortality and complete heart block. Aggressive preoperative medical treatment and early surgical treatment may decrease postoperative complications. Postoperative residual shunt and tricuspid regurgitation were not problematic during the follow-up.
Aortic Valve ; Body Weight ; Critical Care ; Diagnosis ; Echocardiography ; Follow-Up Studies ; Heart Block ; Heart Septal Defects, Ventricular* ; Hemodynamics ; Incidence ; Mortality ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Tricuspid Valve Insufficiency

BACKGROUND: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. MATERIAL AND METHOD: There were 330 males and 170 females with a mean age of 57.4+/-8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. RESULT: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2+/-1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25+/-23 months and there were 5 cases of reoperation. CONCLUSION: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Echocardiography ; Endarterectomy ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Gastroepiploic Artery ; Hematologic Tests ; Hemorrhage ; Hope ; Humans ; Hypertension ; Male ; Mammary Arteries ; Myocardial Infarction ; Radial Artery ; Reoperation ; Risk Factors ; Saphenous Vein ; Smoke ; Smoking ; Transplants

BACKGROUND: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. MATERIAL AND METHOD: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. RESULT: The proportion of the skin incision length to the sternal length was 63.1+/-3.9%(5.2~11cm, mean 7.3cm) in children, and 55.0+/-3.5%(10~13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. CONCLUSION: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.
Adult ; Aneurysm ; Cardiopulmonary Bypass ; Catheterization ; Child ; Cicatrix ; Heart Arrest, Induced ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Hematoma ; Hemorrhage ; Humans ; Manubrium ; Necrosis ; Skin* ; Sternotomy* ; Thoracic Surgery* ; Thorax ; Wound Infection

BACKGROUND: As the early outcome after coronary artery bypass grafting(CABG) has been stabilized, neurologic complication has now become one of the most important morbidity. The aim of this study was to find out the risk factors associated with the neurologic complications after CABG. MATERIAL AND METHOD: In 351 patients who underwent CABG, the incidence and features of neurologic complications, with associated perioperative risk factors, were retrospectively reviewed. Neurologic complication was defined as a new cerebral infarction confirmed by postoperative neurologic examination and radiologic studies, or delayed recovery of consciousness and orientation for more than 24 hours after the operation. RESULT: Neurologic complications occurred in 18 patients(5.1%), of these nine(2.6%) were diagnosed as having new cerebral infarctions(stroke). Stroke was manifested as motor paralysis in four patients, mental retardation or orientation abnormality in four, and brain death in one. Statistical analysis revealed the following variables as significant risk factors for neurologic complications by both univariate and multivariate analyses: cardiopulmonary bypass longer than 180 minutes, atheroma of the ascending aorta, carotid artery stenosis detected by Duplex sonography, and past history of cerebrovascular accident or transient ischemic attack. Age over 65 years, aortic calcification detected by simple X-ray, and intraoperative myocardial infarction were significant risk factors by univariate analysis only. Neither the severity of carotid artery stenosis nor technical modifications such as cannulation of the aortic arch or single clamp technique, which were expected to affect the inciden e of neurologic complications, had significant relationship with the incidence. CONCLUSION: This study confirmed the strong association between neurologic complications after CABG and atherosclerosis of the arterial system. Therefore, to minimize the incidence of neurologic complications, systematic evaluation focused on atheroscleroti.
Aorta ; Aorta, Thoracic ; Atherosclerosis ; Brain Death ; Cardiopulmonary Bypass ; Carotid Stenosis ; Catheterization ; Cerebral Infarction ; Consciousness ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Incidence ; Intellectual Disability ; Ischemic Attack, Transient ; Multivariate Analysis ; Myocardial Infarction ; Neurologic Examination ; Paralysis ; Plaque, Atherosclerotic ; Postoperative Complications ; Retrospective Studies ; Risk Factors* ; Stroke

Heart transplantation was planned for a 10-year old boy who had dilated cardiomyopathy with severe congestive heart failure and had been on dopamine for 1month. However, partial left ventriculectomy and mitral annuloplasty were performed instead, because there was no donor heart of the adequate size and the symptoms were aggravated. The clinical symptoms were markedly improved after the surgery. Comparing the postoperative echocardiographic results with the preoperative results, there were remarkable changes in the left ventricular ejection fraction(preoperative LV EF 17% to postoperative 3 months 29%, 6 months 35%, 1 year 36%) and the left ventricular end-diastolic dimension(preoperative 72 mm to postoperative 3 months 59 mm, 6 months 61 mm, 1 year 61 mm). Partial left ventriculectomy and mitral annuloplasty reduced the cardiac loading in the dilated cardiomyopathy. Partial left ventriculectomy and mitral annuloplasty may be considered as one of the alternative surgical metho s to carry over until a heart transplantation can be performed, especially for children.
Cardiomyopathy, Dilated* ; Child ; Dopamine ; Echocardiography ; Heart ; Heart Failure ; Heart Transplantation ; Humans ; Male ; Mitral Valve ; Mitral Valve Annuloplasty ; Tissue Donors

MATERIALS AND METHODS: Between 1984 to 1994, 136 patients underwent primary and isolated aortic valve replacement with 79 Carbomedics and 57 St. Jude prostheses. RESULTS: Age ranged from 16 to 67 year (mean : 44.5+/-12.7 years). Statistically significant differences in preoperative clinical characteristics between two groups were not found. There was one early death in the St. Jude group and none in the Carbomedics group. Early prosthetic valve-related complications including death were not significantly different between the two groups (p value= 0.572). One hundred thirty five early survivors were followed for a total of 354.2 patient-years (mean=31.5+/-16 months). In the CarboMedics group, actuarial survial rate at 5 years was 97.1+/-1.9%, and in the St. Jude group, it was 95.9+/-2.8%. In the CarboMedics group, actuarial free rate from all valve-related events at 5 years was 92.1+/-3.1%, and in St. Jude group, it was 89.8+/-5.0%. CONCLUSION: We conclude that early and late results after performing isolated aortic valve replacement with CarboMedics and St. Jude valve are not significantlly different.
Aortic Valve* ; Heart Valve Prosthesis ; Humans ; Prostheses and Implants* ; Survivors

We experienced a female patient with intramural hematoma of the aorta. This patient had a severe anterior chest pain radiating to interscapular area with choking sensation. CT revealed a intramural hematoma of the thoracic aorta and a part of the abdominal aorta but there was no evidence of intimal tearing. We did the emergency operation under hypothermic circulatory arrest and retrograde cerebral perfusion. Ascending aorta was replaced and coronary artery bypass graft was done because of intimal tearing of the ostium of right coronary artery. She was discharged without any significant complication. We reported this case with consideration about necessity of emergency operation for intramural hematoma of the thoracic aorta.
Airway Obstruction ; Aorta* ; Aorta, Abdominal ; Aorta, Thoracic ; Chest Pain ; Coronary Artery Bypass ; Coronary Vessels ; Emergencies ; Female ; Hematoma* ; Humans ; Perfusion ; Sensation ; Transplants