BACKGROUND: Elderly patients usually have comorbid and poor general conditions. They are more likely to have complex coronary lesions with cardiac dysfunction. Percutaneous coronary intervention (PCI) in octogenarians remains controversial. In this study, we determined the safety after PCI for octogenarians and their younger counterparts with coronary artery disease. METHODS: We reviewed 1,057 patients (110 octogenarians vs. 947 younger counterparts) who underwent PCI for coronary artery disease at Saint Carollo Hospital. We analyzed the baseline characteristics, angiographic findings, in hospital mortality, and post procedural complications between the two groups. RESULTS: The mean ages of octogenarians and younger counterparts were 83.1+/-4.5 years and 62.6+/-10.3 years, respectively. The octogenarian group had a significantly (p<0.001) higher ratio of female patients compared to their younger counterpart group (57.3% vs. 27.5%). However, the octogenarian group had a significantly (p=0.035) lower ratio of patients with history of diabetes mellitus compare to their younger counterpart group (22.7% vs. 32.6%). Incidence of acute myocardial infarction in octogenarians was significantly (p<0.001) higher than that in the younger counterparts (43.7% vs. 18.0%). There was no significant difference in admission duration, major complication, or in-hospital mortality between two groups. CONCLUSION: Our results revealed that hospital mortality and incidence of major complications in octogenarians who underwent invasive PCI were not higher than those in their younger counterparts, suggesting that PCI could be safely used in patients aged 80 years or older. However, long-term follow-up data are needed.
Aged ; Aged, 80 and over* ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Incidence ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Saints

BACKGROUND: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. MATERIAL AND METHOD: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was 20+/-6% according to transthoracic echocardiography. RESULT: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of 107+/-70 hours of running. The mean EF after discharge was 56+/-7% without dilated cardiomyopathy. CONCLUSION: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated ; Echocardiography ; Emergencies ; Heart ; Heart Transplantation ; Humans ; Myocarditis ; Prognosis ; Retrospective Studies ; Running ; Shock, Cardiogenic ; Stroke Volume ; Tokyo ; Transplants ; Ventricular Dysfunction, Left

A 61-year-old man presented with chest pain and ST elevation, and he underwent coronary angiography under the impression of acute myocardial infarction. Coronary intervention under intra-aortic balloon pumping was necessary due to his hemodynamic instability from the acute total occlusion of a large obtuse marginal branch. In spite of successful intervention, the cardiogenic shock persisted, and so extracoporeal membranous oxygenation was performed to treat this. Afterwards, the cardiogenic shock still persisted, and the auscultatory and echocardiographic findings revealed severe acute mitral valve regurgitation. Emergency mitral valve replacement was then performed. The ECMO and IABP were removed on the 2nd postoperative day. The patient was discharged on the 48th postoperative day.
Chest Pain ; Coronary Angiography ; Emergencies ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Humans ; Intra-Aortic Balloon Pumping ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Myocardial Infarction ; Oxygen ; Papillary Muscles ; Rupture ; Shock, Cardiogenic

As higher mortality rate and frequent incidence of morbidity, early surgical treatment is generally recommended for the multivalvular endocarditis. A 46-year-old female presented with high fever. Echocardiography showed the vegetation on pulmonic valve, tricuspid valve and mitral valve with a ventricular septal defect. Emergency operation was conducted due to uncontrolled infection. We present a clinical success of this rare case with review of the medical literature.
Echocardiography ; Emergencies ; Endocarditis ; Female ; Fever ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Middle Aged ; Mitral Valve ; Tricuspid Valve

We performed a hybrid procedure for a 58-year-old man with coronary artery disease and a left subclavian artery stenosis. He underwent left subclavian artery stenting and off-pump coronary artery bypass surgery, including grafting the in situ left internal mammary artery to the left anterior descending coronary artery. The post-operative coronary angiogram and computed tomography showed good patency of the graft and stent. He discharged at postoperative 8 days and he has been followed up for six month with an excellent clinical condition.
Chimera ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Mammary Arteries ; Middle Aged ; Stents ; Subclavian Artery ; Subclavian Steal Syndrome ; Transplants

BACKGROUND: The choice between a bioprosthetic and a mechanical valve is an important decision in cardiac valve surgery, and the durability of the tissue valve is a major decision factor. We retrospectively evaluated the midterm results of bioprosthetic valve replacement in the mitral position. MATERIAL AND METHOD: The subjects were all patients who had undergone mitral bioprosthesis replacement between July 1989 and August 2007. Among the 216 patients, there were 236 surgical cases. The mean age was 63+/-15 years, and the male to female ratio was 1:3. We retrospectively analyzed hospital and outpatient records such that the total follow-up duration amounted to 760.2 patient-years, and the mean follow-up duration was 41.9+/-40.7 months (range 0~212 months). RESULT: Early death occurred in 18 patients (8.3%), and 13 of these underwent concomitant cardiac procedures. The survival rate after 5 years was 79.9+/-3.5%, and the survival rate after 8 years was 65.5+/-5.5%, while freedom from structural valve deterioration (SVD) was 96.2+/-2.2% at 5 years and 85.9+/-5.3% at 8 years. Freedom from reoperation was 96.0+/-1.7% at 5 years and 90.4+/-4.2% at 8 years, while freedom from reoperation for SVD was 98.1+/-1.2% at 5 years and 92.3+/-4.1% at 8 years. On multivariate analysis of preoperative risk factors, small valve size (between 25 mm and 27 mm) was a significant risk factor for reoperation, and low LV ejection fraction (<40%) was a significant risk factor for SVD and mortality. CONCLUSION: Survival and freedom from reoperation for SVD in mitral bioprosthesis replacement had acceptable midterm results, but freedom from SVD was relatively low. In particular, since SVD increased sharply at the eighth postoperative year, frequent follow-up and echocardiograms around that time will be helpful for the early detection of SVD. It will be necessary to conduct further studies involving long-term follow-up and more patients.
Bioprosthesis ; Female ; Follow-Up Studies ; Freedom ; Heart Valves ; Humans ; Male ; Multivariate Analysis ; Outpatients ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUND: The interest in robotic cardiac surgery has recently grown but there has not been much clinical research reported on this. The aim of this study is to examine our initial experience, since August 2007, with robotic cardiac surgery using the da Vince(TM) surgical system and to evaluate the feasibility and safety of it. MATERIAL AND METHOD: Between August and December 2007, a total of 20 patients underwent robotic cardiac surgery using the da Vinci surgical system. For mitral valve repair (n=11), tricuspid valve repair (n=1), and ASD repair (n=1), cannulation, antegrade cardioplegia and transthoracic aortic cross-clamping were conducted for the right femoral vessels and the right internal jugular vein. For minimally invasive direct CABG (MIDCAB) (n=7), the internal thoracic artery (ITA) was harvested with the da Vinci surgical system. RESULT: The mean age of the patients was 50.1 (range: 26~78) years. Three concomitant Maze procedures and one tricuspid annuloplasty were combined with mitral valve repair. The mean cardiopulmonary bypass time was 208.0+/-61.3 minutes and the aortic cross clamp time was 158.8+/-40.6 minutes. No patients showed more than mild mitral regurgitation after repair and the median hospital stay was 4 days. The robotic-harvested ITA was used for either left ITA (n=6) or bilateral ITA (n=1). The mean harvest time was 43.2+/-12.0 minutes. The harvested ITA showed good flow and it was anastomosed under direct vision after left anterolateral thoracotomy. The patency of all the grafts was 100% (18/18) in MIDCAB. CONCLUSION: Robotic cardiac surgery using the da Vinci surgical system was variously adapted to areas such as mitral and tricuspid valve repair, ASD repair and ITA harvest for MIDCAB. The early results of the robotic cardiac surgery showed its safety and feasibility. With this primary report, we anticipate that clinical applications and further studies on robotic cardiac surgery using the da Vinci surgical system will be actively conducted in Korea.
Cardiopulmonary Bypass ; Catheterization ; Heart Arrest, Induced ; Humans ; Jugular Veins ; Korea ; Length of Stay ; Mammary Arteries ; Mitral Valve ; Mitral Valve Insufficiency ; Research Report ; Robotics ; Thoracic Surgery ; Thoracotomy ; Transplants ; Tricuspid Valve ; Vision, Ocular

BACKGROUND: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. MATERIAL AND METHOD: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echocardiograms to find potential preoperative risk factors. RESULT: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was 54.5+/-14.3 years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was 4.3+/-1.8 (range 1.1~8 cm) cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down to the mitral annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was 5.1+/-1.0 cm, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was 36.2+/-37.5 months, with recurrence reported in 2 (2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. CONCLUSION: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.
Diastole ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mitral Valve Stenosis ; Myxoma ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

BACKGROUND: Pulmonary endarterectomy is widely accepted as a treatment for chronic thromboembolic pulmonary hypertension. Based on our experiences, we sought to find ways to reduce perioperative complications and to improve surgical outcomes in patients undergoing pulmonary endarterectomy. MATERIAL AND METHOD: This study was designed as a retrospective analysis of 20 patients with pulmonary hypertension who underwent pulmonary endarterectomy between January 1998 and March 2008. All patients presented with chronic dyspnea. Deep vein thrombosis (DVT) was the major cause of chronic pulmonary thromboembolism (55%). Seventeen patients (85%) underwent inferior vena cava (IVC) filter placement. Thirteen patients underwent surgery under total circulatory arrest, while the others underwent surgery while on low flow cardiopulmonary bypass. Concomitant tricuspid annuloplasty was done in 6 patients (66%) whose tricuspid regurgitation was as severe as grade IV/IV. The mean follow-up duration was 45+/-32 months. RESULT: Using of University of California, San Diego (UCSD), thromboembolism classification, 4 patients (20%) were type I, 8 patients (40%) were type II, and 8 patients (40%) were type III. Right ventricular systolic pressure was reduced significantly from 77+/-29 mmHg to 37+/-19 mmHg after pulmonary endarterectomy (p<0.001). The degree of tricuspid regurgitation and the NYHA functional class were all improved postoperatively. Reperfusion edema occurred in 7 cases (35%). The incidence of reperfusion edema was higher in the UCSD type III group than in the other group (25% vs 50%, p=0.25) and the length of postoperative intensive care unit stay was longer in type III group (5+/-2 days vs 9+/-7 days, p=0.07). The early mortality rate was 10%, and the late mortality rate was 15% (n=3); one death was due to progression of underlying non-Hodgkin's lymphoma, and the other deaths were related to recurrent thromboembolism and persistent pulmonary hypertension, respectively. CONCLUSION: Pulmonary endarterectomy, as a curative surgical method for treating chronic thromboembolic pulmonary hypertension, should be performed aggressively in patients diagnosed with chronic thromboembolic pulmonary hypertension, and an effort should be made to reduce the frequency of perioperative complications and to improve surgical outcomes.
Blood Pressure ; California ; Cardiopulmonary Bypass ; Dyspnea ; Edema ; Endarterectomy ; Follow-Up Studies ; Humans ; Hypertension, Pulmonary ; Incidence ; Intensive Care Units ; Lymphoma, Non-Hodgkin ; Nitric Oxide ; Pulmonary Embolism ; Reperfusion ; Retrospective Studies ; Thromboembolism ; Tricuspid Valve Insufficiency ; Vena Cava, Inferior ; Venous Thrombosis

Minimally invasive cardiac surgery using AESOP (Automated Endoscope System for Optimal Positioning) offers certain advantages such as better a cosmetic outcome, a shortened post operative recovery time and a shorten hospital stay, and these advantages are not achieved by conventional cardiac surgery. We report here on our first robot-assisted (AESOP) left minithoracotomy surgery in a 26 year-old female with a subarteral ventricular septal defect, and this might have been treated by median sternotomy before the development of AESOP.
Cosmetics ; Endoscopes ; Female ; Heart Septal Defects, Ventricular ; Humans ; Length of Stay ; Robotics ; Sternotomy ; Thoracic Surgery