Leiomyosarcoma may occur anywhere in the body but rarely occurs in the heart or great vessels. Leiomyosarcoma may be managed by surgical resection with or without chemotherapy or radiotherapy. Owing to the high rate of metastasis and poor prognosis, a definitive treatment modality for leiomyosarcoma has not yet been suggested. This case study reports the surgical management of the recurrent leiomyosarcoma of the heart and the great vessels in a 63-year-old woman.
Drug Therapy ; Female ; Heart* ; Humans ; Leiomyosarcoma* ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Saphenous Vein

BACKGROUND: The adequate management of mild to moderate dilatation of the ascending aorta during cardiac operations remains controversial. In this study, we present the short-term outcomes of 90 patients undergoing ascending aortic wrapping with a Dacron graft during other cardiac operations. MATERIALS AND METHODS: From March 2008 to January 2011, 90 consecutive patients underwent treatment for ascending aortic aneurysm using the external wrapping technique during the concomitant procedure. The study group consisted of 49 male and 41 female patients with a mean age of 58.7+/-13 years. The primary cardiac surgical procedures were coronary artery bypass grafting (CABG) in 3, aortic valve replacement in 2, and aortic valvuloplasty in 85 patients (isolated in 62 and combined with CABG or mitral valvuloplasty in 23). The ascending aorta diameter was measured using a computed tomography scan within 4 weeks after surgery, and was compared with the preoperative value. RESULTS: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within a month after surgery from 46.4+/-4.3 mm to 33.0+/-3.5 mm (p<0.05). There was no early mortality or major surgical complication. During the mean follow-up period of 15.4+/-5.2 months, there was only one late death caused by septic multiorgan failure. CONCLUSION: Dacron wrapping of the ascending aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of moderately dilated ascending aorta in selected patients.
Aorta ; Aortic Aneurysm ; Aortic Valve ; Cardiac Surgical Procedures ; Coronary Artery Bypass ; Dilatation ; Female ; Follow-Up Studies ; Humans ; Male ; Polyethylene Terephthalates ; Thoracic Surgery ; Transplants

BACKGROUND: Reoperation of cardiac surgery via median sternotomy can be associated with significant complications. Thoracotomy is expected to reduce the risk of reoperation and to enhance the surgical outcomes. We retrospectively analyzed two operative approaches (thoracotomy vs. sternotomy) in cardiac reoperation. MATERIALS AND METHODS: From September 2007 to December 2010, 35 patients who required reoperation of the mitral valvular disease following previous median sternotomy were included. Average age of patients was 45.8+/-15.4 years (range, 14 to 76 years) and male-to-female was 23:12. Interval period between primary operation and reoperation was 135.8+/-105.6 months (range, 3.3 to 384.9 months). RESULTS: Comparative analysis was done dividing the patient group into two groups that are thoracotomy group (22 patients) and sternotomy group (13 patients). Thoracotomy group was significantly lower in operative time (415.2+/-90.3 vs. 497.5+/-148.0, p<0.05), bleeding control time (108.0+/-29.5 vs. 146.4+/-66.8, p<0.05) and chest tube drainage (287.5+/-211.5 mL vs. 557.3+/-365.5 mL, p<0.05) compared to sternotomy group. CONCLUSION: The thoracotomy approach is superior to sternotomy in some variables, and it is considered as a valid alternative to repeat median sternotomy in patients who underwent a previous median sternotomy.
Chest Tubes ; Drainage ; Hemorrhage ; Humans ; Operative Time ; Reoperation ; Retrospective Studies ; Sternotomy ; Thoracic Surgery ; Thoracotomy

Heart transplantation is a standard treatment for end-stage heart disease. Pediatric heart transplantation, however, is not frequently performed due to the shortage of pediatric heart donors. This is the first report of pediatric heart transplantation in Korea. Our retrospective study included 37 patients younger than 18 yr of age who underwent heart transplantation at Asan Medical Center between August 1997 and April 2009. Preoperative diagnosis was either cardiomyopathy (n = 29, 78.3%) or congenital heart disease (n = 8, 22.7%). Mean follow up period was 56.9 +/- 44.6 months. There were no early death, but 7 late deaths (7/37, 18.9%) due to rejection after 11, 15, 41 months (n = 3), infection after 5, 8, 10 months (n = 3), suspicious ventricular arrhythmia after 50 months (n = 1). There was no significant risk factor for survival. There were 25 rejections (25/37, 67.6%); less than grade II occurred in 17 patients (17/25, 68%) and more than grade II occurred in 8 patients (8/25, 32%). Actuarial 1, 5, and 10 yr survival was 88.6%, 76.8%, and 76.8%. Our midterm survival of pediatric heart transplantation showed excellent results. We hope this result could be an encouraging message to do more pediatric heart transplantation in Korean society.
Adolescent ; Arrhythmias, Cardiac/mortality ; Cardiomyopathies/surgery ; Child ; Child, Preschool ; Female ; Graft Rejection/mortality ; Heart Defects, Congenital/surgery ; *Heart Transplantation ; Humans ; Immunosuppression/methods ; Infant ; Infection/mortality ; Male ; Postoperative Complications ; Republic of Korea ; Retrospective Studies ; Tissue Donors ; Treatment Outcome

We herein present a case of a successful correction of cor triatriatum associated with thrombotic pulmonary hypertension diagnosed in an adult female patient. We confirmed diagnosis using transthoracic and transesophageal echocardiography in addition to cardiac computed tomography and magnetic resonance imaging. Surgical repair comprised excision of the fibromuscular membranous septum in the left atrium, patch closure of an atrial septal defect, and reconstruction of the pulmonary arteries with a vascular graft. Cor triatriatum complicated pulmonary thrombotic hypertension with atrial septal defect is amenable to surgical correction with satisfactory results.
Adult ; Cor Triatriatum ; Echocardiography, Transesophageal ; Female ; Heart Atria ; Heart Septal Defects, Atrial ; Humans ; Hypertension ; Hypertension, Pulmonary ; Magnetic Resonance Imaging ; Pulmonary Artery ; Thrombosis ; Transplants

BACKGROUND: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. MATERIAL AND METHODS: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age 54.4+/-15.1 years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of DLP(R) (Medtronic Inc, Minneapolis, MN) or RMI(R) (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system (EBS(R); Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of 2.4~3.0 L/min/m2 and an activated clotting time (ACT) of around 180 seconds. RESULTS: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. CONCLUSION: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.
Adoption ; Adult ; Anoxia ; Catheterization ; Catheters ; Emergencies ; Extracorporeal Membrane Oxygenation ; Female ; Glycosaminoglycans ; Hemorrhage ; Humans ; Male ; Membranes ; Oxygenators, Membrane ; Pneumonia ; Shock, Cardiogenic ; Tokyo ; Vital Signs ; Weaning

Coronary artery aneurysm is an uncommon disease. The optimal medical or surgical treatment for this disease remains obscure. The causes of coronary artery aneurysms include atherosclerosis, Kawasaki disease, infectious vascular disease, connective tissue disorder and congenital malformation. A 50 year old man visit our institution for chest pain that had started 3 days previously. After coronary angiography, multiple coronary aneurysms were diagnosed and successful surgical intervention was performed.
Aneurysm ; Angina, Unstable ; Atherosclerosis ; Chest Pain ; Connective Tissue ; Coronary Aneurysm ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Mucocutaneous Lymph Node Syndrome ; Vascular Diseases

We report here a case of streaky fat deposition in the middle layer of the left ventricular myocardium, without any underlying etiology, and this was seen on computed tomography coronary angiography. This report suggests that left ventricular middle layer fat deposition should be investigated in order to determine its etiology, the pathogenesis and the prognosis.
Adipose Tissue/*radiography ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Heart Ventricles/pathology/*radiography ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To evaluate the depiction rate and morphologic features of myocardial bridging (MB) of the left anterior descending coronary artery (LAD) using dual-source CT (DSCT). MATERIALS AND METHODS: CT scans from a total of 1,353 patients who underwent DSCT were reviewed retrospectively for LAD-MB. Seventy-eight patients were excluded due to poor image quality or poor enhancement of the coronary artery. The length and depth of the MB were analyzed and classified as superficial or deep with respect to the depth (< or = 1 or > 1 mm) of the LAD tunneled segment. Superficial MB was subdivided into complete or incomplete types according to full or partial encasement of the myocardium. RESULTS: Of the 1,275 patients included in this study, 557 cases of MB were found from 536 patients (42%). Superficial MB was observed in 368 of 557 (66%) cases, and deep MB was seen in 189 of 557 (34%) cases. Superficial MB showed 2 types: complete (128 of 368, 35%) and incomplete (240 of 368, 65%). The mean length of a tunneled segment for superficial MB was 16.4 +/- 8.6 mm. The mean length and depth of a tunneled segment for deep MB were 27.6 +/- 12.8 mm and 3.0 +/- 1.4 mm, respectively. The incidence of atherosclerotic plaques in a 2-cm-long segment proximal to MB was 16%. CONCLUSION: The depiction rate of LAD-MB using DSCT in a large series of patients was 42%, with two-thirds of MB segments being the superficial type.
Contrast Media/diagnostic use ; Coronary Angiography/*methods ; Electrocardiography ; Female ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Male ; Middle Aged ; Myocardial Bridging/*radiography ; Radiographic Image Interpretation, Computer-Assisted ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

BACKGROUND: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. MATERIAL AND METHOD: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed. The mean patient age was 53 years (range: 14~84). The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the AAR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. RESULT: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from 54.6+/-8.4 mm to 38.3+/-3.8 mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from 47.1+/-24.4 mmHg to 15.1+/-11.7 mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. CONCLUSION: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.
Aortic Aneurysm ; Aortic Valve ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Congenital Abnormalities ; Constriction, Pathologic ; Dilatation, Pathologic ; Endocarditis ; Follow-Up Studies ; Humans ; Perfusion ; Sinus of Valsalva