Postoperative Echocardiographic Hemodynamic Comparison between Recently Available Bileaflet Mechanical Valves / 대한흉부외과학회지

BACKGROUND: There was no difference between the bileaflet mechanical valves on the midterm and longterm clinical outcome. We reviewed the hemodynamic comparison between recently available mechanical valves by Doppler Echocardiography. MATERIAL AND METHOD: We retrospectively reviewed 396 postoperative hemodynamic datas (EOA, MDPG, and MSPG) by doppler echocardiography in 345 patients. Mechanical valves from 5 venders (Sorin Bicarbon, SJM, ATS, On-X, and Edward MIRA) were compared. There were 232 valves in mitral position, 162 in aortic, and 2 in tricuspid. RESULT: There were 178 men (mean age; 50.6+/-13.9 years old) and 167 women (52.6+/-14.6). MDPG/EOA of 27 mm in mitral position was Sorin; 4.2+/-1.5 mmHg/3.0+/-0.9 cm2, SJM; 2.3+/-1.2/3.5+/-0.6. In 29 mm, Sorin, SJM, ATS, On-X, MIRA revealed 3.4+/-1.2/3.1+/-0.6, 3.3+/-1.1/2.7+/-0.4, 3.8+/-0.8/3.2+/-0.6, 4.0+/-3.0/3.1+/-0.9, 2.9+/-0.9/3.0+/-0.8. In 31 mm, Sorin, SJM, ATS, MIRA revealed 3.9+/-1.9/2.9+/-0.6, 3.5+/-1.2/3.0+/-0.6, 3.4+/-0.8/2.8+/-0.2, 3.7+/-1.5/2.7+/-0.7. In 33 mm, Sorin, SJM, MIRA revealed 4.4+/-0.9/2.5+/-0.4, 3.4+/-1.5/3.3+/-0.5, 4.7+/-2.4/3.0+/-0.3. MSPG/EOA of 19 mm aortic position was Sorin, SJM, ATS, On-X, MIRA 18.0 mmHg/1.2 cm2, 25.6+/-8.7/1.1+/-0.3, 25.9+/-12.6/1.2+/-0.3, 23.0/1.3, 27.9+/-7.1/1.2+/-0.1 in that order. In 21 mm, SJM, ATS, On-X, MIRA revealed 18.3+/-6.7/1.5+/-0.5, 13.7+/-2.1/1.7+/-0.3, 17.0/1.4, 17.1+/-5.5/1.8+/-0.5. In 23 mm Sorin, SJM, ATS, On-X, MIRA revealed 14.0+/-4.6/1.7+/-0.6, 12.8+/-3.2/2.0+/-0.2, 16.8+/-12.2/2.1+/-0.9, 14.0/1.5, 15.0+/-5.5/1.8+/-0.5. In 25 mm, SJM and MIRA revealed 14.0+/-5.1/1.8+/-1.0, 11.0/2.3. There was no statistically significant difference in these values between the venders given the same position and size. 2 redo valve replacements were performed, 1 due to severe hemolysis in ATS and 1 due to leaflet immobilization in SJM. CONCLUSION: Postoperative hemodynamic comparison by doppler echocardiography shows no statistically significant difference between recently available mechanical valves in this country.

Effectiveness of MDCT for the Followup of CABG Patients with LIMA to LAD and Saphenous Veins to Others / 대한흉부외과학회지

BACKGROUND: There are several options for choosing a graft in CABG, we routinely chose LIMA for LAD and great saphenous vein for other target vessels. To evaluate the posoperative graft patency, we have studied the results using a 16 slices multi-detector computed tomography. MATERIAL NAD METHOD: From 1995 to 2003, 80 CABG patients who did not complain any event of MACE have been examined by 16-MDCT, mostly in an out patient clinic. RESULT: There were 61 men and 19 women. MDCT was used as early as 7 days to 9 years postoperatively with a median follow-up period of 6.5 years, and mean follow-up peiod of 31.5+/-25.4 months. Mean age was 58.4+/-12.6 years old in men and 61.5+/-17.2 years old in women. 72/80 patients received LIMA to LAD, and all other patients received vein grafts for bypass. The target vessel of vein grafts were 8 in LAD, 47 in RCA, 60 in diagonals, and 61 in obtuse marginals. Among them 42 sequential anastomoses were performed. The mean graft number was 3.1+/-1.8 grafts. 5 year graft patency rate of each grafts was as followings; 93.1% in LIMA to LAD, 94.9% in vein to diagonals, 92.1% in vein to obtuse marginals, and 79.2% in vein to RCA. Sequential grafting showed better graft patency than the isolated grafting (95.2% vs 78.7~95.0%). CONCLUSION: In this study, CABG with LIMA and saphenous veins showed satisfactory longterm results. 16-MDCT provided good images for follow-up study after CABG. Additionally, as radiologic tools (64-MDCT, MRI) improve more in the future, they can be used for diagnosing preoperative anatomical coronary disease as well as cardiac functions.

Primary Left Atrial Myxofibrosarcoma: A case report / 대한흉부외과학회지

Primary cardiac tumor has very low incidence, especially in cases of malignancy. A 29 year old male patient visited our cardiologic clinic for recent aggrevation of dyspnea on exertion and palpitation. Echocardiography showed a large tumor in the left atrium, which suggested the left atrial myxoma. Urgent open heart surgery was taken. The operative finding was fossa ovalis based a large tumor (35 x 90 x 50 mm) that invaded the posterior wall of LA and right superior pulmonary vein directly. The tumor was excised well by simple dissection, and the final pathologic report was malignant myxofibrosarcoma. His postoperative course was smooth and he was discharged in good health. Postoperative radiation and chemotherapy had taken with satisfactory clinical outcome.