The Recent Outcomes after Repair of Tetralogy of Fallot Associated with Pulmonary Atresia and Major Aortopulmonary Collateral Arteries / 대한흉부외과학회지

BACKGROUND: Tetralogy of Fallot (TOF) with pulmonary atresia and major aortopulmonary collateral arteries (MAPCAs) is complex lesion with marked heterogeneity of pulmonary blood supply and arborization anomalies. Patients with TOF with PA and MAPCAs have traditionally required multiple staged unifocalization of pulmonary blood supply before undergoing complete repair. In this report, we describe recent change of strategy and the results in our institution. MATERIAL AND METHOD: We established surgical stratagies: early correction, central mediastinal approach, initial RV-PA conduit interposition, and aggressive intervention. Between July 1998 and August 2004, 23 patients were surgically treated at our institution. We divided them into 3 groups by initial operation method; group I: one stage total correction, group II: RV-PA conduit and unifocalization, group III: RV-PA conduit interposition only. RESULT: Mean ages at initial operation in each group were 13.9+/-16.0 months (group I), 10.4+/-15.6 months (group II), and 7.9+/-7.7 months (group III). True pulmonary arteries were not present in 1 patient and the pulmonary arteries were confluent in 22 patients. The balloon angioplasty was done in average 1.3 times (range: 1~6). There were 4 early deaths relating initial operation, and 1 late death due to incracranial hemorrhage after definitive repair. The operative mortalities of initial procedures in each group were 25.0% (1/4: group I), 20.0% (2/10: group II), and 12.2% (1/9: group III). The causes of operative mortality were hypoxia (2), low cardiac output (1) and sudden cardiac arrest (1). Definitive repair rates in each group were 75% (3/4) in group I, 20% (2/10, fenestration: 2) in group II, and 55.6% (5/9, fenestration: 1) in group III. CONCLUSION: In patients of TOF with PA and MAPCAs, RV-PA connection as a initial procedure could be performed with relatively low risk, and high rate of definitive repair can be obtained in the help of balloon pulmonary angioplasty. One stage RV-PA connection and unifocalization appeared to be successful in selected patients.

Endoventricular Circular Patch Plasty (Dor Procedure) for Ischemic Left Ventricular Dysfunction / 대한흉부외과학회지

Background: We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure concomitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141+/-64, 69+/-24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p<0.01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32+/-9% to 52+/-11% (p<0.01). The asynergy portion decreased from 57+/-12% to 22+/-9%, and LVEDV/LVESV indexes improved from 125+/-39 mL/m2, 85+/-30mL/m2 to 66+/-23 mL/m2, 32+/-16 mL/m2 (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase. Conclusion: After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.

Carcinoid tumor located in the parietal pleura / 대한흉부외과학회지

Pulmonary carcinoid tumors are thought to originate from neuroendocrine Kulchitsky's cells in the bronchial epithelium. The majority of typical carcinoid tumors are located centrally. However, atypical carcinoids are frequently situated peripherally and display malignant histologic features with aggressive behavior. Few reports are discribing carcinoid tumors originating from the pleura. We report a typical carcinoid tumor located mainly in the parietal pleura invading the chest wall without evidence of pulmonary parenchymal invasion.

Surgical Treatment of Complications after Fontan Operation / 대한흉부외과학회지

BACKGROUND: The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. MATERIAL AND METHOD: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8+/-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1. RESULT: There were 3 early and late deaths respectively. Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1). In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. CONCLUSION: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However,more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class,Although the results were not satisfactory enough in all patients.

The Role of Bone Scans in Routine Preoperative Evaluations of Non-Small Cell Lung Cancer Patients / 대한흉부외과학회지

BACKGROUND: The objective of this study was to assess the usefulness of bone scans in routine preoperative examinations of patients with newly diagnosed non-small cell lung carcinoma. MATERIAL AND METHOD: We reviewed the medical records of 258 patients who were newly diagnosed with non-small cell lung cancer in our hospital between January 2000 and December 2000. More than half of the patients (132) were deemed to be inoperable due to their advanced stage based on the CT scans. The remaining 126 patients were considered potentially operable. For these patients, clinical evaluation including the presence of bone pain, serum alkaline phosphatase, and calcium levels was used as clinical predictors of bone metastasis. All patients received bone scans. Bone X-rays, MRI or bone biopsy were performed to confirm the presence of bone metastasis. The usefulness of the bone scan was evaluated by comparing its power of predicting bone metastasis to that of the clinical information. RESULT: In all patients, the positive and negative predictive values of bone scans for the bone metastasis were 44%, and 99%, respectively. Those of the clinical information were 38% , and 94%. However, in potentially operable patients, the negative predictive value of the clinical information was as high as 99%. CONCLUSION: If newly diagnosed non-small cell lung cancer patients are presented as potentially operable on the basis of CT scan with no clinical evidence of distant metastases, curative resection could be considered without performing routine bone scans because of the low probability of bone metastasis. However, if there are positive clinical findings, further evaluations, including bone scan should be followed as metastasis will be documented in more than 30% of patients.