Right Coronary Artery to Left Ventricular Fistula with a Giant Right Coronary Artery Aneurysm: A case report / 대한흉부외과학회지

A right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm is a very rare condition. This requires surgical treatment because of the possibility of rupture of aneurysm, heart failure and infective endocarditis. A 47 years old male patient with dyspnea on exertion for 3 months was diagnosed as having a right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm according to the CT and coronary artery angiography. We resected the aneurysm and performed a coronary artery bypass graft.

Unilateral Antegrade Selective Cerebral Perfusion in Aortic Surgery: Clinical Outcomes at Different Levels of Hypothermia

Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either or =24degrees C. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia ( or =24degrees C). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.

Mid-Term Follow Up of Patients Using The St. Jude Medical Aortic Connector System for Proximal Vein Graft in CABG

The aortic connector system may reduce stroke during proximal venous anastomosis. However, the overall anastomotic patency rate has been generally reported to be low. From October 2002 to March 2004, 68 patients who received proximal anastomosis using the St. Jude Aortic Connector System were included in the study. There were 47 men and 21 women and their mean age was 65.68+/-6.68 yr old (52 to 85 yr). Grafts were evaluated by coronary angiography or multi-slice 16 channel 3-D CT at 6 days and at 6 months postoperatively. In the immediate postoperative period, no stenosis was observed by either angiography (n=22) or 3D CT (n=46). At 6-month postoperatively, we performed either angiography (n=7) or 3-D CT (n=52). Of these patients, 5 patients showed graft stenosis in the midportion, and 3 in the ostium. There were no stroke. Simple, and effective proximal anastomosis with good protection from cerebrovascular accident was achieved especially when calcification or atheromatous plaque was observed at the ascending aorta in the operation room. However, our mid term patency results raise concerns related to venous graft stenosis in the midportion. Therefore, longer follow up is recommended.

Score System for Operative Risk Evaluation in Coronary Artery Bypass Surgery / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to assess a score system for operative risk evaluation of CABG. MATERIAL AND METHOD: From January 2001 to September 2005, retrospective study for various perioperative factors of 2993 cases was done. RESULT: The early operative mortality was 2.4% and the beta coefficients of 7 core variables related to it (preoperative LV dysfuction, preoperative renal failure, MI within 1 week, reoperation, combined surgery, preoperative atrial fibrillation, preoperative IABP) were adjusted to score system. ROC curve and Hosmer and Lemeshow goodness of fit test was done. CONCLUSION: This score system was effective in assessing operative risk of CABG. But It is necessary to gather larger volume of case and perform multicenter study.

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.

Surgical Management of Traumatic Cardiac Injury / 대한흉부외과학회지

BACKGROUND: Traumatic cardiac injury is very rare but mortality is very high when the diagnosis and management are delayed. We reviewed our case retrospectively. MATERIAL AND METHOD: From March 1995 to July 2003, 17 patients were diagnosed as having traumatic cardiac rupture. Five patients were stabbed, seven patients were motor vehicle accidents, four patients had fallen down, and the cause was unknown in one patient. Emergency operations were done and six patients were operated under CPB. RESULT: Four patients died during or after operation. The mean ICU stay period was 3.86+/-3.35 days and the mean hospital stay was 18.27+/-14.99 days. No mortality was observed in those whose vital signs were stable in the operating room. CONCLUSION: Preoperative vital status was very important and thoracic traumatic patient should be suspected as having cardiac injury.

Surgical Management of Primary Cardiac Tumor: Early and Late Results / 대한흉부외과학회지

BACKGROUND: Primary cardiac tumors are rare disease and they present nonspecific symptom. They are divided in benign and malignant tumors and require surgical therapy and/or additional therapy. MATERIAL AND METHOD: From March 1995 to March 2003, twenty one patients were diagnosed as having primary cardiac tumors. We analysed them retrospectively in terms of various perioperative factors and early and late results. RESULT: 6 men and 15 women and their average age was 45.44+/-18.76. Pathology revealed eighteen benign (fourteen myxoma, two fibroelastoma, one hemangioma and one paraganglioma) disease and three malignant (one angiosarcoma, one mesothelioma and one myxofibrosarcoma) disease. There was one (myxoma) operative mortality and three late death (hemangioma, angiosarcoma and mesothelioma) during additional therapy and follow up. CONCLUSION: Surgical treatment of primary cardiac tumor is important and sometimes additional therapy is required but the prognosis of malignant cardiac tumor is still very poor.

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.

Leiomyosarcoma of the Bronchus: A case report with long-term follow-up / 대한흉부외과학회지

Primary leiomyosarcomas are rare tumors of the lungs. No typical roentgenographic findings of unusual complex of symptoms distinguish this tumor. The most common therapy is surgical resection. Prognosis and significant survivorship are related to the size, grade, metastasis of the lesion. A 25-year-old female patient with chest pain and cough was admitted. In chest X-ray and CT scan, there was a pulmonary nodule in left upper lung field. She was taken a percutaneous needle aspiration biopsy. The result: was a spindle cell tumor. Left upper lobe lobectomy was done, and pathologic diagnosis was a low grade leiomyosarcoma arising from left bronchus. During 5 years of follow-up period, she has not shown any metastasis or local recurrence.

Anterior Transcervical Approach to Superior Sulcus Tumor / 대한흉부외과학회지

Superior sulcus or pancoast tumor refers to any primary lung cancer locating in thoracic inlet and causing pain in the periscapular region or arm. These originate in peripheral, and involve the extrapulmonary structures more than arenchyma of the lung. We experienced 1 case of superior sulcus tumor radically resected via anterior transcervical approach, which provided more safe exposure of cervical structures of thoracic inlet than classic posterolateral thoracotomy. Therefore we report this case with review of literature.

Papillary Fibroelastoma Causing Neurologic Symptoms in Patients with Valvular Heart Disease / 대한흉부외과학회지

A 43 years old female patient who had been diagnosed as having valvular heart disease but had not received any treatment invited and admitted due to progressive dyspnea. She was diagnosed as having aortic and mitral valve stenosis and regurgitation. Neurologic symptoms developed suddenly therefore, surgery was performed. In the operation field, there were many fungating tissue around the mitral valve annulus and left atrial wall. After operation, no neurologic symptoms were observed and pathologist revealed that fungating tissue was papillary fibroleastoma. The patient recovered and was followed in outpatients department.