Multiple Pulmonary Benign Metastasizing Leiomyoma / 대한흉부외과학회지

We report here a case of pulmonary benign metastasizing leiomyoma from the uterus in a 45 year old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. The patient had undergone uterine myomectomy due to uterine leiomyoma 10 years earlier. We performed thoracoscopic wedge resection for definitive diagnosis. Histologically, spindle shaped smooth muscle cells appeared between collagen stroma, histology similar to that seen in uterine myoma. The tumor tissue tested positive for estrogen and progesterone receptors. The pathological findings were consistent with benign metastasizing leiomyoma. The patient was in pre-menopause. She received no specific treatment for lung tumors, and we did not found any changes in the lesions after one year follow up without any medication.

Behcet's Disease with the Left Carotid Artery Aneurysm and Colon Perforation / 대한흉부외과학회지

Behcet's disease is manifested as ulcers present in oral cavity, on external genital organ, orbital area, and skin. This disease could also cause other symptoms by invading the cardiovascular system, respiratory system, gastrointestinal system, central nervous system, and urogenital system. It is very rare for Behcet's disease to be accompanied by carotid artery aneurysm and intestinal perforation. We report a patient with Behcet's disease, who is diagnosed with symptoms and pathological findings as having carotid artery aneurysm and intestinal perforation at the same time. The patient underwent operation for the aneurysm and the intestinal perforation.

Early and Mid-term Results of Operation for Infective Endocarditis on Mitral Valve / 대한흉부외과학회지

BACKGROUND: Infective endocarditis shows higher operative morbidity and mortality rates than other cardiac diseases. The vast majority of studies on infective endocarditis have been made on aortic endocarditis, with little attention having been paid to infective endocarditis on the mitral valve. This study attempts to investigate the clinical aspects and operative results of infective endocarditis on the mitral valve. METERIAL AND METHOD: The subjects of this study consist of 23 patients who underwent operations for infective endocariditis on the mitral valve from June 1995 to May 2003. Among them, 2 patients suffered from prosthetic valvular endocarditis and the other 21 from native valvular endocarditis. The subjects were evenly distributed age-wise with an average age of 44.8+/-15.7 (11~66) years. Emergency operations were performed on seventeen patients (73.9%) due to large vegetation or instable hemodynamic status. In preoperative examinations, twelve patients exhibited congestive heart failure, four patients renal failure, two patients spleen and renal infarction, and two patients temporary neurological defects, while one patient had a brain abscess. Based on the NYHA functional classification, seven patients were determined to be at Grade II, 9 patients at Grade III, and 6 patients at Grade IV. Vegetations were detected in 20 patients while mitral regurgitation was dominant in 19 patients with 4 patients showing up as mitral stenosis dominant on the preoperative echocardiogram. Blood cultures for causative organisms were performed on all patients, and positive results were obtained from ten patients, with five cases of Streptococcus viridance, two cases of methicillin-sensitive Staphylococcus aureus, and one case each of Corynebacterium, Haemophillis, and Gernella. Operations were decided according to the AA/AHA guidelines (1988). The mean follow-up period was 27.6+/-23.3 (1~97) months. RESULT: Mitral valve replacements were performed on 13 patients, with mechanical valves being used on 9 patients and tissue valves on the other 4. Several kinds of mitral valve repair or mitral valvuloplasty were carried out on the remaining 10 patients. Associated procedures included six aortic valve replacements, two tricuspid annuloplasty, one modified Maze operation, and one direct closure of a ventricular septal defect. Postoperative complications included two cases of bleeding and one case each of mediastinitis, low cardiac output syndrome, and pneumonia. There were no cases of early deaths, or death within 30 days following the operation. No patient died in the hospital or experienced valve related complications. One patient, however, underwent mitral valvuloplasty 3 months after the operation. Another patient died from intra-cranial hemorrhage in the 31st month after the operation. Therefore, the valve-related death rate was 4.3%, and the valve-related complication rate 8.6% on mid-term follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, 3-, and 5-year survival rates were 100%, 88.8%, and 88.8%, respectively. CONCLUSION: The findings suggest that a complete removal of infected tissues is essential in the operative treatment of infectious endocarditis of the mitral valve. It is also suggested that when infected tissues are completely removed, neither type of material nor method of operation has a significant effect on the operation result. The postoperative results also suggest the need for a close follow-up observation of the patients suspected of having brain damage, which is caused by preoperative blood contamination or emboli from vegetation, for a possible cerebral vascular injury such as mycotic aneurysm.

Early Clinical Experience in Aortic Valve Replacement Using On-X(R) Prosthetic Heart Valve / 대한흉부외과학회지

BACKGROUND: Since the first implanted in September 1997, the use of On-X prosthetic heart valve has been increasing around in the world. This study was designed to assess the feasibility, safety, and the postoperative hemodynamics with this new valve in clinical setting. MATERIAL AND METHOD: The current study was carried out on 52 patients undergoing aortic valve replacement with this prosthesis between April 1999 to August 2002 at Chonnam National University Hospital to evaluate the surgical results. 52% of the patients were male and the average age at implant was 50+/-13 years. The study followed the guidelines of the AATS/STS. Preoperatively, 32 (61.5%) patients were in NYHA functional class III or IV and 2 patients had previous aortic valve surgery. Concomitant cardiac surgery was performed in 71.1%. The implanted valve sizes were 19 mm in 13 patients, 21 mm in 26, 23 mm in 10 and 25 mm in 3, respectively. Mean follow-up was 16.6+/-10.5 months (1~39 months). Echocardiographic assessment was performed pre- and immediate postoperatively, as well as 3, 6, 12 months after surgery, evaluating pressure loss and regression of left ventricular hypertrophy. RESULT: Mean cardiopulmonary bypass time was 191+/-94.7 minutes with an aortic cross-clamp time of 142+/-51.7 minutes. There was no early and late mortality. Freedom from adverse events at 1 year in the study were as follows: thromboembolism, 95.6+/-6%; bleeding events, 90.2+/-4%; paravalvular leakage 92.3+/-4%; and overall valve-related morbidity at 1 year was 76.6+/-3%. There were no cases of valve thrombosis, prosthetic valve endocarditis and structural or non-structural failure. Left ventricular function at 12 months after surgery (EF=62.7+/-9.8%) revealed a statistically significant improvement compared to preoperative investigation (EF=55.8+/-15.9%, p=0.006). Left ventricular mass index was 247.3+/-122.3 g/m2 on preoperative echocardiographic study, but regressed to 155.5+/-58.2 g/m2 at postoperative 1 year (p=0.002). Over the follow-up period a further decrease of peak transvalvular gradients was observed in all patients: 62.5+/-38.0 mmHg on preoperative assessment, 18.2+/-6.8 mmHg at immediate postoperative period (p<0.0001), 7.6+/-5.09 mmHg (p<0.0001) at 6 month, 18.0+/-10.8 mmHg (p<0.0001) at 1 year. CONCLUSION: The On-X prosthetic heart valve performs satisfactorily in the first 1 year period. Clinical outcome by examining NYHA functional classification revealed especially good results. Effective regression of left ventricular hypertrophy and statistically significant decrease of transvalvular gradient were observed over the first year, but longer-term follow-up of this patient group is needed to establish the expected rates for late valve-related events as well as the long-term clinical efficacy of this valve.