Arginine Vasopressin Therapy of Vasodilatory Shock after Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: Vasodilatory shock has been implicated in life-threatening complications after open heart surgery, where the systemic inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). The secretion of arginine vasopressin (AVP) has been found to be defective in a variety of vasodilatory shock states and administration of AVP markedly improves vasomotor tone and blood pressure. So we reviewed our experience of AVP therapy in patients with vasodilatory shock following heart surgery using CPB. MATERIAL AND METHOD: From January 2004 to July 2006, we reviewed the records of patients who received AVP therapy for vasodilatory shock following heart surgery using CPB. Vasodilatory shock was defined as a mean arterial pressure lower (MAP) than 70 mmHg, a cardiac index greater than 2.5 L/min/m2, peripheral vascular resistance lower than 800 dyn/s/cm5, and vasopressor requirements. The hemodynamic responses of patients who received AVP therapy for vasodilatory shock after cardiac surgery were analyzed retrospectively. RESULT: One hundred ninety nine open cardiac surgery patients were consecutively included in this study. Twenty two patients (11.1%) met criteria for vasodilatory shock. Despite the administration of high dose catecholamine vasopressor, all patients were hypotensive with a mean arterial pressure less than 70 mmHg. AVP therapy increased MAP from 53.3+/-7.4 to 82.0+/-12.0 mmHg at 1 hour (p <0.001) and decreased other vasopressor requirements from 25+/-7 to 18+/-6 at 1 hour (p <0.001) and individually maintained it for 12 hours. CONCLUSION: Our date suggest that AVP may be a safe and an effective vasopressor in patients with vasodilatory shock. In patients exhibiting vasodilatory shock after heart surgery, replacement of AVP increases blood pressure and reduces catecholamine vasopressor requirements.

Acute Mesenteric Ischemia after Aortic Valve Replacement: A case report / 대한흉부외과학회지

Acute mesenteric ischemia after cardiac surgery is a serious complication associated with high mortality. Superior mesenteric artery is most commonly affected artery. Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. The keys to a successful outcome are early diagnosis and appropriate operative intervention. We successfully treated a patient with acute mesenteric ischemia after aortic valve replacement. Therefore, we report a case with a review of articles.

Rapid Left ventricular Training after Arterial Switch Operation in Transposition of Great Arteries with Left Ventricular Outflow Tract Obstruction and ventricular Septal Defect: 1 case report / 대한흉부외과학회지

There have been few reports documenting the outcome of arterial swich operations(ASO) in selected patients with transposition of great arteries(TGA) and with left ventricular outflow tract obstruction(LVOTO). In the case of TGA with LVOTO, if the atrial septal defect(ASD) is large and the ventricular septal defect(VSD) is restricive, this deprives the left ventricle(LV) of approporiate preload and could lead to underdevelopment of the ventircular mass and lead poor LV performance after the arterial switch operation, dspite a high pressure in the LV preoperatively. Because an increase in the systolic ventricular pressure is not necessarily paralleled by an increase in ventricular mass, which is also essential for optimal ventricular performance after the operation. We report here a case of rapid LV training after ASO in TGA with unprepared LV (because of large ASD and restrictive VSD) despite a high pressure in the LV(due to LVOTO) preoperatively.

Reconstruction of Injured or Inadquate Left Internal Thoracic Artery in Cornonary Artery bypass Graft / 대한흉부외과학회지

BACKGROUND: Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. MATERIAL AND METHOD: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). RESULT: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well. CONCLUSION: Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results.

The Successfully Redoaugmentation of Budd-Chiari Syndrome with Using Gore-Tex Patch of the IVC Obstruction / 대한흉부외과학회지

Budd-Chiari syndrome is a state of hepatic failure caused by impairment of blood flow anywhere from the inferior vena cava to the right atrium. In this case, a 45 year old patient had undergone membranotomy and dilatation with autogenous pericardial graft due to obstruction of the inferior vena cava caused by a congenital membrane in 1987. Ten years after the operation, restenosis occurred. Although a noninvasive method with a Gianturco stent dilatation was performed, a satisfactory result was not obtained. A reoperation was performed. The stenotic segment of inferior vena cava was excised and after augmentation with a prepared pentagon shaped Gore-Tex artificial graft allowing passage of two fingers. The patient's postoperative course was uneventful without signs of rebleeding or any other complications and the patient was discharged at postoperative two weeks without the use of anticoagulants. An excellent result was obtainable after operation using a prepared Gore-Tex graft and such a result. Reoperational case of Budd-Chiari syndrome may require rapid and excellent the operative techenic by prevention of massive bleeding under use of extracorporeal circulation.

Heterotopic Heart Transplantation in the Rat Model / 대한흉부외과학회지

In 1964, Abbott and Colleagues published the world's first heterotopic heart transplantation technique in the rat. Their method established circulation by end-to-end anastomoses of the graft's aorta and pulmonary artery to the recipient's abdominal aorta and Inferior Vena Cava (IVC), respectively. In 1966, Tomita et al altered Abbott's technique by employing end-to-side rather than end-to-end anastomoses, thus eliminating the hind leg paralysis that sometimes resulted from Abbott's technique. In order to prevent postsuture hemorrhage (since 7-0 silk suture was the finest available at that time), Tomita's aortic anastomosis was done with double up-and-down continuous suture technique. A single layer continuous anstomosis effected the pulmonary artery-IVC anastomosis. The availability of Nylon monofilament suture made it possible for Ono and Lindsey to use a single layer suture technique for the aortic end-to-side anastomosis in their modified rat heart transplantation. We observed survival time between control group and Immunosuppression (Cyclosporine administration, 10mg/Kgx4 times postoperatively) group after heterotopic heart transplantation in the rat model. The cyclosporine adminstration group survived longer than the control group, thus we concluded that cyclosporine was based on Immunosuppressive drugs.

Poland Syndrome: One Case Report / 대한흉부외과학회지

The chest wall deformity associated with Poland's syndrome is a very rare anomaly which consists of congenital unilateral absence of the sternal head of the pectoralis major muscle and various abnormalities of the upper extremity. Other clinical features associated with Poland's syndrome include deficiency or absence of the breast and nipple, deficiency of subcutaneous fat and axillary hair, and abnormalities of costal cartilages and anterior ends of ribs. The origin remains uncertain, but is considered not to be hereditary. Poland's syndrome may pose a serious psychologic and cosmetic problem, early recognition and surgical correction may prove beneficial. A 37 year old patient with Poland's syndrome was encountered and underwent satisfactory surgical correction.

Medistinal Teratoma with Pleural and Pericardial Effusion Teratoma with Pleural and Pericardial Effusion / 대한흉부외과학회지

Mediastinal teratoma is a tumor that thoracic surgeons made an operation much less commonly than other mediastinal masses and most of them are asymptomatic. But very rarely, this tumor invades the pleura and pericardium resulting in pleural effusion, pericardial effusion and cardiac tamponade in severe cases. The mechanism of invasion and perforation of the tumor is unknown and tumor-consisting tissue factor is suspected of a cause. In this case, we operated on a patient whose anterior mediastinal teratoma invaded and perforated pericardium and pleura resulting in pericardial effusion and pleural effusion. The patient was improved and discharged with no problem after resection of mass and involved pericardium.

Case Analysis of Pulmonary Sequestration / 대한흉부외과학회지

BACKGROUND: Pulmonary sequestration is not common and it's diagnosis needs special care such as an aortogram ar tomography. MATERIAL AND METHOD: We have experienced 13 patients who had pulmonary sequestration from January 1990 to September 1997. RESULT: Six men and seven women were treated and their mean age was 25.8+/-14.3 years. Their chief complaints were coughing, chest pain, and no symptoms in decreasing order. There were nine intralobar (ILS) and three extralobar (ELS) pulmonary sequestrations and one patient had both. There was no preference in location of either left or right. They were mainly diagnosed by aortography and their feeding arteries commonly originated from the lower thoracic aorta. The patients with ILS were treated by lobectomy and those with ELS by sequestrectomy. CONCLUSION: to treat pulmonary sequestration properhy, aortogram or chest CT is warranted to iidenty the abnormal origin of feeding artery.