Effects of a Proteasome Inhibitor on Cardiomyocytes in a Pressure-Overload Hypertrophy Rat Model: An Animal Study

BACKGROUND: The ubiquitin-proteasome system (UPS) is an important pathway of proteolysis in pathologic hypertrophic cardiomyocytes. We hypothesize that MG132, a proteasome inhibitor, might prevent hypertrophic cardiomyopathy (CMP) by blocking the UPS. Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and androgen receptor (AR) have been reported to be mediators of CMP and heart failure. This study drew upon pathophysiologic studies and the analysis of NF-κB and AR to assess the cardioprotective effects of MG132 in a left ventricular hypertrophy (LVH) rat model. METHODS: We constructed a transverse aortic constriction (TAC)-induced LVH rat model with 3 groups: sham (TAC-sham, n=10), control (TAC-cont, n=10), and MG132 administration (TAC-MG132, n=10). MG-132 (0.1 mg/kg) was injected for 4 weeks in the TAC-MG132 group. Pathophysiologic evaluations were performed and the expression of AR and NF-κB was measured in the left ventricle. RESULTS: Fibrosis was prevalent in the pathologic examination of the TAC-cont model, and it was reduced in the TAC-MG132 group, although not significantly. Less expression of AR, but not NF-κB, was found in the TAC-MG132 group than in the TAC-cont group (p<0.05). CONCLUSION: MG-132 was found to suppress AR in the TAC-CMP model by blocking the UPS, which reduced fibrosis. However, NF-κB expression levels were not related to UPS function.

The Role of Pharmacomechanical Endovascular Intervention for Iliofemoral Vein Thrombosis Compared to Conventional Anticoagulation Therapy

Although anticoagulation therapy is the primary treatment for deep vein thrombosis (DVT), it has not been associated with the rapid recanalization of the venous occlusion. Moreover, it is associated with long-term disability due to post-thrombotic syndrome (PTS). In contrast, pharmacomechanical endovascular intervention (PMI) results in more rapid clinical improvement in DVT patients, but there are few reports on its long-term outcomes. This retrospective study evaluated the clinical effectiveness of PMI compared to conventional anticoagulation therapy (ACA) for acute and subacute iliofemoral DVT. We reviewed the medical records of 102 patients with iliofemoral DVT. A total of 46 patients for ACA and 56 patients for PMI were enrolled. We analyzed the clinical differences between the PMI and ACA groups by comparing the clinical signs, residual DVT free-rate, and PTS-free rate. There were no statistically significant differences in the demographic characteristics and risk factors except age between the groups (age: ACA, 52.0 ± 18.0 years; PMI, 59.0 ± 17.0 years; P = 0.035). The 1-, 3-, and 5-year residual DVT-free rate (ACA = 84.7%, 71.6%, and 46.0%; PMI = 82.1%, 76.8%, and 76.8%, respectively; P = 0.235) was not significantly different. However, the 1-, 3-, and 5-year PTS-free rate was significantly different (ACA = 93.5%, 74.0%, and 55.7%; PMI = 92.9%, 90.0%, and 90.0%, respectively; P = 0.019). There was no significant difference in the rate of other complications. PMI showed a lower incidence of PTS during the follow-up period. Therefore, PMI should be considered as an effective therapeutic modality for patients with iliofemoral DVT.

Aortic Translocation for Complete Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonic Stenosis / 대한흉부외과학회지

The Rastelli operation has been a standard procedure for repairing complete transposition of the great arteries combined with a ventricular septal defect and pulmonary stenosis. Yet this procedure has several shortcomings, including the risk of incurring left ventricular outflow tract obstruction on long-term follow-up. In this regard, aortic translocation has recently been regarded as a potent alternative to Rastelli's operation. We report here on a case of complete transposition of the great arteries that was combined with an inlet-extended perimembranous ventricular septal defect and pulmonary stenosis in a 2-year-old boy. All the problems were successfully repaired using the aortic translocation technique. Postoperative echocardiography showed a straight and wide left ventricular outflow tract.

Surgery for Myocardial Bridging: A report of two cases / 대한흉부외과학회지

Most myocardial bridgings are found incidentally without symptoms, but myocardial bridging may induce symptoms such as angina, myocardial infarction, and ventricular arrythmia. In a patient who has symptoms despite of proper medication, stent insertion, supra-arterial myotomy or coronary artery bypass grafting have been applied without a definite guideline of treatment. We report two surgical cases of myocardial bridging with a review of the literature.

The Use of Greater Saphenous Vein In Situ Graft in Arterial Occlusive Disease of Lower Extremity / 대한흉부외과학회지

BACKGROUND: Distal anastomosis using artificial vascular graft is difficult when luminal size mismatch occurred owing to severe occlusion of popliteal artery and its branches. So we reconstructed blood flow to ischemic lower limb by using autologous greater saphenous vein in situ graft (GSVISG) as vascular graft material. MATERIAL AND METHOD: From July 2000 to July 2005, 26 patients treated using GSVISG. We analyzed clinical results retrospectively by chart review. RESULT: There was no in hospital or early postoperative death and 6 late deaths occurred during follow up period. Postoperative complications were 5 cases of early graft obstruction, 2 cases of wound dehiscence, 1 case of graft aneurysmal change, 1 case of seroma formation at inguinal wound and 1 case of graft injury during valvulotomy. Overall patency rate during follow up period was 69.3%. CONCLUSION: Greater saphenous vein in situ graft is acceptable vascular graft for arterial occlusive disease of lower extremity.

Case Report of Partial Endocardial Cushion Defect with Mild Pulmonary Hypertension in Old Age / 대한흉부외과학회지

The partial endocardial cushion defect including ostium primum atrial septal defect and anterior mitral leaflet cleft, presents less significant clinical symptoms than complete endocardial cushion defect. But, as mitral insufficiency develops, cardiomegaly, congestive heart failure, pulmonary arterial hypertension appear. So, partial endocardial cushion defect has poor prognosis and is rarely seen in elderly patients. A 67 years old woman admitted at our hospital for operative treatment with partial endocardial cushion defect. She had increased pulmonary pressure of 45/22 mmHg, mean 32 mmHg. She had repair of ostium primum defect with patch, and the mitral valve was treated with valve replacement. Because advanced atrioventricular block developed postoperatively, she received permanent pacemaker.

Case Report of Partial Endocardial Cushion Defect with Mild Pulmonary Hypertension in Old Age / 대한흉부외과학회지

The partial endocardial cushion defect including ostium primum atrial septal defect and anterior mitral leaflet cleft, presents less significant clinical symptoms than complete endocardial cushion defect. But, as mitral insufficiency develops, cardiomegaly, congestive heart failure, pulmonary arterial hypertension appear. So, partial endocardial cushion defect has poor prognosis and is rarely seen in elderly patients. A 67 years old woman admitted at our hospital for operative treatment with partial endocardial cushion defect. She had increased pulmonary pressure of 45/22 mmHg, mean 32 mmHg. She had repair of ostium primum defect with patch, and the mitral valve was treated with valve replacement. Because advanced atrioventricular block developed postoperatively, she received permanent pacemaker.

Clinical Analysis of Arteriovenous Fistula in Chronic Renal Failure Patients / 대한흉부외과학회지

BACKGROUND: Owing to the fact that the average life span has increased and the progress in medical science has been made, the number of patients with chronic renal failure (CRF) who have to take hemodialysis (HD) has been going up gradually. Accordingly, it is considered to be as a significant issue to obtain blood vessels which can be used repetitively and supply enough blood flows. Therefore, there have been various kinds of study on an inosculation rate andfactors influencing it following an arteriovenous fistula (AV fistula) and lots of studies are ongoing for the purpose of escalating the inosculation rate. The authors analyzed the effects of short-term result, age, sex, diabetes and hypertension on arteriovenous inosculations in 134 anatomical snuffbox operated subjects among the patients who have taken an AV fistula at this center. MATERIAL AND METHOD: Based on 134 patients who underwent an AV fistula at the department of thoracic surgery of this center from July, 2000 to May, 2004, the difference in arteriovenous inosculation rate was compared and analyzed depending on age (discriminated by 65-year-old), sex and the condition of the presence or absence of diabetes and hypertension. Correlation analyses were conducted for each parameter and statistical tests were performed by using SPSS for windows Release 11.0.1, which were determined to be statistically significant if p value was below 0.05. RESULT: The total number of operations was 169 including 35 of re-operations. The male/female rate was 70:64 (52%:48%). The average age was 56.3+/-12.26 years and there were 33 (24%) old aged patients above 65-year-old; there were 103 (71%) patients with hypertension and 90 (67%) patients with diabetes. Overall arteriovenous inosculation rate was 93+/-2.4%, 91+/-2.7%, 89+/-3.0% at 6, 12, 24 months, respectively. The arteriovenous inosculation rate of above 65-year-old patient group was 85+/-4.8%, 80+/-5.8%, 80+/-5.8% and below 64-year-old patient group's was 85+/-4.8%, 80+/-5.8%, 80+/-5.8% at given time points, respectively, which showed higher inosculation rate in below 64-year-old patient group with a statistical significance (p=0.0034). However, no statistical significance was found between the patients with hypertension and diabetes and the patients with no complication. In addition, there was no statistical significance in inosculation rate between male and female. CONCLUSION: The arteriovenous inosculation ratewas higher in the treated patient below 64-year-old than in the treated patient above 65-year-old. Thus it is advantageous for increase in long-term inosculation rate to obtain hemodialysis routes at an early age. The conditions of sex and the presence or absence of diabetes and hypertension do not make statistically significant effect on the arteriovenous inosculation rate.

Curved Axillary Thoracotomy in Patent Ductus Arteriosus / 대한흉부외과학회지

Muscle sparing thoracotomy is known as alternative of posterolateral thoracotomy because of less postoperative pain, preservation of muscle power and better cosmetic outcome. Curved axillary thoracotomy (CAT) is a type of muscle sparing thoracotomy. Between July 2003 and August 2004, 5 patients diagnosed as pure patent ductus arteriosus (PDA) treated by CAT and we reviewed results retrospectively by clinical record. The operative procedures were ligation of ductus in 4 cases and division of ductus in 1 case. There were no postoperative complication. Curved axillary thoracotomy is considerable alternative for surgical treatment of PDA with merits of muscle sparing effect and cosmetic benefit.

Clinical Analysis of the Early Result of Coronary Artery bypass Graft / 대한흉부외과학회지

BACKGROUND: Recently, coronary artery obstructive disease and coronary artery bypass graft surgery have increased, and the operative result has been improved. We reviewed 154 cases of coronary artery bypass graft surgery from Jan. 1985 to Jun. 2004. MATERIAL AND METHOD: We reviewed 148 patients, 154 cases of coronary artery bypass surgery from Jan. 1985 to Jun. 2004. This investigation is designed to illustrate the preoperative diagnosis, severity of disease, operative method, the kind of used bypass graft used, number of distal anasomosis, associated surgery, and postoperative morbidity and mortality. RESULT: There were 84 males, 64 females and the average age was 58.9+/-8.3 years old. Preoperative clinical diagnosis were unstable angina in 97 cases (63.0%), stable angina in 31 cases (20.1%), acute myocardial infarction in 12 cases (7.8%) and postinfartion angina in 14 cases (9.1%). Preoperative angiographic diagnosis were three-vessel disease in 68 (44.2%), two-vessel disease in 39 (25.3%), one-vessel disease in 35 (22.7%), and left main disease in 12 (7.8%) cases. There were 78 cases of on-pump coronary artery bypass graft surgery and 76 cases of off-pump coronary artery bypass graft surgery. The total distal anastomoses number was 319, mean number of anastomoses was 2.06+/-0.96. There were 10 concomitant procedures. Postoperative intra-aortic balloon pump was used in 21 (13.6%) cases, but only 4 cases were used at off-pump coronary artery bypass surgery. Total early mortality was 7.8%. The mortality was decreased as 4.5% from Jan. 2001 to Jun. 2004. Post operative complication was perioperative myocardial infarction in 9 cases (5.8%), low cardiac output syndrome in 17 cases (11%), and arrhythmia in 30 cases (19.5%) cases. CONCLUSION: Since 1985, The result of coronary artery bypass graft surgery has been improved because of more refined technique, use of off-pump coronary artery bypass surgery, use of internal thoracic artery and radial artery as bypass graft. We should study the long-term follow up more for better operative results.

Pulmonary Arteriovenous Fistula with Hemothorax: A case report / 대한흉부외과학회지

Pulmonary arteriovenous fistula is usually considered as a subset of congenital anomalies or acquired causes which can produce a variety of conditions such as dyspnea, cyanosis, and pulmonary vascular bruit. The diagnostic methods can be diverse such as arterial blood gas analysis (ABGA), chest X-ray, chest CT and pulmonary angiogram but the most accurate diagnostic modality is thought to be the pulmonary angiogram. The complications of this disease are a rupture that can cause hemothorax, brain abscess, and cardiovascular accident, and the treatment options are either segmental resection or therapeutic embolization. A twenty-six year old female developed sudden dyspnea and visited our emergency room. The patient was diagnosed as having pulmonary arteriovenous fistula (size; 4x4x3 cm) in the superior segment of the right lower lobe, evidenced by chest CT and pulmonary angiogram. Consequently, she underwent an emergency right lower lobectomy. We report this rare case of combined hemothorax that we have experienced, from diagnosis to treatment.

Clinical Analysis of Bronchogenic Cyst / 대한흉부외과학회지

BACKGROUND: Bronchogenic cyst is a rare and benign disease. Because of its complication or associated disease, Bronchogenic cyst requires surgical treatment. Recently, with the development of diagnostic methods, its incidence has increased. So we reviewed our results from the past 30 years. MATERIAL AND METHOD: We reviewed 27 cases surgically treated from March 1971 to March 2003. This investigation is designed to illustrate the peak age incidence, sex ratio, symptoms, anatomic location, radiologic imagings, associated diseases, operative methods, postoperative pathologic findings and postoperative complications. RESULT: The peak age incidence laid in the 1st to 3rd decade and the ratio of male and female was 1:1.5. The most common complaints were cough and dyspnea, but some had hemoptysis. There were 22 cases (81%) of Intrapulmonary bronchogenic cysts and 5 cases(19%) of mediastinal bronchogenic cysts. Thirteen cases (48.1%) showed cystic lesion in simple chest X-ray. Ten cases showed cystic lesion among 13 cases that had taken computed tomography. We found associated disease in 15cases (56%). The inflammatory diseases from infection were many in intrapulmonary bronchogenic cysts and especially, one case showed carcinosarcoma. Mitral regurgitation and Bronchial obstruction could be seen in mediastinal bronchogenic cysts. The 13 cases (48%) were managed by lobectomy, and cystectomy, pneumonectomy, and segemental resection were done in 7 cases (26%), 4 cases (15%), 3 cases (11%) respectively. Cystic contents were mucus in 9 cases, pus in 9 cases, blood in 2 cases, and carcinosarcoma in 1 case. Bronchotracheal communications were in 13 cases (48%). Five cases showed Postoperative complications, which were pneumothorax, empyema, bleeding. Postoperative death could not be found. CONCLUSION: Almost all patients had clinical symptoms. Severe complications could be associated with bronchogenic cysts. Recently, With the development of diagnostic methods, preoperatively accurate diagnosis is possible; therefore, invasive study has decreased. Bronchogenic cyst is a benign disease. However, because of its clinical symptoms, complications, and possibility of malignant change, immediate surgical treatment is needed.

The In-hospital Analysis of Outcome of Off-pump CABG and On-pump CABG / 대한흉부외과학회지

Background: With the developement of non-invasive surgical techeniques, coronary artery bypass graft without cardiopulmonary bypass has become popular. We compared the preoperative risk factors and in-hospital outcomes of patients having off-pump CABG with those having on-pump CABG. Material and Method: From January 2001 to June 2003, 87 patients underwent CABG. Thirty-six patients underwent on-pump CABG, fifty-one patinents underwent off-pump CABG. Preoperative risk factors, extent of coronary disease, operative time, postoperative endotracheal intubation time, duration of ICU stay & hospital stay, the amount of bleeding and postoperative levels of cardiac enzymes were compared in both groups. Result: There were no differences in their sex ratios, ages, preoperative risk factors, preoperative MI, Canadian classes, extent of coronary artery diseases and, echocardiographic ejection fraction between Off-pump CABG and On-pump CABG groups. Off-pump CABG group had significantly lower mean operative time (270+/-79.3 min vs 372+/-142.2 min, p<0.001), mean ventilation time (17.1+/-13.1 hr vs 24.3+/-17.8 hr) and CK-MB level (8.9+/-18.7 IU/L vs 25.7+/-8.4 IU/L) than on-pump CABG groups. On-pump CABG group had more distal grafts (2.2+/-0.5 vs 1.7+/-0.7) than Off-pump CABG groups did. There were no differences in their postoperative complications and outcomes including amount of postoperative bleeding for 24 hrs, reoperation for bleeding control, mean in-hospital days, postoperative infection, renal failure and neurologic complications between Off-pump CABG and On-pump CABG groups. Conclusion: This study showed that patients who underwent Off-pump CABG had less operation time & intubation time and lower CK-MB level; however, they also have less distal graft. Even though CABG without CPB provided satisfactory results, more clinical experience & longer follow-up is required.

Early Clinical Experience in Valve Replacement Using On-X Prosthetic Heart Valve / 대한흉부외과학회지

Background: The On-X valve was recently introduced. It was the aim of this study to assess the safety and feasibility from the data derived from 28 patients who underwent aortic and/or mitral valve replacement with this prosthesis in National Medical Center. Material and Method: From May 1999 and May 2003, a series of 28 consecutive patients who had been implanted with 32 On-X prosthesis were reviewed. The operative procedure comprised of 12 MVR, 10 AVR and 6 DVR. The study followed the guidelines of AATS/STS. Mean follow-up was 27 months (total 64 patient-years). Result: Early (

Pulmonary Artery Intimal Sarcoma with Lung Metastasis / 대한흉부외과학회지

Primary pulmonary artery sarcoma is very rare disease. The diagnosis of pulmonary artery sarcoma is frequently confused with pulmonary embolism because its clinical symptom and radiologic findings are similar with pulmonary embolism. It was often diagnosed at autopsy as it progresses rapidly. So Pulmonary artery sarcoma must be suspected if the origin of thrombus is not known and anticoagulation therapy is not effective. In this case, a 57 years old man who has been diagnosed pulmonary embolism was transferred to our department because of ineffective anticoagulant therapy and its worsening lesion despite of 5 month-therapy. In operative findings, it was pulmonary artery sarcoma that invaded to pericardium. There was angiosarcoma in right pulmonary artery, which metastasized to lung parenchyme. Under cardiopulmonary bypass, we resected main pulmonary artery and right lung. The Gore-tex graft was interposed between main pulmonary artery and left pulmonary artery. He was discharged after chemotherapy.

Evaluation of the Safety of Iatrogenic Intestinal Perforation during Placement of Percutaneous Drainage Catheter in Rabbit

PURPOSE: To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. MATERIALS AND METHODS: Eight 8-F straight catheters were percutaneously insertedinto the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed inall animals ten days after catheter placement, and gross and microscopic examination was carried out. RESULTS: Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. CONCLUSION: Although further study is warranted, ourstudy with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications.