Development of Descending Thoracic Aortomyoplasty for Cardiac Bioassist / 대한흉부외과학회지

BACKGROUND: Thoracic aortomyoplasty is one of the surgical treatment for heart failure and has advantages over artificial heart or intraaortic balloon pumps. It uses autogenous skeletal muscles and solves problems such as energy source. However its use in clinical settings has been limited. This preliminary study was designed to develop surgical technique and to determine the effect of acute descending thoracic aortomyoplsty. MATERIAL AND METHOD: Thirteen adult Mongrel dogs were used. The left latissimus dorsi muscle was wrapped around the descending aorta under general anesthesis. Swan-Ganz and microtipped Millar catheter were used for the hemodynamics and endocaridial viability ratio. Data were collected with myostimulator on and off in normal hearts and the ischemic hearts. RESULT: In normal hearts, the mean aortic diastolic pressure increased from 72+/-15mmHg at baseline to 78+/-13mmHg with stimulator on. Coronary perfusion pressure increased from 61+/-11mmHg to 65+/-9mmHg. Diastolic time increased from 0.288+/-0.003 msec to 0.290+/-0.003msec. Systolic time decreased from 0.164+/-0.002msec to 0.160+/-0.002 msec. Endocardial viability ratio increased from 1.21+/-0.22 to 1.40+/-0.18. In ischemic hearts, mean aortic diastolic pressure incrased from 56+/-21mmHg at baseline to 61+/-15mmHg with stimulator on. Coronary perfusion pressure increased from 48+/-17mmHg to 52+/-15mmHg. Diastolic time increased from 0.290+/-0.003 msec to 0.313+/-0.004msec. Systolic time decreased from 0.180+/-0.002 msec to 0.177+/-0.003 msec. Endovascular viability ratio increased from 0.9+/-0.31 to 1.1+/-0.31. The limited number of cases ruled out the statistic significance. CONCLUSIONS: Descending thoracic aortomyoplasty is a simple operation designed to use patient's own skeletal muscles. It trends to increase diastolic augmentation and coronary perfusion pressure. Modification of surgical technique and stimulator protocol would maximize the effect to assist the heart.

Surgical analysis of pulmonary aspergilloma / 대한흉부외과학회지

BACKGROUND: Pulmonary aspergilloma is a potential life-threatening disease resulting from massive hemoptysis. Pulmonary aspergilloma has been treated surgically for many years, however, it has also had higher risk of mortality and complication rate. The purpose of this study is to analyze the operative methods and the types of complications. MATERIAL AND METHOD: Sixty patients who underwent surgical resection for pulmonary their medical reconrds. RESULT: The mean age was 46.3+/-13.4 years(range 20 to 76 years). The most common clinical presentation was hemoptysis which occurred in 48 patients(80%). Pulmonary tuberculosis was the most common pre-existing disease, occurri9ng in 28 patients(46.7%). The other associated lung diseases were bronchiectasis(n=11), silicosis(n=2), and chronic pnumonia(n=1). Operative proceudres wer lobectomy in 35 patients, pneumonectomy in 6, segmentectomy in 5, lobectomy and thoracoplasty in 3, segmentectomy and thoracopasty in 1, and cavernostomy in 10. The operative mortality was 6%(n=3) in lung resection patients but 0% in cavernostomy patients. The most common complications were prolonged air leakage, wound infection and postoperative bleeding. CONCLUSIONS: In most cases of pulmonary aspergilloma surgical resectin remains the only effective therapy. However, cavernostomy may be more effective for pulmonary aspergilloma patients with decreased pulmonary functions and for patients with high risk for lung resection.