Postoperative Atrial Fibrillation after Isolated Coronary Artery Bypass Graft Surgery / 대한흉부외과학회지

BACKGROUND: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Although postoperative AF is regarded as benign, transient and self-limited, it has been associated with increased morbidity, thromboembolic events and an increased duration and cost of hospitalization. MATERIAL AND METHOD: From January 1994 to December 2007, 190 patients that had isolated CABG surgery were divided into two groups. Group 1 (n=139) involved those who had postoperative atrial fibrillation, and group 2 (n=51) did not have any such events. We reviewed the medical records retrospectively including the incidence of postoperative AF, patient characteristics, surgery related factors and the outcome of the patients with postoperative AF. RESULT: The frequency of postoperative AF was 26.8%, the conversion rate to regular sinus rhythm before discharge was 82.4%; 82.4% of the AF developed within the first three postoperative days. Although the postoperative AF group was significantly older and had a prolonged postoperative Intensive care unit (ICU) stay, there was no difference in the aortic crossclamp time or duration of hospitalization. No spontaneous defibrillation at declamping, and longer duration of cardiopulmonary bypass were significantly related to the development of postoperative AF. However, postoperative treatment with a beta blocker was associated with a decreased incidence of postoperative AF. The multivariate analysis showed that age and ICU stay were significantly associated with the development of POAF. Spontaneous defibrillation and postoperative beta blocker treatment were significantly associated with a decreased frequency of POAF. CONCLUSION: AF after CABG surgery is a common complication associated with increased morbidity and a longer ICU stay. Therefore, various strategies aimed at reducing AF, and its complications, such as postoperative treatment with a beta blocker should be considered.

Recurrent Paravalvular Leakage after Mitral Valve Replacement with Annular Reconstruction for Paravalvular Leakage Due to a Paravalvular Abscess: A case report / 대한흉부외과학회지

Paravalvular abscess is defined as infective necrosis of the mitral annulus and surrounding tissue that requires debridement of the necrotic tissue and patch reconstruction before valve implantation. Paravalvular abscess is associated with high operative mortality, postoperative complications, and recurrence. We report here a case of a 59-year old woman that had undergone mitral valvular replacement with a mechanical valve 13 years ago. The patient was determined to have paravalvular leakage due to paravalvular abscess as seen during follow-up. The patient underwent repeat mitral valvular replacement with annular reconstruction. However, the patient with mitral annular reconstruction and valvular replacement on the fifteenth postoperative day due to recurrence of paravalvular leakage. The patient is now receiving follow-up eight months after surgery.

Altered Expression of beta3 Integrin on Sclerotic Aortic Valves in a Hypercholesterolemic Rabbit Model / 대한흉부외과학회지

BACKGROUND: Although aortic valve sclerosis causes no significant hemodynamic alterations, it is associated with an increased risk of cardiovascular death and myocardial infarction. However, the role of beta3 integrin in aortic valve sclerosis remains unclear. MATERIAL AND METHOD: Twenty male New Zealand rabbits were divided into two groups. Group 1 rabbits (n=10) received a normal chow diet, while group 2 (n=10) rabbits received a diet containing 1% cholesterol for 12 weeks. After the rabbits were euthanized, their aortic valves and ascending aortas were excised for analysis. RESULT: Total serum cholesterol (2,148.3+/-1,012.5 mg/dL versus 53.7+/-31.8 mg/dL, p<0.05), triglyceride (240.4+/-218.3 mg/dL versus 31.6+/-6.4 mg/dL, p<0.05), and low density lipoprotein (LDL)-cholesterol (2,065.3+/-960.9 mg/dL versus 29.1+/-30.9 mg/dL, p<0.05) levels were significantly higher in the cholesterol diet group compared with the normal diet group. Myofibroblasts and macrophages were more highly expressed in the aortic valve leaflets of rabbits in the cholesterol diet group than of those in the normal diet group. A real-time polymerase chain reaction revealed decreased beta3 integrin mRNA levels in the hypercholesterolemic aortic valves and aortas. CONCLUSION: The present study shows that hypercholesterolemia induces aortic valve sclerosis. These findings suggest that alterations in beta3 integrin may play a role in the development of aortic valve sclerosis.

Intrapleural Chemotherapy with Cisplatin and Cytarabine in the Management of Malignant Pleural Effusion / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate the efficacy of intrapleural chemotherapy (IPC) with cisplatin and cytarabine in the management of malignant pleural effusion (MPE) from non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: A prospective analysis was carried out on 40 patients with pathologically proven MPE from NSCLC who had received IPC. A single dose of cisplatin 100 mg/m2 plus cytarabine 1200 mg/m2 in 250 ml normal saline was instilled into the pleural space via a chest tube and drained 4 hours later. Patients were evaluated for toxicities and responses at 1, 2, & 3 weeks and then at monthly intervals if possible. Systemic chemotherapy was administered, if the patient agreed to receive it, after achieving complete control (CC) of MPE. RESULTS: The median duration of chest tube insertion for drainage was 7 (3~32) days. Among the assessable 37 patients, CC and partial control (PC) were 32 (86.5%) and 4 (10.8%) patients, respectively (overall response rate 97.3%). The median duration of response was 12 months (2~23) and there were only two relapses of IPC after achieving CC. Among the 35 patients who were assessable until they died, 28 patients (80.0%) maintained CC until the last follow-up. There was only one toxic death and the toxicities of IPC, versus the results obtained, were deemed acceptable. CONCLUSION: The procedures were tolerable to the patients and chemotherapy-induced complications were at an acceptable level. The outcome of this trial indicates that IPC has a superior and long lasting treatment response in the management of patients with MPE from NSCLC.

Prognosis Factors of Tricuspid Regurgitation after the Operation for Left-sided Valvular Heart Disease / 대한흉부외과학회지

BACKGROUND: Tricuspid regurgitation has been considered as a secondary lesion when it is combined with left valvular heart diseases. However, there have been some reports which show that tricuspid regurgitation keeps going and results in congestive heart failure even after a successful operation for left valvular heart disease. So far, there are no definite operation indications and predictive factors for the tricuspid regurgitation which is resulted from the left sided valvular heart disease. We designed this study to evaluate the effects of pulmonary artery pressure and left ventricular ejection fraction on the prognosis of tricuspid regurgitation, and to make an operation indication for the patients with secondary tricuspid regurgitation. MATERIAL AND METHOD: We reviewed the medical records of patients who underwent surgery for the left sided valvular heart disease with tricuspid regurgitation and were followed for more than 1 year with echocardiograms. There was a total of 114 cases. We compared the grades of tricuspid regurgitations and pulmonary artery pressures and left ventricular ejection fractions on the basis of echocardiograms which were checked preoperatively and on the last follow up. RESULT: There were 43 cases of tricuspid annuloplasty. In these patients, the grades of tricuspid regurgitations were improved in 42 cases (97.7%). But in 71 cases without annuloplasty, 29 cases (41%) were improved, 32 cases (45%) had no change, and 10 cases (14%) were aggravated. This finding shows significant differences in the prognoses of tricuspid regurgitations between the two groups (p0.05). The improvements of tricuspid regurgitations are not statistically related to the changes of pulmonary artery pressures or left ventricular ejection fractions. CONCLUSION: This study shows that it is impossible to predict the prognoses of tricuspid regurgitations with preoperative pulmonary artery pressures or left ventricular ejection fractions. Also, the excellent results of tricuspid annuloplasty is proven in controlling the secondary tricuspid regurgitations. Therefore, when tricuspid regurgitation is detected preoperatively, the procedures to correct the tricuspid regurgitation at the time of the operation for the left-sided valvular heart disease must be considered positively, regardless of the grades of tricuspid regurgitations, to prevent significant tricuspid regurgitation that may develop later.

A Case of Cardiac Lymphoma Developed in Right Atrium / 대한흉부외과학회지

Primary cardiac lymphoma is an uncommon malignancy, accounting for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. However, secondary involvement of the heart is seen in 8.7-27.2% of the documented clinical cases of lymphoma. A 66-year-old man was referred to us for evaluation of dyspnea. A tumor mass was detected by transthoracic and transesophageal echocardiogram in the right atrium. The tumor was surgically resected. The pathologic diagnosis was a malignant lymphoma(diffuse large B cell type) had associated with intracavitary involvement of the right atrium. But acute mediastinitis was developed and then the patient was expired due to sepsis and bleeding at postoperative 9 days.

Congenital Cystic Adenomatoid Malformation Associated with Extralobar Pulmonary Sequestration: A case report / 대한흉부외과학회지

Congenital cystic adenomatoid malformation and Extralobar Pulmonary sequestration are very rare congenital anomalies. We experienced a 4 year-old female patient who had Congenital cystic adenomatoid malformation in her lower lobe of left lung. We accidently found extralobar pulmonary sequestration associated with Congenital cystic adenomatoid malformation at operation field. The resection of the left lower lobe and the extralobar pulmonary sequestration were performed. The arterial supply of the extralobar pulmonary sequestration was one anomalous artery arised from the thoracic aorta. The Venous drainage of expralobar pulmonary sequestration was intercostal vein into the azygous vein. The patient was discharged without any problem.

Congenital Giant Left Circumflex Artery-to-Left Ventricle Fistula Detected Using Two-Dimensional and Doppler Echocardiography

Coronary arteriovenous fistula is a rare congenital coronary artery anomaly in adults. Most such fistula drain into a right heart chamber or into the pulmonary artery. Congenital left coronary artery-left ventricle fistula is even more uncommon. Aortography and selective coronary angiography are still the diagnostic mode of choice. However, recent studies have demonstrated that two-dimensional echocardiography with or without Doppler color flow imaging is a useful noninvasive tool in the diagnosis of coronary artery fistula. A 29 year-old female who had an exertional dyspnea, chest pain, and continuous diastolic murmur was referred to our hospital for further evaluation. The transthoracic two-dimensional and color Doppler echocardiography revealed a dilated left coronary artery which was drained into left ventricle. The coronary angiography showed that the left circumflex artery was very dilated and tortuous, and contrast medium passed from the left circumflex artery into the left ventricular cavity via a fistula. However, the right coronary artery and the left anterior descending artery were normal. We reported a case of an echocardiographically documented fistula between the left circumflex coronary artery and the left ventricle in young woman.

A Case of Non-Hodgkin's Lymphoma with Massive Involvement of the Right Atrium

Primary cardiac lymphoma is an uncommon malignancy, accounting for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. But, secondary involvement of the heart is seen in 8.7-27.2% of the documented clinical cases of lymphoma. A 66-year-old man was referred to our ER for evaluation of dyspnea. We incidentally detected the huge intracavitary mass of the right atrium using transthoracic and transesophageal echocardiography. Emergently, the mass was surgically resected due to the possibility of sudden death because the mass was at the risk of obstruction of the right ventricular outflow tract. The mass was confirmed with malignant lymphoma (diffuse large B cell type). We report a case of intracavitary cardiac involved huge non-Hodgkin's lymphoma detected using transthoracic echocardiography in a patient complained of dyspnea.

A Case of Extensive Pulmonary Laceration Caused by Nonpenetrating Trauma

Extensive laceration of the lung itself has relatively little attention as a threat to life compared with other intrathoracic organ injuries. The incidence of pulmonary laceration extensive enough to require thoracotomy is rare, but is higher than expected. The diagnosis of extensive pulmonary laceration may be difficult, but this injury should be suspected with attention and early thoracotomy can be carried out in indicated cases. Recently, thoracoscopy has assumed a major role in the management of a variety of surgical diseases of the chest. We experienced a case of extensive pulmonary laceration caused by nonpenetrating trauma, which underwent lobectomy by thoracoscopic surgery. A 21-year-old man who was injured in a motocycle accident was brought to Emergency Room from the scene by an ambulance, and complained of chest pain and dyspnea. A chest roentgenogram showed a hemothorax and fractures of the posterior ends of the right seventh, eighth, and ninth ribs. A chest tube was inserted. Thirteen hundred ml of blood was drained through the chest tube during the next one hour. Emergency right mini-thoracotomy revealed extensive laceration of the lower lobe extending to the pulmonary hilum. The lower lobe was the most badly torn. A lower lobectomy was done by video-assisted thoracic surgery (VATS). He complained less postoperative pain and the postoperative course was uneventful.

A CASE OF BRONCHIAL RUPTURE CAUSED BY BLUNT TRAUMA

Traumatic rupture of the major airways may be caused by blunt or penetrating injury. The incidence of blunt trauma has risen dramatically in this century with the increase in modern high-velocity transportation. Clinical presentation of bronchial injuries in blunt trauma is varied, and the initial diagnostic evaluation is often misleading. The emphasis in management of these injuries is on early diagnosis and intervention. We experienced a case of bronchial rupture caused by blunt trauma. A 5-year-old male visited Emergency Room complaining of severe dyspnea and chest pain after traffic accident. Chest X-ray showed left tension pneumothorax. After emergent closed-thoracostomy, persistent air leakage and collapse of the left lung were noted. Chest CT revealed cut-off of left main bronchus and "dropped lung". Bronchoscopic examination confirmed the rupture of left main bronchus including proximal part of upper lobe bronchus. The patient underwent left upper lobectomy and bronchoplasty by using interrupted 4-0 Vicryl sutures. The postoperative course was uneventful.