Aortic Valve–Sparing Surgical Treatment of Supravalvar Aortic Stenosis in a 65-Year-Old Adult

Supravalvar aortic stenosis (SVAS) is a rare congenital cardiac disease that usually co-occurs with Williams syndrome. In the adult population, a few SVAS cases have been reported in patients affected by homozygous familial hypercholesterolemia. However, because of the rarity of this disease entity, there is no standard surgical treatment for SVAS. Here, we present a case of successful surgical treatment using an autologous excised aortic patch in a 65-year-old patient with SVAS.

Left Hemitruncus Treated Along with Ventricular Septal Defect in a Neonate

Hemitruncus arteriosus is a rare cardiovascular malformation in which one of the pulmonary arteries anomalously originates from the aorta. Left hemitruncus arteriosus, defined as the origination of the left pulmonary artery from the aorta, is less common than right hemitruncus arteriosus. In this study, we report the case of a neonate diagnosed with left hemitruncus arteriosus, ventricular septal defect, and atrial septal defect who underwent successful surgical treatment.

Aortic Reconstruction Using a Main Pulmonary Artery Flap in an Isolated Aortopulmonary Window / 대한흉부외과학회지

Aortopulmonary window (APW) is a rare cardiac anomaly that was reported to occur in only 43 cases over 33 years at a large-volume cardiac center. It can present as an isolated anomaly or in combination with another cardiac anomaly. The surgical technique for APW has evolved from simple ligation to separation of the 2 great arteries. However, because of the rarity of APW, there is no standard surgical treatment for this disease entity. Herein, we present successful aortic reconstruction using a main pulmonary artery flap after separation of the 2 great arteries in a neonate with isolated APW.

Aortic Reconstruction Using a Main Pulmonary Artery Flap in an Isolated Aortopulmonary Window

Aortopulmonary window (APW) is a rare cardiac anomaly that was reported to occur in only 43 cases over 33 years at a large-volume cardiac center. It can present as an isolated anomaly or in combination with another cardiac anomaly. The surgical technique for APW has evolved from simple ligation to separation of the 2 great arteries. However, because of the rarity of APW, there is no standard surgical treatment for this disease entity. Herein, we present successful aortic reconstruction using a main pulmonary artery flap after separation of the 2 great arteries in a neonate with isolated APW.

True Neurogenic Thoracic Outlet Syndrome Following Hyperabduction during Sleep: A Case Report

True neurogenic thoracic outlet syndrome (TOS) is an uncommon disease and is difficult to diagnose at the early stage and then completely cure. We experienced a case of true neurogenic TOS with typical clinical symptoms and electrophysiologic findings as a result of repetitive habitual sleep posture. A 31-year-old woman who had complained of progressive tingling sensation on the 4th and 5th fingers with shoulder pain was diagnosed of brachial plexopathy at the lower trunk level by electrodiagnostic studies. There was no other cause of brachial plexopathy except her habit of hyperabduction of shoulder during sleep. This case demonstrated that the habitual abnormal posture can be the only major cause of neurogenic TOS. It is of importance to consider TOS with the habitual cause because simple correction of the posture could stabilize or even reverse disease progress.

Ultrasound for Detecting Pleural Adhesion before Video-Assisted Thoracic Surgery / 대한흉부외과학회지

BACKGROUND: Video-Assisted Thoracic Surgery can be performed with the lung collapsed. During the procedure, pleural adhesion may result in lung injury, bleeding, and thoracotomy conversion. Identifying the presence of pleural adhesion before surgery can make it easy to plan trocar introduction and perform the procedure. MATERIAL AND METHOD: Between June 2009 and November 2009, we performed ultrasound in 24 patients to detect pleural adhesion before surgery and compared the results with the operative findings. We primarily examined the lateral chest, where the trocar would be inserted, and, occasionally, the anterior or posterior chest. RESULT: Patient diseases were: 6 hyperhidroses, 8 interstitial lung diseases, 5 lung cancers, 2 mediastinal tumors, 1 peripheral pulmonary embolism, 1 metastatic lung cancer, and 1 sarcoidosis. Of the 22 patients who did not have pleural adhesions on ultrasound, four revealed mild adhesions not related to the trocar insertion sites. However, ultrasound showed pleural adhesions in two patients, consistent with the operative findings. There was no air leak or thoracotomy conversion related with trocar insertion. CONCLUSION: Ultrasound requires only a few minutes to detect the presence of the pleural adhesion and was very useful in identifying the pleural adhesion before VATS.

Feasibility of Extracorporeal Life Support for Out-of-Hospital Cardiac Arrest Patients who are Unresponsive to Conventional Cardiopulmonary Resuscitation

PURPOSE: To determine the feasibility of using extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) patients who are unresponsive to conventional cardiopulmonary resuscitation (CPR) techniques. METHODS: This study was a case series of consecutive nontraumatic OHCA patients aged 18~75 years who received ECLS in the emergency department (ED) of a university teaching hospital. We analyzed outcomes, physiologic effects, and complications associated with ECLS. To compare outcomes of ECLS and conventional CPR, we selected a conventional CPR subgroup, those who were aged 18 to 75 years, who experienced cardiac arrest with pre-hospital CPR, who had no terminal illness, and who had CPR for more than 40 minutes. RESULTS: Of 14 attempts to initiate ECLS, 13 patients received ECLS and one patient failed catheterization. Nine patients achieved return of spontaneous circulation (ROSC) more than 20 minutes later; 4 of the 9? patients survived more than 24 hours; 2 patients were successfully weaned off ECLS; 1 patient was discharged alive without neurologic complications. Median (minimum-maximum) duration of CPR before ECLS (pre-hospital and in-hospital) was 84(41 to 167) minutes. Blood gas parameters obtained 3 hours after the start of ECLS were significantly improved compared with those obtained pre-ECLS. Four patients who arrested from acute myocardial infarction received intervention as during ECLS support to correct the causes of the arrest. Serious complications of ECLS causing mortality were catheterization failure, intracranial hemorrhage, and massive hemothorax. The ECLS group showed a higher ROSC rate than patients who received conventional CPR without ECLS (64.3% vs. 7.1%, p=0.002). CONCLUSION: ECLS in the ED is feasible for OHCA patients who are unresponsive to prolonged CPR. ECLS provides a bridge to evaluation and definitive care in refractory OHCA by improving early hemodynamic and physiologic status. Earlier application of ECLS and reduction of complications associated with ECLS may improve the survival of OHCA patients.

Experiences of Using Extracorporeal Life Support in Cardiac Arrest Unresponsive to Standard Cardiopulmonary Resuscitation

PURPOSE: Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We analyzed the cases of patients who received ECPR in our institute to find indicators for ECPR. METHODS: Patients who received ECPR in the emergency department of Korea University Ansan hospital from April 2006 to March 2007 were candidates for enrolment. Inclusion criteria were 1) a witnessed sudden cardiac arrest with correctable cause, 2) age <75 years, 3) cardiac arrest unresponsive to standard CPR, 4) absence of serious underlying disease such as advanced cancer, 5) impending arrest state due to respiratory failure or cardiogenic shock. Cardiac arrest related to trauma was excluded from the study. Tracked outcomes were hospital survival, improvement of Glasgow Coma Scale-motor respones, and return of spontaneous circulation. We analyzed the cause of arrest, arrest rhythm, time of administration of extracorporeal life support, and laboratory values. RESULTS: A total of seven patients received ECPR during one year. All patients achieved spontaneous circulation after ECPR and four patients showed improvement of GCS-motor response. Two patients were discharged alive. Their GCS and CPC were 15 points and 1 point, respectively. Intervention to correct underlying cause of arrest during ECPR, rapid start of ECPR during chest compression, and recovery of mean arterial pressure, heart rate, and urine output during ECPR all correlated with good outcomes. CONCLUSION: ECPR as a method of extended CPR improved the survival of cardiac arrest patients unresponsive to standard CPR.

Reconstruction of the Superior Vena Cava with Extra-luminal Bypass Shunt / 대한흉부외과학회지

We operated on a 41-year-old man using venous bypass shunt for superior vena cava (SVC) syndrome caused by mediastinal fibrosis. The patient had substantially high venous pressure and high risk of postoperative neurologic deficits. The collateral veins were deemed to be interrupted during the surgical reconstruction of SVC. Treatment included resection of the obstructed SVC and innominate vein and reconstruction with an autologous pericardial tube graft. During the operation, venous drainage from upper body was maintained with an extraluminal bypass shunt. The shunt was effective at prompt relief of venous hypertension, eliminating the time constraints, and preventing the postoperative complications.

Mid-term Outcomes of Side-to-Side Stapled Anastomosis in Cervical Esophagogastrostomy

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.

Mid-term Outcomes of Side-to-Side Stapled Anastomosis in Cervical Esophagogastrostomy

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.

Treatment of Mediastinal Growing Teratoma Syndrome: A case report / 대한흉부외과학회지

A 15-year-old male was admitted with right-sided chest pain and cough for one month. On chest computed tomographic scan, a 10 x 15 x 16 cm-sized huge mediastinal mass was occupied in the right hemithorax. Radiologically, it seemed that the tumor was severely adhesive on the heart and the superior vena cava. Therefore we decided on chemotherapy and radiotherapy first instead of surgery. The tumor marker was nearly normalized afterwards, but the tumor size was seemed to be bigger on chest tomographic scan. This suggests the growing teratoma syndrome. After the successful resection, he showed symptomatic improvement and is being followed up without any symptoms in an out patient department up to now.

The Comparison of Video Assisted Thoracic Surgery (VATS) with 10 mm Thoracoscopy to 2 mm Thoracoscopy for Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: The video-assisted thoracic surgery (VATS) with 2 mm thoracoscopy in primary spontaneous pneumothorax (PSP) was known to be unreliable in its accuracy and recurrence rate. We compared 10 mm VATS with 2 mm VATS in the results of operation. MATERIAL AND METHOD: From Sept. 1998 to Dec. 2002, 176 cases (10 mm VATS; 73 cases, 2 mm VATS; 103 cases) of PSP were treated by VATS bleb resection at Korea University Ansan Hospital. 10 mm thoracoscope, 5 mm port, and 5 mm instruments were used in 10 mm VATS group, and 2 mm thoracoscope, 2 mm ports and 2 mm instruments used in 2 mm VATS group. In the two groups, staples were inserted through 11.5 mm port for chest tube. RESULT: The mean follow-up duration was 20.8+/-16.1 months in 10 mm VATS group, and 13.9+/-8.2 months in 2 mm VATS. The most common indication of operation was a recurrent pneumothorax (34%) in 10 mm VATS and patient's desire (40%) in 2 mm VATS, respectively. The operation time, number of staples used in operation, postoperative chest tube keeping days, postoperative total amount of drainage, and postoperative hospitalization days were statistically lower in 2 mm VATS. Other significant variables affecting the operation time in linear regression analysis were the number of staples that used in operation, the presence of pleural adhesion, and type of pleurodesis and thoracoscope used in operation. However, R2 values were lower than 0.1. The postoperative recurrence rate was 2.7% in 10 mm VATS and 2.9% in 2 mm VATS. It was not significant statistically. Recurrent cases developed within 1 year in both groups but the difference was statistically insignificant. CONCLUSION: Although there were differences in follow-up duration between two groups, the operation time, number of staples that used in operation, postoperative chest tube keeping days, postoperative total amount of drainage, and postoperative hospitalization days were statistically lower in 2 mm VATS. And in 2 mm VATS, there were no technical difficulties during operation and no differences in recurrence rate from 10 mm VATS. As a result, we suggest that 2 mm VATS can be used in the treatment of PSP.

A Case of Extramedullary Plasmacytoma Arising from the Posterior Mediastinum

Plasmacytomas are a localized proliferation of plasma cells in the bone marrow, and are less frequently seen in extraosseous organs or tissues. Extramedullary plasmacytoma is a rare malignant neoplasm, and is especially uncommon when it arises from the mediastinum. Here, we report on a case of posterior mediastinal extramedullary plasmacytoma in a 64-year-old man. He was admitted with an asymptomatic right apical mediastinal mass, which was provisionally diagnosed as a neurogenic mass. However, a subsequent investigation revealed that this tumor was a rare case of IgG kappa type extramedullary plasmacytoma arising from the posterior mediastinum. The patient was treated with local radiation to the mediastinum and is doing well without further evidence of disease.

Curatively resected extragonadal germ cell tumor after chemotherapy / 대한내과학회지

No abstract available.

A New Experimental Model of Heterotopic Intrathoracic Heart Transplantation without Cardiopulmonary Bypass

BACKGROUND AND OBJECTIVES: A variety of experimental heterotopic heart transplantation models have been developed for the purpose of this study. However most were complicated and used extracorporeal circulation. A new and simple experimental working heterotopic intrathoracic heart transplantation model has been developed in dogs, which could be performed without support of extracorporeal circulation. MATERIALS AND METHODS: Six mongrel dogs were used for the three heterotopic heart transplantation experiments. The heterotopic hearts were transplanted in the right thoracic cavity using a right thoracotomy. The superior vena cava and left atrial cuff of the donor heart was anastomosed to the superior vena cava and left atrium of the recipient heart. Consequently, the aorta and pulmonary artery were anastomosed to the ascending aorta and right atrial appendage of the recipient heart, without cardiopulmonary bypass. The electrocardiograms of the donor and recipient hearts were measured by electrodes placed at the ventricular apexes and on the skin. RESULTS: The donor hearts survived for 10, 6 and 18 days after transplantation, without any immunosuppressive agents or anticoagulants. The electrocardiograms of both hearts could be measured using the electrodes. There were no wave or voltage changes on electrocardiography. CONCLUSION: This working heart model of heterotopic intrathoracic transplantation, without cardiopulmonary bypass, may be useful in studies for various purposes, i.e., the effects of different pharmacological agents on the conduction system of the denervated heart and the hemodynamic changes of the recipient with auxiliary support of the transplanted heart.

Intramural Hematoma of the Descending Thoracic Aorta Misdiagnosed as Aortic Rupture: A case report / 대한흉부외과학회지

The treatment modalities of the intramural hematoma (IMH) remain controversial. Nowadays, the IMH of the descending thoracic aorta is generally classified in the medical treatment category. We describe a patient with IMH of the descending thoracic aorta who received the medical treatment. During the follow-up, we speculated that the IMH had been aggravated leading to an aortic rupture including hemothorax. Therefore, we performed an emergency operation. Contrary to our expectations, operative findings showed a well-organized aortic wall and serous pleural effusion. The exact diagnosis was IMH of the descending thoracic aorta with penetrating atherosclerotic ulcer (PAU). This case reminded us of the importance of accurate diagnosis and proper treatment.

A Case of Tubular Esophageal Duplication Presenting with Hematemesis / 대한소화기내시경학회지

A 35-year old male developed epigastric pain and hematemesis one week before admission. Esophagogastroduodenoscopy was performed and a communication between the esophagus and another opening was discovered. On a follow-up CT and barium esophagogram, a tubular duplication was suspected and the patient was referred to the department of cardio-thoracic surgery. A pathological diagnosis of esophageal duplication (tubular type) was established. The patient was discharged and is currently being followed up. Esophageal duplication is a rare congenital malformation. Moreover, it has not heen reported in Korea that esophageal duplication presents with hematemesis.

Acute abdomial aortic obstruction mimcking spinal cord compression in a patient with non-small cell lung cancer / 대한내과학회지

No abstract available.

A Clinical Experience of Korean Artificial Heart(AnyHeart) / 대한흉부외과학회지

Korean artificial heart(AnyHeart) is a single-pieced and implantable bi-ventricular pulsatile pump adapting a moving actuator mechanism. The authors report a case of clinical application of AnyHeart as a life-saving device for the patients with end-stage heart disease combined with biventricular failure.