Ethanol Extract of Chaenomeles sinensis Inhibits the Development of Benign Prostatic Hyperplasia by Exhibiting Anti-oxidant and Anti-inflammatory Effects

Chaenomeles sinensis is known to inhibit the development and progression of many age-related diseases, but the underlying molecular mechanisms are largely unclear. In the present study, we observed that the ethanol extract of Chaenomeles sinensis scavenged 2,2’-diphenylpicrylhydrazyl and 2,2’-azinobis diammonium radicals in vitro. The ethanol extract of Chaenomeles sinensisactivated antioxidant response element-luciferase activity and induced expression of NRF2 target genes in HaCaT cells. The ethanol extract of Chaenomeles sinensis also suppressed LPS-induced expression of COX-2 and iNOS proteins, and mRNA expression of TNF-α and IL-2 in RAW264.7 cells. Finally, the ethanol extract of Chaenomeles sinensis significantly suppressed testosterone propionate-induced benign prostatic hyperplasia in mice. Together, our study provides the evidence that the ethanol extract of Chaenomeles sinensis inhibits the development of benign prostatic hyperplasia by exhibiting anti-oxidant and anti-inflammatory effects.

Is Hypertrophic or Keloid Wound Scar a Risk Factor for Stricture at Esophagogastric Anastomosis Site after Esophageal Cancer Operation? / 대한소화기학회지

Background/Aims@#Anastomotic stricture at the esophagus and the conduit anastomosis site after the surgical resection of esophageal cancer is relatively common. This study examined whether a hypertrophic scar or keloid formation at a surgical wound is related to an anastomotic stricture. @*Methods@#From March 2007 to July 2017, 59 patients underwent curative surgery for esophageal cancer. In 38 patients, end-to-end anastomosis (EEA) of the esophagus and the conduit was performed using EEA 25 mm. A hypertrophic wound scar was defined when the width of the midline laparotomy wound scar exceeded 2 mm. The relationship between the hypertrophic scar and stricture and the other risk factors for anastomotic stricture in these 38 patients was analyzed. @*Results@#Of the 38 patients, eight patients (21.1%) had an anastomotic stricture, and a hypertrophic skin scar was observed in 14 patients (36.8%). Univariate analysis revealed lower BMI and hypertrophic scars as risk factors (p=0.032, p=0.001 respectively).Multivariate analysis revealed a hypertrophic scar as an independent risk factor for an anastomotic stricture (p=0.010, OR=27.06, 95% CI 2.19-334.40). @*Conclusions@#Hypertrophic wound scars can be a risk factor for anastomotic stricture after surgery for esophageal cancer. An earlier prediction of anastomotic stricture by detecting hypertrophic wound healing in patients undergoing esophagectomy may improve the patients’ quality of life and surgical outcomes by earlier treatments.

Effects of Genetic and Pharmacologic Inhibition of COX-2 on Colitis-associated Carcinogenesis in Mice

COX-2 has been inappropriately overexpressed in various human malignancies, and is considered as one of the representative targetsfor the chemoprevention of inflammation-associated cancer. In order to assess the role of COX-2 in colitis-induced carcinogenesis,the selective COX-2 inhibitor celecoxib and COX-2 null mice were exploited in an azoxymethane (AOM)-initiated and dextransulfate sodium (DSS)-promoted murine colon carcinogenesis model. The administration of 2% DSS in drinking water for 1 week aftera single intraperitoneal injection of AOM produced colorectal adenomas in 83% of mice, whereas only 27% of mice given AOM alonedeveloped tumors. Oral administration of celecoxib significantly lowered the incidence as well as the multiplicity of colon tumors. Theexpression of COX-2 and inducible nitric oxide synthase (iNOS) was upregulated in the colon tissues of mice treated with AOM andDSS, and this was inhibited by celecoxib administration. Likewise, celecoxib treatment abrogated the DNA binding of NF-κB, a keytranscription factor responsible for regulating expression of aforementioned pro-inflammatory enzymes, which was associated withsuppression of IκBα degradation. In the COX-2 null (COX-2–/–) mice, there was about 30% reduction in the incidence of colon tumors,and the tumor multiplicity was also markedly reduced (7.7 ± 2.5 vs. 2.43 ± 1.4, P< 0.01). As both pharmacologic inhibition andgenetic ablation of COX-2 gene could not completely suppress colon tumor formation following treatment with AOM and DSS, it isspeculated that other pro-inflammatory mediators, including COX-1 and iNOS, should be additionally targeted to prevent inflammation-associated colon carcinogenesis.

Physical Activity Patterns and Their Associated Factors Measured by Global Physical Activity Questionnaire Survey among Korean / 대한스포츠의학회지

Research on physical activity and health is actively being conducted. In the Korea National Health and Nutrition Examination Survey (KNHANES), the Global Physical Activity Questionnaire (GPAQ) was newly introduced in 2014. The purpose of this study was to investigate the levels of physical activity and related factors in Koreans who were assessed through the GPAQ by dividing the physical activity by occupation, leisure, and transport domain. This study used data from the KNHANES (2014–2016), the study population of which included 17,357 participants aged 12 to 80 years. We compared the differences in physical activity by sociodemographic factors, health-related factors, and psychological health-related factors. Moreover, we also compared the mean metabolic equivalent of task and daily sitting time according to physical activity domain by sex and age group. Finally, we investigated the sociodemographic factors, health-related factors, and psychological health-related factors that significantly affect the average physical activity per week. The various factors were found to differ in the frequency of physical activity levels. In addition, there was a difference in the amount of physical activity per occupation, leisure, and transport domain in each age group. Finally, age, sex, high-density lipoprotein cholesterol levels, arthritis, allergic rhinitis and sinusitis, sleeping time, and perceived health status significantly affected physical activity. The levels of physical activity significantly differed by sociodemographic factors, health-related factors, and psychological health-related factors. There was also a difference in the physical activity levels according to the age and sex per each domain of physical activity.

Impact of Weight Change on Decline of Cognitive Function Among Korean Adults

BACKGROUND@#In South Korea, as an aged society, an understanding of dementia and its risk factors is important from clinical and healthcare policy perspectives. Relationship between cognitive impairment and body weight or weight changes have been reported, but these were contradictory. We have evaluated the association between weight changes and cognitive decline using national level longitudinal data.@*METHODS@#Data from the Korean Longitudinal Study of Ageing from 2006 to 2012 were used. Association between weight changes and decline in cognitive function as measured by K-MMSE (the Korean version of the Minimental state examination) score was assessed by multivariate logistic regression. Weight changes were calculated from 1st wave and 3rd wave survey data, and classified into five groups as stable, increases, decreases of >10%, or 5%–10%.@*RESULTS@#About 37% of the total participants (n=4,512) were 65 years or older. These participants made up the largest proportion of the groups with weight change exceeding 10%. Multivariate logistic regression analyses revealed that weight changes exceeding 10% (10% increase vs stable, adjusted OR [aOR] 1.47, 95% confidence interval (CI) 1.11–1.95; 10% decrease vs stable, aOR 1.44, 95% CI 1.11–1.88) were significant predictive factors for decline in cognitive function. In subgroup analyses, the association between weight changes and cognitive decline was significant in males aged over 65 years and in normal BMI groups.@*CONCLUSION@#Weight changes, both increases and decreases exceeding 10% of baseline, were significantly associated with declines in cognitive function among older adults in South Korea.

Influence of Insurance Status on Survival of Surgically Treated Esophageal Cancer Patients / 대한소화기학회지

BACKGROUND/AIMS: Socioecomomic factor is an important determinant of access to healthcare and is one of the potential causes of disparities in esophageal cancer care outcomes. The aim of the study was to clarify the association between National health Insurance status (health insurance vs. medicare) as a socioeconomic factor and survival of patients with esophageal cancer who underwent surgical resection. METHODS: Among the 66 patients who underwent surgical resection for esophageal cancer between January 2006 and December 2017, 17 patients (25.8%) were in the medicare group. The data were analyzed to identify clinical manifestations and to compare surgical and oncologic outcomes between the groups. RESULTS: There was no significant difference in the distribution of sex (p=0.13), age (p=0.24), and pathologic stage (p=0.61) between the groups. The length of median hospital stay was significantly shorter in the healthy insurance group (18 days vs. 25 days, p=0.04). In the medicare group, postoperative mortality rates and incidence of postoperative complication were non-significantly higher (11.8% vs. 6.1%, p=0.45, 64.7% vs. 46.7%, p=0.21, respectively). However, pulmonary complication rates, including pneumonia, acute respiratory distress syndorme, and prolonged air leakage was significantly higher in the medicare group (47.1% vs. 18.4%, p=0.02). Five-year disease free survival rate was not different between the two groups (61.0% vs. 54.5%, p=0.68); the 5-year overall survival rate was significantly lower in the medicare group (27.7% vs. 53.7%, p=0.03). CONCLUSIONS: The medicare status of National health insurance could have a negative influence on the overall survival in patients with esophageal cancer who underwent surgery.

Comparative Effects of Curcumin and Tetrahydrocurcumin on Dextran Sulfate Sodium-induced Colitis and Inflammatory Signaling in Mice

BACKGROUND: Curcumin, a yellow ingredient of turmeric (Curcuma longa Linn, Zingiberaceae), has long been used in traditional folk medicine in the management of inflammatory disorders. Although curcumin has been reported to inhibit experimentally-induced colitis and carcinogenesis, the underlying molecular mechanisms remain largely unresolved. METHODS: Murine colitis was induced by dextran sulfate sodium (DSS) which mimics inflammatory bowel disease. Curcumin or tetrahydrocurcumin was given orally (0.1 or 0.25 mmol/kg body weight daily) for 7 days before and together with DSS administration (3% in tap water). Collected colon tissue was used for histologic and biochemical analyses. RESULTS: Administration of curcumin significantly attenuated the severity of DSS-induced colitis and the activation of NF-κB and STAT3 as well as expression of COX-2 and inducible nitric oxide synthase. In contrast to curcumin, its non-electrophilic analogue, tetrahydrocurcumin has much weaker inhibitory effects. CONCLUSIONS: Intragastric administration of curcumin inhibited the experimentally induced murine colitis, which was associated with inhibition of pro-inflammatory signaling mediated by NF-κB and STAT3.

Effective Anti-aging Strategies in an Era of Super-aging

The societies of the world in the 21st century have faced challenges arising from an aging population as the fertility rate has dropped dramatically and medical advances have extended the average human life span. The elderly aged 65 years or older make up at least 20% of the population in Korea, making the country a super-aging society as defined by the United Nations. The number of elderly women is higher than that of elderly men and women live longer than men. Based on the analysis of recent trends in previous studies, this study aimed to suggest practical strategies to utilize isoflavones, substances chemically similar to the female hormone estrogen, and to search for effective anti-aging strategies using this substance for women to be prepared to reach the elderly stage in good health.

Successful Endovascular Management of Intraoperative Graft Limb Occlusion and Iliac Artery Rupture Occurred during Endovascular Abdominal Aortic Aneurysm Repair

For high-risk patients, endovascular aortic aneurysm repair (EVAR) is a good option but may lead to serious complications, which should be addressed immediately. A 75-year-old man with a history of abdominal surgery underwent EVAR for an aneurysm of the abdominal aorta and iliac arteries. During EVAR, iliac artery rupture and graft limb occlusion occurred, and they were successfully managed by the additional deployment of an iliac stent graft and balloon thrombectomy, respectively. We, herein, report a rare case of the simultaneous development of the two fatal complications treated by the endovascular technique.

Postoperative Life-Threatening Recurrent Ventricular Arrhythmia Triggered by the Swan-Ganz Catheter in a Patient Undergoing Off-Pump Coronary Artery Bypass Surgery

Recurrent ventricular arrhythmia can be fatal and cause serious complications, particularly when it is caused immediately after an operation. Incorrect placement of a Swan-Ganz catheter can trigger life-threatening ventricular arrhythmia, but even intensive care specialists tend to miss this fact. Here, we report a case of recurrent ventricular arrhythmia causing a severe hemodynamic compromise; the arrhythmia was induced by a severely angulated Swan-Ganz catheter. The recurrent ventricular arrhythmia was not controlled by any measures including repositioning of the catheter, until the complete removal of the Swan-Ganz catheter. It is necessary to keep in mind that the position of the pulmonary artery catheter should be promptly checked if there is intractable recurrent ventricular arrhythmia.

An Integrative Model of the Cardiovascular System Coupling Heart Cellular Mechanics with Arterial Network Hemodynamics

The current study proposes a model of the cardiovascular system that couples heart cell mechanics with arterial hemodynamics to examine the physiological role of arterial blood pressure (BP) in left ventricular hypertrophy (LVH). We developed a comprehensive multiphysics and multiscale cardiovascular model of the cardiovascular system that simulates physiological events, from membrane excitation and the contraction of a cardiac cell to heart mechanics and arterial blood hemodynamics. Using this model, we delineated the relationship between arterial BP or pulse wave velocity and LVH. Computed results were compared with existing clinical and experimental observations. To investigate the relationship between arterial hemodynamics and LVH, we performed a parametric study based on arterial wall stiffness, which was obtained in the model. Peak cellular stress of the left ventricle and systolic blood pressure (SBP) in the brachial and central arteries also increased; however, further increases were limited for higher arterial stiffness values. Interestingly, when we doubled the value of arterial stiffness from the baseline value, the percentage increase of SBP in the central artery was about 6.7% whereas that of the brachial artery was about 3.4%. It is suggested that SBP in the central artery is more critical for predicting LVH as compared with other blood pressure measurements.

Computational Quantification of the Cardiac Energy Consumption during Intra-Aortic Balloon Pumping Using a Cardiac Electromechanics Model

To quantify the reduction in workload during intra-aortic balloon pump (IABP) therapy, indirect parameters are used, such as the mean arterial pressure during diastole, product of heart rate and peak systolic pressure, and pressure-volume area. Therefore, we investigated the cardiac energy consumption during IABP therapy using a cardiac electromechanics model. We incorporated an IABP function into a previously developed electromechanical model of the ventricle with a lumped model of the circulatory system and investigated the cardiac energy consumption at different IABP inflation volumes. When the IABP was used at inflation level 5, the cardiac output and stroke volume increased 11%, the ejection fraction increased 21%, the stroke work decreased 1%, the mean arterial pressure increased 10%, and the ATP consumption decreased 12%. These results show that although the ATP consumption is decreased significantly, stroke work is decreased only slightly, which indicates that the IABP helps the failed ventricle to pump blood efficiently.

Radial Arteriovenous Fistula Developed Late after Coronary Angiography: A Case Report

Transradial access is a widely accepted method for percutaneous coronary diagnostic and interventional procedures, and it has dramatically reduced access site vascular complications compared to transfemoral access. Arteriovenous fistula formation at the access site is an especially rare complication in transradial access. We report an extremely rare case of delayed radial arteriovenous fistula that developed one year after transradial coronary angiography, which was successfully treated by surgical repair.

Theoretical Estimation of Cannulation Methods for Left Ventricular Assist Device Support as a Bridge to Recovery

Left ventricular assist device (LVAD) support under cannulation connected from the left atrium to the aorta (LA-AA) is used as a bridge to recovery in heart failure patients because it is non-invasive to ventricular muscle. However, it has serious problems, such as valve stenosis and blood thrombosis due to the low ejection fraction of the ventricle. We theoretically estimated the effect of the in-series cannulation, connected from ascending aorta to descending aorta (AA-DA), on ventricular unloading as an alternative to the LA-AA method. We developed a theoretical model of a LVAD-implanted cardiovascular system that included coronary circulation. Using this model, we compared hemodynamic responses according to various cannulation methods such as LA-AA, AA-DA, and a cannulation connected from the left ventricle to ascending aorta (LV-AA), under continuous and pulsatile LVAD supports. The AA-DA method provided 14% and 18% less left ventricular peak pressure than the LA-AA method under continuous and pulsatile LVAD conditions, respectively. The LA-AA method demonstrated higher coronary flow than AA-DA method. Therefore, the LA-AA method is more advantageous in increasing ventricular unloading whereas the AA-DA method is a better choice to increase coronary perfusion.

Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction

BACKGROUND: Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. MATERIALS AND METHODS: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age 67.7+/-11.7 yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system (EBS(R)Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). RESULTS: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time 20.8+/-26.0 min). The mean time from vascular access to the initiation of ECMO was 17.2+/-9.4 min and mean support time was 3.8+/-4.0 days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration 50.1+/-31.6 days). Patients survived on average 476.6+/-374.6 days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). CONCLUSION: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.

Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction

BACKGROUND: Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. MATERIALS AND METHODS: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age 67.7+/-11.7 yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system (EBS(R)Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). RESULTS: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time 20.8+/-26.0 min). The mean time from vascular access to the initiation of ECMO was 17.2+/-9.4 min and mean support time was 3.8+/-4.0 days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration 50.1+/-31.6 days). Patients survived on average 476.6+/-374.6 days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). CONCLUSION: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.

Influences of Geometric Configurations of Bypass Grafts on Hemodynamics in End-to-Side Anastomosis

BACKGROUND: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. MATERIALS AND METHODS: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of 45degrees, 60degrees and 90degrees. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. RESULTS: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. CONCLUSION: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.

Comparison of Endovenous Treatment Using a 980 nm Diode Laser versus Conventional Stripping for Truncal Saphenous Vein Incompetence: Mid-term Results by VCSS Score and Recurrence / 대한흉부외과학회지

BACKGROUND: The aims of the present study were to assess and compare mid-term clinical outcomes including recurrences between endovenous laser therapy (EVLT) and stripping. MATERIAL AND METHOD: Between January 2007 and February 2010, 318 limbs in 237 patients with saphenous truncal varicosities were treated by laser energy using a 980 nm diode or were treated with conventional stripping. At the initial visit and at 1, 2, 6, 12, 18, 24, and 36 months postoperatively, clinical examination and questioning for Venous Clinical Severity Score (VCSS) as well as duplex ultrasonography were done. In order to compare clinical outcomes between the two treatment groups, EVLT versus stripping, all data were processed and analyzed. RESULT: There were no significant differences between the two treatment groups in the extent of the reflux and the number of insufficient perforating veins. The in EVLT and the stripping group at 12 months were 90.3+/-4.5% and 93.9+/-4.2%, respectively (p>0.05). Total recurrence rates were 4.4% in the EVLT group and 1.5% in the stripping group (p>0.05). In both groups, the VCSS scores were significantly reduced at week 1, 1 month, and 2 months after EVLT or stripping (p<0.001). CONCLUSION: Efficiency in eliminating truncal saphenous vein incompetence and reducing venous clinical severity were equal in the two treatment groups.

Clinical Experience of VNUS(R)Closure fast in Treatment of Varicose Vein: Comparison with Traditional Radiofrequency Ablation / 대한흉부외과학회지

BACKGROUND: Radiofrequency endovenous ablation of incompetent saphenous vein has gaining popularity over the conventional ligation and stripping as a minimally invasive technique. The latest version of radiofrequency endovenous catheter, VNUS(R)Closure fast VNUS medical Technologies, San Jose, CA, adopted a segmental ablation system, instead of continous pullback, is designed to reduce treatment time in comparison with the previous model-VNUS(R)Closure plus VNUS medical Technologies, San Jose, CA. The purpose of this study is to compare the difference between two endovenous radiofrequency ablation systems in terms of treatment efficacy and complication rates. We analyze the initial efficacy and complication rates of VNUS(R)Closure fast with VNUS(R)Closure plus. MATERIAL AND METHOD: Between June 2006 and August 2009, VNUS(R)Closure plus was performed to treat varicose vein on 59 limbs in 41 patients and VNUS(R)Closure fast was performed on 76 limbs in 67 patients. We retrospectively compared in both group with sex, mean treatment time, mean treatment diameter, conjugated treatment, and complications after the procedure. RESULT: All patient were symptomatic and diagnosed as varicose vein and underwent level 2 clinical classification with color duplex scan. The mean treatment time for the great saphenous vein was significantly less with VNUS(R)Closure fast (17.0+/-6.5 min) than VNUS(R)Closure plus (62.7+/-29.8 min). There was no significant difference in 1 yr closure rate between groups (p=0.32). Minor complications such as skin burn, thrombophlebitis, ecchymosis, hematoma, cellulitis, tenderness, and there were not different between the groups. CONCLUSION: Both VNUS(R)Closure fast and VNUS(R)Closure plus are effective methods of endovenous saphenous ablation. VNUS(R)Closure fast is superior to the previous model with less treatment time preserving compatible efficacy and complications. The efficacy of VNUS(R)Closure fast for long term closure rate remains to be established.

Aortopulmonary Window / 대한흉부외과학회지

BACKGROUND: Aortopulmonary window (APW) is a very rare congenital heart anomaly, often associated with other cardiac anomalies. It causes a significant systemic to pulmonary artery shunt, which requires early surgical correction. Accurate diagnosis and surgical correction will bring good outcomes. The purpose of this study was to describe our 20-year experience of aortopulmonary window. MATERIAL AND METHOD: Between March 1985 and January 2005, 16 patients with APW underwent surgical repair. Mean age at operation was 157.8+/-245.3 (15.0~994.0) days and mean weight was 4.8+/-2.5 (1.7~10.7) kg. Patent ductus arteriosus (8), atrial septal defect (7), interrupted aortic arch (5), ventricular septal defect (4), patent foramen ovale (3), tricuspid valve regurgitation (3), mitral valve regurgitation (2), aortic valve regurgitation (1), coarctation of aorta (1), left superior vena cavae (1), and dextrocardia (1) were associated. Repair methods included 1) division of the APW with primary closure or patch closure of aorta and pulmonary artery primary closure or patch closure (11) and 2) intra-arterial patch closure (3). 3) Division of the window and descending aorta to APW anastomosis (2) in the patients with interrupted aortic arch or coarctation. RESULT: There was one death. The patient had 2.5 cm long severe tracheal stenosis from carina with tracheal bronchus supplying right upper lobe. The patient died at 5th post operative day due to massive tracheal bleeding. Patients with complex aortopulmonary window had longer intensive care unit and hospital stay and showed more morbidities and higher reoperation rates. 5 patients had reoperations due to left pulmonary artery stenosis (4), right pulmonary artery stenosis (2), and main pulmonary artery stenosis (1). The mean follow-up period was 6.8+/-5.6 (57.0 days~16.7 years)years and all patients belonged to NYHA class I. CONCLUSION: With early and prompt correction of APW, excellent surgical outcome can be expected. However, optimal surgical method needs to be established to decrease the rate of stenosis of pulmonary arteries.