Native Coronary Artery and Grafted Artery Spasm Just after Coronary Artery Bypass Grafting: A Case Report

Native coronary artery spasm after coronary artery bypass grafting (CABG) is scarce. It frequently causes disastrous circulatory collapse. We report a 72-yr-old male, who experienced native coronary artery spasm and grafted artery spasm following CABG, which was successfully treated with coronary angiography and intracoronary injection of nitroglycerine.

Extraanatomic Bypass Graft was Performed in Adult Coarctation / 대한흉부외과학회지

We performed three cases of extraanatomic bypass graft for treating adult coarctation. Two cases of left subclavian artery to descending aorta bypass graft were done via left thoracotomy for treating 2 patients who had extensive aortic occlusive disease. One case of ascending aorta to descending aorta bypass graft and aortic valve replacement was done via median sternotomy for a patient who had combined arch hypoplasia and aortic valve regurgitation. One patient was reoperated on for aneurysm rupture of an anastomosis site four months after the first operation and two patients have had no specific problems during and after their operations.

The Role of B-type Natriuretic Peptide in Predicting Postoperative Complications and Outcomes in Patients Undergoing Coronary Artery Bypass Graft / 대한흉부외과학회지

BACKGROUND: Circulating levels of brain natriuretic peptide (BNP) provide prognostic information for patients with heart failure. The aim of our study was to investigate whether preoperative and postoperative BNP levels could predict postoperative complications and outcomes in patients after coronary artery bypass graft (CABG). MATERIAL AND METHOD: Data was collected prospectively on 30 patients (M/F=19/11, age 60.0+/-9.6 years) undergoing conventional CABG during a 1-year period beginning on January 1, 2005. Patients underwent off-pump CABG, and combined surgery was excluded. The BNP assay was performed preoperatively, immediate postoperatively at the intensive care unit (ICU), and 1, 3, 5, and 7days postoperatively. RESULT: Preoperative BNP levels significantly correlated with preoperative echocardiographic ejection fraction and an ICU stay of 5 days or more (r=-0.4, p=0.028; r=0.39, p=0.031, respectively). A preoperative BNP cut-off value above 263 pg/mL demonstrated high specificity (90.5%) for predicting postoperative complications using the receiver operating characteristics curves. Preoperative and postoperative (7 days) BNP levels were different depending on the abscence (mean BNP=99+/-23 pg/mL vs. 296+/-74 pg/mL, p 263 pg/mL predict postoperative complications in patients receivingCABG.

The Effect of Matrix Metalloproteinase Inhibitor for Left Ventricular Remodeling after Myocardial Infarction in a Rabbit Model / 대한흉부외과학회지

BACKGROUND: Matrix Metalloproteinase (MMP) inhibition has emerged as a potential therapeutic strategy for the left ventricular dilatation that occurs after myocardial infarction. This study is designed to evaluate which treatment is better for attenuating the left ventricular remodeling via MMP inhibition 1) during the early, short highly MMP producing period of the initial phase or 2) during most of the period of the initial phase after myocardial infarction. MATERIAL AND METHOD: Myocardial infarction was induced by ligation of the left anterior descending coronary artery in rabbits. The experimental group was divided into 3 groups. The myocardial infarction only (MI only) group consisted of 7 cases. The MMP inhibitor administered for 5 days after MI (MMPI 5d) group had 6 cases, and these rabbits were given MMP inhibitor for 5 days after myocardial infarction, beginning with the postoperative first day. MMP inhibitor administered for 9 days (MMPI 9d) group consisted of 5 cases and these rabbits were given MMPI for 9 days the same manner as above. CG2300 was used as a selective MMPI; this is a potent MMP-2 and -9 inhibitor. Two-D echocardiograms were performed on all the groups at the time of preoperative period, the postoperative 1st week, the postoperative 2d week and the postoperative 3d week, and we measured the end-diastolic dimension (EDD), the end-systolic dimension (ESD), and the ejection fraction (EF). RESULT: The echocardiograms generally showed postoperative left ventricular dilatation in the MI only group. The EDD was increased significantly higher in the postoperative 1 week compared to the preoperative value (p<0.05). The ESD was also increased significantly higher in the postoperative 1st week, the postoperative 2d week and the postoperative 3d week compared to the preoperative value (p<0.05). Left ventricular dilatation was noted to be less In the MMPI 9d group than in the MI only and MMPI 5d groups. In the MMPI 9d group, there was no significant change of EF postoperatively compared to the preoperative period. MMP-2 and MMP-9 were measured from the infarcted myocardial tissue at post-MI 4 weeks by performing western blotting and zymography. The changes the of protein expression and activity of MMP-2 and MMP-9 were not significant in the three MI groups and the normal heart group. Histopathologic examination revealed severe collagen deposition in the MI only group. Collagen accumulation was reduced in both the MMPI groups. The MMPI 9d group revealed an increased number of capillaries. CONCLUSION: Left ventricular dilatation developed rapidly after, MI from ligation of the coronary artery and MMPI attenuated the ventricular dilatation. The effect of MMPI seemed to have better a result from its usage during most of the period of the initial phase after myocardial infarction. This suggested that increased neovascularization by MMPI may also contribute to attenuation of the left ventricular remodeling.

Myocardial Protective Effect of Histidine-Tryptophan-Ketoglutarate Solution and Cold Blood Cardioplegic Solution in Pediatric Cardiac Surgery / 영남의대학술지

BACKGROUND: There is limited data on comparisons between the effect of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegic (CBC) solution in pediatric cardiac surgery. The purpose of this study was to compare the myocardial protective effect of HTK solution and CBC solution in patients undergoing pediatric cardiac surgery. MATERILAS AND METHODS: We selected 49 patients with ventricular septal defect and atrial septal defect. HTK solution was used in 21 patients and CBC solution was used in 28 patents. HTK solution was given as a single dose, whereas CBC solution was used in the usual multi-dose method. The incidence of EKG change and concentration of Troponin T and CK-MB were compared for the evaluation of myocardial damage. RESULTS: There were no significant differences in the incidence of ST, T segment change by EKG and serial cardiac enzyme levels between two groups. CONCLUSION: These results suggested that the myocardial protective effect of HTK solution was similar to CBC solution in simple pediatric cardiac surgery.

Surgical Treatment of Cardiac Tumor / 대한흉부외과학회지

BACKGROUND: Tumors of the heart are uncommon. The aim of this study is to review our clinical experience and outcome of surgical treatment of cardiac neoplasm. MATERIAL AND METHOD: From March 1990 to December 2005, 35 patients (14 males and 21 females) with mean age of 52.4 years underwent surgical treatment of cardiac neoplasm. The clinical and pathologic data were analyzed retrospectively. Surgical treatment consisted in complete resection of the tumor in all cases but 1 patient who was left ventricular fibroma received biopsy only. RESULT: Thirty cases were benign and five cases were malignant tumor. Benign tumors were myxoma (29 cases) and fibroma (1 case). Five malignant tumors were osteosarcoma, hepatocellular carcinoma, renal cell cancer, yolk sac tumor, and unclassified myxoid spindle cell type sarcoma. There were no operative mortality in benign cases and twenty seven cases of myxoma were followed up for 8 months to 15 years without recurrence. But four patients of malignant tumor were expired within six months after operation. CONCLUSION: Left atrial myxomas are most common benign neoplasm. Surgical treatment is effective for the benign cardiac tumors but prognosis is poor in patients with malignant cardiac tumors.

Protamine Induced Anaphylactic Reaction after Cardiopulmonary Bypass: A case report / 대한흉부외과학회지

Anaphylactic reaction to protamine sulfate, which is used widely to reverse the anticoagulative effect of heparin after cardiopulmonary bypass, is very rare. But the result of anaphylactic reaction can be very fatal and the mechanism of it is still not clear. We report a case of severe anaphylactic reaction to protamine sulfate following the replacement of the mitral valve and Maze procedure using microwave in a non-diabetic 57-year-old female patient.

Effect of Surgical Closure of Ventricular Septal Defect on Ventricular Systolic Time Intervals / 대한흉부외과학회지

BACKGROUND: This study was undertaken in infant patients with isolated ventricular septal defect(VSD) to determine the effect of surgical closure on ventricular systolic time interval, as a parameter for ventricular performance, by echocardiography. MATERIAL AND METHOD: Thirty patients were enrolled. Mean age of patients at operation was 6.5+/-3.2 months and all patients had non-restrictive VSD. We checked the left atrium/aorta(LA/Ao) ratio, left ventricle ejection fraction(EF), left ventricular systolic time interval(LVSTI), and right ventricular systolic time interval(RVSTI). Echocardiographic studies were done before surgical correction and postoperative periods(postop1: within 2 weeks, postop2: between 4 and 6 months, postop3: between 1 and 2 years). RESULT: LA/Ao ratio decreased significantly at immediate postoperative period compared to preoperative period and sustained during further follow-up period(from 1.74+/-0.37 to 1.36+/-0.24*, 1.32+/-0.22*, and 1.27+/-0.19*, p<0.01 ). LV EF had not changed during follow-up periods(from 65.1+/-7.0 to 62.3+/-9.5, 62.8+/-5.7, and 64.1+/-6.9). LVSTI decreased significantly at postop2 and sustained during further follow-up period (from 0.46+/-0.13 to 0.46+/-0.11, 0.37+/-0.08*, and 0.34+/-0.07*, p<0.01 ). RVSTI decreased significantly at postop3(0.33+/-0.08 to 0.32+/-0.08, 0.31+/-0.07, and 0.27+/-0.05*, p<0.01). CONCLUSION: We found that right and left ventricular systolic time intervals had decreased over the period of 1 year after surgical correction of VSD. Therefore, it is necessary to observe the change of ventricular function during that period.

Clinical Analysis of Patch Repair of Ventricular Septal Defect in Infant / 영남의대학술지

BACKGROUND: Simple ventricular septal defect(VSD) is the most common congenital heart disease. Although closure of VSD is currently associated with a relatively low risk, experience with younger and smaller infants has been variably less satisfactory. We assessed the results of surgical closure of VSD in infant. MATERIALS AND METHODS: Between 1996 and 2000, 45 non-restrictive VSD patients underwent patch repair and retrospective analysis was done. Patients were divided into two groups based on weight: group I infants weighed 5kg or less(n=16), and group II infants weighed more than 5kg(n=29). Both groups had similar variation in sex, VSD location, aortic cross clamp time and total bypass time. But combined diseases (ASD, PDA, MR) were more in group I. We closed VSD with patch and used simple continuous suture method in all patients. RESULTS: There were no operative mortality, no reoperation for hemodynamically significant residual shunt and no surgically induced complete heart block. As a complication, pneumonia(group I: 2 cases, group II: 2 cases), transient seizure(group II: 2), wound infection(group I: 1, group II: 1), urinary tract infection(group I: 1) and chylopericardium(group I: 1) developed, and there was no significant difference between two groups(p>0.05). CONCLUSION: Early primary closure with simple continuous suture method was applicable in all patients with non-restrictive VSD without any serious complications.

Follow-Up of Residual Shunt after Repair of Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: Obtaining precise hemodynamic and morphological information in the early postoperative period after surgical correction of congenital heart disease is important in determining the need for future medical or surgical intervention. We investigated the residual shunting after surgical repair of simple ventricular septal defect in order to know the incidence of residual shunting in the postoperative period and the natural history of small residual shunts located in the peripatch area. MATERIAL AND METHOD: Forty three consecutive patients under one year of age who underwent patch repair of a simple ventricular septal defect were evaluated for incidence of residual shunts by echocardiography. RESULT: Eleven patients had echocardiographic residual shunt in the peripatch area at immediate postoperative period, however, there were no patients who needed reoperation due to deteriorated hemodynamic effect of residual shunt. The incidence of residual shunts was not significantly different with type of ventricular septal defect and material used for closure. During follow up period, two patients were lost and remaining nine patients no longer showed evidence of residual shunt. The mean time of last evidence of shunt was 4.2+/-3.6 months after operation. CONCLUSION: Residual peripatch shunt flow was frequently noted in the immediate postoperative period following surgical repair of ventricular septal defect, however, most of them were disappeared within six months.

The Usefulness of Harmonic Scalpel During Pericardiectomy for Constrictive Pericariditis / 대한흉부외과학회지

Harmonic Scalpel(Ethicon Endo-Surgery, Cincinnati, OH) has many advantages including no muscular stimulation, low heat, less smoke, easy hemostasis using ultrasound and good operation field. In patient with constrictive pericarditis, Harmonic Scalpel was beneficial during pericardiectomy.

Effects of Pulmonary Vein Isolation Using Intraoperative Radiofrequency Catheter Ablation for the Treatment of Atrial Fibrillation Associated with Mitral Valvular Heart Diseases

BACKGROUND AND OBJECTIVES: The pulmonary veins and surrounding ostial areas frequently house focal triggers or reentrant circuits critical to the genesis of atrial fibrillation (AF). The purpose of this study was to assess the efficacy of pulmonary vein isolation, aided by intraoperative radiofrequency catheter ablation, for the treatment of AF associated with mitral valvular heart disease. SUBJECTS AND METHODS: 32 consecutive patients with AF associated with mitral valvular disease, requiring mitral valvular replacement or valvuloplasty were included. We divided these patients into two groups. The first group, PVI, consisted of 16 patients that had mitral valvular operations with intraoperative radiofrequency pulmonary vein isolation, and the other 16 patients, the controls, had mitral valvular operation only. The conversion rate to sinus rhythm and other clinical data were compared between the two groups. RESULTS: Circumferential pulmonary vein isolation, with radiofrequency catheter ablation, was achieved in an average of 15+/-3 min. There were no mortalities or morbidities associated with this procedure. In the immediate postoperative period, the conversion rate to normal sinus rhythm in the PVI group was significantly higher than in the controls (81% vs. 37.5% p=0.016). After 21+/-4 weeks of follow up, the sinus rhythm maintenance rates in PVI group was also significantly higher than those of the control group (75% vs. 31.2% p=0.01). CONCLUSION: Circumferential pulmonary vein isolation, aided by intraoperative radiofrequency catheter ablation, is simple and effective for the treatment of chronic atrial fibrillation associated with mitral valvular disease.

Echocardiographic Follow-up after Arterial Switch Operation for Transposition of the Great Arteries / 대한흉부외과학회지

BACKGROUND: To evaluate the efficacy of arterial switch operation for transposition of great arteries, serial echocardiographic studies were performed in 8 patients who underwent the surgery between 1989 and 1998 at Dept. of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital in Daegu City, Korea. MATERIAL AND METHOD: Follow-up period ranged from 6 months to 11 years(average of 4.1 years). Body weight ranged from 2.6kg to 4.8kg, with average of 3.6kg. 5 of 8 patients were preoperatively diagnosed as TGA+VSD, and 3 as TGA+IVS. LV function was evaluated by the measurement of LV shortening fraction, LVSTI, and LVEF. RVSTI was also measured. Postoperative function of valve and growth of great vessels were analyzed by the measurement of PSPGV, valvular regurgitation, LA/AO ratio, root dimension of aorta and pulmonary artery, comparing with the age matched controls, respectively. RESULT: LVEF had an average of 65.0+/-9.03% which is tended to increase serially. LVAOPG had an average of 15.9mmHg. RVPAPG, 27.5mmHg. From the measurement of aortic root dimension of 6 patients at end-systole, aortic root growth was assumed to increase more than the mean value of normal growth. PA root dimension at end-systole showed a similar growth progress when compared with age matched normal controls. Postoperative pulmonic valve regurgitation was noted in 5 of total 8 patients, in which 1 patient who showed grade 2 and 4 showed below grade 1. AR, in 6 patients and all grade 1. Except 1 patient, all the valvular regurgitations were below grade 1, which was presumed to be clinically insignificant. CONCLUSION: LV function after arterial switch operation was maintained relatively well. Mild neoaortic stenosis was noted. Neopulmonary stenosis and regurgitation were less than moderate degree and surgical correction was not deemed to be necessary. Growth progress of aortic root was above normal than controls and PA root growth was similar to the normal controls, postoperatively. However, further change and refinement of surgical technique will decrease the incidence of neopulmonary stenosis and regurgitation.

Ascending Aortic Dissection Late After Aortic Valve Replacement / 대한흉부외과학회지

Aortic dissection after aortic valve replacement(AVR) is rare, but it is considered a definite disease entity. It's risk factors are a dilated ascending aorta(>or=50 mm) at the time of AVR, hypertension, and thin fragile aortic wall. We report the surgical treatment of a patient who had ascending aortic dissection 7 years after having undergone AVR due to aortic regurgitation associated with a dilated ascending aorta(50mm in outer diameter).

Surgical Treatment of Lemierre's Syndrome: A case report / 대한흉부외과학회지

Lemierre's syndrome is characterized by a rare fulminant condition resulting from primary oropharyngeal infection followed by secondary septic thrombophlebitis of the internal jugular vein and metastatic infection. A forty-year-old man who had been on ventilator due to severe chest trauma, showed severe reddish inflammatory swelling of the right cervical soft tissue and newly developed pneumonia. He went into in septic condition shortly thereafter. Thrombophlebitis with central abscess in the right internal jugular vein was identified by neck CT and MRA(magnetic resonance angiography). Right cervical swelling worsened in spite of clindamycin and heparin therapy. We performed immediate surgery for removal of septic thrombus and resection of internal jugular vein. Patient's septic condition, pneumonia, and local inflammatory reaction were improved within several days after surgery.

Changes of Interleukin-10 level in Patients Undergoing Cardiopulmonary Bypass / 대한흉부외과학회지

BACKGROUND: Cardiopulmonary bypass during open heart surgery causes systemic inflammatory respose. IL-10 is an anti-inflammatory cytokine that inhibits inflammatory process and protects organ function by down regulation of pro-inflammatory cytokine release and maintenance of blood level balance with pro-inflammatory cytokines. MATERIAL ateial and Method: Plasma IL-10 levels were measured and analyzed in 22 patients who underwent open heart surgery (11 cases of coronary artery bypass graft, 11 cases of valve replacement) under cardiopulmonary bypass since 1988 January to July at Department of Thoracic and Czardiovascular surgery, Yeungnam University Hospital. 1g of methylprednisolone was administrated to thirteen patients randomly. Blood samp.es were taken and collected at the time of induction of anesthesia, 10 min before cardiopulmonary bypass, 10 min after starting of CPB, 10 min aftr aortic cross clamping, 10 min after ACC release, and 10 min, 2 hours, and 5 hours after CPB respectively. The plasma levels of IL-10 were determined by enzyme-linked immunosorbent assays (ELISA). Wilcoxon-Raule Sum test was used for statistical analysis. In all 22 patients, cardiopulmonary bypass time was used for statistical analysis. In all 22 patients, cardiopulmonary bypass time was 171+/-41.4 min and aortic cross clamp time was 118+/-36.5 min. Peak IL-10 level was achieved at 10 min after ACC (361.0+/-52.81pg/ml) and was decreased sharply at 2 hours after CPB. Peak IL-10 level was correlated positively with aortic cross clamp time (p=0.011); however, it did not correlated with bypass time (p=0.181). In valve replacement group, mean IL-10 level at peak point was 567.89+/-107.69 pg/ml and was significantly higher than that of coronary artery bypass group (205.67+/-192.70 pg/ml) (p<0.001). ACC time in valve replacement group was significantly longer than that of coronary artery bypass group (p<0.01), however, bypass time was not (p=0.212). Thirteen patients with steroid pretreatment before starting of CPB showed relatively higher plasma IL-10 level than in control group, however, no statistical significance was noted (p=0.19). CONCLUSION: plasma level of IL-10 was increased in association with cardiopulmonary bypass and revealed peak at 10 min after ACC release. IL-10 level was correlated positively with ACC time. Therefore, systemic inflammatory respeonse in association with cardiopulmonary bypass could be decreased by reducing ACC time during cardiac surgery.

Antioxidative Effect of Ginseng Saponin on Cardiac Endothelial Cells in Culture / 대한해부학회지

The cytotoxic effects of oxygen free radicals and the antioxidative effect of ginseng saponin (SPN) on cardiac endothelial cell cultures derived from 3-day old rats were studied. Reactive oxygen species were generated by hypoxanthine (HX) and xanthine oxidase (XO) mixture to the culture medium. Exposure of cardiac endothelial cells to this oxygen-radical-generating system resulted in significant time-dependent decrease of MTT activity and increase of lactate dehydrogenase (LDH) release. These results correlated well with the morphological examination of randomly selected cultured cardiac endothelial cells, which showed large cytoplasmic vacuoles, disordered organelles, pronounced increase of endoplasmic reticular swelling, and decreased maintenance of membrane integrity. The decrease in cell viability and increase of LDH release induced by the oxygen free radicals in cardiac endothelial cell cultures were blocked during the first two hours by antioxidants such as ginseng saponin (SPN), deferoxamine (DFX), and ginseng saponin/deferoxamine mixture (SPN/DFX). These antioxidative effects were significantly greater in the SPN-treated group than in the other antioxidant-treated groups. Especially, the cells of the SPN-treated group showed well developed cytoskeletons, which enabled them to firmly attach to the culture vessel. In conclusion, these results indicate that ginseng saponin has a significant antioxidative effect on cardiac endothelial cells in culture and plays an important role in stimulating the formation of cytoskeleton and maintaining the integrity of cell membrane.

The Toxicity of Cisplatin Administered by Isolated Lung Perfusion in Dogs / 대한암학회지

PURPOSE: This research was designed to evaluate the chronic effect of isolated lung perfusion (ILP) with cisplatin on dogs. MATERIALS AND METHODS: Fifteen dogs were divided into three groups. Group I was in ILP without cisplatin, group II with 2.5 mg/kg and group III with 5.0 mg/kg of cisplatin for 30 minutes respectively. Serial blood samples were taken before and after ILP for quantitative analysis of serum lactate dehydrogenase (LDH) and blood urea nitrogen/creatinine (BUN/Cr). The specimens from the lung were obtained 2 weeks after ILP. RESULTS: There were no statistic significant differences in LDH concentration according to the time interval among the groups. The LDH concentration peaked at 1 week after ILP and declined thereafter to the pre-ILP concentration. The concentration of BUN/Cr was in normal range. Histologic examination showed no pathologic change. No significant histopathologic differences were found in the pulmonary parenchyme and vasculature among the groups. All of the dogs survived without complication 2 weeks after ILP. CONCLUSION: In ILP with cisplatin of 5.0 mg/kg in normal dog, the toxicity of cisplatin itself was not observed. With further study about the technique of ILP with cisplatin it would be effective to deliver high concentration of cisplatin into the target tissue minimizing lung damage.

Cardiac Surgery Via Lower Partial Sternotomy Lower Partial Sternotomy / 대한흉부외과학회지

BACKGROUND: Recent trends suggest that minimally invasive cardiac surgery reduces postoperative morbidity and offers a cosmetic benefit. This study was performed to evaluate the CPB time, ACC time, OP time, ICU stay and postoperative hospital stay following a lower partial sternotomy and those of the median sternotomy. MATERIAL AND METHOD: A group of 26 adult patients who underwent cardiac surgery through lower partial sternotomy from August 1997 to July 1999 (A group) were compared to 45 adult patients who underwent cardiac surgery through median sternotomy from January 1996 to July 1997 (B group). The mean ages (46.4+/-14.6 years, A group and 46.8+/-13.2 years, B group) were similar. Operations were performed with central cannula and antegrade/retrograde blood cardioplegia. RESULT: There was no death in each group. No differences were found in CPB time, ACC time, OP time, ICU stay and postoperative hospital stay. Postoperative complications were sternal splitting in a patient in group A and a patient with bleeding that required reoperation and a patient with delayed wound closure in group B. CONCLUSION: The lower partial sternotomy offered a cosmetic benefit, but does not significantly reduced the length of operative time and hospital stay. Minimally invasive cardiac surgery will be applied increasing because of the suggested advantage and choosing a proper operative technique will be helpful.

Congenital Aneurysm of The Left Atrium: A Case Report / 대한흉부외과학회지

Isolated congenital aneurysm of the left atrium with intact pericardium is a rate anomaly, which usually presents with arrhythmia, cerebral embolism or abnormalities on routine chest X-ray. Surgery is indicated in most cases to eliminate a potential source of systemic emboli and arrhythmias. A 42-year-old woman having cervical cancer, she was suspected of having a left atrial aneurysm on review of chest X-ray and confirmed by echocardiography and cardiac catheterization. Surgical resection of Left atrial aneurysm was achieved without complication using median sternotomy with cardiopulmonary bypass. The postoperative course was uneventful.