Electrocautery-Ignited Surgical Field Fire Caused by a High Oxygen Level during Tracheostomy

Tracheostomy is a relatively common surgical procedure that is performed easily in an operating room or intensive care unit. Open tracheostomy is needed in patients requiring prolonged ventilation when percutaneous tracheostomy is inappropriate. Sometimes, it is difficult to achieve bleeding control in the peritracheal soft tissue, and in such cases, we usually use diathermy. However, the possibility of an electrocautery-ignited surgical field fire can be overlooked during the procedure. This case report serves as a reminder that the risk of a surgical field fire during tracheostomy is real, particularly in patients requiring high-oxygen therapy.

The inverted left atrial appendage; the possibility of the interference with the bloodstream into the left ventricle during weaning from cardiopulmonary bypass: A case report

This report presents an experience of difficulties in weaning from cardiopulmonary bypass (CPB) after the closure of atrial septal defect. Transesophageal echocardiogram following the first attempt of weaning the CPB revealed the inverted left atrial appendage protruding into the mitral valve. Only after the correction of the inverted left appendage, the CPB weaning was completed without any difficulties.

Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome

Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

Simultaneous Aortic and Tricuspid Valve Endocarditis due to Complication of Sinus of Valsalva Rupture

We experienced a case of ruptured aneurysm of the sinus of Valsalva, and this resulted in simultaneous aortic and tricuspid valve endocarditis through a shunt. The echocardiography showed a ruptured sinus of Valsalva aneurysm to the right atrium with a shunt. The aortic non-coronary cusp was fibro-thickened with vegetation. Vegetations of the septal leaflet and the anterior leaflet of the tricuspid valve were also found. The blood culture grew Enterococcus garllinarum. We replaced both tricuspid and aortic valve with successful surgical result.

Multiple Time Aortic Valve Replacement

No abstract available.

Analysis of Risk Factors and Effect of Vancomycin for Sternal Infection after Coronary Artery Bypass Graft / 대한흉부외과학회지

BACKGROUND: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). MATERIAL AND METHOD: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. RESULT: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). CONCLUSION: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.

Regression of Left Ventricular Mass after Aortic Valve Replacement in Isolated Aortic Regurgitation / 대한흉부외과학회지

BACKGROUND: The aim of our study was to assess the extent of regression of left ventricular mass after aortic valve replacement in isolated aortic regurgitation. MATERIAL AND METHOD: Retrospective analysis of echocardiographic data was collected preoperative and postoperative 1 year. There were 20 patients (12 males, 8 females, mean age 55.8+/-11.8 years, mean body surface area 1.64+/-0.19 m2) with aortic regurgitation from 2002 through 2007. We studied the change of left ventricular ejection fraction, ventricular septum and left ventricular posterior wall thickness, and left vemtricular muscle index (LVMI). The control group was age matched with normal echocardiographic study results. Patients with combined surgery or infective endocarditis were excluded. RESULT: Seven cases of tissue valves and thirteen cases of mechanical valve were used. The valve sizes were 21 mm (3 cases), 23 mm (13 cases) and 25 mm (4 cases). The postoperative (125.5+/-42 g/m2) LVMI has decreased than preoperative LVMI (212.3+/-80 g/m2, p=0.000) but higher than that of control group (80.5+/-15.9 g/m2, p=0.000). Postoperative septal wall (systolic/diastolic: 13.5+/-3.4 mm/17.1+/-4.1 mm) and left ventricular posterior wall (systolic/diastolic: 12.9+/-3.4 mm/16.7+/-3.4 mm) thickness were slightly decreased after the valve replacement but was not significantly different than preoperative levels. And postoperative interventricular septal wall and left ventricular posterior wall thickness (systolic/diastolic: 8.6+/-1.4 mm/12.1+/-1.7 mm, systolic/diastolic: 8.4+/-1.4/13.2+/-1.9) were higher than that of the control group (p<0.001). CONCLUSION: The significant regression of LVMI after aortic valve replacement developed at postoperative one year but the level was higher than control group. The main cause of decreased LVMI is decreased in left ventricular dimension.

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.

Plasma Levels of Brain Natriuretic Peptide Predict Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery / 대한흉부외과학회지

BACKGROUND: The brain natriuretic peptide (BNP) level has been reported in some studies to be associated with the occurrence of atrial fibrillation (AF). The aim of this study is to evaluate the potential usefulness of the BNP level as a predictor of the occurrence of postoperative (postop) AF and to assess the relationship of the BNP level with the onset of AF and the restoration of sinus rhythm. MATERIAL AND METHOD: From January 1, 2005 to February 28, 2006, 82 patients without a history of atrial arrhythmia that had undergone cardiac surgery were enrolled in the study. Blood samples for plasma BNP were drawn daily for all these patients from the preoperative (preop) day to the 7th postop day. The patient records were reviewed and postop EKGs were checked daily for AF until the time of discharge. RESULT: Patients were divided into two groups based on development of postop AF. Postoperative AF developed in 26 patients (31.7%). There was no significant statistical difference in age, sex distribution, preop left ventricle ejection fraction, hypertension, left ventricular hypertrophy, or the use of beta blockers between the non-postop AF and postop AF group. More patients in the AF group had undergone valve surgery (39.3% versus 76.9%, p=0.002). The preop left atrium size was significantly larger in the AF patients (43.8+/-10.3 mm versus 49.8+/-11.5 mm, p=0.029). The preop plasma BNP levels were higher in the postop AF patients (144.1+/-20.8 pg/mL versus 267.5+/-68 pg/mL, p=0.034). In the postop AF group, the plasma BNP level was the highest on the 3rd postop day. Postop AF developed in most patients by the 3rd postop day; restored sinus rhythm developed by the 7th postop day. CONCLUSION: Elevated plasma BNP levels may lead to the occurrence of postop AF in patients undergoing cardiac surgery. Patients who have a high risk of postop AF should be considered for aggressive prophylactic antiarrhythmic therapy.

Extracorporeal Life Support with a Twin-pulse Life Support (T-PLS) System / 대한흉부외과학회지

A mechanical circulatory support system is a life-saving option for treating acute severe respiratory failure or cardiac failure. There are currently a few types of assist devices and the Twin-Pulse Life Support (T-PLS) system is a kind of pulsatile pump. We report here on three patients with severe life threatening cardiopulmonary dysfunction who had the T-PLS system used as an assist device. The indications for applying the T-PLS system were continuing respiratory or cardiac failure in spite of maximal ventilatory and inotropic support. There were two patients with acute respiratory failure due to infection and one patient with cardiac failure due to acute myocarditis. One respiratory failure patient and one cardiac failure patient survived after applying the T-PLS system for 3 days and 5 days, respectively. The T-PLS system is useful as an assist device and it should be considered before multi-organ failure occurs.

Uncommon Iatrogenic Pneumothorax caused by Migration of a K-wire into the Pleural Cavity

Iatrogenic pneumothorax is occasionally caused by invasive medical or surgical procedures in the chest that include fine needle aspiration biopsy, placing a central venous catheter, or insertion of a pleural drain. A 19-year-old male was admitted due to persistent pleuritic right-side chest pain after operation on a fractured clavicle by K-wire. He did not complain of dyspnea or coughing but had experienced chest pain for several days. On physical examination, the patient's breathing sound was slightly decreased in the right lung field. A Chest X-ray was taken, revealing a small degree of pneumothorax at the right apex and an approximately 9 cm-sized linear metallic foreign body at the diaphragm level. A chest CT was then taken, and on lung setting view the object was seen to extend from the right retrocrural space, penetrating the diaphragm and right lung parenchyme, to the IVC and a minimal hemopneumothorax at right. The patient was operated on in the thoracic surgery department for the purpose of simple removal of the foreign body (K-wire). Afterward, he was discharged without specific complaints on the 8th day from admission. In summary, we report a case of uncommon iatrogenic pneumothorax caused by migration of a K-wire into the pleural cavity.

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.

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.

Mesothelial Cyst of the Posterior Mediastinum: A case report / 대한흉부외과학회지

Mesothelial cyst is a rare mediastinal tumor and usually presents in the right cardiophrenic angle. However, it sometimes occurs in atypical locations and it's locating in the posterior mediastinum, especially, is very rare. A large cystic mass of the posterior mediastinum between pericardium and vertebral body was incidentally recognized in a patient of a 30-year-old woman admitted due to traffic accident. Even though it was very large in size measuring 18 cm at longest diameter and is extending mainly to the left pleural cavity, she had no symptomatic complaints. Complete excision was performed through video-assisted thoracoscopic surgery with a additional small working window, which was necessary for dissecting the deepest point to the right pleural cavity. She is in good condition without recurrence on long-term follow-up.

Mesothelial Cyst of the Posterior Mediastinum: A case report / 대한흉부외과학회지

Mesothelial cyst is a rare mediastinal tumor and usually presents in the right cardiophrenic angle. However, it sometimes occurs in atypical locations and it's locating in the posterior mediastinum, especially, is very rare. A large cystic mass of the posterior mediastinum between pericardium and vertebral body was incidentally recognized in a patient of a 30-year-old woman admitted due to traffic accident. Even though it was very large in size measuring 18 cm at longest diameter and is extending mainly to the left pleural cavity, she had no symptomatic complaints. Complete excision was performed through video-assisted thoracoscopic surgery with a additional small working window, which was necessary for dissecting the deepest point to the right pleural cavity. She is in good condition without recurrence on long-term follow-up.

Spinal Cord Infarction following Off-pump Coronary Artery Bypass Surgery / 대한흉부외과학회지

A 62-year-old woman with ischemic heart disease, hypertension and hypercholesterolemia had developed spinal cord infarction after off-pump coronary artery bypass (OPCAB). The incidence of postoperative neurological complications is well known to be less in OPCAB than that of conventional coronary bypass surgery. Furthermore, spinal cord infarction is an uncommon clinical event after coronary bypass surgery. Here we report a case of spinal cord infarction following OPCAB, discuss possible mechanism of spinal cord infarction with relate literatures.

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.

Acute Heart Failure after Relief of Massive Pericardial Effusion / 대한흉부외과학회지

Severe left ventricular dysfunction after relief of massive pericardial effusion has been rarely reported. Interventricular volume mismatch, acute distention of the cardiac chambers and interplay of autonomic nerve system are believed to be the possible causes for ventricular dysfunction. Presenting two patients who had marked decrease in global ventricular systolic function after relief of pericardial tamponade by subxyphoid pericardial window, we recommend gradual removal of pericardial fluid under hemodynamic monitoring, especially in patient with postcardiotomy tamponade.

The Correlation of Abdominal Organ Injury In Rib Fracture Patients

PURPOSE: Rib fracture is a common injury seen in traumatized patients. It can be frequently correlated with concomitant AOI (abdominal organ injury). This study was designed to assess the factors increasing the risk of concomitant AOI. METHOD: We reviewed retrospectively the medical charts of 166 rib-fracture blunt-trauma patients. Data were collected on age, sex, the vectors of injury, the rib-fracture location, the presence of a pneumothorax or a hemothorax, and the presence injury to the abdominal organs. RESULT: The total number of AOI cases correlated with rib fractures was 36 (21.7%). The most frequently injured organ was the liver (13 cases). The probability of AOI increased with the presence of any low-rib fracture. Also, the probability of splenic injury increased with the presence of left-sided rib fracture. There was no difference in the incidence of AOI-correlated pneumo- or hemothorax. CONCLUSION: Low-rib fracture increases the risk of AOI as were taught traditionally. The most commonly injured organ was the liver. Injury to the spleen was correlated with the location of the fracture, especially the left side.