The internal jugular vein as an alternative venous access for a revision of a fractured implantable cardioverter-defibrillator lead

No abstract available.

Intracardiac foreign body caused by cement leakage as a late complication of percutaneous vertebroplasty

No abstract available.

Transient Constrictive Pericarditis after Coronary Bypass Surgery

Constrictive pericarditis is a rare complication after coronary artery bypass grafting In most cases pericardiectomy is required as a definitive treatment. However, there are several types of constrictive pericarditis such as transient cardiac constriction. Some types of constrictive pericarditis can only be managed with medical therapy. We report a 72-year-old female patient who developed subacute transient constrictive pericarditis with persistent left pleural effusion as a result of postcardiac injury syndrome. The patient went through coronary bypass surgery that was successfully treated with postoperative steroid therapy.

The Management of Heparin-induced Thrombocytopenia with Thrombosis after Open Heart Surgery: A Case Report / 대한구급학회지

Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated adverse reaction to heparin therapy. It is caused by antibodies binding to a complex of heparin and platelet factor 4, and this leads to platelet activation, excessive thrombin generation and often thrombosis. HIT with thrombosis (HITT) can lead to limb amputation, stroke, myocardial infarction and death. We report here on a case of a HITT patient who was successfully managed with argatroban therapy. Further knowledge is need about the ideal medical management for HITT.

The Management of Heparin-induced Thrombocytopenia with Thrombosis That Developed after Aortic Dissection Surgery / 대한흉부외과학회지

Heparin-induced thrombocytopenia (HIT) is a clinicopathologic condition and adverse drug reaction caused by immunoglobulin G (IgG) antibodies directed against the heparin-platelet factor 4 complex. HIT with thrombosis (HITT) could lead to limb amputation, stroke, myocardial infarction, and death. We report on the successful management of a HITT patient with argatroban therapy.

Intracardiac Migration of a Renal Stent from the Left Renal Vein to the Right Ventricle during the Treatment of Nutcracker Syndrome: A case report / 대한흉부외과학회지

We report her on a rare case of a renal stent that migrated into the right ventricle in a patient with nutcracker syndrome. A 29-year-old woman was admitted to the hospital and she was suffering from flank pain. The computed tomography of the abdomen demonstrated that the left renal vein was compressed between the abdominal aorta and the superior mesenteric artery (nutcracker syndrome). A self expandable stent was placed across the left renal vein for treating her nutcracker syndrome. The next day after the procedure, the follow up chest radiograph showed that the displaced stent had migrated into the right ventricle. After percutanous endovascular stent removal had failed, the stent was ultimately removed by performing cardiac surgery. At the 6th postoperative month, there have been no abdominal or cardiac symptoms.

Ruptured Penetrating Atherosclerotic Ulcer of the Aortic Arch in a Patient with a Previous History of Replacing the Descending Thoracic Aorta / 대한흉부외과학회지

Aortic disease usually recurs after aortic surgery in the form a new aneurysm distal to the previous operation site, and finding a penetrating atherosclerotic ulcer proximal to the previous operation site has rarely been reported. We report here on a case of successful patch repair of a ruptured penetrating ulcer in the distal aortic arch, and this developed late after replacement of the descending thoracic aorta.

Development of Korean Model for Independent Organ Procurement Organization / 대한이식학회지

PURPOSE: The aims of this project were to increase organ donation by developing potential brain dead donor actively and to provide basic data to settle up independent Organ Procurement Organization (OPO) in Korea. METHODS: Hospital based Organ Procurement Organization (HOPO) of Keimyung university worked as a regional OPO and all the reported potential brain dead patient were treated by OPO team during May through October, 2007. Every reported and confirmed brain dead patient was evaluated for their eligibility of organ donation and these organs were allocated by Korean Network for Organ Sharing (KONOS). In order to increase the development of organ donation, campaign was done for public and medical personnels. To estimate the capacity of brain death donor pool, medical records of the dead patients with brain injury were evaluated. Accommodations and educations to the care-giver to the potential donor, neurosurgeon, neurologist and emergency department physicians were also done. For standardization of potential donor care, frame a clinical pathway of the care of the potential donor from the data of computerized records. The cash flow of whole process from developing potential donor to final procurement of organs were calculated to provide minimum expenses for operating Independent OPO in our environment. RESULTS: Total 33 solid organs were procured from 11 brain dead donor during the experimental period. Twelve more organs were possible to donate but not procured because there were no matched recipient at that time. The reported number of potential donor was increased 2.5 times, compare to the same period of previous year (19 from 5 hospital in 2006 but 47 from 14 collaborating hospitals in 2007). Among 47 notified potential donor, only 11 were succeeded to procure. The reasons of failure for procurement in 36 patients were no familial consent in 12, poor patient condition to donate in 9, not in brain death criteria in 15. These results mean that we have at least 21 more potential donors if we can get familial consent and use marginal donor, and early notification. Mean medical expenses were 3 million won for individual expense beside insurance coverage and 5 million won for management expense of donor care from the detection to organ procurement. CONCLUSION: Our results showed the number of the potential donor and actual organ donation can be increased by continued active relationship with regional hospital and adequate care of the donor. The big gap between the profit from our donor care and calculated donor management expenses of IOPO can be progressively covered by increasing number of brain dead donor, increasing procurement rate and increasing organ fee paid by recipient. But for a certain periods, financial support is necessary to settle up IOPO. Our result can be used as a basic data for management plan of IOPO in the future.

Low Molecular Weight Heparin Treatment in Pregnant Women with a Mechanical Heart Valve Prosthesis

No definitive recommendation is available concerning optimal antithrombotic therapy in pregnant women with a mechanical heart valve. The purpose of the current study was to evaluate the clinical results of nadroparin treatment with respect to pregnancy outcome and maternal complications. From 1997 to 2005, 31 pregnancies were reviewed in 25 women. Nadroparin (7,500 U, twice daily) was used in 23 pregnancies between 6 and 12 weeks of gestation and close-to-term only, and coumarin derivatives were used with aspirin at other times. Eight pregnant women treated with coumarin derivatives throughout pregnancy were compared to evaluate the safety and efficacy of nadroparin. No maternal death or bleeding complication occurred in either of the two groups, and frequencies of maternal thromboembolism including valve thrombosis (8.7% vs. 12.5%, p>0.05) were similar. However, the frequencies of live born (91.3% vs. 50%, p=0.01) and healthy babies (90.4% vs. 25%, p<0.01) were significantly higher, and the fetal loss rate was significantly lower (8.7% vs. 50%, p=0.01) in the nadroparin-treated group. Regarding the efficacy and safety of antithrombotic treatment in pregnant women with prosthetic heart valves, nadroparin treatment during the first trimester is an acceptable regimen and produces better results than coumarin derivatives.

Innominate Artery Rupture after Blunt Chest Trauma / 대한흉부외과학회지

A rupture of an innominate artery caused by blunt trauma is relatively rare because this artery is short and protected by the chest bony cage. This report describes a 25-year-old man who suffered a traffic accident, that resulted in an innominate artery rupture, which was detected by a chest computed tomogram and angiogram. This patient underwent urgent surgery through a right clavicular incision and median sternotomy without a cardiopulmonary bypass due to multiple injuries. An approximately 3 cm sized injury was found from the innominate artery to the proximal right subclavian artery and the origin of the common carotid artery. The injured lesion was repaired with a saphenous vein patch. After surgery, he was discharged from hospital without complications.

Repair of Postinfarct Subacute Left Ventricular Free Wall Rupture Using Fibrin Glue / 대한흉부외과학회지

The mortality of left ventricular free wall rupture after acute myocardial infarction is high; however, subactue myocardial rupture can be diagnosed by echocardiogram and the use of the intraaortic balloon pump reduces the incidence of re-rupture. Bleeding from subacute myocardial rupture can be managed by employing fibrin glue and several patches. We report here on a case of successfully managed case of subactue left ventricular free wall rupture after acute myocardial infarction with using the sutureless technique and fibrin glue.

Surgical Treatment of Delayed Traumatic Anuerysm of the Innominate Artery : A case report / 대한흉부외과학회지

The innominate artery aneurysm is an uncommon entity. A 36-year-old man was transferred to our hospital because of incidental finding of right superior mediastinal mass. He had a history of blunt chest trauma due to automobile accident 16 years earlier. Computed tomography scanning demonstrated 5-cm sized sacular aneurysm with thrombus at the innominate artery. The prosthetic bifurcated bypass grafting from the ascending aorta to the right common carotid artery and right subclavian artery was performed under the moderate hypothermic cardioplumonary bypass. We report a successful surgical treatment for a rare case of the innominate artery aneurysm.

Successful Treatment of Lower Extremity Malperfusion Caused by Acute Aortic Dissection / 대한흉부외과학회지

Organ malperfusion may mask the presence of aortic dissection and is one of major cause of death in patient with aortic dissection. Several key mechanism appear to contribute to the development of malperfusion, therefore optimal choosing of treatment is necessary to obtain better result. In cases of extremity malperfusion, open bypass procedures have been used for primary treatment, but noninvasive interventional procedures are also recommended as good alternatives in some cases. Here in, we report a case of successful aortic replacement followed by stent insertion in patient with extremity malperfusion caused by acute aortic dissection.

Preventive Effect of Conduit Vessel Spasm after Coronary Artery Bypass Grafting Surgery / 대한마취과학회지

BACKGROUND: Use of radial artery (RA) for coronary artery bypass grafting (CABG) is an increasingly common practice. The objective of our study was to compare the effects of two drugs as antispastic agents in patients undergoing CABG. METHODS: Sixty patients, submitting to CABG using the RA, were randomly assigned to two treatment groups (n = 30 in each group). Following the induction of anesthesia, the two groups were administered either 0.2-2microgram/kg/min nitroglycerin or 0.05-0.1 mg/kg/hr diltiazem as a continuous IV infusion. CABG in both groups was performed as per standard surgical protocol. RESULTS: The peak serum creatinine phosphokinase-MB level (59.3 ng/ml for nitroglycerin treatment versus 57.7 ng/ml for diltiazem treatment), postoperative ejection fraction (52.3% versus 48.4%), duration of stay in the ICU and total length of hospital stay were not significantly different between the groups (P > 0.05). However, the need for inotropic agents to prevent or treat intraoperative hypotension was less for patients in the nitroglycerin group than for patients in the diltiazem group (60.0% to 83.3%). CONCLUSIONS: Our results indicate that nitroglycerin is superior to diltiazem as an antispastic agent. We suggest that nitroglycerin should be the agent for choice for the prevention of conduit RA spasm.

Comparison of Myocardial Protective Effect between the Cold Blood Cardioplegia and Histidine-Tryptophan-Ketoglutarate Solution / 대한흉부외과학회지

Background: Blood cardioplegia is known as an established cardioplegic solution during open heart surgery. Recently, the Histidine-Tryptophan-Ketoglutarate (HTK) solution has been introduced as a cardioplegia in Korea. This study was designed to compare the myocardial protective effect between the cold blood cardioplegia (CBC) and HTK solution. Material and Method: Forty patients who underwent valve surgery or coronary artery bypass surgery were randomly divided into CBC group (n=20) and HTK group (n=20). The perioperative hemodynamic and clinical data were analyzed. The concentration of CK-MB, Troponin I and Lactate from coronary sinus and radial arterial blood were compared for the evaluation of the myocardial damage. The postoperative serial CK-MB levels were measured. Result: The characteristics of preoperative patients were similar in two groups. The hemodynamic parameters and postoperative clinical data were also similar between the two groups. There were no statistical significances between the CBC and HTK group in the difference of biochemical markers: delta CK-MB (15.3+/-26.0 vs 19.3+/-14.3), delta Tro-I (2.4+/-4.9 vs 2.0+/-2.20), delta Lac (1.6+/-1.0 vs 1.9+/-2.5). The serial CK-MB levels were not significantly different between the two groups. Conclusion: These results suggested that the myocardial protective effect of HTK solution was similar to cold blood cardioplegia during open heart surgery.

A Case of Infective Endocarditis in Renal Transplant Recipient Successfully Treated by Valve Annuloplasty / 대한이식학회지

Infectious complications are the leading causes of morbidity and mortality among kidney transplant recipients. Infective endocarditis has been reported as a rare complication in kidney transplant recipients and substantially impacts kidney transplant recipient survival. The early diagnosis of endocarditis is essential in order to initiate appropriate antibiotic treatment. In selected cases, surgery can be undertaken to prevent significant subsequent morbidity and mortality. We report a case of subacute bacterial endocarditis due to beta- hemolytic streptococcus in a 25-year-old kidney transplant recipient, which was successfully treated with antibiotics and valve annuloplasty.

Clinical Characteristics of Pleomorphic Carcinoma / 대한흉부외과학회지

BACKGROUND: The research sought to identify the clinical features of pleomorphic carcinoma of the lung generally known as a rare subtype in accordance with the lung cancer classification done in 1999 by WHO. MATERIAL AND METHOD: 256 cases of surgically resected lung cancers were collected in this hospital from January 1992 to December 2001. This study included 42 cases of pleomorphic carcinoma diagnosed through light microscope and immunohistochemistry. RESULT: Out of 42 cases, males represented 31, and females 11, the age ranged from 26 to 77. Main clinical symptoms included coughing, hemoptysis, sputum. Diagnoses disclosed the stage as stage Ia in 3 cases (7%), Ib in 16 (38%), IIa in 1 (2%), IIb in 8 (19%), IIIa in 15 (35%), and IIIb in 1 (2%). Out of these, no lymph node metastasis was represented in 23 cases (54%), while N1 and N2 involving lymph node metastasis was shown 19 cases (46%). A total of 19 patients developed metastasis, comprising the brain in 5 cases (26%), bone in 4 (21%), muscle in 4 (21%), Lymph node in 2 (10%), and 1 liver, ovary, contralateral lung, and adrenal gland, respectively. The size of the tumor ranged from 1 cm to 11 cm, averaging 5.85 cm. Out of the 42 patients, the total two-year and five-year survival rates in accordance with the Kaplan-Meier method represented 26% and 13%, respectively, These figures compared to the corresponding 44% and 34% in cases other than pleomorphic carcinoma from the survey target of 256 cases, proved to be significantly low (p <0.002). No significant difference was found in the survival rates compared between age and tumor size, between stage I and above stage II, and between N0 and above N1. Patients who developed postoperative metastasis all died, and showed significantly low survival rates (p <0.002) compared to those patients without metastasis. CONCLUSION: With the new diagnosis method of 1999 WHO's lung cancer classification applied, pleomorphic carcinoma showed a higher prevalence rate than under previous classifications, their postoperative survival rate was significantly low compared to histologic type of non small cell lung carcinomas.

Bidirectional Cavopulmonary Shunt for Isolated Right Ventricular Endomyocardial Fibrosis / 대한흉부외과학회지

A 44-year-old man had been admitted for dyspnea on exertion and abdominal distension. The echocardiography revealed abnormal mass in right atrium and tricuspid valve stenosis with right ventricular obliteration. The operation was performed with mass removal, enlargement of tricuspid valve opening, and right ventricular endocardiectomy. And then, atrial septal defect was made due to inadequate right ventricular volume. The patient's symptom was improved and he discharged without events. The endomyocardial fibrosis was diagnosed with microscopic examination. Eighteen months later, the patient was readmitted due to aggravated dyspnea and cyanosis. The right ventricular obliteration was progressed and pulmonary blood flow was severely decreased in follow up echocardiography. Palliative bidirectional cavo-pulmonary shunt was performed due to functional single ventricle. The dyspnea and cyanosis was markedly improved. Bidirectional cavo-pulmonary shunt for advanced and isolated right ventricular endomyocardial fibrosis provided effective palliation at early postoperative period, However, long-term follow up is mandatory.

Surgical Treatment of Complete Atrioventricular Septal Defect with Tetralogy of Fallot: Report of one case / 대한흉부외과학회지

We experienced primary repair of complete atrioventricular septal defect with Teralogy of Fallot.The diagnosis was established preoperatively by echocardiography,cardiac catheterization and cardioangiography.Repair was accomplished using cardiopulmonary bypass.Two patch techinque were performed using Dacron patch for ventricular septal defect and pericardial patch for atrial septal defect.Infundibullectomy and right ventricular outflow tract reconstruction with the transannular pericardial patch were performed.The postoperative echocardiography showed mild mitral and tricuspid regurgitation,but there were no hemodynamic abnormalities.

Transhiatal versus Transthoracic Esophagectomy for Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: The classic approach for esophagectomy is via the combined thoracic and abdominal approach. Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, severity of leak, morbidity/mortality, and length of stay, but may represent an inferior cancer operation as a result of survival disadvantage due to inadequate mediastinal clearance compared with ILO. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. MATERIAL AND METHOD: From January 1993 to July 2001, We performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan Medical Center; 27 underwent THO, and 45 underwent ILO RESULT: The two groups were comparable in terms of age, sex, and stage of the disease. Mean tumor length and mean operative time were 3.81cm and 354 minutes for THO versus 5.31cm and 453 minutes for ILO, respectively (p < 0.01 and p < 0.001). Respiratory complications were 11.1% for THO versus 35.6% for ILO(p < 0.05). Hospital mortality was 11.1% for THO versus 22.2% for ILO. There were no significant differences between THO and ILO with respect to other types of complications, amount of blood transfusion, leak and stricture rates, and hospital stay. Overall long-term survival at 5 years was 37%, respectively. CONCLUSION: There was no significant difference in long-term survival of patients of both operative approach. ILO had significantdifference in respiratory complications associated with hospital mortality. Hence, THO is a valid alternative to ILO for well selected patients. And either approach appears to be acceptable depending on the surgeons, preferences and experiences.