Nuclear Medicine Methods of Rejection Diagnosis in Transplanted Rat Model / 대한흉부외과학회지

BACKGROUND: An accurate diagnosis of the severity of the rejection after a heart transplantation relies on endomyocardial biopsy, but because of its invasiveness and the need for repeated examination makes it is an inappropriate monitoring method. Therefore, we have tried to find a monitoring method that is continuous and less invasive. MATERIAL AND METHOD: Heterotopic heart transplantation using Ono-Lindsey Method was done in 20 rats, and then 99mTc-Pyrophosphate (PYP) scan was done after a month. Uptake ratio of transplanted heart to vertebrae (H/V) was obtained to be compared with the biopsy result. RESULT: Rejection was defined when the H/V uptake ratio was higher than 0.09, and we compared the uptake ratio with the results of biopsy. The result was true positives was 3, true negatives 12, false negatives 2, andfalse positives 3. Therefore sensitivity was 60% and specificity was 80%, diagnostic value was 75%. CONCLUSION: 99mTc-Pyrophosphate (PYP) scan was a useful method for the evaluation of the heart transplantation rejection and it will be helpful for monitoring rejection as an non-invasive and simple method.

Taussig-Bing Anomaly with Coarctation of Aorta / 대한흉부외과학회지

The patient was a 30-day-old female infant with symptoms of severe dyspnea and cyanosis, when she was admitted to the ER. The echocardiography revealed DORV with subpulmonary VSD, and the diagnosis of Taussig-Bing anomaly was made. Two days after admission, an urgent operation was performed. The operation consisted of intraventricular tunnel repair and arterial switch operation. She was discharged, and after checking her chest X-ray through OPD, there was no interval change of cardiomegaly. She was then re-admitted, and the angiography revealed coactation of aorta. We performed a resection and end-to-end anastomosis of aorta. She is currently in good condition 11 months postoperatively.

The comparision of Right anterolateral thoracotomy and Median sternotomy in the Atrial Septal Defect repair / 대한흉부외과학회지

BACKGROUND: Currently, atrial septal defect repair has been considered low risk operation due to the development of open heart surgery. Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. MATERIAL AND METHOD: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy (group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. RESULT: The mean weight of group A was 38.77+/-15.57kg and 38.21+/-21.82kg in group B. In group A, mean operation(OP) time was 197.6+/-61.40min, mean cardiopulmonary bypass(CPB) time was 48.66+/-13.02min and mean fibrillation time or aortic cross clamp (ACC) time was 30+/-11.64min. In group B, mean OP time was 212.33+/-31.95min, mean CPB time was 55+/-12.10min, and mean fibrillation or ACC time was 29.33+/-9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78+/-0.78 hours, mean postoperative ICU stay was 1.2+/-0.47 days and mean postoperative hospital stay was 10.20+/-1.08 days. In group B, mean mechanical ventilation time was 5.95+/-3.73 hours, mean post operative ICU stay was 1.41+/-0.61 days, and mean postoperative hospital stay was 12.20+/-3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33+/-90.54cc vs 352.33+/-239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block. CONCLUSION: Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument (p<0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.