Early Results of Coronary Artery Bypass Grafting Using Multiple Arterial Grafts / 대한흉부외과학회지

BACKGROUND: Coronary artery bypass grafting(CABG) has been established as an effective treatment modality in improving the symptoms of ischemic heart disease as well as in preventing sudden death. Since the relatively wide use of arterial grafting in the 80's, an improvement in long term patency rates compared with saphenous vein grafting has been suggested. We have been using multiple arterial grafts since 1998, and we attempted to compare our early results with those of saphenous vein grafting. MATERIAL AND METHOD: Out of the 355 patients that received CABG at our center between June,1998 and May,1999, 153 patients that used cardioplegia were reviewed. 76 had received single arterial graft(Group I) and 77 had received more than 2 arterial grafts(Group II). Preoperative clinical data, ecohocardiography, and angiographic studies were analyzed retrospectively. RESULT: Preoperatively, there were statistically significant differences between Group I and Group II with respect to age and smoking history. There was one early postoperative mortality in each group. The number of anastomoses constructed per patient showed a statistical difference. There were no other differences in operative and postoperative results. CONCLUSION: Even in our learning period, there was no difference in our early results between arterial grafting and saphenous vein grafting. These early results suggest that arterial grafting may afford patients as improving in late survival. Futhermore, these results suggest that complete arterial revasularization may serve to prolong life expectancy.

The Clinical Analysis of 100 cases of Coronary artery Bypass Grafting with the Right Gastroepiploic artery / 대한흉부외과학회지

BACKGROUND: In an effort t enhance long term patency of coronary bypass grafts, utilization of arterial conduits have been on an icrease. With the same objective, we have been using the right gastroepiploic artery (RGEA) in coronary artery bypass procedures since 1998. The current paper has been undertaken with the aim of assessing the apropriateness, problems, and short term results of using the RGEA as an arterial graft conduit by studying the postoperative clinical results of 100 patients than received coronary artery bypass grafting (CARG) with this artery. MATERIAL AND METHOD: Between May of 1998 and May of 1999, an analysis of the mortality, postoperative myocardial infarction, and the need for IABP insertion as a result of low cardiac output were made between 100 consecutive patients undergoing CABG with the RGEA. There was one postoperative death due to cerebral infarction. Postoperative complications/morbidity comprised myocardial infarction in 2, cerebral infarct in 3, reoperation due to bleeding in 1, mediastinitis in 1, and low cardiac output syndrome necessitating IABP in 3 patients. Complicatons related to harvesting of the arterial grafts were not experienced in any of the patients. CONCLUSION: The results of the current data show that utilization of the RGEA in CABG is not associated with increased mortality/morbidity and demonstrates satisfactory short term results suggesting the usefulnessof this conduit as an arterial graft.

Valvuloplasy in Mitral Regurgitation: available option in Young rheumatic mitral regurgitation patients / 대한흉부외과학회지

BACKGROUND: The present study was undertaken to assess the effectiveness of surgical repair as a method of treatment for rheumatic mitral regurgitation by comparing the results of mitral valvuloplasty(MVP) in rheumatic mitral regurgitation and degenerative mitral regurgitation. MATERIAL AND METHOD: Among the 184 MVP patients between January 1995 to December 1998, 49 Rheumatic mirtal regurgiation patients(Group I) and 72 degenerative mirtal regurgitation(Group II) patients were studied. The mean age in group I was 36.3+/-14.6(16-74) and in group II, 52.5+/-13.4(14-77) years. The total follow up duration was 72.2patient years for group I and 77.2 patient years for group II. The Echocardiography was performed preoperatively, at 6months and 1 year postoperatively, and then yearly thereafter in both groups. RESULT: Preoperatively, there were no hemodynamic differences between the two groups. The preoperative mitral regurgitation was 3.9+/-0.4 in group I and 3.9+/-0.3 in group II, but on follow up, both groups showed decrease of grade of regurgitation to 0.9+/-0.9 in group I and 0.8+/-0.7 in group II. The mitral valve area or the mean transmitral pressure gradient was not significantly different between the two groups. There was neither early nor late mortality in either group and the reoperation rate in group I was 1.4% per patient year and 2.6% per patient year in group II. The rate of thromboembolism in group I was 2.8% per patient year and 1.3% per patient year in group II. There was one bacterial endocarditis in group I. Statistical analysis of the data between the two groups failed to reveal any significant differences. CONCLUSION: Although the results of a long term follow up will be required, the current intermedite term study showed that repair was a viable option in the treatment of rheumatic mitral regurgitation.

Right Anterolateral Thoracotomy for Cardiac Surgery in the Adult / 대한흉부외과학회지

BACKGROUND: To secure a rapid and safe approach which is at the same time cosmetically appealing, we employed the right anterolateral thoracotomy incision for repair of atrial septal defects and valvular heart diseases in the adult. MATERIAL AND METHOD: Between October 1989 and June 1998, 44 adult patients underwent open heart surgery through right anterolateral thoracotomy at our institution. Operative time, cardiopulmonary bypass time, aortic cross clamp time, blood loss until chest tube removal, length of ICU stay, days to discharge, and survival were compared with those that received cardiac surgery via conventional sternotomy. RESULT: No significant differences were observed between the two groups. There was no death and no additional morbidity directly related to this approach. Cosmetically satisfying results were obtained with safety using the right anterolateral thoracotomy approach. CONCLUSION: Our data show that the right anterolateral thoracotomy approach is a safe alternative to conventional median sternotomy as it offers excellent exposure and aesthetically more acceptable wounds while not adding on to the operative risks.

Left ventricular muscle mass regression after aortic valve replacement

Implanting a valve that will reduce left ventricular mass is critical in aortic stenosis. Regression of left ventricular hypertrophy in 46 aortic valve replacement (AVR) patients receiving a St. Jude Medical (SJM) valve was assessed by serial electrocardiographic and echocardiographic studies during the preoperative, immediate, and late postoperative periods. The patients were divided into three groups according to valve size; 19 mm group (n=9), 21 mm group (n=20), and 23+mm group (n=17). There was no surgical mortality. The NYHA functional class improved from an average of 2.2+/-0.8 preoperatively to 1.3+/-0.5 post-operatively. Left ventricular muscle mass index (LVMI) regression failed to reach statistical significance in the 19 mm group, whereas in the other two groups a steady decrease in the LVMI occurred with follow up. ECG findings were less remarkable showing insignificant differences in voltage among the three groups (p=0.000). In conclusion, the current data suggest that the 19 mm SJM valve may not result in satisfactory left ventricular muscle mass regression despite adequate function, even in small patients. Therefore, additional procedures to accommodate a larger valve may be warranted in the aortic annulus smaller than 21 mm.

Pulmonary Hematocele Mimicking Posterior Mediastinal Mass: Two Cases Report

Closed chest trauma occasionally results in the development of traumatic lung cyst or pulmonary hematocele.Radiologically, this latter rarely mimicks posterior mediastinal mass, which can cause unnecessary surgicalresection, We encountered two cases of pulmonary hematocele simulating posterior mediastinal mass. Multiplicity ofthe lesion, fracture of surrounding bony structure, decrease of mass size at follow-up examination, an acute anglebetween the mass and chest wall, peripheral rim enhancement of the mass, as seen on CT scans, or characteristicsignal intensity suggesting hematoma, as seen on MR images, helped differentiate pulmonary hematocele fromposterior mediastinal mass.

A Case of Juvenile Granulosa Cell Tumor of the Ovary

Juvenile granulosa cell tumor (JGCT) is one of the sex cord stromal tumors of the ovary ocurring in the first two decades of life. These tumors are different from adult granulosa cell tumor (AJCT) with regard to clinical and pathological fetures. Follicles are often irregular, Call-exner bodies are rare, and luteinization is frequent. The tumor may be solid, cystic, or both. The most common presenting symptoms are abnormal uterine bleeding and pain. Breast swelling, pain and tenderness may also be associated with unopposed estrogen secretion by granulosa cell tumors. The tumor should be removed as soon as the diagnosis is estabilished. The juvenile granulosa cell tumor has a good overall prognosis because fewer than 5% of these tumors in children are malignant.

A Case of Nonfamilial Generalized Gastrointestinal Juvenile Polyposis with Pancytopenia

In contrast to the child with a solitary juvenile polyp, generalized gastrointestinal juvenile polyposis have a much different clinical course. In generalized juvenile polyposis blood loss can be considerable and iron-deficiency anemia is a common observation. Although it is usually regarded as a benign condition, juvenile polyposis may predispose to cancer of the gastrointestinal tract. We experienced a case of nonfamilial generalized gastrointestinal juvenile polyposis with pancytopenia in a 15 year-old male patient who had hospitalized because of intermittent rectal bleeding with anemia for three years. Histological examination of polyps from affected patient revealed a spectrum of change from juvenile polyps, to juvenile polyps with adenomatous changes. Subtotal colectomy, rectal mucosectomy, and endorectal pull-through procedure were successfully performed. No complication has occured since the discharge. A brief review of related literatures is also presented.

Vitreous Surgery for Macular Hole

Idiopathic macular holes are believed to arise from traction of the posterior vitreous membrane. Traditionally, macular holes have been considered as untreatable condition, but recently vitreous surgeries are being attempted to manage them. Pars plana vitrectomy in conjunction with separation of the posteror vitreous membrane and intraocular achieve visual improvement and anatomic reattachment in eyes with full thickness macular hole. A total of 9 eyes which included 2 eyes with stage 2 macular hole and 7 eyes with stage 4 macular hole underwent vitrectomy. The macular holes were successfully occluded in all 9 eyes and visual improvement of two lines or more was achieved in 6(67%) in which symptom duration was 3 months or less and/or hole size was 1/3DD or smaller. These results suggested that the full thickness macular holes would be surgically treatable lesions and better visual results can be expected in cases with shorter duration and smaller size.

Comparison of Pneumatic Retinopexy with Scleral Buckling in the Management of Rhegmatogenous Retinal Detachments

Pneumatic retinopexy(PR) is an alternative procedure to treat an uncomplicated rhegmatogenous retinal detachment with the retinal tear(s) within the superior 8 clock hours of the retina. To determine the efficacy of the PR, the authors treated 45 consecutive retinal detachment not exceeding proliferative vitreoretinopathy grade C2 with PR(PR group) and compared the results with those of 63 similar cases treated with scleral buckling procedure(SB group). Initially, 87% of PR group and 91% of SB group were reattached. However, overall cure rates with single operation decreased to 789,6 and 83%, respectively. With subsequent procedures, retinas were finally reattached in 98% and 94%, respectively. In eyes with preoperative macular detachment, vision was similarly improved 2 lines or more in 73% of PR group and in 77% of SB group after surgery. The incidence of the new breaks was higher in PR group than in SB group(9% vs 5%). Other postoperative complications including reopening of original tear, proliferative vitreoretinopathy, and delayed resorption of subretinal fluid were also noted with similar frequency in both group. These data suggest that PR would be a good alternative procedure in the selected cases of retinal detachments and initial failure with this procedure does not adversely affect the final retinal attachment.

Aorto-bicarotid-subclavian bypass in Takayasu's arteritis: one case report / 대한흉부외과학회지

No abstract available.