Intracardiac Repair of the Coronary Sinus Laceration during Retrograde Cardioplegia: A case report / 대한흉부외과학회지

Coronary sinus injuries related to the use of retrograde cardioplegia are rare and have potentially lethal complications. This report describes a case of coronary sinus laceration during retrograde cardioplegia in an old patient with mitral valve regurgitation, endocarditis, and left ventricular hypertrophy, and tells the details of the method of intracardiac repair.

Transluminal Radio-Frequency Thermal Ablation Using a Stent-Type Electrode: an Experimental Study

PURPOSE: To assess the feasibility of transluminal radiofrequency thermal ablation using a stent-type electrode and to determine, by means of in-vitro and in-vivo animal studies, the appropriate parameters. MATERIALS AND METHODS: In vitro: The radiofrequency electrode used was a self-expandable nitinol stent with 1cm insulated ends. A stent was placed in the portal vein of bovine liver, and ablations at target temperatures of 70, 80, 90, and 100degrees C were performed. Ablated sizes were measured longitudinally. In vivo: Four mongrel dogs were anesthetized, and a stent was inserted in the common bile duct under fluoroscopic guidance through an ultrasound-guided gall bladder puncture site. The ablation temperature was set at 80 degrees C, and each dog underwent proximal and distal esophageal ablations lasting 12 minutes. They were sacrificed immediately. RESULTS: In-vitro: Ablated sizes showed significant correlation with target temperatures (r>0.04; p<0.05). Although most lesions were fusiform, dumbbell-shaped lesions with central thinning were found in two cases in the 70degrees C group. In all cases in the 70 degrees C and 80 degrees C group, the length of the insulated segment was less than 1 cm. In-vivo: At microscopy, tissues at the center of the biliary stent showed more prominent pathological change than those at the periphery while those remote from the stent showed minimal or no change. In esophageal ablations, the mean highest temperature was 48.6 degrees C. Microscopy demonstrated the destruction and shedding of mucosa, edema, and coagulation necrosis of submucosa, but in muscle layers no abnormalities were apparent. CONCLUSION: Transluminal radio-frequency thermal ablation using a stent-type electrode may be useful for elongating patency. The appropriate target temperature for biliary ablation is 80 degrees C.

Development of an Abdominal Aortic Aneurysm Model for Stent-graft Insertion

PURPOSE: To determine the efficacy of an abdominal aortic aneurysm model for stent-graft placement. MATERIALS AND METHODS: The model consists of two parts, the heart and the vascular system. A peristaltic pump and a solenoid valve were used to simulate a pulsatile flow from the heart. A ball-shaped piece of clay was placed inside a square box and liquid silicone was poured. After the silicone was formed, the clay was removed and a silicone tube was used to connect the heart model and the aneurysm model. The silicone tube was also used to simulate the iliac arteries and one end of the artery was clamped and the other one was extended to a water bath. Water at 37 degrees was circulated through the model, and the pressure at the thoracic aorta, aneurysm and iliac artery was measured with the outlet valve opening at 25, 50, and 100% before and after stent-graft placement. RESULTS: The liquid pressure measurements were 253/252, 271/162 and 264/166 mmHg at the thoracic aorta, aneurysm and iliac artery, respectively, when the outlet was 100% open. They were 173/121, 145/99, 145/106 mmHg when the outlet was 50% open, and 35/28, 61/44, 24/22 mmHg when it was 25% open. After placement f the stent-graft, the pressure measurements were 170/132, 174/128, and 167/128 mmHg, respectively. CONCLUSION: Since it was easy to produce, the model was useful for in-vitro stent-graft testing, and a wide range of pressure could be applied.

Effects of Leukocyte Depleted Priming Solution on Cardiopulmonary Edema by Extracorporeal Circulation / 대한흉부외과학회지

BACKGROUND: Extracorporeal circulation using pump-oxygenator is an inevitable process to keep vital sign during cardiac arrest for open heart surgery. However, the diversion of blood through nonendothelialized channels appears to stimulate inflammatory response, and leukocyte activation may lead to cardiopulmonary edema. Our study evaluated the effect of leukocyte-induced cardiopulmonary edema using three different pump-oxygenator priming solutions; non-hemic crystalloid solution ; leukocyte-depleted homologous blood; non leukocyte-depleted homologous blood in priming solutions. MATERIAL AND METHOD: Each different priming solution was used on five dogs, and the effect of leukocyte-induced cardiopulmonary edema during cardiopulmonary bypass(CPB) was evaluated. For each dog after 2 hours of exracorporeal circulation and another 4 hours of post-pump period, the dog was sacrificed and its heart and lung tissues were obtained for measuring Wet/Dry ratio. Arterial O2 partial pressure(PaO2) and CO2 partial pressure(PaCO2) were checked. For the evaluation of ventilatory function, CO2 partial pressure difference between arterial blood (PaCO2) and exhaled air(EtCO2) was measured. RESULT: 1. No significant difference was seen in arterial PaO2 and PaCO2 among groups. 2. Ventilatory function evaluated by PaCO2 and EtCO2 showed no significant difference between non-hemic and blood-mixed priming solution (P<0.05). 3. Cardiac and lung Wet/Dry ratios were remarkedly lower in the leukocyte- depleted group. There was no significant difference between the non-hemic and blood-mixed groups. CONCLUSION: Based upon this result, we concluded that the leukocyte depletion from homologous blood of CPB priming solution has a beneficial effect in reducing cardiopulmonary edema compared with non leukocyte-depleted or crystalloid priming solutions.

Lung Volume Reduction Surgery in Patients with Severe Emphysema , 7 cases / 대한흉부외과학회지

BACKGROUND: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. MATERIAL AND METHOD: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. RESULT: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. CONCLUSION: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.

Valve Replacement in an Anuric Patient with Chronic Renal Failure: 1 Case Report / 대한흉부외과학회지

It is now generalized to perform cardiac surgery in the patients with end-stage renal disease. The growing number of patients with chronic renal failure wake us up to the need to prepare for proper management. There are not only the prevalence of coronary artery disease, but also a great amount of valve dysfunction exist in this group. Peritoneal dialysis may be one of the obstacles for cardiopulmonary bypass but it is not a great hindrance in cardiac surgery with careful preparation and well organized perioperative care. The author has performed mitral valve replacement in a 33-year-old anuric female patient with chronic renal failure and severe mitral insufficiency. Preoperatively, the patient was kept in adequate fluid and electrolyte balance using peritoneal dialysis. Peritoneal dialysis continued and regulated according to the laboratory data in this patient during and after the surgery. She recovered well showing an uneventful course and was discharged on postoperative 1 th day.

Primary Malignant Melanoma of the Esophagus: A Case Report / 대한흉부외과학회지

Primary malignant melanoma of the esophagus (PMME) is an uncommon neoplasm. And the world literature reports only about 200 cases. A case of primary malignant melanoma of the esophagus is presented, and followed by review of the literature. In our patient, the walnut-sized melanoma was located at the midportion of esophagus and there were two small satellite lesions at the esophagogastric junction. The main mass was diagnosed as primary malignant melanoma histologically and immunohistologically. The tumor was curatively resected by the transthoracic subtotal esophagectomy and the 2 fields node dissection. Post-operative immunotherapy was performed but the tumor recurred 7 months later at the stomach.