Effects of the combinations of amlodipine/valsartan versus losartan/hydrochlorothiazide on left ventricular hypertrophy as determined with magnetic resonance imaging in patients with hypertension.

BACKGROUND: Left ventricular hypertrophy (LVH), a marker of cardiac end-organ damage, is frequently found in patients with arterial hypertension and is associated with cardiovascular and cerebrovascular morbidity and mortality. Therefore, LVH regression is an important treatment goal. For amlodipine plus valsartan (A/V) no specific study on LVH has been reported to date. METHODS: Prospective, open-label, randomized parallel-group study. Patients with essential hypertension and LVH were randomized to 52-week treatment with A/V 10/160 mg (n = 43) or the active comparator losartan/HCT 100/25 mg (L/H, n = 47). Add-on medication was allowed in case of inadequate blood pressure control. LV parameters were measured by cardiovascular magnetic resonance imaging (MRI), and adjudicated in a blinded manner. Study identifiers were NCT00446563 and EudraCT 2006-001977-17. RESULTS: In addition to the study treatment, 35% of patients in the A/V group and 49% in the L/H group received additional antihypertensive medication. Compared to baseline, both treatments reduced measures of LVH significantly after 52 weeks (e.g. LV mass index in the A/V group from 64.7 g/m(2) by -3.5 g/m(2), in the L/H group from 69.1 g/m(2) by -4.4 g/m(2), p < 0.01 for both). LV ejection fraction and LV volumes were not significantly changed by any regimen. A/V and L/H treatments were well tolerated. CONCLUSIONS: Both regimen were effective in reducing LV mass compared to baseline and were well tolerated.

New technique for single-staged repair of aortic coarctation and coexisting cardiac disorder.

The management of adults with aortic coarctation and a coexisting cardiac disorder is still a surgical challenge. Single-staged procedures have lower postoperative morbidity and mortality rates than do 2-staged procedures. We present our experience with arch-to-descending aorta bypass grafting in combination with intracardiac or ascending aortic aneurysm repair.From October 2004 through April 2010, 5 patients (4 men, 1 woman; mean age, 45.8 ± 9.4 yr) underwent anatomic bypass grafting of the arch to the descending aorta through a median sternotomy and concomitant repair of an intracardiac disorder or an ascending aortic aneurysm. Operative indications included coarctation of the aorta in all cases, together with severe mitral insufficiency arising from damaged chordae tendineae in 2 patients, ascending aortic aneurysm with aortic regurgitation in 2 patients, and coronary artery disease in 1 patient. Data from early and midterm follow-up were reviewed.There was no early or late death. Follow-up was complete for all patients, and the mean follow-up period was 34.8 ± 18 months (range, 18 mo-5 yr). All grafts were patent. No late graft-related sequelae or reoperations were observed.For single-staged repair of aortic coarctation with a coexistent cardiac disorder, we propose arch-to-descending aorta bypass through a median sternotomy as an alternative for selected patients.

Aortic root and ascending aortic aneurysm in an adult with a repaired tetralogy of fallot.

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Aortic Root and Ascending Aortic Aneurysm in an Adult with a Repaired Tetralogy of Fallot

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Aortic Root and Ascending Aortic Aneurysm in an Adult with a Repaired Tetralogy of Fallot

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Treating a Ruptured Ascending Aorta with an Endovascular Stent Graft / 대한흉부외과학회지

Endovascular stent grafting is regarded as a promising alternative approach to open surgical repair for treating various aortic diseases in high risk patients. We report here on a case of a 79-year-old female who underwent endovascular stent-graft insertion in the ascending aorta for treating a complicated ascending aortic rupture that occurred secondary to radiation necrosis during the treatment of recurrent breast cancer.

The Surgical Treatment for Aorto-cutaneous Fistula after Open Heart Surgery: A case report / 대한흉부외과학회지

Aorto-cutaneous fistula is a rare complication after performing open heart surgery, but if this develops, it is a fatal condition. So, prompt diagnosis and aggressive surgical treatment is needed. We report here on a patient who had two mechanical double valves placed during heart surgery and she was treated for repeated sternal wound infections for about 5 years. She visited the ER due to abrupt bleeding at the sternal wound. She was diagnosed as having an aorto-cutaneous fistula by performing an aortogram and we then performed cardio-pulmonary bypass surgery. The patient is currently doing well and is under follow up 24 months after the repair.

Acute Aortic Injury after Nuss Bar Removal: A case report / 대한흉부외과학회지

Nuss operation as a method for correction of pectus excavatum is safe and satisfactory, but its complication presents pneumothorax, displaced bar, wound infection, pericarditis, pleural effusion, hemothorax, cardiac injury etc. We report a rare case of acute ascending aortic rupture after displaced and adhered Nuss bar removal. The patient was a 30-years old man who received Nuss operation 3 years ago. Nuss bar was removed without resistance but massively bled at both operation wound, so immediately femoro-femoral CPB and median sternotomy was done and repaired proximal aortic arch under deep hypothermic total circulatory arrest. The patient was discharged without complication at postoperative 13 day.

Surgical Therapy of Stanford Type A Acute Aortic Dissection: Dose intimal tear within replaced aortic segment make any differnce in its clinical characteristics / 대한흉부외과학회지

BACKGROUND: Stanford type A aortic dissection is a sur gical disease which has its intimal tear point somewhere in the aorta. The start ing intimal tear point of the type A aortic dissection has not been a common iss ue in the therapy of the aortic dissection. So we analysed our surgical cases of the type A acute aortic dissection subdivided by the location of intimal tear point. MATERIAL AND METHOD: Between M arch 1991 and July 1999, 40 patients with type A acute aortic dissection underwe nt surgical repair. In 27 patients intimal tear was found within the ascending a orta and aortic arch(Group I), but in 13 patients not found(Group II). All clini cal factors were compared between two groups and analized retrospectively. RESULT: The Group I had more s erious preoperative conditions such as shock, aortic regurgetation, cardiac isch emia and renal failure than the Group II. Group I had more aortic valve abnormal ies. Group II had more hematoma in the false lumen but it had no statistical sig nificance. Group II had more frequent postoperative renal dysfunction than Group I, but Group I had more reoperations from bleeding. The surgical mortality rate was 22.2 % in Group I and 0 % in Group II. CONCLUSION: The patients with ascending aortic intimal tear point had poor preoperative conditions and more ao rtic valve abnormalities, which resulted in the poor postoperative prognosis. Be sides the patients without ascending aortic intimal tear point developed intraop erative malperfusion of distal organ more frequently. Conclusively the prognosis of the patient without intimal tear in ascending aorta was better than that of the patient with intimal tear in ascending aorta.