• Journal of Chest Surgery
• /
• 제52권1호
• /
• pp.32-35
• /
• 2019

Surgical management of interrupted aortic arch (IAA) with systemic outflow tract obstruction is clearly a challenge. If both ventricles are adequate, the Yasui operation is a useful option. Otherwise, a staged approach through initial hybrid palliation and delayed biventricular repair, tailored to the degree of obstructed outflow, serves to avoid a high-risk neonatal procedure. Herein, we present a patient with IAA and severe systemic outflow tract obstruction whose treatment involved hybrid palliation, followed by a Yasui operation.

• 대한수의학회지
• /
• 제55권3호
• /
• pp.209-211
• /
• 2015

An 8-year-old spayed female Maltese (2.5 kg of body weight) presented with the primary complaint of loud heart murmur and exercise intolerance. Diagnostic imaging revealed severe pulmonic stenosis (peak velocity 5.2 m/s) with right ventricular hypertrophy. The dog revisited after 2 years, at which time, diagnostic imaging revealed severe biventricular hypertrophy, dynamic left ventricular outflow tract obstruction, left atrial dilation and pulmonary hypertension with worsened pre-existing pulmonic stenosis. Postmortem investigation revealed hypertrophic cardiomyopathy and regional myocardial infarction. The case was diagnosed as hypertrophic cardiomyopathy secondary to severe right and left ventricular outflow tract obstruction.

• Journal of Chest Surgery
• /
• 제57권4호
• /
• pp.413-417
• /
• 2024

A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

• Journal of Chest Surgery
• /
• 제43권6호
• /
• pp.725-728
• /
• 2010

횡문근육종은 영아에서 발생하는 가장 흔한 심장 내 양성종양으로 많은 수에서 그 크기가 감소하여 자연 소멸되는 것으로 알려져 있다. 하지만 일부 환자에서는 성장의 기능적 문제를 야기하여 수술적 치료를 필요로 하기도 한다. 환아는 산전 초음파에서 심실 내 다발성 종양이 발견되었으며 출생 직후부터 심한 좌심실 유출로 폐쇄로 인한 심장기능부전이 발생하였다. 생후 1일째 응급으로 수술을 시행하였으며 대동맥 절개를 통한 경판막 접근법으로 유출로를 막고 있는 종양의 일부분만을 절제하였다. 수술 후 시행한 초음파에서 유출로 폐쇄가 완전히 없어진 것을 확인할 수 있었으며, 3년간 정기적으로 경과 관찰한 결과 남아있는 종양은 그 크기가 점차 줄어드는 것을 확인할 수 있었다.

• Journal of Chest Surgery
• /
• 제27권2호
• /
• pp.157-160
• /
• 1994

Primary tumors of the heart are extremely rare, and about 25 per cent of primary cardiac tumors are malignant. Recently, We experienced a case of primary cardiac liposarcoma occurred on the right ventricular outflow tract and extended into the main pulmonary artery. The patient was 57 year-old man and the chief complaints was severe exertional dyspnea. Emergency operation to relieve the right ventricular outflow tract obstruction was performed under cardiopulmonary bypass. The tumor was 5$\times$4$\times$3 cm in size and infiltrated into the right ventricle and ventricular septum. The tumor in the main pulmonary artery was removed without any difficulty but the on the right ventricular outflow tract was difficult to remove completely. The patient was recovered without any specific problems. After successful surgical resection and postoperative radiotherapy the patient discharged with good condition. Herein, the clinical characteristics of cardiac liposarcoma, the problems in differential diagnosis, the prognosis and current therapy are reviewed.

• Journal of Chest Surgery
• /
• 제25권7호
• /
• pp.739-744
• /
• 1992

Discrete membranous subaortic stenosis[DMSS] is one of the subtype of congenital left ventricular outflow obstruction and can be associated with aortic regurgitation, infective endocarditis, ventricular obstruction. DMSS should be removed early, when diagnosed, and completely before secondary myocardial changes occur. Recently we experienced a case of DMSS with aortic regurgitation, and its left ventricular outflow tract obstruction[LVOTO] peak systolic gradient was 10lmmHg. Resection of membrane and aortic valve replacement is adequet for LVOTO and postoperative pressure gradient was 26mmHg. Postoperative echocardiogram shows no obstuctive membrane and well functioning aortic valve.

• 대한핵의학회지
• /
• 제22권1호
• /
• pp.47-53
• /
• 1988

Budd-Chiari syndrome (BCS) is a rare clinical entity characterized by post-sinusoidal portal hypertension caused by the obstruction to the hepatic vein outflow The diagnosis is suggested by hepatic scintigraphy and is usually confirmed by hepatic venography, inferior vena cavography and biopsy. The scintigraphic finding of BCS caused by the obstruction of main hepatic vein has been reported to consist typically of hypertrophy of the caudate lobe with increased radionuclide accumulation. Such a typical finding has been accounted for by the fact that the venous outflow from the caudate lobe is preserved when the main hepatic vein is obstructed. But usually, the hepatic venous outflow from the caudate lobe is also obstructed in BCS due to inferior vena caval obstruction. So hepatic scintigraphic findings of BCS due to inferior vena caval obstruction show different findings as compared with the BCS due to hepatic vein obstruction. We evaluate the hepatic scintigrams of the 13 cases of BCS due to inferior vena caval obstruction and review the literatures. The results are as follows : 1) We cannot observe the caudate lobe hypertrophy with increased uptake, which is known as a classic finding in BCS due to hepatic vein obstruction. 2) The most prominent hepatic scintigraphic findings of BCS are nonhomogenous uptake in the liver with extrahepatic uptake in the all cases. 3) We can see cold areas at the superior aspect of right hepatic lobe in 7 cases (54%). This is a useful finding suggesting BCS due to inferior vena caval obstruction.

• Journal of Chest Surgery
• /
• 제33권3호
• /
• pp.252-256
• /
• 2000

There have been few reports documenting the outcome of arterial swich operations(ASO) in selected patients with transposition of great arteries(TGA) and with left ventricular outflow tract obstruction(LVOTO). In the case of TGA with LVOTO, if the atrial septal defect(ASD) is large and the ventricular septal defect(VSD) is restricive, this deprives the left ventricle(LV) of approporiate preload and could lead to underdevelopment of the ventircular mass and lead poor LV performance after the arterial switch operation, dspite a high pressure in the LV preoperatively. Because an increase in the systolic ventricular pressure is not necessarily paralleled by an increase in ventricular mass, which is also essential for optimal ventricular performance after the operation. We report here a case of rapid LV training after ASO in TGA with unprepared LV (because of large ASD and restrictive VSD) despite a high pressure in the LV(due to LVOTO) preoperatively.

• Journal of Chest Surgery
• /
• 제22권5호
• /
• pp.766-774
• /
• 1989

Four neonates with critical pulmonary outflow obstruction underwent emergency palliative operation between February 1988 and May 1989 at the department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital. There were three boys and one girl, the mean age was 12.25 days [ranging from 3 days to 26 days], and the mean body weight was 3,625 gm [ranging from 3,450 gm to 4,200 gm]. Two patients had severe pulmonic valvular stenosis with intact ventricular septum, a third had pulmonary atresia with intact ventricular septum, and another had pulmonary atresia with ventricular septal defect. All were cyanotic, showed arterial desaturation with metabolic acidosis, and had congestive heart failure. To relieve the pulmonary outflow tract obstruction, we performed transventricular pulmonary valvulotomy [Brock operation] with a mosquito clamp in all cases without extracorporeal circulation. Three patients survived the operation and showed satisfactory postoperative results. The patient who had pulmonary atresia with ventricular septal defect expired 5 days after surgery. We consider transventricular pulmonary valvulotomy [Brock operation] with a mosquito clamp as one of the preferable procedures for critical pulmonary outflow obstruction in the neonatal period.

• Journal of Chest Surgery
• /
• 제41권3호
• /
• pp.363-365
• /
• 2008

부승모판막(accessory mitral valve tissue)은 매우 드문 선천성 심장병이며, 좌심실 유출로 협착(left ventricular outflow tract obstruction)의 드문 원인 중의 하나이다. 심수축기시에 부승모판막이 낙하산처럼 펴지며 잡아당기고 있어서 앞승모판막첨(anterior mitral valve leaflet)이 좌심실 유출로 쪽으로 당겨지면서 유출로 협착을 유발한다. 저자들은 본 환자에서 심초음파 검사를 통해 대동맥판막하 협착(subaortic stenosis)의 진단 하에 수술을 하였으며, 수술 중 부승모판막을 화인하고 수술을 하였기에 증례 보고를 하는 바이다.