• Journal of Chest Surgery
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• v.37 no.5
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• pp.452-455
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• 2004

We report a case of a 40-year-old woman whose right ventricular out-flow tract was moderately obstructed by a heavily calcified pericardial ring. It was passing over the base of pulmonary artery and mid-portion of left ventricle but the other parts of the pericardium was mildly fibrotic. The pericardium and calcified ring were completely removed under cardiopulmonary bypass. The patient was recovered uneventfully and we could not find the specific cause of calcified pericardial ring.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.785-788
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• 1996

Pericardial abscess due to liver abscess is a very rare disease, the result of which is usually fatal when untreated. But a combination of antibiotics therapy and pericardial drainage has broug t good result. A 32-year-old man was admitted to the emergency room because of fever and chilling sensation. Chest X-ray showed cardiomegaly and a mass lesion In the left lobe of liver on ultrasonography. The echocardiography revealed impending cardiac tamponade. Pus drainage of the liver abscess through per- foration of right diaphram and pericardiotomy were performed. The pericardium was thickened and 600 ml of purulent fluid and necrotic debris were drained. Fibrin clots were firmly attached to the undelying myocradium. Histological examination of the pericardium showed acute inflammation with microabsscess and Escherichia soli was cultured from pericardial pus. He was discharged after 4 weeks on antibiotics, but Doppler echocardiograpy revealed a slightly thickened pericardium with a mild constrictive physiology.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.392-395
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• 2005

Primary pericardial mesothelioma is extremely rare and the incidence is low among the mesotheliomas that originate from other parts of the body. The prognosis of the tumor is unfavorable due to its late presentation, difficulties in early diagnosis and complete resection, and the limited treatment options. Herein, we report a case of pericardial mesothelioma. The patient is a 55-year-old woman who presented with chronic cough and dyspnea. During the examination, pericardial effusion was found and pericardial window formation was followed. She visited our hospital because of persistent dyspnea, with right shoulder and chest pain. Four discrete masses were discovered in the chest CT. CT guided-fine needle aspiration biopsy was negative for malignancy. Right exploratory thoracotomy and partial resection of 3${\times}$3 cm mass abutting pericardium was performed and was histologically diagnosed as malignant mesothelioma, biphasic type. Pericardial mesothelioma is rare, but it should be remembered as an important differential diagnosis in patients with persistent pericardial effusion and symptoms of dyspnea and constrictive pericarditis.

• Tuberculosis and Respiratory Diseases
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• v.70 no.4
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• pp.347-351
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• 2011

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.371-382
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• 1985

Over the past 4 decades after World War II a great deal of data and clinical experiences have been accumulated relating to the diagnosis and surgical treatment of congenital and acquired cardiovascular diseases in Korea. Clinical data on cardiovascular surgical cases performed in all 22 hospitals for open heart surgery in Korea was collected from it`s starting up to December 1984. The first recorded open heart surgery for a young adult atrial septal defect was performed by Young Kyoon Lee, M.D. on August 7, 1959, Seoul National University Hospital, Korea. And, some scattered reports on cardiovascular surgical cases in it`s early period have changed recently the number of hospitals for open heart surgery and clinical cases enormously in total amount of 13, 100 cardiovascular operations performed on 12, 990 cases up to December 1984. Of the total 13, 100 cardiovascular operations, congenital cardiovascular anomaly occupied 70%. Of the congenital cases, 6, 580 operations for acyanotic group [operative mortality 4.5%], and 2, 489 operations for cyanotic group [operative mortality 20%]. The incidence of congenital cardiovascular anomaly in order of frequency was ventricular septal defect [29%], patent ductus arteriosus [26%], Tetralogy of Fallot [22%], atrial septal defect [8, 6%], pulmonary valve stenosis [3.0%], and endocardial cushion defect [1.1%]. Of the 3, 412 valvular heart disease cases, which occupied 85% of total 4, 031 acquired cardiovascular disease, individual incidence was in mitral 2, 565 [63.5%], double valve 451 [11.1%], and simple aortic valve 351 [8.7%]. Total number of valve replaced, mechanical and tissue, was 2, 795, and 1, 884 for mitral, 808 for aortic, and 103 for tricuspid in position. Operative mortality for prosthetic valve replacement in total was 9.8%. Remained acquired cardiovascular cases chronic constrictive pericarditis [7.9%], cardiac tumor [1.9%], coronary artery bypass [1.8%], cardiac trauma [1.2%] and less than 1% of thoracic aortic aneurysm. Overall operative mortality for open and non-open cardiovascular surgical operation was 7.7% [congenital acyanotic group 3.2%, congenital cyanotic group 19.4%, and acquired group 7.8%]. In conclusion, present status of cardiovascular surgery in Korea is stabilized with accumulation of clinical cases and experiences, and the future in the field of cardiovascular surgery is promising, especially in the infant cardiac surgery and aortocoronary bypass surgery, with abrupt increase of specialized cardiac centers, trained specialists, and expanding social health insurance.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.446-455
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• 1985

A total and consecutive 156 patients have undergone cardiac valve surgery including 13 closed mitral commissurotomy, 13 open mitral commissurotomy, one mitral annuloplasty, 75 mitral valve replacement, one aortic annuloplasty, 24 aortic valve replacement, 3 tricuspid valve replacement, 25 double valve replacement and one triple valve replacement. 155 prosthetic valves were replaced in a period between September 1976 and August 1985. There were 68 males and 88 females with age range from 8 to 69 yrs [mean 36.5 yr]. Out of replaced valves, 61 was tissue valve including 54 Carpentier-Edwards, and 4 was mechanical valves including 74 St. Jude Medical, and the position replaced was 101 valves for mitral, 46 for aortic and 8 for tricuspid. Single valve replacement in 102 cases, double valve replacement in 25 cases [17 for AVR+MVR, and 8 for MVR+TVR], and only one case was noted in the triple valve replacement. Early mortality within 30 days after operation was noted in 11 cases [7%]; 7 after MVR, 2 after DVR, and each one after open mitral commissurotomy and mitral annuloplasty. Cause of death was valve thrombus, cerebral air embolism, low output syndrome, uncontrollable arrhythmia, parapneumonic sepsis, acute cardiac tamponade and left atrial rupture. 7 late deaths were noted during the follow-up period from 1 to 104 months [average 48 month]; three due to valve and left atrial thrombus formation, two due to CVA from overdose of warfarin, and each one due to congestive heart failure and chronic constrictive pericarditis, Anticoagulants after prosthetic valve replacement were maintained with warfarin, dipyridamole and aspirin to the level of around 50% of normal prothrombin time in 79 cases, and Ticlopidine with aspirin in 47 cases to compare the result of each group. There were 11 major thromboembolic episodes including 3 deaths in the warfarin group. Two cases of CVA due to overdose of warfarin was noted in the warfarin group. In the ticlopidine group, there was only one left atrial thrombus confirmed at the time of autopsy. Among the survived 138 cases, nearly all cases[136 cases] were included in NYHA functional class I and II during the follow-up period. In conclusion, surgical treatment of the cardiac valve disease in 156 clinical cases revealed excellent result with acceptable operative risk and late mortality. Prevention of thrombus formation with anti-platelet aggregator Ticlopidine has better result than warfarin group presently with no specific side effect such as bleeding or gastrointestinal trouble.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.693-700
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• 1997

To assess the effectiveness of subxipoid pericardial drainage for the treatment of pericardial effusion, we reviewed 80 cases of subxiphoid pericardial drainage between January 1986 and December 1995. There were 39 males and 41 females with ages ranging from 20 to 80 years. The diagnosis of pericardial effusion was made by echocardiography. The procedure was carried out under general anesthesia in 50(62.5%) and under local anesthesia in 30 patients(37.5%). Among the 33 p tients with malignant pericardial effusion, cytology was positive .in 14 of 31(45%), and pericardial biopsy showed malignancy in 7 of 29 patients(24%). Among the 27 patients with tuberculous pericardial effusion, the diagnosis was confirmed by histology of pericardial biopsy in 12 patient or bacteriologic culture in 1 patient. The operative mortality was 17.5% (14180 patients) and all the mortality occurred in the malignant group. There were no operation-related mortality Sixty six patients were followed from 9 days to 5 years; mean follow-up was 452 days. Recurrent pericardial effusions, necessitating further surgical intervention, occurred in 6 (7.5%) patients. Constrictive pericarditis developed later in 4 patients(5%) and two of them had undergone complete pericardiectomy. In summary, subxiphoid pericardial drainage allowed safe and efficient drainage of pericardial effusions with sampling for cytology and pericardial biopsy, and had an acceptable morbidity and mortality.