• Journal of Chest Surgery
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• v.35 no.9
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• pp.692-696
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• 2002

Pulmonary artery sarcoma is a rare disease and hard to diagnose; therefore, suspicion is very important for the diagnosis and treatment. Surgical resection is almost always needed because of progressive right heart failure. Adjuvant chemotherapy and radiation therapy are still controversial. We report a case of a 42-year-old man who had a right pulmonary arterial tumor Curative resection was impossible because the tumor invaded the left pulmonary artery. Palliative endarterectomy was performed followed by radiation therapy. The patient refused the chemotherapy. Until the postoperative 6th month, the residual tumor was stable. However, 15 months later, follow-up chest computed tomography revealed a metastatic pulmonary nodule at left lower lobe and the increased residual tumor. The patient received chemotherapy with limited tumor response. The metastatic nodule and residual tumor did not increase but bone scan revealed a rib metastasis at postoperative 24 months. He will be receiving additional chemotherapy.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1327-1336
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• 1992

Between Jan. 1986 and Aug. 1992. 72 patients underwent Rastelli procedure. There were 43 male and 29 female, aged 46 days to 16 years [mean age, 5.2 years] with 18 patients less than 2 years of age. All patients had complex defect, 27 pulmonary atresia with ventricular septal defect, 18 corrected transposition of great arteries with pulmonary atresia or punmonary stenosis, 10 truncus arteriosus, 10 double outlet right ventricle with pulmonary atresia or stenosis, 7 complete transposition of great artersia with pulmonary atresia or pulmonary stenosis. The types of extracardiac valved conduit used were prosthetic valve[n=47, 24 car-bomedics, 19 Ionescu-Shiley, 4 Bjork-shiley] and hand-made trileaflet valve using pericardium. [n=23, 20 bovine pericardium, Z autologous pericardium, 1 equine pericardium] The mean size of valved cinduit was 5.25mm larger in diameter than the size of main pulmonary artery. [normalized to the patient`s body surface area] There were 17 hospital death[24%] and 4 late deaths[5.6%]. Postoperative complication rate was 38.9%a, none of which was conduit-related. All patients were followed pos-toperatively for 1 to 73 months. [mean 25.8 months] During follow-up period, reoperation was done in 6 patients due to stenosis of valved conduit. Mean interval between intial repair and reoperation was 20.3 months. In our experience, li recently extracardaic valved conduits between right ventricle [or pulmonary ventricle] and pulmonary artery were inserted with increasing frequency in infants less than 2 year, but hospital mortality was decreased, 2] Risk of reoperation due to conduit stenosis is low, so that the effect of graft failure on overall survival is minimized. 3] Nevertheless, because any type of extracardaic valved conduit is not ideal in children, we recommended that Lecompte should be done if cardiac anatomy is permitted.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.696-700
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• 2007

We report here on the midterm results after a Starnes operation for a severely symptomatic neonate with Ebstein's anomaly. A one-day-old baby presented with cyanosis and severe cardiomegaly. We peformed patch closure of the tricuspid valve with a central shunt after failure of tricuspid valve repair with vertical plication of the atrialized ventricle at her age of 19 days. The coronary sinus was drained into the right ventricle. She underwent bidirectional cavopulmonary shunt and extracardiac conduit Fontan operation at her age of 16 and 30 months, respectively. She is now 56 months old and is doing very well. The recent follow-up study revealed that she was in normal sinus rhythm and had a normal sized left ventricle with good function and the small right ventricle without thrombus formation.

• Journal of Veterinary Clinics
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• v.34 no.1
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• pp.1-6
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• 2017

Heartworm disease (HWD) in dogs is a life-threatening mosquito-borne disease resulting in right-sided congestive heart failure and inflammatory pulmonary disease. Due to complications from adulticidal therapy with melarsomine, slow kill protocol either with preventive dose of ivermectin or combined with doxycycline has been proposed for an alternative adultcidal therapy in dogs with HWD. Therefore, this study evaluated the clinical outcome of adultcidal therapy in dogs with class II stage of HWD after treating either American Heartworm Society (AHS) or slow kill protocol for 10 months. Clinical outcome after therapy was evaluated by clinical, radiographic and echocardiographic examination along with hematology before (D0) and after therapy (D300). Although clinical signs associated with HWD were all resolved after therapy in both groups, the infection was not cleared out 67% of dogs treated by slow kill protocol at the end of therapy. Furthermore, pulmonary arterial flow of acceleration time to ejection time ratio (AT/ET) and the right pulmonary artery distensibility index (RPADI) have been firstly used for detecting pulmonary hypertension in this study group. The pulmonary hypertension was more common in dogs with mild clinical signs, although tricuspid and pulmonary regurgitation were not detectable in most dogs in this study. Our study findings suggested that the slow kill protocol might not be efficacious enough to clear out HWD in dogs and more attention on the presence of pulmonary hypertension might be necessary for effective management of HWD in dogs.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.184-187
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• 2010

Although it is a rare complication of cardiac surgery, constrictive pericarditis still remains a difficult problem that needs an appropriate treatment after cardiac surgery. We had two patients with constrictive pericarditis presenting with unexplained right heart failure early after cardiac surgery, and the diagnosis of constrictive pericarditis was made by a specific finding of septal bounce shown in echocardiographic study. On the postoperative 40th day and 31st day, they underwent pericardiectomy by a left limited anterolateral thoracotomy. For one to two weeks since pericardiectomy, the cardiac failure symptoms were gradually relieved. For patients without improvement of the constrictive symptom and sign even with conservative medical therapy for constrictive pericarditis developed early after cardiac surgery, pericardiectomy by a left limited anterolateral thoracotomy is considered as a useful therapeutic mode.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.727-733
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• 1988

Two cases of the discrete membranous subaortic stenosis were experienced at the Department of Thoracic & Cardiovascular Surgery, National Medical Center, Seoul, Korea. Case I was 31 years old male with a history of aortic valve replacement[Ionescu-Shiley, 19mm] at the other hospital in 1980. Heart failure was noticed 6 years later. On cardiac catheterization, pressure gradient between left ventricle 4 aorta was 104 mmHg, but subvalvular aortic stenosis was not detected by preoperative 2-D echo <% left ventriculogram. Above case revealed stenoinsufficiency of the prosthetic valve. Under the diagnosis of the prosthetic valve failure, re-do aortic valve replacement[Bjork-Shiley, 23 mm] was done. During operation, the discrete membranous subaortic stenosis was incidentally found, and it was completely resected. So we thought that above discrete membranous subaortic stenosis was not detected at first operation, and it was progressed during 6 years, and accelerated the degeneration of the prosthetic valve. Case II was 20 years old female. Her complaints were exertional dyspnea, angina, syncope, which were aggravated since 5 years ago. 2-D echo <% left ventriculogram revealed the discrete membranous subaortic stenosis. Pressure gradient was 20 mmHg, but her symptoms were serious. Associated cardiac anomaly was the persistent left superior vena cava without connection with right superior vena cava. Complete excision of the membranous tissue was done. Post-operative pressure gradient between left ventricle & aorta was absent, and her complaints were nearly subsided. Both cases were type I according to the Newfeld classification of the discrete subvalvular aortic stenosis, and complete excision of the membranous tissue was done without myotomy or mymectomy. And short-term follow-up results[Case I:2 years, Case II: 1 ~ years] were good except soft systolic murmur[grade II/VI] at the aortic area in both cases.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.792-796
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• 2001

Chronic pulmonary artery thromboembolism is a relatively rare phenomenon causing hypoxia and pulmonary hypertension that eventually leads to respiratory failure and right heart failure. Patients with acute pulmonary artery thromboembolism are generally treated with antithrombotics and thrombolytics. However, in cases with chronic pulmonary artery thromboembolism the fibrinized thrombus is so strongly adhered to the pulmonary artery wall that medical treatment becomes ineffective and surgical treatment must then be considered. We report a 47year old patient, with a history of repeated admission due to unresolved chronic obstructive pulmonary disease and chronic pulmonary artery thromboembolism at a local hospital, who underwent a successful endarterectomy of pulmonary artery thromboemboli using intermittent total circulatory arrest.

• Molecules and Cells
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• v.43 no.4
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• pp.408-418
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• 2020

The sinus node (SN) is located at the apex of the cardiac conduction system, and SN dysfunction (SND)-characterized by electrical remodeling-is generally attributed to idiopathic fibrosis or ischemic injuries in the SN. SND is associated with increased risk of cardiovascular disorders, including syncope, heart failure, and atrial arrhythmias, particularly atrial fibrillation. One of the histological SND hallmarks is degenerative atrial remodeling that is associated with conduction abnormalities and increased right atrial refractoriness. Although SND is frequently accompanied by increased fibrosis in the right atrium (RA), its molecular basis still remains elusive. Therefore, we investigated whether SND can induce significant molecular changes that account for the structural remodeling of RA. Towards this, we employed a rabbit model of experimental SND, and then compared the genome-wide RNA expression profiles in RA between SND-induced rabbits and sham-operated controls to identify the differentially expressed transcripts. The accompanying gene enrichment analysis revealed extensive pro-fibrotic changes within 7 days after the SN ablation, including activation of transforming growth factor-β (TGF-β) signaling and alterations in the levels of extracellular matrix components and their regulators. Importantly, our findings suggest that periostin, a matricellular factor that regulates the development of cardiac tissue, might play a key role in mediating TGF-β-signaling-induced aberrant atrial remodeling. In conclusion, the present study provides valuable information regarding the molecular signatures underlying SND-induced atrial remodeling, and indicates that periostin can be potentially used in the diagnosis of fibroproliferative cardiac dysfunctions.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.900-905
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• 2006

Background: Homografts and bioprostheses are most commonly used for Rastelli operation in congenital heart disease, but the limited durability is responsible for multiple reoperations associated with increased morbidity This study evaluated long-term results after Rastelli operation with a mechanical valved conduit. Material and Method: A total of 20 patients underwent Rastelli operation with mechanical valved conduit from January 1990 to July 1992. Operative mortality was 1 of 20 patients, and a retrospective review of 19 patients(10 males, 9 females) was done. Initial diagnosis was congenitally corrected transposition of great arteries(cc-TGA, n=4), complete TGA (n=2), ventricular septal defect with pulmonary atresia(VSD with PA, n=9), truncus arteriosus(n=2), double outlet right ventricle with pulmonary stenosis(DORV with PS, n=2). The mean age at Rastelli operation was $4.6{\pm}3.4$ years, and mean follow-up period was $12.8{\pm}2.7$ years. Patients underwent Rastelli opearation using 16 CarboMedics mechanical valve, and 3 Bjork-Shiley mechanical valve($17{\pm}2$ mm). Result: There were 15 reoperations for failed mechanical valved conduit. The freedom from reoperation at 5 and 10 years was 53% and 37%. Most patients were received oral anticoagulation with warfarin, and maintained the international normalized ratio(INR) of 1.5 to 2.0. There was no anticoagulation or thromboembolism related complication. There was a significant difference in the causes of a conduit failure between early(within 3 years) and late(after 3 years) failure groups. The six patients reported early prosthetic valve failure, mainly due to valvular dysfunction by thrombosis or pannus formation. The other nine patients reported late prosthetic valve failure, mainly due to dacron conduit stenosis at anastomosis sites, whereas their valvar motion was normal except 1 patient. Conclusion: To avoid early prosthetic valve failure, strict anticoagulation therapy would be helpful. About the late development of obstructive intimal fibrocalcific peels within the Dacron conduit, an improvement of conduit material is necessary to reduce late prosthetic valve failure. In selected patients, the long term results were satisfactory.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.787-791
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• 2001

Coronary artery aneurysm is a rare disorder. It is defined as abnormal dilatation of coronary artery with diameter exceeding 1.5 times the adjacent normal segments. The incidence of coronary aneurysm is 2.6% in Caucasians and 0.25% in Asians. Over half of the former were associated with atherosclerotic coronary artery disease. However, 70 percents of the latter were nonobstructive coronary artery aneurysms. Coronary artery fistula is a rare disorder. It has been identified in only 0.2% of routine cardiac angiographic studies conducted over a 10-year period. The clinical spectrums are various, asymtomatic, asymptomatic murmur, dyspnea on exertion, fatigue, and congestive heart failure. The right coronary artery (56%) and left coronary artery(36%) are mainly involved in the origin site of congenital coronary artery fistula. The draining site of fistula are right ventricle(39%), right atrium(33%), and pulmonary artery(20%) and so on. This 54 years-old woman had intermittent chest tightness and an abnormal mediastinal shadow on chest roentgenogram and chest C-T examination, which was diagnosed as a mediastinal mass such as teratoma. We performed the operation under left anterolateral thoracotomy for mass excision. However, we knew the mass had the pulsating arterial blood flow through a fine needle puncture of the mass and that it was attached to the left ventricle. We believed the excision of mass on beating heart would be very dangerous. Therefore, we closed the wound without excising the mass. After several days, we performed an echocardiography and coronary angiography, We knew it was cardiac tumor. Incidentally, the patient had a tortuous coronary fistula from the right coronary artery to pulmonary trunk. Using cardiopulmonary bypass with moderate systemic hypothermia, the mass was resected and the fistula was clipped with surgical clips. Pathology of the specimen was a giant coronary arterial aneurysm.