• Journal of Chest Surgery
• /
• v.39 no.12 s.269
• /
• pp.927-930
• /
• 2006

Hybrid procedure was performed for a thirteen-day-old girl with a functionally single ventricle, who weighed 2.2 kg and had been prematurely born at $32^{+5}$ weeks of gestation. She underwent bilateral pulmonary artery banding using 3.5 mm Gore-Tex graft, ductal stenting using balloon expandable stent, and reverse Blalock-Taussig shunt with 3.5 mm Gore-Tex vascular graft. After discharge, she was followed up for 4 months, and underwent 2nd stage operation(extensive arch reconstruction with Damus-Kaye-Stansel anastomosis, atrial septectomy, bilateral pulmonary artery angioplasty, bidirectional cavopulmonary shunt). She has been followed up for 4 months after the 2nd operation with an excellent clinical condition.

• Journal of Chest Surgery
• /
• v.40 no.7 s.276
• /
• pp.499-502
• /
• 2007

Left ventricular inflow obstruction can be caused by a persistent left superior vena cava (SVC) and a dilated coronary sinus. A 31-day-old male infant with secondum atrial septal defect (ASD) and bilateral SVC underwent an operation for treating his uncontrollable congestive heart failure. The preoperative 2-dimensional echocardiography showed a normally sized mitral valve shrouded by a dilated coronary sinus. The operation consisted of pericardial patch closure of the ASD, coronary sinus unroofing and left SVC transfer to the right atrial auricle. The postoperative course was complicated by persistent chylothorax, which was controlled by thoracic duct ligation, He was discharged to home at the postoperative day 39. He has been followed up for 9 months and has displayed normal development.

• Archives of Plastic Surgery
• /
• v.44 no.1
• /
• pp.42-47
• /
• 2017

Background Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition. Methods The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0-1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study. Results Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage. Conclusions Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.

• Journal of Chest Surgery
• /
• v.41 no.2
• /
• pp.273-276
• /
• 2008

Since the introduction of extracorporeal cardiopulmonary support of cardiac arrest in 1983, emergent cardiopulmonary support has been used to treat cardiac arrest. Acute massive pulmonary embolism is associated with a high mortality rate and it poses a challenge for both the anesthesiologist and the surgeons especially during operations. This report describes the use of the emergent bypass system in the effective management of an intraoperative massive pulmonary embolism and cardiac arrest in a 56-year-old woman. The patient was discharged on warfarin and there was no recurrence of the pulmonary embolism at the follow-up visit.

• Journal of Chest Surgery
• /
• v.54 no.1
• /
• pp.45-52
• /
• 2021

Background: Atrial septal defect (ASD) is the most common congenital heart disease. However, the details of cardiac chamber remodeling after surgery are not well known, although this is an important issue that should be analyzed to understand long-term outcomes. Methods: Between November 2017 and January 2019, cardiac magnetic resonance imaging was performed preoperatively, at a 1-month postoperative follow-up, and at a 1-year postoperative follow-up. Cardiac chamber volume, valve regurgitation volume, and ejection fraction were measured as functions of time. Results: Thirteen patients (10 men and 3 women) were included. The median age at surgery was 51.4 years. The preoperative median ratio of flow in the pulmonary and systemic circulation was 2.3. The preoperative mean right ventricular (RV) end-diastolic volume index (EDVi) and RV end-systolic volume index (ESVi) had significantly decreased at the 1-month postoperative follow-up (p<0.001, p=0.001, respectively). The decrease in the RVEDVi (p=0.085) and RVESVi (p=0.023) continued until the postoperative 1-year follow-up, although the rate of decrease was slower. Tricuspid valve regurgitation had also decreased at the 1-month postoperative follow-up (p=0.022), and continued to decrease at a reduced rate (p=0.129). Although the RVEDVi and RVESVi improved after ASD closure, the RV volume parameters were still larger than the left ventricular (LV) volume parameters at the 1-year follow-up (RVEDVi vs. LVEDVi: p=0.016; RVESVi vs. LVESVi: p=0.001). Conclusion: Cardiac remodeling after ASD closure is common and mainly occurs in the early postoperative period. However, complete normalization does not occur.

• Journal of Chest Surgery
• /
• v.14 no.3
• /
• pp.228-234
• /
• 1981

Measurement of cardiac output by thermodilution method is easy to perform and can be repeated at very short intervals and offers a number of theoretical and practical advantages. The purpose of this paper is to reevaluate the accuracy and reproducibility of the thermodilution cardiac output by comparing the results with those obtained by the direct Fick technique. From January through April 1981 [4 months], 26 simultaneous cardiac output measurements were made using thermodilution and direct Fick methods in 12 patients in the intensive care unit of Severance Hospital following open heart surgery. The average age of the patients was $34.8{\pm}12.0$ [SD] years [range; 17-57 years]. For cardiac output determination by thermodilution technique [$CO_TD$], a Swan-Ganz Thermodilution Catheter, Model 93A-131-7F [Edwards Laboratories], a Cardiac Output Computer, Model 9520A, and Strip Chart Recorder, Model 9810 [Edwards Laboratories] were used. For the determination of cardiac output by direct Fick principle [$CO_Fick$], a Van Slyke Manometric Apparatus [Thomas] for the measurements of arteriovenous oxygen content difference and a Collin`s Respirometer with Kymograph for the measurement of oxygen consumption were used. The correlation between the simultaneously measured $CO_TD$ and $CO_Fick$ was found to be $CO_Fick$ = 0.95.$CO_TD$ + 0.1073, [r= 0.9777, P < 0.001 ]. For 26 double or triple determinations of $CO_TD$, the values ranged from 1.77 L/min to 6.66 L/min, with a reproducibility of 2.18%. The maximum difference of $CO_TD$ for $CO_Fick$ was between +11.99% and -12,99% [$Mean{\pm}SD$ = $6.07{\pm}3.97$%]. Measurement of cardiac output by thermodilution method provides a simple, rapid, reproducible and highly accurate method for multiple cardiac output measurements suitable for use at the bedside. Comparison of Cardiac Output Determination by Direct Fick and Thermodilution Method in Man.

• Journal of Chest Surgery
• /
• v.25 no.11
• /
• pp.1192-1202
• /
• 1992

Postoperative cardiac outputs and other hernoaynamic values were serially measured in fifteen patients of cyanotic congenital heart disease, after use of blood cardioplegic solution. Cardiac indices showed no change untill eight postoparative hours, then it began to decline to reach as low as 3.22$\pm$0.7L/min/m2 at 12 hours. After then gradual increse occ-ured to recover upto immediate postoperative value at 20 hours. Sharp decrese of heart rate and increse of systemic vascular resistance during 8~16 hours and steady increase of stroke indices during the whole study periods were observed. These observations suggested that the myocardium recovered gradually after open heart surgery, and that the decrease of cardiac indices during 8~16 hours could be a result of decrease of heart rates and increase of afterload. The changes of cardiac indices correlated with the changes of heart rate, postoperative time and mixed venous oxygen saturation [p<0.05]. No other hemodynamic values found to be in statistically significant correlation with the changes of cardiac indices. Left ventricular dysfunction seemed to occur more frequently during 8~12 hours, but it was not statistically significant. [p=0.73] In conclusion, great care must be taken during 2~3 days after the operation of cyanotic congenital heart disease, not to fall into a low cardiac output state, by maintaing adequate heart rates and reducing afterload especially when the systemic vascular resistance increases.

• Journal of Chest Surgery
• /
• v.49 no.2
• /
• pp.126-129
• /
• 2016

We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively.

• Journal of Chest Surgery
• /
• v.22 no.1
• /
• pp.50-58
• /
• 1989

The emergence and expansion of cardiac surgery over the past decade has resulted in an increasing number of patients undergoing cardiac operations but many kinds of heart surgery was realized only palliative, resulting in increasing numbers of secondary cardiac procedures. From 1978 to 1988, 10 cases of various congenital heart diseases and 17 cases of acquired heart diseases were reoperated at Hanyang University Hospital. The leading indication of second operation was residual shunt or valvular malfunction due to technical failure in congenital heart disease and primary valve failure, endocarditis, paravalvular leakage were for acquired heart disease. The mortality of reoperation was 0% for congenital heart disease and 11.7%[2 death among the 17 patients] for acquired heart disease. The leading causes of death were myocardial failure, sepsis with endocarditis, acute renal failure and congestive heart failure.

• Journal of Chest Surgery
• /
• v.43 no.5
• /
• pp.550-552
• /
• 2010

An accessory cardiac bronchus (ACB) is a rare congenital anomaly of the trachobronchial tree. It rarely presents with symptoms, and is usually diagnosed incidentally by chest CT, bronchoscopy, or during surgery. We experienced a case of accessory cardiac bronchus found incidentally in the bronchus intermedius with lung cancer in the right lower lobe, and surgically removed.