Pulmonary Vein Extension for Large Left Atrium Size Mismatch During Heart Transplantation.

In cases with a large recipient left atrium (LA), matching of the donor and recipient anastomoses can be challenging. In the presented case, this is addressed by reducing the circumference of the recipient LA cuff by extending the pulmonary veins. The inferior pulmonary veins were extended by making neopulmonary veins using the remnant recipient LA cuff; the circumference of the recipient LA cuff could then be reduced to easily make an anastomosis. This new technique could be an alternative method to resolve LA size discrepancies in orthotopic heart transplantation.

Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery?

OBJECTIVE: Malnutrition is known to affect postoperative outcomes, but only a limited number of assessment methods are available for evaluating nutritional status before cardiac surgery. The purpose of this study was to investigate the clinical significance of the prognostic nutritional index for adult patients undergoing cardiac surgery. METHODS: We retrospectively reviewed the medical records of 374 patients aged more than 18 years who underwent cardiac surgery with cardiopulmonary bypass. Patients were divided into 2 groups based on the cutoff prognostic nutritional index, and these groups were compared with respect to early morbidity and mortality rates, intensive care unit stays, and long-term outcomes. Logistic regression analyses were performed to identify the risk factors of early outcomes. RESULTS: The calculated cutoff value of the prognostic nutritional index was 46.13. Early mortality and morbidity were significantly more common in the high-risk group (9.0% vs 2.9%: P = .02, 58.0% vs 42.0%: P = .01). The median duration of mechanical ventilation support (18.0 vs 16.0 hours: P < .01) and intensive care unit stays (3.0 vs 2.0 days: P < .01) were also longer in the high-risk group. However, no significant intergroup difference was observed for the long-term clinical outcomes. Multivariate analysis showed that the prognostic nutritional index, age, cardiopulmonary bypass time, and aortic crossclamp time independently predicted early outcomes. Of these, only the prognostic nutritional index and age were significant preoperative variables (P = .01 and P < .01). CONCLUSIONS: The prognostic nutritional index may be a useful preoperative nutrition screening tool for predicting the early clinical outcomes of adult patients after cardiac surgery using cardiopulmonary bypass.

A Rare Combination of CYP2C9*3/*3 and VKORC1 1639AA in a Patient Who Had Myxoma and Thromboembolism.

We report a case of intolerance to warfarin. A 20-year-old woman with toe pain was diagnosed with myxoma with multiple systemic embolisms. She was prescribed warfarin for remaining embolic pain after myxoma excision and mitral annuloplasty. Even on 1 mg of warfarin, the international normalized ratio was much increased. The patient was found to have cytochrome P450 2C9 (CYP2C9)*3/*3 and vitamin K epoxide reductase complex subunit 1 (VKORC1) 1639AA genotype, which is extremely rare in Koreans. Based on this result, we assessed the potential risks and benefits of warfarin and decided to switch to aspirin because the risk of bleeding was considered to be too high.

Attenuation of Inflammation and Leptin Resistance by Pyrogallol-Phloroglucinol-6,6-Bieckol on in the Brain of Obese Animal Models.

Obesity induces inflammation both in the adipose tissue and the brain. Activated macrophage infiltration, polarization of macrophages to a more inflammatory type (M1), and increased levels of pro-inflammatory cytokines are related to brain inflammation, which induces leptin resistance in the brain. Pyrogallol-phloroglucinol-6,6-bieckol (PPB), a compound from Ecklonia cava, has anti-inflammatory effects. In this study, we evaluated the effects of PPB effect M1 polarization and inflammation and its ability to restore the effects of leptin, such as a decrease in appetite and body weight. We administered PPB to diet-induced obesity (DIO) and leptin-deficient (ob/ob) mice, evaluated macrophage activation, polarization, and changes of inflammatory cytokine level in adipose tissue and brain, and determined the effect of PPB on leptin resistance or leptin sensitivity in the brain. The levels of activated macrophage marker, M1/M2, and pro-inflammatory cytokines were increased in the adipose tissue and brain of DIO and ob/ob mice than control. TLR4 expression, endoplasmic reticulum (ER) stress, and NF-κB expression in the brain of DIO and ob/ob mice were also increased; this increase was related to the upregulation of SOCS3 and decreased phosphorylated STAT3, which decreased leptin sensitivity in the brain. PPB decreased inflammation in the brain, restored leptin sensitivity, and decreased food intake and weight gain in both DIO and ob/ob mice.

Ecklonia Cava Extract Attenuates Endothelial Cell Dysfunction by Modulation of Inflammation and Brown Adipocyte Function in Perivascular Fat Tissue.

It is well known that perivascular fat tissue (PVAT) dysfunction can induce endothelial cell (EC) dysfunction, an event which is related with various cardiovascular diseases. In this study, we evaluated whether Ecklonia cava extract (ECE) and pyrogallol-phloroglucinol-6,6-bieckol (PPB), one component of ECE, could attenuate EC dysfunction by modulating diet-induced PVAT dysfunction mediated by inflammation and ER stress. A high fat diet (HFD) led to an increase in the number and size of white adipocytes in PVAT; PPB and ECE attenuated those increases. Additionally, ECE and PPB attenuated: (i) an increase in the number of M1 macrophages and the expression level of monocyte chemoattractant protein-1 (MCP-1), both of which are related to increases in macrophage infiltration and induction of inflammation in PVAT, and (ii) the expression of pro-inflammatory cytokines (e.g., tumor necrosis factor-α (TNF-α) and interleukin (IL)-6, chemerin) in PVAT which led to vasoconstriction. Furthermore, ECE and PPB: (i) enhanced the expression of adiponectin and IL-10 which had anti-inflammatory and vasodilator effects, (ii) decreased HFD-induced endoplasmic reticulum (ER) stress and (iii) attenuated the ER stress mediated reduction in sirtuin type 1 (Sirt1) and peroxisome proliferator-activated receptor γ (PPARγ) expression. Protective effects against decreased Sirt1 and PPARγ expression led to the restoration of uncoupling protein -1 (UCP-1) expression and the browning process in PVAT. PPB or ECE attenuated endothelial dysfunction by enhancing the pAMPK-PI3K-peNOS pathway and reducing the expression of endothelin-1 (ET-1). In conclusion, PPB and ECE attenuated PVAT dysfunction and subsequent endothelial dysfunction by: (i) decreasing inflammation and ER stress, and (ii) modulating brown adipocyte function.

Pyrogallol-Phloroglucinol-6,6-Bieckol from Ecklonia cava Attenuates Tubular Epithelial Cell (TCMK-1) Death in Hypoxia/Reoxygenation Injury.

The hypoxia/reoxygenation (H/R) injury causes serious complications after the blood supply to the kidney is stopped during surgery. The main mechanism of I/R injury is the release of high-mobility group protein B1 (HMGB1) from injured tubular epithelial cells (TEC, TCMK-1 cell), which triggers TLR4 or RAGE signaling, leading to cell death. We evaluated whether the extracts of Ecklonia cava (E. cava) would attenuate TEC death induced by H/R injury. We also evaluated which phlorotannin-dieckol (DK), phlorofucofuroeckol A (PFFA), pyrogallol phloroglucinol-6,6-bieckol (PPB), or 2,7-phloroglucinol-6,6-bieckol (PHB)-would have the most potent effect in the context of H/R injury. We used for pre-hypoxia treatment, in which the phlorotannins from E. cava extracts were added before the onset of hypoxia, and a post- hypoxia treatment, in which the phlorotannins were added before the start of reperfusion. PPB most effectively reduced HMGB1 release and the expression of TLR4 and RAGE induced by H/R injury in both pre- and post-hypoxia treatment. PPB also most effectively inhibited the expression of NF-kB and release of the inflammatory cytokines TNF-α and IL-6 in both models. PPB most effectively inhibited cell death and expression of cell death signaling molecules such as Erk/pErk, JNK/pJNK, and p38/pp38. These results suggest that PPB blocks the HGMB1-TLR4/RAGE signaling pathway and decreases TEC death induced by H/R and that PPB can be a novel target for renal H/R injury therapy.

The attenuating effects of pyridoxamine on adipocyte hypertrophy and inflammation differ by adipocyte location.

It is known that receptor for advanced glycation end products (RAGE) and its ligands accumulate in the fat tissues of obese individuals, and RAGE ligands induce M1 macrophage polarization, which in turn induces inflammation. We evaluated the effect of pyridoxamine on RAGE ligand accumulation and M1 polarization in the visceral, subcutaneous, and perivascular fat tissues of Sprague-Dawley rats fed a high fat diet (HFD). Pyridoxamine reduced HFD-induced weight gain, attenuated adipocyte size increases, RAGE ligand accumulations, RAGE-RAGE ligands binding, decreased macrophage M1 polarization and increased M2 polarization in visceral fat tissues, but not in subcutaneous tissues. Pyridoxamine induced glyoxalase 1 (Glo-1) expression in visceral fat in the HFD group, whereas pyridoxamine induced Glo-1 expression in perivascular fat tissues was no higher than that observed in the normal fat diet (NFD) controls. In vitro, pyridoxamine suppressed the release of RAGE ligands from AGE treated macrophages, but non-significantly attenuated RAGE ligands release in AGE treated adipocytes. Pyridoxamine was found to suppress weight increases and M1 polarization, and to increase Glo-1 expression through the RAGE pathway in perivascular and visceral fat tissues of HFD-induced obese rats. These findings suggest pyridoxamine is a candidate for the treatment of obesity or complications related to obesity-induced inflammation.

Historical Perspectives of Korean Society for Thoracic and Cardiovascular Surgery: Inauguration and Activities of the Historical Records Preservation Committee.

The Korean Society for Thoracic and Cardiovascular Surgery (KTCVS) was founded in 1968 and celebrated the 50th anniversary of its founding in 2018. The launch of the KTCVS may seem somewhat recent, given that the American Association for Thoracic Surgery was founded in 1917. However, considering the circumstances of the Korean medical community after the Japanese occupation (1910-1945), World War II (1940-1945), and the Korean War (1950-1953), this apparent delay is understandable. Even before the foundation of the KTCVS, the early pioneers of thoracic and cardiovascular surgery promptly adopted medical technologies from more advanced countries such as the United States, and contributed significantly to both cardiac and thoracic surgery despite difficult circumstances. In 2012, before the 50th anniversary of the founding of the KTCVS, members shared the opinion that objective records of the activities of the early pioneers should be identified and preserved, and reacted positively towards the necessity for historians who would preserve such records. With this background, the Historical Records Preservation Committee of the KTCVS (hereinafter, referred to as 'the Committee') was launched. The Committee published a white paper on the history of thoracic and cardiovascular surgery in 2015 and held an exhibition of the achievements of the pioneers at the 50th anniversary of the founding of the KTCVS. The Committee also published a book entitled "The history of Korean thoracic surgery with photographs: celebrating the 50th anniversary of the society." The Committee will keep making efforts to find and preserve materials related to activities during the early development of thoracic and cardiovascular surgery in Korea.

Prognostic imaging of iatrogenic and traumatic ureteral injury by near-infrared fluorescence.

BACKGROUND: Iatrogenic or traumatic ureteral injuries are life-threatening but difficult to diagnose early. Ureteral visualization is essential for both the prevention and diagnosis of iatrogenic or traumatic ureter injuries. In the present study, we evaluated the feasibility of near-infrared (NIR) with ZW800-1C as a diagnostic tool of iatrogenic or traumatic ureteral injury in addition to ureter visualization, compared to methylene blue. METHODS: With mice model, we compared the image quality of ZW800-1C with methylene blue for ureter visualization. We also made ureter perforation, obstruction, crushing injury, and transection model with mice and evaluated the feasibility of ZW800-1C for diagnostic tool for ureteral injuries. RESULTS: We could confirm the ureter in the ZW800-1C images in maximally 30 minutes after injection, and the ureter was visible until NIR imaging concluded at 180 minutes after injection. However, methylene blue failed to provide clear ureter imaging during the same period. ZW800-1C imaging successfully visualized ureters subjected to obstruction, transection, perforation, and crush injuries, although urinary leakage was not visible by eye. CONCLUSIONS: Our results indicate ZW800-1C is better suited for ureter visualization than methylene blue and that ZW800-1C has considerable potential for the early diagnosis of various ureteral injuries.

Rapid evaluation of acute pulmonary embolism with thromboembolism-in-transit.

We report a case of thromboembolism-in-transit through a patent foramen ovale that could cause systemic embolism in a patient with pulmonary embolism. An accurate and quick diagnosis by transthoracic echocardiography and computed tomography allowed emergent surgical thromboembolectomy to be performed without complications. Integral diagnostic workup should be performed in case of acute pulmonary thromboembolism whether the patient is hemodynamically stable or not.

Isolated Unilateral Absence of Pulmonary Artery Associated with Contralateral Lung Cancer.

Unilateral absence of a pulmonary artery (UAPA) is a rare congenital anomaly that may present with various symptoms, depending on the nature and severity of other cardiovascular anomalies. Furthermore, contralateral lung surgery in patients with UAPA is extremely rare, and clinical experience is limited. This report describes a case of surgical treatment of contralateral primary lung cancer in a patient with isolated UAPA. A 56-year-old man was diagnosed with primary lung cancer accompanied by isolated UAPA on the contralateral side. He underwent meticulous cardiorespiratory function tests preoperatively. We performed a right lower lobectomy. Although in the immediate postoperative period, the patient suffered from a mild decline in his respiratory function, he recovered uneventfully. The present case shows that preoperative awareness of UAPA and meticulous perioperative management enable contralateral lung surgery to be performed safely.

Explantation of a failed endovascular stent graft in a patient with a type B dissection.

We report a patient who underwent insertion of an endovascular stent graft in the descending aorta for an aneurysmal type B dissection. The patient developed a proximal type I endoleak which required explantation of the graft and replacement of the descending aorta. Carotid artery cannulation was utilized for antegrade perfusion during the period of circulatory arrest.

Esophageal Endoscopic Vacuum Therapy with Enteral Feeding Using a Sengstaken-Blakemore Tube.

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.