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1.
Korean Journal of Radiology ; : 890-900, 2021.
Article in English | WPRIM | ID: wpr-902456

ABSTRACT

Objective@#To identify the association between morphological and functional characteristics of the bicuspid aortic valve (BAV) and bicuspid aortopathy and to identify the determinants of aortic dilatation using transthoracic echocardiography (TTE) and cardiac computed tomography (CCT). @*Materials and Methods@#This study included 312 subjects (mean [SD] age, 52.7 [14.3] years; 227 males [72.8%]) who underwent TTE and CCT. The BAVs were classified by anterior-posterior (BAV-AP) or right-left (BAV-RL) orientation of the cusps and divided according to the presence (raphe+) or absence of a raphe (raphe-) based on the CCT and intraoperative findings. The dimensions of the sinus of Valsalva and the proximal ascending aorta were measured by CCT. We assessed the determinants of aortic root and proximal ascending aortic dilatation (size index > 2.1 cm/m2) by Univariable and multivariable logistic regression analyses. @*Results@#Of the 312 patients, BAV-AP was present in 188 patients (60.3%), and 185 patients (59.3%) were raphe+. Moderateto-severe aortic stenosis (AS) was the most common hemodynamic abnormality (54.8%). The most common type of aortopathy was the combined dilated root and mid-ascending aortic phenotype (62.5%). On multivariable analysis, age and AS severity were significantly associated with aortic root dilatation (p < 0.05), and age, sex, and AS severity were significantly associated with ascending aortic dilatation (p < 0.05). However, the orientation of the cusps, presence of a raphe, and severity of aortic regurgitation were not associated with aortic root and ascending aortic dilatation. @*Conclusion@#BAV morphological characteristics were not determinants of aortic dilatation. Age, sex, and AS severity were predictors of bicuspid aortopathy. Therefore, age, sex, and AS severity, rather than valve morphology, need to be considered when planning treatment for BAV patients.

2.
Korean Journal of Radiology ; : 890-900, 2021.
Article in English | WPRIM | ID: wpr-894752

ABSTRACT

Objective@#To identify the association between morphological and functional characteristics of the bicuspid aortic valve (BAV) and bicuspid aortopathy and to identify the determinants of aortic dilatation using transthoracic echocardiography (TTE) and cardiac computed tomography (CCT). @*Materials and Methods@#This study included 312 subjects (mean [SD] age, 52.7 [14.3] years; 227 males [72.8%]) who underwent TTE and CCT. The BAVs were classified by anterior-posterior (BAV-AP) or right-left (BAV-RL) orientation of the cusps and divided according to the presence (raphe+) or absence of a raphe (raphe-) based on the CCT and intraoperative findings. The dimensions of the sinus of Valsalva and the proximal ascending aorta were measured by CCT. We assessed the determinants of aortic root and proximal ascending aortic dilatation (size index > 2.1 cm/m2) by Univariable and multivariable logistic regression analyses. @*Results@#Of the 312 patients, BAV-AP was present in 188 patients (60.3%), and 185 patients (59.3%) were raphe+. Moderateto-severe aortic stenosis (AS) was the most common hemodynamic abnormality (54.8%). The most common type of aortopathy was the combined dilated root and mid-ascending aortic phenotype (62.5%). On multivariable analysis, age and AS severity were significantly associated with aortic root dilatation (p < 0.05), and age, sex, and AS severity were significantly associated with ascending aortic dilatation (p < 0.05). However, the orientation of the cusps, presence of a raphe, and severity of aortic regurgitation were not associated with aortic root and ascending aortic dilatation. @*Conclusion@#BAV morphological characteristics were not determinants of aortic dilatation. Age, sex, and AS severity were predictors of bicuspid aortopathy. Therefore, age, sex, and AS severity, rather than valve morphology, need to be considered when planning treatment for BAV patients.

3.
Korean Journal of Radiology ; : 1007-1020, 2018.
Article in English | WPRIM | ID: wpr-719139

ABSTRACT

OBJECTIVE: To compare the diagnostic performance of cardiovascular magnetic resonance (CMR) myocardial perfusion at 1.5- and 3-tesla (T) for detecting significant coronary artery disease (CAD), with invasive coronary angiography (ICA) as the reference method. MATERIALS AND METHODS: We prospectively enrolled 281 patients (age 62.4 ± 8.3 years, 193 men) with suspected or known CAD who had undergone 1.5T or 3T CMR and ICA. Two independent radiologists interpreted perfusion defects. With ICA as the reference standard, the diagnostic performance of 1.5T and 3T CMR for identifying significant CAD (≥ 50% diameter reduction of the left main and ≥ 70% diameter reduction of other epicardial arteries) was determined. RESULTS: No differences were observed in baseline characteristics or prevalence of CAD and old myocardial infarction (MI) using 1.5T (n = 135) or 3T (n = 146) systems. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) for detecting significant CAD were similar between the 1.5T (84%, 64%, 74%, 76%, and 0.75 per patient and 68%, 83%, 66%, 84%, and 0.76 per vessel) and 3T (80%, 71%, 71%, 80%, and 0.76 per patient and 75%, 86%, 64%, 91%, and 0.81 per vessel) systems. In patients with multi-vessel CAD without old MI, the sensitivity, specificity, and AUC with 3T were greater than those with 1.5T on a per-vessel basis (71% vs. 36%, 92% vs. 69%, and 0.82 vs. 0.53, respectively). CONCLUSION: 3T CMR has similar diagnostic performance to 1.5T CMR in detecting significant CAD, except for higher diagnostic performance in patients with multi-vessel CAD without old MI.


Subject(s)
Humans , Area Under Curve , Atherosclerosis , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Magnetic Resonance Imaging , Methods , Myocardial Infarction , Perfusion , Prevalence , Prospective Studies , ROC Curve , Sensitivity and Specificity
4.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 42-45, 2016.
Article in English | WPRIM | ID: wpr-222287

ABSTRACT

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.


Subject(s)
Humans , Male , Middle Aged , Academic Medical Centers , Aneurysm, False , Causality , Echocardiography , Echocardiography, Transesophageal , Heart Atria , Heart Diseases , Heart Neoplasms , Heart Transplantation , Magnetic Resonance Imaging , Mitral Valve , Pathology , Thrombosis , Unconsciousness
5.
Korean Journal of Radiology ; : 463-471, 2016.
Article in English | WPRIM | ID: wpr-29169

ABSTRACT

OBJECTIVE: The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). MATERIALS AND METHODS: We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. RESULTS: All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). CONCLUSION: Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.


Subject(s)
Humans , Aortic Valve Insufficiency , Aortic Valve Stenosis , Aortic Valve , Classification , Consensus , Constriction, Pathologic , Echocardiography , Magnetic Resonance Imaging , Membranes , Multidetector Computed Tomography , Retrospective Studies
6.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 328-334, 2015.
Article in English | WPRIM | ID: wpr-128346

ABSTRACT

BACKGROUND: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. METHODS: In this study, we assessed 15 patients (mean age, 47.7+/-9.7 years; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5+/-7 years. The mean preoperative Wilkins score was 9.4+/-2.6. RESULTS: The mean mitral valve area obtained using planimetry increased from 1.16+/-0.16 cm2 to 1.62+/-0.34 cm2 (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from 202.4+/-58.6 ms to 152+/-50.2 ms (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4+/-4.0 mmHg to 5.8+/-1.5 mmHg (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39+/-16 months). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467-64.866). CONCLUSION: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.


Subject(s)
Female , Humans , Balloon Valvuloplasty , Disease-Free Survival , Endocarditis , Follow-Up Studies , Mitral Valve , Ultrasonography
7.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 240-248, 2014.
Article in English | WPRIM | ID: wpr-215833

ABSTRACT

BACKGROUND: Open heart surgery using cardiopulmonary bypass (CPB) is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) is a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in cardiac surgery (CS). METHODS: Thirty-seven adult patients undergoing CS with CPB were included in this retrospective study. They had normal preoperative renal function, as assessed by the creatinine (Cr) level, NGAL level, and estimated glomerular filtration rate. Serial evaluation of serum NGAL and Cr levels was performed before, immediately after, and 24 hours after the operation. Patients were divided into two groups: those who showed normal immediate postoperative serum NGAL levels (group A, n=30) and those who showed elevated immediate postoperative serum NGAL levels (group B, n=7). Statistical analysis was performed using Statistical Package for the Social Sciences version 18. RESULTS: Of the 37 patients, 6 (6/37, 16.2%) were diagnosed with AKI. One patient belonged to group A (1/30, 3.3%), and 5 patients belonged to group B (5/7, 71.4%). Two patients in group B (2/7, 28.5%) required further renal replacement therapy. Death occurred in only 1 patient (1/37, 2.7%), who belonged to group B. CONCLUSION: The results of this study suggest that postoperative plasma NGAL levels can be used as an early biomarker for the detection of AKI following CS using CPB. Further studies with a larger sample size are needed to confirm our results.


Subject(s)
Adult , Humans , Acute Kidney Injury , Biomarkers , Cardiopulmonary Bypass , Creatinine , Glomerular Filtration Rate , Lipocalins , Neutrophils , Plasma , Renal Replacement Therapy , Retrospective Studies , Sample Size , Social Sciences , Thoracic Surgery
8.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 249-254, 2014.
Article in English | WPRIM | ID: wpr-215832

ABSTRACT

BACKGROUND: Delirium after cardiac surgery is associated with serious long-term negative outcomes and high costs. The aim of this study is to evaluate neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine, compared with the current postoperative sedative protocol (remifentanil) in patients undergoing open heart surgery with cardiopulmonary bypass (CPB). METHODS: One hundred and forty two eligible patients who underwent cardiac surgery on CPB between April 2012 and March 2013 were randomly divided into two groups. Patients received either dexmedetomidine (range, 0.2 to 0.8 microg/kg/hr; n=67) or remifentanil (range, 1,000 to 2,500 microg/hr, n=75). The primary end point was the prevalence of delirium estimated daily via the confusion assessment method for intensive care. RESULTS: When the delirium incidence was compared with the dexmedetomidine group (6 of 67 patients, 8.96%) and the remifentanil group (17 of 75 patients, 22.67%) it was found to be significantly less in the dexmedetomidine group (p<0.05). There were no statistically significant differences between two groups in the extubation time, ICU stay, total hospital stay, and other postoperative complications including hemodynamic side effects. CONCLUSION: This preliminary study suggests that dexmedetomidine as a postoperative sedative agent is associated with significantly lower rates of delirium after cardiac surgery.


Subject(s)
Adult , Humans , Cardiopulmonary Bypass , Delirium , Dexmedetomidine , Hemodynamics , Incidence , Critical Care , Length of Stay , Postoperative Care , Postoperative Complications , Prevalence , Thoracic Surgery
9.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 145-148, 2014.
Article in English | WPRIM | ID: wpr-24187

ABSTRACT

Here, we present a rare case of cardiac parasitic infection found in an adult female patient who had the symptoms of dyspnea upon exertion. She was diagnosed with a double-chambered right ventricle due to infundibular hypertrophy confirmed by transthoracic echocardiography and cardiac computed tomography. We performed surgery of infundibulectomy around the pulmonary valve. In the end, histopathological findings of the resected infundibular muscle demonstrated trichinellosis, a type of roundworm infection.


Subject(s)
Adult , Female , Humans , Dyspnea , Echocardiography , Heart Ventricles , Hypertrophy , Pulmonary Valve , Trichinellosis
10.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 35-38, 2014.
Article in English | WPRIM | ID: wpr-29894

ABSTRACT

Leiomyosarcoma may occur anywhere in the body but rarely occurs in the heart or great vessels. Leiomyosarcoma may be managed by surgical resection with or without chemotherapy or radiotherapy. Owing to the high rate of metastasis and poor prognosis, a definitive treatment modality for leiomyosarcoma has not yet been suggested. This case study reports the surgical management of the recurrent leiomyosarcoma of the heart and the great vessels in a 63-year-old woman.


Subject(s)
Female , Humans , Middle Aged , Drug Therapy , Heart , Leiomyosarcoma , Neoplasm Metastasis , Prognosis , Radiotherapy , Saphenous Vein
11.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 202-204, 2012.
Article in English | WPRIM | ID: wpr-55385

ABSTRACT

A 55-year-old woman who had a history of percutaneous vertebroplasty was referred to our institution with sudden onset of chest pain. Computed tomography (CT) scan demonstrated a long, linear, highly-attenuated segment in the right side of the heart and fragmented pieces in the right pulmonary artery. The CT scan and echocardiogram revealed no pericardial effusion or hemopericardium. Based on these findings, we performed surgery through right anterolateral thoracotomy without cardiac arrest. As a result, we safely removed the foreign body. This approach may be a feasible and effective procedure for selected cases.


Subject(s)
Female , Humans , Middle Aged , Bone Cements , Chest Pain , Foreign Bodies , Heart , Heart Arrest , Pericardial Effusion , Pulmonary Artery , Thoracotomy , Vertebroplasty
12.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 225-229, 2012.
Article in English | WPRIM | ID: wpr-64036

ABSTRACT

BACKGROUND: Reoperation of cardiac surgery via median sternotomy can be associated with significant complications. Thoracotomy is expected to reduce the risk of reoperation and to enhance the surgical outcomes. We retrospectively analyzed two operative approaches (thoracotomy vs. sternotomy) in cardiac reoperation. MATERIALS AND METHODS: From September 2007 to December 2010, 35 patients who required reoperation of the mitral valvular disease following previous median sternotomy were included. Average age of patients was 45.8+/-15.4 years (range, 14 to 76 years) and male-to-female was 23:12. Interval period between primary operation and reoperation was 135.8+/-105.6 months (range, 3.3 to 384.9 months). RESULTS: Comparative analysis was done dividing the patient group into two groups that are thoracotomy group (22 patients) and sternotomy group (13 patients). Thoracotomy group was significantly lower in operative time (415.2+/-90.3 vs. 497.5+/-148.0, p<0.05), bleeding control time (108.0+/-29.5 vs. 146.4+/-66.8, p<0.05) and chest tube drainage (287.5+/-211.5 mL vs. 557.3+/-365.5 mL, p<0.05) compared to sternotomy group. CONCLUSION: The thoracotomy approach is superior to sternotomy in some variables, and it is considered as a valid alternative to repeat median sternotomy in patients who underwent a previous median sternotomy.


Subject(s)
Humans , Chest Tubes , Drainage , Hemorrhage , Operative Time , Reoperation , Retrospective Studies , Sternotomy , Thoracic Surgery , Thoracotomy
13.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 148-154, 2012.
Article in English | WPRIM | ID: wpr-79088

ABSTRACT

BACKGROUND: The adequate management of mild to moderate dilatation of the ascending aorta during cardiac operations remains controversial. In this study, we present the short-term outcomes of 90 patients undergoing ascending aortic wrapping with a Dacron graft during other cardiac operations. MATERIALS AND METHODS: From March 2008 to January 2011, 90 consecutive patients underwent treatment for ascending aortic aneurysm using the external wrapping technique during the concomitant procedure. The study group consisted of 49 male and 41 female patients with a mean age of 58.7+/-13 years. The primary cardiac surgical procedures were coronary artery bypass grafting (CABG) in 3, aortic valve replacement in 2, and aortic valvuloplasty in 85 patients (isolated in 62 and combined with CABG or mitral valvuloplasty in 23). The ascending aorta diameter was measured using a computed tomography scan within 4 weeks after surgery, and was compared with the preoperative value. RESULTS: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within a month after surgery from 46.4+/-4.3 mm to 33.0+/-3.5 mm (p<0.05). There was no early mortality or major surgical complication. During the mean follow-up period of 15.4+/-5.2 months, there was only one late death caused by septic multiorgan failure. CONCLUSION: Dacron wrapping of the ascending aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of moderately dilated ascending aorta in selected patients.


Subject(s)
Female , Humans , Male , Aorta , Aortic Aneurysm , Aortic Valve , Cardiac Surgical Procedures , Coronary Artery Bypass , Dilatation , Follow-Up Studies , Polyethylene Terephthalates , Thoracic Surgery , Transplants
14.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 9-17, 2011.
Article in English | WPRIM | ID: wpr-205223

ABSTRACT

BACKGROUND: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. MATERIAL AND METHODS: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age 54.4+/-15.1 years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of DLP(R) (Medtronic Inc, Minneapolis, MN) or RMI(R) (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system (EBS(R); Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of 2.4~3.0 L/min/m2 and an activated clotting time (ACT) of around 180 seconds. RESULTS: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. CONCLUSION: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.


Subject(s)
Adult , Female , Humans , Male , Adoption , Hypoxia , Catheterization , Catheters , Emergencies , Extracorporeal Membrane Oxygenation , Glycosaminoglycans , Hemorrhage , Membranes , Oxygenators, Membrane , Pneumonia , Shock, Cardiogenic , Tokyo , Vital Signs , Weaning
15.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 432-436, 2011.
Article in English | WPRIM | ID: wpr-19763

ABSTRACT

We herein present a case of a successful correction of cor triatriatum associated with thrombotic pulmonary hypertension diagnosed in an adult female patient. We confirmed diagnosis using transthoracic and transesophageal echocardiography in addition to cardiac computed tomography and magnetic resonance imaging. Surgical repair comprised excision of the fibromuscular membranous septum in the left atrium, patch closure of an atrial septal defect, and reconstruction of the pulmonary arteries with a vascular graft. Cor triatriatum complicated pulmonary thrombotic hypertension with atrial septal defect is amenable to surgical correction with satisfactory results.


Subject(s)
Adult , Female , Humans , Cor Triatriatum , Echocardiography, Transesophageal , Heart Atria , Heart Septal Defects, Atrial , Hypertension , Hypertension, Pulmonary , Magnetic Resonance Imaging , Pulmonary Artery , Thrombosis , Transplants
16.
Korean Journal of Radiology ; : 514-521, 2010.
Article in English | WPRIM | ID: wpr-207990

ABSTRACT

OBJECTIVE: To evaluate the depiction rate and morphologic features of myocardial bridging (MB) of the left anterior descending coronary artery (LAD) using dual-source CT (DSCT). MATERIALS AND METHODS: CT scans from a total of 1,353 patients who underwent DSCT were reviewed retrospectively for LAD-MB. Seventy-eight patients were excluded due to poor image quality or poor enhancement of the coronary artery. The length and depth of the MB were analyzed and classified as superficial or deep with respect to the depth ( 1 mm) of the LAD tunneled segment. Superficial MB was subdivided into complete or incomplete types according to full or partial encasement of the myocardium. RESULTS: Of the 1,275 patients included in this study, 557 cases of MB were found from 536 patients (42%). Superficial MB was observed in 368 of 557 (66%) cases, and deep MB was seen in 189 of 557 (34%) cases. Superficial MB showed 2 types: complete (128 of 368, 35%) and incomplete (240 of 368, 65%). The mean length of a tunneled segment for superficial MB was 16.4 +/- 8.6 mm. The mean length and depth of a tunneled segment for deep MB were 27.6 +/- 12.8 mm and 3.0 +/- 1.4 mm, respectively. The incidence of atherosclerotic plaques in a 2-cm-long segment proximal to MB was 16%. CONCLUSION: The depiction rate of LAD-MB using DSCT in a large series of patients was 42%, with two-thirds of MB segments being the superficial type.


Subject(s)
Female , Humans , Male , Middle Aged , Contrast Media , Coronary Angiography/methods , Electrocardiography , Iohexol/analogs & derivatives , Myocardial Bridging/diagnostic imaging , Radiographic Image Interpretation, Computer-Assisted , Retrospective Studies , Tomography, X-Ray Computed/methods
17.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 743-746, 2010.
Article in Korean | WPRIM | ID: wpr-126397

ABSTRACT

Coronary artery aneurysm is an uncommon disease. The optimal medical or surgical treatment for this disease remains obscure. The causes of coronary artery aneurysms include atherosclerosis, Kawasaki disease, infectious vascular disease, connective tissue disorder and congenital malformation. A 50 year old man visit our institution for chest pain that had started 3 days previously. After coronary angiography, multiple coronary aneurysms were diagnosed and successful surgical intervention was performed.


Subject(s)
Aneurysm , Angina, Unstable , Atherosclerosis , Chest Pain , Connective Tissue , Coronary Aneurysm , Coronary Angiography , Coronary Artery Bypass , Coronary Vessels , Mucocutaneous Lymph Node Syndrome , Vascular Diseases
18.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 696-703, 2009.
Article in Korean | WPRIM | ID: wpr-203875

ABSTRACT

BACKGROUND: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. MATERIAL AND METHOD: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed. The mean patient age was 53 years (range: 14~84). The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the AAR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. RESULT: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from 54.6+/-8.4 mm to 38.3+/-3.8 mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from 47.1+/-24.4 mmHg to 15.1+/-11.7 mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. CONCLUSION: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.


Subject(s)
Humans , Aortic Aneurysm , Aortic Valve , Aortic Valve Insufficiency , Aortic Valve Stenosis , Congenital Abnormalities , Constriction, Pathologic , Dilatation, Pathologic , Endocarditis , Follow-Up Studies , Perfusion , Sinus of Valsalva
19.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 34-40, 2008.
Article in Korean | WPRIM | ID: wpr-62294

ABSTRACT

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary bypass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. MATERIAL AND METHOD: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of 62+/-10 years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean 56.7+/-11.6%). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). RESULT: The mean number of grafts was 2.7+/-1.2 per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial infarctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was 20+/-35 hours and the mean duration of stay in the intensive care unit was 68+/-47 hours. The mean amounts of blood transfusion were 4.0+/-2.6 packs/patient. CONCLUSION: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.


Subject(s)
Female , Humans , Male , Angina, Stable , Angina, Unstable , Angiography , Arrhythmias, Cardiac , Arteries , Blood Transfusion , Cardiopulmonary Bypass , Carotid Artery Diseases , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Bypass, Off-Pump , Coronary Vessels , Hypertension , Inflammation , Intensive Care Units , Kidney Failure, Chronic , Mammary Arteries , Myocardial Infarction , Postoperative Complications , Pulmonary Disease, Chronic Obstructive , Radial Artery , Saphenous Vein , Sepsis , Sternotomy , Stroke , Transplants , Ventilators, Mechanical , Wound Infection
20.
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 147-150, 2007.
Article in Korean | WPRIM | ID: wpr-198525

ABSTRACT

Desmoplastic small round cell tumor (DSRCT) is rare and a recently described, poorly differentiated malignant tumor and it usually presents with widespread intra-abdominal involvement. We report a case of DSRCT arising form the mediastinum which was treated with multimodality anticancer therapy in 15 year-old girl.


Subject(s)
Adolescent , Female , Humans , Desmoplastic Small Round Cell Tumor , Mediastinum , Pathology
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