Spontaneous Echo Contrast Mistaken for Left Ventricular Thrombus during Venoarterial Extracorporeal Membrane Oxygenation / 대한구급학회지

No abstract available.

Spontaneous Echo Contrast Mistaken for Left Ventricular Thrombus during Venoarterial Extracorporeal Membrane Oxygenation / 대한중환자의학회지

No abstract available.

Extracorporeal membrane oxygenation support in patients with hematologic malignancies: to whom and when?

No abstract available.

A Korean Multi-Center Survey about Warfarin Management before Gastroenterological Endoscopy in Patients with a History of Mechanical Valve Replacement Surgery

BACKGROUND: Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases. METHODS: The questionnaire was administered to cardiac surgeons and consisted of eight questions, including two case scenarios. RESULTS: Thirty-six cardiac surgeons at 28 hospitals participated in the survey, and 52.7% of the participants chose to stop warfarin before EGD in aortic valve replacement patients without risk factors for thromboembolism. When the patient’s INR level was 2, 31% of the participants indicated that they would choose to continue warfarin therapy. For EGD with biopsy, 72.2% of the participants chose warfarin withdrawal, and 25% of the participants chose heparin replacement. In mitral valve replacement patients, 47.2% of the participants chose to discontinue warfarin, and 22.2% of the participants chose heparin replacement. For EGD with biopsy in patients with a mitral valve replacement, 58.3% of the participants chose to stop warfarin, and 41.7% of the participants chose heparin replacement. CONCLUSION: This study demonstrated that attitudes regarding warfarin treatment for EGD are very different among Korean surgeons. Guidelines specific to the Korean population are required.

Students' Perceptions of Team-Based Learning by Individual Characteristics in a Medical School / 한국의학교육

PURPOSE: The purpose of this study was to examine medical students' perceptions of team-based learning (TBL) according to their individual characteristics: gender, team efficacy, interpersonal understanding, proactivity in problem solving, and academic ability. METHODS: Thirty-eight second-year medical students who took an integrated cardiology course participated in this study; 28 were male and 10 were female. A questionnaire on individual characteristics and a questionnaire on the perception of TBL were administered, and the scores of individual characteristics were grouped into three: high, middle, and low. The data were analyzed by t-test, analysis of variance, and multiple regression analysis. RESULTS: The TBL efficacy perception scale consisted of 3 factors: team skill, learning ability, and team learning. The group of male students and the group of students with high academic ability recognized the effect of TBL on improvements in learning ability more than females and those with low academic ability. The group of students with high team efficacy reported that TBL was effective with regard to team skill improvement. The group of students with high scores on interpersonal understanding and high proactive problem solving tended to perceive the TBL's effect on team skill improvement. Team efficacy and proactivity in problem solving had a positive effect on the perception of TBL. CONCLUSION: Medical students' perceptions of the effectiveness of TBL differ according to individual characteristics. The results of this study suggest that these individual characteristics should be considered in planning of team learning, such as TBL, to have a positive impact and stronger effects.

Acute Type A Aortic Dissection Initially Diagnosed with Myocardial Infarction

No abstract available.

Right Coronary Cusp Prolapse Resembling Subpulmonic Stenosis in an Old Adult Patient with Ventricular Septal Defect

Ventricular septal defect (VSD) can be associated with various complications such as aortic regurgitation (AR). AR in VSD come from a deficiency or hypoplasia of the conal septum which leads to abnormal apposition in diastole and prolapse of the poorly supported noncoronary or right coronary cusp through the VSD into the right ventricle resembling subpulmonic stenosis and subsequently results in distortion of the aortic valve and progressive AR. AR often increases in severity with age and it indicates a worse prognosis. Therefore, appropriate timing of surgical repair in progressive AR in VSD might be important. Until now, many earlier experiences about surgical repair of AR complicating VSD were on adolescents or young adults. We reported a case of AR in 48-year-old male patient with right coronary cusp prolapse complicating the subarterial type of VSD which was properly assessed by echocardiography and was successfully treated with surgical repair. Right coronary cusp or noncoronary cusp prolapse should be suspected in AR complicating VSD through proper echocardiographic assessment and the surgical repair on VSD and distorted aortic valve should be considered in the old patient, as well as the young.

A Case of Endocarditis due to Granulicatella adiacens

Granulicatella species are nutritionally variant streptococci first described in 1961. Granulicatella species form a part of the normal flora of the oral cavity, genitourinary tract, and intestinal tract. These micro-organisms cause bacteremia or local infections such as endocarditis, central nervous system infections, arthritis, and osteomyelitis. Since isolation of Granulicatella species is difficult, only a few cases of infection caused by this microorganism have been reported. Herein, we report a case of endocarditis caused by Granulicatella adiacens in a 46-year-old patient with ventricular septal defect.

Familiar Myxoma with a Positive Genetic Test: A case report / 대한흉부외과학회지

Ten percent of all myxomas are the familial form. Familial myxomas appear to have autosomal dominant transmission. We experienced two siblings with familial myxomas. A left atrial myxoma was surgically removed in a 21-year-old woman. Six years later, other myxomas were found in the right atrium and the left atrium and these were also surgically removed. Right ventricular and right atrial myxomas were surgically excised in her brother. The two siblings were found to have frame-shift mutations in the PRKAR1A gene (c.537delA; p.Gly180GlufsX26), which is the causative gene for Carney complex. Obtaining the genetic diagnosis makes it possible to prepare more effective therapeutic strategies for these patients and the gene carriers. Complete excision, ruling out multicentricity and proper postoperative follow up are all necessary to avoid recurrence of myxoma.

Mitral Valve Repair for Congenital Mitral Regurgitation in Children / 대한흉부외과학회지

BACKGROUND: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. MATERIAL AND METHOD: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. RESULT: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value (2.2+/-.1 vs. 0.7+/-.3, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral regurgitation. CONCLUSION: Our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

Surgical Complications in Heart Transplant Recipients: A Single Center Experience / 대한흉부외과학회지

BACKGROUND: As the patients who undergo heart transplantation have achieved better survival in recent years, a growing number of recipients are at a risk for experiencing surgical complications in addition to rejection and infection. In this paper, we report on our experience with the surgical complications that occurred in heart transplant recipients. MATERIAL AND METHOD: From April 1994 to September 2003, 37 heart transplantations were performed at our center by a single surgeon. The indications for transplantation were dilated cardiomyopathy, ischemic cardiomyopathy, valvular cardiomyopathy and familial hypertrophic cardiomyopathy. RESULT: Twenty postoperative complications required surgeries in 15 patients (41%). The types of operations required were; redo-sternotomy for bleeding (5), pericardiostomy for effusion (4), implantation of a permanent pacemaker (1), right lower lobe lobectomy for aspergilloma (1), removal of urinary stone (1), cholecystectomy for gall bladder stone (1), drainage of a perianal abscess (1), paranasal sinus drainage (1), total hip replacement (1), partial gingivectomy due to gingival hypertrophy (1), urethrostomy (1), herniated intervertebral disc operation (1) and total hysterectomy for myoma uteri (1). The locations of the complications were mediastinal in 10 (27%) cases and extramediastinal in 10 (27%) cases. CONCLUSION: The relatively high incidence of extrathoracic complications associated with heart transplantation emphasizes the importance of a multidisciplinary approach to the improve long-term survival when managing those complex patients.

The Surgical Management of Hypoplastic Left Heart Syndrome andthe Results of a Fontan Operation / 대한흉부외과학회지

BACKGROUND: Hypoplastic left heart syndrome is uniformly fatal if this condition is not properly treated. We reviewed the surgical results of treating hypoplastic left heart syndrome, and we evaluated the hemodynamics and functional status of these patients after they underwent a Fontan operation. MATERIAL AND METHOD: To assess the surgical results, we retrospectively reviewed the medical records of 6 (M/F=4/2) patients who underwent a staged operation, including a Norwood procedure, a bidirectional Glenn procedure and a Fontan procedure between October 1997 to May 2005. The mean age of the patients was 17.3+/-10.8 days (range: 9~36 days) at the 1st staged operation, 8.9+/-7.1 months (4.6~23.3 months) at the 2nd staged operation (the Bidirectional Glenn procedure) and 32.4+/-9.8 months at the final staged operation (the Fontan procedure). During the 2nd staged operation, one of the patients received tricuspid valve repair due to regurgitation. All the patients underwent an extracardiac Fontan procedure using Gore-Tex conduit (20 mm: 2 patients, 18 mm: 4 patients) and one of them required fenestration. RESULT: 21 patients underwented a Norwood procedure. There were 7 early deaths and 4 interstage deaths. Bidirectional cavopulmonary shunt was performed in 10 patients and the Fontan procedure was done in 6 (mortality: 1 patient, Flow up loss: 1 patient, Awaiting a Fontan procedure: 2 patients). After the Fontan procedure, there was no complication except for one case of post operative bleedings. All the patients had good ventricular function and 2 had grade I tricuspid regurgitation, as noted on their echocardiography. The average follow up period after the Fontan procedure was 19.6+/-14.9 months (range: 1.5~39.1 month). All the patients had normal sinus rhythm and they were put on aspirin and cardiac medication. During follow up period, all the patients had a good functional status (NYHA functional class I). CONCLUSION: All the patients who suffered with hypoplastic left heart syndrome and who underwent a Fontan procedure achieved a good hemodynamic and functional status, even though there was a relatively high operative mortality rate after stage I Norwood palliation. Therefore, thise staged operation should be strongly recommended as an important surgical strategy for treating hypoplastic left heart syndrome.

Dorsal Mini-thoracotomy for PDA Closure in Premature Neonates / 대한흉부외과학회지

BACKGROUND: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. MATERIAL AND METHOD: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30 degrees. Bimanual cotton swab blunt dissection completed the extrapleural access to the PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. RESULT: The infants mean gestational age was 26.5+/-2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11+/-11 days. The mean body weight at operation was 933+/-271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. CONCLUSION: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

Comparison of Outcomes after Curative Resection of Primary Lung Cancer between 50 Year or Younger and 70 Year or Older Patients / 대한흉부외과학회지

BACKGROUND: Previous series have suggested that younger patients with primary lung cancer exhibit a more aggressive disease course with a worse prognosis, as compared to older patients, although this issue is still debatable. MATERIAL AND METHOD: We reviewed the medical records of 79 patients (32 patients 50 years and younger (Group I) and 47 patients 70 years and older (Group II)) who underwent curative resection for primary lung cancer between July 2000 and June 2008. RESULT: The median age of the patients was 46.5 years in Group I and this was 73 years in Group II. The older patients were more likely to have major comorbidities (44% versus 77%, respectively; p=0.003). Histological examinations identified that the minor histological types (excluding non-small cell lung cancer (NSCLC)) were predominantly found in the Group I patients (16% versus 2%, respectively; p=0.037). For the TNM staging of the NSCLC, with excluding the minor histologic types, a higher proportion of patients had stage III disease in Group I (33% versus 13%, respectively; p=0.038). There was no significant difference in major morbidity (16% versus 30%, respectively; p=0.148) and operative mortality (0% versus 4.3%; p=0.512) between the groups. The mean follow-up interval was 33 months (range: 1~98 months) for patients in both groups. For the patients with NSCLC, the five-year overall survival rate was 52.3% for Group I and 53.7% for Group II (p=0.955). The rate of freedom from recurrence at five years was significantly lower for the Group I patients than for the Group II patients (39.4% versus 70.4%, respectively; p=0.027), and only being a member of Group I impacted recurrence, based on the Cox proportional hazard analysis (p=0.034). Of the patients who had recurrence, four patients in Group I underwent aggressive surgical treatment. All of these patients exhibited long-term survival (range: 46~87 months). CONCLUSION: In our study, the early outcome and long-term survival were similar for the younger and older patients after curative resection of primary lung cancer. However, we think that younger patients require meticulous follow-up as they had a tendency to proceed to surgery with advanced stage disease, a higher recurrence rate than did the older patients and the survival rates were improved, even for the recurred cases, with early aggressive treatment.

The Effects of Additional Tetracycline Pleurodesis during Thoracoscopic Procedures for Treating Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: This study was performed to evaluate the safety and efficacy of performing additional tetracycline pleurodesis during the thoracoscopic treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: Between March 2004 and December 2007, 91 cases of primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The thoracoscopic procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. For 27 cases (Tetracycline group, group I), 20 mg/kg tetracycline was instilled into the pleural space through a trocar before closing the chest. The control group (group II) consisted of 64 cases of primary spontaneous pneumothorax for which the same thoracoscopic procedures alone were performed during the same study period. RESULT: There was no significant difference between the two groups in terms of the demographic data, the operative findings and the operation time. The percentage of cases that needed intravenous analgesics and the duration of intravenous analgesics were comparable in both groups. There was no significant difference in the duration of air leaks and complications between the two groups. The patients treated with tetracycline pleurodesis had a longer period of postoperative chest drainage (4.2 days vs 3.5 days, respectively, p=0.03) and hospitalization (5.0 days vs 4.0 days, respectively, p=0.006). During the follow up period, the ipsilateral recurrence rate was much lower for the patients who were treated with tetracycline pleurodesis (0% vs 10.9%, respectively, p=0.099), and freedom from recurrence tended to be more favorable for group I (p=0.077), although this was not statistically significant. CONCLUSION: Additional tetracycline pleurodesis during thoracoscopic treatment for primary spontaneous pneumothorax caused prolongation of chest drainage and a prolonged hospital stay. However, further investigations are needed because tetracycline pleurodesis can be performed safely without serious complications and it showed a distinct tendency to reduce the rate of recurrence.

Extended Unroofing Procedure for Creation of a New Ostium for an Anomalous Right Coronary Artery Originating from the Left Coronary Sinus: A case report / 대한흉부외과학회지

An anomalous origin of the coronary artery with subsequent coursing between the great vessels is a rare congenital heart defect that may cause myocardial ischemia and sudden death. Several surgical techniques have been described to address this defect. An extended unroofing procedure to create an alternative ostium for the right coronary artery was successfully carried out in a patient having an anomalous origin of the right coronary artery. The newly constructed orifice was widely patent 3 months later, without any episodes of myocardial ischemia or aortic regurgitation.

Development of Porcine Pericardial Heterograft for Clinical Application(Microscopic Analysis of Various Fixation Methods) / 대한흉부외과학회지

BACKGROUND: Various experimental trials for the development of bioprosthetic devices are actively underway, secondary to the limited supply of autologous and homograft tissue to treat cardiac diseases. In this study, porcine bioprostheses that were treated with glutaraldehyde (GA), ethanol, or sodium dodecylsulfate (SDS) were examined with light microscopy and transmission electron microscopy for mechanical and physical imperfections before implantation. MATERIAL AND METHOD: 1) Porcine pericardium, aortic valve, and pulmonary valve were examined using light microscopy and JEM-100CX II transmission electron microscopy, then compared with human pericardium and commercially produced heterografts. 2) Sections from six treated groups (GA-Ethanol, Ethanol-GA, SDS only, SDS-GA, Ethanol-SDS-GA and SDS-Ethanol-GA) were observed using the same methods. RESULT: 1) Porcine pericardium was composed of a serosal layer, fibrosa, and epicardial connective tissue. Treatment with GA, ethanol, or SDS had little influence on the collagen skeleton of porcine pericardium, except in the case of SDS pre-treatment. There was no alteration in the collagen skeleton of the porcine pericardium compared to commercially produced heterografts. 2) Porcine aortic valve was composed of lamina fibrosa, lamina spongiosa, and lamina ventricularis. Treatment with GA, ethanol, or SDS had little influence on these three layers and the collagen skeleton of porcine aortic valve, except in the case of SDS pre-treatment. There were no alterations in the three layers or the collagen skeleton of porcine aortic valve compared to commercially produced heterografts. CONCLUSION: There was little physical and mechanical damage incurred in porcine bioprosthesis structures during various glutaraldehyde fixation processes combined with anti-calcification or decellularization treatments. However, SDS treatment preceding GA fixation changed the collagen fibers into a slightly condensed form, which degraded during transmission electron micrograph. The optimal methods and conditions for sodium dodecylsulfate (SDS) treatment need to be modified.

Closure of secundum atrial septal defect: comparison between percutaneous and surgical occlusion / 소아과

PURPOSE: This study was performed to compare the safety, efficacy and clinical results of the Amplatzer septal occluder (ASO) for closure of secundum atrial septal defect (ASD) with surgery. METHODS: One hundred fifteen patients diagnosed as isolated secundum ASD in Gil Medical Center, Gachon University of Medicine from January 2000 to July 2006 were included. Seventy patients underwent surgical repair of ostium secundum ASD. Forty-five consecutive patients were treated with percutaneous closure using ASO. We compared the mortality, morbidity, hospital stay, and efficacy between two groups. RESULTS: Male to female ratio was 1:2.4. The mean age and the size of defects were not statistically different. No mortality occurred in either group. The success rate was 97.8% in the device group and 100% in the surgical group. The overall rate of complications was higher in the surgical group than in the device group (64.0 vs. 15.6%, P<0.05). Hospital stay was shorter in the device group than in the surgical group (4.2+/-1.2 vs. 12.4+/-4.7 days, P<0.0001). Residual shunt rates were more frequent in the device group (8.9%) than in the surgical group (4.3%) at discharge. All residual shunts disappeared at 3 months follow-up. CONCLUSION: Percutaneous closure of ASD using ASO is a safe and effective alternative to surgical repair. The indications of percutaneous ASD closure with ASO would be expanded by accumulation of experiences and evolutions of device.

Pneumocephalus after Thoracoscopic Excision of Posterior Mediastinal Mass: A case report / 대한흉부외과학회지

Pneumocephalus after thoracoscopic excision of a mediastinal mass is a very rare complication. It presumably occurs due to dural injury near the spinal root and development of a subsequent subarachnoid-pleural fistula. A 60-year-old woman complained of nausea and headache after thoracoscopic excision of a posterior mediastinal mass. She was diagnosed with pneumocephalus by brain CT and recovered with supportive management.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in an Adult: A case report / 대한흉부외과학회지

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has rarely been reported on in adults because 90% of the untreated infants die in the first year of life. We report here on a case of ALCAPA that was detected in a 41-year-old woman and she was successfully treated by direct re-implantation of the anomalous coronary artery into the aorta.