One-stage Repair of Aortic Arch Anomalies and Intracardiac Defects through Median Sternotomy / 대한흉부외과학회지

BACKGROUND: One-stage repair of aortic arch anomalies and intracardiac defects through median sternotomy has been recently adopted by many institutions since it is known to be safer than the staged repair. The early and midterm results of the one-stage repair of aortic arch anomalies and intracardiac defects were retrospectively evaluated. MATERIAL AND METHOD: 45 patients who underwent one-stage repair of aortic arch anomalies and intracardiac defects performed by one surgeon from January 1996 to July 2003 were included in this retrospective study. The median age of repair was 16 days (range, 3 days~23.7 months) and the mean weight was 3.62+/-1.30 kg. Thirty one (68.9%) had coarctation and 14 (31.1%) had interrupted aortic arch. Associated intracardiac anomalies were VSD in 31 patients (VSD group), TGA or Taussig-Bing anomaly in 10 (TGA group), and others in 4 (ASD in 1, aortopulmonary window 1, truncus arteriosus 1, aortic and mitral stenoses 1, miscellaneous group). The arch obstruction was repaired with end-to-side anastomosis in 23 patients and end-to-end anastomosis in 22. RESULT: Overall postoperative hospital mortality was 22.2% (10/45); 16.1% (5/31) in VSD group, 40% (4/10) in TGA group, and 25% (1/4) in miscellaneous group. There was no mortality in VSD group since 1998, and the mortality in TGA group has remarkably reduced since technical modification for coronary transfer was adopted (75% vs 16.7%). There was no postoperative seizure or other neurological complications. Postoperative aortic restenosis occurred in 5 patients (5/35, 14.3%). Two patients underwent balloon aortoplasty with successful results. There was no reoperation. There was one late death caused by pneumonia 5 months after the operation. Two-year actuarial survival rate including operative death was 72.9%. CONCLUSION: The operative mortality of one-stage repair has been reduced with time and aortic restenosis rate was also acceptable. We concluded that this procedure is a reproducible procedure for aortic arch anomalies associated with intracardiac defects.

Early and Midterm Results of Arterial Switch Operation for Double-Outlet Right Ventricle with Subpulmonary VSD / 대한흉부외과학회지

BACKGROUND: Excellent clinical results of the arterial switch operation and the limited availablity of the intraventricular rerouting has recently made an arterial switch operation to become the therapeutic method of choice for the repair of double-outlet right ventricle (DORV) with subpulmonary ventricular septal defect (VSD). The early and midterm outcomes of arterial switch operation for this anomaly were evaluated. MATERIAL AND METHOD: Between August 1994 and July 2002, 13 patients underwent an arterial switch operation for the correction of double-outlet right ventricle with subpulmonary VSD at Dong-A university hospital.. The 50% rule was used to define DORV. Median age and mean body weight were 27 days (range, 3~120 days) and 3.8+/-0.7 kg (range, 2.92~5.3 kg) respectively. Aortic arch anomalies were associated in 6 cases (46.2%), which were all repaired through one-stage operation. The relationship of the great arteries were side-by-side in 8 cases (61.5%) and anteroposterior in 5 (38.5%). Coronary artery patterns were 1LCx-2R in 6 cases, retropulmonary left coronary artery (LCA) in 6, and intramural LCA in 1 respectively. The enlargement of VSD was required in 1 patient and the patch enlargement of right ventricular outflow tract was performed in another one patient. The Lecompte maneuver was used in all but 3 patients with a side by side relationship of the great arteries. RESULT: Overall postoperative hospital mortality was 23.1% (3/13). All operative deaths were occurred in the patients with aortic arch anomalies. There was one late death related to the postoperative complication of the central nerve system during the mean follow-up of 41.3+/-30.7 months. Pulmonary valvar stenosis (>30 mmHg of pressure gradient) developed in 1 patient (10%) and left pulmonary artery stenosis in 2 (20%), among them, one required reoperation 52 months after repair. There was an asymptomatic patient with moderate aortic regurgitation. 5-year survival rate including operative deaths was 68.3%. CONCLUSION: Although the operative mortality is high in the patients with aortic arch anomaly, the arterial switch operation for DORV with supbpulmonary VSD can be performed with low operative mortality and low reoperation rate in the patients without arch anomaly. The arterial switch operation can be considered a good option for this complex anomaly.

Arterial Switch Operation: The Technical Modification of Coronary Reimplantation and Risk Factors for Operative Death / 대한흉부외과학회지

BACKGROUND: Anatomic correction of the transposition of the great arteries (TGA) or Taussig-Bing anomaly by means of the arterial switch operation is now accepted as the therapeutic method of choice. This retrospective study was conducted to evaluate the risk factors for operative deaths and the efficacy of technical modification of the coronary transfer. MATERIAL AND METHOD: 85 arterial switch operations for TGA or Taussig-Bing anomaly which were performed by one surgeon from 1994 to July 2002 at Dong-A university hospital were included in this retrospective study. Multivariate analysis of perioperative variables for operative mortality including technical modification of the coronary transfer was performed. RESULT: Overall postoperative hospital mortality was 20.0% (17/85). The mortality before 1998 was 31.0% (13/42), but reduced to 9.3% (4/43) from 1998. The mortality in the patients with arch anomaly was 61.5% (8/13), but 12.5% (9/72) in those without arch anomaly. In patients who underwent an open coronary reimplantation technique, the operative mortality was 28.1% (18/64), but 4.8% (1/21) in patients undergoing a technique of reimplantation coronary buttons after neoarotic reconstruction. Risk factors for operative death from multivariated analysis were cardiopulmonary bypass time (> = or 250 minutes), aortic cross-clamping time (> = or 150 minutes), aortic arch anomaly, preoperative event, and open coronary reimplantation technique. CONCLUSION: Operative mortality has been reduced with time. Aortic arch anomaly and preoperative events were important risk factors for postoperative mortality. However atypical coronary artery patterns did not work as risk factors. We think that the technical modification of coronary artery transfer played an important role in reducing the postoperative mortality of arterial switch operation.

One-stage Repair of Truncus Arteriosus with Interrupted Aortic Arch / 대한흉부외과학회지

Truncus arteriosus with interrupted aortic arch is a very rare congenital cardiac anomaly that has an unfavorable natural course. We report a successful one-stage repair of truncus arteriosus with interrupted aortic arch through median sternotomy in a 25-day-old neonate weighing 3.1 kg. We reconstructed the aortic arch with direct side-to-end anastomosis between ascending and descending aortas. The right ventricular outflow reconstruction was performed with untreated autologous pericardial conduit without valve following Lecompte maneuver. The patient has been grown-up in good condition (25~50 percentile of body weight) and shows the right ventricular outflow tract wide 1 year after the operation.

Surgical Repair of Truncus Arteriosus in an Low-Birth Weight Premature Baby:Right Ventricular Outflow Reconstruction with Valveless Autologous Pericardial Conduit and the Result of 20-Month's Follow-up / 대한흉부외과학회지

It is known that low birth weight is a risk factor for poor outcome in cardiac surgery for many cardiac defects. Truncus arteriosus is a rare congenital anomaly that has an unfavorable natural course. We report a successful surgical correction of truncus arteriosus in an 13-day-old premature infant with body weight of 1.5 kg and gestational age of 32 weeks. We used autologous untreated pericardial conduit without valve in right ventricular outflow reconstruction. The patients remains in good condition with normal body weight (50 percentile) and wide right ventricular outflow tract 20 months after the operation.

Anormalous Origin of Left Coronary Artery from Pulmonary Artery / 대한흉부외과학회지

Anomalous origin of left coronary artery from pulmonary artery(ALCAPA) is a rare fatal congenital anormaly that needs early surgical intervention. Many reports say that the choice of operative procedure is reimplantation of the left coronary artery into the ascending aorta. We experienced the surgical management of a case of the ALCAPA. The patient was 44 days old and 3.45 kg weighed female baby who had a symptom of congestive heart failure. She underwent implantation of coronary artery on the aorta with cardiopulmonary bypass and recovered without any complications.

A case of xanthogranulomatous pyelonephritis misdiagnosed as Wilms' tumor

No abstract available.