-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: Constrictive pericarditis is a disease characterized by marked thickening of the pericardium which causes restriction of diastolic cardiac function. The purpose of this report is to review the outcome of pericardiectomy for constrictive pericarditis and to discuss its problems. METHODS: Sixteen consecutive patients who underwent pericardiectomy for constrictive pericarditis in our institution between March 2000 and June 2011 were reviewed. All patients underwent decortication including at least the anterior surface from the right atrium to the left phrenic nerve and the diaphragmatic surface of the heart. The epicardium was concomitantly resectioned because it was usually sclerotic and constrictive. RESULTS: Postoperatively, mean central venous pressure decreased to 8.8 ± 3.1 mmHg and was significantly lower than the preoperative value 15.3 ± 3.7 mmHg (p < 0.001). The mean postoperative duration of hospitalization was 25.6 ± 13.5 days. There were 2 in-hospital deaths and early mortality rate was 12.5 %; however, excluding hospital deaths, there were no significant postoperative complications and all survivors recovered and maintained good cardiac function during the mean follow-up period of 3.7 ± 2.8 years. CONCLUSION: For an acceptable outcome, surgical intervention should be performed at an appropriate time and the pericardiectomy should have proper scope and depth to prevent irreversible changes in the heart, liver, and other organs.
General Thoracic and Cardiovascular Surgery 10/2012;
-
[show abstract]
[hide abstract]
ABSTRACT: The ATS Open Pivot mechanical heart valve has been implanted routinely at our institution since 1999. The objective of this study is to retrospectively analyze our 12-year clinical results with ATS prostheses.
ATS Open Pivot mechanical valves were implanted in 268 adult patients between May 1999 and August 2010. We selected 259 subjects who could be adequately followed (follow-up rate 96.6 %). Aortic valve replacement was performed in 157 patients, mitral valve replacement (MVR) in 71, and double (aortic and mitral) valve replacements (DVR) in 31. Mean age at the time of implant was 58.8 ± 10.6 years. The gender ratio was 128 males/131 females. Mean follow-up was 4.4 ± 7.8 years, and the cumulative follow-up was 1144 patient-years (pt-yr).
Early death within 30 days after the operation occurred in 5 (2.5 %) patients. Late death occurred in 27 patients including valve-related deaths in 13. The 10-year survival rate after the operation was 82.7 ± 2.9 %. The rate of freedom from valve-related death was 92.2 ± 2.2 %. The incidence of valve-related complications was 2.19 %/pt-yr. Of these, the incidence of thromboembolic events and that of bleeding complications were 1.22 and that 0.87 %/pt-yr. The incidence of valve thrombosis was 0.09 %/pt-yr. No structural valve deterioration was observed in any of the three operative procedure groups.
Our 12-year experience with aortic and MVR using the ATS mechanical heart valve demonstrated low incidences of thromboembolic events, bleeding complications, and valve thrombosis.
General Thoracic and Cardiovascular Surgery 07/2012; 60(9):561-8.
-
[show abstract]
[hide abstract]
ABSTRACT: Mechanical valve replacement is associated with complications, however, there is little information on the quality of life (QOL) of octogenarians who had undergone mechanical valve replacement at a relatively younger age. We examined survival, valve-related events, and the QOL of octogenarians who had undergone mechanical valve replacement.
A total of 56 octogenarians who underwent mechanical valve replacement between 1969 and 1997 (age at the time of surgery, 65.6 ± 6.7 years), completed a questionnaire on survival, valve-related events, and QOL (basic activities of daily living, instrumental activities of daily living, mental health).
The mean follow-up was 12.4 ± 6.6 years, and the cumulative follow-up period was 642.4 patient-years. Six valve-related deaths (0.9%/patient-year) were registered during the follow-up. Furthermore, 11 valve-related events (1.8%/patient-year) were recorded. The mean age of the 21 survivors was 82.9 ± 1.8 years, and 19 of the survivors lived at home. Their QOL was excellent.
The valve-related deaths and events in octogenarians who had previously undergone mechanical valve replacement at a younger age were within acceptable limits. The QOL was similar to that of octogenarians described in previous studies.
General Thoracic and Cardiovascular Surgery 04/2012; 60(4):213-6.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to determine the mechanism of systolic anterior motion (SAM) after mitral valve (MV) repair by analyzing the clinical data of patients with MV repair.
A total of 104 MV repairs were performed for patients with isolated degenerative posterior leaflet prolapse. Eight patients (7.7%) developed SAM with severe mitral regurgitation. We compared the preoperative and intraoperative findings of the two groups (8 patients in the SAM group, 96 in the non-SAM group) and reported the clinical courses of the SAM patients.
Preoperative left ventricular end-diastolic and end-systolic diameters were significantly smaller and the preoperative left ventricular ejection fraction was significantly greater in the SAM group than in the non-SAM group. The number of patients with a sigmoid septum and the number with anterior leaflet-septal contact (LSC) during diastole were significantly larger in the SAM group. Incidence of billowing posterior leaflet, prolapsed segments, and operative techniques were comparable for the two groups. SAM improved with correction of hemodynamic status in four patients. In four other patients secondary cardiopulmonary bypass was required to resolve SAM. SAM resolved with additional repairs in two patients, whereas the other two required MV replacement. Of the six patients in whom conservative treatment or re-repair was successful, one had recurrent SAM 3 months after surgery.
The sigmoid septum and LSC may predict SAM after MV repair. A strict follow-up is imperative for patients with persistent or recurrent SAM.
General Thoracic and Cardiovascular Surgery 11/2011; 59(11):737-42.
-
[show abstract]
[hide abstract]
ABSTRACT: A 35-year-old man was admitted to the hospital with prolonged high-grade fever. Chest computed tomography revealed multiple pulmonary infiltrations in both lungs, suggesting septic emboli. Echocardiography revealed patent ductus arteriosus and mobile large vegetations in the pulmonary artery. Because of uncontrollable infection and the imminent possibility of massive pulmonary embolism, he underwent transpulmonary surgical closure of the ductus and resection of the vegetations under hypothermic circulatory arrest using cardiopulmonary bypass. We report a rare case of open heart surgery in a patient with pulmonary infective endarteritis associated with patent ductus arteriosus.
General Thoracic and Cardiovascular Surgery 08/2011; 59(8):563-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Osteosarcoma is a rare primary cardiac malignancy. Calcification on imaging is crucial to differentiating osteosarcoma, but we encountered a case that was difficult to diagnose because imaging revealed no calcification. A 67-year-old man was admitted for heart failure. Echocardiography demonstrated mitral regurgitation and a mass in the left atrium. A cardiac malignancy was suspected. Computed tomography revealed no calcification. Operation was performed, and histopathological examination identified the tumor as an osteosarcoma.
General Thoracic and Cardiovascular Surgery 03/2011; 59(3):184-6.
-
[show abstract]
[hide abstract]
ABSTRACT: We successfully performed aortic root replacement and partial aortic arch replacement by a T-shaped sternotomy at the second intercostal space in a patient who had undergone tracheotomy for respiratory insufficiency and cardiac failure caused by methicillin-resistant Staphylococcus aureus pneumonia during preservation treatment of chronic type A aortic dissection and aortic regurgitation.
General Thoracic and Cardiovascular Surgery 02/2011; 59(2):110-3.
-
[show abstract]
[hide abstract]
ABSTRACT: We have encountered a rare case of ruptured true thoracic aortic aneurysm coexisting with DeBakey type IIIb aortic dissection. The patient was a 67-year-old woman who had a past history of hypertension and cerebral infarction. She experienced DeBakey type IIIb acute aortic dissection, and initially conservative medical treatment was carried out. However, the patient suddenly went into shock, and emergency contrast-enhanced computed tomography revealed the presence of a ruptured true thoracic aortic aneurysm coexisting with the type IIIb dissection. Replacement of the descending aorta was performed through a left thoracotomy using circulatory arrest and deep hypothermia. The rupture site and intimal tear were located in the middle of the aneurysm. Open proximal and distal anastomoses were carried out using a 22 × 10 mm gelatin-covered Dacron graft. The patient was discharged from our hospital uneventfully on the 33rd postoperative day.
General Thoracic and Cardiovascular Surgery 01/2011; 59(1):34-7.
-
[show abstract]
[hide abstract]
ABSTRACT: Objective: A modified Bentall procedure with a Carrel patch and inclusion technique (Modified Bentall Procedure) has been used to treat combined disease of the aortic valve and aortic root. The current study examined the outcomes of this surgical technique. Materials and Methods: Between April 1999 and March 2009, 16 patients (10 males, 6 females; 63.3 ± 9.4 years) underwent elective surgery involving the Modified Bentall Procedure and no additional surgery, so they were included in the study. Results: The mean cardiopulmonary bypass time was 140.2 ± 34.4 min (range: 97-232 min), and aortic cross-clamp time was 97.3 ± 16.6 min (range: 76-132 min). There were no hospital deaths. No patients required additional surgery to correct excessive bleeding. The follow-up rate was 100% (16/16). The mean follow-up period was 5.6 ± 2.8 years (range: 0.7-9.9 years). One of the 16 patients died (6.3%) due to lung cancer, and 1 of the 15 surviving patients required additional surgery (6.7%) for a thoracic aortic aneurysm. Kaplan-Meier analysis found that 1-year and 5-year survival and event-free survival rates were all 100%. Conclusions: The Modified Bentall Procedure provided satisfactory results over both the short term and long term.
Annals of Vascular Diseases 01/2011; 4(1):32-6.
-
[show abstract]
[hide abstract]
ABSTRACT: A 46-year-old woman was admitted to our hospital because of progressive exertional dyspnea and occasional premature ventricular contraction. An enhanced computed tomographic scan revealed partial defect of the left ventricular myocardium and prominent trabecular meshwork at the same thin-wall segment. She underwent resection and endoventricular patch plasty using cardiopulmonary bypass. Histopathologic examination showed transmural fibro-fatty replacement of the myocardium, with an extremely thickened endocardium. Here we report an extremely rare case of surgery in a patient with arrhythmogenic left ventricular cardiomyopathy associated with left ventricular noncompaction.
The Annals of thoracic surgery 12/2010; 90(6):2044-6. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Ventricular septal perforation (VSP) is a rare but life-threatening complication of acute myocardial infarction (AMI). Even with assisted circulation heart failure often progresses quickly, and urgent surgical intervention is required to close the VSP. For several years, we have been performing a double patch closure technique using an equine pericardial patch. In this report, we present details of our patch closure technique and the VSP surgical results; we also examine the problems we encountered.
The present study was a review of nine patients who underwent our patch closure of VSP secondary to AMI. We used a large double-layered equine pericardial patch to close the VSP and did not exclude the infarction area from the left ventricular cavity. No necrotic myocardium was excised to avoid simultaneous excision of stunned myocardium.
No patients died within 30 days of the surgery, and there were no in-hospital deaths. Over a mean clinical follow-up period of 4.5 years, no residual shunts were detected, and all patients were alive and had New York Heart Association functional class II.
Our patch closure technique was effective for closing VSPs securely. The operating times and cardiopulmonary bypass times were short, and blood loss was minimal. Our patch closure technique may improve the prognosis of VSP.
General Thoracic and Cardiovascular Surgery 11/2010; 58(11):555-60.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to investigate the outcome of aortic valve replacement (AVR) performed with a 17-mm St. Jude Medical Regent prosthetic valve (17SJMR) for an aortic annulus ≤19 mm in elderly patients aged ≥65 years.
Six female patients (age 73.0 ± 5.1 years, body surface area 1.43 ± 0.07 m²) underwent AVR between October 2005 and February 2008.
Peak transaortic pressure gradient, which was 80.8 ± 31.0 mmHg preoperatively, decreased to 31.0 ± 4.2 mmHg postoperatively (P < 0.01) and to 21.7 ± 1.5 mmHg long term (P < 0.01). The left ventricular mass index, which was 112.1 ± 10.6 g/m² preoperatively, also significantly decreased to 101.4 ± 15.0 g/m² postoperatively and to 88.3 ± 14.8 g/m² long term (P < 0.01). Subjective symptoms diminished in all patients, and neither mortality nor hemorrhagic complications occurred. The postoperative mean effective orifice area index was 0.91 ± 0.04 cm²/m².
A favorable outcome was obtained by aortic valve replacement with the 17SJMR. Patients showed improved postoperative hemodynamic performance without valve-related complications.
General Thoracic and Cardiovascular Surgery 10/2010; 58(10):506-10.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to determine the long-term results of a 7-year follow-up of endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs) using custom-made stent grafts (SGs).
We performed a retrospective review of 17 patients (14 males, 3 females; mean age: 74.3 +/- 7.9 years; range: 53-85) undergoing EVAR of infrarenal aortic aneurysms at our institution from April 2000 to August 2006. The primary and secondary clinical success rates were 82.4% (14/17) and 100% (17/17). The initial and short-term clinical success rates were 100%. During follow-up (mean: 38.8 +/- 35.9 months; range: 0.8-90 months), 4 patients died, but there was no aneurysm-related death. In 2 patients, additional surgery was performed. The long-term clinical success rate was 83.3% (5/6). In the Kaplan-Meier curve, the 1- and 5-year survival rates were 55.0% and 45.8%, respectively.
The initial and short-term clinical success rates were 100%; regarding the short-term, aneurysm-related death could be avoided. However, during long-term follow-up, aneurysm-related events did occur. Follow-up should be performed over a long period.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2010; 16(1):26-30.
-
Asian cardiovascular & thoracic annals 02/2010; 18(2):203-4.
-
[show abstract]
[hide abstract]
ABSTRACT: A 22-year-old man was diagnosed with active mitral endocarditis 14 months after mitral valve repair. The responsible organism was methicillin-resistant Staphylococcus epidermidis. Transthoracic echocardiography showed an 8-mm patch of vegetation adhering to the anterior part of the artificial ring. Although antibiotics (piperacillin, minocycline, imipenem/cilastatin, and ampicillin) were administered, the vegetation grew to 30 mm. Reoperation was performed 35 days after the diagnosis. Before surgery, there was mild mitral regurgitation without congestive heart failure. Re-repair was performed by removing the vegetation and the artificial ring, and mattress sutures repaired the circumferential sulcus formed by the artificial ring. Teicoplanin and minocycline were administered for 6 weeks. At 20 months, infective endocarditis was absent. Residual mitral regurgitation has been consistently mild. Although active mitral endocarditis after mitral valve repair is rare, prompt reoperation should be considered if the responsible organism is drug-resistant and infection spreads to the artificial ring.
General Thoracic and Cardiovascular Surgery 01/2010; 58(1):49-52.
-
[show abstract]
[hide abstract]
ABSTRACT: Residual mitral regurgitation (MR) is a risk factor of reoperation. Here we report the midterm results of mitral valve repair for degenerative disease with mitral valve prolapse and identify important factors for durable repair.
From April 1999 to September 2007, 116 patients with leaflet prolapse (59 men; mean age 63 years) underwent mitral valve repair; they consisted of 19 anterior, 67 posterior, 23 bileaflet, and 7 isolated commissures. The mean clinical and echocardiographic follow-ups were at 4.1 +/- 2.3 and 3.3 +/- 2.4 years, respectively.
Altogether, 12 patients showed recurrent moderate or severe MR during the follow-up period; and 10 of the 12 patients (83.8%) had recurrent moderate or severe MR within 1.5 years. Causes of early MR recurrence were dehiscence of sutured segments and ineffectiveness of the artificial chords. The rates of freedom from reoperation at 3 and 7 years were 95.3% +/- 2.0% and 91.0% +/- 4.7%, respectively. The rates of freedom from recurrent moderate or severe MR at 3 and 7 years were 90.5% +/- 2.9% and 83.8% +/- 5.9%, respectively.
The prevention of dehiscence of the sutured segment and reestablishment of coaptation using artificial chords are imperative to maintain the durability of mitral valve repair for patients with degenerative disease.
General Thoracic and Cardiovascular Surgery 02/2009; 57(1):10-21.
-
[show abstract]
[hide abstract]
ABSTRACT: There have been various arguments concerning the patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) for small valves. The objective of this study was to evaluate the postoperative hemodynamics in patients. Methods: The subjects were 6 patients [6 females aged 64 (17~74) years, with a median body surface area (BSA) of 1.37 (1.29~1.51) m2] who underwent AVR at our facility using the 18-mm ATS-AP and tolerated exercise loading. We estimated pressure gradient(PG) ,ejection fraction(EF), left ventricular mass Index(LVMI)at pre-operation and post-operation. Exercise echocardiography on an ergometer was performed before and 29.0 ± 14.4 months after surgery. We estimated PG and effective orifice area(EOAI) at rest and at exercise. We compared echo data between pre-operation and post-operation, between at rest and at exercise. Results: The effective orifice area index(EOAI) at rest was 0.92(0.75~1.06) cm2/m2. There was a significant change in the LVMI between pre-operation and post-operation[158.5(104.0~222.2) g/m2 versus 102.4(92.3~146.4) g/m2; P < 0.05]. However, There was no significant change in the EOAI[0.92(0.75~1.06) cm2/m2 versus 0.84(0.78~0.91) cm2/m2; P > 0.05] and mean PG[11.0(6.6~16) mmHg versus 14.0(6.3~16) mmHg; P > 0.05], on maximal exercise. Conclusion: In patients whose BSA were 1.37(1.29~1.51) m2,the 18-mm ATS-AP was suggested to be a prosthetic valve that improves myocardial remodeling and provides stable hemodynamics even during exercise
