Dae-Gyun Park

Restoration of atrial mechanical function after maze operation in patients with structural heart disease

Abstract Background The maze operation is effective for the restoration of sinus rhythm; however, restoration of atrial mechanical function has not been demonstrated in all patients. Methods Maze operations were performed in 32 patients (13 men, 19 women; mean age 47.1 ± 9.0 years) combined with valvular surgery (n = 25), coronary artery bypass graft (CABG) (n = 3), and others (n = 4). At 1 week, 3 months, 6 months, and 1 year after the operation, prospective serial Doppler echocardiographic examination was carried out to determine the presence of atrial mechanical function. Results Sinus rhythm was restored and maintained during the follow-up period in 26 (81%) patients; in 22 patients this was due solely to the operation, whereas in four patients an antiarrhythmic agent was needed to maintain sinus rhythm. Another four patients showed paroxysmal atrial fibrillation (AF) despite treatment with an antiarrhythmic agent. Right atrial mechanical function was restored in all 30 patients with sinus rhythm or paroxysmal AF; in 19 (63%) of these, left atrial mechanical function was restored. In patients with restored left atrial mechanical function, peak A velocity (A) and A/E ratio (A/E) of mitral inflow were significantly lower than in the 16 postoperative control patients (A: 0.46 ± 0.14 m/sec vs 0.75 ± 0.29 m/sec, p

Utility of B-Type Natriuretic Peptide for Predicting Perioperative Cardiovascular Events in Patients Without History of Cardiovascular Disease Undergoing Major Non-Cardiac Surgery

Background and Objectives Patients without previous history of cardiac disease can be regarded as low-risk when undergoing major non-cardiac surgery. The aim of this study was to examine whether preoperative B-type natriuretic peptide (BNP) level predicted postoperative cardiac events in these patients. Subjects and Methods Preoperative BNP level was measured in 163 patients whose risk was considered low according to the Revised Cardiac Risk Index. Postoperative cardiac events, including death during hospitalization, myocardial injury, arrhythmia, cerebrovascular accidents and congestive heart failure were assessed. Results Postoperative cardiac events occurred in 8 patients (4.9%). Preoperative BNP levels were significantly higher among patients who experienced postoperative cardiac events, compared to those who did not (130.6±148.8 vs. 57.9±70.8 pg/mL, p=0.009). Conclusion Preoperative BNP level may provide prognostic information in low-risk patients undergoing major non-cardiac surgery.

Systematic Review of Treatment for Trapped Thrombus in Patent Foramen Ovale

Background and Objectives Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. Subjects and Methods A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. Results Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. Conclusion This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.

Echocardiographic Serial Changes of Hypertensive Cardiomyopathy With Severely Reduced Ejection Fraction: Comparison With Idiopathic Dilated Cardiomyopathy

Hypertensive cardiomyopathy with reduced ejection fraction (HTCMREF) is known as an important cause of reversible cardiomyopathy, but its serial changes on echocardiography is yet to be elucidated.