Hark Jei Kim

Infected infradiaphragmatic retroperitoneal extralobar pulmonary sequestration: A case report

Infradiaphragmatic extralobar pulmonary sequestration is an extremely rare congenital malformation. It is more frequently diagnosed in the antenatal period due to routine ultrasonic examination of the fetus or in the first 6 months of life, though on rare occasions it is discovered incidentally in adults. A 32-yr-old man presenting with epigastric discomfort and fever was referred. Computed tomographic scanning showed that a 16-cm, multiseptated, dumbbell-shaped, huge cystic tumor was located beneath the diaphragm. On the next day, 850 mL of thick yellowish pus was drained by sonography-guided fine needle aspiration for the purpose of infection control and diagnosis, but no microscopic organisms were found in repeated culture studies. Surgical removal of the cyst was performed through thoracoabdominal incision and most of these pathologic lesions were removed but we could not find the feeding arteries or any fistulous tract to surrounding structures. Histopathologic study revealed that it was extralobar pulmonary sequestration and culture study showed that many WBC and necrotic materials were found but there were no microorganisms in the cystic contents. We report the first case of an infected infradiaphragmatic retroperitoneal extralobar sequestration which was administered a staged management and achieved an excellent clinical course.

Simultaneous repair for aortic incompetence with annuloaortic ectasia and pectus excavatum by modified Ravitch procedure with pectus bars in an adult patient with Marfan syndrome.

rence, even if this operation impaired the patient’s quality of life (bypass, valve replacement, and ventricular septal defect patch closure). Cases of cardiac transplantation to treat these fibromas have also been reported. However, subtotal resection seems to be the best therapeutic option when the size or location of the tumor makes total resection impossible. The risk of tumor regrowth seems to be relatively low. Several colleagues have described the absence of tumor progression at long-term follow-up, even if the number of cases reported is low. Finally, transplantation does not seem to be an acceptable option, even with voluminous fibromas; subtotal resection should be the treatment of choice. Even if it is widely accepted that fibromas should be totally resected because of their recurrence risk, subtotal surgical intervention might be an acceptable option when the volume or location of the tumor makes total resection a high-risk procedure.

Endovenous lasering versus ambulatory phlebectomy of varicose tributaries in conjunction with endovenous laser treatment of the great or small saphenous vein.

Endovenous laser treatment (EVLT) is a widely used minimally invasive alternative to stripping of varicose veins involving the great and small saphenous veins. We expanded the applications to tributary varicosities and compared EVLT alone with combined EVLT and ambulatory phlebectomy. The study included 132 patients (76 males, 56 females) who were treated with EVLT and ambulatory phlebectomy. In addition, 133 patients (67 males, 66 females) were treated only with EVLT. Perforating vein reflux was identified in 65 patients in the combination group (49.2%) and in 121 patients (91.0%) in the EVLT only group (p=0.000). Postoperative complications and reoperation rates were compared between the two groups and the risk factors for reoperation analyzed. Ecchymosis (about 85%) and pain (>20%) were the major postoperative complications for both groups. There were no significant differences in the complications noted between the combination and EVLT only groups. During the follow-up period (25.6+/-12.8 months, range 15.5-37.3, in combination group; 11.8+/-8.2 months, range 1.3-18.5, in EVLT only group), residual tributary varicosities were noted in 12 patients (9.1%) in the combination group and in 11 (8.3%) in the EVLT only group (p=0.813). For patients who had reflux in the perforating veins, the reoperation rate was significantly higher compared to the patients without reflux in the perforating veins in each group (p=0.015 in combination group, p=0.006 in EVLT only group). The presence of perforating reflux was a significant risk factor (odds ratio=3.938, 95% confidence interval 1.05-14.78, p=0.042). EVLT as the sole therapy for the management of combined saphenous and tributary varicose veins was found to be safe and effective. However, longer follow-up is needed for confirmation of these findings.

Myocardial Protective Effect of Tezosentan, an Endothelin Receptor Antagonist, for Ischemia-Reperfusion Injury in Experimental Heart Failure Models

The myocardial protective effects of endothelin antagonist in ischemic cardiomyopathy (ICMP), doxorubicin-induced cardiomyopathy (DOX) and pressure-overload hypertrophy by transverse aortic constriction (TAC) models have been predicted to be different. The objective of this experiment, therefore, is to evaluate the myocardial protective effect of tezosentan, an endothelin receptor antagonist, in various experimental heart failure models. Sprague-Dawley rats (6-8 weeks old, 200-300 g) were randomized to three experimental groups (n=30 each): ICMP; DOX; and TAC group. Each of these groups was randomly assigned further to the following subgroups (n=10 each): sham-operated ischemia-reperfusion subgroup (SHAM); tezosentan treated ischemia-reperfusion subgroup (Tezo); and tezosentan non-treated ischemia-reperfusion subgroup (N-Tezo). Total circulatory arrest was induced for 1 hr, followed by 2 hr of reperfusion. The left ventricular developed pressure, peak positive and negative first derivatives, and coronary blood flow were significantly different (P<0.05) among the SHAM, Tezo, and N-Tezo subgroups of the ICMP group at 30 min of reperfusion, but there were no statistically significant differences among the subgroups of the DOX and TAC groups. In conclusion, tezosentan, an endothelin receptor antagonist, showed myocardial protection effects only on the ischemic cardiomyopathy rat model, but not in the non-ischemic heart failure rat models.

Sinus of Valsalva Aneurysm From Left Sinus: Value of Angioscopic View of a 3-Dimensional Computed Tomographic Angiography

A 57-year-old man was referred for exertional chest pain and a mediastinal mass. Computed tomographic angiography (CTA) revealed a huge aneurysm arising from the left sinus of Valsalva (Figure 1, Video I in the online-only Data Supplement). The opening of aneurysm was 18 mm in its largest diameter. Because the left coronary arteries were stretched and narrowed, the chest pain was considered to be caused by the aneurysm. The right coronary artery and other cardiac structures were normal. In transthoracic echocardiography, there was mild aortic and mitral regurgitation. The transesophageal echocardiography also showed competent aortic valve and aneurysm. However, it was not clear whether the aortic valve annulus was intact or not (Video II in the online-only Data Supplement). To understand the anatomy of aortic root complex, including aortic valve, coronary ostium, …

Upper extremity ischemia from developmental failure of brachial artery-a case report.

Advances in medicine and technology have increased brachial artery utilization for diagnostic and interventional radiology. Hence, detection and assessment of variations in upper extremity vasculature are important regardless of the low surgical intervention rate in the upper extremity. Anomalies of the upper extremity artery are infrequently reported, and anomalies of the brachial artery are even less common. Presented here is a case of developmental failure of the brachial artery. A segment about 2.1 cm from its origin was treated with bypass surgery. This is presented as an uncommon variation of the brachial artery.

A simple modification for a longer and larger internal thoracic artery as a composite Y-graft

Abstract Objectives. Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) has been proven to improve survival. Many surgeons use the composite Y-graft which is made of left ITA (LITA) and right ITA (RITA) grafts. The LITA is typically anastomosed to left anterior descending artery (LAD). However, we have used RITA for LAD instead of LITA and reviewed the patency of ITA grafts and their clinical outcomes. Methods. We analyzed 48 patients who underwent CABG using a BITA composite Y-graft from 2002 to 2012. In 30, LITA was anastomosed to LAD (Group L). The other 18 had RITA to LAD anastomosis (Group R). Results. The mean age of Group R was higher than that of Group L (p = 0.009). Postoperative angiography was performed in 35 patients (73%). Two patients in Group L and none of the patients in Group R had an ITA graft failure. The incidence of ITA graft failure and new adverse cardiovascular events were not different between the two groups. Conclusion. The clinical outcome of RITA to LAD anastomosis is comparable with anastomosis of LITA to LAD in CABG using BITA composite Y-grafts. This technique may be useful when longer and larger ITA grafts are needed.

Changes in N-terminal Pro B-type Natriuretic Peptide Concentration: Comparative Study of Percutaneous Transluminal Coronary Angioplasty and Off-Pump Coronary Artery Bypass Graft

The goal of this study was to compare the effects of different reperfusion methods on N-terminal B-type natriuretic peptide (NT-proBNP) in percutaneous transluminal coronary angioplasty (PTCA) or off-pump coronary artery bypass (OPCAB) patients. Fifty subjects were enrolled in the study, 32 patients received PTCA and 18 OPCAB. An NT-proBNP measurement was performed before intervention and at 1, 3, and 7 days after the procedures. NT-proBNP levels were not significantly different before intervention (PTCA group 297±147.3 vs. OPCAB group 235±167.8 pg/mL, p>0.05). However, 1 day after the procedures, NT-proBNP levels were higher in the OPCAB group (PTCA 375±256.4 vs. OPCAB 1,415±737.6 pg/mL, p<0.05), after 3 days NT-proBNP reached peak levels (PTCA 480±363.0 vs. OPCAB 2,119±818.4 pg/mL, p<0.05), and levels were reduced after 7 days (PTCA 292±243.7 vs. OPCAB 522±334.0 pg/mL, p>0.05). PTCA induced a mild and transient increase in NT-proBNP concentration, but OPCAB caused sustained high NT-proBNP levels during the 7 day postoperatively. However, differences between NT-proBNP levels associated with these two modalities showed a tendency to decrease rapidly postoperatively.

Clinical evaluation of the ATS Medical valve

With the introduction of a new cardiac prosthesis, it behooves surgeons and cardiologists to carefully monitor its performance. The ATS Medical prosthetic valve has been used at Guro Hospital in Korea since 1994.