Ho-Ki Min

Nafamostat mesilate as a regional anticoagulant in patients with bleeding complications during extracorporeal membrane oxygenation

Purpose Anticoagulation is mandatory for extracorporeal membrane oxygenation (ECMO), but systemic heparinization, which has been most widely used as an anticoagulant, has been associated with bleeding complications. The present study reviewed the usefulness and safety of nafamostat mesilate as a regional anticoagulant in patients with bleeding complication during ECMO. Methods We retrospectively reviewed the record of 13 cases. The nafamostat mesilate dose was regulated to maintain the activated clotting time (ACT) or activated partial thromboplastin time (aPTT) values within an adequate range at the ECMO reinfusion route. ACT or aPTT values in blood samples from the ECMO circuit and from the patients were measured simultaneously and consecutively. Results We measured the ACT value in 6 cases and aPTT in 7 cases. The bleeding complications were treated in 11 cases. When we compared the difference in 2 anticoagulation values (ACT and aPTT) between the 2 blood samples, one taken from ECMO and the other from patients, mean anticoagulation values of blood from patients were lower than those from ECMO circuit in 11 cases. With respect to the type of ECMO reinfusion mode, the difference was significant only in veno-arterial mode ECMO group (p<0.001). Conclusions Nafamostat mesilate, with which we can reduce anticoagulation values of patient to a safe level without losing the ECMO anticoagulation values is expected to be useful as a regional anticoagulant in patients with bleeding complications or a high risk of bleeding during ECMO.

Three different situations and approaches in the management for anomalous origin of the right coronary artery from the left coronary sinus: case report.

Anomalous origin of the right coronary artery from the left coronary sinus is rare but potentially dangerous if any ischemic signs are present. Multiple therapeutic options were advocated so far. We experienced three different situations and surgical approaches to these anomalies, and reviewed retrospectively. For the first case, we made a neo-ostium on the right sinus of Valsalva and anastomosed with the right coronary artery after arteriotomy. For the second and third cases, we applied coronary artery bypasses emergently: patient 2 the gastroepiploic artery during off-pump coronary artery bypass and patient 3 the left internal thoracic artery during surgery for acute aortic dissection. For the better outcomes, it is important to understand anatomic and hemodynamic characteristics of each patient and select the surgical options considering each characteristic.

Long-term clinical and angiographic outcomes of patients with sirolimus-eluting stent fracture

BACKGROUND There is limited data on the long-term outcomes of patients with sirolimus-eluting stent (SES) fracture. METHODS After performing index percutaneous coronary intervention (PCI) with SES from Dec. 2003 to Dec. 2007, the patients with stent fracture (SF) detected by angiography at follow-up or adverse events were enrolled. SF was angiographically defined as complete or partial separation of the stent and this had been contiguous after stenting. The patients were divided into two groups as SF without in-stent restenosis (ISR) (Group 1, n=55) and SF with ISR (Group 2, n=44) and the patients were clinically and angiographically followed up after the detection of SF. The major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) were determined. RESULTS At SF detection, most patients were asymptomatic (92.7% in Group 1 vs. 43.2% in Group 2, p=0.001). Acute coronary syndrome developed in 18.2% of Group 2, but it developed in only 1.8% of the patients of Group 1. Clinical follow-up was done in all patients for 675 ± 375 days from SF detection. From the detection of SF, MACEs were noted in 32.3% of the patients (10.9% in Group 1 vs. 59.1% in Group 2, p=0.001), mostly from TVR (9.1% in Group 1 vs. 54.5% in Group 2, p=0.001). CONCLUSION The long-term follow-up results of SF after SES implantation show an increased risk of adverse cardiac events, and especially for the patients with ISR.

Stanford type A aortic dissection secondary to infectious aortitis: a case report.

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

A modified root reinforcement technique for acute aortic dissection with a weakened aortic root: a modified Florida sleeve technique and two cases report.

Despite marvelous advances in repair for acute type A aortic dissection over past decades, it remains challenging to repair the aortic root when aortic dissection extended to the sinuses causes the fragile root because of its thinner layers, which are susceptible to suture trauma. Here, we describe a modified Florida sleeve technique to strengthen the weakened aortic root. After mobilization of the aortic root and the coronary arteries, a designed Dacron tube graft was wrapped outside the sinuses as neo-adventitia to reinforce the dissected weakened wall. During surgery for aortic dissection, our technique is easy and effective to reinforce a weakened root and avoid bleeding. Furthermore, this might be an alternative technique to restore and maintain the geometry of the aortic root.

Long Segmental Reconstruction of Diffusely Diseased Left Anterior Descending Coronary Artery Using Left Internal Thoracic Artery with Extensive Endarterectomy

In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.

A New Surgical Repair Technique for Ischemic Total Papillary Muscle Rupture

Papillary muscle (PM) rupture is an emergency surgical condition that may occur after acute myocardial infarction. In patients with compete rupture of the PM, mitral valve replacement is preferred or recommended generally because of unstable vital signs or technical difficulties with successful repair, as compared with patients with partial PM rupture. This case report describes the successful repair of a complete anterolateral PM rupture by using the single PM formation technique with subsequent ring annuloplasty.

Giant Cell Tumor Arising from Anterior Arc of the Rib

A primary giant cell tumor of the rib is very rare. The most common site of a giant cell tumor arising from the rib is the posterior arc. A giant cell tumor arising from the anterior arc of the rib is extremely rare. The treatment of a giant cell tumor of the rib is not well defined. Generally, a complete surgical resection is performed in a patient with a primary giant cell tumor of the rib. We report a case of a giant cell tumor arising from the anterior arc of the rib that was treated with a wide excision and chest wall reconstruction.

The “High Take-Off” Left Main Coronary Artery in a Patient With Acute Type A Aortic Dissection

A 73-year-old woman with a history of hypertension was admitted to the emergency room for chest pain and dyspnea. A chest radiograph showed mediastinal widening and increased cardiothoracic ratio (Figure 1A). Electrocardiography showed normal sinus rhythm without any ST changes (Figure 1B). Preoperative echocardiography was unremarkable except for moderate pericardial effusion. Enhanced computed tomography (CT) revealed acute type A aortic dissection with moderate amount of pericardial effusion and ectopic high origin of the left main coronary artery (LMCA; Figure 1C). Figure 1. The preoperative diagnostic work-ups. A , The preoperative chest x-ray shows mediastinal widening and increased cardiothoracic ratio. B , The preoperative EKG shows normal sinus rhythm without any ST changes. C , Computed tomography shows the ostium of the left main coronary artery to be at ≈28 mm above the aortic valve and moderate amount of pericardial effusion (*). AoV indicates aortic valve; and LM, left main coronary artery. Emergency surgery was performed under cardiopulmonary bypass with cardioplegic arrest. During surgery, we recognized that LMCA originated ≈28 mm above the aortic valve and coursed down extramurally (Figure 2). LMCA was mobilized cautiously and separated from the aortic wall. After …

Late simultaneous presentation of left ventricular pseudoaneurysm and tricuspid regurgitation after blunt chest trauma.

A 32-yr-old man developed progressive exertional dyspnea 4 yr after blunt chest trauma due to an automobile accident. Two-dimensional echocardiography and computed-tomographic coronary angiography demonstrated a large pseudoaneurysm of the left ventricle and severe tricuspid regurgitation. The patient underwent successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure and repair of the tricuspid valve regurgitation. To the best of our knowledge, this is the first case of these 2 different pathologies presenting late simultaneously after blunt chest trauma and successful surgical repairs in the published literature.