Jih-Hsin Huang

Recurrent Cervical Carcinoma Presenting as a Primary Aortoduodenal Fistula

Aortoduodenal fistula is a rare cause of gastrointestinal (GI) bleeding, and carries high morbidity and mortality even in modern practice. Cervical carcinoma is a major health threat among adult women, and its recurrence is not uncommon. We herein present a case of primary aortoduodenal fistula because of recurrent cervical carcinoma. Our case demonstrated that diagnosis of primary aortoenteric fistula requires a high index of suspicion and a combination of diagnostic modalities to establish the diagnosis. Prompt diagnosis and rapid treatment are critical in reducing mortality and morbidity. Although rare, metastatic carcinoma can lead to aortoenteric fistula.

The Provisional Extension To Induce Complete Attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results

OBJECTIVES To report our preliminary results of an aggressive technique, the Provisional Extension To Induce Complete Attachment (PETTICOAT), in repair of acute DeBakey type I aortic dissection. METHODS From April 2014 to November 2014, 18 patients with acute DeBakey type I aortic dissection were reviewed retrospectively. Nine patients underwent open repair combined with proximal stent grafting and distal bare stenting (PETTICOAT group). For comparison, another 9 patients underwent open repair combined with proximal stent grafting (NON-PETTICOAT group) were included. Open repair entailed ascending aorta plus total arch replacement under circulatory arrest, with variable aortic root work. Mortality and morbidity were recorded, and computed tomography was performed to evaluate the aortic remodelling at 6 months postoperatively. RESULTS Preoperative parameters were similar. In the PETTICOAT group, one early mortality was noted. One complication of cardiac tamponade and sternal wound infection led to reopen surgeries. In the NON-PETTICOAT group, one case of transient ischaemic attack took place. Compared with the NON-PETTICOAT group, a significant increase in diameter of true lumen (median, 0.6 vs 0.1 mm, P < 0.01) and a decrease in diameter of false lumen (FL; median, -0.9 vs 0.0 mm, P < 0.01) at the level of lowest renal artery were noted in the PETTICOAT group. Moreover, significant FL volume regression (median, -102.0 vs -42.2 mm(3), P = 0.03) was observed in the PETTICOAT group. More cases of total thrombosis or regression of FL down to the level of renal artery were also noted in the PETTICOAT group (5/8 vs 0/9, P < 0.01). Two patients of the NON-PETTICOAT group received endovascular distal aortic reintervention at 6 months. CONCLUSIONS The PETTICOAT technique in the management of acute DeBakey type I dissection is a feasible and promising method to promote distal aortic remodelling. However, outcomes are preliminary and further follow-up is required.

Cardioplegia Delivery by Transcutaneous Pigtail Catheter in Minimally Invasive Mitral Valve Operations

For cardioplegia delivery and removing air from the aorta in minimally invasive mitral valve operations, we would like to propose a cost-effective pigtail method. The 8F pigtail punctures the aorta, delivers cardioplegia, and stays in place for removing air from the aorta. We then slide its tip out of the aorta as an accessory drain. With more than 100 successes, we are using it in every case and would like to share it with peer surgeons.

Pseudoaneurysm of the ascending aorta

A 69-year old man underwent ascending aorta grafting and aortic valve replacement for an acute aortic dissection. Nine months later, he suffered from painful ecchymosis and swelling of the sternal wound (Fig. 1). Computed tomography revealed a huge pseudoaneurysm of the ascending aorta (Fig. 2). Reoperation was successfully performed to repair the anasto-motic suture line tears. Figure 1: Prominent ecchymosis and swelling were noted over the upper half of the sternotomy wound. This area was not pulsatile by palpation, but its size rapidly increased day-by-day. It was quite painful, even without touching. Figure 2: (A) A computed tomography revealed a huge ascending aortic pseudoaneurysm full of blood clots. Contrast extravasation could be easily identified over proximal anastomosis (arrowhead). (B) Although the sternum was stable without obvious malunion, trans-sternal extension of the pressurized blood clots in the pseudoaneurysm resulted in a rapidly expanding subcutaneous haematoma (arrow).

Delayed lung herniation after minimally invasive cardiac surgery.

A 29-year old man underwent mitral valvuloplasty for severe valve insufficiency via right minithoracotomy. Five years after the operation, a chest X-ray incidentally disclosed a subcutaneous air chamber, which was not found 1 year before (Fig. 1). Computed tomography showed right lung herniation via the fourth intercostal space (Fig. 2). Lung herniation is still possible many years after minimally invasive cardiac surgery.

Physical Activity, Physical Fitness, and Quality of Life after Coronary Artery Bypass Grafting

背景和目的：冠狀動脈繞道術後患者長期存活率已大幅提高，因此促進這些患者長期體適能與生活品質是相當重要的健康議題。本研究的目的包括：(1)比較冠狀動脈繞道術後4年內與4年以上患者之身體活動量、體適能與生活品質是否有差異；(2)分析影響這些患者體適能和生活品質的因素。方法：共有311位（265位男性和46位女性）參與本研究。我們分別採用國際身體活動量問卷(International Physical Activity Questionnaire)和世界衛生組織生活品質問卷－短版(World Health Organization Quality of Life Instrument-Brief Version)評估身體活動量和生活品質。體適能評估包括手握力、30秒椅子站立和6分鐘行走測驗。結果：冠狀動脈繞道術後4年內與4年以上患者之身體活動量、體適能與生活品質並無統計上顯著差異(p ＞ 0.05)。與中、高身體活動量組比較，低身體活動組有顯著較低的手握力、30秒椅子站立次數、6分鐘行走距離和生活品質(p ＜ 0.01)。經過校正共變數後，高身體活動量組患者的身體健康面向和心理面向顯著較低身體活動量組高，β值分別為1.19和1.01(p ＜ 0.01)。此外，生活品質與身體活動量的關係主要受到6分鐘行走距離影響(p ＜ 0.01)。結論：對於冠狀動脈繞道手術後的長期患者，低身體活動量仍是影響體適能和生活品質顯著且重要的因素。

Intraoperative Measurement of Fractional Flow Reserve in Off-Pump Coronary Artery Bypass: A Pilot Study

BACKGROUNDS Fractional flow reserve of myocardium (FFRmyo) is a functional study of significant coronary artery stenosis, defined as the ratio of the pressure distal to the stenosis (poststenosis) divided by the pressure of aortic root (prestenosis). Instead of cath laboratory, we could measure it in operating room for off-pump coronary artery bypass (OPCAB) surgery and here shared our methods in the pilot study. METHODS AND RESULTS We used needles, catheters, and pressure tracing but without guidewires or fluoroscopy to measure FFRmyo during OPCAB. In February 2010, we conducted the pilot study and collected 32 anastomosis data from 10 patients. Without revising the anastomosis plans based on coronary angiographies, 24 FFRmyo of the 32 anastomoses (75%) were less than 0.75, which represented significant functional stenosis. The FFRmyo measurements did not lead to any adverse events. CONCLUSION The measurement of fractional flow reserve in OPCAB is safe and feasible. It can serve as a functional assessment of coronary artery stenosis in adjuvant to conventional coronary angiography.

Left ventricular pseudoaneurysm after apicoaortic bypass

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Emergent Embolization of a Ruptured Internal Iliac Artery Aneurysm with an Amplatzer Vascular Plug

— see front matter # 2011 European Association for Cardio-Thoracic S doi:10.1016/j.ejcts.2011.04.036 A 78-year-old man had severe aortic stenosis. Because of ascending aorta calcification and previous coronary artery bypass graft, we performed apicoaortic bypass through left thoracotomy. An enlarging mass was noted (Fig. 1). Echocardiography and computed tomography revealed a large left ventricular pseudoaneurysm (Fig. 2). Re-operation was performed smoothly through re-thoracotomy to repair the tear.

Staphylococcal infection-related constrictive pericarditis with formation of a mycotic aneurysm in the right coronary artery

We shared our experience of endovascular treatment for a ruptured internal iliac artery aneurysm. A 70-year-old man was brought to the emergency department with the presentation of abdominal pain and profound shock. Computed tomography disclosed a ruptured internal iliac artery aneurysm. He was quickly stabilized by the blood flow occlusion in the abdominal aorta with two parallel balloons. Internal iliac artery embolization was performed with an Amplatzer Vascular Plug. Because of bleeding tendency, the adequately positioned vascular plug could not induce complete thrombosis. Temporary balloon occlusion of the iliac artery induced stasis of blood and facilitated the thrombosis process. Complete thrombosis was finally attained. This was the first report of using an Amplatzer Vascular Plug for emergent internal iliac artery embolization.