Jiun-Yi Li

Acute Fulminant Myocarditis after Diphtheria, Polio, and Tetanus Vaccination

We report an infant case of acute fulminant myocarditis which occurred after administration of a diphtheria, polio, and tetanus vaccination. Fever and dyspnea developed after the vaccination. Extracorporeal membrane oxygenation was used for intractable cardiogenic shock. The patient survived the extracorporeal support, but poor ventricular contractility recurred 2 months later and she died while waiting for heart transplantation.

Aortic Dissection: Single Center Experience with Surgical Treatment

Objectives: This study reports our surgical results for aortic dissection and the post-operative follow up. Possible reasons for post-operative cerebral insults are discussed. Methods: From October 2000 to April 2004, 23 patients (18 men; 5 women; mean age 54.8±15.8 years) underwent operation for aortic dissection in our hospital. According to the Standford classification, there were 19 cases in Type A and 4 cases in Type B. Five patients had a Marfan syndrome. All the cases except two with the Marfan syndrome had surgery under profound hypothermic circulatory arrest with retrograde perfusion. Surgical strategies included aortic grafting only (9/23, 39.1%), aortic valve replacement with supracoronary ascending aortic grafting (1/23, 4.3%), aortic valve resuspension with supracoronary ascending aortic grafting (6/23, 26.1%), aortic valve resuspension with supracoronary ascending aortic grafting and coronary artery bypass grafting (2/23, 8.7%), Bentall operation (3/23, 13.0%) and Bentall operation with coronary artery bypass grafting (2/23, 8.7%). Results: There was no operative or in-hospital mortality. Median ventilator supporting time was 4 days (range: 1 to 94). Re-exploration for hemostasis was needed in 2 patients. Cerebral ischemic infarction was found in 3 patients. All the patients received post-operative follow up. Mean follow-up time was 20.7±14.2 months (range: 2 to 40). All the patients had clear consciousness during the follow up. There were 5 late deaths. Both the one-year and two-year survival rates were 78.9%, and the three-year survival rate was 70.1%. Conclusion: Aortic dissection is a challenge for cardiovascular surgeons. However, good results and acceptable morbidities can be achieved under profound hypothermic circulatory arrest with retrograde perfusion.

Extracorporeal Membrane Oxygenation and an Emergency Embolectomy for an Acute Massive Pulmonary Embolism

An acute massive pulmonary embolism causing circulatory collapse is fatal without aggressive intervention. Pulmonary angiography is usually required to confirm the diagnosis in an emergency condition. However the procedure carries a high risk in patients with unsupported cardiogenic shock. Extracorporeal membrane oxygenation plays an important role in resuscitation and preoperative support during pulmonary angiography. We describe a patient who was sent to the emergency station with the presentation of cardiac arrest. She was successfully resuscitated using extracorporeal membrane oxygenation and subsequently treated by a surgical embolectomy.

Total descending thoracic and abdominal aorta grafting in type III aortic dissection with aneurysm

Single-stage complete replacement of the descending thoracic aorta and the abdominal aorta is a surgical challenge. A 65-year-old man developed acute DeBakey type IIIB aortic dissection and was treated medically. The affected aorta dilated progressively, reaching a maximal diameter of 7 cm 2 years later. Computed tomography revealed a Crawford type II thoracoabdominal aortic aneurysm and an additional infrarenal abdominal aortic aneurysm below the dissected aorta. The descending thoracic aorta and the abdominal aorta were completely replaced with a Hemashield graft under deep hypothermic circulatory arrest. The postoperative course was complicated with transient left hemiparesis and upper gastrointestinal bleeding which were successfully treated by transarterial embolization. The results of this case indicate that complete replacement of the descending thoracic and abdominal aorta can adequately and safely treat type III aortic dissection.