Shye-Jao Wu

Atrial gap junctions, NF-kappaB and fibrosis in patients undergoing coronary artery bypass surgery: the relationship with postoperative atrial fibrillation.

Objectives: We examined the role of atrial gap junctions, NF-κB and fibrosis in the occurrence of postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Forty-five patients with sinus rhythm were randomly assigned to the beating heart (n = 22) or cardioplegic cardiac arrest (n = 23) technique for surgery. Of them, 14 patients experienced post-CABG AF. Atrial samples taken before and after CABG surgery were analyzed. Results: During surgery, Cx43 and Cx40 proteins were significantly reduced (both p < 0.05) in the arrested heart group, but only mildly decreased in the beating heart group. However, the change of either connexin was not associated with AF. In contrast, patients with AF had a higher baseline expression of NF-κB and more fibrosis compared to those without AF (both p < 0.05). Conclusions: CABG surgery with the beating heart technique attenuated the reduction of atrial Cx43 and Cx40 compared to the cardioplegic cardiac arrest technique. Atrial inflammation and fibrosis status before surgery, but not the changes of connexins during surgery, were associated with the occurrence of post-CABG AF.

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.

Cardiac Trauma: A Review

Since Dr. Ludwig Rehn completed the first successful human cardiac repair in 1895, cardiac trauma has become one of the most challenging injuries to treat. It requires immediate diagnosis, repair with excellent surgical skills, and thorough post-operative care. The clinical presentation of the two kinds of cardiac trauma, penetrating and blunt contusion injury, has a broad range, from hemodynamic stability to cardiopulmonary arrest. In spite of the fact that trauma to the heart is fatal in a significant percentage of cases and many patients are found dead at the scene, patients who arrive at the hospital with intact vital signs have a good chance of survival if well managed. The purpose of this review is to summarize current understanding concerning the natural history, initial evaluation, diagnosis and management of patients with cardiac trauma, including penetrating and blunt contusion injury.

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.