Youn-Ho Hwang

Vagus nerve stimulation in pediatric intractable epilepsy: a Korean bicentric study.

OBJECTIVE To present our experience with vagus nerve stimulation (VNS) and to evaluate the long-term efficacy and safety of the procedure in pediatric intractable epilepsy. METHODS This study included sixteen patients, who were implanted with a vagus nerve stimulator and could be followed up for at least more than 12 months in two epilepsy centers. Data including seizure frequency, EEG, quality of life measures and adverse events were prospectively filed over a 5-year period. RESULTS VNS resulted in a > 50% reduction in seizure frequency in 50.0% (8/16) of children with 31.3% (5/16) of patients achieving a > 90% reduction. Additionally, enhancements in quality of life were as follows: memory in 50.0% (8/16), mood in 62.5% (10/16), behavior in 68.8% (11/16), alertness in 68.8% (11/16), achievement in 37.5% (6/16), and verbal skills in 43.8% (7/16) of the patients. Adverse events included hoarseness in two patients, dyspnea during sleep in two patients, and sialorrhea in one patient. However, these events were tolerable or could be controlled by the adjustment of output currents. In one patient, wound revision was required. CONCLUSION Our data supports the role of VNS as an alternative therapy for pediatric intractable epilepsy.

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.

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.

Benign Mature Teratoma in Anterior Mediastinum

Teratoma of mediastinum is rare germ cell tumor. Anterior mediastinum is the most common extragonadal site. Benign mediastinal teratoma accounts for 60% of all mediastinal germ cell tumors. Benign mature teratoma has excellent prognosis after surgical excision. We present a case of 20-year-old woman diagnosed as benign mature teratoma which compressed main pulmonary trunk. The patient underwent surgical excision.

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.