• Journal of Chest Surgery
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• v.37 no.3
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• pp.272-274
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• 2004

We report an unusual case of left atrial auricular abscess which was successfully treated by surgical resection, treatment with antibiotics and mediastinal irrigation. A 9-year-old female patient with previous history of urinary tract infection was admitted because of persistent fever. Echocardiography and magnetic resonance imaging revealed massive pericardial effusion and a mass lesion at the left upper cardiac border. Pericardiocentesis isolated Staphylococcus aureus on culture. The patient underwent mass removal under cardiopulmonary bypass. The mass was located within the left atrial auricular wall with fibropurulent abscess formation inside. Postoperative mediastinal irrigation was performed. Pathologic examination of the mass showed organized thrombi with chronic fibrosing mural endocarditis. She discharged on the 21st postoperative day without complication.

• Tuberculosis and Respiratory Diseases
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• v.57 no.6
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• pp.599-603
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• 2004

Primary pericardial malignant mesothelioma is a lethal and rare cardiac neoplasm of mesodermal origin. Most cases are associated with history of pericarditis with constriction and/or tamponade. Authors experienced a case of primary pericardial malignant mesothelioma in a 55-year old female who had suffered from dyspnea and chest pain. Pericardial nodules revealed intense uptake by FDG-PET scan and confirmed as primary pericardial malignant mesothelioma by thoracoscopic biopsy. Here we report this case with a brief review of the relevant literatures.

• Journal of Chest Surgery
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• v.24 no.4
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• pp.397-403
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• 1991

From June 1987 to January 1991, 24 patients with moderate or massive pericardial effusion underwent subxiphoid pericardial window procedures for diagnosis and therapy. The patients` ages were ranged from 28 years to 71 years. The underlying diseases were chronic renal failure with long term hemodialysis in 3 cases, malignant lung cancer in 7 cases, stomach cancer in 2 cases, tuberculous pericarditis in 5 cases, pyogenic pericarditis in 2 cases, myxedema in one case, one metastatic squamous cell carcinoma from unknown origin and three of undefined etiology. Preoperative diagnoses of pericardial effusions were confirmed by echocardiogram in all cases. Subxiphoid pericardial drainages were performed under general[n=19] or local anesthesia[n=5]. Histological diagnoses were made from the inferior pericardial tissue in all cases except one. In this one case[tuberculous pericarditis], the subxiphoid pericardial approach was failed from intraoperative bleeding. There were two postoperative death, one[in malignant lung cancer] had postoperative ventricular tachycardia which result in cardiac arrest, and the other[unknown origin metastatic malignant effusion] had persistent tachyarrhythmia postoperatively and died on postoperative 5th days. Twenty three patients were followed up from 3 days to 9 months; mean follow-up day was 43 days. The preoperative and postoperative mean cardiothoracic ratio in chest x-ray were 0.69 and 0.52 respectively. Subxiphoid pericardial drainage may provide definitive diagnosis and treatment for pericardial effusions. The approach through subxiphoid pericardium under general or local anesthesia avoids the complications of pericardiocentesis and is effective for malignant pericardial effusion.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.363-366
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• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.487-490
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• 1995

We have experienced the 37 patients of pericardial effusion during last 8 years[1986-1993 . They were 17 male and 20 female patients, and their age range was 6months to 80 years.The causes of this pericardial effusion were 10 cases of tuberculosis, 7 cases of malignancy, 2 cases of acute pyogenic infection, 2 cases of postpericardiotomy pericardial effusion, 2 cases of trauma, 1 case of congenital heart disease, 1 case of SLE, and other 12 cases of unknown origin. All patients, except one, were managed by pericardiotomy with subxiphoid tube drainage. One case was managed by pericardiectomy. After operation, their symptoms and sign were dramaticaly improved. However, 3 patients were died postoperatively. Two of them were died of respiratory failure. One of them was died 28 months later with unrelated cause. They have already far advanced lung cancer. We conclude that the pericardiotomy with subxiphoid tube drainage was effective treatment in the patients with pericardial effusion.

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.539-544
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• 2006

Purpose : The purpose of this study was to determine whether N-terminal fragment of B-type natriuretic peptide(NT-proBNP) may be used to differentiate acute Kawasaki disease(KD) from other clinically similar diseases. Methods : Using electrochemiluminescence immunoassay, NT-proBNP concentrations were measured in the acute phase within 10 days after the onset of KD(n=58) and in the convalescent phase, 60 to 81 days after the onset(n=51), and also in patients with acute febrile disease as a control(n=34). Echocardiography was performed to detect pericardial effusion(PE) and coronary artery lesions(CAL), and to measure the left ventricular dimension at diastole(LVIDd) and ejection fraction(LVEF). The cutoff value of NT-proBNP for separating KD from other diseases was determined. Results : NT-proBNP concentration in the acute phases of KD was significantly higher than that in the control group($1,501.6{\pm}2,132.6$ vs. $139.0{\pm}88.8pg/mL$, P<0.0001). In KD patients, NT-proBNP was elevated in the acute phase and was lowered in the convalescent phase($1,466.0{\pm}2,173.2$ vs. $117.5{\pm}95.5pg/mL$, P<0.0001). The cutoff value of 260 pg/mL discriminated KD patients from other patients, with a sensitivity of 93 percent and a specificity of 88 percent. The NT-proBNP was higher in patients with PE(n=17) compared with those without PE(n=41)($1,784.2{\pm}1,903.1$ vs. $1,384.4{\pm}2,232.6pg/mL$, P=0.52). Comparison of NT-proBNP could not be done between patients with CAL and those without, owing to a small number of patients with CAL(n=3). There was no correlation between NT-proBNP and LVEF index(r=0.104, P=0.46) or LVIDd index(r=0.171, P=0.22). Conclusion : NT-proBNP increases in the acute phase of KD and decreases to within normal range in the convalescent phase. NT-proBNP >260 pg/mL may be highly suggestive of acute KD. NT-proBNP may be used as a diagnostic tool for KD.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.376-381
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• 2004

Primary cardiac lymphoma is an extranodal malignant lymphoma of any cell type involving only heart and pericardium without dissemination. Patients usually present symptoms of heart failure, arrhythmias, pericardial effusion and cardiac tamponade. Diagnosis of primary cardiac lymphoma can be performed by echocardiogram, CT and MRI and cytologic examination of pericardial effusion or transvenously biopsied cardiac tissue. Prognosis of primary cardiac lymphoma is poor. Because of poor prognosis, early diagnosis and complete surgical excision is essential and postoperative systemic chemotherapy or radiotherapy is useful. In this case extensive tumor infiltration on the right ventricle and atrioventricular groove preclude surgical excision. Tissue biopsy revealed primary cardiac lymphoma. After postoperative chemotherapy and radiotherapy, the size of intracardiac mass is decreased in follow up chest CT scan and echocardiogram and symptoms of patient are relieved. Therefore, we report a case of primary cardiac lymphoma with review of literatures.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.95-97
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• 2008

Ischemic ventricular rupture is one of the most fatal complications following myocardial infarction, and this requires prompt diagnosis and operation. A 75-year-old female was admitted to the ER in a semicomatous mentality with cyanotic extremities. Cardiac echography was carried out in the ER, and a $1.5{\sim}2\;cm$ thickness of effusion in the pericardium was seen. Because the patient's heart had declined to 35 times per min, an emergency operation was started while giving cardiac massage. After observing a 1 cm rupture on the right ventricular wall and a necrotic hemorrhagic scar with a rupture on the left ventricular apical wall, repair of the ruptured areas with a large Satinsky clamp was carried out to control bleeding without cardiopulmonary bypass. On the 28th day after surgery, she was discharged home with a minimal degree of dyspnea.

• Tuberculosis and Respiratory Diseases
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• v.47 no.3
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• pp.400-405
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• 1999

Mediastinal teratomas are rare and represent less than 10 per cent of all mediastinal tumors. Almost all arise in the anterosuperior mediastinal compartment, and most symptoms, when present, result from compression of adjacent structures. They contain different tissues derived from all three germinal layers, with the prevalence of ectodermal elements which can include hair, teeth and sebaceous material. Benign teratomas may rupture into adjacent organs. Up to 36% of all mediastinal teratomas rupture, most frequently into the lung and bronchial tree, followed by the pleural space, pericardial space, or great vessels. The signs and symptoms of a ruptured teratoma vary with the structures involved. We report a case of mediastinal teratoma ruptured spontaneously in a 18 year old female who experienced 4 or 5 times of hemoptysis for 1 year and sudden onset of pleural effusion, pericardial effusion and pneumonia.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.190-196
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• 1991

Clinical experience of 48 acute pericarditis with effusion was reviewed and presented. There were 28 male and 20 female patients ranging from 3 years to 77 years old. Malignant effusion; Twenty patients had underlying malignancy. These etiologies were lung ca[8 patients, 40%], breast ca[7 patients 35%], lymphoma[2 patients, 10%], esophageal ca[1 patients, 5%], stomach ca[1 patient, 5%], ovarian ca[1 patient, 5%]. Uremic effusion; 15 patients with renal failure required surgical intervention. Traumatic effusion; 7 patients had traumatic pericarditis. These etiologies were stab wound [5 patients, 71.4%] and aspiration[2 patients, 28.6%]. Pyogenic effusion: 6 patients had pyogenic pericarditis. These etiologies were empyema thoracis[3 patients, 50%], liver abscess[2 patients, 33.3%], pneumonia[1 patient, 16.7%]. The patients were treated by pericardiocentesis, subxiphoid tube drainage, pericardiectomy: 4 of them underwent pericardiocentesis; 37, subxiphoid tube drainage; 5, pericardiectomy. We conclude that subxiphoid tube pericardial drainage was effective for treatment of pericardial effusion.