• Journal of Chest Surgery
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• v.33 no.6
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• pp.469-475
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• 2000

Background: Thoracic aortomyoplasty is one of the surgical treatment for heart failure and has advantages over artificial heart or intraaortic balloon pumps. It uses autogenous skeletal muscles and solves problems such as energy source. However its use in clinical settings has been limited. This preliminary study was designed to develop surgical technique and to determine the effect of acute descending thoracic aortomyoplsty. Material and Method: Thirteen adult Mongrel dogs were used. The left latissimus dorsi muscle was wrapped around the descending aorta under general anesthesis. Swan-Ganz and microtipped Millar catheter were used for the hemodynamics and endocaridial viability ratio. Data were collected with myostimulator on and off in normal hearts and the ischemic hearts. Result: In normal hearts, the mean aortic diastolic pressure increased from 72$\pm$15mmHg at baseline to 78$\pm$13mmHg with stimulator on. Coronary perfusion pressure increased from 61$\pm$11mmHg to 65$\pm$9mmHg. Diastolic time increased from 0.288$\pm$0.003 msec to 0.290$\pm$0.003msec. Systolic time decreased from 0.164$\pm$0.002msec to 0.160$\pm$0.002 msec. Endocardial viability ratio increased from 1.21$\pm$0.22 to 1.40$\pm$0.18. In ischemic hearts, mean aortic diastolic pressure incrased from 56$\pm$21mmHg at baseline to 61$\pm$15mmHg with stimulator on. Coronary perfusion pressure increased from 48$\pm$17mmHg to 52$\pm$15mmHg. Diastolic time increased from 0.290$\pm$0.003 msec to 0.313$\pm$0.004msec. Systolic time decreased from 0.180$\pm$0.002 msec to 0.177$\pm$0.003 msec. Endovascular viability ratio increased from 0.9$\pm$0.31 to 1.1$\pm$0.31. The limited number of cases ruled out the statistic significance. Conclusion: Descending thoracic aortomyoplasty is a simple operation designed to use patient's own skeletal muscles. It trends to increase diastolic augmentation and coronary perfusion pressure. Modification of surgical technique and stimulator protocol would maximize the effect to assist the heart.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.422-427
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• 1999

Background: Tachycardia induced heart failure model would be the model of choice for the dilated cardiomyopathy. This more closely resembles the clinical syndrome and does not require major surgical trauma, myocardial ischemia and pharmacological or toxic depression of cardiac function. When heart failure is progressive, application of new surgical procedures to the faling heart is highly risky. It has been shown that recovery trajectory from heart failure is a new method in decreasing animal mortality. The purpose is to establish the control datas for recovery trajectory in the canine heart failure model. Material and Method: 21 mongrel dogs were studied at 4 stages(baseline, at the heart failure, 4 and 8 weeks after recovery). Heart failure was induced during 4 weeks of continuous rapid pacing using a pacemaker. Eight weeks of trajectory of recovery period was allowed. Indices of left ventricular function and dimension were measured every 2 weeks and the hemodynamics were measured by use of Swan-Ganz catheterization and thermodilution method every 4 weeks. Values were expressed as mean${\pm}$standard deviation. Result: 4(20%) dogs died due to heart failure. Left ventricular end-diastolic volume at the 4 stages were 40.8${\pm}$7.4, 82.1${\pm}$21.1, 59.9${\pm}$7.7 and 46.5${\pm}$6.5ml. Left ventricular end-systolic volume showed the same trend. Ejection fractions were 50.6${\pm}$4.1, 17.5${\pm}$5.8, 36.3${\pm}$7.3, and 41.5${\pm}$2.4%. Blood pressure and heart rate showed no significant changes. Pressures of central vein, right ventricle, pulmonary artery, and pulmonary capillary wedge showed significant increase during the heart failure period, normalizing at the end of recovery period. Stroke volumes were 21.5${\pm}$8.2, 12.3${\pm}$3.5, 17.9${\pm}$4.6, and 15.5${\pm}$3.4ml. Blood norepinephrine level was 133.3${\pm}$60.0pg/dL at the baseline and 479.4${\pm}$327.3pg/dL at the heart failure stage(p=0.008). Conclusion: Development of tachycardia induced heart failure model is of high priority due to ready availability and reasonable amenability to measurements. Recovery trajectory after cessation of tachycardia showed reduction of cardiac dilatation and heart function. Application of new surgical procedures during the recovery period could decrease animal mortality.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.281-288
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• 2006

Background: Extracardiac pericardial-flap lateral tunnel Fontan operation has theoretical advantage of growth potentiality of the extracardiac tunnels. The mid-term results of this technique and morphologic change of the lateral tunnel were studied. Material and Method: Clinical data was reviewed in 42 patients who underwent extracardiac pericardial-flap lateral tunnel Fontan operation between November 1993 and December 2004. The age was $2.8{\pm}1.5$ years and the body weight was $12.3{\pm}3.2$ kg. Extracardiac tunnel was constructed using the pedicled pericardium with the base undetached. By reviewing the follow-up cardiac angiograms, the diameter and the cross-sectional area of the lateral tunnel was compared to those of inferior vena cava. Result: There were four operative mortality cases (9.8%) and the causes of death were low cardiac output for all four cases. Postoperatively, five patients had prolonged pleural effusion longer than two weeks and one patient required a permanent pacemaker due to complete heart block. Follow-up was possible in 37 patients and the follow up duration was $3.8{\pm}2.2$ years. During that period, one patient died, of upper gastrointestional bleeding combined with heart failure and one patient died a sudden death of unknown cause. Two patients required reoperation due to subaortic stenosis and anastomosis site stenosis between inferior vena cava and lateral tunnel. In one patient, bradyarrhythmia was anew but there was no thromboembolic complication. The lateral tunnel showed growth in proportion to the size of the inferior vena cava. Conclusion: Extracardiac pericardial-flap lateral tunnel Fontan operation is relatively simple and safe. The mid-term result was favorable and the extracardiac tunnel showed potential for growth.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.939-944
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• 1998

Background: The sugical results of the Cox-Maze procedure (CMP) for lone atrial fibrillation(AF) have proven to be exellent. However, those for AF associated with mitral valve(MV) disease have been reported to be a little inferior. Materials and methods: To assess the efficacy and safety of the CMP as a combined procedure with MV operation, we studied retrospectively our experiences. Between April 1994 and October 1997, we experienced 70 (23 males, 47 females) cases of CMP concomitantly with MV operation. Results: The etiologies of MV disease were rheumatic in 67 and degenerative in 3 cases. The mean duration of AF before sugery was 66$\pm$70 months. Fifteen patients had the past medical history of thromboembolic complications, and left atrial thrombi were identified at operation in 24 patients. Twelve cases were reoperations. Aortic cross clamp (ACC) time was mean 151$\pm$44 minutes, and cardiopulmonary bypass (CPB) time was mean 246$\pm$65 minutes. Concomitant procedures were mitral valve replacement (MVR) in 19, MVR and aortic valve replacement (AVR) in 14, MVR and tricupid annuloplasty (TAP) in 8, MVR with AV repair in 3, MV repair in 11, MVR and coronary artery bypass grafting (CABG) in 2, MVR and AVR and CABG in 1, redo-MVR in 10, redo-MVR and redo-AVR in 2 patients. The rate of hospital mortality was 1.4%(1/70). Perioperative recurrence of AF was seen in 44(62.9%), and atrial tachyarrhythmias in 10(14.3%), low cardiac output syndrome in 4(5.7%), postoperative bleeding that required mediastinal exploration in 4(5.7%) patients. Other complications were acute renal failure in 2, aggravation of preoperative hemiplegia in 1, and transient delirium in 1 patient. We followed up all the survivors for 16.4 months(3-44months) on an average. Sinus rhythm has been restored in 65(94.2%) patients. AF has been controlled by operation alone in 73.9% and operation plus medication in 20.3%. Two patients needed permanent pacemaker implantation; one with sick sinus syndrome, and the other with tachycardia- bradycardia syndrome. Only two patients remained in AF. We followed up our patients with transthoracic echocardiography to assess the atrial contractilities and other cardiac functions. Right atrial contractility could be demonstrated in 92% and left atrial contractility in 53%.We compared our non-redo cases with redo cases. Although the duration of AF was significantly longer in redo cases, there was no differences in ACC time, CPB time, postoperative bleeding amount and sinus conversion rate. Conclusions: In conclusion, the CMP concomitant with MV operation demonstrated a high sinus conversion rate under the acceptable operative risk even in case of reoperation.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.619-626
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• 2010

Background: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. Material and Method: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was $20.78{\pm}16.00$ days. There were 12 (52.2%) urgent operations. The average follow up period was $49.26{\pm}33.21$ months. Result: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was $24.39{\pm}15.98$ days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value < 0.05). Conclusion: We could obtain the satisfactory results without any moftalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.