• Journal of Chest Surgery
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• v.43 no.2
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• pp.161-163
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• 2010

A 12-day-old female baby underwent a Norwood procedure for hypoplastic left heart syndrome. The left superior vena cava (LSVC), which was found incidentally during the operation, was divided to facilitate surgical exposure. After the operation, she developed signs of low cardiac output and died 7 hours afterward. Autopsy findings showed that the coronary sinus was atretic at the orifice without unroofing into both atria, rendering the LSVC the sole route of coronary sinus drainage. In patients with incidentally-found LSVC during surgery, special care should be taken to leave the LSVC intact because the LSVC may be the exclusive drainage vein of the coronary venous system.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.528-531
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• 2009

Transesophageal echocardiography (TEE) is widely used to evaluate the heart function and the result of surgery during a cardiac operation. The incidence of complications associated with TEE is low, yet critical complications such as lower pharyngeal injury and esophageal perforation may happen. We report hereon a case of 77-year old male patient who suffered from injury to the pyriform sinus and concurrent deep neck infection after off pump coronary artery bypass surgery and intraoperative TEE.

• Journal of Chest Surgery
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• v.24 no.3
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• pp.280-286
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• 1991

Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta which originates just distal to the level of the origins of the coronary arteries It may be localized or diffuse. Enlargement of the aorta with a diamond-shaped patch of the noncoronary sinus of Valsalva was reported in 1961 by McGoon and associates But this reconstruction is asymmetric and the aortic obstruction may remain. In 1977, Dotty and associates reported the extended aortoplasty, the supravalvular ring was incised at two points in the noncoronary and in the right coronary sinuses of Valsalva closed with a tubular Dacron prosthesis of inverted Y-shape tailored to reconstruct the aorta We experienced three cases of the supravalvular aortic stenosis. The 11-year-old female and 4-year-old male with localized supravalvular aortic stenosis in William`s syndrome were operated with an inverted Y-shaped aortotomy toward the non-coronary sinus and the right coronary sinus and closed with "Hemashield`s collagen impregnated Dacron" tube graft, fashioned into "pantaloon" form patch. The 12-year-old male with localized supravalvular aortic stenosis and mitral insufficiency in William`s syndrome were operated with same procedure as two other patient above-mentioned for relief of supravalvular aortic stenosis and with mitral valve replacement. Postoperative course has been good.ourse has been good.

• The Korean Journal of Physiology
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• v.20 no.2
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• pp.184-191
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• 1986

Membrane potential of cells in the isolated rabbit coronary sinus was measured by conventional glass microelectrode and investigated the effect of $[K^+]_0$ variation in control, 20 mM and Ach-containing Tyrode solution. The results obtained were as follows: 1) The resting membrane potential exposed to normal Tyrode solution containing 3 mM $K^+\;was\;about\;-60{\sim}\;-65mV$. At extracellular $K^+$ concentrations from 1 to 30 mM the resting Potential was reasonably well described by Goldman -Hodgkin -Katz equation on the assumption that $[K^+]_1$ was 150 mM and that the ratio of membrane permeability coefficient for $Na^+\;and\;K^+,\;P_{Na}/P_K\;({\alpha})$ was 0.07. 2) In 20 mM Na-Tyrode solution (replacing by equimolar Tris) the resting membrane potential was hyperpolarized by 15 to 20 mV and showed slightly deviated to depolarized direction compared to the predicted value by Goldman-Hodgkin -Katz equation. 3) In the presence of $10^{-6}M$ Ach, the resting potentials at $[K^+]_0$ levels from 1 to 30 mM were well fitted with the predicted value on the assumption that $P_{Na}/P_K$ was 0.0144. It could be concluded that the low resting membrane potential of coronary sinus cells reflects a relatively high ratio $P_{Na}/P_K$ of about 0.07.

• Journal of Chest Surgery
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• v.11 no.4
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• pp.373-377
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• 1978

Aneurysmal rupture of sinus Valsalva is known as one of rare cardiac disease and not controlled with medical treatment. We experienced 9 cases which were composed with 7 case of male and 2 cases of female during last 15 years. 7 cases were ruptured into right ventricle from right. coronary sinus and 2 cases were ruptured into right atrium from non-coronary sinus. The diagnosis was made with cardiac catheteriza1icn and cineangiccardicgram but 2 cases were misdiagnosed with only cardiac catheterization. All cases were corrected under cardiopulmonary bypass with means of direct suture with tdlon pledget by transatrial or transventricular approach. All were not confirmed in it's origin because of no history, no evidences of syphilis, TB, or bacterial endocarditis and only fibrosis in pathologic report. In postoperative course, 1 case had postoperative bleeding and 1 case was sufferd from left hemiplegia due to may be air embolism. Follow up study revealed all patient go on their usual life well with good improvement at this present time.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.621-623
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• 1994

Over the past 3.5 years, 5 cases with ruptured sinus of Valsalva were operated upon at Asan Medical Center. Four patients were congenital and 1 traumatic. Coexistent lesions included 2 subarterial VSD, 3 AR requiring procedures [2 AVR, 1 valvoplasty], 2 subaortic membranes, 1 PDA,and 1 bicuspid AV. The communication is noncoronary sinus to RA in I and fight Coronary sinus to RV in the other 4 patients. The ~rstula was repaired through the aorta whenever possible and reinforced through the right sided chamber. There are no surgical mortality and, no recurrence of rupture yet.

• Journal of Yeungnam Medical Science
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• v.31 no.1
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• pp.13-16
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• 2014

Congenital abnormalities of the coronary arteries are found in 0.6% to 1.3% of patients in coronary angiography. Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is incidentally detected during coronary angiography. We report a case of a 65-year-old female with a rare coronary anomaly who was diagnosed with dual LAD via coronary computed tomography and coronary angiography. The imaging studies revealed dual LAD originating from the left main stem and right coronary sinus. These angiographic findings were considered to be consistent with the type IV variety of dual LAD by Spindola-Franco classification. Recognition of dual LAD is important to prevent errors of interpretation of the coronary angiogram and for optimal surgery.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.962-967
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• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.96-99
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• 2009

We report here on a case of a ruptured sinus of a valsalva aneurysm into the left ventricle with the rupture site communicating with both the left coronary sinus and the noncoronary sinus in a 37-year-old male who presented with symptoms of congestive heart failure. Echocardiography showed a sac-like structure around the sinus of valsalva, an enlarged left ventricle (LV) and severe aortic regurgitation, which all suggested a ruptured sinus of a valsalva aneurysm or an aortic-left ventricular tunnel. The operative findings revealed that both the left coronary sinus and the noncoronary sinus had an opening into the left ventricle. The proximal opening into the LV was closed with bovine pericardium and the aortic root was replaced with a composite graft (a 21 mm St. Jude Epic Supra tissue valve and a 24 mm Hemashild graft) by the modified Bentall procedure. The patient was discharged on the 15th postoperative day, and he was regularly followed up for 2 months. We report on this case due to its rarity and to describe the surgical repair techniques.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.201-208
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• 1974

The purpose of this paper is to present author's experience with 6 cases of ruptured aneurysm of sinus of Valsalva which were treated surgically during last 10 years. Among the 6 cases, 5 were male and one was female. All of them originated from the right coronary sinus and 5 cases were ruptured into the RV while remained one into RA. The diagnosis was obtained in 4 cases by cineangiocardiogram. Clinically, we had difficulties in differential diagnosis with combined cases of VSD with A.I. and had special experience in its differentiation during cardiac catheterization. By simultaneous trans-venous and trans-arterial catheterization, identified two catheter tips in the RV, and pull back tracing obtained aortic pressure directly from RV, and RA from RV pressure which were benefit in confirm ruptured aneurysm of the aortic sinus. Surgical correction was performed by means of direct suture closure or combined Teflon pledget Of patch enforcement graft after aneurysm resection by trans-RA or trans-RV approach. All patients had no history of bacterial endocarditis, syphilis, or tuberculosis and operative findings revealed intact coronary sinus except involved one moreover 3 cases combined with high VSD which uggested congenital in origin although pathologic reports revealed only fibrosis. Post-operative course were uneventful in all cases but one who had bleeding and 2 months to 9 years follow up results were good and spend their usual life in all cases.