• Journal of Chest Surgery
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• v.25 no.12
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• pp.1563-1569
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• 1992

From Jan. 1981 to Dec. 1991, we had treated 25 patients with congenital coronary art-eriovenous fistulas [CAVF] in Seoul National University Hospital. A retrospective review was made to delineate the course and the management of CAVF and to clarify the role of surgical treatment. Fifteen patients were male and 10 were female with The mean age of 17.4 years[from 3 months to 58 years]. The most frequent symptom was dyspnea on exertion[56%]. Other symptoms were angina and palpitation. Sixty-eight percent of the patients were symptomatic. Fifty-three percent of patients less than 20 years old were symptomatic and 100% of patients over 20 years old were symptomatic. Three patients had multiple CAVFs. The fistula drained into the right ventricle in 13, pulmonary artery in 9, left ventricle in 4, right atrium in 2, and left atrium in 1. Thirteen patients had other associated cardiac lesions. The mean pulmonary-to-systemic blood flow[Qp /Qs] in the isolate CAVF group was 2.19. All patients were operated on to correct the fistulas and other associated cardiac lesions. All patients were followed from 1 month to 11 years without late death. Postoperative complication rate was 24% -significant arrhythmia [3], recurred CAVF[1], psychosis[1], pneumonia [1]. Symptomatic improvement was evident postoperatively. Below 20 years old, 94% of patients were asymptomatic, but above 20 years old, symptoms persisted in 25%. In summary, early elective repair of CAVF is indicated in all patients because of higher complication rate and frequent persistent symptoms in older patients.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.228-231
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• 2007

Chest trauma can lead to various cardiac complications ranging from arrythmia to myocardial rupture. Coronary artery injury in patients with blunt chest trauma is rare, and traumatic aneurysm of the left coronary artery is even more unusual than right coronary artery. Injury to the coronary arteries, including intimal aneurysm, dissection, laceration, arteriovenous fistula and thrombosis, are sequelae that rarely occur after a blunt trauma. Occlusion of the coronary artery results is a serious complication for the patient via acute myocardial infarction, We report here on a case of acute myocardial infarction with coronary artery aneurysm that arose from blunt chest trauma in a 33-year-old male, and he was successfully managed by a coronary bypass graft without performing cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.453-463
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• 1995

During 42 month period 91 consecutive patient underwent coronary artery bypass surgery. The mean age of these patient was 57 years [range from 28 to 78 years . There were 57 men and 34 women. The preoperative risk factors that include beyond the 50 % of total patients were male sex, obesity, hypo-high-density lipoproteinemia, smoking, hypercholesterolemia, hyper-low-density lipoproteinemia, hypertriglyceridemia and hypertension. Preoperatively 27 patients had stable angina pectoris and 39 patients of unstable angina pectoris. Twenty five patients had previous myocardial infarction history. The patterns of disease were 8 patients of single vessel involvement, 18 patients of double vessel involvement, 54 patients of triple vessel involvement and 11 patients of left main coronary artery disease. Fifty five patients were in Canadian Cardiovascular Society functional class III. Myocardial revascularization was performed under emergency conditions in 5 patients. Nine percent of patients had previous PTCA history. We performed 16 cases of sequential anastomosis, internal mammary artery harvest in 86 percent of total patients and total 284 distal anastomoses[mean 3.1 anastomosis per patient . The mean ACC time was 60.5 minutes and ECC time was mean 110 minutes. The combined surgeries were 16 cases of endarterectomy, 2 cases of LV aneurysmectomy, 1 case of Bentall operation, 1 case of repair of sinus of Valsalva, 1 case of ligation of coronary AV fistula and 1 case of excision of breast mass. The most common complication was wound infection[12 cases, 13 % . There was one hospital death due to postoperative respiratory failure and low output syndrome in patient with postinfarction VSD, LV aneurysm. Postoperative 88 patients were in Functional class I or II. The 99mTc-MIBI myocardial perfusion scan that used as evaluation of postoperative state was well correlated with patient`s symptoms instead of some disadvantages.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.693-697
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• 1989

A forty-eight-year-old female patient with ascending aortic aneurysm with aortic insufficiency underwent a modified Bentall operation. The ascending aorta and the aortic valve were replaced with a composite graft containing a St. Jude valve. The coronary orifices were anastomosed to the tubular Dacron prosthesis by means of a second smaller Gore-Tex tube, and a fistula between the aneurysmal sac and the right atrial appendage was created to drain oozing from the prosthesis. The postoperative course was uneventful and the patient was discharged without complication. She is doing well on the 14 months follow-up.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.926-929
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• 1991

A 31 year-old male patient underwent surgical treatment of the pseudoaneurysm of the ascending aorta complicating after the Bentall operation, He had undergone the replacement of the ascending aorta using the composite valved graft with direct coronary reimplantation under the diagnosis of the annuloaortic ectasia of ascending aorta associated with Marfan syndrome. Eleven months after the operation, he started to feel dyspnea and anterior chest pain, and was diagnosed as pseudoaneurysm around the ascending aortic graft. The second operation consisted of the dacron patch closure of the defect of the aortic graft which was the hole for previous coronary reimplantation, and the anastomosis between the coronary orifice and the aortic graft with the intermediate graft of a 10mm woven dacron tube, and suture closure of the fistula opening from the aneurysm. His postoperative course was uneventful and discharged without complication. He is doing well 10 months postoperatively.

• Clinical and Experimental Pediatrics
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• v.56 no.11
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• pp.500-504
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• 2013

Here we present the case of an 11-year-old female patient diagnosed with Caroli syndrome, who had refractory esophageal varices. The patient had a history of recurrent bleeding from esophageal varices, which was treated with endoscopic variceal ligation thrice over a period of 2 years. However, the bleeding was not controlled. When the patient finally visited the Emergency Department, the hemoglobin level was 4.4 g/dL. Transhepatic intrajugular portosystemic shunt was unsuccessful. Subsequently, the patient underwent percutaneous transhepatic variceal obliteration. Twenty hours after this procedure, the patient complained of aphasia, dizziness, headache, and general weakness. Six hours later, the patient became drowsy and unresponsive to painful stimuli. Lipiodol particles used to embolize the coronary and posterior gastric veins might have passed into the systemic arterial circulation, and they were found to be lodged in the brain, kidney, lung, and stomach. There was no abnormality of the portal vein on portal venography, and blood flow to the azygos vein through the paravertebral and hemiazygos systems was found to drain to the systemic circulation on coronary venography. Contrast echocardiography showed no pulmonary arteriovenous fistula. Symptoms improved with conservative management, and the esophageal varices were found to have improved on esophagogastroduodenoscopy.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1482-1486
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• 1992

Ruptured aneurysms of the sinus of Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Eight patients underwent operative treatment at Chonnam University Hospital from June, 1986 to May, 1992. Six of the patients were male and two female. Age ranged from eight to fifty six years. Associated cardiac lesions were common including AR and VSD in four patients respectively. Diagnosis was made by 2D-Echo and cine-angiogram. In six patients aneurysms of the sinus of valsalva ruptured from the right coronary sinus to the right ventricle and in two from right coronary sinus to the right atrium Direct closure of aneurysmal rupture and patch closure of VSD in four cases, resection of the aneurysm and direct closure in one case, direct closure of the fistula and AVR in two cases, direct closure in one case were performed. One patient combined with VSD, pulmonary hypertention and bacterial endocarditis underwent operation, but he died of sudden cardiac arrest the day after the operation. Operative results were relatively good in the other patients.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.687-692
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• 1989

Aneurysm of the sinus of Valsalva is an uncommon cardiac anomaly, usually congenital in origin, which may occur as an isolated defect or in conjunction with other cardiac malformation. This report is a case of a ruptured sinus of Valsalva aneurysm with ventricular septal defect in a 18-year-old female patient who complained progressive exertional dyspnea. She underwent operative management using total cardiopulmonary bypass. The fistula originated from the right coronary sinus and ruptured into the right ventricle and coexistent lesion was supracristal ventricular septal defect. The repair was done through aortic and right ventricular approach. The ruptured sinus of Valsalva was closed with pledget suture and the ventricular septal defect was closed with patch. The postoperative result was good.

• Journal of Veterinary Clinics
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• v.5 no.2
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• pp.111-118
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• 1988

One four-month-old female shepherd mongrel dog with chief complaints of abdominal distension and dysponea was referred. The authors performed physical examination, hematological examination, X-ray examination, exploratory laparotomy, electrocardiography and angiography as antemortem investigation in addition to postmortem examination. This patient revealed complicated congenital cardiac anormaly including patent ductus arteriosus, both atrial and ventricular hypertrophy, distension in the base of the pulmonary artery, pulmonary stenosis, aortic insufficiency, patent foramen ovate and coronary arteriovenous fistula.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.373-380
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• 1982

Experience with intracardiac surgery in infants indicates that for most anomalies the operation and late mortality after primary total correction is lower than the combined mortality after early palliation and delayed correction. In addition, there are secondary benefits of primary total correction in terms of reversal of retarded physical growth and social development and alleviation of parental anxiety. One hundred and fifteen infants under 2 years of age with congenital cardiac anomalies underwent primary surgical intervention at Seoul National University Hospital from Jan. `78 to Sep. `82. There were 70 patients with VSD, 17 patients with TOF, 10 patients with TGA, 4 patients with ASD, 4 patients with TA, 3 patients with TAPVR, and the remainders are Coronary AV Fistula, partial ECD+COA, SV, DORV, PA, Trilogy+PDA. The overall surgical mortality was 18.3%. In acyanotic group 6 patients died among 76 operated patients, and surgical mortality was 6.6%. But in cyanotic group, the mortality was very high as41.0% [16 patients among 39 patients]. This poor surgical result in cyanotic group was due to Improper pre-, intra- and post-operative care, and we are convincing that these factors soon be improved as experiences accumulated.