• Journal of Chest Surgery
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• v.16 no.4
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• pp.476-484
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• 1983

Ventricular septal defect[VSD] associated with aortic regurgitation[AR] represents 2 to 7.5% of all VSD which is most common congenital heart disease. The aortic valve may by normal in infants with VSD, but the aortic regurgitation may be developed in these patients later. The aortic valve became fibrotic, thickened, deformed and prolapsed, so these late deformities require to be corrected with plication, valvuloplasty or aortic valve replacement [AVR]. There are some controversy between the early repair of VSD alone and the late repair of VSD and aortic valve till now. From December 1971 to August 1983, we had experienced 24 patients of VSD associated with AR which constitute 6.5% of our total patients with VSD. The VSD was subpulmoary [type I] in 14[58.3%], subcristal [type II] in 8[33.3%], atrioventricular canal type[type III] in 1, and combine of type I and II in 1. Patch repair of VSD was made in 15 patients and direct suture of small VSD in 9.14 patients had aortic plication of valvuloplasty and 9 had AVR accompanying VSD repair, and 1 patient had VSD closure alone. The postoperative courses of these patients were uneventful except in some cases. A patient who was undertaken AVR with Starr-Edwards ball valve and VSD closure, died due to left ventricular failure and low cardiac output syndrome. Follow up shows, in 14 patients with aortic plication or valvuloplasty, AR was developed in 9. In 9 AVR, there were two later complications which were paravalvular leakage in one and re-AVR due to subacute bacterial endocarditis in another.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.18-22
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• 1995

From January 1989 to December 1993, cardiac catheterization and open heart surgery for ventricular septal defect closure were performed in 115 pediatric patients who were selected as meeting the criteria for elective closure of restrictive ventricular septal defect. These criteria included age greater than 1 year and less than 15 years, no evidence of congestive heart failure, Qp/Qs 2.0, pulmonary artery systolic pressure 35mmHg, and no associated cardiac anomalies. Mean age of patients was 5.25$\pm$ 3.53, and 72 patients were male, 43 patients were female[male:female=1.9:1 . Mean systolic pulmonary artery pressure was 19.66$\pm$4.79mmHg, and mean pulmonary to systemic flow ratio was 1.27$\pm$ 0.28. Aortic cusp prolapse was present in 30 patients [26% , aortic insufficiency was present in 1 paient, and 1 patient had prior bacterial endocarditis. There were no instances of complete atrioventricular dissociation, reoperations for bleeding, or reoperations for recurrent ventricular septal defect, but wound infection was present in 1 patient, and there were 7 patients who had the hemodynamically insignificant remnant shunt. There were no early or late deaths or major morbidity.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1207-1211
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• 1996

During the recent 10 years, ten patients with ruptured sinus of Valsalva were operated on our institute. Eight patients were congenital but two patients were proved acquired lesions due to bacterial endocarditis. Coexistent cardiac lesions were 4 aortic regurgitations, 2 atrial septal defects, 1 ventricular septal defect, 1 tricuspid regurgitation and 1 mitral regurgitation. In all cases, aneurysms of sinus of Valsalva arose from the right coronary sinus, and they ruptured to right ventricle in 8 patients and to right atrium in 2 patients. We preferred double approach, through both the aorta and the involver. cardiac chamber, The repair of ruptured site was performed Dacron patch graft in 8 patients and simple closure in 2 patients. Operative results were very good in all cases with no surgical mortality.

• Journal of Chest Surgery
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• v.27 no.5
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• pp.353-363
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• 1994

From January 1978 to December 1992, 59 patients of double chambered right ventricle were repaired. Surgical correction consisted of closure of the ventricular septal defect and resection of anomalous muscle bundles through right ventriculotomy [Group I ; 34 patients] or right atriotomy [Group II ; 25 patients]. Between these two groups, there was no difference in the operation time and the postoperative results. All patients survived. In group I, hemodynamically significant residual ventricular septal defect was found in three and reoperations were necessary. In one patient, subacute bacterial endocarditis developed postoperatively. In group II, complete atrioventricular block developed in one and mediastinitis in two. Follow-up period was from 2 to 75 months [mean 17.1 months]. There was no late death. All patients have remained in sinus rhythm except one patient. Careful evaluation of echocardiographic and catheterization data preoperatively and careful examination of the anatomy intraoperatively are necessary so that double chambered right ventricle should not be overlooked, because most ventricular septal defects are now closed through the right atrium. Repair of double chambered right ventricle is also easily performed through the atrial approach. Transatrial repair should be considered as an alternative to the transventricular approach in patients with this congenital heart defect. Successful surgical correction of double chambered right ventricle is expected with excellent long term results.

• Biomedical Science Letters
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• v.27 no.4
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• pp.195-207
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• 2021

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial pathogen capable of causing human diseases, such as soft tissue infection, bacteremia, endocarditis, toxic shock syndrome, pneumonia, and sepsis. Although the incidence rate of diseases caused by MRSA has declined in recent years, these diseases still pose a clinical threat due to their consistently high morbidity and mortality rates. However, the role of virulence factors in staphylococcal infections remains incompletely understood. Methicillin resistance, which confers resistance to all β-lactam antibiotics in cellular islets, is mediated by the mecA gene in the staphylococcal cassette chromosome mec (SCCmec). Differences in SCCmec types and differences in their sizes and structures serve epidemiological purposes and are used to differentiate between hospital-associated (HA)-MRSA and community-associated (CA)-MRSA. Some virulence factors of S. aureus are also providing a distinction between HA-MRSA and CA-MRSA. These factors vary depending on the presence of toxins, adhesion, immune evasion, and other virulence determinants. In this review, we summarized an overview of MRSA such as resistance mechanisms, SCCmec types, HA- and CA-MRSA, and virulence factors that enhance pathogenicity or MRSA epidemiology, transmission, and genetic diversity.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.977-982
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• 1996

Cardiac valve implantation was performed in 107 patients from September, 1988 to May, 1995. There were 3) men and 74 women, whose ages ranged from 19 to 75 years(mean 42.6$\pm$11.7). Mitral valve was implanted in 61 patients, double(mitral & aortic) valve were Implanted in 28 patients and aortic valve was implanted in 18 patients. Follow up was 100% complete, with 345.6 patient-years and a mean fo low up of 41 months(from 1.5 to 84 months). The total mortality was 14.9%(16 patients). The early mortality was 5.6%(6 patients) and the late mortality was 9.3%(10 patients). The overall actuarial survival was 92.6 $\pm$ 2 6% at 2 years, 88.6$\pm$3.8% at 6 years. The probability of freedom from valve failure, thromboembolism and bacterial endocarditis were 388.6 $\pm$ 3.8, 88.3 $\pm$3.9, 89.5 $\pm$3.7 at 6 years, respectively.

• Journal of Chest Surgery
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• v.11 no.3
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• pp.326-332
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• 1978

There appears some conduction defects frequently after total correction of Tetralogy of Fallot. Common defect is right bundle branch block due to surgical intervention. We experienced complete A-V block which occured 3 months later after total correction of Tetralogy of Fallot in a 8 year old boy. The patient was completely free of any A-V block after the operation for 3 months, and sudden onset of A-V block with coupled premature ventricular contractions resulted him in shock state during the attack of severe bronchopneumonia for 4 days prior to the second visit. Emergency implantation of Cordis demand type temporary pacemaker was necessary to control the complete heart block with bradyarrhythmia and frequent ventricular fibrillation. Permanent cardiac pacemaker was implanted two weeks later as indicated with Cordis Stanicor lambda demand pacemaker, and the patient was discharged uneventfully on the 8th post implantation day with the heart rate of 72/min. Another 3 months after the implantation, the patient was transported to this hospital as dead on arrival after an accidental fall from a 2 meter height, and all possible cardiopulmonary resuscitation was performed for 60 minutes at the emergency room in vain. Autopsy was done to find out the cause of sudden death and the etiology of complete heart block. Microscopic focal infarctions with scar formation were noted along the course of conduction system in the interventricular septum, which might be the main cause of complete heart block during the attack of severe bronchopneumonia complicated with acute bacterial endocarditis. The tip of the pacemaker wire was slipped from the granulation scar at the apex of the right ventricular cavity, and this might be the direct cause of pacing failure and death.

• Journal of Periodontal and Implant Science
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• v.38 no.sup2
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• pp.335-342
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• 2008

Purpose: Cytolethal distending toxin (CDT) considered as a key factor of localized aggressive periodontitis, endocarditis, meningitis, and osteomyelitis is composed of five open reading frames (ORFs). Among of them, the individual role of CdtA and CdtC is not clear; several reports presents that CDT is an AB2 toxin and they enters the host cell via clathrin-coated pits or through the interaction with GM3 ganglioside. So, CdtA, CdtC, or both seem to be required for the delivery of the CdtB protein into the host cell. Moreover, recombinant CDT was suggested as good vaccine material and antibody against CDT can be used for neutralization or for a detection kit. Materials and Methods: We constructed the pET28a-cdtC plasmid from Aggregatibacter actinomycetemcomitans Y4 by genomic DNA PCR and expressed in BL21 (DE3) Escherichia coli system. We obtained the antibody against the recombinant CdtC in mice system. Using the anti-CdtC antibody, we test the native CdtC detection by ELISA and Western Blotting and confirm the expression time of native CdtC protein during the growth phase of A. actinomycetemcomitans. Results: In this study we reconstructed CdtC subunit of A. actinomycetemcomitans Y4 and generated the anti CdtC antibody against recombinant CdtC subunit expressed in E. coli system. Our anti CdtC antibody can be interacting with recombinant CdtC and native CDT in ELISA and Western system. Also, CDT holotoxin existed at 24h but not at 48h meaning that CDT holotoxin was assembled at specific time during the bacterial growth. Conclusion: In conclusion, we thought that our anti CdtC antibody could be used mucosal adjuvant or detection kit development, because it could interact with native CDT holotoxin.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.3
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• pp.330-336
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• 2000

A large number of streptococci that do not fit readily into any of the established classification schemes have been relegated to a large heterogeneous group called the Streptococcus viridans, which are members of the normal flora of the mucous membranes of the body, including the oral cavity, the nasopharynx, and genitourinary tract. This group includes S. mitis, S. oralis, S. sanguis, S. salivarius, S. milleri, etc. Surveying on the literature, it has been reported that infective endocarditis, meningitis, rhabdomyolysis, cholangitis, appendicitis caused by Streptococcus viridans, which were the most important pathogen in children with malignant hematologic disease. Various antibiotics has been chosen for treatment or prophylaxis for these infections, but were generally lower antimicrobial susceptibilities because of an abuse of antibiotics and advent of resistant group. Therefore, surveillant culture must be performed to evaluate personal antimicrobial susceptibilities of intraoral microbes for proper antimicrobial choice for dental procedures. This study examined sampling from subgingival plaque of 60 chidren's microbes. The cultured bacterial isolates, Streptococcus viridans were examined 10 antimicrobial drugs with the Kirby-Bauer agar disk diffusion method. The used drugs were Penicillin, Ampicillin, Oxacillin, Cephalothin, Imipenem, Gentamicin, Erythromycin, Vancomycin, Ciprofloxacin, Clindamycin. The results were as follows : 1. Sampling Streptococcus viridans were S. mitis(65%), S. oralis(22%), S. sanguis(5%), S. intermedius(3%), S. salivarius(2%), S acidominimus(2%), Unidentified streptococcus(2%). 2. The antimicrobial susceptibility of total Streptococcus viridans : Oxacillin< Erythromycin< Pencillin=Ciprofloxacin< Cephalothin< Ampicillin< Clindamycin< Gentamicin< Imipenem=Vancomycin. 3. The antimicrobial susceptibility of S. mitis : Oxacillin=Erythromycin< Ciprofloxacin< Cephalothin< Penicillin=Ampicillin< Gentamicin< Clidamycin< Imipenem=Vancomycin. 4. The antimicrobial susceptibility of S. oralis : Oxacillin< Erythromycin< Penicillin=Ciprofloxacin=Clindamycin< Cephalothin=Gentamicin< Ampicillin< Imipenem=Vancomycin. 5. There was no significant difference in the antimicrobial susceptibility among each Streptococcus viridans group.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.649-655
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• 1988

One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.