• Journal of Chest Surgery
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• v.50 no.3
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• pp.211-214
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• 2017

Outcomes of ventricular septal rupture (VSR) as a complication of acute myocardial infarction are extremely poor, with an in-hospital mortality rate of 45% in surgically treated patients and 90% in patients managed with medication. Delaying surgery for VSR is a strategy for reducing mortality. However, hemodynamic instability is the main problem with this strategy. In the present case, venoarterial extracorporeal membrane oxygenation (ECMO) was used to provide stable hemodynamic support before the delayed surgery. Awake ECMO was also used to avoiding the complications of sedatives and mechanical ventilation. Here, we describe a successful operation using awake ECMO as a bridge to surgery.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.184-194
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• 2024

Background: Left ventricular assist devices (LVADs) are widely employed as a therapeutic option for end-stage heart failure. We evaluated the outcomes associated with centrifugal-flow LVAD implantation, comparing 2 device models: the Heartmate 3 (HM3) and the Heartware Ventricular Assist Device (HVAD). Methods: Data were collected from patients who underwent LVAD implantation between June 1, 2015 and December 31, 2022. We analyzed overall survival, first rehospitalization, and early, late, and LVAD-related complications. Results: In total, 74 patients underwent LVAD implantation, with 42 receiving the HM3 and 32 the HVAD. A mild Interagency Registry for Mechanically Assisted Circulatory Support score was more common among HM3 than HVAD recipients (p=0.006), and patients receiving the HM3 exhibited lower rates of preoperative ventilator use (p=0.010) and extracorporeal membrane oxygenation (p=0.039). The overall early mortality rate was 5.4% (4 of 74 patients), with no significant difference between groups. Regarding early right ventricular (RV) failure, HM3 implantation was associated with a lower rate (13 of 42 [31.0%]) than HVAD implantation (18 of 32 [56.2%], p=0.051). The median rehospitalization-free period was longer for HM3 recipients (16.9 months) than HVAD recipients (5.3 months, p=0.013). Furthermore, HM3 recipients displayed a lower incidence of late hemorrhagic stroke (p=0.016). In the multivariable analysis, preoperative use of continuous renal replacement therapy (odds ratio, 22.31; p=0.002) was the only significant predictor of postoperative RV failure. Conclusion: The LVAD models (HM3 and HVAD) demonstrated comparable overall survival rates. However, the HM3 was associated with a lower risk of late hemorrhagic stroke.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.989-994
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• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.74-77
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• 1984

Left ventricular-Right atrial canal is a rare congenital heart disease. The vast majority of the cases reported in the literature are clinically diagnosed as atrial septal defect or ventricular septal defect. The method of choice in establishing the diagnosis of left ventricular-right atrlal canal is selective left ventriculography. Recently we experienced one case of left ventricular-right atrial canal which was diagnosed as ventricular septal defect preoperatively. The type of defect was tricuspid perforation of infravalvular type, and repaired with direct suture. Postoperative course was uneventful and discharged without complication.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.637-639
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• 2006

Cardiac myxoma is the most common primary tumor of the heart, but right ventricular myxoma causing outflow obstruction is relatively rare. A 15 years old girl developed dyspnea on exertion and intermittent syncope caused by a right ventricular mass obstructing the right ventricle outflow tract. Transthoracic echocardiography revealed $3.6{\times}3.0\;cm$ sized pedunculated subpumonic mass originating from the right ventricular anterior free wall. The patient underwent an emergency operation, consisting of the removal of the mass by wide excision of the tumor base and PTFE (polytetrafluoroethylene) patching of the right ventricular anterior free wall defect. Pathological findings of the mass were compatible with myxoma, and the patient was discharged uneventfully 7 days after the operation.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.745-749
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• 2002

Cardiac rhabdomyoma is a rare type of benign tumor affecting the heart. There are a few previous reports of intracardiac rhabdomyomas causing ventricular arrythmia. We describe a 1-year-old female tuberous sclerosis patient who was presented with a ventricular tachycardia. Diagnostic echocardiography revealed two masses in the left ventricular outflow tract originating from the ventricular septum. The masses were surgically resected through aortotomy using cardiopulmonary bypass and the masses appeared benign. The pathology was that of a cardiac rhabdomyomas. Postoperative course was uneventful and the ventricular tachycardia was controlled.

• Journal of Chest Surgery
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• v.33 no.5
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• pp.385-390
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• 2000

Background: To review the experience that used both ventricular assist device(VAD) and extracorporeal membrane oxygenation(ECMO) for children with congential heart disease requiring postcardiotomy mechanical circulatory support. Material and Method: Between March 1993 and May 1995, we applied mechanical assist device using centrifugal pump to the 16 patients who failed to be weaned from cardiopulmonary bypass(n=15) or had been in cardiogenic shock in intensive care unit(n=1). The diagnosis were all congenital heart diseases and the ages of patients ranged from 20 days to 10 years (mean age=2.5$\pm$3.5 years). Result: The methods of mechanical circulatory support were LVAD(n=13), BVAD (n=1), and ECMO(n=2). The mean assist times were 54.0$\pm$23.7 hours. Post-assist complications were in orders: bleeding, acute renal failure, ventricular failure, respiratory failure, infection, and neurologic complication. It was possible for 9 patients(56.3%) to be weaned from assist device and 5 patients(31.3%) were discharged from hospital. There was no statistical significant between hospital discharged group and undischarged group by age, body weight, cardiopulmonary bypass time, and assist time. Conclusion: The ventricular assist device is an effective modality in salvaging the patient who failed to be weaned from cardiopulmonary bypass, but multiple factors must be considered for improving the results of mechanical circulatory support ; such as patient selection, optimal time of starting the assist device, and prevention and management of the complications.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.319-322
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• 2024

Venovenous extracorporeal membrane oxygenation (VV ECMO) is often used in cases of severe respiratory failure, especially in patients considered for lung transplantation. However, because many lung diseases can ultimately result in right heart failure, the treatment of secondary right heart failure can present a challenge when the patient is already under VV ECMO support. In such cases, an oxygenated-right ventricular assist device (OxyRVAD) can be used. OxyRVAD is designed to maintain anterograde blood flow and prevent right ventricular distension. Moreover, the pulmonary arterial cannula can be inserted percutaneously. We report a case in which percutaneous OxyRVAD was successfully implemented to manage right heart failure in a patient with respiratory failure who was on VV ECMO.

• Journal of the Korea Society of Computer and Information
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• v.22 no.5
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• pp.65-72
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• 2017

Premature Ventricular Contraction(PVC) arrhythmia is most common abnormal-heart rhythm that may increase mortal risk of a cardiac patient. Thus, it is very important issue to identify the specular portraits of PVC pattern especially from the patient. In this paper, we propose a new method to extract the characteristics of PVC pattern by applying K-means machine learning algorithm on Heart Rate Variability depicted in Poinecare plot. For the quantitative analysis to distinguish the trend of cluster patterns between normal sinus rhythm and PVC beat, the Euclidean distance measure was sought between the clusters. Experimental simulations on MIT-BIH arrhythmia database draw the fact that the distance measure on the cluster is valid for differentiating the pattern-traits of PVC beats. Therefore, we proposed a method that can offer the simple remedy to identify the attributes of PVC beats in terms of K-means clusters especially in the long-period Electrocardiogram(ECG).

• Clinical and Experimental Pediatrics
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• v.59 no.6
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• pp.262-270
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• 2016

Purpose: Pulmonary arterial hypertension (PAH) leads to right ventricular failure (RVF) as well as an increase in pulmonary vascular resistance. Our purpose was to study the effect of sildenafil on right ventricular remodeling in a rat model of monocrotaline (MCT)-induced RVF. Methods: The rats were distributed randomly into 3 groups. The control (C) group, the monocrotaline (M) group (MCT 60 mg/kg) and the sildenafil (S) group (MCT 60 mg/kg+ sildenafil 30 mg/kg/day for 28 days). Masson Trichrome staining was used for heart tissues. Western blot analysis and immunohistochemical staining were performed. Results: The mean right ventricular pressure (RVP) was significantly lower in the S group at weeks 1, 2, and 4. The number of intra-acinar arteries and the medial wall thickness of the pulmonary arterioles significantly lessened in the S group at week 4. The collagen content also decreased in heart tissues in the S group at week 4. Protein expression levels of B-cell lymphoma-2 (Bcl-2)-associated X, caspase-3, Bcl-2, interleukin (IL)-6, matrix metalloproteinase (MMP)-2, endothelial nitric oxide synthase (eNOS), endothelin (ET)-1 and ET receptor A (ERA) in lung tissues greatly decreased in the S group at week 4 according to immunohistochemical staining. According to Western blotting, protein expression levels of troponin I, brain natriuretic peptide, caspase-3, Bcl-2, tumor necrosis factor-${\alpha}$, IL-6, MMP-2, eNOS, ET-1, and ERA in heart tissues greatly diminished in the S group at week 4. Conclusion: Sildenafil alleviated right ventricular hypertrophy and mean RVP. These data suggest that sildenafil improves right ventricular function.