• The Journal of the Society of Stroke on Korean Medicine
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• v.10 no.1
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• pp.74-80
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• 2009

Myocardial bridging, a congenital coronary anomaly, is present when a segment of a major epicardial coronary artery, runs intramurally through the myocardium. So with each systole, the coronary artery is compressed. It has been associated with angina, arrhythmia, myocardial infarction and sudden cardiac death. This is a case of a 39-year-old woman who was diagnosed myocardial bridge. She complained of recurrent chest pain, palpitation. We diagnosed her as Gyesimtong(JiXiTong, 悸心痛), and prescribed Jeongkicheonhyang-tang(正氣天香湯). After treatment, all of the symptoms had improved and have not recurred for 18 months. This case suggests that oriental medicine therapy can be applicable to improve in symptoms of myocardial bridge.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.181-184
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• 1999

Systolic coronary arterial narrowing, secondary to myocardial bridging which is capable of producing chest pain, myocardial infarction and ventricular fibrillation is a known but an uncommon entity. A supra-arterial myotomy in a case of myocardial bridge causing medication-refractory angina is described. Under the partial sternotomy incision, we performed a supra-arterial myotomy in the left anterior descending coronary artery without cardiopulmonary bypass. The postoperative course was uneventful.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.629-632
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• 2007

Most myocardial bridgings are found incidentally without symptoms, but myocardial bridging may induce symptoms such as angina, myocardial infarction, and ventricular arrythmia. In a patient who has symptoms despite of proper medication, stent insertion, supra-arterial myotomy or coronary artery bypass grafting have been applied without a definite guideline of treatment. We report two surgical cases of myocardial bridging with a review of the literature.

• 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.52 no.2
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• pp.70-77
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• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.672-674
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• 2002

A 40-years-old male with dilated cardiomyopathy(DCMP) and end-stage heart failure had undergone partial left ventriculectomy(PLV) in July 1997 and then underwent cardiac transplantation in January 1999. Three months later he showed increased ejection fraction (EF) from 26% to 42.6%, decreased left ventricular end diastolic diameter(LVEDD) from 71mm to 45mm, cardiac output(CO) 3.95 L/min and cardiac index(CI) 2.28 L/min/m$^2$echocardiographically. Eight months later, left ventriclular end diastolic and systolic diameters increased to 56 and 51 mm respectively and EF decreased to 17% in echocardiographic follow-up. He had been on maximum medication until he underwent cardiac transplantation 18 months after the PLV. Consecutive myocardial biopsies (1, 3 and 6 month later) showed ISHLT (international society of heart and lung transplantation) class la and the treatment for rejection was not needed until now on. We report a partial left ventriculectomy as a successful bridge to cardiac transplantation in a patient with DCMP and end-stage heart failure.

• Journal of Biomedical Engineering Research
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• v.14 no.2
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• pp.163-167
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• 1993

We developed a ventricular assist device(VAD) to be used as a bridge to heart transplantation or a circulatory assist device for patients with end-stage heart disease or poor myocardial function after cardiac surgery. It is a pneumatic and diaphragm-type VAD and its stroke volume is 90 cc. The upper housing and diaphragm is made of a segmented polyurethane and the lower back plate is made of a polycarbonate. Two Carbomedics$^R$ mechanical valves are used as inlet and outlet valves. It was tested in vitro and the cardiac output of the VAD was 7 L/min at a heart rate of 70 bpm. The line pressure from a pressure transducer inserted in the pneumatic line was recorded and compared with the ideal pressure tracing.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.247-252
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• 1997

Ten acute and chronic in vivo studies were utilized to develop a pneumatic ventricular assist device (VAD) as a bridge to heart transplantation or a circulatory assist device for patients with end-stage heart disease or poor myocardial funct on after cardiac surgery. Two sizes of blood pump of 70cc for adult patients and 34cc for pediatric patients were implanted in the animals. Ventricle of the blood pump was made from the polyurethaae to enhance antithrombogenecity. The VAD was implanted between the left atrium and the descending aorta. Average flow rate was 2.38 L/min for adult and 0.41 L/min for pediatric VAD at the rate of 60 bum. The duration of support ranged from 1 to 26 hours. The most frequent complication was bleeding. Main causes of death were heart failure and respiratory failure. The device function was good for short term use. Studies to date suggest that, with further refinement, a reliable long term VAD that will have clinical application can be developed.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1065-1077
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• 1999

Background : Ventricular assist devices(VADs) are being used for patients in postcvardiotomy cardiogenic shock status bridge to cardiac transplant settings and in post-myocardial infarction cardiogenic shock. The VAD which was developed at the Deparment of medical engineering in Dankook University College of Medicine was a pneumatically driven device and can maintain pulsatile flow. The goal of this study is to develop animal experimental models using the VAD and to clarify the reliability and hemodynamic property adequacy of end organ perfusion durability and severity of thrombotic-hemolytic tendency of the device. Material and Method : The pneumatic VAD was applied to 8 adult female lambs, We examined some hemodynamic parameters such as arterial blood pressure pulmonary capillary wedge pressure(pcwp) pulmonary artery pressure(PAP) left atrial pressure hour urine output cardiac index VAD flow EKG to determine the reliability of the VAD and hemodynamic compatibility of the experimental animals within 24 hours of experiment. We also observed the end organ perfusion durability of the VAD and thrombotic-hemolytic property of the VAD after 24 hours of VAD insertion. Result: We could monitor all hemodynamic parameters including pcwp PAP cardiac index EKG, adn hour urine as true clinical settings. We observed that the reliability of the VAD was excellent and the hemodynamic property of the experimental animal and end organ perfusion were adequate within 24 hours of experiment. In four lambs surviving 24 hours after insertion the reliability of the VAD and end organ perfusion were excellent and no thrombotic-hemolytic tendency was noted. However after 15 days of experiment the diaphragm of the VAD was torn and it was recommende that the durability of the VAD should be extended. Conclusion : e conclude that the pneumatic VAD developed at Dankook University Biomedical Engineering has good hemodynamic property and low thromboembolic tendency and presents adequate end organ perfusion but we noted that the durability of the device should be expanded further. It will be possible to do more reliable experiment in the future according to the animal experimental method developed in this study especially with the heart failure models.