• Journal of Chest Surgery
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• v.18 no.4
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• pp.537-541
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• 1985

Recently, we met a 12 year old female patient who suffered from bacterial endocarditis and pericarditis which were complicated by patent ductus arteriosus. She was admitted to our hospital because of dyspnea, fever, headache, and generalized ache for 10 days. The initial diagnosis was bacterial endocarditis and pericarditis complicated by patent ductus arteriosus and congestive heart failure. At first, we tried to treat the patient medically with digitalis, diuretics, and massive antibiotics. On echocardiography large amount of pericardial fluid was accumulated mainly right anterior aspect and also noted a large vegetation at pulmonary valve area. With vigorous medical treatment including repeated pericardiocentesis, the patient showed no improvement. So we decided to perform pericardiectomy for elimination of the most probable septic focus. On operation, we encountered an unpredicted event, the pericardium was thickened, distended, and its surface showed pulsating which meant connecting to systemic circulation. We decided to close the operative wound and reoperate her under cardiopulmonary bypass later. On the next day, we operated her under cardiopulmonary bypass later. On the next day we operated her under cardiopulmonary bypass. The operative findings were ruptured main pulmonary artery about 1.5cm in diameter on its ventral portion, the blood from the ruptured main pulmonary artery was filled up the localized pericardial sac due to previous pericarditis. Through the ruptured main pulmonary artery, we also found 0.5cm diametered patent ductus arteriosus. With the aid of partial cardiopulmonary bypass and inserting 24F ballooned Foley catheter at aorta, pericardiectomy was performed first. After completion of the pericardiectomy, total cardiopulmonary bypass was established. With minimum pump flow [0.3L/min/m2] the PDA was closed with two Teflon-felted 4-0 Prolene interrupted sutures. The ruptured main pulmonary artery was also closed using thickened pericardium with three Teflon-felted 4-0 Prolene interrupted sutures. The operation was successful and postoperative course was uneventful. She was discharged on the 16th POD. We report this case as a very rare secondary complication of bacterial endocarditis complicated by patent ductus arteriosus.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.502-505
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• 2001

Pulmonary sequestration is an abnormal lung tissue that does not communicate with tracheobronchial tree, and that receives blood supply from anomalous arteries. Pulmonary sequestration is divided into two anatomical forms, intralobar and extralobar. Extralobar pulmonary sequestration is usually located between the diaphragm and the lower lobe and has systemic arterial supply and venous drainage, and most patients are diagnosed in their infancy. We report an extralobar pulmonary sequestration located between the right upper lobe and the lower lobe in a 48-year-old female adult, which has anomalous blood supply from the right pulmonary artery and venous drainage directly into the left atrium.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.314-319
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• 1985

Nineteen patients with various types of cyanotic congenital heart disease underwent systemic-pulmonary artery shunts with a microporous polytetrafluoroethylene [PTFE] graft between September, 1983, and April, 1985. Age ranged from 3 months to 18 years, and seven of them were less than 12 months old. There were seventeen Great Ormond Street type of modified Blalock-Taussig shunts, and two central polytetrafluoroethylene shunt [ascending aorta-right pulmonary artery]. There was one postoperative death [1/19=5.3%] in a 10 Kg child born with pulmonary atresia and ventricular septal defect associated with patent ductus arteriosus. He had another anomaly of imperforated anus. Relief from cyanosis was achieved in other eighteen patients with variable degree. Eighteen survivors have been followed up from 1 month to 19 months. Clinical status, auscultation, oxygen partial pressure of arterial blood, and hemoglobin have been used to establish shunt patency in all survivors. By above criteria, all survivors have good patent shunt.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.30-33
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• 1983

Truncus Arteriosus is an uncommon congenital anomaly which is now correctable surgically in patients with favorable anatomy. A case of a 9 month old male with truncus arteriosus, type II, is reported operation was done on cardiopulmonary bypass with deep hypothermia and circulatory arrest. The pulmonary arteries were not disconnected from the truncus, and the pulmonary common orifice was closed with a Dacron patch through anterior truncotomy and, for the distal anastomosis, the left pulmonary artery was opened near the common orifice. Continuity between the right ventricle and the left pulmonary artery was established with a valved conduit [Ionescu-Shiley, 14mm]. The postoperative course was excellent and uneventful.

• Journal of Chest Surgery
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• v.25 no.7
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• pp.736-738
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• 1992

We report the successful use of Nifedipine in the treatment of acute pulmonary hypertension in an young child after a cardiac operation. This patient had undergone patch closure of large ventricular septal defect. She had signs of severe pulmonary artery hypertension unresponsive to hyperventilation, oxygenation, sedation, and a myriad of vas-oactive drugs. Nifedipine, 0.3mg /kg every 4 hours, effectively treated her pulmonary artery hypertension and allowed for a smooth postoperative course and positive outcome. The drug lowered systemic diastolic pressure, but not systolic pressure.

• Journal of Chest Surgery
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• v.24 no.11
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• pp.1149-1153
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• 1991

A modified procedure for the operative management of the corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis or atresia was performed in 4 patients. (age ; 18 months-9 years). The operation consists of a venous switch procedure (Senning), intraventricular baffling directing the blood flow from the morphologic left ventricle into the aorta via ventricular septal defect through the right ventriculotomy, and insertion of valved conduit between the morphologic right ventricle and the pulmonary artery. All the four patients had large non-restrictive ventriular septal defects and no evidence of significant mitral valve regurgitation. Both ventricles were well-developed. Three cases had pulmonary atresia, and the remainder had severe subpulmonic stenosis. Postperatively, all patients showed no findings of systemic or pulmonary venous obstruction withnormal sinus rhythm. One patient died of sepsis due to infection by Methicillin-resistant S. aureus on the thirteenth postoperative day. Follow-up is done on the survivors, and all of them are dong well with regular sinus rhythm, with their functional class I or II at 2 to 8 months after the operation.

• Journal of Chest Surgery
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• v.15 no.3
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• pp.331-337
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• 1982

Complete TGA is a common congenital cardiovacular anomaly, and without palliative or corrective surgery, the infant born with TGA rarely survives the first year of life. Hemodynamically, recirculated blood flow in the systemic and pulmonary circuit has a key role in systemic arterial oxygen saturation and the status of the pulmonary vascular bed. Recently a d-TGA with VSD and PS, in a 12 year old male patient had been tried for inversion of the ventricular flow with Rastelli operation. An intracardiac tunnel was constructed between the VSD and the aortic orifice to connect the ventricle to the aorta. The right ventricle was connected with the pulmonary circulation by anastomosis of an valved conduit between the right ventricle and the distal end of the pulmonary artery. During the postop, period, the irreversible renal failure, accompanied by metabolic acidosis and pulmonary edema, occured under relative stabilized cardiac performance state. The autopsy was done, which revealed diffuse infarcted area in both kidney and preserved intra & extracardiac graft constructed.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.638-642
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• 1993

Congenital coronary arteriovenous fistula is relatively uncommon and widespread use of echocardiogram and selective coronary angiogram are being recognized with increasing frequency. The right coronary artery is most commonly involved and the fistulous communication is most common to right ventricle. Surgical correction is strongly recommended to prevent the development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and pulmonary hypertension, as well as coronary aneurysm formation, with subsequent rupture or embolism. We report two cases of coronary arteriovenous fistula originated from right coronary artery terminated in the right ventricle. These 8 year-old female and 7 year-old male patients had surgical interventions using cardiopulmonary bypasses.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.643-645
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• 1993

It is generally acknowledged that congenital coronary artery fistula is an abnormal communication of the coronary artery with the right ventricle, right atrium,left atrium and left ventricle. In young people the symptoms are unusual , but significant symptoms and complications appear among the older age group such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension. Therefore, early surgical treatment is recommended. We experienced a case of coronary arteriovenous fistula that was involving the circumflex branch of the left coronary artery with the right ventricle. It was 10mm in diameter with multiple vegetation. We repaired the fistula under extracoporeal circulation. The patient was discharged in a healthy condition twelve days after operation .

• Tuberculosis and Respiratory Diseases
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• v.39 no.6
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• pp.548-553
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• 1992

The Unilateral absence of a pulmonary artery (UAPA) is an uncommon congenital anomaly. Approximately 160 cases have been reported in the literature since Frantzel's first report in 1968. Most of the patients with UAPA are asymptomatic but some patients may suffer from recurrent respiratory infections, hemoptysis, or pulmonary hypertension. The diagnosis could be suspected from the chest roentgenogram and lung scan, and definitely confirmed by pulmonary angiography. We experienced a case of UAPA in a 39-year-old male with the recurrent hemoptysis. Chest X-ray revealed that the left lung volume was moderately decreased and the heart and mediastinum were displaced to the left side. Lung perfusion scan showed that the left lung was not perfused. Pulmonary angiography revealed the absence of the left main pulmonary artery. Aortic arch and descending aorta on aortogram were right sided. Blood supply to the left lung was originated from numerous systemic collaterals from intercostal and brachiocephalic origin. No other intrinsic or internal abnormalities of the cardiac chambers were noted.