BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such ...BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such functions between individuals with varicose veins and healthy individuals remain unclear.AIM To investigate changes in physical function and the quality of life(QOL)following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity.METHODS We enrolled 37 participants(those with varicose veins,n=17;healthy individuals,n=20).We performed the following measurements pre-and post-nonsurgical treatment in the varicose vein patients and healthy individuals:Calf muscle oxygenation during the two-minute step test,open eyes one-leg stance,30 s sit-to-stand test,visual analog scale(VAS)for pain,Pittsburgh sleep quality index,physical activity assessment,and QOL assessment.RESULTS Varicose veins patients and healthy individuals differ in most variables(physical function,sleep quality,and QOL).Varicose veins patients showed significant differences between pre-and post-nonsurgical treatment—results in the 30 sit-to-stand test[14.41(2.45)to 16.35(4.11),P=0.018],two-minute step test[162.29(25.98)to 170.65(23.80),P=0.037],VAS for pain[5.35(1.90)to 3.88(1.73),P=0.004],and QOL[39.34(19.98)to 26.69(17.02),P=0.005];however,no significant difference was observed for muscle oxygenation.CONCLUSION Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients,bringing their condition close to that of healthy individuals.Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.展开更多
Objectives:To access the effectiveness of our modified right-ventricular overhauling procedure on tricuspid valve(TV)growth in patients with pulmonary atresia with intact ventricular septum(PAIVS).Methods:We retrospec...Objectives:To access the effectiveness of our modified right-ventricular overhauling procedure on tricuspid valve(TV)growth in patients with pulmonary atresia with intact ventricular septum(PAIVS).Methods:We retrospectively reviewed 21 patients with PAIVS who underwent modified right ventricular overhauling(mRVoh)between 2008 and 2019 at two institutions.Our mRVoh consisted of wide resection of hypertrophied infundibular and trabecular muscle,peeling off fibrotic endocardial tissue in the right ventricle(RV)cavity,surgical pulmonary valvotomy,and Blalock-Taussig shunt or banding of ductus arteriosus under cardiopulmonary bypass.The TV annulus sizes were measured and analyzed using echocardiography before and after mRVoh.Results:No mortalities were observed during a median follow-up of 3 years(interquartile range:1.3–4.7 years)of follow-up were noted.mRVoh was performed at a median age of 163.5 days(range:21–560 days),including seven neonates and two infants(<60 days).During follow-up,the median TV annular z-score increased significantly from−2.24 to−1.15 before and after mRVoh(p=0.004).In ten patients with a prior history of percutaneous interventions for RV outflow tract(RVOT)widening at least 6 months before mRVoh,the TV annular z-score significantly changed during the period after mRVoh(−2.03 to−1.61,p=0.028)compared with the period before mRVoh(−2.51→–2.03,p=0.575)after percutaneous intervention only.Conclusions:mRVoh in PAIVS patients was positively associated with TV annular growth,and it was more effective than percutaneous RVOT widening interventions without mRVoh.展开更多
BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotom...BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotomy.However,in this case,the aneurysm could be safely resected by thoracoscopic simultaneous lateral and subxiphoid access methods.CASE SUMMARY A 58-year-old male presented with intermittent chest pain and persistent discomfort in the chest area.A chest computed tomography scan revealed a 6.2 cm aneurysm in the left innominate vein and SVC junction.For surgical resection,simultaneous lateral and subxiphoid access were planned to achieve optimal proximal and distal aneurysm control.The approach site was 1 cm below the xiphoid process,the fifth mid-axillary line and the seventh anterior axillary line on the right side.The aneurysm was resected using a stapler.The patient was discharged on the third day after chest tube removal on the second postoperative day with no particular issues.CONCLUSION Aneurysms located within the mediastinum can be accessed through thoracoscopic approach without open surgery and safely resected using vascular staples.展开更多
BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE...BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.展开更多
Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study...Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study at the Surgery Department “A” at the University Hospital Point G from January 2001 to August 2015. Inclusion criteria were all pregnant women with ectopic pregnancy treated with coelioscopy. Sociodemographic, clinical, paracclinical and therapeutic aspects were recorded. Results: In 15 years, 42 cases of ectopic pregnancy out of 3840 gynecologic coelioscopies (1.04%) were collected. The average age was 28.5 years old with the extremes of 16 and 41 years old. Metrorragia was associated to pain in 83.3% (35/42);amenorrhea was found in 66.7% (28/41). Physical exam revealed pain with abdominal defense in 59.5% (25/42), adnexal mass in 31% (13/42), and pelvic contracture in 9.5% (4/42). In pre-operative, ectopic pregnancy was diagnosed complicated in 71.4% (30/42) and uncomplicated in 28.6% (12/42). Patients underwent salpingectomy in 85.7% (36/42), delivery from the fallopian tube in 9.8% (4/42), and hemostatic salpingectomy in 4.4% (2/42). The average duration of hospital stay was 1.88 day with the extremes of 1 and 7 days. The postoperative evolution was favorable in 97.6% (41/42), infection at the site of surgery was reported in 2.4% (1/42). Not a single death was registered. Conclusion: Treatment of ectopic pregnancy is of routine at the surgery department “A” in Point G. Fertility is preserved in the future.展开更多
Objective:Junctional ectopic tachycardia is common after cardiac surgery for congenital heart disease.However,its incidence and related risk factors in infants after cardiac surgery are not well known.The objective of...Objective:Junctional ectopic tachycardia is common after cardiac surgery for congenital heart disease.However,its incidence and related risk factors in infants after cardiac surgery are not well known.The objective of this study was to determine the overall incidence and related risk factors for junctional ectopic tachycardia in neonates and infants.Methods:We enrolled a total of 271 patients aged<1 year who underwent open cardiac surgery at Severance Cardiovascular Hospital from January 2018 to December 2020.Exclusion criteria were immediate postoperative mortality,other arrhythmias detected in the perioperative period,and prematurity.Result:The overall incidence of junctional ectopic tachycardia was 12.9%.The logistic regression analysis revealed that longer cardiopulmonary bypass time,surgery involving atrioventricular node stretching,and the presence of early repolarization on preoperative electrocardiography increased the risk of junctional ectopic tachycardia.Patients with junctional ectopic tachycardia had longer intubation time and intensive care unit stay.Conclusion:Junctional ectopic tachycardia is a common arrhythmia after cardiac surgery for congenital heart disease in infants.Occasionally,infants developing junctional ectopic tachycardia after cardiac surgery have specific preoperative electrocardiography findings.The risk factors for junctional ectopic tachycardia were associated not only with surgical procedural factors but also with preoperative electrocardiographic parameters.展开更多
Background: The proportion of never?smokers with non?small cell lung cancer(NSCLC) is increasing, but that in Korea has not been well addressed in a large population. We aimed to evaluate the proportion and clinical f...Background: The proportion of never?smokers with non?small cell lung cancer(NSCLC) is increasing, but that in Korea has not been well addressed in a large population. We aimed to evaluate the proportion and clinical features of never?smokers with NSCLC in a large single institution.Methods: We analyzed clinical data of 1860 consecutive patients who were newly diagnosed with NSCLC between June 2011 and December 2014.Results: Of the 1860 NSCLC patients, 707(38.0%) were never?smokers. The proportions of women(83.7% vs. 5.6%) and adenocarcinoma(89.8% vs. 44.9%) were higher among never?smokers than among ever?smokers. Significantly more never?smokers were diagnosed at a younger median age(65 vs. 68 years, P < 0.001) and earlier stage(stage I–II, 44.5% vs. 38.9%, P < 0.001) a= 0.015) compared with ever?smokers. Epidermal growth factor receptor mutations(57.8% vs. 24.4%, Pnd anaplastic lymphoma kinase rearrangements(7.8% vs. 2.8%, P < 0.001) were more common in never?smokers, whereas Kirsten rat sarcoma viral oncogene homolog mutations(5.8% vs. 9.6%, P ntly encountered in never?smokers than in ever?smokers. Never?smokers showed longer su= 0.021) were less frequervival after adjust?ing for the favorable effects of younger age, female sex, adenocarcinoma histology, better performance status, early stage disease, being asymptomatic at diagnosis, received antitumor treatment, and the presence of driver mutations(hazard ratio, 0.624; 95% confidence interval, 0.460–0.848; P = 0.003).Conclusions: More than one?third of the Korean patients with NSCLC were never?smokers. NSCLC in never?smokers had different clinical characteristics and major driver mutations and resulted in longer overall survival compared with NSCLC in ever?smokers.展开更多
AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging(CMR)compared to[^(18)F]-fluorodeoxyglucose(FDG)-positron emission tomography(PET)depending on left ventricular(LV)function....AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging(CMR)compared to[^(18)F]-fluorodeoxyglucose(FDG)-positron emission tomography(PET)depending on left ventricular(LV)function.METHODS One-hundred-five patients with known obstructive coronary artery disease(CAD)and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner.The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement(LGE)imaging for viability assessment in 8 mm long and contiguous short axis slices.All patients underwent PET using[^(18)F]-FDG.Myocardial scars were rated in both CMR and PET on a segmental basis by a 4-point-scale:Score 1=no LGE,normal FDG-uptake;score 2=LGE enhancement<50% of wall thickness,reduced FDG-uptake(≥50% of maximum);score 3=LGE≥50% ,reduced FDG-uptake(<50% of maximum);score 4=transmural LGE,no FDG-uptake.Segments with score 1 and 2 were categorized"viable",scores 3 and 4 were categorized as"non-viable".Patients were divided into three groups based on LV function as determined by CMR:Ejection fraction(EF),<30% :n=45;EF:30% -50% :n=44;EF>50% :n=16).On a segmental basis,the accuracy of CMR in detecting myocardial scar was compared to PET in the total collective and in the three different patient groups.RESULTS CMR and PET data of all 105 patients were sufficient for evaluation and 5508 segments were compared in total.In all patients,CMR detected significantly more scars(score 2-4)than PET:45% vs 40% of all segments(P<0.0001).In the different LV function groups,CMR found more scar segments than PET in subjects with EF<30% (55% vs 46% ;P<0.0001)and EF 30% -50% (44% vs 40% ;P<0.005).However,CMR revealed less scars than PET in patients with EF>50% (15% vs 23% ;P<0.0001).In terms of functional improvement estimation,i.e.,expected improvement after revascularization,CMR identified"viable"segments(score 1 and 2)in 72% of segments across all groups,PET in 80% (P<0.0001).Also in all LV function subgroups,CMR judged less segments viable than PET:EF<30% ,66% vs 75% ;EF=30% -50% ,72% vs 80% ;EF>50% ,91% vs 94% .CONCLUSION CMR and PET reveal different diagnostic accuracy in myocardial viability assessment depending on LV function state.CMR,in general,is less optimistic in functional recovery prediction.展开更多
AIM:To determine the prevalence,demographic,clinical and histopathologic features of heterotopic gastric mucosa(HGM)in Chinese patients.METHODS:Patients referred to three endoscopy units were enrolled in this study.Th...AIM:To determine the prevalence,demographic,clinical and histopathologic features of heterotopic gastric mucosa(HGM)in Chinese patients.METHODS:Patients referred to three endoscopy units were enrolled in this study.The macroscopic characteristics of HGM were documented.Biopsies were obtained and observed using hematoxylin and eosin staining.Helicobacter pylori colonization was examinedby Whartin-Starry staining.RESULTS:HGM was observed in 420 Chinese patients,yielding a prevalence of 0.4%.The majority of patients had a single patch(300/420;71.4%),while the remainder had two(84/420;20%)or multiple patches(36/420;8.6%).The size of the patches and the distance from the patch to the frontal incisor teeth varied significantly.The large majority of HGM patches were flat(393/420;93.6%),whereas the remaining patches were slightly elevated.The primary histological characteristic was fundic-type(216/420;51.4%)within the HGM patch,and antral-(43/420;10.2%)and transitional-type(65/420;15.5%)mucosa were also observed.The prevalence of intestinal metaplasia was3.1%(13/420)and the prevalence of dysplasia was1.4%(6/420),indicating the necessity for endoscopic follow-up in patients with HGM.Esophageal and extraesophageal complaints were also observed in patients with HGM.Dysphagia and epigastric discomfort(odds ratios:6.836 and 115.826,respectively;P s<0.05)were independent risk factors for HGM.CONCLUSION:Clinical complaints should be considered to improve the detection rate of HMG.The prevalence of intestinal metaplasia and dysplasia also indicates a need for endoscopic follow-up.展开更多
Objective: To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods: We ret-rospectively collected data on 24 patients who underwent surgical management in the past ten years in tw...Objective: To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods: We ret-rospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair (anterior mitral leaflet plication); 2 patients underwent aortic valve re-placement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall’s procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge. Results: One patient died of post-operative heart failure. The mean follow-up time was 4.3 years. There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association (NYHA) Classes I^II due to associated valvular lesions. Conclusion: Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indi-cation for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion (SAM) of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.展开更多
This study examined the effect of astilbin on the proliferation of rat aortic smooth muscle cells (RASMCs) induced by angiotensin Ⅱ (AngⅡ) and explored the possible mechanisms. Cell proliferation model of RASMCs was...This study examined the effect of astilbin on the proliferation of rat aortic smooth muscle cells (RASMCs) induced by angiotensin Ⅱ (AngⅡ) and explored the possible mechanisms. Cell proliferation model of RASMCs was induced by treatmente with AngⅡ. Cells were randomly di-vided to 8 groups. Normally cultured VSMCs serves as blank control group; in AngⅡ model group, cells were treated with AngⅡ at 10-7 mol/L; in three astilbin groups, cells were treated with 10, 15, 30 mg/L of astilbin; in three AngⅡ+astilbin groups, cells were treated with AngⅡ (at 10-7 mol/L) and astilbin at 10, 15, 30 mg/L. Cell proliferation ability was detected by MTT method and the cell cycles and proliferation index were flow cytometrically determined. The expression of c-myc mRNA was assessed by using reverse transcription polymerase chain reaction (RT-PCR), and the expression of NF-κB in RASMCs was immunocytochemically observed. Our results showed that MTT metabo-lism in RASMCs in the basic and AngII stimulated situation was inhibited by astilbin, and the cells numbers of G0/G1 phase were increased and that of G2/S phase were decreased markedly. Not only highly expression of c-myc gene stimulated by AngⅡ could be inhibited by Astilbin significantly, but also the expression of NF-κB protein can be down regulated by Astilbin. We are led to conclude that astilbin astilbin can inhibit the AngⅡ-mediated proliferation of RASMCs by blocking the tran-sition of RASMCs from G0/G1 phase to S phase and by down-regulating the expression of NF-κB, c-myc gene.展开更多
AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all elig...AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation(AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n = 40107) met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke(OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of allcause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.展开更多
Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopu...Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopulmonary arrest caused by tension pneumothorax. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax;this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.展开更多
Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-tho...Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.展开更多
We report a case of myxoma with multiple recurrences in both the atrium and ventricle in a 26-year-old woman five years after the surgical removal of left atrial myxoma.Her 52-year-old mother had a similar medical his...We report a case of myxoma with multiple recurrences in both the atrium and ventricle in a 26-year-old woman five years after the surgical removal of left atrial myxoma.Her 52-year-old mother had a similar medical history.To our knowledge,this was the first familial case who suffered multifocal cardiac myxoma recurrences without any sign of the myxoma complex.Based on our understanding of the mechanism of recurrence,the approaches to prevent the recurrence,and markers to predict recurrence,we propose that multifocal recurrences,as reported herein,may result from a combination of familial predisposition and multifocal onset.The bi-atrial surgical approach and transesophageal echocardiography are preferred for patients with recurrent cardiac myxomas,especially for those with multiple recurrences and familial myxoma.Immunological and genetic screenings may help to identify family members at risk for developing this disease.展开更多
Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:T...Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020.We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs.The previous surgical history of patients who underwent PVR during the study period was also included.Patients who underwent the Rastelli operation,and those who underwent single PVR without previous open-heart surgery were excluded.Results:The median age of the patients at the time of surgical PVR was 14.9 years(Interquartile range,IQR,11.0–22.0).The median follow-up duration was 10.5 years(IQR,5.5–14.8 years).There were 3 patients with operative mortality(1.0%)and 15 patients with overall mortality(5.1%).The survival rate was 95.1%over 20 years follow-up period.Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR,older age at the first operation,longer cardiopulmonary bypass(CPB)time and longer intensive care unit(ICU)stay were predictors for overall mortality.Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times(P<0.001).Age younger than 10 years,male,multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis.Conclusions:Though surgical PVR has excellent long-term outcome,it should be performed with caution for those who previously underwent multiple open-heart surgeries,especially if patient received more than 3 times of open-heart surgeries.展开更多
BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enou...BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram(ECG)changes or be asymptomatic.CASE SUMMARY In this case,we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography.We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment.The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.CONCLUSION Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.展开更多
We report the case of a rare complex cardiac anomaly involving situs solitus,concordant atrioventricular connection with left-hand ventricular topology,and L-looped ventricles.The ventricles had a superior-inferior re...We report the case of a rare complex cardiac anomaly involving situs solitus,concordant atrioventricular connection with left-hand ventricular topology,and L-looped ventricles.The ventricles had a superior-inferior relationship with an inferiorly located right ventricle,which had a double outlet with far posteriorly located great arteries.The left atrium was elongated,with juxta-positioned atrial appendages on the right side.The 3D-printed model using a computed tomography scan taken on the fourth day of birth demonstrated the anatomy clearly and helped us decide on the surgical management.展开更多
BACKGROUND Multiple exostoses generally develop in the first decade of life.They most frequently arise from the distal femur,proximal tibia,fibula,and proximal humerus.Costal exostoses are rare,contributing to 1%-2% o...BACKGROUND Multiple exostoses generally develop in the first decade of life.They most frequently arise from the distal femur,proximal tibia,fibula,and proximal humerus.Costal exostoses are rare,contributing to 1%-2% of all exostoses in hereditary multiple exostoses(HME).They are usually asymptomatic,but a few cases have resulted in severe thoracic injuries.Pneumothorax caused by costal exostoses is rare,with only 13 previously reported cases.We report a new case of pneumothorax caused by costal exostoses.CASE SUMMARY A 17-year-old male with HME underwent surgery for removal of exostoses around his right knee.Four months following the operation,he felt chest pain when he was playing the trumpet;however,he did not stop playing for a week.He was referred to our hospital with a chief complaint of chest pain.The computed tomography(CT)scan revealed right pneumothorax and multiple exostoses in his right ribs.The CT scan also revealed visceral pleura thickness and damaged lung tissues facing the exostosis of the seventh rib.We diagnosed that exostosis of the seventh rib induced pneumothorax.Costal exostosis resection was performed by video-assisted thoracoscopic surgery(VATS)2 wk after the onset.The patient’s postoperative course was uneventful,and there was no recurrence of pneumothorax for 2 years.CONCLUSION Costal exostoses causing thoracic injuries should be resected regardless of age.VATS must be considered in cases with apparently benign and relatively small exostoses or HME.展开更多
基金Supported by Biomedical Research Institute,Pusan National University Hospital,202200420001.
文摘BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such functions between individuals with varicose veins and healthy individuals remain unclear.AIM To investigate changes in physical function and the quality of life(QOL)following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity.METHODS We enrolled 37 participants(those with varicose veins,n=17;healthy individuals,n=20).We performed the following measurements pre-and post-nonsurgical treatment in the varicose vein patients and healthy individuals:Calf muscle oxygenation during the two-minute step test,open eyes one-leg stance,30 s sit-to-stand test,visual analog scale(VAS)for pain,Pittsburgh sleep quality index,physical activity assessment,and QOL assessment.RESULTS Varicose veins patients and healthy individuals differ in most variables(physical function,sleep quality,and QOL).Varicose veins patients showed significant differences between pre-and post-nonsurgical treatment—results in the 30 sit-to-stand test[14.41(2.45)to 16.35(4.11),P=0.018],two-minute step test[162.29(25.98)to 170.65(23.80),P=0.037],VAS for pain[5.35(1.90)to 3.88(1.73),P=0.004],and QOL[39.34(19.98)to 26.69(17.02),P=0.005];however,no significant difference was observed for muscle oxygenation.CONCLUSION Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients,bringing their condition close to that of healthy individuals.Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.
文摘Objectives:To access the effectiveness of our modified right-ventricular overhauling procedure on tricuspid valve(TV)growth in patients with pulmonary atresia with intact ventricular septum(PAIVS).Methods:We retrospectively reviewed 21 patients with PAIVS who underwent modified right ventricular overhauling(mRVoh)between 2008 and 2019 at two institutions.Our mRVoh consisted of wide resection of hypertrophied infundibular and trabecular muscle,peeling off fibrotic endocardial tissue in the right ventricle(RV)cavity,surgical pulmonary valvotomy,and Blalock-Taussig shunt or banding of ductus arteriosus under cardiopulmonary bypass.The TV annulus sizes were measured and analyzed using echocardiography before and after mRVoh.Results:No mortalities were observed during a median follow-up of 3 years(interquartile range:1.3–4.7 years)of follow-up were noted.mRVoh was performed at a median age of 163.5 days(range:21–560 days),including seven neonates and two infants(<60 days).During follow-up,the median TV annular z-score increased significantly from−2.24 to−1.15 before and after mRVoh(p=0.004).In ten patients with a prior history of percutaneous interventions for RV outflow tract(RVOT)widening at least 6 months before mRVoh,the TV annular z-score significantly changed during the period after mRVoh(−2.03 to−1.61,p=0.028)compared with the period before mRVoh(−2.51→–2.03,p=0.575)after percutaneous intervention only.Conclusions:mRVoh in PAIVS patients was positively associated with TV annular growth,and it was more effective than percutaneous RVOT widening interventions without mRVoh.
文摘BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotomy.However,in this case,the aneurysm could be safely resected by thoracoscopic simultaneous lateral and subxiphoid access methods.CASE SUMMARY A 58-year-old male presented with intermittent chest pain and persistent discomfort in the chest area.A chest computed tomography scan revealed a 6.2 cm aneurysm in the left innominate vein and SVC junction.For surgical resection,simultaneous lateral and subxiphoid access were planned to achieve optimal proximal and distal aneurysm control.The approach site was 1 cm below the xiphoid process,the fifth mid-axillary line and the seventh anterior axillary line on the right side.The aneurysm was resected using a stapler.The patient was discharged on the third day after chest tube removal on the second postoperative day with no particular issues.CONCLUSION Aneurysms located within the mediastinum can be accessed through thoracoscopic approach without open surgery and safely resected using vascular staples.
文摘BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.
文摘Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study at the Surgery Department “A” at the University Hospital Point G from January 2001 to August 2015. Inclusion criteria were all pregnant women with ectopic pregnancy treated with coelioscopy. Sociodemographic, clinical, paracclinical and therapeutic aspects were recorded. Results: In 15 years, 42 cases of ectopic pregnancy out of 3840 gynecologic coelioscopies (1.04%) were collected. The average age was 28.5 years old with the extremes of 16 and 41 years old. Metrorragia was associated to pain in 83.3% (35/42);amenorrhea was found in 66.7% (28/41). Physical exam revealed pain with abdominal defense in 59.5% (25/42), adnexal mass in 31% (13/42), and pelvic contracture in 9.5% (4/42). In pre-operative, ectopic pregnancy was diagnosed complicated in 71.4% (30/42) and uncomplicated in 28.6% (12/42). Patients underwent salpingectomy in 85.7% (36/42), delivery from the fallopian tube in 9.8% (4/42), and hemostatic salpingectomy in 4.4% (2/42). The average duration of hospital stay was 1.88 day with the extremes of 1 and 7 days. The postoperative evolution was favorable in 97.6% (41/42), infection at the site of surgery was reported in 2.4% (1/42). Not a single death was registered. Conclusion: Treatment of ectopic pregnancy is of routine at the surgery department “A” in Point G. Fertility is preserved in the future.
文摘Objective:Junctional ectopic tachycardia is common after cardiac surgery for congenital heart disease.However,its incidence and related risk factors in infants after cardiac surgery are not well known.The objective of this study was to determine the overall incidence and related risk factors for junctional ectopic tachycardia in neonates and infants.Methods:We enrolled a total of 271 patients aged<1 year who underwent open cardiac surgery at Severance Cardiovascular Hospital from January 2018 to December 2020.Exclusion criteria were immediate postoperative mortality,other arrhythmias detected in the perioperative period,and prematurity.Result:The overall incidence of junctional ectopic tachycardia was 12.9%.The logistic regression analysis revealed that longer cardiopulmonary bypass time,surgery involving atrioventricular node stretching,and the presence of early repolarization on preoperative electrocardiography increased the risk of junctional ectopic tachycardia.Patients with junctional ectopic tachycardia had longer intubation time and intensive care unit stay.Conclusion:Junctional ectopic tachycardia is a common arrhythmia after cardiac surgery for congenital heart disease in infants.Occasionally,infants developing junctional ectopic tachycardia after cardiac surgery have specific preoperative electrocardiography findings.The risk factors for junctional ectopic tachycardia were associated not only with surgical procedural factors but also with preoperative electrocardiographic parameters.
文摘Background: The proportion of never?smokers with non?small cell lung cancer(NSCLC) is increasing, but that in Korea has not been well addressed in a large population. We aimed to evaluate the proportion and clinical features of never?smokers with NSCLC in a large single institution.Methods: We analyzed clinical data of 1860 consecutive patients who were newly diagnosed with NSCLC between June 2011 and December 2014.Results: Of the 1860 NSCLC patients, 707(38.0%) were never?smokers. The proportions of women(83.7% vs. 5.6%) and adenocarcinoma(89.8% vs. 44.9%) were higher among never?smokers than among ever?smokers. Significantly more never?smokers were diagnosed at a younger median age(65 vs. 68 years, P < 0.001) and earlier stage(stage I–II, 44.5% vs. 38.9%, P < 0.001) a= 0.015) compared with ever?smokers. Epidermal growth factor receptor mutations(57.8% vs. 24.4%, Pnd anaplastic lymphoma kinase rearrangements(7.8% vs. 2.8%, P < 0.001) were more common in never?smokers, whereas Kirsten rat sarcoma viral oncogene homolog mutations(5.8% vs. 9.6%, P ntly encountered in never?smokers than in ever?smokers. Never?smokers showed longer su= 0.021) were less frequervival after adjust?ing for the favorable effects of younger age, female sex, adenocarcinoma histology, better performance status, early stage disease, being asymptomatic at diagnosis, received antitumor treatment, and the presence of driver mutations(hazard ratio, 0.624; 95% confidence interval, 0.460–0.848; P = 0.003).Conclusions: More than one?third of the Korean patients with NSCLC were never?smokers. NSCLC in never?smokers had different clinical characteristics and major driver mutations and resulted in longer overall survival compared with NSCLC in ever?smokers.
文摘AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging(CMR)compared to[^(18)F]-fluorodeoxyglucose(FDG)-positron emission tomography(PET)depending on left ventricular(LV)function.METHODS One-hundred-five patients with known obstructive coronary artery disease(CAD)and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner.The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement(LGE)imaging for viability assessment in 8 mm long and contiguous short axis slices.All patients underwent PET using[^(18)F]-FDG.Myocardial scars were rated in both CMR and PET on a segmental basis by a 4-point-scale:Score 1=no LGE,normal FDG-uptake;score 2=LGE enhancement<50% of wall thickness,reduced FDG-uptake(≥50% of maximum);score 3=LGE≥50% ,reduced FDG-uptake(<50% of maximum);score 4=transmural LGE,no FDG-uptake.Segments with score 1 and 2 were categorized"viable",scores 3 and 4 were categorized as"non-viable".Patients were divided into three groups based on LV function as determined by CMR:Ejection fraction(EF),<30% :n=45;EF:30% -50% :n=44;EF>50% :n=16).On a segmental basis,the accuracy of CMR in detecting myocardial scar was compared to PET in the total collective and in the three different patient groups.RESULTS CMR and PET data of all 105 patients were sufficient for evaluation and 5508 segments were compared in total.In all patients,CMR detected significantly more scars(score 2-4)than PET:45% vs 40% of all segments(P<0.0001).In the different LV function groups,CMR found more scar segments than PET in subjects with EF<30% (55% vs 46% ;P<0.0001)and EF 30% -50% (44% vs 40% ;P<0.005).However,CMR revealed less scars than PET in patients with EF>50% (15% vs 23% ;P<0.0001).In terms of functional improvement estimation,i.e.,expected improvement after revascularization,CMR identified"viable"segments(score 1 and 2)in 72% of segments across all groups,PET in 80% (P<0.0001).Also in all LV function subgroups,CMR judged less segments viable than PET:EF<30% ,66% vs 75% ;EF=30% -50% ,72% vs 80% ;EF>50% ,91% vs 94% .CONCLUSION CMR and PET reveal different diagnostic accuracy in myocardial viability assessment depending on LV function state.CMR,in general,is less optimistic in functional recovery prediction.
文摘AIM:To determine the prevalence,demographic,clinical and histopathologic features of heterotopic gastric mucosa(HGM)in Chinese patients.METHODS:Patients referred to three endoscopy units were enrolled in this study.The macroscopic characteristics of HGM were documented.Biopsies were obtained and observed using hematoxylin and eosin staining.Helicobacter pylori colonization was examinedby Whartin-Starry staining.RESULTS:HGM was observed in 420 Chinese patients,yielding a prevalence of 0.4%.The majority of patients had a single patch(300/420;71.4%),while the remainder had two(84/420;20%)or multiple patches(36/420;8.6%).The size of the patches and the distance from the patch to the frontal incisor teeth varied significantly.The large majority of HGM patches were flat(393/420;93.6%),whereas the remaining patches were slightly elevated.The primary histological characteristic was fundic-type(216/420;51.4%)within the HGM patch,and antral-(43/420;10.2%)and transitional-type(65/420;15.5%)mucosa were also observed.The prevalence of intestinal metaplasia was3.1%(13/420)and the prevalence of dysplasia was1.4%(6/420),indicating the necessity for endoscopic follow-up in patients with HGM.Esophageal and extraesophageal complaints were also observed in patients with HGM.Dysphagia and epigastric discomfort(odds ratios:6.836 and 115.826,respectively;P s<0.05)were independent risk factors for HGM.CONCLUSION:Clinical complaints should be considered to improve the detection rate of HMG.The prevalence of intestinal metaplasia and dysplasia also indicates a need for endoscopic follow-up.
文摘Objective: To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods: We ret-rospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair (anterior mitral leaflet plication); 2 patients underwent aortic valve re-placement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall’s procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge. Results: One patient died of post-operative heart failure. The mean follow-up time was 4.3 years. There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association (NYHA) Classes I^II due to associated valvular lesions. Conclusion: Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indi-cation for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion (SAM) of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.
基金supported by agrant from the National Natural Science Foundation of China(No.30500656)
文摘This study examined the effect of astilbin on the proliferation of rat aortic smooth muscle cells (RASMCs) induced by angiotensin Ⅱ (AngⅡ) and explored the possible mechanisms. Cell proliferation model of RASMCs was induced by treatmente with AngⅡ. Cells were randomly di-vided to 8 groups. Normally cultured VSMCs serves as blank control group; in AngⅡ model group, cells were treated with AngⅡ at 10-7 mol/L; in three astilbin groups, cells were treated with 10, 15, 30 mg/L of astilbin; in three AngⅡ+astilbin groups, cells were treated with AngⅡ (at 10-7 mol/L) and astilbin at 10, 15, 30 mg/L. Cell proliferation ability was detected by MTT method and the cell cycles and proliferation index were flow cytometrically determined. The expression of c-myc mRNA was assessed by using reverse transcription polymerase chain reaction (RT-PCR), and the expression of NF-κB in RASMCs was immunocytochemically observed. Our results showed that MTT metabo-lism in RASMCs in the basic and AngII stimulated situation was inhibited by astilbin, and the cells numbers of G0/G1 phase were increased and that of G2/S phase were decreased markedly. Not only highly expression of c-myc gene stimulated by AngⅡ could be inhibited by Astilbin significantly, but also the expression of NF-κB protein can be down regulated by Astilbin. We are led to conclude that astilbin astilbin can inhibit the AngⅡ-mediated proliferation of RASMCs by blocking the tran-sition of RASMCs from G0/G1 phase to S phase and by down-regulating the expression of NF-κB, c-myc gene.
基金Supported by no external funding.Dr.Benditt is supported in part by a grant from the Dr.Earl E Bakken family in support of heart-brain research
文摘AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation(AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n = 40107) met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke(OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of allcause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.
文摘Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopulmonary arrest caused by tension pneumothorax. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax;this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.
文摘Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.
文摘We report a case of myxoma with multiple recurrences in both the atrium and ventricle in a 26-year-old woman five years after the surgical removal of left atrial myxoma.Her 52-year-old mother had a similar medical history.To our knowledge,this was the first familial case who suffered multifocal cardiac myxoma recurrences without any sign of the myxoma complex.Based on our understanding of the mechanism of recurrence,the approaches to prevent the recurrence,and markers to predict recurrence,we propose that multifocal recurrences,as reported herein,may result from a combination of familial predisposition and multifocal onset.The bi-atrial surgical approach and transesophageal echocardiography are preferred for patients with recurrent cardiac myxomas,especially for those with multiple recurrences and familial myxoma.Immunological and genetic screenings may help to identify family members at risk for developing this disease.
文摘Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020.We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs.The previous surgical history of patients who underwent PVR during the study period was also included.Patients who underwent the Rastelli operation,and those who underwent single PVR without previous open-heart surgery were excluded.Results:The median age of the patients at the time of surgical PVR was 14.9 years(Interquartile range,IQR,11.0–22.0).The median follow-up duration was 10.5 years(IQR,5.5–14.8 years).There were 3 patients with operative mortality(1.0%)and 15 patients with overall mortality(5.1%).The survival rate was 95.1%over 20 years follow-up period.Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR,older age at the first operation,longer cardiopulmonary bypass(CPB)time and longer intensive care unit(ICU)stay were predictors for overall mortality.Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times(P<0.001).Age younger than 10 years,male,multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis.Conclusions:Though surgical PVR has excellent long-term outcome,it should be performed with caution for those who previously underwent multiple open-heart surgeries,especially if patient received more than 3 times of open-heart surgeries.
文摘BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram(ECG)changes or be asymptomatic.CASE SUMMARY In this case,we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography.We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment.The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.CONCLUSION Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.
文摘We report the case of a rare complex cardiac anomaly involving situs solitus,concordant atrioventricular connection with left-hand ventricular topology,and L-looped ventricles.The ventricles had a superior-inferior relationship with an inferiorly located right ventricle,which had a double outlet with far posteriorly located great arteries.The left atrium was elongated,with juxta-positioned atrial appendages on the right side.The 3D-printed model using a computed tomography scan taken on the fourth day of birth demonstrated the anatomy clearly and helped us decide on the surgical management.
文摘BACKGROUND Multiple exostoses generally develop in the first decade of life.They most frequently arise from the distal femur,proximal tibia,fibula,and proximal humerus.Costal exostoses are rare,contributing to 1%-2% of all exostoses in hereditary multiple exostoses(HME).They are usually asymptomatic,but a few cases have resulted in severe thoracic injuries.Pneumothorax caused by costal exostoses is rare,with only 13 previously reported cases.We report a new case of pneumothorax caused by costal exostoses.CASE SUMMARY A 17-year-old male with HME underwent surgery for removal of exostoses around his right knee.Four months following the operation,he felt chest pain when he was playing the trumpet;however,he did not stop playing for a week.He was referred to our hospital with a chief complaint of chest pain.The computed tomography(CT)scan revealed right pneumothorax and multiple exostoses in his right ribs.The CT scan also revealed visceral pleura thickness and damaged lung tissues facing the exostosis of the seventh rib.We diagnosed that exostosis of the seventh rib induced pneumothorax.Costal exostosis resection was performed by video-assisted thoracoscopic surgery(VATS)2 wk after the onset.The patient’s postoperative course was uneventful,and there was no recurrence of pneumothorax for 2 years.CONCLUSION Costal exostoses causing thoracic injuries should be resected regardless of age.VATS must be considered in cases with apparently benign and relatively small exostoses or HME.
