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Coronary artery fistula is an abnormal communication between the coronary artery and the cardiac chambers. In particular, an abnormal connection between the conus branch of the right coronary artery and the proximal left anterior descending coronary artery is defined as Vieussens’ arterial ring. Coronary artery fistulas are usually asymptomatic, but some can cause complications such as infective endocarditis. Here, we report a case of Vieussens’ arterial ring causing infective endocarditis with severe mitral regurgitation. more...

Sialolithiasis, the most common salivary gland pathology, is caused by calculi in the gland itself and its duct. While patients with small sialoliths can undergo conservative treatment, those with standard-size or larger sialoliths require sialolithotomy. In the present case study, we removed two sialoliths located beneath the mucosa in the posterior and anterior regions of Wharton's duct, respectively. For the posterior calculus, we performed sialolithotomy via an intra-oral approach; thereafter, the small anterior calculus near the duct orifice was removed by hydraulic power. This method has not previously been reported. There were no complications either during the operation or postoperatively, and the salivary function of the gland remained normal. more...

An 81-year-old male patient presented with complaint of a pulsating neck mass. The patient had a previous history of cervical lymphadenopathy by non-tuberculous mycobacterium infection. Rapid growth of the mass on admission and contrast enhanced computed tomography of the neck resulted in a diagnosis of non-tuberculous mycobacterium induced pseudoaneurysm. The patient underwent emergency open repair of the pseudoaneurysm. Pseudoaneurysm of the common carotid artery is regularly reported, but here we report a rare case of non-tuberculous mycobacterium induced pseudoaneurysm of the common carotid artery. more...

Oncologic and surgical outcomes of bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) are comparable with those of open thyroidectomy (OT). We compared degree of scarring and psychological/physical distress between OT and BABA RoT.Study included 129 cases of thyroidectomy (78 OT, 51 BABA RoT). Patients were evaluated by psychology consultant using 5-point scale questionnaire.BABA RoT was associated with lower degree of scarring than OT (7.8 vs. 11.7, P0.001). Psychological distress immediately after operation and during surveillance period was higher in OT than in BABA RoT (3.1 vs. 2.6, P=0.009 and 2.4 vs. 1.9, P0.001). Physical distress (pain and exercise limitation) did not differ between groups (2.5 vs. 2.6, P=0.321 and 2.0 vs. 1.9, P=0.0175).BABA RoT was associated with less scarring and psychological distress than OT. BABA RoT might be alternative for patients who are concerned about neck scar. more...

Anticoagulation therapy is essential after cardiac valve surgery. However, spontaneous bleeding remains a major concern during anticoagulation therapy. Spontaneous gallbladder (GB) hemorrhage (hemobilia) is a rare occurrence during standard anticoagulation therapy. This report presents a case of GB hemorrhage that occurred shortly after initiating oral anticoagulant therapy in a patient who had undergone mitral valve replacement surgery. more...

We report a rare case of an extremely large right ventricular myxoma involving the ventricular side of the tricuspid valve. The tumor was excised along with the entire posterior leaflet and part of the anterior leaflet. The tricuspid valve was repaired by sliding valvuloplasty combined with ring annuloplasty. more...

Primary epithelial-myoepithelial carcinoma (EMC) of the lung is an extremely rare neoplasm that originates from submucosal bronchial glands and has been found in the salivary glands, breast tissue, and sweat glands. However, only a few cases in the respiratory tract have been identified. In the literature, most pulmonary EMCs have been reported to have developed endobronchially although a few EMC cases have been presented as intraparenchymatous tumors. We have identified a case of primary EMC that developed in the peripheral lung parenchyma. more...

Background: The conventional method of aortic cross-clamping is very difficult and increases the risk of cerebral infarct due to embolism of the calcified aorta in these patients. Accordingly, we analyzed our experience with 11 cases of ascending aorta and aortic valve replacement with hypothermic circulatory arrest. Materials and Methods: From January 2002 to December 2009, 11 patients had ascending aorta and aortic valve replacement with hypothermic arrest at our hospital. We performed a retrospective study. Results: There were 5 males and 6 females, with a mean age of 68 years (range, 44 to 82 years). Eight patients had aortic stenosis, and 3 patients had aortic regurgitation. An aortic cannula was inserted into the right axillary artery in 3 patients and ascending aorta in 6 patients. Two patients with aortic regurgitation had a remote access perfusion catheter inserted though the right femoral artery. The mean cardiopulmonary bypass time was 180 minutes (range, 110 to 306 minutes) and mean hypothermic circulatory arrest time was 30 minutes (range, 20 to 48 minutes). The mean rectal temperature during hypothermic circulatory arrest was 21℃ (range, 19℃ to 23℃). No patient had any new onset of cerebral infarct or cardiovascular accident after surgery. There was no hospital mortality. Early complications occurred in 1 patient who needed reoperation due to postoperative bleeding. Late complications occurred in 1 patient who underwent a Bentall operation due to prosthetic valve endocarditis. The mean follow-up duration was 32 months (range, 1 month to 8 years) and 1 patient died suddenly due to unknown causes after 5 years. Conclusion: Patients with a calcified aorta can be safely treated with a technique based on aorta and aortic valve replacement under hypothermic circulatory arrest. more...

Background: The optimal surgical strategy for coarctation of the aorta (CoA) with ventricular septal defect (VSD) is controversial. The aim of this study is to evaluate the clinical outcome of a single-stage repair of CoA with VSD. Methods: We reviewed 72 patients who underwent single-stage repair for CoA with VSD between January 1995 and December 2007. There were 43 males and 29 females. The median age of the patients was 28 days (range = 3 to 188) and median weight was 3.7 kg (range = 2.16 to 5.6). Deep hypothermic circulatory arrest was used in 22 patients and selective antegrade cerebral perfusion was performed in 43 patients. Results: There were no operative deaths and one late death at a median follow-up of 60 months (range = 16 to 158). Postoperative complications were left main bronchus compression requiring aortopexy in one patient and recoarctation requiring balloon dilatation in one patient. Subaortic stenosis occurred in two patients and surgical repair was performed. Conclusions: One-stage simultaneous repair can be performed with a low risk at an early age. (J Card Surg 2011;26:420-424) more...

Vieussens' arterial ring (VAR) is the connection between the conus branch of the right coronary artery and the proximal right ventricular branch of the left anterior descending coronary artery. VARs are found in 48% of the population; however, pathologic VAR is rare. We experienced a case of pathologic VAR that involved a fistula connecting to the main pulmonary artery. more...

Two stents were placed across the right subclavian vein due to stenosis of the right subclavian vein in a 40-year-old patient with chronic renal failure on hemodialysis. During the follow up period, one of stents migrated into the right ventricle inducing tricuspid valve insufficiency. Percutaneous stent removal had failed and the stent was removed by open heart surgery with Tricuspid valve repair with a good result, and then we report the case. more...

Anomalous origin of a coronary aortic artery is a rare cardiac anomaly. Although it can cause angina, syncope, and palpitations, most patients are asymptomatic. This anomaly requires surgical treatment or intervention because it is associated with sudden death. Several surgical techniques, such as coronary reimplantation, coronary artery bypass grafting (CABG), unroofing, and neo-ostium formation, have been proposed as treatments. We report a case surgically treated with neo-ostium formation in anomalous origin of the left coronary artery from the right coronary sinus. more...

This case series study demonstrates the possibility of successful implant rehabilitation without bone augmentation in the atrophic posterior maxilla with cystic lesion in the sinus. Sinus lift without bone graft using the lateral approach was performed. In one patient, the cyst was aspirated and simultaneous implantation under local anesthesia was performed, whereas the other cyst was removed under general anesthesia, and the sinus membrane was elevated in a second process, followed by implantation. In both cases, tapered 11.5-mm-long implants were utilized. With all of the implants, good stability and appropriate bone height were achieved. The mean bone level gain was 5.73 mm; adequate bone augmentation around the implants was shown, the sinus floor was moved apically, and the cyst was no longer radiologically detected. Completion of all of the treatments required an average of 12.5 months. The present study showed that sufficient bone formation and stable implantation in a maxilla of insufficient bone volume are possible through sinus lift without bone materials. The results serve to demonstrate, moreover, that surgical treatment of mucous retention cyst can facilitate rehabilitation. These techniques can reduce the risk of complications related to bone grafts, save money, and successfully treat antral cyst. more...

Mitral stenosis after mitral repair with using an annuloplasty ring is not common and it is almost always due to pannus formation. Mitral valve replacement was required in most of the previous cases of pannus covering the mitral valve leaflet, which could not be stripped off without damaging the valve leaflets. In two cases, we removed the previous annuloplasty ring and pannus without leaflet injury, and we successfully repaired the mitral valve. During the follow-up of 4 months and 39 months respectively, we observed improvement of the patients' symptoms and good valvular function. Redo mitral repair may be a possible method for treating mitral stenosis due to pannus formation after ring annuloplasty. more...

Ventricular septal rupture (VSR) is a disastrous mechanical complication of myocardial infarction. Although several surgical interventions have been developed, mortality due to surgical management remains high, especially in the case of posterior VSR. We report a successful case of repair of posterior VSR using an alternative transatrial approach to avoid the complications related to ventricular incision. more...

The aim of the present study was to investigate the relationship among nutritional status, N-terminal probrain-type natriuretic peptide (NT–proBNP) and ventricular remodeling in hemodialysis (HD) patients. Serum concentrations of NT-proBNP were measured by immunoassay. Nutritional status was assessed using the subjective global assessment (SGA) score and malnutrition–inflammation score (MIS). Echocardiographic examinations were performed on all patients. Forty-four patients undergoing maintenance HD were enrolled in this study. Malnourished patients, assessed according to SGA, had higher levels of extracellular water (ECW) per kg body weight (BWt) than well-nourished patients (mean, 0.30 vs 0.26 l/ kg, respectively) and higher levels of NT-proBNP (median, 24,807 vs 4,342 pg/ml, respectively). MIS was positively correlated with left ventricular mass index (LVMI), log NT–proBNP and ECW/BWt ( r =0.35, 0.45 and 0.38), and negatively correlated with fat mass and LV systolic dysfunction ( r =–0.41 and –0.32). LV systolic dysfunction, LVMI and MIS were associated with log NT-proBNP levels. Multiple regression analysis showed that log NT–proBNP, mean arterial pressure and ECW/BWt were independently associated with LVMI. In conclusion, malnutrition in HD patients is accompanied by volume overload and associated with increased log NT–proBNP levels independent of volume status, and these levels are independently associated with increased LVMI. This suggests that malnutrition may affect ventricular remodeling or dysfunction in HD patients. more...

Background and Objectives: Stanford type A aortic dissection is a potentially catastrophic event that requires surgical repair, on an emergency basis. The extent of arch repair that should be carried out during emergency surgery of this type is controversial. This study was designed to evaluate the results of arch replacement carried out during acute type A dissection. Subjects and Methods: 28 patients with Stanford type A dissection and who underwent arch replacement between 1995 and 2006 were reviewed. Results: Hospital mortality was 3.6% (1 patient), and transient neurocognitive dysfunction was observed in 5 patients. During the follow-up period (mean 26±20 months; range 1 to 66 months), 3 patients underwent reoperation due to descending thoracic or abdominal aortic aneurysm. There was no late death. Follow up computed tomography was performed in 15 patients and false lumen disappeared totally or partially in 10 patients (66.7%). Conclusion: Arch replacement for acute Stanford type A dissection may decrease the risk of late complications related to false lumen and lead to an excellent midterm survival rate. (Korean Circ J 2009;39:270-274) KEY WORD: Aortic dissection. more...

Approximately one-third of all patients with renal cell carcinoma have metastasis at the time of diagnosis. Metastatic lesions of renal cell carcinoma are most commonly seen in the lung, and they are frequently seen in the bone and liver. However, spleen and rectal metastases are extremely rare. A 63-year-old man had undergone left radical nephrectomy for renal cell carcinoma. About 22 months later, computed tomography revealed multiple enhanced masses in the spleen. Spleen metastasis was suspected and splenectomy was then performed. One year later, the patient visited with complaints of voiding difficulty. A huge pelvic mass was detected by performing prostate ultrasonography and MRI. The mass was 13cm in diameter and it was between the rectum and the prostate. Removal of the pelvic mass and lower anterior resection with end colostomy was done. Histologically, the resected specimens were diagnosed as metastases from the renal cell cancer. Herein, we report on a case of metachronous splenic and rectal metastasis from renal cell carcinoma. more...

Purpose: To evaluate the safety and efficacy of a laparoscopic nephroureterectomy in patients with a transitional cell carcinoma of the renal pelvis and ureter. Materials and Methods: All patients underwent a nephroureterectomy for an upper tract transitional cell carcinoma. Of these, 23 and 22 underwent a laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU), respectively, between January 2002 and June 2006. After the nephrectomy had been performed, a 5-6cm modified Gibson incision was created to allow dissection of the lower ureter and bladder cuff, and extraction of the intact specimen. A retrospective analysis was performed on the operating time, blood loss, analgesic requirement, ambulation time, interval to resume oral intake, hospital stay, complications and follow-up results for both groups. Results: The LNU was superior to the ONU with regard to the mean operation time; 275 (190-390) versus 258 (180-400) (p=0.259), blood loss; 188 (130-250) versus 488ml (350-750) (p more...

Purpose: Pheochromocytomas are relatively uncommon tumors, the operative resection of which presents clear medical and technical challenges. We report our experience of a laparoscopic transperitoneal adrenalectomy in a series of 22 patients with a pheochromocytoma. In a comparison of the early (A) and late (B) surgery groups, the “learning curve” and efficacy and safety of a laparoscopic transperitoneal adrenalectomy for a pheochromocytoma were evaluated. Materials and Methods: Between January 1998 and August 2005, 22 patients with a pheochromocytoma underwent a laparoscopic transperitoneal adrenalectomy (LTA). Patients were divided into groups A (early surgery group, LTA between January 1998 and January 2002) and B (late surgery group, LTA February 2002 and August 2005). The operative time, intraoperative blood loss, mean time to oral intake, mean postoperative hospital stay and intraoperative hypertensive crises were analyzed retrospectively. Results: The mean operative times were 169.4 and 122.5 min in the groups A and B (p=0.003), with mean blood losses of 149.4 and 129.5cc, respectively (p=0.045). The mean postoperative hospital stays were 6.5 and 4.4 days in groups A and B, respectively (p=0.015). Intraoperative hypertensive crises occurred in two and one patient in groups A and B, respectively. With a mean follow-up of 34 months, the regression of symptoms and control of blood pressure were obtained in all patients, without additional treatment. Conclusions: In group B, the mean operative time, intraoperative blood loss and the mean postoperative hospital stay were shortened. In our experience, an adrenal pheochromocytoma can be treated safely and effectively using a laparoscopic transperitoneal approach. (Korean J Urol 2006;47:1204-1209) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏 more...

Budd-Chiari syndrome (BCS caused by hepatic venous outflow obstruction due to occlusion of hepatic vein and/or the inferior vena cava (IVC consists of a variety of clinical manifestations such as abdominal pain, hepatomegaly, ascite associated with acute or chronic liver dysfunction and portal hypertension. A large number of therapies have been introduced for BCS, both medical (including diuretics, thrombolytics, and anticoagulants and surgical (such as peritoneovenous shunt, direct correction of the venous obstruction, decompressive portosystemic venous shunt, and in end-stage liver disease, orthotopic liver transplantation. More recently percutaneous transluminal angioplasty (PTA has been used to relieve the obstruction. PTA differs from surgery in that it can be used repeatedly because it is less invasive and safer. Possible complicati- ons of PTA include stent migration, occlusion due to thrombus formation or neointimal hyperplasia, pulmonary embolism, hemorrage and infection. We experienced one case with complication of stent migration into right ventricle after PTA for BCS. (Korean Circulation J 2000;30(7 :885-889 more...