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P10-05 Transmediastinal single-stage extensive aortic arch replacement by the reversed sleeve graft technique
$68
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S1~75
group 1), renal dysfunction (creatinine>2.5, 9.5% in group 1 and 5.3% in group 2), and left ventricle dysfunction (left ventricle ejection fraction less than 0.35, 16.9% in group 1 and 20.2% in group 2). The mean ntmlber of distal anastomoses was 3.22 in group 1 and 3.75 in group 2. Five patients in group 1 turned to cardiopulmonary bypass during the operation due to unstable vital signs and three patients needed intraoperative IABP to help stabilize hemodynamics. The 30 days mortality rate is 2.94% in group 1 and 3.86% in group 2. Mean ICU stay was 3.9 days in group 1 and 5.4 days in group 2. Mean postoperative days was 12.4 days in group 1 and 13.7 days in group 2. C o n c l u s i o n : The early clinical results of OPCAB in total arterial revas cularization ale acceptable. The use of OPCAB should not compromise the strategy of total arterial revascularization.
P10-05 T R A N S M E D I A S T I N A L SINGLE-STAGE E X T E N S I V E A O R T I C ARCH REPLACEMENT BY THE REVERSED SLEEVE GRAFT TECHNIQUE
Shih Rong Hsieh, Hao Ji Wei, Hung Wen Tsal, Chung Chi Wang, Yen Chang. Division of cardiovascular Surgery, Department of Surgery, Taichung Veterans General Hospital Purpose: The definition of extensive aortic arch replacement should be
that the replaced segments of the aorta involved the ascending aorta, total aortic arch, and a segment of descending aorta at least 8 cm distal to the orifice of the left subclavian artery. Extensive aortic arch replacement may Desent a formidable technical challenge. Marked enlargement of the proximal descending aorta or ruptured arch aneurysm excluded the staged procedures. The reversed sleeve graft technique, an innovative method, was introduced to help the performance of this kind of operation. M a t e r i a l a n d Methods: From Janua~T? 2000 to June 2004, 11 patient (10 men,1 woman, mean age 74 years) underwent extensive aortic arch replacement. By the aid of the reversed sleeve graft we used single stage replacement with a median sternotomy incision. And according to intraoperative findings the concomitant method included a stepwise technique or an arch first technique. Associated procedures included one modified Bentall operation and two coronary arterial bypass grafting (CABG). Result: There was no hospital mortality. 2 patients required reoperation for bleeding. 2 patients had minor stroke but ~ec overed completely without sequela. One patient developed acute renal failure requl~ed temporary hemodialysis. Four patients ~equlred assisted ventilation for more than 72 horns, and three of them ~qulred a tracheostomy due to pneumonia. All were successfully weaned from ventilatory support. No patient had paraplegia. C o n e l u s i o n : The reversed sleeve graft technique is a safe procedure and an effective help to the performance of tt-ansmediastinal extensive aortic arch replacement.
P10-06 AN UNCOMMON CAUSE OF ACUTE CORONARY SYNDROME: CORONARY ARTERIOVENOUS FISTULA - A CASE REPORT
Ai Hsien Li, Pen Chih Liao, Shu Hsun Chu. Department of Cardiology, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC An adult, 53 years old women, found to coronary arteriovenous fistula, a congenital cardiovascular defect manifested with acute coronary syndrome. Initially, she reported to have Decordial chest tightness, cold sweating, and dyspnea. She visited emergency department. Dynamic ST segment change of Decordial leads of electrocardiog~am were found. In addition, a serial follow up of cardiac enzymes showed elevation. They might be elevated, if her chest tightness or dyspnea recurred. Cardiac catheterization revealed a large coronary arteriovenous fistula from left main coronary artery and proximal part of right coronary artery to main pulmonary trunk with a large left to right shunt (Qp: Qs 2.73: 1). Cardiac catheterization with
coronary stenting (cover stent) may be the other choice except ligation of fistula. However, instent restenosis is another problem after percutaneous intervension. That may lead to ~ecurrence of angina and repeat intervention. Percutaneous Wanscather coil embolization of coronary fistula had been reported, but myocardial ischemia may be complicated during procedure. Finally, the patient received the ligation of fistulas. During operation, engorgement of fistula tracts and an inlet to main pulmonary trunk (about lmm) were found. Ligation of coronary artery fistulas were performed after thoracotomy. She is symptom free after operation, and follow up at outpatient department regularly now.
P10-07 CHRONIC BILIARY TRACT INFECTION AND PANCREATITIS COMPLICATED WITH RETROPERITONEAL ABSCESS AND M Y C O T I C A N E U R Y S M O F A B D O M I N A L AORTA: S U C C E S S F U L EXTRA-ANATOMIC REPAIR
h Ming Chen, Jason Chang, Shiau Ting Lal, Chun Che Shih. National Yang-Ming University School of Medicine, Institute of Clinical Medicine; Division of Cardiovascular Surgery, Taipei Veterans General Hospital, Taiwan, ROC A 75 year old nmle had the history of gall stone s/p open cholecystec tomy, common bile duct stone with relapsing pancreatitis. He received inWa hepatic ductal stent insertion one week before a&~ission due to inWa hepatic duct stone with ductal stricture, Unfortunatly, he suffered from severe abdominal pain with high fever and abdominal CT disclosed fluid accumulation over left para renal and pava aortic space with tiny gas bubbles, Retroperitoneal abscess with perforation of 3rd portion of duode ntm~ was highly suspected, CT guided pig tail drainage was performed and culture yielded Klebsiella pneumonia. The follow up abdominal CT re vealed progression of the abscess, Further MR angiography was performed (10 days after pig tail drainage) revealed infia renal type abdominal aor tic mycotic aneurysm with suspicious rupture unexpectedly, Due to the severe peritoneal and aortic adhesion, extra anatomic repan- with right axillo femoral (10mm PTFE) and femoro femeral (Smm F I F E ) cross over bypass surgery following by transabdominal ligation of infra renal aorta were performed before retroperitoneal debridement. After serial meticu lous debridement, and drainage, this patient was then discharged under stable condition with uneventful result. The follow up CT angiography 5 months after surgery all showed well patency of the grafts and no any recurrence of abdominal abscess.
P10-08 R E S U L T OF E X T R A C O R P O R E A L M E M B R A N E O X Y G E N A T I O N S U P P O R T IN P E D I A T R I C C A R D I A C T R A N S P L A N T A T I O N
Nal Hsin Chi, Shu42hien Huang, Nal Kuan Chou, Yih Shal]lg Chen, Hsi Yu Yu, Ron Bin Hsu, WenOe Ko, Shu Hsun Chu, Shoei Shan Wang. Dept. of Cardiothoracic Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan B a c k g r o u n d : Pretransplant cardiogenic shock and posttransplant graft failure may happen in the pediatric patients required heart transplantation. These problems can be managed acutely with mechanical support, most commonly extracorporeal membrane oxygenation (ECMO). The purpose of this study was to evaluate the long term outcome of ECMO support after pediatric cardiac Wansplantation. M e t h o d s : From March 1995 through July 2004, 188 patients underwent isolated cardiac transplantation. Eight pediatric patients (4.25%) required mechanical support perioperatively. We reviewed and analyzed these patients' data and followed the long term outcome. Results: Indication for transplantation was complex congenital heart disease in 3, cardiomyopathy in 4, and Kawasaki's disease in 1. All of them required ECMO support because of cardiac reasons. Three patients were also on ECMO preoperatively. Four patients required circulatory support immediately after transplantation due to primary graft dysfunction
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S1~75
group 1), renal dysfunction (creatinine>2.5, 9.5% in group 1 and 5.3% in group 2), and left ventricle dysfunction (left ventricle ejection fraction less than 0.35, 16.9% in group 1 and 20.2% in group 2). The mean ntmlber of distal anastomoses was 3.22 in group 1 and 3.75 in group 2. Five patients in group 1 turned to cardiopulmonary bypass during the operation due to unstable vital signs and three patients needed intraoperative IABP to help stabilize hemodynamics. The 30 days mortality rate is 2.94% in group 1 and 3.86% in group 2. Mean ICU stay was 3.9 days in group 1 and 5.4 days in group 2. Mean postoperative days was 12.4 days in group 1 and 13.7 days in group 2. C o n c l u s i o n : The early clinical results of OPCAB in total arterial revas cularization ale acceptable. The use of OPCAB should not compromise the strategy of total arterial revascularization.
P10-05 T R A N S M E D I A S T I N A L SINGLE-STAGE E X T E N S I V E A O R T I C ARCH REPLACEMENT BY THE REVERSED SLEEVE GRAFT TECHNIQUE
Shih Rong Hsieh, Hao Ji Wei, Hung Wen Tsal, Chung Chi Wang, Yen Chang. Division of cardiovascular Surgery, Department of Surgery, Taichung Veterans General Hospital Purpose: The definition of extensive aortic arch replacement should be
that the replaced segments of the aorta involved the ascending aorta, total aortic arch, and a segment of descending aorta at least 8 cm distal to the orifice of the left subclavian artery. Extensive aortic arch replacement may Desent a formidable technical challenge. Marked enlargement of the proximal descending aorta or ruptured arch aneurysm excluded the staged procedures. The reversed sleeve graft technique, an innovative method, was introduced to help the performance of this kind of operation. M a t e r i a l a n d Methods: From Janua~T? 2000 to June 2004, 11 patient (10 men,1 woman, mean age 74 years) underwent extensive aortic arch replacement. By the aid of the reversed sleeve graft we used single stage replacement with a median sternotomy incision. And according to intraoperative findings the concomitant method included a stepwise technique or an arch first technique. Associated procedures included one modified Bentall operation and two coronary arterial bypass grafting (CABG). Result: There was no hospital mortality. 2 patients required reoperation for bleeding. 2 patients had minor stroke but ~ec overed completely without sequela. One patient developed acute renal failure requl~ed temporary hemodialysis. Four patients ~equlred assisted ventilation for more than 72 horns, and three of them ~qulred a tracheostomy due to pneumonia. All were successfully weaned from ventilatory support. No patient had paraplegia. C o n e l u s i o n : The reversed sleeve graft technique is a safe procedure and an effective help to the performance of tt-ansmediastinal extensive aortic arch replacement.
P10-06 AN UNCOMMON CAUSE OF ACUTE CORONARY SYNDROME: CORONARY ARTERIOVENOUS FISTULA - A CASE REPORT
Ai Hsien Li, Pen Chih Liao, Shu Hsun Chu. Department of Cardiology, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC An adult, 53 years old women, found to coronary arteriovenous fistula, a congenital cardiovascular defect manifested with acute coronary syndrome. Initially, she reported to have Decordial chest tightness, cold sweating, and dyspnea. She visited emergency department. Dynamic ST segment change of Decordial leads of electrocardiog~am were found. In addition, a serial follow up of cardiac enzymes showed elevation. They might be elevated, if her chest tightness or dyspnea recurred. Cardiac catheterization revealed a large coronary arteriovenous fistula from left main coronary artery and proximal part of right coronary artery to main pulmonary trunk with a large left to right shunt (Qp: Qs 2.73: 1). Cardiac catheterization with
coronary stenting (cover stent) may be the other choice except ligation of fistula. However, instent restenosis is another problem after percutaneous intervension. That may lead to ~ecurrence of angina and repeat intervention. Percutaneous Wanscather coil embolization of coronary fistula had been reported, but myocardial ischemia may be complicated during procedure. Finally, the patient received the ligation of fistulas. During operation, engorgement of fistula tracts and an inlet to main pulmonary trunk (about lmm) were found. Ligation of coronary artery fistulas were performed after thoracotomy. She is symptom free after operation, and follow up at outpatient department regularly now.
P10-07 CHRONIC BILIARY TRACT INFECTION AND PANCREATITIS COMPLICATED WITH RETROPERITONEAL ABSCESS AND M Y C O T I C A N E U R Y S M O F A B D O M I N A L AORTA: S U C C E S S F U L EXTRA-ANATOMIC REPAIR
h Ming Chen, Jason Chang, Shiau Ting Lal, Chun Che Shih. National Yang-Ming University School of Medicine, Institute of Clinical Medicine; Division of Cardiovascular Surgery, Taipei Veterans General Hospital, Taiwan, ROC A 75 year old nmle had the history of gall stone s/p open cholecystec tomy, common bile duct stone with relapsing pancreatitis. He received inWa hepatic ductal stent insertion one week before a&~ission due to inWa hepatic duct stone with ductal stricture, Unfortunatly, he suffered from severe abdominal pain with high fever and abdominal CT disclosed fluid accumulation over left para renal and pava aortic space with tiny gas bubbles, Retroperitoneal abscess with perforation of 3rd portion of duode ntm~ was highly suspected, CT guided pig tail drainage was performed and culture yielded Klebsiella pneumonia. The follow up abdominal CT re vealed progression of the abscess, Further MR angiography was performed (10 days after pig tail drainage) revealed infia renal type abdominal aor tic mycotic aneurysm with suspicious rupture unexpectedly, Due to the severe peritoneal and aortic adhesion, extra anatomic repan- with right axillo femoral (10mm PTFE) and femoro femeral (Smm F I F E ) cross over bypass surgery following by transabdominal ligation of infra renal aorta were performed before retroperitoneal debridement. After serial meticu lous debridement, and drainage, this patient was then discharged under stable condition with uneventful result. The follow up CT angiography 5 months after surgery all showed well patency of the grafts and no any recurrence of abdominal abscess.
P10-08 R E S U L T OF E X T R A C O R P O R E A L M E M B R A N E O X Y G E N A T I O N S U P P O R T IN P E D I A T R I C C A R D I A C T R A N S P L A N T A T I O N
Nal Hsin Chi, Shu42hien Huang, Nal Kuan Chou, Yih Shal]lg Chen, Hsi Yu Yu, Ron Bin Hsu, WenOe Ko, Shu Hsun Chu, Shoei Shan Wang. Dept. of Cardiothoracic Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan B a c k g r o u n d : Pretransplant cardiogenic shock and posttransplant graft failure may happen in the pediatric patients required heart transplantation. These problems can be managed acutely with mechanical support, most commonly extracorporeal membrane oxygenation (ECMO). The purpose of this study was to evaluate the long term outcome of ECMO support after pediatric cardiac Wansplantation. M e t h o d s : From March 1995 through July 2004, 188 patients underwent isolated cardiac transplantation. Eight pediatric patients (4.25%) required mechanical support perioperatively. We reviewed and analyzed these patients' data and followed the long term outcome. Results: Indication for transplantation was complex congenital heart disease in 3, cardiomyopathy in 4, and Kawasaki's disease in 1. All of them required ECMO support because of cardiac reasons. Three patients were also on ECMO preoperatively. Four patients required circulatory support immediately after transplantation due to primary graft dysfunction