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Kuan-Ming Chiu

Publications and source records attributed to Kuan-Ming Chiu.

17 recordsLinked to original sources
PubMed2006

Carvedilol can restore the multifractal properties of heart beat dynamics in patients with advanced congestive heart failure.

INTRODUCTION: Human heart beats in an extremely inhomogeneous and non-stationary manner. Recent study has demonstrated that it belongs to a class of signals called multifractal. Loss of multifractality was also uncovered in patients with congestive heart failure. We investigated whether carvedilol could restore the multifractal properties in a group of patients with advanced congestive heart failure. METHODS AND RESULTS: A Holter ECG recording was obtained before and 1 and 3 months after titrated addition of carvedilol therapy in 10 patients with advanced congestive heart failure. Multifractal spectrum, detrended fluctuation analysis (DFA) as well as the traditional time- and frequency-domain heart rate variability (HRV) parameters were compared before and after carvedilol therapy together with those in age and sex-matched normal control. The results showed that the multifractal spectrum tau(q) vs. q of N-N interval time series returned toward normal during carvedilol treatment. All the traditional HRV parameters and the short-term DFA improved significantly after 3 months of carvedilol therapy. CONCLUSION: We concluded that the deteriorated multifractal properties could be reversed by carvedilol treatment in patients with advanced congestive heart failure.

Adrenergic beta-Antagonists↗
PubMed2006

Reduction of carbon dioxide embolism for endoscopic saphenous vein harvesting.

BACKGROUND: The endoscopic saphenous vein harvesting (EVH) introduced in coronary artery bypass surgery (CABG) is associated with less wound complication and postoperative pain. Carbon dioxide (CO2) insufflation is used during EVH to facilitate the procedure. The purpose of this study was to determine whether the incidence of CO2 embolism during EVH with CO2 insufflation could be reduced with lower CO2 insufflation pressure. METHODS: Four hundred and ninety-eight consecutive patients scheduled for elective off-pump CABG were prospectively studied. These patients were randomly assigned into high and low groups in which 15 and 12 mm Hg CO2 insufflation pressures were used during EVH, respectively. Multiplane transesophageal echocardiography (TEE) with transgastric inferior vena cava view was used to monitor the appearances of CO2 bubbles. If a burst of many CO2 bubbles were found by TEE, the CO2 insufflation would be stopped until detailed examination of the operative field. RESULTS: The incidence of CO2 embolisms in the high group of patients (13.3%) was significantly higher than that in the low group (6.5%, p < 0.05). Two episodes of emergent cessation of CO2 insufflation occurred in the high group of patients. No massive CO2 embolism with significant hemodynamic alterations occurred in either group. CONCLUSIONS: The incidence of CO2 embolisms during EVH could be reduced with lower CO2 insufflation pressure, which, in combination with increased surgical experience and continuous TEE monitoring of the inferior vena cava, helps to reduce the risks of massive CO2 embolism.

Aged↗
PubMed2006

Endoscopic radial artery harvest for coronary artery bypass surgery.

BACKGROUND/PURPOSE: Coronary artery bypass grafting (CABG) provides better long-term patency than percutaneous intervention in patients with significant coronary artery disease. The radial artery is the second most common arterial conduit used for CABG in Western countries. However, radial artery harvesting necessitates a large surgical wound and has gained few patients' acceptance in subtropical areas. This study investigated the use of the minimally invasive approach of endoscopic radial artery harvest for CABG, and the surgical results at the harvest site. METHODS: An endoscopic harvest program for radial arteries was implemented in this hospital in September 2003. During the first 12 months of the program until September 2004, 122 patients underwent the procedure. Preoperative evaluation included Allen's test and the modified palmar arch perfusion test. The age of patients ranged from 32 to 88 years old. Patients were excluded from participation if they had undergone recent transradial catheterization, had end-stage renal disease or documented peripheral artery occlusive disease. The VasoView system was utilized for the procedure. Details of the surgical techniques used were recorded and analyzed. RESULTS: Using the endoscopic technique, 122 radial arteries were harvested successfully. The mean resting length of the harvested radial artery was 15.7 cm. No obvious arterial injury was visually confirmed. All radial arteries were used for CABG, except for two which were noted to have atherosclerotic plaques causing stenoses. Forty-seven patients presented with mild numbness over the dorsum of the thumb base, which improved significantly during the 3-month follow-up. No arterial insufficiency in the forearms or hands was noted. CONCLUSION: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.

Adult↗
PubMed2006

Less invasive mitral valve surgery via right minithoracotomy.

BACKGROUND/PURPOSE: Current trends in cardiac surgical intervention are moving toward less invasiveness, with smaller wound or sternum-sparing, less pump time or off-pump, and beating rather than arrested heart. Data on the efficacy and safety of these newer less invasive techniques, as well as their cosmetic results, are limited. This study analyzed the results of a sternum-sparing mitral valve operation. METHODS: Thirty patients with mitral valve diseases, including 20 who underwent mitral valve repair and 10 mitral valve replacement, were enrolled. Cardiopulmonary bypass was established via femoral cannulation, and blood cardioplegic arrest was induced by using a percutaneous, transthoracic cross-clamp. The main surgical wound was made over the lateral border of the right breast. Two additional small wounds were required for the transthoracic aortic clamp and the mitral retractor. RESULTS: There was no operative mortality, and all patients had an uneventful recovery. Two patients underwent redo mitral surgery. Nine associated procedures were performed including tricuspid valve annuloplasty in six patients, tricuspid valve replacement in two patients and atrial septal defect repair in one patient. The length of the main wound was between 5.8 and 7.8 cm (mean, 7.1 cm). The mean cardiopulmonary bypass time and cross-clamp time were 91.1 and 43.7 minutes, respectively. Although the length of stay was not significantly reduced compared with traditional median sternotomy, all patients had satisfactory results with good cosmesis. CONCLUSION: Sternum-sparing mitral valve surgery appears to be a safe and effective alternative to conventional mitral valve surgery; it is less invasive and provides superior cosmetic results for patients.

Adolescent↗
PubMed2006

Managing sternal osteomyelitis with antibiotic bead implantation.

Early, aggressive debridement followed by closure with muscle flaps is thought to improve the resolution of deep sternal wound infection that occurs after sternotomy. However, persistently discharging sternal osteomyelitis remains difficult to resolve. We successfully treated 2 patients who developed deep sternal wound infection after cardiac surgery by combining one-stage debridement with implantation of gentamicin beads to fill up the evacuated bone marrow space. This approach provides a simple and effective solution for sternal osteomyelitis.

Aged↗
PubMed2006

Surgical resection of primary cardiac lymphoma.

Primary cardiac lymphoma is a rare cardiac malignancy. Surgical resection is rarely performed on this disease entity. We report a case of primary cardiac lymphoma with rapid progression. Debulking surgery was done extensively before final pathology was obtained. Complete remission was exhibited after several courses of chemotherapy.

Biopsy, Needle↗
PubMed2005

Cell saver does not increase pro-inflammatory cytokine levels and expression of adhesive molecules in the salvaged blood of patients undergoing off-pump coronary artery bypass surgery.

BACKGROUND: Autotransfusion has been developed to avoid the risks of contaminating with infectious diseases and susceptivity to other complications of allogeneic blood transfusion. Previous studies have shown significant pro-inflammatory cytokine release and complement activation during blood salvage with cell saver (CS) in the course of on-pump coronary artery bypass grafting (CABG) surgery. Because both extracorporeal pump and CS machine are possible to induce the adverse cytokines release, thus, in this study, we investigated the influence of CS alone on the levels of pro-inflammatory cytokines and the expression of leukocyte surface antigens in patients undergoing off-pump CABG. METHODS: Thirty patients proposed to undergo off-pump CABG were enrolled in this study. Five perioperative blood samples (peripheral blood before operation, blood in pericardial sac at operation, blood in the cell saver container, blood in the blood bag before transfusion, and peripheral blood one hour after operation) were obtained from each patient. The expression of activated leukocyte adhesive molecules (CD11b and CD18) and cytokine-inducible leukocyte-endothelial adhesive molecule (CD62P) were studied by flow cytometry. Enzyme-linked immunosorbent assay (ELISA) was conducted to determine the levels of pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6) and IL-8. RESULTS: All blood samples except the one obtained one hour after operation showed no difference of the expression of CD11b, and CD62P and the levels of TNF-alpha, IL-6 and IL-8 (P> 0.05). However, the expression of CD18 was decreased during the course of blood salvage. The peripheral blood obtained one hour after operation had significantly higher expression of the three tested leukocyte surface antigens and higher levels of three studied cytokines (P < 0.05). CONCLUSIONS: Our investigation indicated that the blood processing in cell saver alone did not increase the expression of either CD11b, CD18, or CD62P, and the levels of TNF-alpha, IL-6 and IL-8. The results suggest that cell saver seems not to significantly activate the leukocytes or cause inflammatory responses in the salvaged blood.

Adult↗
PubMed2004

Use of extracorporeal membrane oxygenation to rescue a newborn with early-onset group B streptococcal sepsis and cardiopulmonary failure.

Group B streptococcal (GBS) infection is an important cause of perinatal morbidity and mortality. We report the use of extracorporeal membrane oxygenation (ECMO) to rescue a newborn with refractory GBS sepsis and meningitis who developed cardiopulmonary failure. This 2-day-old infant weighed 2640 g and was born to a healthy mother at full term. Respiratory distress, hypotension, and persistent pulmonary hypertension developed on the second day of life. The clinical condition deteriorated rapidly despite conventional treatment, and venoarterial ECMO was established to rescue this moribund newborn. During ECMO, the patient regained stable hemodynamics and good oxygenation, and infection was controlled. ECMO was used for 90 hours and the baby was weaned smoothly. Neurologic assessment after ECMO revealed hydrocephalus, abnormal electroencephalogram, and increased brain auditory evoked potential threshold. This report emphasizes that ECMO may be considered to rescue neonatal patients with cardiopulmonary failure due to GBS sepsis. Possible neurologic complications after ECMO should be carefully monitored.

Extracorporeal Membrane Oxygenation↗
PubMed2004

Hand-assisted laparoscopic surgery for abdominal aortic aneurysm.

There is a trend toward the use of minimally invasive surgery and limited incision for the surgical repair of abdominal aortic aneurysm (AAA). Conventional AAA repair is performed with a large laparotomy wound and uses either a transperitoneal or retroperitoneal approach. Due to the older age of this patient population, they often suffer more from the surgical wound, require prolonged hospital stay and have a slower recovery. We describe the use of hand-assisted laparoscopic surgery for grafting of a 5.5-cm infrarenal AAA identified by computed tomography scan. The operator inserted the left hand with a Pneumo Sleeve device in the abdomen through a 7-cm midline supraumbilical incision for laparoscopic surgery. Using the left hand and laparoscopic instruments to do the surgery provided control over the operation and sensation of touch. At the completion of the laparoscopic dissection, the first Clawford clamp was applied above the aortic bifurcation through the laparoscopic incision. The second Clawford clamp was applied below the renal arteries through the midline laparotomy incision. After cross-clamping the AAA, the aneurysm was incised, the clot removed, and lumbar bleeding points were oversewn with 3-O prolene suture. Then, the aneurysmal segment was grafted with a Dacron prosthesis using conventional suturing technique. The patient was extubated 3 hours after the operation, stayed in the intensive care unit for 1 night and was discharged 7 days later. He resumed oral intake on the postoperative day 1. There were no complications. This case illustrates that hand-assisted laparoscopic surgery for AAA can allow quick recovery of bowel function, quick progression to regular diet, short length of hospital stay, and probably a reduction in the total cost of care.

Aged↗
PubMed2003

Carbon dioxide embolism during endoscopic saphenous vein harvesting in coronary artery bypass surgery.

OBJECTIVES: Our objectives were to determine the incidence and severity and the time course of the CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation in coronary artery bypass surgery with transesophageal echocardiography monitoring. METHODS: Four hundred three consecutive patients scheduled for off-pump coronary artery bypass grafting surgery or femoral-to-popliteal artery bypass grafting surgery were prospectively studied. Multiplane transesophageal echocardiography with a new transgastric view was used to monitor CO(2) bubbles in the inferior vena cava and hepatic vein. RESULTS: CO(2) embolisms occurred in 17.1% of patients. Minimal, moderate, and massive CO(2) embolisms occurred in 13.1%, 3.5%, and 0.5%, respectively. The occurrence of moderate and massive CO(2) embolisms was frequently associated with the surgical manipulation of branches of saphenous veins. No significant risk factors were identified in multiple logistic regression analysis. CONCLUSION: The incidence of significant CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation procedures was more than 4%. Continuous transesophageal echocardiographic monitoring of the CO(2) bubbles in the inferior vena cava is essential in early detection and can help to prevent the development of significant CO(2) embolisms in these patients.

Aged↗
PubMedDate not supplied

Hybrid angioplasty for left pulmonary artery stenosis after total correction of tetralogy of Fallot: report of one case.

Pulmonary artery stenosis is common in tetralogy of Fallot. Surgical correction usually achieves good results. For those patients undergoing total correction with residual pulmonary artery stenosis, percutaneous transluminal angioplasty (PTA) plays an important role. However, this might not be possible for complex anatomies. We report a 19-month-old boy who underwent total correction of tetralogy of Fallot at 1 year of age. He developed main pulmonary artery (MPA) aneurysm and left pulmonary artery (LPA) stenosis 4 months after the operation. PTA was attempted, but the guidewire failed to thread into the LPA due to the dilated MPA and tiny LPA ostium. A hybrid approach consisting of left anterior small thoracotomy and balloon angioplasty via the introducer sheath in the MPA was proposed. Rapid access to the LPA and successful balloon angioplasty followed by stenting concluded the hybrid intervention. Such intervention is a good alternative to treat this complex anatomy.

Angioplasty, Balloon↗