Biomedical subjects

Soo-Cheol Kim

Publications and source records attributed to Soo-Cheol Kim.

6 recordsLinked to original sources

PubMed2005

Surgical strategy for pulmonary coarctation in the univentricular heart.

OBJECTIVE: The placement of a modified Blalock-Taussig shunt in patients suffering from pulmonary coarctation can result in the aggravation of uneven pulmonary blood flow. This may subsequently obviate the possibility of future performance of the Fontan procedure. The objective of this study was to evaluate mid-term results in patients with pulmonary coarctation who had undergone the placement of a modified Blalock-Taussig shunt, coupled with a pulmonary artery angioplasty. METHODS: We retrospectively reviewed the records of 13 patients who had undergone the placement of a modified Blalock-Taussig shunt, coupled with concomitant pulmonary angioplasty, between September 1998 and August 2002. All patients received follow-up angiographic evaluations. RESULTS: On the ipsilateral side of the modified Blalock-Taussig shunt, we observed a significant increase in the pulmonary artery index during a mean follow-up period of 11+/-5 months (preoperative 82+/-37 mm2/m2, follow-up 129+/-57, p=0.03). On the contralateral side, we also observed a significant increase in the pulmonary artery index (preoperative 90+/-56 mm2/m2, follow-up 137+/-56, p=0.047). There was one late death. During the follow-up period (mean 23+/-18 months), 10 patients received either a bidirectional or total cavopulmonary shunt and five of these patients underwent extracardiac Fontan operations. CONCLUSIONS: Our study demonstrated that the placement of a modified Blalock-Taussig shunt, with concomitant pulmonary artery angioplasty, constitutes a good initial surgical strategy in cases of univentricular heart with pulmonary coarctation.

Anastomosis, Surgical↗

PubMed2005

Alternative Fontan connection for apicocaval juxtaposition.

We present an alternative technique to the modified Fontan procedure used in a 3-year-old boy who had complex heart defects with bilateral superior vena cava and apicocaval juxtaposition. The left superior vena caval pathway was used behind the ventricle to connect the inferior vena cava to the pulmonary artery. We proved the technical feasibility of this with good midterm results at the 5-year follow-up angiography.

Abnormalities, Multiple↗

PubMed2004

Early replacement of pulmonary valve after repair of tetralogy: is it really beneficial?

OBJECTIVES: Debate on the proper timing of pulmonary valve replacement (PVR) after repair of tetralogy of Fallot (TOF) is still continuing. Significant pulmonary regurgitation (PR) could result in right ventricular (RV) dysfunction, exercise intolerance, arrhythmia, and sudden death. We analyzed clinical results of PVR after repair of TOF to investigate potential risk factor for late outcomes. METHODS: From January 1993 to July 2002, 58 patients (38 males and 20 females) received PVR after repair of TOF. More than moderate degree of PR was observed in these patients by echocardiography. Mean age at PVR was 13.5+/-9.6 years (1.2-44) and TOF repair was performed at 5.2+/-7.1 years of age (0.5-34). Therefore, PVR was performed at 8.3+/-5.2 years (4 months-28 years) after repair. Preoperative electrocardiogram showed complete right bundle branch block in 49 patients (84.5%). Mean duration of QRS complex was 142+/-30 ms. Major arrhythmia occurred in eight patients. Twenty-nine patients complained decreased physical activity and 10 patients showed clinical signs of right heart failure. RESULTS: Early death occurred in one patient (2.5%). Major complication occurred in three patients (complete heart block in two, aortic rupture in one). Follow-up was performed for 2.5+/-2.4 years (46 days-10.3 years). There was no late death. Postoperative cardiothoracic ratio was significantly decreased (0.61+/-0.07 to 0.55+/-0.06, P < 0.001). Marked symptomatic improvement was noted in all patients. Postoperative symptomatic group (n = 14) showed older age at repair of TOF (12.5+/-10.7 vs 2.6+/-2.3 years, P = 0.003), older age at PVR (23.2+/-12.8 vs 10.1+/-5.0 years, P = 0.001), longer interval between repair of TOF and PVR (10.6+/-7.0 vs 7.5+/-4.2 years, P < 0.05), higher degree of functional class (2.4+/-0.5 vs 1.4+/-0.8, P < 0.001), and longer duration of hospitalization (30.0+/-14.2 vs 18.9+/-11.4 days, P = 0.004) than postoperative asymptomatic group (n = 43). CONCLUSIONS: In patients with significant PR after repair of TOF, PVR had clinical benefits including symptomatic improvement with low mortality and morbidity. Proper timing must be carefully selected according to objective evaluation of RV function. In our study, earlier PVR prior to symptomatic manifestation showed beneficial effects.

Adolescent↗

PubMed2003

Staged biventricular repair of Taussig-Bing anomaly with subaortic stenosis and coarctation of aorta.

We present successful procedures for 2 infants who had the Taussig-Bing anomaly with subaortic stenosis and coarctation of the aorta. The initial procedure was coarctoplasty and the Damus-Kaye-Stansel procedure with modified Blalock-Taussig shunt. The second procedure was intraventricular repair (Kawashima procedure), Damus-Kaye-Stansel take-down and the reuse of native aortic and pulmonary valves 19 and 25 months later. Both patients survived the operations and postoperative hemodynamics were excellent at both 28 and 59 months follow-ups.

Aortic Coarctation↗

PubMed2003

Aortic arch reconstruction using regional perfusion without circulatory arrest.

OBJECTIVES: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. Regional cerebral and myocardial perfusion may eliminate those potential side effects. METHODS: From March 2000 to March 2002, 48 neonates or infants with complex arch anomaly were operated on using the regional perfusion technique. Thirty-three patients were male and the median age was 24 days (range 5-301 days). Preoperative diagnosis consisted of coarctation or interruption of the aorta associated with ventricular septal defect (group I, n = 26) and arch anomaly with complex intracardiac defects such as hypoplastic left heart syndrome or its variants (group II, n = 22). Arterial cannula was inserted through the innominate artery and the flow rate was regulated to about 50-100 ml/kg per min during regional perfusion. Simultaneous myocardial perfusion was maintained using a Y-connected infusion line. Cardioplegia was applied during intracardiac repair. RESULTS: Cardiopulmonary bypass and aortic cross-clamp times were 154 +/- 49 and 39 +/- 34 min, respectively. Temporary circulatory arrest for intracardiac procedures was performed in eight patients. However, the mean arrest time was minimized (range 1-18 min). The descending aorta clamping time was 33 +/- 16 min. Operative mortality rates in each group were 0 and 18.2% (0/26 and 4/22). Late mortality rates were 0 and 11.1% (0/26 and 2/18) during 9.1 months of follow-up. Complications consisted of low cardiac output in eight cases, transient neurological problems in two cases, and transient renal insufficiency in two cases, respectively. CONCLUSIONS: Regional perfusion is feasible and can be used with acceptable results. It may reduce potential complications following aortic arch reconstruction using circulatory arrest. However, repair of aortic arch in the patients with complex intracardiac defects still imposes a significant rate of mortality and morbidity.

Aorta, Thoracic↗

PubMed2002

Truncus arteriosus with coarctation of persistent fifth aortic arch.

Truncus arteriosus is a rare form of congenital heart defect. Among cases, 10% to 20% are associated with arch anomalies, such as interruption, coarctation, or patent ductus arteriosus. We treated a rare case of combined truncus with complex arch anomaly. The patient was a 2-month-old girl weighing 3.8 kg. Echocardiogram and computed tomogram showed interrupted aortic arch, truncus arteriosus, persistent fifth aortic arch, and its coarctation. One-stage total correction was performed under cardiopulmonary bypass without circulatory arrest. The operation consisted of a Rastelli procedure with a 12-mm valved conduit, coarctoplasty, and intraventricular baffling. The patient recovered well without complications.

Aorta, Thoracic↗