Abstract Background Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. Methods From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. Conclusions The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

Objective To evaluate the safety and efficacy of epicardial ventricular restoration (EVR) using REVIVENT system in patients with antero-septal scar and dilated ischemic cardiomyopathy. Methods Ten ischemic heart patients with antero-septal scar underwent the operation. The scarred lateral left ventricular wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural excluding the non-viable portions of the chamber. Left ventricular hemodynamic assessments as well as left ventricular ejection fraction, left ventricular end-systolic/diastolic volume (LVEDV/LVESV) and their indexes (LVEDVI/LVESVI) were measured by cardiac magnetic resonance (CMR). Results Ten ischemic heart failure patients with antero-septal scar, aged(55.2±13.9)years, received a hybrid epicardial ventricular restoration. Cardiac MR done at one a month after the procedure showed an elevation of LVEF from(27.8±4.6%)to(37.5±11.4)% (+35%, P<0.01). LVESV was significantly reduced from(149.9±61.6) ml to(109.9±58.0)ml (–26.7%, P<0.01), LVESVI was reduced from(84.8±36.7)ml/m2to(63.0±34.2) ml/m2(reduced by 25.7%, P<0.01); LVEDV was reduced from(203.0±64.0)ml to(167.9±58.2)ml (reduced by 17.3%, P<0.01), and LVESV was reduced from(114.5±37.8)ml/m2to(96.2±35.2)ml/m2(reduced by 16.0%, P<0.01). Cardiac output (CO) increased from(4.0±1.5)L/min to(4.8±1.2)L/min(increased by 20.0%, P=0.034) and cardiac index (CI) increased from(2.2±0.7)L/(min ? m2) to(2.7±0.7)L/(min ? m2) (increased by 22.4%, P=0.023). Conclusions Our preliminary experience on EVR using the REVIVENT system demonstrated signifi cant increase in LVEF, CO and CI, with decreases in LVEDV/LVESV at 1 month following the procedure. Its feasibility and safety need further evaluation in the future.

目的:评价40例胸腔镜辅助下二尖瓣手术的技术特点、安全性及应用价值.方法:2015年6月-2017年12月在厦门大学附属心血管病医院心外科接受胸腔镜二尖瓣手术治疗的40例患者.根据二尖瓣病变类型分为风湿性二尖瓣病变12例,二尖瓣退行病变24例,感染性心内膜炎4例,合并中重度三尖瓣关闭不全8例.手术采用双腔气管插管,单肺通气.股动、静脉插管,建立体外循环.右侧胸壁打孔,在胸腔镜辅助下迸行二尖瓣手术.结果:40例患者住院期间无死亡,未发生术后低心排,术中转正中开胸等严重并发症,1例患者术后弓流多,行二次胸腔镜下探查止血.全组患者二尖瓣成形26例,二尖瓣置换14例,其中8例同期行三尖瓣成形术.二尖瓣成形组行二尖瓣后叶部分切除并缝合15例、人工腱索18例、缘对缘技术2例、裂缺缝合1例、交界缝合3例,所有成形患者均使用二尖瓣成形环固定瓣环.结论:胸腔镜辅助二尖瓣手术治疗临床安全可行,对机体创伤小,美容效果好,具有良好应用前景.

Percutaneous closure devices used after percutaneous endovascular procedures have become more popular over the past decade. Occlusive vascular complication of the device is rare but always leads to limb-threatening consequence. We report a case of arterial occlusion caused by distal embolization of the suture material in the percutaneous closure device.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 37-year-old woman with Marfan's syndrome underwent a modified Bentall's operation with the coronary button technique in 2007. Eight months later, she presented with non–ST-segment elevation myocardial infarction with the

Primary sarcomas of the pulmonary vein are extremely rare. Although myxomas are the most common intracavitary tumor of the left atrium, some findings should alert the clinician to the probability of malignancy. A 28-year-old woman developed hemoptysis, night fever, generalized malaise, anorexia and weight loss for 2 months, with progressive dyspnea for 2 weeks. She was preoperatively diagnosed as left atrial myxoma with a concurrent right lower lung tumor. (Circ J 2009; 73: 1547 - 1549)

機械性體外維生系統近年來已廣泛被接受，成為心、肺衰竭病人使用傳統治療無效時的另一種治療方式，使用在心衰竭的病人存活率約為40%，呼吸衰竭病人存活率約為62%，近年來用在心衰竭病人有增加的趨勢，但是在新生兒呼吸衰竭上因高頻呼吸器，表面張力素及一氣化氮的發展，用在呼吸衰竭病人有減少的情形。對於機械性體外維生系統近年發展及研究的趨勢包括，在心肺復甦術早期使用、體外循環機器的改良（機器本身輕巧易操作、氣和氣體交換速率、導管的材質等）及動脈－靜脈非幫浦式肺輔助器。研究的方向將以大型的隨機控制實驗、長時間的追蹤、成本效益的探討及降低使用上的危險性等為主，經由不斷的研究相信對於臨床的病人會有很大的幫助。

Journal of Cardiac SurgeryVolume 21, Issue 2 p. 170-171 Ventricular Septal Defect Repair by the Left-Handed Operator Po-Yuan Hu M.D., Po-Yuan Hu M.D. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this authorLiang-Ting Liu M.D., Liang-Ting Liu M.D. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this authorShye-Jao Wu M.D., Shye-Jao Wu M.D. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this authorIng-Sh Chiu M.D., Ph.D., M.Div., Ing-Sh Chiu M.D., Ph.D., M.Div. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this author Po-Yuan Hu M.D., Po-Yuan Hu M.D. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this authorLiang-Ting Liu M.D., Liang-Ting Liu M.D. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this authorShye-Jao Wu M.D., Shye-Jao Wu M.D. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this authorIng-Sh Chiu M.D., Ph.D., M.Div., Ing-Sh Chiu M.D., Ph.D., M.Div. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanSearch for more papers by this author First published: 21 February 2006 https://doi.org/10.1111/j.1540-8191.2006.00202.x Address for correspondence: Ing-Sh Chiu, M.D., Ph.D., M.Div., Department of Surgery, National Taiwan University Hospital, No.7 Chung-Shan S. Road, Taipei, Taiwan 100. Fax: +886 2 2393-8383; e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCE 1 Chan CY, Chiu IS, Wu SJ, et al: A minimal transverse incision with low median sternotomy for pediatric congenital heart surgery. Eur J Cardiothorac Surg 2001; 19: 290- 293. Volume21, Issue2March 2006Pages 170-171 ReferencesRelatedInformation

We report an infant case of acute fulminant myocarditis which occurred after administration of a diphtheria, polio, and tetanus vaccination. Fever and dyspnea developed after the vaccination. Extracorporeal membrane oxygenation was used for intractable cardiogenic shock. The patient survived the extracorporeal support, but poor ventricular contractility recurred 2 months later and she died while waiting for heart transplantation.

Background and objective: Symptomatic large pleural effusions (> 25% of hemithorax) are sometimes diagnosed after coronary artery bypass graft surgery (CABG). Their incidence and outcome have not been fully described. This study aims to discuss the prevalence and the clinical course in patients diagnosed with symptomatic newly developed large pleural effusions at least 30 days after CABG.Methods: A retrospective study of 410 patients who underwent CABG over a three and a half year period was undertaken. The type of surgery, timing of occurrence of effusion after CABG, amount and characteristics of the pleural effusion, left ventricular dimension and ejection fraction were obtained from medical records and cardiac surgery databases.Results: The records of 356 patients 1 month post CABG were available for evaluation. The initial diagnosis of a newly developed symptomatic large pleural effusions was made in 11 patients (3.1%) at least 30 days after CABG. Eight had a pleural effusion predominantly on the left side and three on the right. Patients were further divided into two groups: those who had effusions diagnosed between 30 and 90 days post CABG (group 1) and those diagnosed more than 90 days post-CABG (group 2). The pleural fluid LDH levels were higher in patients in group 1 (1262.0 +/- 921.3 U/L vs. 117.5 +/- 35.1 U/L, P = 0.02). Patients in group 2 had evidence of cardiac impairment compared with those in group 1, as evidenced by a lower ejection fraction (68.8 +/- 6.0% vs. 52.0 +/- 10.6% in groups 1 and 2, respectively, P = 0.01) and higher left ventricular end-diastolic dimension (45.2 +/- 6.0 mm vs. 55.3 +/- 8.4 mm in groups 1 and 2, respectively, P = 0.05).Conclusions: The incidence of symptomatic newly developed large pleural effusions first diagnosed at more than 30 days post CABG was 3.1%. Those who were diagnosed between 30 and 90 days post CABG tended to have exudative effusions, whereas those diagnosed more than 90 days post CABG often had left ventricular impairment and transudative effusions. Most of these effusions settled with conservative management and did not recur.

Objectives: This study reports our surgical results for aortic dissection and the post-operative follow up. Possible reasons for post-operative cerebral insults are discussed. Methods: From October 2000 to April 2004, 23 patients (18 men; 5 women; mean age 54.8±15.8 years) underwent operation for aortic dissection in our hospital. According to the Standford classification, there were 19 cases in Type A and 4 cases in Type B. Five patients had a Marfan syndrome. All the cases except two with the Marfan syndrome had surgery under profound hypothermic circulatory arrest with retrograde perfusion. Surgical strategies included aortic grafting only (9/23, 39.1%), aortic valve replacement with supracoronary ascending aortic grafting (1/23, 4.3%), aortic valve resuspension with supracoronary ascending aortic grafting (6/23, 26.1%), aortic valve resuspension with supracoronary ascending aortic grafting and coronary artery bypass grafting (2/23, 8.7%), Bentall operation (3/23, 13.0%) and Bentall operation with coronary artery bypass grafting (2/23, 8.7%). Results: There was no operative or in-hospital mortality. Median ventilator supporting time was 4 days (range: 1 to 94). Re-exploration for hemostasis was needed in 2 patients. Cerebral ischemic infarction was found in 3 patients. All the patients received post-operative follow up. Mean follow-up time was 20.7±14.2 months (range: 2 to 40). All the patients had clear consciousness during the follow up. There were 5 late deaths. Both the one-year and two-year survival rates were 78.9%, and the three-year survival rate was 70.1%. Conclusion: Aortic dissection is a challenge for cardiovascular surgeons. However, good results and acceptable morbidities can be achieved under profound hypothermic circulatory arrest with retrograde perfusion.

Acute myocardial infarction (AMI) secondary to acute ascending aortic dissection is a rare condition. The clinical presentations are similar but treatment strategies are different between AMI due to thrombotic occlusion of coronary arteries and that secondary to aortic dissection. In the latter, emergency surgery is the first choice and thrombolytic therapy is absolutely contraindicated. We report a 44-year-old man, who suddenly developed acute anterior chest pain. The diagnosis at emergency room was inferior wall AMI and the patient was treated with thrombolysis followed by coronary intervention. However, aortic dissection was suspected during cardiac catheterization and then comfirmed by echocardiography. The patient underwent emergent cardiac surgery to repair the aortic wall and bypass the proximal portion of right coronary artery (RCA). The follow-up coronary angiogram 3 months later showed patent RCA. From this case, we learn that in patients with an AMI, the possibility of aortic dissection should be kept in mind. If there is any suspicion, echocardiography can serve as a safe and quick tool to detect the possibility.

Coronary arteriovenous fistula is a rare congenital heart disease. A 71-year-old woman suffered from heart failure due to massive coronary arteriovenous fistulae from the right coronary artery and left circumflex artery to the coronary sinus. Using the off-pump technique, we successfully performed Starfish-assisted obliteration of the fistulae. Intraoperative transesophageal echocardiography was used to confirm the complete elimination of the abnormal shunt flow.

We report a 5-year-6-month-old case of pneumonia complicating with septic shock and acute respiratory distress syndrome. He was successfully treated with extracorporeal membrane oxygenation (ECMO). Veno-arterial mode of ECMO was used at first and it was shifted to veno-venous mode of ECMO after hemodynamics were stabilized. Total supporting duration of ECMO was 684 hours. The patient is well now, in functional class I of the New York Heart Association.

An acute massive pulmonary embolism causing circulatory collapse is fatal without aggressive intervention. Pulmonary angiography is usually required to confirm the diagnosis in an emergency condition. However the procedure carries a high risk in patients with unsupported cardiogenic shock. Extracorporeal membrane oxygenation plays an important role in resuscitation and preoperative support during pulmonary angiography. We describe a patient who was sent to the emergency station with the presentation of cardiac arrest. She was successfully resuscitated using extracorporeal membrane oxygenation and subsequently treated by a surgical embolectomy.

Background: Although widely applied in the coronary artery bypass surgery, saphenous vein graft is more vulnerable to atherosclerosis than arterial grafts. The use of bilateral internal mammary arteries (IMA) as well as right gastroepiploic artery (RGEA) provides the possibility of complete arterial revascularization in multi-vessel coronary artery disease. We reported the short-term outcome of complete myocardial revascularization with only pedicle arterial grafts. Methods: Between February 1999 and January 2003, 171 patients were planned to receive complete myocardial revascularization with only pedicle arterial grafts. Additional vein grafts were required in 22 patients and the other 149 patients were operated on using the technique. All procedures were performed by using internal mammary and right gastroepiploic arteries. We reviewed perioperative and postoperative data of these patients. Results: A total of 399 arterial grafts were harvested and 434 distal anastomoses were created, an average of 2.9 (range, 1-5) per patient. LIMA was used in all 149 patients, RIMA was used in 131 patients (87.9%), and RGEA was used in 119 patients (79.9%). Thirty-five arterial grafts were used for sequential grafting. Six patients (4.1%) had reoperations for mediastinal bleeding. Two patients (1.4%) experienced perioperative myocardial infarction. Sternal wound infection occurred in 7 patients (4.8%). Three patients (2.1%) died in the hospital within 30 days of operation. Conclusion: Our experience shows that complete arterial revascularization can be safely performed. The long-term benefit for patients could be expected.

Single-stage complete replacement of the descending thoracic aorta and the abdominal aorta is a surgical challenge. A 65-year-old man developed acute DeBakey type IIIB aortic dissection and was treated medically. The affected aorta dilated progressively, reaching a maximal diameter of 7 cm 2 years later. Computed tomography revealed a Crawford type II thoracoabdominal aortic aneurysm and an additional infrarenal abdominal aortic aneurysm below the dissected aorta. The descending thoracic aorta and the abdominal aorta were completely replaced with a Hemashield graft under deep hypothermic circulatory arrest. The postoperative course was complicated with transient left hemiparesis and upper gastrointestinal bleeding which were successfully treated by transarterial embolization. The results of this case indicate that complete replacement of the descending thoracic and abdominal aorta can adequately and safely treat type III aortic dissection.