Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4±43.6 months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

Early postoperative complications after heart transplantation in adult recipients: asan medical center experience.

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Morphometric Study of the Trachea in Korean

Morphometric Study of Cricoid Cartilage in Korean

This morphometric study of main bronchus was performed to provide the basic data necessary for anatomists, anesthetists and emergency medical technicians. A total of 48 cadavers, 33 men and 15 women, were used in this study. When it comes to their average age, men were 70 years old (50 to 91 years old), and women were 74 years old (47 to 92 years old). For this study, the length of the left and right main bronchi and the angle between them, and the first bronchial cartilage’s each anteroposterior diameter, transverse diameter, vertical height, and distance between posterior ends of cartilage were measured. As for the length, left length was longer than right length regardless of gender, and there was no significant difference between men and women. When it comes to anterorposterior diameter, transverse diameter, and distance between posterior ends of the first bronchial cartilage in main bronchi, the right side was longer and wider than left side regardless of gender, but statistical significance was shown only in the distance between posterior ends of cartilage. Vertical height of the first bronchial cartilage in main bronchi did not show any difference between the left and right and between men and women, and men cadavers had a very large individual difference from 2.35 mm to 9.22 mm. As for the angle of the main bronchi’s separation from trachea’s major axis, the left side was larger than the right side in both men and women cadavers and it was larger in men than women, but there was no significant statistical difference. Lastly, as for the length of the main bronchi, the right and left lengths in men were 16.83±1.36 and 37.26±1.42 mm respectively; and the right and left lengths in women were 16.90±2.26 and 36.08±3.39 mm respectively. These results are expected to be used as the basic clinical data useful for medical procedures of emergency care practitioners, anesthetists and emergency medical technicians.

/pdf/the-morphometric-study-of-main-bronchus-in-korean-cadaver-346eypw2fw.pdf

The Morphometric Study of Main Bronchus in Korean Cadaver

Dynamic cardiomyoplasty occupies an important place among recent advances in treatment of heart failure. We report the first clinical dynamic cardiomyoplasty case in Korea. The patient was a 25-year-old male with viral cardiomyopathy and chronic active hepatitis. The preoperative echocardiogram showed a left ventricular ejection fraction of 30% and grade 2 mitral and tricuspid regurgitation with dilated left and right atria. The left latissimus dorsi muscle was mobilized to wrap the heart and a myocardial stimulator was connected and placed in the abdominal pocket. After a 10-week training period, the stimulation ratio was set at 1:4 and the stimulator functioned well. At the 8-month follow-up the left ventricular ejection fraction ranged between 30% and 35% and the patient was feeling much better with slightly increased activity.

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