Biomedical subjects

C H Chang

Publications and source records attributed to C H Chang.

At least 253 records · Page 14Linked to original sources

PubMed1997

Transaortic patch angioplasty for left main coronary artery occlusion.

Isolated total occlusion of the left main coronary artery is rare, and may be conventionally treated by standard bypass surgery. We describe a 54-year-old woman with isolated left main coronary artery disease presenting as unstable angina of 1 week's duration. She was treated with transaortic autologous pericardial patch angioplasty. Postoperative coronary angiography showed a widely patent left main coronary artery. She was angina-free 5 months postoperatively. In selected patients, this technique offers a valuable alternative to coronary artery bypass with the advantage of restoring more physiologic perfusion to the coronary tree.

Angioplasty↗

PubMed1997

Refined fetal abdominal growth assessment in normal pregnancy: Part I. Abdominal anteroposterior diameter.

BACKGROUND: The assessment of the adequacy of fetal growth by parameters other than the abdominal anteroposterior diameter (AAPD) of the fetus has been studied extensively. However the designs of these studies and the statistical methods used appears to deserve some criticism, based on present knowledge. Noncross-sectional cases selection, uncertainty of the fetal normality and inadequacy in statistical method, mostly ignored the changing property of each standard deviation (SD) of each gestational age (GA) which was proposed by Altman et. al. in 1993, are the three most common flaws in previous publishes. We tried to use AAPD with a strict study design as well as a reasonable statistical method to evaluate the fetal growth. METHODS: This study was performed in the Division of Maternal Fetal Medicine, National Cheng Kung University Hospital, Taiwan. The prenatal sonographic data of the fetuses were collected prospectively based on the following criteria: (1) accurate dating by knowing the maternal last menstration period (LMP) and early ultrasonography of the fetuses, (2) singleton pregnancy, (3) no fetal structural or chromosomal abnormality confirmed by prenatal ultrasonography and postnatal examination, (4) GA at birth was between 37 and 41 weeks' gestation, (5) no birth asphyxia, (6) appropriate birth body weight, and (7) no maternal medical disease or obstetrical complication which might predictably interfere with fetal growth. The collected data were analyzed by polynomial regression test and the best-fit equation for prediction of fetal growth was selected. The standard deviation (SD) of each GA was modeled before constructing the fetal growth centile charts by Altman's method. RESULTS: A total of 2077 cross-sectional sonographic data meeting the above criteria were collected for statistical analysis. The best-fit equation for the prediction of fetal GA by AAPD is GA = 20.8539 - 3.36743 x AAPD + 0.86927 x (AAPD)2 - 0.03789 x (AAPD)3 +/- k x [1.2533 x (0.36772 + 0.10938 x AAPD)], (r = 0.97287, p < 0.0001). The best-fit equation for prediction of fetal AAPD by GA is AAPD = -2.49495 + 0.38247 x GA - 1.07071 x 0.001 x (GA)2 +/- k x [1.2533 x (0.01760 + 0.01372 x GA)], r = 0.97122, p < 0.0001. The SD of AAPD for each complete GA was not the same. The fetal growth centile charts in the study are presented in this article. CONCLUSIONS: The SD of each complete GA changed with each specific GA. The GA of the fetus can be assessed accurately by measuring the AAPD alone. The utilization of these growth centile charts for evaluation of fetal growth is recommended.

Abdomen↗

PubMed1997

Home-made endoloops for bullous lung disease: a case report.

Various surgical techniques for bulla ablation have been used since the introduction of video-assisted thoracoscopic surgery. Endoscopic stapler resecting (Endo-GIA) is now the most common procedure for bulla ablation. Other endoscopic techniques include bulla suturing, clipping, laser ablation and electrocauterization. We present here a select report on using a "home-made" endoloop on a patient with bullous lung disease. No intraoperative morbidity was attributable to the procedure. The operating room time was 110 minutes, and ventilator support was given for 18 hours. The chest tube was removed on day 7 and the patient discharged on the ninth postoperative day uneventfully. The patient exhibited subjective improvement in his symptom preceptions during an one-month follow-up examination. A comparison of pre- and post operative functional evaluation showed increase in FEV1 (from 0.45 L to 1.02 L) during 3-month follow-up. From our experience, thoracoscopic home-made endoloop ligation is a safe and cost effective means of volume reduction surgery for bullous emphysema that interferes with optimum function of the adjacent lung parenchyma.

Aged↗

PubMed1997

Evaluation of critical postoperative situations in orthopedic patients.

Most orthopedic surgery is elective. Even in the severely traumatized patient, orthopedic surgery is carried out after the patient's general condition stabilizes. Critical postoperative situations are still problems in orthopedic surgery. From November 1992 through May 1995, 7,325 patients were admitted to the orthopedic ward at the National Taiwan University Hospital and underwent surgery. We present a retrospective study of 78 postoperative orthopedic patients who were admitted to a surgical intensive care unit (ICU) during this period. Fourteen of these became vegetative or died. The patients admitted to an ICU were categorized into four groups, based on the type of surgery: arthroplasty (13 patients), spinal surgery (50), fracture other than spine (13), and others (2). The causes of ICU admission in each group were analyzed. The following operations were found to carry a high risk of postoperative complications: revisional total hip arthroplasty (one of four ICU-admitted patients died); debridement for infected total hip arthroplasty (two of two died); bilateral total knee arthroplasty (two of four died); and debridement of spinal infection (three of five died). The associated risk factors for ICU admission were: old age, underlying medical disease, pulmonary embolism in multiple fracture, respiratory compromise in spinal surgery, and massive blood loss. Great care should be taken when performing orthopedic surgery on patients with these risk factors.

Adult↗

PubMed1997

Establishing the diagnostic validity of premenstrual dysphoric disorder using rasch analysis.

Premenstrual Dysphoric Disorder (PMDD) has remained in appendices of the last two editions of The Diagnostic and Statistical Manual of Mental Disorders due to lack of empirical study. Items included in its set of research criteria are considered tentative pending evidence of diagnostic validity. The present study attempts to establish the construct validity of the PMDD criteria using the Rasch method to analyze the validity of individual items as contributors to the diagnosis, in contrast to the usual but less precise approach of using an external validator to establish the diagnostic utility of psychiatric conditions. Analysis of which items best differentiate participants with and without PMDD provides an idea of the relative ability of these items to distinguish PMDD. It is recommended that the areas of anger/irritability, depressed mood, and problems in interpersonal functioning be expanded in further studies and corresponding items added to symptom checklists.

Adolescent↗

PubMed1996

Prolonged circulatory arrest in moderate hypothermia with retrograde cerebral perfusion. Is brain ischemic?

BACKGROUND: Circulatory arrest (CA), which provides a bloodless field and good visualization without the need of aortic cross-clamp, is commonly used to facilitate repair of aortic lesions. However, extended periods of CA may impair cerebral metabolism and cause ischemic injury. Studies were performed to evaluate the efficacy of retrograde cerebral perfusion (RCP) in protecting the brain from ischemic injury during a prolonged period of CA in moderate hypothermia. METHODS AND RESULTS: Twenty-three patients (18 men and 5 women) were operated on for aortic lesions (17 acute type A aortic dissection and 6 chronic type A aortic dissection with Marfan's syndrome). The aortic operations were performed with CA (58 to 104 minutes; mean +/- SD, 75 +/- 12 minutes) at a rectal temperature of 23.3 +/- 0.5 degrees C (21 degrees C to 25 degrees C). For RCP, cold (14 degrees C to 18 degrees C) oxygenated blood (300 mL/min) was pumped to the superior vena cava with internal jugular venous pressure of 15 +/- 5 mm Hg. The cardiopulmonary bypass time was 157 +/- 18 minutes. Cortical blood flow during RCP detected by subdural laser Doppler probe was 10 +/- 5% of baseline. Percent oxygen extraction and pyruvate and lactate levels (26 +/- 2% and 0.43 +/- 0.17 and 45 +/- 16 mg/dI) were insignificantly different from those before CA (28 +/- 3% and 0.71 +/- 0.08 and 62 +/- 20 mg/dL, P > .05). Creatine kinase-BB isoenzyme was undetectable. All but 1 patient survived the operation (95.5%) and woke up without neurological deficit. Follow-up (mean, 13 months) was complete in all survivors. There were no late deaths. Cerebral functional studies performed 3 months after discharge showed results insignificantly different from those of the normal control subjects. CONCLUSIONS: There is no evidence of ischemia of the brain during prolonged moderate hypothermic CA with the aid of RCP. Retrograde cerebral perfusion effectively extends the safe time of CA. Deep hypothermia during CA seems unnecessary.

Adult↗

PubMed1996

Mapping hydration water molecules in the HIV-1 protease/DMP323 complex in solution by NMR spectroscopy.

A tetrahedrally hydrogen-bonded structural water molecule, water 301, is seen in the crystal structure of nearly every HIV-1 protease/inhibitor complex. Although the urea oxygen of the designed inhibitor, DMP323, mimics and replaces water 301, other water molecules are seen in the protease/DMP323 crystal structure. As a first step toward understanding how water molecules may contribute to inhibitor potency and specificity, we have recorded water-NOESY and water-ROESY spectra of the protease/ DMP323 complex. Cross relaxation rates derived from these spectra, together with interproton distances calculated from the crystal structure of the complex, were used to classify the exchange cross peaks as follows: (A) a direct NOE with a water proton, (B) an indirect NOE with water through a labile protein proton, and (C) direct exchange of an amide proton with water. Type A and B cross peaks were analyzed using three models of water dynamics: (1) two-site exchange, with water molecules randomly hopping between bound and free states, (2) bound water with internal motion, and (3) free diffusion. Using the two-site exchange model to analyze the relaxation data of the type A cross peaks, it was found that the water molecules had short residence times, ca. 500 ps. in contrast with the > 9 ns residence time estimated for water 301 in the protease/P9941 complex [Grzesiek et al. (1994) J. Am. Chem. Soc. 116, 1581-1582]. The NMR data are consistent with the X-ray observation that two symmetry-related water molecules, waters 422 and 456, are bound at the DMP323 binding site. Hence, these water molecules may help to stabilize the structure of the complex. Finally, it was found that three buried and hydrogen-bonded Thr hydroxyl protons were in slow exchange with solvent. In contrast, it was found that the DMP323 H4/H5 hydroxyl protons and the Asp25/125 carboxyl protons, which form a buried hydrogen-bonded network at the catalytic site of the protease, are in rapid exchange with solvent, suggesting that solvent can penetrate into the buried protein/inhibitor interface on the millisecond to microsecond time scale.

Azepines↗

PubMed1996

Cyclic HIV protease inhibitors: synthesis, conformational analysis, P2/P2' structure-activity relationship, and molecular recognition of cyclic ureas.

High-resolution X-ray structures of the complexes of HIV-1 protease (HIV-1PR) with peptidomimetic inhibitors reveal the presence of a structural water molecule which is hydrogen bonded to both the mobile flaps of the enzyme and the two carbonyls flanking the transition-state mimic of the inhibitors. Using the structure-activity relationships of C2-symmetric diol inhibitors, computed-aided drug design tools, and first principles, we designed and synthesized a novel class of cyclic ureas that incorporates this structural water and preorganizes the side chain residues into optimum binding conformations. Conformational analysis suggested a preference for pseudodiaxial benzylic and pseudodiequatorial hydroxyl substituents and an enantiomeric preference for the RSSR stereochemistry. The X-ray and solution NMR structure of the complex of HIV-1PR and one such cyclic urea, DMP323, confirmed the displacement of the structural water. Additionally, the bound and "unbound" (small-molecule X-ray) ligands have similar conformations. The high degree of preorganization, the complementarity, and the entropic gain of water displacement are proposed to explain the high affinity of these small molecules for the enzyme. The small size probably contributes to the observed good oral bioavailability in animals. Extensive structure-based optimization of the side chains that fill the S2 and S2' pockets of the enzyme resulted in DMP323, which was studied in phase I clinical trials but found to suffer from variable pharmacokinetics in man. This report details the synthesis, conformational analysis, structure-activity relationships, and molecular recognition of this series of C2-symmetry HIV-1PR inhibitors. An initial series of cyclic ureas containing nonsymmetric P2/P2' is also discussed.

Animals↗

PubMed1996

Lysine 2,3-aminomutase: rapid mix-freeze-quench electron paramagnetic resonance studies establishing the kinetic competence of a substrate-based radical intermediate.

Lysine 2,3-aminomutase from Clostridia catalyzes the interconversion of L-lysine and L-beta-lysine. The enzyme contains iron-sulfur clusters and is activated by pyridoxal 5'-phosphate and S-adenosylmethionine, all of which participate in catalysis. Current spectroscopic evidence implicates two substrate-based organic radicals as intermediates in the mechanism. One of these species, the radical N3-(5'-phosphopyridoxylidene)-beta-lysin-2-yl (3), appears in the steady state of the reaction of lysine and has been definitively characterized by EPR and ESEEM spectroscopy. The 2-deuterio form of this radical, 3-2-d, which is generated in the reaction of L-[2-2H]lysine, can be distinguished by line shape analysis from 3. The rate at which the signal for 3-2-d is transformed into that for 3 has been measured by rapid mix-freeze quench kinetic analysis. The rate constant for this process is 24 +/- 8 s-1 at 21 degrees C. This is the rate constant for the turnover of radical 3 and is indistinguishable from the turnover number of lysine 2,3-aminomutase. Therefore, radical 3 is kinetically competent as an intermediate in the reaction of lysine 2,3-aminomutase.

Amino Acid Isomerases↗

PubMed1996

Three-dimensional solution structure of the HIV-1 protease complexed with DMP323, a novel cyclic urea-type inhibitor, determined by nuclear magnetic resonance spectroscopy.

The three-dimensional solution structure of the HIV-1 protease homodimer, MW 22.2 kDa, complexed to a potent, cyclic urea-based inhibitor, DMP323, is reported. This is the first solution structure of an HIV protease/inhibitor complex that has been elucidated. Multidimensional heteronuclear NMR spectra were used to assemble more than 4,200 distance and angle constraints. Using the constraints, together with a hybrid distance geometry/simulated annealing protocol, an ensemble of 28 NMR structures was calculated having no distance or angle violations greater than 0.3 A or 5 degrees, respectively. Neglecting residues in disordered loops, the RMS deviation (RMSD) for backbone atoms in the family of structures was 0.60 A relative to the average structure. The individual NMR structures had excellent covalent geometry and stereochemistry, as did the restrained minimized average structure. The latter structure is similar to the 1.8-A X-ray structure of the protease/DMP323 complex (Chang CH et al., 1995, Protein Science, submitted); the pairwise backbone RMSD calculated for the two structures is 1.22 A. As expected, the mismatch between the structures is greatest in the loops that are disordered and/or flexible. The flexibility of residues 37-42 and 50-51 may be important in facilitating substrate binding and product release, because these residues make up the respective hinges and tips of the protease flaps. Flexibility of residues 4-8 may play a role in protease regulation by facilitating autolysis.

Azepines↗

PubMed1996

Determination of the appropriate fraction number and size of the HDR brachytherapy for cervical cancer.

Based on the linear-quadratic model, we have made two isoeffect tables for transforming the traditional low dose rate (LDR) point A doses at 20, 30, 40, 50, 60, and 70 Gy to those of the high dose rate (HDR) dose per fraction. HDR fractions ranged from 1 to 12, with corresponding sizes for each fraction. We also propose the therapeutic gain ratio (TGR) method for determining the appropriate fraction number of HDR brachytherapy in cervical cancer. TGR is defined as addition of the calculated biological therapeutic difference with the supposed physical therapeutic difference of HDR brachytherapy. Through the TGR method, we predicted that after 2 to 3, 2 to 4, and 4 to 7 fractions of HDR treatments, the tumor control rate and complication rate would be equivalent to those of LDR point A doses of 30, 40, and 70 Gy, respectively. The TGR is affected by many factors, such as the equivalent total dose of LDR, dose rate of LDR, HDR fraction number, T1/2, and differences between LDR and HDR in the dose in critical organs. The TGR method might explain why a low fraction number of HDR can be used in clinical practice. We may use this principle to replace the traditional trial-and-error method for transcribing the relationship between LDR and HDR treatments.

Brachytherapy↗

PubMed1996

The endothelium-dependent response of human hepatic artery after preservation with the UW solution.

The University of Wisconsin's (UW) solution has been used commonly for current liver transplantation. However, its effect on the vascular endothelium remains unclear. Experiments were designed to study the effects. Human hepatic arteries harvested from patients with hepatocellular carcinoma undergoing liver resection were preserved in 4 degree C physiological solution (group 1, the content showed on the text) and UW solution (group 2) for 1 hr. Segments of preserved and control (group 3) hepatic arteries were suspended in organ chamber to measure the isometric force. The relaxations to acetylcholine (ACH) and adenosine diphosphate in segments of hepatic artery with endothelium were significantly greater than those segments without endothelium. The maximal relaxation to ACH in arterial segments with endothelium of group 2 was significantly different from those of group 1 and 3 (group 1 to group 3, 82 +/- 2%, 57 +/- 6%, and 83 +/- 4% of the initial tension contracted by neoepinephrine (3 X 10-7 mole/l, P < 0.05). The maximal relaxation to adenosine diphosphate was similar to the response to ACH. Perfusate hypoxia (oxygen tension 30 +/- 5 mmHG) caused endothelium-dependent contraction of the arterial segments (group 1 to group 3, 233 +/- 32%, 276 +/- 35%, and 251 +/- 40% of the initial tension, P < 0.05). Endothelium-independent relaxation and contraction of human hepatic artery to sodium nitroprusside and norepinephrine were not altered by UW solution. In summary, the impaired endothelium-dependent relaxation by UW solution and prominent endothelium-dependent contraction to hypoxia of human hepatic artery would favor vasospasm and thrombus formation after liver transplantation.

Adenosine↗

PubMed1996

Deterioration of cutaneous microcirculatory status and its clinical correlation in tetralogy of Fallot.

The purpose of this study was to evaluate the hemodynamic deterioration in cutaneous microcirculation and its clinical correlation in patients with tetralogy of Fallot (TF). Laser Doppler flowmetry and capillary microscopy were used to assess thermoregulatory and nutritional microcirculation, respectively. A significant increase in blood flow in thermoregulatory vessels was noticed only in TF patients with hemoglobin (Hb) levels under 19 g/dl. In patients with Hb levels above 19 g/dl, the blood flow declined into the normal range. This result indicated an extreme decrease of blood flow velocity in the thermoregulatory vessels in patients with Hb concentration higher than 19 g/dl. All TF patients with Hb concentrations higher than 19 g/dl revealed Maricq's type III capillaries. Type III capillaries revealed a significant retardation of capillary blood cell velocity (CBV). There was a reciprocal relationship between CBV and hematocrit (Hct). All the responses of the cutaneous microcirculation revealed a good correlation with the clinical severity of TF. All patients with type III capillaries (with Hb concentrations higher than 19 g/dl or Hct level higher than 60%) indicated an advanced disease progression. Laser Doppler flowmetry and capillary microscopy provide a sensitive noninvasive approach for the evaluation of the hemodynamic disturbances in TF and conditions resulting from long-term hypoxia.

Adolescent↗

PubMed1996

Acute renal failure associated with Yersinia pseudotuberculosis infection in children.

We report 45 pediatric cases of Yersinia pseudotuberculosis infection confirmed by stool culture between May 1993 and June 1994. In 41 (91.1%) cases there had been contact with untreated well or mountain water. Y. pseudotuberculosis was also isolated from 4 samples of mountain spring water thought to be the sources of infection. During the course of the illness, acute renal failure (ARF) developed in 6 patients (13.6%). The age distribution of the ARF group (12.3 +/- 1.2 years) was significantly different from the non-ARF group (8.0 +/- 3.2 years). The serogroups of Y. pseudotuberculosis isolates from stool samples were 5 (n = 30) and 4 (n = 15). Isolates from the water samples were all serogroup 5. The main symptoms of both groups were fever, rash, abdominal pain, and vomiting. ARF developed between the 2nd and 14th days (mean 6 days) after the onset of fever, and oliguria (< 400 ml/m2 per day) developed in 3 patients (3/6, 50%) immediately after their fevers had subsided. ARF underwent a benign course, with complete recovery within a maximum of 4 weeks (mean 10.2 days), with 1 exceptional patient requiring hemodialysis. Renal biopsy showed evidence of tubulointerstitial nephritis. Y. pseudotuberculosis should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have histories of drinking untreated water in endemic areas.

Acute Kidney Injury↗

PubMed1996

Video-assisted mitral valve operations.

BACKGROUND: Video-assisted endoscopy has been applied frequently in the management of a variety of surgical diseases. However, it has rarely been applied in mitral valve surgery. METHODS: We report 2 patients who received emergency operations for thrombosis of a mitral prosthesis (patient 1, a 68-year-old man) and acute mitral regurgitation due to rupture of anterior chordae (patient 2, a 75-year-old woman). They both had severe congestive heart failure. Cardiogenic shock was noted in patient 2. The mitral valve was approached through a right anterior minithoracotomy with the aid of an endoscope by means of projected images on the video monitor under femorofemoral cardiopulmonary bypass. The aorta was not cross-clamped, and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest. The left atrium was entered posterior to the interatrial groove. Thrombectomy and mitral valve repair were performed successfully. RESULTS: The duration of extracorporeal circulation was 204 and 147 minutes, respectively. Both patients recovered from the operation rapidly with uneventful postoperative courses. CONCLUSIONS: Our preliminary results suggest that video-assisted endoscopic cardiac surgery is technically feasible and could be performed in the milieu of open heart surgery.

Aged↗

PubMed1996

A highly attenuated strain of Japanese encephalitis virus induces a protective immune response in mice.

A pair of virulent (RP-9) and attenuated (RP-2ms) mutants of Japanese encephalitis virus (JEV) were generated from a Taiwanese isolate NT109. The mutants differed in several aspects in vitro and in vivo. RP-2ms exhibited smaller plaque than RP-9 on BHK-21 cells, and when intracerebrally injected, RP-2ms was much less neurovirulent than RP-9. As peripherally inoculated, RP-2ms lost neuroinvasiveness while RP-9 penetrated blood-brain barrier, replicated in mouse brain, and killed all the mice. Single RP-2ms immunization completely protected C3H and ICR mice from a lethal challenge with RP-9; the sera from such mice contained antibodies against JEV envelope and nonstructural 1 proteins, indicating RP-2ms had replicated in the mice Neutralizing activity against NT109 in such sera was further demonstrated by plaque reduction neutralization test. In addition, significant lymphoproliferation was detected in spleen cells from the RP-2ms-immunized mice, and cytotoxic activity in these cells specific for the MHC-matched, JEV-infected cells, but not mock cells, was also observed. Altogether, these results demonstrate that RP-2ms, a highly attenuated JEV strain, can induce a protective immunity in mice.

Aedes↗

PubMed1996

Hepatoprotective effects of emodin from Ventilago leiocarpa.

A major component of ethyl acetate (EtOAc) and chloroform (CHCl3) fractions of Ventilago leiocarpa Bunge (Rhamnaceae), emodin, was isolated and exhibited hepatoprotective effects on carbon tetrachloride (CCl4) as well as D-galactosamine (D-GalN)-induced liver damage. The histopathological examination also clearly showed that emodin reduced lymphocyte cells, Kupffer cells, ballooning degeneration, cell necrosis and hyaline degeneration on CCl4 and D-galactosamine-induced tests.

Acetates↗

PubMed1996

Video-assisted cardiac surgery in closure of atrial septal defect.

BACKGROUND: Video-assisted endoscopy has been applied in the management of a variety of intrathoracic vascular lesions. Here we report its use in the correction of intracardiac congenital defects. METHODS: Eight patients (3 male and 5 female) underwent operation for closure of an atrial septal defect. The patients ranged in age from 2.0 to 60.9 years (mean, 19.2 +/- 19.0 years). The patients weighed 11 to 66 kg (mean, 41.3 +/- 23.5 kg). The ratio of pulmonary blood flow to systemic blood flow ranged from 2.0 to 6.0 (mean, 3.4 +/- 1.3). The mean pulmonary artery pressure was 19.7 +/- 4.0 mm Hg (range, 13 to 24 mm Hg). The operations were performed through a right anterior minithoracotomy and guided by video-assisted endoscopic techniques under femorofemoral or femoral-right atrial extracorporeal circulation. The aorta was not cross-clamped, and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature, 22.0 degrees +/- 2.0 degrees C). Transesophageal echocardiographic monitoring was maintained during the operations. The right atrium was entered after pericardiotomy. Primary closure of the defect was performed successfully in all patients. Conventional nondisposable instruments were used for dissection, grasping, suturing, and hemostasis. RESULTS: The durations of extracorporeal circulation and operation ranged from 47 to 126 minutes (mean, 80 +/- 31 minutes) and from 2.2 to 4.5 hours (mean, 3.1 +/- 0.8), respectively. All patients recovered from the operation rapidly with an uneventful postoperative course. CONCLUSIONS: Our experience demonstrates that video-assisted cardiac surgery is technically feasible and can be used with excellent results for the repair of congenital heart defects in general.

Adolescent↗