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Biomedical subjects

C R Hung

Publications and source records attributed to C R Hung.

133 records · Page 8Linked to original sources
PubMedDate not supplied

Clinical implications of short-axis aortopulmonary rotation on juxtacommissural origin of the coronary artery in transposition of the great arteries and surgical strategy.

BACKGROUND: The relationship of short-axis aortopulmonary rotation (APR) with juxtacommissural origin of the coronary arteries (JOCA) in transposition of the great arteries (TGA) has never been elucidated. The surgical outcome of arterial switch operation (ASO) is influenced by the presence of JOCA. METHODS: Fifteen patients with TGA who presented to our institution between 1988 and 1995, and 23 cases from the literature, all with documented JOCA and APR, were analyzed. Each coronary arterial type was assigned to one of five patterns, according to similarities of epicardial configuration. All our patients underwent an ASO with various techniques to deal with JOCA. RESULTS: JOCA near the facing commissure (FC, 35 cases), were more frequent with anterior TGA (29/31, 94%) except types 5cj and 9j that were seen with posterior and right lateral TGA (4/4, 100%); whereas JOCA near the right-hand nonfacing commissure (RNC, 3 cases) were related with posterior TGA. Eta-square analysis showed significant correlation between various JOCA and short axis APR. Thirteen of our cases had JOCA near FC, two near RNC. Five of the former in whom the coronary artery was excised as a single button had a superior trapdoor; using a two-button technique three of the former had a lateral funnel and one of the latter had a medial trapdoor for the JOCA; all survived although on late noncoronary death was noted. In the remaining six cases without augmentation, only one survived (8/1 vs 1/5, p < 0.02). CONCLUSION: JOCA in TGA was related to short axis APR, generally near FC in anterior TGA (except types 5cj and 9j), and near the RNC in posterior TGA. A superior (lateral) or medial flap, to augment the coronary button for JOCA near FC or RNC is helpful for a successful ASO.

Aorta↗
PubMedDate not supplied

[Double aortic arch: report of one case].

A case of double aortic arch is reported. The male patient, 11-month-old, had breathed with a constant stridor since his birth and had frequent attacks of respiratory tract infection and dyspnea. The child was admitted because of restlessness, fever, stridor and cough. Dyspnea with cyanosis appeared later, and required intubation and mechanical ventilation. After then, three attempts to extubate the infant were made, but failed. A double aortic arch was suspected by bronchogram, esophagogram, and confirmed by cardiac catheterization. Through a left thoracotomy, the smaller left arch and the ligmentem arteriosum were divided to relieve the obstruction of trachea from the compression of the vascular ring. Postoperative convalescence was normal. Symptoms of double aortic arch vary with the degree of obstruction of the trachea and esophagus, ranging from mild to life-threatening respiratory obstruction and apnea. Inspiratory stridor, dyspnea, and wheezing, which are accentuated with feeding, crying, or respiratory infections, are characteristic clinical findings. The diagnosis is established by aid of an esophagography. Left thoracotomy, with division of the smaller aortic arch, is the only satisfactory treatment.

Aorta, Thoracic↗
PubMedDate not supplied

Pulsatile flow during routine cardiopulmonary bypass.

The effect of pulsatile flow during cardiopulmonary bypass (CPB) was studied on two groups of 11 patients each (aged between 18 and 48 years) undergoing open valvular and congenital heart surgery. In the nonpulsatile group, mean blood pressure (BP) and systemic vascular resistance index (SVRI) increased steadily during CPB; while in the pulsatile group, both BP and SVRI remained stationary. The difference of SVRI between the two groups was not significant within 30 minutes after initiation of CPB (3136 +/- 882 to 2536 +/- 530 dynes X sec X cm-5 X m2). Contrarily, it was significantly higher in the nonpulsatile group after 40 minutes of CPB (3748 +/- 562 to 2612 +/- 609 dynes X sec X cm-5 X m2, p less than 0.02) and thereafter. Oxygen consumption index (59.6 +/- 12.9 to 77.8 +/- 32.6 ml X min-1 X m-2) and carbon dioxide production index (41.1 +/- 16.0 to 59.3 +/- 28.1 ml X min-1 X m-2) measured 20 minutes after institution of CPB seemed lower in the nonpulsatile group than in the pulsatile group, but the differences were not statistically significant. Increased urine flow during CPB (1.8 +/- 1.1 to 6.3 +/- 3.8 ml X min-1 X m-2, p less than 0.001) with less variability indicated better reserve of renal function in the pulsatile group; and less percent change of postoperative sGOT from preoperative level (529.8 +/- 129.8 to 310.0 +/- 175.2%, p less than 0.005) also showed better hepatic function in the pulsatile group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗