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Biomedical subjects

Jen-Ping Chang

Publications and source records attributed to Jen-Ping Chang.

At least 19 recordsLinked to original sources
PubMed2006

Mediastinal hematoma and left main dissection following blunt chest trauma.

A 40-year-old man sustained blunt chest trauma resulting in sternal fracture, mediastinal hematoma, and dissection of the left main coronary artery. Because of associated injury, the coronary angiogram was performed 7 days after the accident and off-pump coronary bypass surgery was performed immediately. Two months later, follow-up angiogram revealed completely healed left main dissection. The patient continues to do well 4 months postoperatively.

Accidents, Traffic↗
PubMed2006

Role of the simultaneous sequential strategy for failed acute sinus restoration after modified left maze procedure for persistent atrial fibrillation with concomitant mitral surgery.

BACKGROUND: We assessed whether the simultaneous sequential strategy could (1) achieve additional sinus restoration for those patients who were not in sinus rhythm while coming off bypass after modified left maze procedure and (2) attain the same long-term success rates as the bi-atrial maze procedure in patients with persistent atrial fibrillation (AF) and mitral valve disease. MATERIALS AND METHODS: Twenty-seven consecutive patients - ten men and 17 women with a mean age of 52 +/- 13 years, all with persistent AF and mitral valve disease - underwent the modified maze procedure with the simultaneous sequential strategy. In the first phase, the modified left atrial maze operation was carried out with concomitant valvular surgery; the right side maze operation was subsequently carried out as a second phase of the sequential strategy only if AF re-appeared following the spontaneous restoration of heart beats during the operation. RESULTS: Twenty patients (74.1%) underwent the left atrial maze procedure only, and seven patients (25.9%) required the subsequent right atrial maze procedure as part of the sequential strategy. At a mean follow-up of 15.1 +/- 7.7 months, six of the 27 patients (22.2%) who underwent additional right atrial maze procedure had restored sinus rhythm. At a mean follow-up of 17.8 +/- 7.3 months, 24 of the 27 patients (88.9%) had restored sinus rhythm and 22 patients (81.5%) had restored bi-atrial transport function (right atrial filling fraction: 40.8 +/- 11.7%; left atrial filling fraction: 22.9 +/- 8.1%) after application of the sequential strategy. CONCLUSIONS: Compared with modified left atrial maze procedure, the application of the simultaneous sequential strategy successfully restored sinus rhythm in an additional 22.2% of patients with persistent AF. The overall sinus conversion rate of 88.9% was comparable with that of the standard bi-atrial maze procedure.

Adult↗
PubMed2006

Bilateral coronary-to-pulmonary artery fistulas.

Coronary angiography and multi-detector computed tomography provide crucial information for anatomical correlation and surgical planning for coronary vessel malformation. This study reports a successful experience of bilateral coronary-to-pulmonary artery fistula with a vascular malformation.

Cardiac Surgical Procedures↗
PubMed2005

Clinical determinants of sinus conversion by radiofrequency maze procedure for persistent atrial fibrillation in patients undergoing concomitant mitral valvular surgery.

The radiofrequency Maze procedure can effectively restore sinus rhythm in most patients with atrial fibrillation (AF) and mitral valve disease. AF after cardiac surgery is associated with increased morbidity and mortality. However, clinical determinants of long-term postoperative AF after the radiofrequency Maze procedure and concomitant mitral valve surgery are poorly defined. This study comprised 99 consecutive patients with persistent AF and mitral valve disease who underwent radiofrequency Maze procedures and concomitant mitral valvular operations. The predictive values of clinical variables for postoperative AF were examined. After a mean follow-up period of 46.1+/-24.6 months, 83 patients (83.8%) had sinus conversion after the Maze procedure, and 16 patients remained in persistent or paroxysmal AF. Multiple logistic regression analysis determined that predictors of sinus conversion were preoperative left atrial diameter (odds ratio [OR] 1.127 per 1-mm increment in left atrial diameter, 95% confidence interval [CI] 1.045 to 1.215, p<0.002) and the duration of AF (OR 1.022 per 1-month increment in duration of AF, 95% CI 1.009 to 1.035, p<0.001). Discriminant analysis showed that the sinus conversion rate was significantly lower in patients with preoperative left atrial diameters>56.8 mm (p<0.001) or AF duration>66 months (p<0.001) than in patients with preoperative left atrial diameters<56.8 mm or AF duration<66 months. In conclusion, the preoperative left atrial size and duration of AF are primary predictors of sinus conversion by the radiofrequency Maze procedure for patients with persistent AF and mitral valve disease.

Adult↗
PubMed2005

Structural allograft implantation for thoracic spinal impalement.

Impalement injury is uncommon, with only occasional reports. Thoracic impalement injuries from falls are rarely seen in the emergency department, because most patients die at the scene of injury. We present an unusual case in which a patient survived a bilateral thoracic impalement injury and was successfully treated for the bleeding thoracic spinal defect with a method that used a structural ulnar allograft implantation.

Accidental Falls↗
PubMed2005

Less-invasive surgical extraction of problematic or infected permanent transvenous pacemaker system.

BACKGROUND: The best management of problematic or infected transvenous permanent pacemaker system is complete surgical or percutaneous intravascular extraction of the pacemaker leads and removal of the generator. We present our experiences in 13 such patients in whom the leads were removed with the less-invasive technique. METHODS: From 1996 to 2003, 13 patients, from 31 to 83 years of age (mean, 66.9 +/- 14.0 years), with problematic or infected transvenous permanent pacemaker systems were referred to our department for surgical treatment. In 6 patients, the original pacemakers were dual-chamber. A subxiphoid pericardiotomy was used as the monitoring port during the ventricular lead extraction. In addition, a right parasternal pericardiotomy through the third intercostal space was used as the monitoring port during the atrial lead extraction. RESULTS: Pacemaker systems were completely removed in all patients. Three bleeding episodes (23%), including two right atrial tears and one right ventricular rupture, were successfully circumvented through these monitoring ports. Concomitantly, a new epicardial single-chamber device was implanted through the subxiphoid pericardiotomy whenever indicated in 9 patients. All patients recovered and were discharged uneventfully. At a mean follow-up of 24.8 months (range, 1 to 90 months), no recurrent infections were observed. CONCLUSIONS: A less-invasive technique for explantation of the complete pacemaker system is feasible. This is a reliable method to eradicate infection. Neither cardiopulmonary bypass nor specific intravascular lead extraction devices, such as locking stylets or laser-assisted sheath, are needed.

Adult↗
PubMed2005

Atrial pacemaker complex preserved radiofrequency maze procedure reducing the incidence of sick sinus syndrome in patients with atrial fibrillation.

BACKGROUND: The Cox maze III procedure can effectively restore sinus rhythm in most patients with permanent atrial fibrillation (AF). However, previous studies have shown that the maze procedure results in significant sinus node dysfunction, and, consequently, a considerable number of patients required postoperative pacemaker implantation. HYPOTHESIS: This study investigates the hypothesis that the modification of the Cox III maze procedure, to avoid injuring the sinus node and the atrial physiologic pacemaker complex, will reduce the incidence of sick sinus syndrome following surgery. METHODS AND RESULTS: This study investigated 71 patients with permanent AF and mitral valve disease who were undergoing concomitant open-heart surgery. Most atrial incisions in the Cox maze III procedure were replaced with radiofrequency ablation, and the intercaval counterablation was moved posterolaterally to avoid injury to the sinus node and atrial pacemaker complex. At a mean (+/- SD) follow-up time of 46.5 +/- 24 months, 59 patients (83.1%) regained sinus rhythm without receiving antiarrhythmic drug therapy or undergoing electrical cardioversion. The transmitral atrial wave was observed in 44 patients (62%), and the transtricuspid atrial wave was also observed in 53 patients (74.6%). Late sinus node dysfunction developed in only two patients (2.8%), who received permanent pacemaker implantation. CONCLUSION: This modified radiofrequency maze procedure produces few patients with sick sinus syndrome and effectively restores sinus rhythm and atrial transport function in most patients with permanent AF undergoing concomitant open-heart surgery.

Atrial Fibrillation↗
PubMed2004

Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery.

BACKGROUND: The radiofrequency (RF) maze procedure can effectively restore sinus rhythm and atrial transport function in the majority of patients with permanent atrial fibrillation (AF) and mitral valve disease. No previous study has described a cutoff value of preoperative atrial size determined by the discriminant analysis in predicting the success of sinus conversion by the RF maze procedure for permanent AF in patients with mitral valve disease. METHODS AND RESULTS: This study included 81 patients with permanent AF and mitral valve disease who underwent the RF maze IV procedure while undergoing concomitant valvular operations. There was one surgical death (1.2%). Another patient died of acute necrotizing pancreatitis 13 months later. Two patients (2.5%) developed sick sinus syndrome and received transvenous permanent pacemaker implantation. In the remaining 77 patients, there were 38 men and 39 women, with a mean (+/- SD) age of 51 +/- 11 years. At a mean follow-up time of 38 months, 65 patients (84.4%) had persistent sinus conversion that had been accomplished by the RF maze procedure (group 1), and 12 patients (15.6%) did not regain sinus rhythm (group 2). We evaluated the preoperative variables between the two groups. Univariate analysis demonstrated that the preoperative left atrial area and the left atrial diameter of group 1 patients were significantly smaller than those of group 2 patients. Group 1 had significantly fewer patients associated with tricuspid valve disease than did group 2. By multiple stepwise logistic regression analysis, only the preoperative left atrial area was an independent determinant of sinus conversion by the RF maze procedure (odds ratio, 0.961; 95% confidence interval, 0.935 to 0.988; p < 0.005). Linear discriminant analysis demonstrated that the sensitivity and specificity of the cutoff value of 56.25 cm(2) of the preoperative left atrial area in predicting the sinus conversion by the RF maze procedure were 50.0% and 86.2%, respectively, and the positive and negative predictive values were 40.0% and 90.3%, respectively. CONCLUSION: The preoperative left atrial area is an independent determinant of sinus conversion by the RF maze procedure for patients with permanent AF and mitral valve disease.

Adult↗
PubMed2004

Pseudoaneurysm formation 12 years after ringed intraluminal graft replacement for type B aortic dissection.

A sutureless ringed intraluminal graft has been used as a substitute for the diseased aorta with the advantage of decreasing the aortic cross-clamp time and blood loss. Concerns remain about implications of anecdotal accounts of late complications with this graft. We report on the experience of a 68-year-old man, successfully treated for type B aortic dissection using the sutureless technique, who developed a pseudoaneurysm and aortobronchial fistula over the distal anastomosis of the intraluminal graft 12 years after the operation.

Aged↗
PubMed2003

Idiopathic calcific constrictive pericarditis causing pulmonary stenosis associated with a ventricular septal defect mimicking tetralogy of Fallot.

We describe an unusual case of pulmonary stenosis caused by calcific constrictive pericarditis associated with a congenital ventricular septal defect in a 16-year-old boy who had a 2-week history of progressive dyspnea, cyanosis, fatigue, and bilateral leg edema. Echocardiographic findings led to an initial diagnosis of tetralogy of Fallot; however, findings on chest radiography and CT were suggestive of calcific constrictive pericarditis with pulmonary stenosis, which was then confirmed on cardiac catheterization. Total pericardiectomy and repair of the ventricular septal defect resulted in a satisfactory outcome. Follow-up examinations at 6 and 20 months showed that the patient was asymptomatic and considered to have class I New York Heart Association functional status. To our knowledge, this is the first reported case of calcific constrictive pericarditis with pulmonary stenosis associated with a ventricular septal defect.

Adolescent↗
PubMed2003

Conduit-on-valve replacement of a degenerated mitral bioprosthesis with a bioprosthesis.

Explantation of a degenerated mitral bioprosthesis with reimplantation of a new bioprosthesis is time-consuming and can be associated with several life-threatening complications. We developed a technique to simplify this procedure and avoid the complications by attaching a new bioprosthesis supported by a pericardium-covered Dacron tube to the intact stent.

Bioprosthesis↗
PubMed2003

Mitral valve repair in uremic congestive cardiomyopathy.

BACKGROUND: There is limited reported experience on mitral valve repair in patients with chronic renal failure. This study was designed to evaluate the outcomes of mitral valve repair in patients suffering from congestive heart failure as a result of uremic cardiomyopathy and severe mitral regurgitation requiring chronic hemodialysis. METHODS: From 1995 to 2002, 5 women, ages 41 to 64 years (53 +/- 8 years), with uremic congestive cardiomyopathy and end-stage renal disease on chronic hemodialysis who underwent mitral valve repair for severe mitral regurgitation were identified retrospectively and followed for clinical and echocardiographic outcomes. The preoperative New York Heart Association functional class was 3.8 +/- 0.45. RESULTS: All patients had good results immediately after surgical mitral valve repair with no more than mild mitral regurgitation. During the follow-up at an average of 22.4 +/- 14.9 months (range, 3 to 41 months) postoperatively, all patients returned to New York Heart Association functional class I. Neither mitral calcification nor increasing peak transmitral gradient (or decreasing mitral valve orifice area) was notable by two-dimensional echocardiography. No reoperation was required. CONCLUSIONS: Although accelerated calcification of the repaired mitral valve and high incidence of failure of the reconstruction had been reported in patients with end-stage renal disease, based on our experience we advocate mitral valve repair when this can be safely performed, especially in patients with uremic congestive cardiomyopathy, in view of the added advantage of retaining the native valve in such patients.

Adult↗
PubMed2003

Large extracranial vertebral aneurysm with absent contralateral vertebral artery.

The extracranial segment of the vertebral artery is well protected, and the rate of occurrence of extracranial vertebral aneurysms is very low. We describe the case of a 40-year-old woman who presented with a large aneurysm of the left vertebral artery in the angiographic absence of a right vertebral artery. Her medical history included a motorcycle accident at the age of 20, at which time a neck sprain had been diagnosed. Computed tomography of the chest and neck revealed a 6- x 4-cm aneurysm with mural thrombus in the left thoracic outlet and in the first portion of the left vertebral artery before the entrance of the transverse foramen of the 6th cervical vertebra. Angiography of the arch vessels confirmed both the presence of an aneurysm of the left vertebral artery and the absence of a right vertebral artery. Due to the lack of contralateral vertebral flow, we planned to perform a graft interposition under deep hypothermic circulatory arrest, for cerebral protection. Unfortunately, the patient refused the operation and was lost to follow-up. To our knowledge, there has been no previous report of an extracranial vertebral artery aneurysm in the absence of a contralateral vertebral artery. We believe that deep hypothermic circulatory arrest with graft interposition is the best treatment strategy, although we did not, in this case, have opportunity to treat the patient.

Adult↗
PubMed2003

Perigraft-to-right atrial shunt for aortic root hemostasis.

We have modified the technique of perigraft-to-right atrial shunt to control hemorrhage after aortic root replacement. We have performed this operation in 2 patients, including one who had acute aortic dissection and another who underwent aortic root replacement and single-vessel coronary artery bypass. Neither patient required re-exploration for bleeding, and both shunts closed spontaneously during the follow-up period without any related complications. With this modification, even in the presence of concomitant coronary artery bypass grafting, hemostasis was achieved with preservation of the proximal vein graft.

Adult↗