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A one-day-old baby was transferred for cyanosis and heart murmur. Echocardiographic evaluation revealed that he had severe neonatal Ebstein’s anomaly (Carpentier type C), pulmonary atresia, and pulmonary circulation via patent ductus arteriosus. Because the wall of the atrialized right ventricle was very thin, showed decreased contractility, and the small right ventricle showed pulmonary atresia, we decided that a two-ventricular repair was impossible. When the patient was one-month-old, he underwent right atrium reduction-plasty, a right ventricular exclusion procedure (including atrialized right ventricle resection and functional right ventricle plication), and right modified Blalock-Taussig shunt. He was discharged without specific problems. He received a bidirectional cavopulmonary shunt successfully at 4 months later.

Background We implanted Shelhigh porcine pulmonic valve conduits because of the limited availability of homografts in our country. The aim of this study was to evaluate the short-term results of SPVC. Methods From November 2002 to July 2005, the Shelhigh porcine pulmonic valve conduit was implanted in 73 patients (81 procedures) in the right ventricular outflow tract to correct congenital heart diseases. Operative procedures were Rastelli operation in 65, anatomic correction of atrioventricular discordance in 5, and Ross operation in 3. Age at operation was 6.8 ± 7.5 years, including 11 patients under 1 year. The median conduit size was 18 mm (range, 12 to 24 mm). Results There was no operative mortality and 1 nonconduit-related late death (mean follow-up, 11.3 ± 10.7 months). Ten conduits (12.3%, 7 patients) were removed at a median of 9.6 months (range, 2.5 to 25.4) owing to obstruction in 9 and pseudoaneurysm in 1. In the explanted conduits, we found a prominent intimal peel at the distal anastomosis without leaflet calcification. Freedom from reoperation at 24 months was 87% ± 11.7% in large-sized conduits (≥18 mm) and 62.8% ± 10.6% in small-sized conduits (≤16 mm). Especially, 12-mm sized conduit showed 33.3% freedom from reoperation during the first 12 months of follow-up. Conclusions On the basis of our short-term results, Shelhigh porcine pulmonic valve conduits are not satisfactory. Small-sized conduits (≤16 mm) fail earlier; large-sized conduits (≥18 mm) fail after 2 years of implantation due to intimal peel formation at the distal segment.

We report a very rare case of left Valsalva sinus aneurysm rupture into left atrium in a 55-year-old man with severe aortic regurgitation caused by aortic valve prolapse. The Valsalva sinus aneurysm rupture was clearly visualized with transesophageal echocardiography performed to further delineate the aortic valve pathology. The 3-dimensional reconstruction of multislice computed tomography images nicely visualized the left Valsalva sinus aneurysm.

The purpose of this study was to evaluate the result of arteriovenous (A-V) grafting with the deep forearm veins as an outflow system in hemodialysis patients. Between June 1999 and July 2001, 27 A-V grafts consisting of ePTFE and deep forearm veins were constructed in 26 patients. All patients followed up for assessment of all relevant values, and the median follow-up period was 17.3 months. Seven grafts (26%) failed during the follow-up. The patency rates were 93% and 80% at 3 months and 12 months, respectively. No difference in patency rate was found between males and females, or between diabetics and nondiabetics. Graft-related complications, excluding graft thrombosis, occurred in five patients. These included operative wound dehiscence in two cases, a graft infection, a seroma, and a mild hypoperfusion in the hand. We conclude that the early patency rate of A-V graft using the forearm deep veins as an outflow system is very good and that this technique may be a recommended surgical modality for vascular access in patients with exhausted superficial veins.

Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Republic of Korea Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Xenotransplantation Research Center, Seoul National University Hospital Clinical Research Institute, 28 Yongon-dong, Jongro-gu, Seoul 110-744, Republic of Korea Department of Surgery, Seoul National University College of Medicine, Seoul National University Children’s Hospital, Republic of Korea