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Abstract
Two patients with neurofibromatosis presented with expanding masses at the left supraclavicular region. Computed tomography (CT) scans revealed vascular masses. The patients underwent surgery and ruptures of the left subclavian artery were found. Both patients were treated by ligation of subclavian artery.
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Affiliation(s)
- Worawong Slisatkorn
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Khuangsirikul W, Jalayondeja W, Chuanchaiyakul R, Krittayaphong R, Chotinaiwattarakul C, Laksanabunsong P. Metabolic equivalent of exercise stress test explained by six-minute walk test in post coronary artery bypass graft and post percutaneous coronary intervention patients. J Med Assoc Thai 2014; 97 Suppl 7:S6-S9. [PMID: 25141519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the relationship among metabolic equivalents of an exercise stress test (METs of EST), demographic parameters (age, body weight, height, BMI), peak oxygen consumption (VO(2) peak), and six-minute walk distances (6MWD) determined from a six-minute walk test (6MWT). MATERIAL AND METHOD Exercise capacity was estimated by a 6MWT and EST at the sixth week post operation in post coronary artery bypass graft (post CABG n = 17) and post percutaneous coronary intervention (post PCI, n = 13)patients. RESULTS METs of EST showed: high correlation (p<O.01) with VO(2) peak of 6MWT (r = 0.94), 6MWD (r = 0.92); muscle strength (r = 0.78), moderate correlation (p<0.01) with height (r = 0.53); negative correlation with age (r = -0.50). Low correlation was found (p<O. 05) with step length (r = 0.43), and weight (r = 0.38). No correlation was found among METs of EST and rating perceived exertion (RPE) of EST and 6MWT. The multiple linear regression equation for explaining METs of EST is as follows: METs of EST = -2.94+0.02 (6MWD), (r = 0.923, R2 = 0.85, p<0.001). CONCLUSION The 6MWT may possibly be used as an alternative choice for estimating energy expenditure to design exercise programs for these post operation groups.
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Karunasumetta C, Laksanabunsong P, Slisatkorn W, Wongkornrat W, Sakiyalak P, Thongcharoen P, Subtaweesin T, Phanchaipetch T, Sriyoschati S. Validation of EuroSCORE for coronary artery bypass grafting at Siriraj Hospital. J Med Assoc Thai 2012; 95:1178-1183. [PMID: 23140035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To access the performance of the EuroSCORE when applied to CABG patients at Siriraj hospital. MATERIAL AND METHOD One thousand five hundred forty nine patients diagnosed with coronary artery disease (CAD) who underwent isolated CABG between January 2007 and December 2009 was prospectively studied. RESULTS The patients included 1,102 men and 447 women and had a mean age of 67 years old. The mean additive score in expired and survived groups were 9.65 +/- 5.14 and 3.87 +/- 3.06. In logistic, score were 25.43 +/- 26.31 and 4.88 +/- 7.88 respectively (p < 0.001). The best cut-off value of EuroSCORE for prediction of a death rate was 6 for additive score and 10 for logistic score. Area under the curve was 0.831 for the additive score and 0.823 for the logistic score. The observed overall mortality rate was 2.0% while the predict mortality was 5.27%. The difference between observed and predicted deaths was significant with additive score and logistic score (p < 0.001). CONCLUSION Our results suggest that EuroSCORE is not valid for CABG in Thai patient due to over prediction.
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Affiliation(s)
- Chananya Karunasumetta
- Division of Cardiothoracic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Wongcharoenkiat N, Tresukosol D, Laksanabunsong P, Udompunturak S. A comparison of outcomes between percutaneous coronary intervention versus coronary artery bypass surgery in octogenarian patients. J Med Assoc Thai 2012; 95 Suppl 2:S154-S164. [PMID: 22574545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Percutaneous Coronary Intervention (PCI) is emerging as new revascularization procedure for coronary artery disease patients. The octogenarians are the most fragile and vulnerable age group for any type of revascularization therapy and usually discarded from any randomized trials. There is no consensus in the choice of treatment among octogenarians including PCI and coronary artery bypass grafting (CABG). OBJECTIVE To compare PCI and CABG among Thai octogenarians (> or = 80 years old) with coronary artery disease for immediate and 24-month clinical outcomes. MATERIAL AND METHOD Retrospective cohort study was conducted at Siriraj Hospital from January 2005 to December 2007 to obtain a complete 24-month follow-up period after revascularization. From CALYSTO database, a list of all octogenarians was retrieved (n = 333); after cleaning of the data, 265 patients (PCIn = 202, CABG n = 63) were enrolled for the present study. The primary endpoint is defined as a 30-day major adverse cardiac and cerebral event (MACCE). Secondary endpoint is a 24-month major adverse event (MACE). RESULTS The 30-day MACCE were 11.4% in PCI group vs. 44.4% in CABG group (p < 0.001), all cause-mortality was 2.5% in PCI group vs. 8.3% in CABG group (p = 0.05), cardiovascular mortality was 1% vs. 5% (p = 0.046), mortality from sepsis was 1.5% vs. 1.5% (p = 1.0). Recurrent MI was 5.4% vs. 4.8% (p = 0.74). Cerebrovascular event occurred in 0.5% vs. 1.6% (p = 0.10). There was a crossover treatment as 0.5% vs. 0% (p = 1.0). There was no repeat target revascularization at 30-day in both groups. Major vascular complication due to bleeding requiring > or = 5 of pack-red cell transfusion was more common in CABG group (1.5% vs. 31.8%, p < 0.001). At 24-month follow-up, MACE were 35.2% in PCI group vs. 27.9% in CABG group (p = 0.36), all cause-mortality was 11.3% vs. 27.9% (p = 0.002), cardiovascular mortality was 1.5% vs. 11.5% (p < 0.001). Sepsis mortality was 2.5% vs. 11.1% (p = 0.05). MI occurred in 7.4% vs. 6.3% (p = 1.0). Repeat target revascularization was higher in PCI group (20.3% vs. 0%, p < 0.001). However, hospital stay was longer in CABG group (4.7 +/- 9 vs. 16.8 +/- 17.4 days, p = 0.01). CONCLUSION The current revascularization strategy was evaluated. These results reflect our physician selection, patient willingness to undergo the treatment option. Lesser 30-day and 24-month all-caused mortality, cardiovascular mortality, hospital stay was observed in PCI treated octogenarians with a trade off of more frequent repeat target revascularization.
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Affiliation(s)
- Nuntaporn Wongcharoenkiat
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sakiyalak P, Slisatkorn W, Pornratanarangsi S, Wongpraparut N, Jakrapanichakul D, Raksamani K, Prakanrattana U, Laksanabunsong P. Transcatheter aortic valve implantation (TAVI): first case in Thailand. J Med Assoc Thai 2012; 95:124-128. [PMID: 22379752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Aortic valve replacement (AVR) is the standard treatment for patients with symptomatic severe aortic stenosis (AS). However many patients are not offered surgery due to high surgical risk for open AVR. Transcatheter aortic valve implantation has been an alternative to open heart surgery in patients with symptomatic severe aortic stenosis (AS) who are not suitable for open surgery. The first transcatheter aortic valve implantation in Thailand via the transapical route is described. An 87-year-old woman with symptomatic severe AS, calcified aorta and peripheral arterial disease, who was at high surgical risk, was successfully treated, and had good functional and haemodynamic results at six-months follow-up.
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Affiliation(s)
- Pranya Sakiyalak
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Krittayaphong R, Laksanabunsong P, Maneesai A, Saiviroonporn P, Udompunturak S, Chaithiraphan V. Comparison of cardiovascular magnetic resonance of late gadolinium enhancement and diastolic wall thickness to predict recovery of left ventricular function after coronary artery bypass surgery. J Cardiovasc Magn Reson 2008; 10:41. [PMID: 18808697 PMCID: PMC2561019 DOI: 10.1186/1532-429x-10-41] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 09/22/2008] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The objective was to compare the value of late gadolinium enhancement (LGE) and end-diastolic wall thickness (EDWT) assessed by cardiovascular magnetic resonance (CMR) in predicting recovery of left ventricular function after coronary artery bypass surgery (CABG). METHODS We enrolled patients with coronary artery disease and left ventricular ejection fraction < 45% who were scheduled for CABG. Regional contractility was assessed by cine CMR at baseline and 4 months after CABG. EDWT and LGE were assessed at baseline. Predictors for improvement of regional contractility were analyzed. RESULTS We studied 46 men and 4 women with an average age of 61 years. Baseline left ventricular ejection fraction was 37 +/- 13%. A total of 2,020 myocardial segments were analyzed. Abnormal wall motion and the LGE area were detected in 1,446 segments (71.6%) and 1,196 segments (59.2%) respectively. Wall motion improvement was demonstrated in 481 of 1,227 segments (39.2%) that initially had wall motion abnormalities at baseline. Logistic regression analysis showed that the LGE area, EDWT and resting wall motion grade predicted wall motion improvement. Comparison of Receiver-Operator-Characteristic (ROC) curves demonstrated that the LGE area was the most important predictor (p < 0.001). Adding information from LGE to the EDWT can decrease the number of false predictions by EDWT alone from 483 to 127 segments. CONCLUSION LGE and EDWT are independent predictors for functional recovery after revascularization. However, LGE appears to be a more important factor and independent of EDWT.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pansak Laksanabunsong
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adisak Maneesai
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pairash Saiviroonporn
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthipol Udompunturak
- Department of Research Promotion, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vithaya Chaithiraphan
- Her Majesty Cardiac Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
A case of a ruptured right aortic arch aneurysm in a 74-year-old woman presenting with shock is reported. The diagnostic and operative findings are presented. We discuss the surgical approach and review the literature.
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Affiliation(s)
- Worawong Slisatkorn
- Division of Cardiovascular Thoracic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Chuangsuwanich T, Warnnissorn M, Leksrisakul P, Laksanabunsong P, Thongcharoen P, Sahasakul Y. Pathology and etiology of 110 consecutively removed aortic valves. J Med Assoc Thai 2004; 87:921-34. [PMID: 15471297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES To study the pathology and determine the etiology and prevalence of aortic valve disease from surgically removed aortic valve specimens. MATERIAL AND METHOD All the native surgically excised aortic valves (AV) received from June 1997 to March 1999 (22 months) were studied macroscopically including cuspal measurements and microscopically. By preoperative echocardiographic and macroscopic studies, they were classified into functional disorders of predominant aortic stenosis (AS), aortic stenosis with regurgitation (AS-AR) and predominant aortic regurgitation (AR). The patients' medical records were reviewed and the clinical information was extracted. The etiology was determined according to the macroscopic, microscopic and clinical findings. RESULTS Among 110 AV (76 isolated AV and 34 with concomitant mitral valves from patients aged 15-96 years, mean age 47.54 years; male:female = 1.39:1) there were 25 AS (22.73%), 34 AS-AR (30.91%) and 51 AR (46.36%) cases. Eighty-four (76.36%) were tricuspid, 16 (14.54%) were bicuspid and 10 were undetermined. Cuspal measurements of each disease were provided and compared. All AS specimens were related to moderate to severe calcification and causes included postinflammatory disease (14 cases, 56%; age range 38-67 years, mean age 53.29 years, male:female = 0.56:1), degenerative calcific change (11 cases, 44%, age range 56-76 years, male:female = 1.2:1; mean age 69 years of 5 tricuspid AV and 60.83 years of 6 bicuspid AV). In AS-AR, 29 cases (85.29%; mean age 47.10 years; male:female = 1.23:1) were attributable to postinflammatory disease and 5 cases (mean age 70.20 years; male:female = 1.5:1) to degenerative calcific change. In pure AR, there were 21 cases (age range 15-65 years, mean age 29.76 years) of postinflammatory disease, 14 cases of infective endocarditis (IE) and postIE (age range 20-63 years, mean age 42.21 years; all 10 IE cases contained gram positive cocci), 1 case (age 55 years) of bicuspid calcific change, 8 cases of AV with dilated valve ring, 5 cases of miscellaneous causes and 2 cases of indeterminate etiology. Aschoff bodies were found in 3 AR cases. Four of 18 postinflammatory AS-AR and 4 of 14 postinflammatory disease AR cases had past history of rheumatic fever. One postinflammatory AS also had infective endocarditis from gram positive cocci without clinical sign. Severe degenerative calcific change had a higher incidence of underlying diabetes (3 of 15 cases, 20%), hypertension (8 of 14 cases, 57.14%) and dyslipoproteinemia (9 of 13 cases, 69.23%) in comparison with 3.37% (3/89) for diabetes, 9.09% (8/88) for hypertension and 30.99% (22/71) for dyslipoproteinemia in other AV diseases in combination. CONCLUSION The three common causes of severe AV functional disorders were postinflammatory disease (58.18%), degenerative calcific change (15.45%) and IE-postIE (12.72%). Underlying diseases of severe degenerative calcific change included hypertension, dyslipoproteinemia and diabetes. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details are important in evaluating the etiology of valvular diseases especially in severely calcified specimens.
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Affiliation(s)
- Tuenjai Chuangsuwanich
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Thongcharoen P, Laksanabunsong P, Thongtang V. Left ventricular outflow tract obstruction due to a left ventricular myxoma: a case report and review of the literature. J Med Assoc Thai 1997; 80:799-806. [PMID: 9470335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 17-year-old-man who presented with syncope, had a left ventricular (LV) myxoma causing left ventricular outflow tract obstruction. The tumor was removed through left ventriculotomy using conventional cardiopulmonary bypass with good result. There have been 47 cases of LV myxoma reported in the world literature since 1957. Most of them are symptomatic (92.7%). Systemic embolism is the most common manifestation (50%) and often leads to death. The surgical removal should be performed urgently. Resection of the mass with limited normal tissue surrounding its pedicle is recommended. There are only three recurrences and five operative deaths.
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Affiliation(s)
- P Thongcharoen
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Bhuripanyo K, Laksanabunsong P, Raungratanaamporn O, Nutakul T, Nademanee K, Chaithiraphan S. Successful implantation of transvenous automatic implantable cardioverter defibrillator (AICD): the first case report in Thailand. J Med Assoc Thai 1996; 79:536-540. [PMID: 8855638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We successfully implanted transvenously the AICD in a case of sudden cardiac arrest survivor. Though the device is very expensive, it is useful in some selected cases. With its diagnostic capabilities, the device may be useful in elucidating the underlying mechanism of Lai Tai.
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Affiliation(s)
- K Bhuripanyo
- Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Suwanchinda V, Prakanrattana U, Laksanabunsong P, Subtaweesin T, Sakiyalak P. Intraoperative transesophageal echocardiography: preliminary experience at Siriraj hospital. J Med Assoc Thai 1995; 78:487-91. [PMID: 7561577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to evaluate the result of intraoperative TEE monitoring for cardiothoracic surgery, 113 patients were involved in this study. They included 65 males and 48 females, with an average age of 48.8 +/- 16.6 years, ranging from 10 to 74 years. The pre-operative diagnoses consisted of 41.6 per cent coronary artery disease, 34.5 per cent valvular disease, 12.4 per cent congenital heart disease, 8 per cent aortic aneurysm or aortic dissection, and 3.5 per cent of miscellaneous. The TEE appeared to provide accurate information by beating to changes in the left ventricular preload and contractility in all patients. The severity of valvular dysfunction, intracardiac air/mass, Swan Ganz catheter position, sites of congenital heart defect and aortic dissection were either assessed or reconfirmed during the operation. The ease of TEE technique was satisfactory, since unsuccessful attempt was observed in only 1.8 per cent. One patient died from rupture of thoracic aortic dissection which was related to TEE probe insertion. These data suggest the favorable result of intraoperative TEE as a valuable tool for monitoring in cardiothoracic surgery. Although the technique is simple, special precaution must be observed for patients suffering from acute aortic dissection.
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Affiliation(s)
- V Suwanchinda
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Laksanabunsong P, Wongbunnate S, Charoenratanakul S. Leiomyomas of the lower respiratory tract: a case report. J Med Assoc Thai 1993; 76:465-9. [PMID: 7964250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A rare case of leiomyoma of the left main bronchus in a 16-year-old female has been reported. Of the pulmonary leiomyomas reported, 18.3 per cent were found in the trachea, 33.8 per cent in the bronchi and 47.9 per cent in the parenchyma. Bronchial lesions tend to produce symptoms due to partial or complete obstruction of the affected bronchus, whereas, over 90 per cent of parenchymal lesions which are more common in women, are asymptomatic and usually discovered on routine chest radiographs. Tracheal lesions may present as bronchial asthma. The correct diagnosis is not usually made until the lesion has been resected. However, early and correct diagnosis may be made in suspicious cases by histological examination of bronchoscopic biopsy specimens or frozen section material obtained at thoracotomy. The surgical approach to these tumors is conservative but lobectomy or pneumonectomy is often necessary because of secondary pulmonary destruction.
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Affiliation(s)
- P Laksanabunsong
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Jootar P, Sahasakul Y, Laksanabunsong P, Thamtakerngkit S. Pneumopyopericardium due to perforation of the stomach in a patient with lymphoma. J Med Assoc Thai 1986; 69:113-8. [PMID: 3754884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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