Chaw-chi Chiu - Academia.edu (original) (raw)

Papers by Chaw-chi Chiu

Experimental biology and medicine (Maywood, N.J.), 2006

Pulmonary hypertension (PH) usually develops secondary to left ventricular (LV) dysfunction; ther... more Pulmonary hypertension (PH) usually develops secondary to left ventricular (LV) dysfunction; therefore, it is also called retrograde PH. To investigate our hypothesis that PH is at least partially reversible, as in some congenital heart diseases, in a rat model we investigated whether release of constriction could attenuate pulmonary vascular remodeling and change the expression of endothelin (ET)-1 and endothelial nitric oxide synthase (eNOS). We used rats with LV dysfunction produced by an ascending aortic banding. In this study, there were four groups enrolled: 4-weeks banded (AOB(1-28); n = 7), 7-weeks banded (AOB(1-49); n = 7), debanded groups (AOB(1-28)/DeB(29-49); n = 7), and rats receiving a sham operation (n = 7). Subsequently, there was significant attenuation of medial hypertrophy in pulmonary arterioles and reversal of PH in the AOB(1-28)/DeB(29-49) group (sham, 19 +/- 1.3 mm Hg; AOB(1-28), 31 +/- 2.7 mm Hg; AOB(1-49), 32 +/- 2.7 mm Hg; and AOB(1-28)/DeB(29-49), 20 +/- 1...

Pharmacology, 2004

Eugenosedin-A is a newly synthesized compound with special serotonergic, alpha- and beta1-adrener... more Eugenosedin-A is a newly synthesized compound with special serotonergic, alpha- and beta1-adrenergic blocking actions. Intravenous injection of eugenosedin-A significantly caused dose-dependent decreases in the mean arterial blood pressure and heart rate in normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). The effects of eugenosedin-A-decreased blood pressure and heart rate in SHR were more potent than in WKY. In in vitro experiments, eugenosedin-A competitively antagonized the serotonin-, norepinephrine- and clonidine-induced vasocontraction in a concentration-dependent manner in isolated thoracic aorta of WKY and SHR. We also observed that eugenosedin-A competitively antagonized the isoproterenol-induced positive inotropic effects in a concentration-dependent manner in the isolated left atrium of WKY and SHR. These findings clearly suggested that eugenosedin-A possesses alpha1/alpha2, beta1 and 5-HT2A receptor-blocking activities. The order of pA2 values i...

General Pharmacology: The Vascular System, 2000

KMUP 880723 (0.5, 1.0, and 3.0 mg/kg, iv) produced dose-dependent hypotensive and bradycardia res... more KMUP 880723 (0.5, 1.0, and 3.0 mg/kg, iv) produced dose-dependent hypotensive and bradycardia responses in pentobarbitalanesthetized Wistar rats. KMUP 880723 (1.0 mg/kg, iv) also markedly inhibited both the tachycardia effects induced by ( À )isoproterenol and arterial pressor responses induced by phenylephrine. In the isolated Wistar rat right atria, left atria, and guinea pig tracheal strips, KMUP 880723 competitively antagonized the ( À )isoproterenol-induced positive chronotropic effects, inotropic effects, and tracheal relaxation effects in a concentration-dependent manner. The parallel shift to the right of the concentration -response curve of ( À )isoproterenol suggested that KMUP 880723 was a b 1 /b 2 -adrenoceptor competitive antagonist. The apparent pA 2 values were 6.89 ± 0.10 in the right atria, 7.02 ± 0.09 in the left atria, and 6.59 ± 0.11 in the trachea, indicating that KMUP 880723 was a nonselective b-adrenoceptor blocker. In thoracic aorta experiments, KMUP 880723 also produced a competitive antagonism of norepinephrine-induced contraction with a pA 2 value of 7.14 ± 0.06. In isolated rat thoracic aorta, KMUP 880723 more potently relaxed the contractions induced by norepinephrine (3 Â 10 À 6 M) than those by high K + (75 mM). In the radioligand-binding assay, the pK i values of [ 3 H]CGP-12177 binding to rat ventricle and lung membranes were 6.56 and 6.40, respectively, and the value of [ 3 H]prazosin binding to rat brain membranes was 6.66. These results further confirmed the a/b-adrenoceptor blocking activities of KMUP 880723 reported in the functional studies. We conclude that KMUP 880723 is a nonselective b-adrenoceptor antagonist with a-adrenoceptor blocking-associated vasorelaxant activity. D 2001 Elsevier Science Inc. All rights reserved.

Pharmacology, 2004

The antihypertensive effect of vanylidilol, a new alpha/beta-adrenoceptor antagonist with endothe... more The antihypertensive effect of vanylidilol, a new alpha/beta-adrenoceptor antagonist with endothelium-dependent and K(+)-channel-opening activities, was investigated in normotensive and hypertensive Wistar rats. Vanylidilol competitively antagonized (-)isoproterenol-induced positive chronotropic effects, inotropic effects, and tracheal relaxation effects in isolated rat right atria, left atria, and guinea pig tracheal strips in a concentration-dependent manner. Vanylidilol's apparent pA(2) values were 6.36 +/- 0.08 (right atria), 6.41 +/- 0.07 (left atria), and 6.31 +/- 0.06 (trachea). Vanylidilol also produced a competitive antagonism of phenylephrine-induced contraction in the isolated rat aorta with pA(2) values of 6.79 +/- 0.18. In the radioligand binding assay, vanylidilol inhibited [(3)H]CGP-12177 binding to rat ventricle and lung tissues and [(3)H]prazosin binding to brain membranes with Ki values of 535.17, 2,066.69, and 431.11, respectively. In isolated rat thoracic aorta, vanylidilol's vasorelaxant effects on phenylephrine (10 micromol/l)-induced contractions were attenuated by removing endothelium and by the presence of L-N(G)-nitro arginine methyl ester (L-NAME; 100 micromol/l), methylene blue (10 micromol/l), 1H-[1,2,4]oxadiazolol[4,3,-a] quinoxalin-1-one (ODQ; 10 micromol/l), tetraethylammonium (10 mmol/l), glibenclamide (1 micromol/l), apamin (1 micromol/l), and charybdotoxin (0.1 micromol/l). In addition, vanylidilol, in an equally antagonistic activity, inhibited phenylephrine-induced phasic and tonic contractions. Intravenous vanylidilol further reduced mean blood pressure in pentobarbital-anesthetized normotensive Wistar rats in a dose-dependent manner. The oral administration of vanylidilol to conscious spontaneously hypertensive rats had a long-lasting hypotensive effect on the heart rate and decreased it in a dose-dependent manner. Furthermore, vanylidilol's vasodilator effect can be attributed in part to the release of NO or NO-related substance from vascular endothelium, while the endothelium-independent mechanism involved in vanylidilol's relaxation is probably linked to the activation of the K(+) channels and the alpha-adrenoceptor blocking activity in these vessels.

Ultrasound in Medicine & Biology, 2004

To evaluate if pericardium is a suitable calibration reference in the integrated backscatter (IBS... more To evaluate if pericardium is a suitable calibration reference in the integrated backscatter (IBS) analysis, the grossly normal pericardial specimens from 23 patients without a history of pericarditis were mounted on a steel platform and immersed in a 0.9% saline bath. The 2-D IBS images acquired at the uniform time gain compensation settings of 50 and 70 dB were analyzed. For the pericardial IBS, the limits of agreement for intraobserver and interobserver measurements were ؊1.2 to 1.4 dB and ؊1.6 to 2.2 dB, respectively. However, the calibrated IBS intensity of the pericardium presented a rather wide range of variation and was ؊13 ؎ 5 (؊5 to ؊29) and ؊10 ؎ 4 (؊4 to ؊22) dB at the overall gain settings of 50 and 70 dB, respectively. Conclusively, pericardium may not be an ideal IBS calibration reference in a population study of cardiac tissue characterization. (E-mail: wcvoon@giga.net.tw) © 2004 World Federation for Ultrasound in Medicine & Biology.

PLoS ONE, 2014

Matrix metalloproteinases play a role in regulating cardiac remodeling. We previously reported an... more Matrix metalloproteinases play a role in regulating cardiac remodeling. We previously reported an association between tissue inhibitor of metalloproteinase 2 (TIMP-2) expression and mitral valve (MV) disease. However, the determinants and prognostic value of mitral TIMP2 after MV surgery are unknown. This retrospective study of 164 patients after MV surgery in a tertiary medical center in Taiwan assessed mitral TIMP2 on a semiquantitative scale (0-2) by immunohistochemical staining. The primary endpoints were the composite of cardiovascular death and heart failure admission. Mean age was 50.4±13.7 years. After a mean follow-up period of 101±59 months, primary endpoints had occurred in 25 (15.2%) subjects. Patients with and without primary endpoint events significantly differed in terms of age (56.6±14.4 vs. 49.2±13.4 years, respectively; p = 0.013) and left ventricular end-systolic diameter (LVESD) (39.7±8.2 vs. 35.5±7.5 mm, p = 0.010) at surgery. The TIMP2 had a significant dose-dependent association with development of a primary endpoint (p = 0.002). Kaplan-Meier analysis showed that TIMP2 expression has a significant positive association with primary endpoint-free survival (log-rank test; p = 0.004). Cox regression analysis showed that independent predictors of primary endpoints were TIMP2 (hazard ratio [HR] 0.28; 95% confidence interval [CI] 0.12-0.65; p = 0.003), age (HR 1.05; 95% CI 1.02-1.09; p = 0.003) and LVESD (HR 1.05; 95% CI 1.01-1.10; p = 0.020). The lack of mitral TIMP2 expression is associated with increases in cardiovascular death and heart failure following MV surgery.

Plastic and Reconstructive Surgery, 1984

Venograms were performed in three cases of reverse forearm flap. The "crossover ... more Venograms were performed in three cases of reverse forearm flap. The "crossover pattern" of the communicating branches between the two venae comitantes and the "bypass pattern" of the collateral branches of each vein have been demonstrated. These factors may explain the reverse drainage of venous blood, even though the valves of the vein are intact. Notably, the cephalic vein also shows a good communication with the deep venous system. Thus it can contribute another route for venous drainage in this flap.

Life Sciences, 2006

The effects of labedipinedilol-A, a novel dihydropyridine-type calcium channel blocker with alpha... more The effects of labedipinedilol-A, a novel dihydropyridine-type calcium channel blocker with alpha-/beta-adrenoceptor blocking activities, on myocardial infarct size, apoptosis and necrosis in the rat after myocardial ischemia/reperfusion (45 min/120 min) were investigated. Ten minutes prior to left coronary artery occlusion, rats were treated with vehicle or labedipinedilol-A (0.25 or 0.5 mg/kg, i.v.). In the vehicle group, myocardial ischemia-reperfusion induced creatine kinase (CK) release and caused cardiomyocyte apoptosis, as evidenced by DNA ladder formation and terminal dUTP deoxynucleotidyltransferase nick end-labeling (TUNEL) staining. Treatment with labedipinedilol-A (0.25 or 0.5 mg/kg) reduced infarct size significantly compared to vehicle group (18.75+/-0.65% and 8.27+/-0.29% vs. 41.72+/-0.73%, P<0.01). Labedipinedilol-A also reduced the CK, CK-MB, lactate dehydrogenase (LDH) and troponin T levels in blood. In addition, labedipinedilol-A (0.5 mg/kg) significantly decreased TUNEL positive cells from 19.21+/-0.52% to 9.73+/-0.81% (P<0.01), which is consistent with absence of DNA ladders in the labedipinedilol-A group. Moreover, labedipinedilol-A pretreatment also decreased calcium content in ischemic-reperfused myocardial tissue. In conclusion, these results demonstrate that labedipindielol-A, through reduction of calcium overload and apoptosis, exerts anti-infarct effect during myocardial ischemia-reperfusion and would be useful clinically in the prevention of acute myocardial infarction.

The Kaohsiung Journal of Medical Sciences, 2005

The Kaohsiung Journal of Medical Sciences, 2006

The increasing use of coronary stents in current percutaneous coronary intervention (PCI) has bee... more The increasing use of coronary stents in current percutaneous coronary intervention (PCI) has been accompanied by several complications, including groin site bleeding due to aggressive anticoagulation, stent thrombosis, and stent malposition . Stent entrapment has been reported rarely but sometimes requires emergency surgical treatment . We report here a patient suffering from such a rare PCI complication. During the procedure the stent was entrapped in the left circumflex and left main coronary artery. Later, the angioplasty balloon with stent became disconnected from the proximal shaft of the balloon catheter.

The Kaohsiung Journal of Medical Sciences, 2005

We present the case of a 71-year-old diabetic man who came to us complaining of dyspnea for 1 mon... more We present the case of a 71-year-old diabetic man who came to us complaining of dyspnea for 1 month. Chest X-ray showed cardiomegaly and bilateral pleural effusion. Echocardiography showed a pericardial cystic mass with external compression of the right ventricle. Because of clinically impending cardiac tamponade, we performed urgent sternotomy and removed the pericardial mass without event. Pathologic examination of the excised pericardial specimen showed caseous necrosis compatible with tuberculosis infection. The patient was put on a 1-year treatment regimen of anti-tuberculosis medication. This case is an important reminder that tuberculosis can occur as a pericardial abscess.

Journal of Microbiology, Immunology and Infection, 2010

BACKGROUND/PURPOSE: Surgical site infection (SSI) after cardiac surgery leads to morbidity and mo... more BACKGROUND/PURPOSE: Surgical site infection (SSI) after cardiac surgery leads to morbidity and mortality. Identifying SSI risk factors, which vary between populations, is important in preventing infection. METHODS: A retrospective chart review of adult cases receiving cardiac surgery in a Taiwan medical center in 2004 and 2005. RESULTS: Of the 260 cases included in the study, 169 (65.0%) received a coronary artery bypass graft, 65 (25.0%) cardiac valvular surgery and 26 (10.0%) aortic or septal defect operations. The SSI rate was 13.5%. Univariate analysis showed that chronic obstructive pulmonary disease (COPD) (p = 0.008), congestive heart failure New York Heart Association class IV (p = 0.048), longer preoperative hospital stay, preoperative nosocomial infection, higher volume of blood loss and larger packed red blood cell transfusions during the operation were significantly related to SSI. Logistic regression analysis further identified COPD, preoperative nosocomial infection and emergency surgery as being independently associated with SSI (odds ratios of 4.96, 5.88 and 9.77, respectively). Obesity and diabetes mellitus were not associated with SSI. CONCLUSION: COPD is an independent underlying illness associated with SSI after cardiac surgery. Minimizing preoperative hospitalization and nosocomial infection, and awareness of cases presenting with relevant risk factors, are useful in reducing SSI.

Journal of Hypertension, 2009

We previously found the association between mitral chordae tendinae ruptures (MCTR) and hypertens... more We previously found the association between mitral chordae tendinae ruptures (MCTR) and hypertension. Tissue inhibitor of metalloproteinase-2 (TIMP2), which expresses differently under pressure loads, could trigger a signal cascade instigating cardiac fibrosis, possibly predisposing to MCTR. We aimed to elucidate the relationship between the TIMP2 and hypertension and the effect they may have on the occurrence of MCTR. Using a cross-sectional study in a tertiary medical center in Taiwan, we enrolled 186 patients who had received mitral valve replacements and classified them into two groups: 64 (34%) with MCTR and 122 (66%) without MCTR. Expression of mitral TIMP2 was assessed on a semiquantitative scale (grade 0-3) by immunohistochemical staining using antibodies against TIMP2. TIMP2 expression was significantly higher in MCTR patients (P < 0.001). Multiple logistic regression analysis showed four independent risk factors: TIMP2 [odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.18-2.81, P = 0.007], hypertension (OR = 2.40, CI = 1.08-5.34, P = 0.032), rheumatic heart disease (OR = 0.18, CI = 0.05-0.70, P = 0.014), and left ventricular end-diastolic dimension (OR = 1.10, CI = 1.05-1.15, P < 0.001). Among nonhypertensive patients, the higher expression of TIMP2 (grade 2 and 3 vs. 0 and 1) was associated with a 3.27-fold risk. However, hypertensive patients with higher TIMP2 expression had a significantly 10-fold higher risk (P < 0.001 for interaction). Mitral TIMP2 expression is higher in patients with MCTR and there is a synergistic effect of mitral TIMP2 staining with hypertension on the occurrence of MCTR.

Journal of Cardiovascular Pharmacology, 2005

Intravenous and oral labedipinedilol-C showed a dose-dependent long-lasting hypotension and a dec... more Intravenous and oral labedipinedilol-C showed a dose-dependent long-lasting hypotension and a decrease of heart rate in normotensive and conscious spontaneously hypertensive rats (SHR). In isolated Wistar rat and guinea pig tissues, labedipinedilol-C competitively antagonized (-)isoproterenol-induced cardiac stimulation, tracheal relaxation, and phenylephrine-, CaCl2-, and high-K-induced aorta contractions in a concentration-dependent manner. The estimated pA2 and pKCa values were 8.22+/-0.04 and 7.11+/-0.52, respectively. [H]CGP-12177 binding to ventricle and lung tissues as well as [H]prazosin and [H]nitrendipine binding to brain membranes were inhibited by labedipinedilol-C with Ki values of 2.86, 9.03, 0.39, and 0.05 muM, respectively. The vasorelaxant effects of labedipinedilol-C on phenylephrine (10 microM)-induced contractions were attenuated by removing endothelium, by pretreatment with soluble guanylyl cyclase (sGC) inhibitors ODQ (10 microM) and methylene blue (10 microM), a NOS inhibitor L-NAME (100 microM), a K channel blocker TEA (10 mM), a KATP channel blocker glibenclamide (1 microM), and Ca-dependent K channel blockers apamin (1 microM) and charybdotoxin (0.1 microM). In human umbilical vein endothelial cells (HUVECs), labedipinedilol-C increased NO release, which was significantly inhibited by L-NAME. The Western blot analysis on HUVECs indicated that labedipinedilol-C increased the expression of eNOS. These results indicate that hypotension effects of labedipinedilol-C result from alpha-adrenoceptor and Ca entry-blocking activities and release of NO or NO-related substance from vascular endothelium. The endothelium-independent relaxation of vascular smooth muscle is probably linked to K channel opening and alpha-adrenoceptor-blocking activities.

Journal of Cardiovascular Pharmacology, 2005

The cellular mechanisms of vasorelaxant effects of newly synthesized KMUP-3 and KMUP-4 were inves... more The cellular mechanisms of vasorelaxant effects of newly synthesized KMUP-3 and KMUP-4 were investigated in rat aortic smooth muscle (RASM). KMUP-3 (7-[2-[4-(4-nitrobenzene)piperazinyl]ethyl]-1,3-dimethylxanthine) and KMUP-4 (7-[2-[4-(2-nitrobenzene)piperazinyl]ethyl]-1,3-dimethylxanthine) elicited concentration-dependent relaxation of endothelium-intact and denuded RASM precontracted with phenylephrine. Relaxant responses were also produced by the PDE inhibitors theophylline, milrinone, rolipram, and zaprinast (1 nM-100 microM). The relaxant responses of KMUP-3 and KMUP-4 were reduced by endothelium removal and by the presence of the NOS inhibitor L-NAME (100 microM), the sGC inhibitor ODQ (1 microM), the adenylyl cyclase (AC) inhibitor SQ 22536 (100 microM), and the prostaglandin inhibitor indomethacin (10 microM). Additionally, the vasorelaxations of both agents were also attenuated by pretreatment with the nonselective K+ channel blocker TEA (10 mM), the KATP channel blocker glibenclamide (1 microM), the voltage-dependent K+ (KV) channel blocker 4-AP (100 microM), and Ca(2+)-dependent K+ (KCa) channel blockers apamin (1 microM) and charybdotoxin (ChTX, 0.1 microM). In addition, elevated extracellular K+ (80 mM) interferes with KMUP-3- and KMUP-4-induced vasorelaxations. Preincubation with both agents (1 microM) significantly enhanced the dilator responses of isoproterenol and SNP. KMUP-3 and KMUP-4 inhibited PDE activities and increased cAMP and cGMP levels in primary culture of RASM that were inhibited by SQ 22536 and ODQ, respectively. In cultured HUVECs, KMUP-3 and KMUP-4 (0.1 microM), more potent than YC-1, significantly increased the expression of eNOS protein. In summary, KMUP-3 and KMUP-4 induce aortic relaxations through both endothelium-dependent and -independent mechanisms. Mechanisms of vasorelaxation induced by both compounds involve multiple processes, such as accumulation of cyclic nucleotides partly as a result of PDE inhibition, K-channel activation, and indomethacin-sensitive endothelium function.

Journal of Cardiovascular Pharmacology, 2004

Labedipinedilol-A is a novel 1, 4-dihydropyridine type calcium antagonist with alpha-receptor blo... more Labedipinedilol-A is a novel 1, 4-dihydropyridine type calcium antagonist with alpha-receptor blocking activity. This study investigates the effects of labedipinedilol-A on mitogen-induced proliferation of rat vascular smooth muscle cells (VSMCs). Labedipinedilol-A's inhibition on cell proliferation was measured by the tetrazolium salt (XTT) test. Labedipinedilol-A dose-dependently inhibited mitogen-induced DNA synthesis, determined by the incorporation of 5-bromo-2'-deoxyuridine (BrdU). Labedipinedilol-A was also found capable of inhibiting the migration of VSMCs induced by PDGF-BB with an IC50 value of 5.6 microM. In accordance with these findings, labedipinedilol-A revealed blocking of the FBS-inducible progression through G0/G1 to S phase of the cell cycle in synchronized cells. Labedipinedilol-A appeared to cause inhibition of mitogens-induced PKC translocation, suggesting the probable involvement of protein kinase C (PKC) in this cellular response. Labedipinedilol-A reduced both intracellular Ca and the phosphorylation of extracellular signal-regulated protein kinase 1/2 in PDGF-BB-stimulated VSMCs. It also suppressed the levels of proliferative cell nuclear antigen (PCNA) in VSMCs both time- and dose-dependently. These results indicate that labedipinedilol-A may inhibit cell proliferation by attenuating activation of the ERK 1/2 pathway, which is regulated by PKC and Ca, suggesting that it may have great potential in the prevention of progressive atherosclerosis.

Journal of Cardiac Surgery, 2008

Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the c... more Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the cause of postoperative morbidity and mortality. We present a case of deep sternal wound infection after sternotomy. The patient received three treatments of surgical debridement, irrigation, topical negative pressure (TNP) dressing, and hyperbaric oxygen (HBO) therapy. Forty-five HBO therapy sessions were administered. After nine weeks, the sternal wound was healed and completely epithelialized. This conservative therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.

International Journal of Cardiology, 2007

giographic analysis was done for lesion and reference segments; these parameters were compared be... more giographic analysis was done for lesion and reference segments; these parameters were compared before and after coronary intervention. The two different TZDs angiographic and clinical outcome were compared. Results: There were better clinical outcomes at seven years follow up. TZDs group had better survivial rate (93.3% vs. 87.8%, p<0.0001). The total death (17.3% vs. 7.1%, p<0.001), cardiac death (8.8% vs. 3.1%, p<0.001), and noncardiac death (8.5% vs. 3.9%, p<0.05) were significantly reduced in TZDs group. At angiographic follow up symptomatic patients reocclusion rate is significant lower (6% vs. 12%, P=0.036) in TZDs group. Among angiographic follow up pateints, TZDs group also had better clinical outcomes. The total death (14.8% vs. 75.8%, p<0.001), cardiac death (7.2% vs. 2.4%, p<0.05), and non-cardiac death (7.6% vs. 3.4%, p<0.05) were significantly reduced in TZDs group. The difference was not seen between rosiglitazone and pioglitazone. Conclusions: TZDs are a efficacy treatment strategy for diabetic patients with coronary angiography proved coronary artery disease. TZDs reduced the total death, cardiac death, and non-cardiac death. There was better survival rate in seven years follow up. A favorable angiographic outcome of reduction reocclusion rate was found in symptomatic diabetic patients. The results revealed better angiographic and clinical outcome in TZDs group. There was no stastic difference of clinical and angiographic outcomes between the two TZDs.

International Journal of Cardiology, 2003

Japanese Heart Journal, 2000

Cardiac fibromas are rare lesions which occur more often in infants and children than in adults. ... more Cardiac fibromas are rare lesions which occur more often in infants and children than in adults. These tumors are benign proliferations of connective tissue most often found in the left ventricular myocardium or septum. In an 8-month-old infant with cyanosis and progressive exertional dyspnea, a huge cardiac tumor obstructing the right ventricular outflow tract (RVOT) was diagnosed by means of 2-dimensional echocardiography and cardiac catheterization. At surgery, a whitish gray solitary tumor measuring 5.0 x 4.5 cm could be well visualized. It was nearly totally resected, and the RVOT was reconstructed with an Equine pericardial patch. Histologic examination classified the tumor as a fibroma. Although surgical mortality in cardiac fibroma with RVOT obstruction is extremely high, early diagnosis and prompt excision of the tumor is mandatory in relieving its dangerous symptoms.

Experimental biology and medicine (Maywood, N.J.), 2006

Pulmonary hypertension (PH) usually develops secondary to left ventricular (LV) dysfunction; ther... more Pulmonary hypertension (PH) usually develops secondary to left ventricular (LV) dysfunction; therefore, it is also called retrograde PH. To investigate our hypothesis that PH is at least partially reversible, as in some congenital heart diseases, in a rat model we investigated whether release of constriction could attenuate pulmonary vascular remodeling and change the expression of endothelin (ET)-1 and endothelial nitric oxide synthase (eNOS). We used rats with LV dysfunction produced by an ascending aortic banding. In this study, there were four groups enrolled: 4-weeks banded (AOB(1-28); n = 7), 7-weeks banded (AOB(1-49); n = 7), debanded groups (AOB(1-28)/DeB(29-49); n = 7), and rats receiving a sham operation (n = 7). Subsequently, there was significant attenuation of medial hypertrophy in pulmonary arterioles and reversal of PH in the AOB(1-28)/DeB(29-49) group (sham, 19 +/- 1.3 mm Hg; AOB(1-28), 31 +/- 2.7 mm Hg; AOB(1-49), 32 +/- 2.7 mm Hg; and AOB(1-28)/DeB(29-49), 20 +/- 1...

Pharmacology, 2004

Eugenosedin-A is a newly synthesized compound with special serotonergic, alpha- and beta1-adrener... more Eugenosedin-A is a newly synthesized compound with special serotonergic, alpha- and beta1-adrenergic blocking actions. Intravenous injection of eugenosedin-A significantly caused dose-dependent decreases in the mean arterial blood pressure and heart rate in normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). The effects of eugenosedin-A-decreased blood pressure and heart rate in SHR were more potent than in WKY. In in vitro experiments, eugenosedin-A competitively antagonized the serotonin-, norepinephrine- and clonidine-induced vasocontraction in a concentration-dependent manner in isolated thoracic aorta of WKY and SHR. We also observed that eugenosedin-A competitively antagonized the isoproterenol-induced positive inotropic effects in a concentration-dependent manner in the isolated left atrium of WKY and SHR. These findings clearly suggested that eugenosedin-A possesses alpha1/alpha2, beta1 and 5-HT2A receptor-blocking activities. The order of pA2 values i...

General Pharmacology: The Vascular System, 2000

KMUP 880723 (0.5, 1.0, and 3.0 mg/kg, iv) produced dose-dependent hypotensive and bradycardia res... more KMUP 880723 (0.5, 1.0, and 3.0 mg/kg, iv) produced dose-dependent hypotensive and bradycardia responses in pentobarbitalanesthetized Wistar rats. KMUP 880723 (1.0 mg/kg, iv) also markedly inhibited both the tachycardia effects induced by ( À )isoproterenol and arterial pressor responses induced by phenylephrine. In the isolated Wistar rat right atria, left atria, and guinea pig tracheal strips, KMUP 880723 competitively antagonized the ( À )isoproterenol-induced positive chronotropic effects, inotropic effects, and tracheal relaxation effects in a concentration-dependent manner. The parallel shift to the right of the concentration -response curve of ( À )isoproterenol suggested that KMUP 880723 was a b 1 /b 2 -adrenoceptor competitive antagonist. The apparent pA 2 values were 6.89 ± 0.10 in the right atria, 7.02 ± 0.09 in the left atria, and 6.59 ± 0.11 in the trachea, indicating that KMUP 880723 was a nonselective b-adrenoceptor blocker. In thoracic aorta experiments, KMUP 880723 also produced a competitive antagonism of norepinephrine-induced contraction with a pA 2 value of 7.14 ± 0.06. In isolated rat thoracic aorta, KMUP 880723 more potently relaxed the contractions induced by norepinephrine (3 Â 10 À 6 M) than those by high K + (75 mM). In the radioligand-binding assay, the pK i values of [ 3 H]CGP-12177 binding to rat ventricle and lung membranes were 6.56 and 6.40, respectively, and the value of [ 3 H]prazosin binding to rat brain membranes was 6.66. These results further confirmed the a/b-adrenoceptor blocking activities of KMUP 880723 reported in the functional studies. We conclude that KMUP 880723 is a nonselective b-adrenoceptor antagonist with a-adrenoceptor blocking-associated vasorelaxant activity. D 2001 Elsevier Science Inc. All rights reserved.

Pharmacology, 2004

The antihypertensive effect of vanylidilol, a new alpha/beta-adrenoceptor antagonist with endothe... more The antihypertensive effect of vanylidilol, a new alpha/beta-adrenoceptor antagonist with endothelium-dependent and K(+)-channel-opening activities, was investigated in normotensive and hypertensive Wistar rats. Vanylidilol competitively antagonized (-)isoproterenol-induced positive chronotropic effects, inotropic effects, and tracheal relaxation effects in isolated rat right atria, left atria, and guinea pig tracheal strips in a concentration-dependent manner. Vanylidilol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s apparent pA(2) values were 6.36 +/- 0.08 (right atria), 6.41 +/- 0.07 (left atria), and 6.31 +/- 0.06 (trachea). Vanylidilol also produced a competitive antagonism of phenylephrine-induced contraction in the isolated rat aorta with pA(2) values of 6.79 +/- 0.18. In the radioligand binding assay, vanylidilol inhibited [(3)H]CGP-12177 binding to rat ventricle and lung tissues and [(3)H]prazosin binding to brain membranes with Ki values of 535.17, 2,066.69, and 431.11, respectively. In isolated rat thoracic aorta, vanylidilol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s vasorelaxant effects on phenylephrine (10 micromol/l)-induced contractions were attenuated by removing endothelium and by the presence of L-N(G)-nitro arginine methyl ester (L-NAME; 100 micromol/l), methylene blue (10 micromol/l), 1H-[1,2,4]oxadiazolol[4,3,-a] quinoxalin-1-one (ODQ; 10 micromol/l), tetraethylammonium (10 mmol/l), glibenclamide (1 micromol/l), apamin (1 micromol/l), and charybdotoxin (0.1 micromol/l). In addition, vanylidilol, in an equally antagonistic activity, inhibited phenylephrine-induced phasic and tonic contractions. Intravenous vanylidilol further reduced mean blood pressure in pentobarbital-anesthetized normotensive Wistar rats in a dose-dependent manner. The oral administration of vanylidilol to conscious spontaneously hypertensive rats had a long-lasting hypotensive effect on the heart rate and decreased it in a dose-dependent manner. Furthermore, vanylidilol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s vasodilator effect can be attributed in part to the release of NO or NO-related substance from vascular endothelium, while the endothelium-independent mechanism involved in vanylidilol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s relaxation is probably linked to the activation of the K(+) channels and the alpha-adrenoceptor blocking activity in these vessels.

Ultrasound in Medicine & Biology, 2004

To evaluate if pericardium is a suitable calibration reference in the integrated backscatter (IBS... more To evaluate if pericardium is a suitable calibration reference in the integrated backscatter (IBS) analysis, the grossly normal pericardial specimens from 23 patients without a history of pericarditis were mounted on a steel platform and immersed in a 0.9% saline bath. The 2-D IBS images acquired at the uniform time gain compensation settings of 50 and 70 dB were analyzed. For the pericardial IBS, the limits of agreement for intraobserver and interobserver measurements were ؊1.2 to 1.4 dB and ؊1.6 to 2.2 dB, respectively. However, the calibrated IBS intensity of the pericardium presented a rather wide range of variation and was ؊13 ؎ 5 (؊5 to ؊29) and ؊10 ؎ 4 (؊4 to ؊22) dB at the overall gain settings of 50 and 70 dB, respectively. Conclusively, pericardium may not be an ideal IBS calibration reference in a population study of cardiac tissue characterization. (E-mail: wcvoon@giga.net.tw) © 2004 World Federation for Ultrasound in Medicine & Biology.

PLoS ONE, 2014

Matrix metalloproteinases play a role in regulating cardiac remodeling. We previously reported an... more Matrix metalloproteinases play a role in regulating cardiac remodeling. We previously reported an association between tissue inhibitor of metalloproteinase 2 (TIMP-2) expression and mitral valve (MV) disease. However, the determinants and prognostic value of mitral TIMP2 after MV surgery are unknown. This retrospective study of 164 patients after MV surgery in a tertiary medical center in Taiwan assessed mitral TIMP2 on a semiquantitative scale (0-2) by immunohistochemical staining. The primary endpoints were the composite of cardiovascular death and heart failure admission. Mean age was 50.4±13.7 years. After a mean follow-up period of 101±59 months, primary endpoints had occurred in 25 (15.2%) subjects. Patients with and without primary endpoint events significantly differed in terms of age (56.6±14.4 vs. 49.2±13.4 years, respectively; p = 0.013) and left ventricular end-systolic diameter (LVESD) (39.7±8.2 vs. 35.5±7.5 mm, p = 0.010) at surgery. The TIMP2 had a significant dose-dependent association with development of a primary endpoint (p = 0.002). Kaplan-Meier analysis showed that TIMP2 expression has a significant positive association with primary endpoint-free survival (log-rank test; p = 0.004). Cox regression analysis showed that independent predictors of primary endpoints were TIMP2 (hazard ratio [HR] 0.28; 95% confidence interval [CI] 0.12-0.65; p = 0.003), age (HR 1.05; 95% CI 1.02-1.09; p = 0.003) and LVESD (HR 1.05; 95% CI 1.01-1.10; p = 0.020). The lack of mitral TIMP2 expression is associated with increases in cardiovascular death and heart failure following MV surgery.

Plastic and Reconstructive Surgery, 1984

Venograms were performed in three cases of reverse forearm flap. The &amp;amp;quot;crossover ... more Venograms were performed in three cases of reverse forearm flap. The &amp;amp;quot;crossover pattern&amp;amp;quot; of the communicating branches between the two venae comitantes and the &amp;amp;quot;bypass pattern&amp;amp;quot; of the collateral branches of each vein have been demonstrated. These factors may explain the reverse drainage of venous blood, even though the valves of the vein are intact. Notably, the cephalic vein also shows a good communication with the deep venous system. Thus it can contribute another route for venous drainage in this flap.

Life Sciences, 2006

The effects of labedipinedilol-A, a novel dihydropyridine-type calcium channel blocker with alpha... more The effects of labedipinedilol-A, a novel dihydropyridine-type calcium channel blocker with alpha-/beta-adrenoceptor blocking activities, on myocardial infarct size, apoptosis and necrosis in the rat after myocardial ischemia/reperfusion (45 min/120 min) were investigated. Ten minutes prior to left coronary artery occlusion, rats were treated with vehicle or labedipinedilol-A (0.25 or 0.5 mg/kg, i.v.). In the vehicle group, myocardial ischemia-reperfusion induced creatine kinase (CK) release and caused cardiomyocyte apoptosis, as evidenced by DNA ladder formation and terminal dUTP deoxynucleotidyltransferase nick end-labeling (TUNEL) staining. Treatment with labedipinedilol-A (0.25 or 0.5 mg/kg) reduced infarct size significantly compared to vehicle group (18.75+/-0.65% and 8.27+/-0.29% vs. 41.72+/-0.73%, P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Labedipinedilol-A also reduced the CK, CK-MB, lactate dehydrogenase (LDH) and troponin T levels in blood. In addition, labedipinedilol-A (0.5 mg/kg) significantly decreased TUNEL positive cells from 19.21+/-0.52% to 9.73+/-0.81% (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), which is consistent with absence of DNA ladders in the labedipinedilol-A group. Moreover, labedipinedilol-A pretreatment also decreased calcium content in ischemic-reperfused myocardial tissue. In conclusion, these results demonstrate that labedipindielol-A, through reduction of calcium overload and apoptosis, exerts anti-infarct effect during myocardial ischemia-reperfusion and would be useful clinically in the prevention of acute myocardial infarction.

The Kaohsiung Journal of Medical Sciences, 2005

The Kaohsiung Journal of Medical Sciences, 2006

The increasing use of coronary stents in current percutaneous coronary intervention (PCI) has bee... more The increasing use of coronary stents in current percutaneous coronary intervention (PCI) has been accompanied by several complications, including groin site bleeding due to aggressive anticoagulation, stent thrombosis, and stent malposition . Stent entrapment has been reported rarely but sometimes requires emergency surgical treatment . We report here a patient suffering from such a rare PCI complication. During the procedure the stent was entrapped in the left circumflex and left main coronary artery. Later, the angioplasty balloon with stent became disconnected from the proximal shaft of the balloon catheter.

The Kaohsiung Journal of Medical Sciences, 2005

We present the case of a 71-year-old diabetic man who came to us complaining of dyspnea for 1 mon... more We present the case of a 71-year-old diabetic man who came to us complaining of dyspnea for 1 month. Chest X-ray showed cardiomegaly and bilateral pleural effusion. Echocardiography showed a pericardial cystic mass with external compression of the right ventricle. Because of clinically impending cardiac tamponade, we performed urgent sternotomy and removed the pericardial mass without event. Pathologic examination of the excised pericardial specimen showed caseous necrosis compatible with tuberculosis infection. The patient was put on a 1-year treatment regimen of anti-tuberculosis medication. This case is an important reminder that tuberculosis can occur as a pericardial abscess.

Journal of Microbiology, Immunology and Infection, 2010

BACKGROUND/PURPOSE: Surgical site infection (SSI) after cardiac surgery leads to morbidity and mo... more BACKGROUND/PURPOSE: Surgical site infection (SSI) after cardiac surgery leads to morbidity and mortality. Identifying SSI risk factors, which vary between populations, is important in preventing infection. METHODS: A retrospective chart review of adult cases receiving cardiac surgery in a Taiwan medical center in 2004 and 2005. RESULTS: Of the 260 cases included in the study, 169 (65.0%) received a coronary artery bypass graft, 65 (25.0%) cardiac valvular surgery and 26 (10.0%) aortic or septal defect operations. The SSI rate was 13.5%. Univariate analysis showed that chronic obstructive pulmonary disease (COPD) (p = 0.008), congestive heart failure New York Heart Association class IV (p = 0.048), longer preoperative hospital stay, preoperative nosocomial infection, higher volume of blood loss and larger packed red blood cell transfusions during the operation were significantly related to SSI. Logistic regression analysis further identified COPD, preoperative nosocomial infection and emergency surgery as being independently associated with SSI (odds ratios of 4.96, 5.88 and 9.77, respectively). Obesity and diabetes mellitus were not associated with SSI. CONCLUSION: COPD is an independent underlying illness associated with SSI after cardiac surgery. Minimizing preoperative hospitalization and nosocomial infection, and awareness of cases presenting with relevant risk factors, are useful in reducing SSI.

Journal of Hypertension, 2009

We previously found the association between mitral chordae tendinae ruptures (MCTR) and hypertens... more We previously found the association between mitral chordae tendinae ruptures (MCTR) and hypertension. Tissue inhibitor of metalloproteinase-2 (TIMP2), which expresses differently under pressure loads, could trigger a signal cascade instigating cardiac fibrosis, possibly predisposing to MCTR. We aimed to elucidate the relationship between the TIMP2 and hypertension and the effect they may have on the occurrence of MCTR. Using a cross-sectional study in a tertiary medical center in Taiwan, we enrolled 186 patients who had received mitral valve replacements and classified them into two groups: 64 (34%) with MCTR and 122 (66%) without MCTR. Expression of mitral TIMP2 was assessed on a semiquantitative scale (grade 0-3) by immunohistochemical staining using antibodies against TIMP2. TIMP2 expression was significantly higher in MCTR patients (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Multiple logistic regression analysis showed four independent risk factors: TIMP2 [odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.18-2.81, P = 0.007], hypertension (OR = 2.40, CI = 1.08-5.34, P = 0.032), rheumatic heart disease (OR = 0.18, CI = 0.05-0.70, P = 0.014), and left ventricular end-diastolic dimension (OR = 1.10, CI = 1.05-1.15, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Among nonhypertensive patients, the higher expression of TIMP2 (grade 2 and 3 vs. 0 and 1) was associated with a 3.27-fold risk. However, hypertensive patients with higher TIMP2 expression had a significantly 10-fold higher risk (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 for interaction). Mitral TIMP2 expression is higher in patients with MCTR and there is a synergistic effect of mitral TIMP2 staining with hypertension on the occurrence of MCTR.

Journal of Cardiovascular Pharmacology, 2005

Intravenous and oral labedipinedilol-C showed a dose-dependent long-lasting hypotension and a dec... more Intravenous and oral labedipinedilol-C showed a dose-dependent long-lasting hypotension and a decrease of heart rate in normotensive and conscious spontaneously hypertensive rats (SHR). In isolated Wistar rat and guinea pig tissues, labedipinedilol-C competitively antagonized (-)isoproterenol-induced cardiac stimulation, tracheal relaxation, and phenylephrine-, CaCl2-, and high-K-induced aorta contractions in a concentration-dependent manner. The estimated pA2 and pKCa values were 8.22+/-0.04 and 7.11+/-0.52, respectively. [H]CGP-12177 binding to ventricle and lung tissues as well as [H]prazosin and [H]nitrendipine binding to brain membranes were inhibited by labedipinedilol-C with Ki values of 2.86, 9.03, 0.39, and 0.05 muM, respectively. The vasorelaxant effects of labedipinedilol-C on phenylephrine (10 microM)-induced contractions were attenuated by removing endothelium, by pretreatment with soluble guanylyl cyclase (sGC) inhibitors ODQ (10 microM) and methylene blue (10 microM), a NOS inhibitor L-NAME (100 microM), a K channel blocker TEA (10 mM), a KATP channel blocker glibenclamide (1 microM), and Ca-dependent K channel blockers apamin (1 microM) and charybdotoxin (0.1 microM). In human umbilical vein endothelial cells (HUVECs), labedipinedilol-C increased NO release, which was significantly inhibited by L-NAME. The Western blot analysis on HUVECs indicated that labedipinedilol-C increased the expression of eNOS. These results indicate that hypotension effects of labedipinedilol-C result from alpha-adrenoceptor and Ca entry-blocking activities and release of NO or NO-related substance from vascular endothelium. The endothelium-independent relaxation of vascular smooth muscle is probably linked to K channel opening and alpha-adrenoceptor-blocking activities.

Journal of Cardiovascular Pharmacology, 2005

The cellular mechanisms of vasorelaxant effects of newly synthesized KMUP-3 and KMUP-4 were inves... more The cellular mechanisms of vasorelaxant effects of newly synthesized KMUP-3 and KMUP-4 were investigated in rat aortic smooth muscle (RASM). KMUP-3 (7-[2-[4-(4-nitrobenzene)piperazinyl]ethyl]-1,3-dimethylxanthine) and KMUP-4 (7-[2-[4-(2-nitrobenzene)piperazinyl]ethyl]-1,3-dimethylxanthine) elicited concentration-dependent relaxation of endothelium-intact and denuded RASM precontracted with phenylephrine. Relaxant responses were also produced by the PDE inhibitors theophylline, milrinone, rolipram, and zaprinast (1 nM-100 microM). The relaxant responses of KMUP-3 and KMUP-4 were reduced by endothelium removal and by the presence of the NOS inhibitor L-NAME (100 microM), the sGC inhibitor ODQ (1 microM), the adenylyl cyclase (AC) inhibitor SQ 22536 (100 microM), and the prostaglandin inhibitor indomethacin (10 microM). Additionally, the vasorelaxations of both agents were also attenuated by pretreatment with the nonselective K+ channel blocker TEA (10 mM), the KATP channel blocker glibenclamide (1 microM), the voltage-dependent K+ (KV) channel blocker 4-AP (100 microM), and Ca(2+)-dependent K+ (KCa) channel blockers apamin (1 microM) and charybdotoxin (ChTX, 0.1 microM). In addition, elevated extracellular K+ (80 mM) interferes with KMUP-3- and KMUP-4-induced vasorelaxations. Preincubation with both agents (1 microM) significantly enhanced the dilator responses of isoproterenol and SNP. KMUP-3 and KMUP-4 inhibited PDE activities and increased cAMP and cGMP levels in primary culture of RASM that were inhibited by SQ 22536 and ODQ, respectively. In cultured HUVECs, KMUP-3 and KMUP-4 (0.1 microM), more potent than YC-1, significantly increased the expression of eNOS protein. In summary, KMUP-3 and KMUP-4 induce aortic relaxations through both endothelium-dependent and -independent mechanisms. Mechanisms of vasorelaxation induced by both compounds involve multiple processes, such as accumulation of cyclic nucleotides partly as a result of PDE inhibition, K-channel activation, and indomethacin-sensitive endothelium function.

Journal of Cardiovascular Pharmacology, 2004

Labedipinedilol-A is a novel 1, 4-dihydropyridine type calcium antagonist with alpha-receptor blo... more Labedipinedilol-A is a novel 1, 4-dihydropyridine type calcium antagonist with alpha-receptor blocking activity. This study investigates the effects of labedipinedilol-A on mitogen-induced proliferation of rat vascular smooth muscle cells (VSMCs). Labedipinedilol-A&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s inhibition on cell proliferation was measured by the tetrazolium salt (XTT) test. Labedipinedilol-A dose-dependently inhibited mitogen-induced DNA synthesis, determined by the incorporation of 5-bromo-2&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-deoxyuridine (BrdU). Labedipinedilol-A was also found capable of inhibiting the migration of VSMCs induced by PDGF-BB with an IC50 value of 5.6 microM. In accordance with these findings, labedipinedilol-A revealed blocking of the FBS-inducible progression through G0/G1 to S phase of the cell cycle in synchronized cells. Labedipinedilol-A appeared to cause inhibition of mitogens-induced PKC translocation, suggesting the probable involvement of protein kinase C (PKC) in this cellular response. Labedipinedilol-A reduced both intracellular Ca and the phosphorylation of extracellular signal-regulated protein kinase 1/2 in PDGF-BB-stimulated VSMCs. It also suppressed the levels of proliferative cell nuclear antigen (PCNA) in VSMCs both time- and dose-dependently. These results indicate that labedipinedilol-A may inhibit cell proliferation by attenuating activation of the ERK 1/2 pathway, which is regulated by PKC and Ca, suggesting that it may have great potential in the prevention of progressive atherosclerosis.

Journal of Cardiac Surgery, 2008

Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the c... more Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the cause of postoperative morbidity and mortality. We present a case of deep sternal wound infection after sternotomy. The patient received three treatments of surgical debridement, irrigation, topical negative pressure (TNP) dressing, and hyperbaric oxygen (HBO) therapy. Forty-five HBO therapy sessions were administered. After nine weeks, the sternal wound was healed and completely epithelialized. This conservative therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.

International Journal of Cardiology, 2007

giographic analysis was done for lesion and reference segments; these parameters were compared be... more giographic analysis was done for lesion and reference segments; these parameters were compared before and after coronary intervention. The two different TZDs angiographic and clinical outcome were compared. Results: There were better clinical outcomes at seven years follow up. TZDs group had better survivial rate (93.3% vs. 87.8%, p<0.0001). The total death (17.3% vs. 7.1%, p<0.001), cardiac death (8.8% vs. 3.1%, p<0.001), and noncardiac death (8.5% vs. 3.9%, p<0.05) were significantly reduced in TZDs group. At angiographic follow up symptomatic patients reocclusion rate is significant lower (6% vs. 12%, P=0.036) in TZDs group. Among angiographic follow up pateints, TZDs group also had better clinical outcomes. The total death (14.8% vs. 75.8%, p<0.001), cardiac death (7.2% vs. 2.4%, p<0.05), and non-cardiac death (7.6% vs. 3.4%, p<0.05) were significantly reduced in TZDs group. The difference was not seen between rosiglitazone and pioglitazone. Conclusions: TZDs are a efficacy treatment strategy for diabetic patients with coronary angiography proved coronary artery disease. TZDs reduced the total death, cardiac death, and non-cardiac death. There was better survival rate in seven years follow up. A favorable angiographic outcome of reduction reocclusion rate was found in symptomatic diabetic patients. The results revealed better angiographic and clinical outcome in TZDs group. There was no stastic difference of clinical and angiographic outcomes between the two TZDs.

International Journal of Cardiology, 2003

Japanese Heart Journal, 2000

Cardiac fibromas are rare lesions which occur more often in infants and children than in adults. ... more Cardiac fibromas are rare lesions which occur more often in infants and children than in adults. These tumors are benign proliferations of connective tissue most often found in the left ventricular myocardium or septum. In an 8-month-old infant with cyanosis and progressive exertional dyspnea, a huge cardiac tumor obstructing the right ventricular outflow tract (RVOT) was diagnosed by means of 2-dimensional echocardiography and cardiac catheterization. At surgery, a whitish gray solitary tumor measuring 5.0 x 4.5 cm could be well visualized. It was nearly totally resected, and the RVOT was reconstructed with an Equine pericardial patch. Histologic examination classified the tumor as a fibroma. Although surgical mortality in cardiac fibroma with RVOT obstruction is extremely high, early diagnosis and prompt excision of the tumor is mandatory in relieving its dangerous symptoms.