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Background The aim of this study is to evaluate our institutional results of the aortic valve replacement through minimally invasive approaches compared with conventional sternotomy. Materials and Methods From August 1997 to July 2010, 838 patients underwent primary isolated aortic valve replacement. Of them, 73 patients underwent surgery through minimally invasive approaches (MIAS group) whereas 765 patients underwent surgery through the conventional sternotomy (CONV group). Clinical outcomes were compared using a propensity score matching design. Results Propensity score matching yielded 73 pairs of patients in which there were no significant differences in baseline profiles between the two groups. Patients in the MIAS group had longer aortic cross clamp than those in the CONV group (74.9±27.9 vs.. 66.2±27.3, p=0.058). In the MIAS group, conversion to full sternotomy was needed in 2 patients (2.7%). There were no significant differences in the rates of low cardiac output syndrome (4 vs. 8, p=0.37), reoperation due to bleeding (7 vs. 6, p=0.77), wound infection (2 vs. 4, p=0.68), or requirements for dialysis (2 vs. 1, p=0.55) between the two groups. Postoperative pain was significantly less in the MIAS group than the conventional group (pain score, 3.79±1.67 vs. 4.32±1.56; p=0.04). Conclusion Both minimally invasive approaches and conventional sternotomy had comparable early clinical outcomes in patients undergoing primary isolated aortic valve replacement. Minimally invasive approaches significantly decrease postoperative pain.

Sensitivity to noise, particularly road traffic noise, can increase cortisol levels and result in changes in immune system biomarkers. Therefore, continuous exposure to noise can have an effect on immune function, hormonal levels, and cardiovascular function, leading to hypertension and stress. The purpose of this study was to investigate the changes in stress-and immune system-related biomarkers according to the self-reported sensitivity to noise and exposure to road traffic noise, to ultimately determine the potential effects of noise on health. A survey was conducted through questionnaire (ISO/TS 15666) sent to 172 female subjects in Korea, including 128 from Ulsan and 44 from Seoul. The average noise level was calculated, and blood samples were collected for measurements of cortisol levels, Natural killer (NK) / Natural killer T (NKT) cell populations, and NK cell activity (through measurements of interleukin-12 (IL-12) and interferon-gamma (INF-γ) concentrations). Multivariate linear regression analysis of the measured biomarkers according to the road traffic noise level and self-reported noise sensitivity was conducted adjusting for the effects of age, alcohol status, smoking status, regular exercise, and residence period. IL-12 levels increased, whereas the NKT cell population decreased with increasing noise levels. The results further suggested that cortisol levels are more influenced by the subject’s sensitivity to noise than to the level of chronic road traffic noise. Therefore, noise appears to have the largest effect on IL-12 levels as well as the population and activity of NKT cells. In conclusion, our results suggest that low-level road traffic noise and sensitivity to noise can affect health by causing changes in the immune response through mechanisms other than increased cortisol.

Detachment of the TV can be used safely for better exposure of the VSD without increased risk of tricuspid regurgitation in infants younger than 3 months. Preoperative echocardiography might be useful for predicting the possibility of detachment of the TV for enhancing exposure of the VSD.

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A standardized follow-up protocol including CT angiography or coronary angiography after the ASO is required to address coronary artery stenosis. Good reoperation results were observed using the unroofing and cut-back angioplasty techniques.

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The path of the thoracic duct may vary in pediatric patients with complex congenital heart disease. Left periaortic mass ligation should be considered in patients with chylothoraces that persist after the right-sided approach, especially in patients with dextrocardia.