Sang Yoon Kim, M.D., Samina Park, M.D., Eung Rae Kim, M.D., In Kyu Park, M.D., Ph.D., Young Tae Kim, M.D., Ph.D., Chang Hyun Kang, M.D., Ph.D.. Korean Journal of Thoracic and Cardiovascular Surgery 2016;49:214-7. http://dx.doi.org/10.5090/kjtcs.2016.49.3.214

Introduction Meckel scan is an effective tool for diagnosing symptomatic Meckel diverticulum (MD). However, the clinical relevance of Meckel scan remains controversial because of its rare use. To evaluate the clinical relevance of Meckel scan with initial hemoglobin (Hb) level, we investigated its diagnostic accuracy in our patient population over a 10-year period, and we propose clinical considerations for Meckel scan with initial Hb levels. Patients and Methods A total of 70 patients (41 males and 29 females; median age, 3 years; range, 3 months to 49 years) who underwent Meckel scans for symptomatic MD evaluation from October 2003 to August 2012 were reviewed retrospectively. Of the 70 patients, 13 were pathologically confirmed by surgery. Nine patients had MD, and the others were diagnosed with gastritis, colitis, and juvenile polyps. Overall, 57 patients were evaluated with endoscopy and clinical examinations, and were followed up for 3 to 6 years. The patients were classified into two groups by their initial Hb levels. Group I consisted of anemic patients whose initial Hb levels were less than the reference range for each individual's age and sex (n = 16), and group II consisted of patients within the normal range for Hb level (n = 52). The two groups were compared using Fisher exact test. Results Of the 70 patients, 9 (12.3%) showed positive findings on Meckel scan, and the others demonstrated negative findings. In the negative scan group, 1 patient was confirmed as MD after surgery; 60 patients showed spontaneous improvement and no symptom recurrence was detected during the 3- to 6-year follow-up. In the positive Meckel scan group, eight patients were pathologically diagnosed with MD. One patient was reported as having a juvenile polyp with no evidence of ectopic gastric mucosa. The sensitivity and specificity of Meckel scan were 89 and 98%, respectively. In group I, Meckel scan was positive in seven patients (44%) and showed a significantly higher prevalence than in group II (p < 0.001). When limited to the patients with gastrointestinal bleeding and anemia, the positive predictive value and negative predictive value were 100 and 100%, respectively. Conclusion In this study, Meckel scan showed high diagnostic accuracy in detecting symptomatic MD. Meckel scan also showed the highest positive results when applied in patients with gastrointestinal bleeding who were in anemic conditions.

Sang Yoon Kim, M.D., Samina Park, M.D., In Kyu Park, M.D., Ph.D., Young Tae Kim, M.D., Ph.D., Chang Hyun Kang, M.D., Ph.D.. Korean J Thorac Cardiovasc Surg 2019;52:353-9. https://doi.org/10.5090/kjtcs.2019.52.5.353

Central image Preoperative favourable computed tomography features and incidence of late positive remodelling of proximal descending thoracic aorta. OBJECTIVES: Our goal was to identify the preoperative findings in computed tomography correlated with the postoperative changes of the false lumen (FL) remaining in the descending thoracic aorta following tear-oriented surgery for acute type I dissection. METHODS: Patients who underwent ascending +/- partial arch replacement, with available preoperative and postoperative late (>1 year) CT scans, were included. Preoperative cross-sectional parameters were measured by the semi-automated centreline method at the level of the anastomosis. The parameters of the patients who presented positive remodelling of the proximal descending thoracic aorta were compared with those of the patients who did not in the late images. RESULTS: Among the included 101 patients, positive remodelling of the proximal descending thoracic aorta was observed in 46.5%, of which 76.6% extended downwards to the middle descending thoracic aorta. In the univariable analysis, an FL area ratio <50% (P < 0.001), a circumferential ratio of dissection <50% (P = 0.028), an FL width <20 mm (P = 0.008) at the distal anastomotic zone and not leaving residual arch branches having patent false lumens (P = 0.005) correlated with positive remodelling. The number of fulfilled above-mentioned features revealed a better correlation, which was stronger in patients without Marfan syndrome and in those older than 50 years. CONCLUSIONS: The cross-sectional extent of dissection at the presumed distal anastomotic zone is associated with descending thoracic aorta positive remodelling following tear-oriented replacement for acute type I aortic dissection. Considering the anatomical features in determining the extent of aortic replacement, some of the non-Marfan elderly patients can be spared from aggressive total arch replacement with the frozen elephant trunk technique.

The impacts of elevated troponin I levels after coronary artery bypass grafting (CABG) on long-term outcomes were investigated. A total of 996 patients who underwent elective isolated CABG for stable or unstable angina were enrolled. Patients were divided into higher and lower groups based on 80^th percentile postoperative peak troponin I (ppTnI) levels. The relationship between ppTnI and long-term clinical outcomes was analyzed. The median ppTnI was 1.55 (2.74) ng/mL, and was significantly higher in the conventional CABG subgroup than in the beating-heart CABG subgroup: 4.04 (4.71) ng/mL vs 1.24 (1.99) ng/mL, P < 0.001. The 80^th percentile of ppTnI was 3.3 ng/mL in the beating-heart CABG subgroup and 8.9 ng/mL in the conventional CABG subgroup. In the conventional CABG subgroup (n = 150), 10-year overall survival showed no significant difference between the higher (≥ 8.9 ng/mL) and lower (<8.9 ng/mL) ppTnI groups: 71% (10%) vs 76% (5%), P = 0.316. However, the beating-heart CABG subgroup (n = 846) showed significantly worse 10-year overall survival in the higher ppTnI group (≥ 3.3 ng/mL) than in the lower ppTnI group (< 3.3 ng/mL): 64% (6%) vs 73% (3%), P = 0.010. In the beating-heart CABG subgroup, multivariable analysis showed that ppTnI exceeding the 80^th percentile was a risk factor for overall death (hazard ratio: 1.505, 95% confidence interval: 1.019 to 2.225, P = 0.040). Higher ppTnI over the 80^th percentile was associated with worse long-term survival in beating-heart CABG, but not in conventional CABG.