• Journal of Chest Surgery
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• v.34 no.8
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• pp.604-610
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• 2001

Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 200, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. Material and method: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. Result: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperationc ases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.113-117
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• 1998

From October 1993 to April 1997, 37 patients(30 male and 7 female patients), ranging in age from 23 to 73 years, were operated for annuloaortic ectasia with or without aortic dissection. Four patients were in New York Heart Association Class I, 10 in Class II, 20 in Class III, and 3 in Class IV. In cases of annuloaortic ectasia with aortic dissection, the surgical treatment in all cases consisted of total replacement of the ascending aorta with composite graft and reimplantation of the coronary arteries to the tube graft. The postoperative complication, as postoperative bleeding or LV dysfunction, was 18%(7 cases) and late mortality for entire group was 2.7%(one death). The period of follow-up ranged from 1 month to 36 months(average 9.6 months). In conclusion, Bentall operation for annuloaortic ectasia with or without aortic dissection is reliable method with low mortality and excellent short-term results.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.663-669
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• 1997

This is a report on the clinical outcome and hemodynamic profile of the ATSwcardiac valve prosthesis, which is a recently introduced pyrolytic carbon bileaflet prosthesis. We retrospectively reviewed the early outcome of 100 consecutive patients who underwent isolated cardiac valve replacement with the ATS(w prosthesis from October 1994 through June 1996 at our hospital. All patients were evaluated with Doppler echocardiography before discharge from the hospital. The mean age of the patients was 48.6 years(range: 2 to 74). A tota of 124 prosthesis were implanted; 71 mitral, 46 aortic, and 7 tricuspid. The two most frequently used sizes were 27 mm(40.8%) and 29 mm(35.2%) in the mitral position, and 23 mm(30.4%) and 21 mm(28.3%) in the aortic position. There was no early or late death. The total follow-up period was 950 patient-months with 99% follow-up rate. Serious late morbidity occurred in three patients; reoperation in two patients for late rupture of Sinus of Valsava in one and for endocarditis with prosthetic dehiscence in the other, and intracranial hemorrhage due to hypertension in one patient. There has been no thromboembolic complication or structural valval deterioration. In the mitral position, the average values of peak and mean transprosthetic pressure gradients and valve area calculated from pressure half time were 6.9$\pm$2.8 mmHg, 2.6$\pm$ 1.5 mmHg, and 2.7 $\pm$0.8 cm2 respectively. In the aortic position, the peak and mean pressure gradients'were 26.4 $\pm$ 15.9 mmHg and 14.2 $\pm$ 7.9 mmHg. For the mitra prostheses larger than 25-mm size, there was no significant difference among prosthetic sizes in terms of transprosthetic gradients, whereas there was a significant negative correlation between the prosthesis size and the transprosthetic gradients for the aortic valves. The peak and mean Pressere pradients were 52.2 $\pm$ 17.6 tmHg and 26.9$\pm$ 7.4 mmHg across the 19-mm aortic Prostheses, and 27.1 $\pm$ 11.9 mmHg and 13.3$\pm$6.6 mmHg across the 21-mm size. Above results can lead to the conclusion that the early clinical outcome of the ATS valve prosthesis is quite satisfactory, And the hemodynamic characteristics are comparable, if not better, with other bileaflet prostheses.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1212-1217
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• 1996

From Dec. 1993 to May 1995, 9 male and 5 female patients ranging in age from 25 to 65 years, were operated on for ascending aorta and/or aortic arch diseases. Six patients had acute aortic dissection, type A(ruptured in 4 cases); four had ruptured ascending aortic aneurysm; three had annuloaortic ectasia(ruptured in 1 cases); one had aortic arch aneurysm. The diagnostic procedures were echo cardiography and dynamic CT scan in all patients having acute dissection or rupture. The aortic angiography was performed in two cases. Indications for operations were rupture in five cases, acute aortic dissection in five cases, severe congestive heart failure in two cases, progressive aortic insufficiency in one case and impending rupture in one case. The emergent repair was performed in ten cases(71%). The surgical treatment consisted of 6 Cabrol operations, a Cabrol operation combined with arch replacement, a modified Bentall operation, 4 replacement of ascending aorta, a replacement of aortic arch, and a replacement of ascending aorta and aortic arch. Complications were a hypoxic encephalopathy, two atrial fibrillations, a sternal deheiscence, and a mediastinitis. Two early mortality(14%) were due to intractable bleeding and multiple organ failure, and one late mortality(7%) was due to ventricular arrhythmia. In eleven survivors, follow-up period was from 2 months to 12 months and the course was uneventful.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.891-899
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• 2006

Background: This study is to evaluate the safety of ATS valve by examining the clinical results of ten-years experience. Material and Method: From July 1995 to March 2005, we reviewed 305 patients with ATS valve implantation. Mean age was $49.8{\pm}11.7$ years and 140(45.6%) males were included. Etiologies were rheumatic diseases in 207 cases(67.4%), degenerative changes in 57 cases(18.6%), valve dysfunction in 23 cases(7.5%) and infective endocarditis in 14 cases(4.6%). AVR was performed in 72 patients(23.5%), MVR in 156 patients (50.8%), DVR(AVR+MVR) in 63 patients(20.5%) and TVR in 16 patients(5.2%). Result: There were 9 operative mortalities(2.9%). Follow up period was $56.5{\pm}34.0(0{\sim}115)$ months and 96.4% patients were followed up with 9 late deaths. Five and ten years survival rates were $94.9{\pm}1.3%,\;91.2{\pm}2.3%$ using Kaplan-Meier's methods. Valve related event free survival rates in 5 and 10 years were $90.8{\pm}2.0%$ and $86.9{\pm}3.2%$. There were 16 anticoagulation-related hemorrhages, 6 thromboembolisms, 3 prosthetic valve endocarditis and 1 paravalvular leakage. NYHA class improved after operation(p<0.05). Postoperative echocardiography showed significant decrease in LA size, LVEDD and IVESD(p<0.01). Patients with 19 and 21 mm valve showed significantly higher transvalvular pressure gradient in aortic position(p<0.001, p<0.001). Conclusion: ATS valve showed good hemodynamic results with few valve related complications and thus can be used with acceptable risk.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.322-328
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• 2001

배경: 우심실 유출로 재건술후에는 폐동맥판막부전이 우심실기능에 나쁜 영향을 미친다. 이를 막기 위해 여러 재료로 판막을 제조하여 사용하는데 가피 형성이 적은 막형 ePTEE(expanded polytetrafluoroethylene, Goretex) 단엽판막의 효과를 알아보고자 연구를 시행하였다. 대상 및 방법; 1996년 3월부터 1997년 2월까지 우심실유출로 재건술을 시행받고 수술 1일까지 우심실 압력을 측정할 수 있었던 47명중 막형 Goretex단엽판막을 사용한 환자(비교군) 19명, 사용하지 않은 환자(대조군) 28명에서 단엽판막의 유용성을 조사하였다. 두 군간에는 나이, 체중 그리고 McGoon ratio 등에는 통계학적 차이가 없었다.(p>0.05) 이전의 수술은 대조군에서 19번, 비교군에서 22번을 시행하였다. 우심실 유출로에 대한 수술은 대조군에서 REV수술 2예, 우심실폐동맥 연결수술 8예, 우심실 유출로 재개건술 2예, 우심실 유출로에 대한 수술은 대조군에서 16예였으며, 비교군에서는 REV 수술 5예, Rastelli 씨 수술 6예, 재우심실 유출로 재건술 5예, 그리고 우심실 재건술 3예였다. 결과: 대동맥 차단 시간이나 총심폐순환시간에는 두군간의 차이는 없었다. 또한 수술직후와 수술후 1일째 측정한 우심실 압력 및 좌심방압력의 차이도 두군간에는 차이가 없었으며 수술후 7일째 시행한 심에코도 결과 ejection fraction., 우심실/ 좌심실 압력비 , 그리고 우심실 유출로의 압력차, 강심제 투여일수, 호흡기 사용 기간 등에서도 두군간의 차이는 없었으나 흉관 삽입기간이 비교군에서 의미있게 짧았다. 추적 조사 기간 중 비교군 1예에서 사망을 하였으나. Goretex 단엽판막에 의한 것은 아니였으며 심초음파검사상 우심실 유출로 압력차이나 재수술은 두군간에 차이는 없었으나 폐동맥 폐쇄부전은 비교군에서 의미 있게 낮은 것을 보이고 있다. 결론; 막형 Goretex 단엽판막의 조기성적은 우수하였으며 폐동맥 폐쇄분전의 정도를 적게 하는 효과를 보이나 앞으로 이들이 성장함에 따라 우심실 유출로에 폐쇄를 일으키는지는 계속적인 추적관찰이 요구된다.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.297-300
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• 2007

Idiopathic hypereosinophilic syndrome is a rare systemic, leukoproliferative disorder characterized by eosinophilmediated tissue injury causing multiple organ failure, including the heart. Cardiac involvement occurs in more than 75% of patients with hypereosinophilic syndrome. Cardiac manifestations include subendocardial fibrosis, thrombus leading to peripheral emboli, restrictive cardiomyopathy, and valvular dysfunction. It is more common in men than in women (9 : 1), and trends to present between the ages of 20 and 50 years. Presentation in childhood is unusual. We report for the first time a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic aortic valve dysfunction that was successfully treated by steroid and hydroxyurea therapy after surgical valvular replacement.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.785-791
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• 2002

The results of reoperative valve replacement can be improved if appropriate analysis for the risk of reoperation was achieved. The purpose of our study was to analyze the results of reoperations for failure of bioprosthesis, and to define the risk factors in high-risk populations for reoperative procedures. Material and Method The series of 46 consecutive patients who had undergone first reoperative replacement for failed bioprosthesis between 1993 and 2001 were reviewed retrospectively. Mean age was 42 $\pm$ 12 years, mean body surface area was 1.52 $\pm$0.15 $m^2$. The reoperative procedure comprised of 36 MVR, 8 DVR, and 2 AVR. The first operation comprised of 2 DVR, 1 AVR, and 43 MVR. Factors which were choose to assess a predictor of results in reoperative valve replacement were sex, old age(＞60 years), early age at first operation(＜30 years), long interval between first and redo operation(.15years), poor NYHA functional class(＞3), LV dysfunction(LVEF＜45%), long operation time(＞8hours), endocarditis, combined procedures, and renal insufficiency, Result : Overall mortality was 4.3%(2 cases). The risk factors that influenced postoperative complications and unexpected postoperative results were lower ejection fraction(p＝0.012), older age(p＝0.045), endocarditis(p＝0.023), long operation time above 8 hours(p＝0.027). There was no statistically significant factor influencing hospital mortality. Conclusion : No factor influenced the mortality. Better results could be achieved if reoferation was performed carefully in poor left ventricular function, old aged patient, and with endocarditis. Effort to shorten the operation time would be helpful on postoperative results.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.510-513
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• 2003

Annuloaortic ectasia, aortic regurgitation(AR), and ventricular septal defect(VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hapoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.341-350
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• 2007

Background: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. Material and Method: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. Result: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. Conclusion: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.