• Journal of Chest Surgery
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• v.29 no.8
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• pp.875-882
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• 1996

Multlvalvular heart surgery was performed In 78 cases, in the Department of Thoracic & Cardiovascu far Surgery of Chonbuk national University Hospital from november 1983 to March 1994. There Where 31 men and 47 women. whose ranged from 14 to 63 years. The causes of the valvular lesions were 57 rheumatic origin, 18 degenerative, 1 previous endocarditls, 1 prosthetic valve mal-function. There were 25 double valve replacement with or wit out tricuspid valve repair, i M VR and aortic valve repair, 18 MVR and tricuspid valve repair, 1 MVR and aortic and tricuspid valve repair, 10 AVR and mi- tral valve repair, 1 AVR and tricuspid valve repair, 8 mitral aortic valve repair, 13 mitral and tricuspid valve repair. They were improved mean New York Heart Association functional cldss, from 2.72% 121 Early deaths were 5 cases(6.4%). The cause of death wet'e low cArdiac output syndrome. veritricular tachycardia, massive bleeding and cerebral thromboembolism. All the survivors belonged to New York Heart Association functional class I or ll at discharge. The patients who had had valve replacement operation were medicated with warfarin to maintain the level of 30∼ 50% of normal prothrombin time. During follow-up(93.6%, mean 49.9 months), 2 late deaths were developed. One was due to intracranial hemorrhage and the other congestive heart failure. The pre-operative New York Heart Association Functional class IV was statistically sig ificant operat- ive risk factors(p< 0.05).

• Journal of Chest Surgery
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• v.31 no.6
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• pp.591-597
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• 1998

Background: The aim of the current study was to analyze the early and intermediate-term performance of aortic valve replacement. Material and Method: Between January 1986 and January 1996, records of 61 consecutive patients who had received aortic valve replacement were reviewed. 38 were male and 23 were female patients, ranging from 10 to 71 years of age(mean: 40.5${\pm}$11.2). Results: The early death rate was 4.9%(3/61). A thorough follow-up rate of 93.1% was accomplished in these 58 patients who left the hospital(mean: 51.5${\pm}$32.0 patient-months) under the assistance of the same operator. Three of these patients who left the hospital died. The late death rate was 5.2%(3/58). Five patients experienced anticoagulant-related hemorrhage(all were minor). Three patients had thromboembolic episodes. There was no clinical evidence of hemolysis and structural failure of valves used. Of those patients who survived, the NYHA functional class improved significantly. Linearized rate were 1.58%/patient-year and 2.0%/patient-year respectively for thromboembolism and anticoagulant-related hemorrhage. The 10 year actuarial survival rate was 83.6%. Conclusion: This early and intermediate-term follow-up suggests that the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and low rate of prosthesis-related complication.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.305-310
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• 2001

배경: 판막대치술에 냉동보존판막의 이용은 감염에 대한 저항성과 탁월한 혈류역학으로 증가하고 있다. 판막육아세포의 생존율은 이식된 냉동보존 판막의 내구성에 영향을 미친다고 알려져 있고, 세포의 생존율은 warm ischemic time에 영향을 받는 것으로 알려져 있다. 냉동 보존하여 이식할수 있는 공여 판막의 warm ischemic time 의 적정치를 구하기 위하여, warm ischemic time에 다른 세포의 생존율을 관찰하였다. 대상 및 방법: 1.조직의 획득: 실제 판막을 냉동 보존하는 상황과 유사하게 하기 위하여 도살된 돼지의 심장과 폐를 밀봉한 상태로 4~8$^{\circ}C$로 냉장 보관하여 (warm ischemic time) 일정시간이 경과한 후, 심장과 폐에서 심장을 적출하여 4$^{\circ}C$하트만 용액에 24시간 보관하였다.(cold ischemic time). Warm ischemic time에 따라 2시간, 12시간, 24시간 36시간으로 4군으로 나누었으며, 각 군마다8개의 돼지 심자을 이용하였다. 2. 조직의 멸균: RRMI 1640에 항생제를 섞은 용액에 멸균하고, 3 냉동과 냉동보존; American tissue bank에서 제시한 냉동곡선에 따라 냉동하여, 액체질소 탱그에서 7일간 보존 후 해동하였다. 4. 생존율의 측정; 판막의 생존율 검사는 Triphan blue test로 하였고, 각각 warm ischemic period후 , cold ischemic period 후, 해동 후에 시행하였다. 5. 분석방법; 분석은 SAS program의 pearson correlation으로 하였다. 결과: 1. 멸균, 냉동과 냉동 보존하는 과정의 적합성을 규명하기 위하여 이 과정의 전과 후인 Cold ischemic period 후와 해동 후의 대동맥판막의 생존율의 차이를 비교한 결과, 차이가 없었다.(p =0.619). 2, warm ischemic time 과 warm ischemic period 후 , Cole ischemic period 후와 해동후의 대동맥판막의 생존율과의 correlation 은 각각 R= -0.857, -.0.673과 -0.549로 강하거나 , 혹은 뚜렷한 음성적 관계가 있었다. 삼천판막의 생존율과 대동맥판막의 생존율과 뚜렷한 상관관계가 있었다. 결론; 1. Warm ischemic time 이 길어지면 판막유아세포의 생존율이 감소하고, 12시간 이상되면 해동후의 판막육 아페포의 생존율이 50% 이하로 떨어졌다. 2. 본 연구에서 시행한 판막의 냉동보존방법은 세포의 생존율을 유지하는데 양호한 것으로 나타났으며 삼천판막으로 대동맥판막의 생존율을 예측해 볼 수 있다. 3. 그러나, 이식후 장기간 적절한 내구성을 갖기 위한 이식될 판막의 생존율은, 육아세포에 관한 여구가 좀 더 되어야 규명될 것이다.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.133-136
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• 2002

A 28 year-old male who had received Konno procedure twelve years ago with 23mmmechanical aortic valve and bovine pericardium with which his small aortic annulus, ventricular septum and right ventricular outflow tract had been enlarged was transferred due to sudden congestive heart failure. There were perforations on aortic and interventricular portion of bovine pericardial patch above and below the aortic valve, respectively, which was calcified and denaturated severely. The perforations seemed to be attributed to the cracks, resulting from mobility of mechanical aortic valvc itself and stiffness of calcified and denaturated bovine patch. We performed a redo Konno procedure applying PTFE patch.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.262-269
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• 1999

Background: To review the middle and long term results of aortic valve replacement(AVR) for 11 years, we surveyed and followed up the patients who underwent AVR. Material and Method: Between Feb. 1986 and May 1997, 134 patients underwent AVR. The patients consisted of 71 men and 63 women whose mean age was 38.9 years, ranging from 17 to 70. Result: The concomitant operations were 62 mitral valve replacement(MVR), 14 MVR + tricuspid valve annuloplasty, 10 Cabrol operation, 16 aortic annulus widening, and so forth. We used 119 mechanical(75 St. Jude Medical, 38 CarboMedics, 6 Sorin) and 15 tissue (Carpentier-Edwards) valves. Early postoperative complications occurred in 35 cases; 9 congestive heart failure, 6 low cardiac output, 5 postoperative bleeding, 5 pleural effusion, and so forth. There were 13 early postoperative deaths(9.7%) due to low cardiac output(5), CHF (2), disseminated intravascular coagulopathy(2), and so forth. The cumulative total follow-up period was 452.7 patient-years with a mean of 3.4${\pm}$3.1 years/patient. There were 9 cases of valve-related complications; anticoagulant-related bleeding(4), prosthetic valve endocarditis(2), thromboembolism(2) and prosthetic valve failure(1) occured at rate of 0.9, 0.4, 0.4, 0.2%/ pt-yr, respectively. Late valve-related death occurred in 3 cases(2.0%/pt-yr) associated with anticoagulant-related bleeding(2) and prosthetic valve endocarditis(1). Conclusion: Actuarial survival rate by Kaplan-Meier method was 91.0${\pm}$4.3 % at 11 years.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.305-310
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• 2009

Background: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. Material and Method: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: $0.5\sim14.0$). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8$\sim$138.2 months). We reviewed the echocardiographic data with focusing on the, auto-graft dysfunction and reoperation. Result: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from $1.6{\pm}1.7/0.9{\pm}1.7$ at preoperation to $1.8{\pm}1.6$(p=0.64)/$2.2{\pm}0.9$ (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency. Conclusion: Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Vet reoperation due to allograft dysfunction was a major concern.

• The Korean Nurse
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• v.8 no.5 s.43
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• pp.33-37
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• 1969

• Proceedings of the KTCVS Conference
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• 1993.06a
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• pp.40-40
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• 1993

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.127-127
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• 1996

• Journal of Chest Surgery
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• v.37 no.7
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• pp.578-584
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• 2004

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.