• Journal of Chest Surgery
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• v.34 no.2
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• pp.118-124
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• 2001

배경: 승모판막재건술이 승모판막치환술보다 술후 좌심실기능이 보다 향상될 수 있으며 또한 수술사망율과 인공판막에 관련된 합병즈인 혈전색전증, 심내막염 및 항응고제사용에 따른 출혈빈도는 낮다고 하였다. 방법: 1996년 1월부터 2000년 5월까지 승모판막폐쇄부전으로 진단된 환자 87례를 대상으로 재건술군 59례, 치환술군 28례로 나누어 비교분석하였다. 결과: 술전 환자들의 NYHA 기능분류, 흉부 X-선상 심흉곽의 비, 심초음파상 좌심실박출계수는 두 군간에 유의한 차이가 없었다. 원인질환은 양군에서 퇴행성 병변이 가장 많았다. 체외순환시간은 재건술군에서 유의하게 길었으나 수술사망은 양군에서 없었다. 술후 NYHA 기능분류, 흉부 X-선상 심흉곽의 비는 향상되었으나 두 군간에 차이가 없었으며 술후 좌심실박출계수는 두 군에서 감소되었으나 유의한 차이는 없었다. 결론: 이상의 결과로 승모판막폐쇄부전에 대하여 재건술이 치환술처럼 비교적 안전하게 시행될 수 있는 술식으로 사료된다.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.221-225
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• 1998

From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years(mean, 53). Thirteen patients were in New York Heart Association(NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty(16 cases), rectangular resection of posterior leaflet(15 cases), chordal shortening(5 cases), triangular resection of anterior leaflet(2 cases), commissurotomy(2 cases), partial transposition of posterior leaflet(1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.598-606
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• 1997

Among 136 patients having undergone mitral valve surgery from September of 1994 through August of 1995 in Sejong Heart Institute, forty four patients(18 males, 26 females) underwent mitral valve reconstruction using prosthetic rings and their clinical results were evaluated. Patients'ages ranged from 5 to 63 years(mean age 38.2 years). Mitral valvular diseases were due to rheumatic origin in 30 patients(68%), degenerative in 13(30%), and congenital in one patient(2%). Mitral regurgitation(MR) was in 33 patients(76%), mitral stenosis 2(5%), and mitral stenoinsufaciency 9 patients(19%). The patients were divided into Carpentier's functional groups : type I, 5 patients(11%) : type I, 24 patients(55%) ; type III, 4 patients (9%) i and mixed(II + III), 11 patients(25%). Average number of anatomic lesions of mitral valve per patient was 3.7. The techniques included prosthetic ring amluloplasty(44 patients, 32 Carpentier ring and 12 Duran ring), leaflet mobilization(24, 55%), chordae shortening(23, 52%), chordae transposition(23, 52%), commissurotomy(16, 35%), leaflet resection(9, 20%), papillary muscle splitting(8, 18%), and chordae reimplantation(1, 2%). Average 3.4 surgical procedures were applied on mitral valve per patient. There were two hospital mortality and one reoperation due to development of MR(grade III) after 2 weeks. During the mean follow up of 12 months, patients improved in terms of functional class of the New York Heart Association, which was mean 3.0 preoperatively and 1.3 postoperatively. Doppler echocardiographic studies showed adequate valve area(2.07$\pm$0.11 cm2 mean $\pm$standard error), improved ventricular contractiliy in 41 patients(93%), ab ence of MR in 23(53%), trace MR in 18(42%), and garde II MR in 2 patients(5%).

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.290-301
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• 2020

The surgical technique of mitral valvuloplasty or transcatheter mitral valve (MV) replacement has been developed recently. Surgeons and interventionists require detailed anatomical information on the MV for the purpose of treatment planning. In this review, we discussed the anatomic features of the MV on CT and the method of evaluating the MV for treatment planning, as well as its preservation, for interventional procedures.

• Journal of Chest Surgery
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• v.34 no.1
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• pp.51-56
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• 2001

배경: 이상적인 판막의 개발이 있기 전에는 가능하다면 원래의 판막을 보수하는 것이 좋을 것이라는 생각이 당연하며 실제 임상연구가들은 기술적으로 가능하다면 판막재건술이 판막치환에 비해 대단히 좋은 임상경과를 취한다고 보고하고 있다. 그러나 판막 치환례에서 수술성적과 임상성적이 오히려 좋게 나타나는 경우 이유가 있을 것이고 그 근본원인은 심실의 기능에 따라 좌우되리라는 가설 하에 이를 규명하고자 하였다. 대상 및 방법: 순수승모판막폐쇄부전증으로 수술 받은 40명의 환자를 대상으로 하여 고전적 판막 치환술을 시행한 12례를 1군으로, 후엽을 보전한 18례를 2군으로 그리고 성형수술을 시행한 10례를 3군으로 나누어 수술전의 심에코 소견을 포함하여 입원시에 시행한 전신상태와 수술 후 4주 이내에 시행한 심에코도의 각종 지표를 시행하였다. 결과: 일반적인 환자의 상태변화로는 1군에 비해 2군, 3군에서는 더 나은 결과를 보였으나, 통계적인 차이는 발견할 수 없었다. 뉴욕 심장협회의 분류에 따라서는 수술전보다 많은 호전이 보였으나 세군간의 유의한 차이는 발견할 수 없었다. 심에코도에 따른 심기능을 비교한 바에 의하면 1군에서는 오히려 나빠졌으며 2군, 3군에서는 수술직후에는 술전에 비해 별 차이가 없으며 회복후에는 모든 지표에서 의미있는 호전을 발견할 수 있었으나, 구별분획에 있어 두 군간에는 수술전, 수술후, 회복후의 상호간의 통계적으로 의미 있는 차이는 발견되지 않았다. 결론: 심기능의 차이가 나므로 승모판막폐쇄부전증에 대한 수술로는 가능한한 판막 성형술이 좋고, 판막 성형술이 불가능한 변형이 많은 경우 판엽 일부를 보전이라도 하는 것이 좋다.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.820-827
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• 2003

Background: Mitral valve repair rather than replacement for mitral regurgitation (MR) offers a number of well-accepted benefits. However, the surgical results of repair for mitral valve endocarditis remain largely unknown. Material and Method: Fourteen patients who underwent mitral valve repair for MR caused by mitral valve endocarditis from April 1995 through October 2001 were reviewed retrospectively. There were 9 male patients and mean age was 32$\pm$10 years. Four patients had previous embolism and 2 had active infections. The grade of MR were III in 6 patients and IV in 8. Operatively, mitral annuloplasty was performed in 12 patients and various valvuloplasty techniques were applied in all patients. One patient had immediate valve replacement due to residual MR after weaning of cardiopulmonary bypass. Result: There was no early operative death. Early postoperative transthoracic echocardiography revealed no or grade I of MR and no or mild mitral stenosis in 13 patients. After the mean follow-up of 36 months, there was no late death, and no or grade I of MR in 11 patients (84.6%) and no or mild mitral stenosis in 12 patients (92.3%). Reoperation required in one patient (7.1%). The cumulative freedom from recurrent MR and valve-related reoperation at 5 years were 91$\pm$9% and 75$\pm$22%, respectively. Conclusion: This study suggests that mitral valve repair for mitral regurgitation caused by endocarditis offers good early and intermediate survival and functional improvement without reinfection, and it is an attractive alternative to valve replacement in selective patients with bacterial endocariditis.

• Proceedings of the KTCVS Conference
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• 1998.10a
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• pp.78-78
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• 1998

• Journal of Chest Surgery
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• v.43 no.5
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• pp.475-481
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• 2010

Background: We evaluated mid-term results of mitral annuloplasty using a flexible band and a completely rigid ring for mitral valve repair in patients with degenerative mitral regurgitation (MR). Material and Method: From January 2004 to September 2008, 71 patients (M:F=36:35, $55{\pm}13$ years) underwent mitral valve repair with mitral annuloplasty for degenerative MR. Ring annuloplasty was done using a Cosgrove-Edwards flexible band (Group I, n=43) or a Carpentier-Edwards classic ring (Group II, n=28). There were no differences in preoperative characteristics of the participants. Average duration of follow-up was 36 months (range: 2~69 mos). Result: There was no in-hospital mortality. Postoperative morbidity, which included atrial fibrillation (n=7) and low cardiac output syndrome (n=5) in groups I and II were similar. There was one late death in group II. The proportion exhibiting freedom from recurrent mitral regurgitation ($\geq$moderate) at 4 years in Groups I and II were, respectively, 94.5 and 91.8%, (p=0.695). Left ventricular ejection fraction decreased in the early postoperative period ($7{\pm}2$ days) and recovered by last follow-up ($25{\pm}16$ mos; p=0.002). The pattern was similar in groups I and II (p=0.905). Re-operation was performed in 3 patients (1 in Group I and 2 in Group II, p=0.316). Four-year event-free survival (free of adverse valve-related events) was 95.2% for Group I and 92.6% for Group II; this difference was not significant, p=0.646). Conclusion: The type of technique used in mitral annuloplasty to repair the mitral valve repair after degenerative MR did not affect mid-term clinical and functional results.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.268-272
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• 2008

Paravalvular abscess is defined as infective necrosis of the mitral annulus and surrounding tissue that requires debridement of the necrotic tissue and patch reconstruction before valve implantation. Paravalvular abscess is associated with high operative mortality, postoperative complications, and recurrence. We report here a case of a 59-year old woman that had undergone mitral valvular replacement with a mechanical valve 13 years ago. The patient was determined to have paravalvular leakage due to paravalvular abscess as seen during follow-up. The patient underwent repeat mitral valvular replacement with annular reconstruction. However, the patient with mitral annular reconstruction and valvular replacement on the fifteenth postoperative day due to recurrence of paravalvular leakage. The patient is now receiving follow-up eight months after surgery.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1037-1042
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• 1998

Background: Among the various techniques for the adequate exposure of the mitral valve, the extended transseptal approach is the essential prerequisite for accurate repair or replacement of the mitral apparatus. But the efficacy and safty of the extended transseptal approach has not determined in Korea yet. Materials and methods: Retrospective data of 80 consecutive patients, operated from September 1992 to July 1997 were reviewed. Seventy- eight patients underwent mitral valve replacement and 2 patients underwent excision of left atrial myxoma. Thirty-eight of 78 patients had other concomitant procedures such as aortic valve replacement(n=22), tricuspid annulopasty(n=14), coronary artery bypass graft(n=1) and closure of ventricular septal defect(n=1). Mean follow up was 23.3±15.0 months and total follow up was 1792 patient-months. Results: The hospital mortality rate was 3.8%(3 patients). Two deaths were due to low cardiac output and one due to postoperative bleeding of coagulopathy. Among the 46 patients who had atrial fibrillation preoperatively, 45 had atrial fibrillation postoperatively and 1 converted to sinus rhythm. All 34 patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after the operation. Mean aortic cross clamping time was 62 minutes for isolated mitral procedure and 90 minutes for concomitant procedures. There were no specific complications related to this approach. Conclusions: We suggest that the extended transseptal approach is an easy and good method for mitral valve surgery, especially in patients with small sized left atrium.