• Title/Summary/Keyword: 심장판막

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Surgical Management of Aortic Valve Injury after Nonpenetrating Trauma (외상성 대동맥 판막 손상의 수술적 처치)

  • Seo, Yeon-Ho;Kim, Kong-Soo;Kim, Jong-Hun
    • Journal of Chest Surgery
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    • v.40 no.3 s.272
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    • pp.232-235
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    • 2007
  • We present 2 cases of patients who underwent surgical repair and replacement of an injured aortic valve that was secondary to nonpenetrating trauma. Primary repair was undertaken on an 18-year old boy, but he had persistent moderate aortic regurgitation for five years after surgery. Another 64-year old man was treated successfully with surgical replacement of the aortic valve via employing a prosthetic mechanical valve. Attempts at valvuloplasty for the treatment of traumatic aortic valve injury have not been uniformly successful, and prosthetic valve replacement is recommended for repair, except for highly selected cases.

Aprotinin Therapy for Cardiac Operation in Adult -Full dose regimen- (개심술에서 아프로티닌의 효과 (고용량 요법))

  • 장운하;오태윤;김미혜
    • Journal of Chest Surgery
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    • v.32 no.4
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    • pp.358-363
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    • 1999
  • Background: Recently, many cardiac centers have been using aprotinin to reduce operative bleeding in cardiac operations using cardiopulmonary bypass. A variety of reports have confirmed the effectiveness of the drug in cardiac operations. In addition to the operations which could be considered to cause severe operative bleeding such as redo operation, long cardiopulmonary bypass operation and etc, the use of aprotinin is increasing in the field of primary cardiac operations. Varying doses of regimen have been introduced since the first report by Royston et al, and also various opinions on the effectiveness and safeness of the each regimen have been reported. We reviewed our own experience of the full dose aprotinin regimen(Hammersmith regimen) retrospectively. Material and Method: From October 1994 to February 1998, 40 cases of cardiac operative patients were randomized into two groups: aprotinin group(20 patients) which received a full dose aprotinin regimen and control group(20 patients) which did not receive aprotinin. To evaluate the degree of bleeding decrease, we analysed and compared the amount of postoperative 6 hours and 24 hours bleeding in the each group. To confirm the renal dysfunction, we measured the postoperative creatinine level. Result: In the amount of postoperative 6 hours bleeding, a statistically significant bleeding decrease was demonstrated in the aprotinin group compared to the control group(aprotinin group: 186${\pm}$40cc, control group:409${\pm}$69cc, P=0.010). Similar result was observed in the postoperative 24 hours(aprotinin group:317${\pm}$53cc, control group: 671${\pm}$133cc, P=0.024). Conclusion: We concluded that full dose regimen of aprotinin can remarkably reduce postoperative bleeding in cardiac operations without significant renal dysfunctions.

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Mitral Valve Surgery Via Dome of the Left Atrium (Dome 접근법을 이용한 승모판막 수술)

  • 최용선;류상완;홍성범;박종춘;김상형;안병희
    • Journal of Chest Surgery
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    • v.37 no.8
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    • pp.722-725
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    • 2004
  • Mitral valve surgery is most commonly performed through the left atriotomy via the inter-atrial groove or trans-septal approach. An alternative method for approaching to the mitral valve is via the dome of the left atrium located between the ascending aorta and superior vena cava. Although this approach was described 30 years ago, it has not been popularized in mitral valve surgery. We introduce our recent experiences with mitral valve surgery carried out through the dome of the left atrium with brief review of literature.

Repair of Paravalvular Leak at Mitral Position after Redo DVR (승모판막 재치환술후 발생한 판막주위 누출 치험 1례)

  • 김경훈;정승혁
    • Journal of Chest Surgery
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    • v.30 no.4
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    • pp.428-431
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    • 1997
  • We experienced a casts of prosthetic mitral paravalvular leak after redo DVR. As far as nonstructural dysfunction is concerned, the prosthetic paravalvular leak is not the result of prosthetic valve endocarditis, but is due to technical difficulties at the time of operation, either residual calcification or poor native tissue. Occasionally paravalvular leaks, particulary around mitral prostheses, may be silent. Paravalvular leaks are usually repaired when there is significant anemia or hemodynamic compromise. At reoperation, some of theses leaks can be repaired simply by patch losure around the paravalvular leak without placing additional suture or explanting the valve.

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Mechanical Obstruction of Right Coronary Artery during Aortic Valve Replacement (대동맥판막 치환술중에 발생한 우관상동맥 폐색증)

  • 정철현;허재학;이택연;이윤석
    • Journal of Chest Surgery
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    • v.34 no.4
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    • pp.365-367
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    • 2001
  • 매우 드물게 발생하지만 대동맥판막수술중에 우관상동맥의 급성폐색은 우심실부전을 일으켜 매우 치명적인 결과를 초래할 수 있다. 심한 대동맥 판막부전증을 가진 67세 여자 환자에서 19 mm Hancock II 조직판막을 이용하여 대동맥판막치환술을 시행한 후 심폐기에서 이탈하는 과정주에 우심실부전이 발견되었으며, 우관상 동맥의 폐색을 의심하여 우측 내흉동맥을 사용하여 관상동맥 우회수술을 시행하였고 이후에 심폐기에서 순조롭게 이탈할 수 있었다. 수술후 9일째 시행한 관상동맥 조영술에서 우관상동맥 근위부에 색전에 의한 폐색을 확인할 수 있었다. 이에 저자들은 우관상동맥의 폐색으로 인한 우심부전증이 우관상동맥우회수술후에 회복된 증례를 보고하고자 한다.

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Papillary Fibroelastoma of the Aortic Valve: Discovered by Chance with Intraoperative Transesophageal Echocardiography - A case report - (수술실 내 경식도 심장초음파검사에서 우연히 발견된 유두상 섬유탄력종 - 1예 보고 -)

  • Kim, Jeong-Won;Jung, Jong-Pil;Park, Soon-Eun;Kim, Young-Min;Park, Chang-Ryul;Shin, Je-Kyoun
    • Journal of Chest Surgery
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    • v.40 no.9
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    • pp.637-640
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    • 2007
  • Papillary fibroelastoma is a rare benign cardiac tumor with an elevated risk for embolization and most papillary fibroelastomas do not cause symptoms. In this report, we describe a case of previous undiagnosed masses of the aortic valve that were incidentally found on intraoperative transesophageal echocardiography during coronary artery bypass surgery. Upon surgery, masses were found on the left and right aortic cusps and the pathological findings were consistent with a papillary fibroelastoma.

Thrombosis of a St. Jude Medical Cardiac Valve in the Mitral Position - case report - (St.Jude 기계판막에 의한 승모판대치술후 발생한 판막의 혈전증 1례)

  • 임종수
    • Journal of Chest Surgery
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    • v.22 no.4
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    • pp.677-679
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    • 1989
  • Recently, we have experienced a case of acute thrombotic obstruction of the St. Jude Medical cardiac valve in the mitral position of the Heart. We will discuss about the incidence, recognition and preventive measurement of the thrombotic St. Jude Medical valve with the review of literatures.

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Risk Factors of Redo-valve Replacement (판막재치환술의 위험인자)

  • 최강주;조광현;김성룡;이상권;전희재;윤영철;이양행;황윤호
    • 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.