• Journal of Chest Surgery
• /
• v.32 no.11
• /
• pp.1049-1051
• /
• 1999

We performed a reoperation of failed tricuspid mechanical valve in a 63-year-old female patient because the overgrown endothelial pannus had entrapped the prosthetic leaflets. Four years ago, the patient underwent mitral and tricuspid valve replacements with 31 and 33 mm Carbomedics, respectively. The patient showed symptoms of neck vein distention, abdominal distention and peripheral edema. The chest film, echocardiography and cineangiography confirmed the diagnosis of tricuspid valve. During the operation, we found the entrapped leaflets of the tricuspid valve in a partially closed state and the endothelial pannus had overgrown into the leaflets. Carpentier-Edward bovine pericardial valve was inserted and the patient was discharged with no significant events.

• Journal of Chest Surgery
• /
• v.37 no.4
• /
• pp.369-372
• /
• 2004

Acute myocardial infarction due to coronary occlusion by emboli originating from the prosthetic valve thrombosis is very rare but fatal disease which needs immediate diagnosis and urgent treatment. We report a case of acute myocardial infarction after left anterior descending embolic occlusion in whom had previous mitral valve replacement. Redo valve replacement following the interventional catheterization and anti platelet therapy lead to successful results.

• Journal of Chest Surgery
• /
• v.34 no.1
• /
• pp.91-93
• /
• 2001

기계판막의 비구조적 기능이상은 판막 치환 후 생길 수 있는 심각한 합병증 중의 하나이다. 이러한 기계판막의 비구조적 기능이상은 일반적으로 1) pannus나 조직 혹은 봉합물질에 의한 장애 2) 치환 판막 주위의 틈 3) 부적절한 판막의 크기나 위치, 판막 삽입시의 잘못 등에 의해 생긴다. 저자들은 상대적으로 작은 판막륜을 가진 환자에서 치환 판막의 잘못된 위치로 야기된 pannus 형성에 의한 판막의 기능부전을 경험하였으며, 이 환자에 대해 pannus 제거 후 판막륜 확장술(닉스 술식, Nicks procedure)을 포함한 판막 재치환술을 성공적으로 시행하여 이를 보고하는 바이다.

• Journal of Chest Surgery
• /
• v.25 no.2
• /
• pp.158-166
• /
• 1992

From 1985 to 1990, a total of 160 new valves were implanted for 125 adult patients to whom prosthetic valve replacement had been performed [One patient had consecutive 2 reoperations]. Following data are the results from the follow-up study from January 1985 to February 1991. Mean age of the patients was 37.9$\pm$12.1 years. Mean follow-up period was 25.8$\pm$18.8 months. In bioprosthesis, mean interval between the previous operation and reoperation was 85.6$\pm$36.4 months in aortic valve, and 87.3$\pm$30.0 months in mitral valve. The causes of reoperation were prosthetic valve failure[103 patients, 81.7%], prosthetic valve endocarditis[17 patients, 13.5%], periprosthetic leakage[5 patients, 4.0%], and aneurysm of ascending aorta[1 patient, 0.8%]. Fourteen patients[11.1%] died in hospital; 5 in 22 replacement of aortic valve[22.7%], 6 in 73 rereplacement of mitral valve[8.2%], and 3 in 31 replacement of multiple valves [9.7%] Except for 3 intraoperative deaths, postoperative, major and minor complications occurred in 39 patients[31.0%]. And the actuarial 5-year survival rate of operative survivors was 95.5$\pm$8.6%.

• Journal of Chest Surgery
• /
• v.29 no.2
• /
• pp.164-170
• /
• 1996

From January 1986 to June 1993, 12 patients Aad required reoperation: 9 had undergone mitral and 3 aortic valve replacement. Five were male and 7 female, and ages ranged from 29 to 61 years. Replacement of the prosthetic heart valve was performed at a mean interval of 98 $\pm$ 1 months after the Hrst operation. In aortic valve replacement patients the mean interval was 115 $\pm$ 2 months and in mitral valve replacement patients 98 $\pm$ 4 months. Primary tissue failure was the most frequent reason of replacement (10 patients) followed by valve thrombosis (1 patient) and prophylactic replacement (1 patient) in order. The most pronounced pathology of the failed prosthetic heart valves seen in the primary tissue failure group was calcification, perforation, shrinkage and tearing of the cusps. There was one early operative death (8.3%) due to intractable low cardiac output and acute renal failure. Eleven early survivors had successful operative results and there was no late death.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.655-662
• /
• 1985

From January 1985 to July 1985, prosthetic heart valves were replaced in 5 patients at Keimyung University Dongsan Medical Center. The patients included three women and two men ranging in age from 22 to 41 years. Three mitral valve replacements, one aortic valve replacement and one double valve replacement [mitral and aortic valve replacement] were done at the first valve operations. Reoperation were performed 2 to 76 months after the first operations, Prosthetic valve endocarditis occurred in 3 patients, early in one and late in two and primary valve failure occurred in 2 patients. In operative findings, vegetation in prosthetic valve endocarditis and calcification in primary valve failure were found. All except one had relatively successful operative results. One died of early fungal prosthetic valve endocarditis due to relapsed prosthetic valve endocarditis with heart failure and block.

• Proceedings of the Korean Society of Precision Engineering Conference
• /
• 2006.05a
• /
• pp.511-512
• /
• 2006

According to development of medical science and engineering, people has made efforts to solve tile discomfort of body accident as well as the life span. Many cases that reduce pain of a hip joint or limitation of motion using Revision Total Hip Replacement are getting increased. However it has not proved which material is the most appropriate. Scientists are still studying about materials of the artificial joint. In accordance with advance of science, the materials are Betting better. Recently, when Revision Total Hip Replacement is performed, typical materials are Ti-alloys Ceramics. We have studied materials of artificial joints and analyzed which one is better for human's body.

• Journal of Chest Surgery
• /
• v.30 no.10
• /
• pp.973-978
• /
• 1997

We reviewed data of 64 patients who underwent reoperation because of prosthetic valve malfunction from January 1991 to December 1995. The indications for reoperation were prosthetic valve failure(primary tissue failure: 53 patients, 82.8%), prosthetic valve thrombosis(6 patients, 9.4%), paravalvular leak(3 patients, 4.7%), prosthetic valve endocarditis(2 patients, 3.6%). Prosthetic valve failure developed most frequently in mitral portion(40 patients, 75%), prosthetic valve thrombosis also in mitral portion(4 patients, 67%), paravalvular leak significantly in aortic portio (3 patients, 100%). Explant period was longest in prosthetic valve failure(mean 107.4 $\pm$ 24.6 months), shortest in prosthetic valve endocarditis with prosthetic valve thrombosis(1 patient, 1 month). Mean explant period, defined as from first valve replacement operation to redo-valve replacement operatopn, was 109.2$\pm$ 10.7 months in mitral portion, 97.8$\pm$ 10.4 months in aortic portion, 109.5$\pm$ 10.4 months in total. Overall hospital mortality was 9.38%. The most common cause of death was the low cardiac output(4 patients), other causes were bleeding(1 patient), CNS injury(1 patient). Preoperative NYHA class IV(P=0.011), emergency operation(P=0.011), prosthetic valve endocarditis(P=0.001) were the independent risk factors, but age, sex, explant period, ACC time, double valve replacement, valve position, second reoperation did not appear to be significant risk factors. Mean follow up period was 28.8 $\pm$ 17.8 months. Actuarial survival at 3 year was 92.0$\pm$6.2%, 2 year event-free survival w s 84.3$\pm$6.1%. We propose that patients undergoing reoperation because of prosthetic valve failure are carfully controlled and selected in regarding to above mentioned risk factors NYHA class IV, emergency operation, prosthetic valve endocarditis in preoperative state. About other risk factors possible, there is necessary of following study.

• Journal of Chest Surgery
• /
• v.33 no.11
• /
• pp.863-868
• /
• 2000

배경: Cox-Maze III (CM-III) 술식은 복잡한 심방 절개로 인한 긴 수술시간 때문에 다른 개심 수술과 병행하여 시행하기 어려운 단점이 있다. 대상 및 방법: 저자들은 CM-III 술직을 다음과 같이 변형하여 시행하고 그 임상성적을 분석하였다. \circled1 좌심방이를 절제하는 대신 좌심방이를 외부에서 결찰하고, \circled2 폐정맥 분리 절개선과 좌심방이 사이에 냉동절제술을 시행하며, \circled3 우심방이를 절제하는 대신에 우심방 외측 절개선을 우심방이까지 연장하고, \circled4 후종 우심방 절개 하부에서 우심방 외측을 지나 삼첨판막륜으로 향하는 T-자 절개선을 생략하였다. 저자들이 시행한 변형 술식의 용이성과 효율성을 평가하기 위하여, 우리나라에서도 빈도가 높은 류마치스성 승모판막 질환에서, 전통적인 Cox-III 술식(그룹 I)의 임상결과와, 변형된 CM-III 술식(그룹 II)의 임상결과를 비교하였다. 결과: 그룹 I(n=18)에서 동반된 수술은 승모판막 치환술 10례, 승모판막 성형술3례, 승모판막 치환술과 삼첨판막륜 성형술3례, 승모판막 재치환술 2례 등이었다. 그룹II(n=23)에서 동반된 수술은 승모판막 치환술 7례, 승모판막 성형술 5례, 승모판막 치환술과 삼첨판막륜 성형술 1례, 승모판막 재치환술 10례 등이었다. 그룹 I과 그룹 II에서 평균 대동맥 차단 시간(ACC)은 각각 135$\pm$29분과 104$\pm$18 분, 심패바이패스(CPB) 시간은 각각 240$\pm$33분과 185$\pm$42분이었다. 그룹 I과 그룹 II의 평균 추적 관찰 기간은 각각 47$\pm$14 개월과 29$\pm$4 개월이었다. 그룹 I에서는 16례(88.9%)에서 정상 동율동으로 회복되었고 1례에서 심방세동이 남아 있었으며, 다른 1례는 서맥증후군(sick sinus syndrome)으로 인공 심박조율기를 삽입하였다. 그룹 II에서는 21례(91.3%)에서 정상 동율동으로 회복되었고 2례는 심방세동이 지속되었다. 그룹 I에서 정상동율동으로 회복된 16례는 100%(16/16)에서 우심방의 수축을 심장 초음파검사에서 확인할 수 있었으며, 좌심방의 수축은 75%(12/16)에서 확인할 수 있었다. 그룹 II에서는 정상 동율동으로 회복된 21례 중 100%(21/21)에서 우심방의 수축을 확인할 수 있었으며, 좌심방의 수축은 76.2%(16/21)에서 확인할 수 있었다. 결론: 변형 CM-III 술식은 전통 CM-III 술식에 비하여 ACC time(p<0.005)과 CPB time(p<0.001)을 의미있게 줄이면서도 필적할 만 한 정상 동율동 전환율과 심방 수축력의 회복을 보여주었다.

• Proceedings of the Korean Society of Precision Engineering Conference
• /
• 2006.05a
• /
• pp.179-180
• /
• 2006

In this study, the effect of stem-end design on contact pressure and stress distribution in revision TKR was investigated using finite element method. The finite element model of tibia, including the cortical bone, the cancellous bone and canal, was developed based on CT images. The stem models with various stem lengths, diameters and frictional coefficients, and press-fit effects were considered. The results showed that the longer stem length, the stronger press-fit, the bigger stem diameter, and the higher frictional coefficient increased both peak contact pressure and the highest Von-Mises stress values. We hypothesized that peak contact pressure and Von-Mises stress distribution around the stem, may be related to the stem end pain. The results of this study will be useful to design the stem endand reduce the end-of-stem pain in revision TKR.