• Journal of Chest Surgery
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• v.29 no.6
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• pp.651-654
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• 1996

Recently, we report a surgical experience of one case of acute prosthetic valve failure due to throe- bosis. The patient was 39-year old male who complained of dyspnea and orthopnea for 3 days before admission. The patient had not taken anticoagulant therapy for recent 4 months against medical ad- vice. The limitation of valve motion was revealed on echocardiography. We performed emergency reoperation with thrombectomy and prosthetic valve replacement. The patient had anuncomplicated postoperative course and have been followed up.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.26-33
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• 2021

Purpose: This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA). Materials and Methods: From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author's hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis-Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65-82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1-108 months). The mean follow-up period was 23 months (12-65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated. Results: The mean union time was 17.4 weeks (7-40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2-4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0-4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70-95 points) at the last follow-up. Conclusion: Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.37-44
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• 2019

Purpose: Tumor infiltration around the knee joint or skip metastasis, repeated infection sequelae after tumor prosthesis implantation, regional recurrence, and mechanical failure of the megaprosthesis might require combined distal femur and proximal tibia replacement (CFTR). Among the aforementioned situations, there are few reports on the indication, complications, and implant survival of CFTR in temporarily arthrodesed patients who had a massive bony defect on either side of the knee joint to control infection. Materials and Methods: Thirty-four CFTR patients were reviewed retrospectively and 13 temporary arthrodesed cases switched to CFTR were extracted. All 13 cases had undergone a massive bony resection on either side of the knee joint and temporary arthrodesis state to control the repeated infection. This paper describes the diagnosis, tumor location, number of operations until CFTR, duration from the index operation to CFTR, survival of CFTR, complications, and Musculoskeletal Tumor Society (MSTS) score. Results: According to Kaplan-Meier plot, the 5- and 10-year survival of CFTR was 69.0%±12.8%, 46.0%±20.7%, respectively. Six (46.2%) of the 13 cases had major complications. Three cases underwent removal of the prosthesis and were converted to arthrodesis due to infection. Two cases underwent partial change of the implant due to loosening and periprosthetic fracture. The remaining case with a deep infection was resolved after extensive debridement. At the final follow-up, the average MSTS score of 10 cases with CFTR was 24.6 (21-27). In contrast, the MSTS score of 3 arthrodesis cases with failed CFTR was 12.3 (12-13). The average range of motion of the 10 CFTR cases was 67° (0°-100°). The mean extension lag of 10 cases was 48° (20°-80°). Conclusion: Although the complication rates is substantial, conversion of an arthrodesed knee to a mobile joint using CFTR in a patient who had a massive bony defect on either side of the knee joint to control infection should be considered. The patient's functional outcome was different from the arthrodesed one. For successful conversion to a mobile joint, thorough the eradication of scar tissue and creating sufficient space for the tumor prosthesis to flex the knee joint up to 60° to 70° without soft tissue tension.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.939-944
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• 1998

Background: The sugical results of the Cox-Maze procedure (CMP) for lone atrial fibrillation(AF) have proven to be exellent. However, those for AF associated with mitral valve(MV) disease have been reported to be a little inferior. Materials and methods: To assess the efficacy and safety of the CMP as a combined procedure with MV operation, we studied retrospectively our experiences. Between April 1994 and October 1997, we experienced 70 (23 males, 47 females) cases of CMP concomitantly with MV operation. Results: The etiologies of MV disease were rheumatic in 67 and degenerative in 3 cases. The mean duration of AF before sugery was 66$\pm$70 months. Fifteen patients had the past medical history of thromboembolic complications, and left atrial thrombi were identified at operation in 24 patients. Twelve cases were reoperations. Aortic cross clamp (ACC) time was mean 151$\pm$44 minutes, and cardiopulmonary bypass (CPB) time was mean 246$\pm$65 minutes. Concomitant procedures were mitral valve replacement (MVR) in 19, MVR and aortic valve replacement (AVR) in 14, MVR and tricupid annuloplasty (TAP) in 8, MVR with AV repair in 3, MV repair in 11, MVR and coronary artery bypass grafting (CABG) in 2, MVR and AVR and CABG in 1, redo-MVR in 10, redo-MVR and redo-AVR in 2 patients. The rate of hospital mortality was 1.4%(1/70). Perioperative recurrence of AF was seen in 44(62.9%), and atrial tachyarrhythmias in 10(14.3%), low cardiac output syndrome in 4(5.7%), postoperative bleeding that required mediastinal exploration in 4(5.7%) patients. Other complications were acute renal failure in 2, aggravation of preoperative hemiplegia in 1, and transient delirium in 1 patient. We followed up all the survivors for 16.4 months(3-44months) on an average. Sinus rhythm has been restored in 65(94.2%) patients. AF has been controlled by operation alone in 73.9% and operation plus medication in 20.3%. Two patients needed permanent pacemaker implantation; one with sick sinus syndrome, and the other with tachycardia- bradycardia syndrome. Only two patients remained in AF. We followed up our patients with transthoracic echocardiography to assess the atrial contractilities and other cardiac functions. Right atrial contractility could be demonstrated in 92% and left atrial contractility in 53%.We compared our non-redo cases with redo cases. Although the duration of AF was significantly longer in redo cases, there was no differences in ACC time, CPB time, postoperative bleeding amount and sinus conversion rate. Conclusions: In conclusion, the CMP concomitant with MV operation demonstrated a high sinus conversion rate under the acceptable operative risk even in case of reoperation.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.248-251
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• 2009

Nonocclusive mesenteric ischemia (NOMI) is a rare complication that occurs in about 0.05% of patients after openheart surgery, and NOMI refers to the mesenteric ischemia that's caused by splanchnic vasospasm without occlusion of the great intestinal vessels. In the presently reported case, NOMI developed to maintain the blood flow to the heart and brain after several minutes of a hypotensive status and the latter was caused by acute aortic dissection that complicated an aortic cannulation procedure. Unfortunately, the patient died even though the problems were diagnosed early and proper treatment was administered. Early diagnosis of NOMI by angiography and the selective infusion of vasodilators are thought to be the only way to improve survival for patients with clinically suspected NOMI.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.23-30
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• 1995

From January 1985 to December 1992, of 1257 patients who underwent a heart valve replacement 210 [16.8% underwent reoperation on prosthetic heart valves, and 6 of them had a second valve reoperation. The indications for reoperation were structural deterioration [176 cases, 81.5% , prosthetic valve endocarditis [25 cases, 11.6% , paravalvular leak [12 cases, 5.6% , valve thrombosis [2 cases, 0.9% and ascending aortic aneurysm [1 case, 0.4% . Prosthetic valve failure developed most frequently in mitral position [57.9% and prosthetic valve endocarditis and paravalvular leak developed significantly in the aortic valve [40%, 75% [P<0.02 . Mean intervals between the primary valve operation and reoperation were 105.3$\pm$28.4 months in the case of prosthetic valve failure, 61.5$\pm$38.5 months in prosthetic valve endocarditis, 26.8$\pm$31.2 months in paravalvualr leak, and 25.0$\pm$7.0 months in valve thrombosis. In bioprostheses, the intervals were in 102.0$\pm$23.9 months in the aortic valve, and 103.6$\pm$30.8 months in the mitral valve. The overall hospital mortality rate was 7.9% [17/26 : 15% in aortic valve reoperation [6/40 , 6.5% in reoperation on the mitral prostheses [9/135 and 5.7% in multiple valve replacement [2.35 . Low cardiac output syndrome was the most common cause of death [70.6% . Advanced New York Heart Association class [P=0.00298 , explant period [P=0.0031 , aortic cross-clamp time [P=0.0070 , prosthetic valve endocarditis [P=0.0101 , paravalvularr leak [P=0.0096 , and second reoperation [P=0.00036 were the independent risk factors, but age, sex, valve position and multiple valve replacement did not have any influence on operative mortality. Mean follow up period was 38.6$\pm$24.5 months and total patient follow up period was 633.3 patient year. Actuarial survival at 8 year was 97.3$\pm$3.0% and 5 year event-free survival was 80.0$\pm$13.7%. The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, so reoperation before severe hemodynamic impairment occurs is recommended.

• Journal of Biomedical Engineering Research
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• v.25 no.6
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• pp.455-464
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• 2004

Total hip arthroplasty(THA) considerably depends on high-experienced doctors because of high difficulty of the operation. Selection of acetabular cup's and femoral implant's position is closely related with success or failure of THA. Nevertheless the selection has usually depended on doctor's eye measurement, which makes the position accuracy of artificial joint lower after THA, often resulting in revision of THA. The present study determined a method to select accurately the position of acetabular cup and femoral implant through surgical simulation with 3D characteristic geometrical information of patient's pelvis and femur. We examined the change of femoral anteversion angle and neck-shaft angle accompanied by the change of acetabular cup's position and the insertion position of femoral implant. As result of analyzing geometrical information through different surgical simulations, we found that it was possible to select the accurate position of acetabular cup and femoral implant. It is expected to help doctors get experienced in THA operation through repetitive surgical simulations using the method suggested in the study.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1347-1353
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• 1996

To assess the long-term results of mitral valve replacement, we reviewed our cases of the 374 patients undergoing mitral valve replacement between March 1982 to February 1992 There were 159 male and 215 female and mean age was 37.8 years. There were 24 hospital deaths(6.4%);the most commonly from low cardiac output syndrome(12 deaths). We used 314 mechanical valves and 60 tissue valves. Most of all were anticoagulated with coumadin maintaining target level of 1.5~3.0 INR of prothrombin time. Follow up was 94% complete(2270 patient-years). There were 12 late deaths 3 due to hemorrhage, 3 due to cerebral embolism and 6 from Overall actuarial survival including hospital mortality, was 82.3% after 10 years of operation Linealized rates of late complication events are follows thromboembolism, 1.3% per patient-year; anti coagulant related hemorrhage, 0.5% per patient year. We analyzed the factors of favorable effect to postoperative course were preoperat ve clinical status including NYHA class, first operation, valve apparatus preservating operation technique, not biggest size of prosthetic valve.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.200-207
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• 2021

Periprosthetic femoral fractures remain as one of the most challenging complications following total hip arthroplasty. A thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are essential to obtain optimal results for these fractures. The Vancouver classification system is a simple, effective, and reproducible method for the planning treatments of these injuries. The fractures associated with a stable femoral stem can be treated effectively with osteosynthesis, but periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. This paper describes the principle of the treatment of patients with periprosthetic femoral fractures and how to assess the stability of the femoral stem.

• Journal of Chest Surgery
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• v.24 no.7
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• pp.663-668
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• 1991

To evaluate risks, complications and mortality of reoperations on heart valve prosthesis, we reviewed clinical records of 53 patients who underwent reoperation because of prosthetic valve failure[PVF], from Jan 1959 through Jun. 1991. They had undergone 48 mitral, 10 aortic valve rereplacement Primary tissue failure was the main cause of reoperation : it occurred in 51 valves at a mean postoperative interval of 58 months. Calcification and collagen disruption of prosthesis were main causes of primary tissue failure in macro and micropathology, In 3 failing mechanical prostheses, paravalvular leak was in 2 cases, another one case had the thrombi at the hinge portion. If conditions such as emergency operation with or without endocarditis, thromboembolism and advanced NYHA functional class are prevented, we think that reoperative valve replacement has similar morbidity and mortality to initial valve replacement surgery. But our sturdy represents higher mortality [22.6%] because of late surgical intervention failing the prevention of conditions leading to myocardial damage. In conclusion if the tearing, calcification, and a new murmur were detected the early reoperation should be considered to increase late survival.