• Journal of Chest Surgery
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• 제33권10호
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• pp.777-784
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• 2000

Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. Material and Method: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. Result: After surgical correction peak aortic gradient fell from 58.4${\pm}$17.6, to 23.7${\pm}$17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6${\pm}$24.3 to 143.7${\pm}$27.1 mmHg and from 1.78${\pm}$0.4 to 1.76${\pm}$0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10${\pm}$0.2, to 1.27${\pm}$0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2${\pm}$24.9 to 57.1${\pm}$27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. Conclusion ; We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.

• Journal of Chest Surgery
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• 제27권11호
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• pp.893-901
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• 1994

Forty nine patients [M: 31, F: 18], age from 2 months to 17 years [mean= 4.9 years], underwent operations, from April 1986 to December 1992, for the relief of subvalvular aortic stenosis in normal atrioventricular and ventriculoarterial connections.There were 4 anatomic types of subaortic stenosis : membranous in 29 cases [59.2%], fibromuscular in 11 [22.4%], diffuse tunnel type in 7 [14.3%], and miscellaneous in 2 cases. Thirty four patients [69.4%] had associated cardiac anomalies, of which ventricular septal defect was the most common [27 cases]. Other anomalies were patent ductus arteriosus, coarctation of the aorta, valvular aortic stenosis, double chambered right ventricle [DCRV], infundibular pulmonic stenosis, persistent left superior vena cava, and rigt aortic arch. Mean systolic pressure gradient between the left ventricle and ascending aorta was 26.4$\pm$17.6 mmHg : 13.1$\pm$17.6mmHg in the membranous type, 22.0$\pm$18.4mmHg in the fibromucular type, and 56.1$\pm$38.4mmHg in the diffuse tunnel type. Operative procedures were determined according to the type of subvalvular aortic stenosis : simple excision of subaortic membrane in the membranous type [29 cases], left ventricular myectomy with or without myotomy or fibrous tissue excision in the fibromuscular type [11 cases]. Among the 7 of diffuse tunnel type cases, ventricular myectomy was performed in 2 and a modified Konno operation was performed in 5 . Postoperative follow up was made with periodic echocardiography. The Mean postoperative follow up period was 33.8 months. There were 2 hospital mortalities [4.1%] and 2 late deaths. Residual stenosis remained in 3 cases and recurrence developed in 2 cases during the follow up period. 5 years actuarial survival rate was 91.8$\pm$3.9% and 5 year complication free rate was 72.3$\pm$10.4%. Conclusions : 1. Subvalvular aortic stenosis should be relieved completely as soon as possible when diagnosed, regardless of left ventricular outflow tract pressure gradient. 2. Good results were obtained using only simple excision of subaortic membrane in the membranous type of subaortic stenosis. However, aortoventriculoplasty [modified Konno prodedure] was necessary for good results in the diffuse tunnel type. 3. Periodic postoperative echocardiography was helpful in detecting the progression of residual stenosis and development of new stenosis.

• Journal of Chest Surgery
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• 제36권11호
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• pp.858-861
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• 2003

대동맥판막질환에 동반된 허혈성 심질환의 원인은 대부분 전신적인 동맥경화의 진행에 따른 것이며, 심한 석회화가 초래된 대동맥판협착증 환자에서 대동맥판막의 일부가 떨어져 나와서 관상동맥 색전증 및 협착을 유발시킨 예는 매우 드물다. 저자들은 흉부압박감을 주소로 내원한 73세 여자 환자에서 심초음파검사와 관상동맥조영술을 시행하여 중증 대동맥판협착증과 우관상동맥의 색전증을 진단하고 대동맥판치환술과 우관상동맥의 색전제거술 및 관상동맥성형술을 시행하였던 예를 치험하였다. 수술 후 우관상동맥 색전의 원인 물질이 대동맥판막으로부터 떨어져 나온 석회성 판막조직으로 판단되었기에 이와 관련된 문헌고찰과 함께 보고하는 바이다.

• 융합정보논문지
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• 제8권5호
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• pp.131-135
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• 2018

현대인의 사망원인 2위를 차지하고 있는 심장병은 자각 증세 없이 갑자기 돌연사를 당할 수 있는 무서운 질병으로 예방이 중요하다. 심장병 중 대동맥판막 협착증을 판단하기 위해서 physioNet에서 제공하는 심음 데이터 중 S1과 S2 사이의 수축 심음 데이터를 이용하여 병명을 진단하였다. 대동맥 판막은 좌심실에서 대동맥으로 피가 유출되는 부위의 판막이다. 심장병 중 대동맥판막 협착증은 대동맥판막이 좁아져 좌심실의 수축 시 판막이 열리지 않는 질환이다. 위 논문에서는 정상인과 대동맥판막 협착증 환자를 합쳐 특징이 180개로 이루어진 3126개의 샘플 심음 데이터를 실험데이터로 사용하였다. 정상과 대동맥판막 협착증 환자를 구분하기 위해 가중퍼지신경망(NEWFM, Neural Network with Weighted Fuzzy Membership Function)이용하였다. 가중퍼지신경망의 특징선택 방법으로 가중치의 평균 방법을 이용하였으며, 분류 결과는 91.0871%의 정확도를 나타내었다.

• Journal of Chest Surgery
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• 제31권8호
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• pp.763-769
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• 1998

배경: 판막상부 대동맥협착증은 상행대동맥의 관상동맥 기시부 상부의 협착을 초래하는 드문 형태의 선천성 기형이다. 대상 및 방법: 본 서울대학교 어린이병원 흉부외과에서는 1986년 7월부터 1997년 3월까지 12예의 판막상부 대동맥협착증 환자들에게 수술적치료를 하였다. 평균나이는 10.2세였고 4세에서 17세까지 분포하였다.11명이 남자환자였고 Williams증후군의 임상양상을 보인 경우는 12예중 9예였다. 두가지형태의 판막상부 대동맥협착증을 경험하였고 10예가 모래시계형(hour glass type)이였고 2예가 미만형(diffuse type) 이었다. 결과: 모든 환자들은 수술 전에 심도자검사를 하였다. 술전 좌심실과 대동맥의 평균압력차이는 92 mmHg였고 40에서 180 mmHg까지 분포하였다. 폐동맥협착은 5예에서 관찰되었으며 그중 2예에서 폐동맥혈관성형 술을 시행하였다. 세 가지 종류의 수술적기법을 시행하였는바 타원형의 포편을 이용한 단순포편대동맥성형술이 6예였고 역Y모양의 포편을 이용한 확장형 대동맥성형술이 4예였고 변형 Brom 기법이 2예였다. 수술사망례는 없었고 수술후 심에코검사를 평균 12개월에 시행하였다. 1도와 2도의 대동맥판폐쇄부전이 3예에서 있었다. 술후 시행한 심도자검사상 좌심실과 대동맥 사이에 평균 26 mmHg (0∼75 mmHg)의 압력차이가 있었고 평균압력차이의 감소는 78 mmHg(30∼114 mmHg)였다. 모든 환자는 평균 40개월(1∼67개월)간의 추적관찰기간동안 특별한 문제없는 임상 경과를 보였다. 결론: 본 연구는 소아의 판막상부 대동맥협착증의 수술적 교정이 술후 낮은 사망률을 보장하면서 양호한 혈역학적 개선을 가져옴을 보여주었다.

• Journal of Chest Surgery
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• 제45권5호
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• pp.338-341
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• 2012

Vascular ring, caused by Kommerell's diverticulum and ligamentum arteriosum, in a patient with right aortic arch and mirror image branching is extremely rare. A 10-month-old boy with coughing and stridor was diagnosed as having tracheo-esophageal stenosis, which is caused by a vascular ring with Kommerell's diverticulum, ligamentum arteriosum, right aortic arch, and mirror image branching. Kommerell's diverticulum was successfully resected via a left thoracotomy. The patient has been free from tracheo-esophageal stenosis for a year after the surgery.

• Journal of Chest Surgery
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• 제23권3호
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• pp.532-536
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• 1990

We experienced surgical correction of 2 cases of discrete membranous subaortic stenosis. Case 1 was 19 years old male patient. His complaints were fatigue, exertional dyspnea, syncope and angina for 8 years. Ejection. systolic murmur was heard at the second right intercostal space and diastolic murmur was heard at the apex. A thrill was palpated over the second right intercostal space and area of the carotid artery. 2-D echo, cardiac cath and left ventriculogram revealed discrete membranous subaortic stenosis and VSD. Complete excision of discrete membrane without mymectomy was done. VSD was closed with dacron patch and aortic valve was replaced with St. Jude medical valve. Case 11 was 16 years old female whose complaints were exertional dyspnea and syncope. Ejection systolic murmur was heard at second right intercostal space, but diastolic murmur was not heard. A thrill was palpated over the second right intercostal space and the area of carotid artery. 2-D echo, cardiac cath and left ventriculogram revealed discrete membranous subaortic stenosis. Complete excision of fibrous tissue and myotomy were made and aortic valve was replaced with St. Jude medical valve. Operative finding was followed: both aortic valves showed deformity of leaflets. Subaortic region had a thickened central fibrous body from which the ridge protruded. Both patient`s postoperative course were uneventful and short-term follow-up results were good except soft systolic murmur at the aortic area.

• Journal of Chest Surgery
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• 제20권4호
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• pp.710-714
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• 1987

Over the past 6 years, from July, 1981. through June, 1987., 14 consecutive patient with congenital aortic stenosis underwent corrective surgery in our department of Thoracic and Cardiovascular Surgery. The patient ranged in age from 1 to 20 years. There were 8 male and 6 female patients. According to the operative findings, stenotic site was valvular stenosis [5 cases], subvalvular stenosis [5 cases], supravalvular stenosis [2 cases], valvular and supra valvular stenosis [1 case]. We have performed valvotomy and commissurotomy [5 cases]. Resection of subvalvular membrane [3 cases], patch enlargement of Ascending aorta [2 cases], LV myotomy [2 cases], valvotomy and excision of membrane [1 case], patch enlargement of ascending aorta and valve ring [1 case]. There was one hospital mortality [7.1%]. He died of C-I bleeding and sepsis on the 25th postoperative day. All survivors showed improvement in NYHA functional class in the 160 patient/month follow up period.

• Journal of Chest Surgery
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• 제49권2호
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• pp.115-118
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• 2016

Williams syndrome (WS) is a developmental disorder characterized by vascular abnormalities such as thickening of the vascular media layer in medium- and large-sized arteries. Supravalvular aortic stenosis (SVAS) and peripheral pulmonary artery stenosis (PPAS) are common vascular abnormalities in WS. The natural course of SVAS and PPAS is variable, and the timing of surgery or intervention is determined according to the progression of vascular stenosis. In our patient, SVAS and PPAS showed rapid concurrent progression within two weeks after birth. We report the early manifestation of SVAS and PPAS in the neonatal period and describe the surgical treatment for stenosis relief.

• Journal of Chest Surgery
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• 제12권4호
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• pp.350-354
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• 1979

The incidence of congenital aortic valvular stenosis has been known rare, and approximately 3-6% of congenital heart diseases. Recently, we experienced 1 case of congenital aortic valvular stenosis, and which was corrected surgically under extracorporeal circulation successfully. A 11 years old male pt. was admitted to N.M.C. because of dyspnea, dizziness, chest pain and episode of syncope. An auscultation, harsh systolic murmur [Gr. IV/VI] was noted at aortic area and also palpable strong thrill. ECG showed LVH c strain pattern and suspicious LVH finding in simple chest P-A film. In Lt. cardiac catheterization, abrupt pressure change [110mmHg] between LV & Aorta was noted across the aortic valve. And aortic insufficiency was absent, well visualized both coronary arteries and suspicious bicuspid aortic valve in aortography. Valve form was bicuspid, large one was noncoronary cusp and another cusp was Rt. & Lt. coronary cusp which was interpositioned rudimentary commissure. Central aortic orifice was about 5ram in diameter. Valvulotomy was done along the fusioned commissure between noncoronary cusp and Rt. & Lt.coronary cusp, and then short incision was added between Rt. coronary cusp & Lt. coronary cusp. Immediate postoperative course smooth but unknown cardiac arrest was noted in POD second day. Complete recovery was done without sequelae by resuscitation. After operation, clinical symptoms were subsided but systolic murmur [Gr. II/VI] was audible at aortic area, diastolic murmur was absent. ECG showed still remained LVH but much decreased R wave voltage in Lt. precordial leads. Simple chest P-A showed no interval changes compared to preop film. Control Lt. heart catheterization revealed still remained pressure gradient [40ramrig] between LV & Aorta. But much decreased pressure gradient compared to preop pressure gradient [110mmHg].