• Journal of Chest Surgery
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• v.25 no.5
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• pp.550-554
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• 1992

The selection of an appropriate surgical technique for repair of aneurysm of the ascending aortia with aortic insufficiency is unsettled. The etiology of the disease process has been the best indicator for the type of repair. Placement of a supracoronary graft[seperate graft and valve] is a compromise if the coronary ostia are displaced cephalad by the aneurysm, where as insertion of a valved conduit is difficult and unnecessary if the coronary ostia are normally placed. A 53 year old female patient underwent primary repaiar of proximal dissected layer and aortic valve replacement with 24mm carbomedics, The operative findings consisted of a supravalvular intimal tear, cicumferential dissection, dilated aortic annulus and normal position of coronary ostia. She is good physical activity now llmonths posoperatively.

• Journal of Chest Surgery
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• v.50 no.4
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• pp.235-241
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• 2017

Background: The Ross/Ross-Konno procedure is considered a good option for irreparable aortic valve disease in pediatric patients because of its hemodynamic performance and potential for growth of the pulmonary autograft. This study is a review of the long-term results of our 20-year experience with the Ross and Ross-Konno operations in a single institution. Methods: Between June 1995 and January 2016, 16 consecutive patients (mean age, $6.0{\pm}5.9years$; range, 16 days to 17.4 years) underwent either a Ross operation (n=9) or a Ross-Konno operation (n=7). The study included 12 males and 4 females, with a median follow-up period of 47 months (range, 6 to 256 months). Results: There were no cases of in-hospital or late mortality. Six reoperations were performed in 5 patients. Four patients underwent right ventricular-pulmonary artery (RV-PA) conduit replacement. Two patients underwent concomitant replacement of the pulmonary autograft and RV-PA conduit 10 years and 8 years after the Ross operation, respectively. The rate of freedom from adverse outcomes of the pulmonary autograft was 88% and 70% at 5 and 10 years, respectively. The rate of freedom from valve-related reoperations was 79% and 63% at 5 and 10 years, respectively. Conclusion: Pulmonary autografts demonstrated good durability with low mortality. The Ross/Ross-Konno procedure is a good option that can be performed safely in pediatric patients with aortic valve disease, even in a small-volume center.

• Journal of Chest Surgery
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• v.11 no.3
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• pp.342-347
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• 1978

A 8 year old male was admitted to the Department of Thoracic Surgery, Korea University Hospital on June 22, 1978. The chief complaints were cyanosis and exertional dyspnea since at birth. EKG shows BVH and dextrocardia, phonocardiogram revealed the accentuation of second heart sound in aortic area. Echocardiogram from the left ventricle to the base of the heart, there is a discontinuity between the ventricular septum and the anterior aortic margin with a large aortic root & aortic overriding. His cardiac catheterization data and cardiac angiogram shows situs inversus totalis, dextrocardia, right aortic arch, large ventricular septal defect etc., and finally diagnosed Truncus Arteriosus. Edwards type IV with retrograde aortogram and selective bronchial angiogram. This is the first operative case reported as Rastelli operation for Truncus Arteriosus type IV in the literatures in Korea. Authors have experienced I case of Truncus Arteriosus, Edward type IV and Rastelli operation with Dacron Arterial Conduit Graft under cardiopulmonary bypass on July 3, 1978. The procedures were as follows; 2] Cardiopulmonary bypass: Origin of bronchial arteries excised from descending aorta bilaterally; defects in aorta closed. 2] Horizontal incision made high in right ventricle. 2] Ventricular septal defect [Kirklin type I+II] closed with Teflon patch. 4] Bifurcated dacron arterial graft with pericardial monocusp sutured to the bilateral pulmonary arteries. [Diameter 9 mm: Length 7 cm]. 5] Proximal end of the conduit graft anastomosed to right ventricle. [Diameter 19 mm: Length 5 cm]..Total perfusion time was 220 min. The result of operation was poor due to anastomotic leakage and increased pulmonary vascular resistance resulting acute right heart failure. The patient was died on the operation table. Literatures were briefly reviewed.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.458-472
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• 1987

A heart supplies bloods of about 15, 000 liters to each human organ in a day. A normal function of heart valves is necessary to this act of heart. The disease of heart valve develops to a narrowness of a closure, resulting in an abnormal circulation of bloods. In an attempt to eliminate the affliction of heart valves, the operation method to repair with artificial heart valves has been developed and saved numerous patients over past 30 years. This replacement operation has been performed since early 1960`s in Korea, but all the artificial heart valves used are imported from abroad with very high costs until recent years. The artificial heart valve using pyrolytic carbon has been developed at KAIST, which was proved to be stable in the mechanical performance and durability. Therefore, the in viva performance of this valve was examined through animal tests. The artificial heart valves used in this study are tilting disc type valves, in which the disc were made of graphite coated with pyrolytic carbon and the cages were made of titanium. In viva testings of these valves were performed in 12 dogs, in which right ventriculo-pulmonary arterial [Croup I] or inter-aortic [Croup IV] valved conduit was implanted using polytetrafluoroethylene conduits containing KAIST valve and aortic valve [Group II] or pulmonary valve [Croup III] was replaced by a KAIST valve with a 21mm or 19mm tissue annulus diameter. In group I and II, pre-and post-operative transvalvular pressure gradient was measured and compared with other prosthetic valves. During post operative period laboratory examination was performed including hemoglobin, hematocrit, red cell count, white cell, lactic acid dehydrogenase and platelet. The eight surviving dogs were sacrificed and autopsy was performed at 2, 6, and 8 weeks. KAIST valve has low transvalvular gradient and relatively high orifice area. Average ventriculo-aortic peak systolic transvalvular gradient was 14 mmHg in 21 mm valve and 19 mmHg in 19 mm valve. The valve has slight intravascular hemolysis effect. Thrombogenic effect of low polishing quality and eddy currents around small orifice is high. The valve has vulnerability of disc movement. These animal tests suggest that the improvement of the heart valve design, surface polishing state and prescription methods.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.856-859
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• 2005

A male neonate was referred to our hospital with facial cyanosis and tachypnea at 19 days of age. Two-dimensional echocardiography showed type B interrupted aortic arch, posterior malalignment ventricular septal defect and valvular aortic stenosis. A new surgical repair was done with biventricular repair and neo-aortic arch reconstruction. Left ventricular outflow track (LVOT) was consisted of aortic valve and pulmonic valve. Right ventricular outflow (RVOT) track was reconstructed with extracardiac conduit. Postoperative two-dimensional echocardiography showed no stenosis and turbulency flow on LVOT and RVOT.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.676-680
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• 2000

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.357-362
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• 1997

In vivo testings of the monoleaflet polymer valve were performed in seven dogs to prove its blood biocompatibility. The monoleaflet polymer valve used in this study was developed for short-term usage n the ventricular assist device. The frame and leaflet of the polymer valve were made of polyurethane. The inter-aortic valved conduit were implanted in four dogs and the ventriculo-atrial valved conduit was implanted in one dog. The ventricular assist devices with polymer valve were implanted in two dogs. The longest survival was 20 days. Main causes of death were bleeding and infection. To examine the blood compatibility, each blood sample was collected and RBC, WBC, hematocrit, hemoglobin, platelet and lactic acid dehydrogenase were analyzed. These studies thus far demonstrated that, with further development, a reliable and inexpensive polymer valve will be used in the ventricular assist device as short term usage.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.759-765
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• 2003

Truncus arteriosus with interrupted aortic arch is a very rare congenital cardiac anomaly that has an unfavorable natural course. We report a successful one-stage repair of truncus arteriosus with interrupted aortic arch through median sternotomy in a 25-day-old neonate weighing 3.1 kg. We reconstructed the aortic arch with direct side-to-end anastomosis between ascending and descending aortas. The right ventricular outflow reconstruction was performed with untreated autologous pericardial conduit without valve following Lecompte maneuver. The patient has been grown-up in good condition (25 ∼ 50 percentile of body weight) and shows the right ventricular outflow tract wide 1 year after the operation.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.340-346
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• 1988

The surgical treatment of annuloaortic ectasia falls into two basic categories, depending on the management of the coronary artery ostia and the sinus of Valsalva. The conventional method, first suggested by Groves, Wheat and their associates, employs a supracoronary graft for the treatment of aneurysm and conventional valve replacement. A more radical approach, that of Bentall and DeBono, uses a valve conduit from the aortic annulus to the distal extent of the aneurysm. This latter technique requires reimplantation of the coronary artery ostia for reestablishment of coronary artery blood flow. Recently we experienced a case of annuloaortic ectasia to which we applied the Bentall operation with the good postoperative result, and now we report this with literature review.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.382-384
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• 2005

Background: It is very difficult to choose the ideal valved conduit used in right ventricle outflow reconstruction in child. We can use the cryopreserved homograft but there is a limit of application because of its difficulties in the size matching and supply capacity. The $Shelhigh^{(R)}$porcine-valved conduit is commercially available and used as an alternative choice in these days. We report two cases of early Shelhigh conduit failure in right ventricular outflow tract after Ross operation in congenital aortic stenosis.