• Journal of Chest Surgery
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• v.20 no.4
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• pp.760-764
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• 1987

Fifty seven patients underwent repair of a partial atrioventricular septal defect from January 1980 to December 1986. The ostium primum atrial septal defect was closed with autologous or bovine pericardium. The cleft in the anterior mitral leaflet was present in 53 cases, absent in 4 cases. Of the 53 cases with a cleft in the anterior mitral leaflet, 48 received suture repair of the cleft, 3 received mitral valve replacement. There was no hospital death and all the patients were followed-up for a mean period of 26.4 months. Four required permanent pacemaker implantation due to complete heart block, and one of them died of sudden malfunction of pacemaker. Two received reoperation due to significant residual mitral insufficiency. Suture repair of the cleft in the anterior mitral leaflet resulted in significant decrease in degree of mitral regurgitation. During follow-up period 49 patients were in NYHA class I, 7 patients were in NYHA class II. This report suggests that excellent result can be achieved from repair of the partial atrioventricular septal defect by managing the left A-V valve as a bileaflet structure.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.189-200
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• 1974

The mitral valve replacement with Beall prosthetic valve was performed on three patients, and double valve replacement. aortic and mitral valve, was performed in this department.1) The preoperative studies about the first case were compatible with mitral steno-insufficency.The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary hypass using hypothermic hemodilution technique. The total perfusion time was eighty minutes. Immediate postoperative course was smooth, but this patient was died of asphyxia due to tracheomalacia complicated after tracheostomy 3 months after operation. Autopsy on this patient revealed that no thrombus and no ball variance could be found, and endothelization on the valve cuff was satisfactory. 2) The preoperative studies on the second case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary bypass using hypothermic hemodilution technigue. The total perfusion time was 123 minutes. This patient was discharged in good condition and follow-up study after 16 months revealed the patient had enjoyed healthy life. 3) The preoperative studies about the third case were compatible with aortic insufficiency and mitral stenoinsufficiency. The diseased valves were replaced with type 2 sutureless Magovern aortic valve and the medium sized Beall mitral prosthesis under cardiopulmonary bypass using hypothermic hemodilution technIque and coronary artery perfusion. The total perfusion time was 155 minutes. This patient was discharged in good condition, but thromboembolism was developed 2 months after discharge. 4) The preoperative studies about the fourth case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve. The total perfusion time was 132 minutes. The atrioventricular block developed just after operation but converted to normal sinus rhythmn on the third postperative day. The preoperative NYHA functional classification IV was converted to Class 1 or 11 at the time of discharge and this patient enjoyed healthy life. Attendum; The fifth case, nineteen years old male with mital insufficiency underwent Beall valve replacement and his course was uneventful 2 weeks after operation.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.902-906
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• 1994

Between May 1991 and August 1993, 16 patients underwent repair of complete atrioventricular septal defect without another major anomaly at Cardiovascular Center,Yonsei University College of Medicine. Ages of the patients ranged from 3 months to 38 years with a mean of 42 months. Among 16, 10 patients[63%] are associated with Down`s syndrome. All patients underwent primary repair except and one who received had been repaire of coactation of aorta and patent ductus arteriosus 2 month before. Preoperative mitral valve regurgitation [MR] was evaluated with Doppler echocardiography and angiography which revealed absent or grade I in 1, grade II in 8, grade III in 4, and grade IV in 3. Operative technique was performed under the moderate hypothermic cardiopulmonary bypass with crystalloid cardioplegia. Intraoperative echocardiography was performed epicardial approach [n=7] in the operative table or transthoracic approach [n=9] at intensive care unit. In all patients except 3, MR were improved. But in 3 patients, was not improved or exagerated comparing preoperative one. All of them were died.One patient was showed MR grade IV in intraoperative echocardiography, we re-repaired atriventricular valve with cardiopulmonary bypass. During follow-up period [at a mean of 11 months after repair], doppler echocardiography was performed in all patients. The follow up echocardiography revealed that the degree of MR in immediate postoperative period was not changed except in two patients in whom it was aggravated. Thus it seems that intraoperative and early postoperative echocardiography was employed important role of survival and can be predictable for long term results.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.625-631
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• 1984

A modified Fontan procedure was performed on two patients with Univentricular heart. The first patient had UVH of right ventricular type with trabecular pouch and had various associated anomalies, such as common atrium, common atrioventricular valve and combined pulmonary stenosis. The second patient had UVH of left ventricular type with outlet chamber and the associated anomalies were atrial septal defect, tricuspid stenosis and combined pulmonary stenosis. Postoperative hemodynamic insufficiency, fluid retention and renal insufficiency were occurred in the first patient, but relieved with the aid of inotropics and vasodilators. We thought that the good postoperative course and surgical result were gained from the widely patent atriopulmonary anastomosis.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.41-48
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• 1990

Thirteen patients underwent repair of atrioventricular septal defect [AVSD] from January 1980 to July 1989 at Kyungpook National University Hospital. Two patients had complete AVSD [Rastelli type A] and eleven patients had partial AVSD [ostium primum atrial septal defect and cleft of anterior mitral leaflet]. In all the patients of partial AVSD, atrial septal defect was closed with Dacron patch and the mitral cleft was approximated with interrupted simple sutures. In one patient of complete AVSD, one patch technique was used to close the atrial and ventricular septal defect, and in the other patient of complete AVSD, two patch technique was used. In six patients, there were associated anomalies; four had isolated ostium secundum ASD, two had patent foramen ovale. Postoperative complete A-V block was noted in a patient of partial AVSD, but it was returned to 1st degree A-V block 30 months later and in another case of partial AVSD, severe congestive heart failure [NYHA functional class IV] due to residual mitral insufficiency was developed postoperatively, but this patient was recovered to the state of functional class I after receiving mitral valve replacement. There was one hospital death [8 %] resulting from low cardiac output.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.657-665
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• 1984

Thirty-seven patients had undergone repair of a endocardial cushion defect between 1977 and Aug. 1983 in Seoul National University Hospital. Twenty eight had a partial defect, one intermediate defect and eight complete endocardial cushion defect. Tricuspid cleft was found in 4 cases and mitral cleft was in all p-ECD. Seven patients were of type C anatomy in c-ECD. Four patients had associated major anomalies, including three TOF in c-ECD, one coarctation in p- ECD. In p-ECD patients, the septal defect was closed with patch in all cases and the atrioventricular valvular insufficiency was corrected with MVR in 4 cases, TVR in 1 case and simple interrupted sutures in remainders. In c-ECD patients the septal defect was closed with single patch except one case. The atrioventricular valve was repaired with simple interrupted sutures except one MVR and TVR case. The operative mortality was 14.2% in p-ECD, 44.4% in c-ECD, but recent 3 years [1980-1983] mortality was 8.7% in p-ECD, 20% in c-ECD. More than grade III systolic regurgitant murmur was oted postoperatively in 4 cases of c-ECD and 3 cases of p-ECD. The operative risk factors were preoperative NYHA classification, cyanosis, Rp/Rs, systolic pressure of main pulmonary artery and the degree of regurgitation of atrioventricular valves. The causes of death were low cardiac output syndromes, pulmonary complications and arrhythmias.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.137-140
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• 2002

Aortic regurgitation in the pediatrics who had previous cardiac surgery is increased with their improved longterm survival rate and their complexity of heart disease. So the need of aortic valve surgery in pediatrics is also on the increase. A 10-year old boy was admitted for progressive cyanosis and dyspnea on exertion(DOE). The patient had been underwent lateral tunnel Fontan operation before. Echocardiography and cardiac catheterization study revealed hepatic vein drained to pulmonary atrium via intrahepatic collaterals, moderate atrioventricular regurgitation, and severe aortic regurgitation due to aortic root dilation. We report a case who had aortic root reconstruction, valvuloplasty of the atrioventricular valve, and hepatic vein ligation successfully Cyanosis and DOE was dramatically improved after the operation

• Journal of Chest Surgery
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• v.23 no.5
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• pp.953-961
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• 1990

Congenitally corrected transposition of the great arteries is a rare congenital heart anomaly, in isolation, has no hemodynamic consequences. It is usually associated with one or more of a variety of intracardiac lesions, ventricular septal defect, valvular or subvalvular pulmonary stenosis, and deformity of the systemic atrioventricular valve with insufficiency. This report describes a successful two stage operation for congenitally corrected transposition, [SLL] type, with ventricular septal defect, pulmonary atresia, persistent ductus arteriosus, and atrial septal defect. A 9 years old patient underwent modified Blalock-Taussig operation because of severe pulmonary hypoplasia. 2 years later a corrective operation, direct closure of ASD and PDA, VSD closure with Dacron patch, Enlargement of left pulmonary artery with pericardial patch and Relief of ROTO with Rastelli procedure could be successfully performed without complication.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.961-969
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• 2003

The purpose of this study was to evaluate the fate of left atrioventricular valve regurgitation(LAVVR) following repair of complete atrioventricular septal defects (AVSDs). Material and Method: Between July 1984 and March 2002, repair of complete AV defects were performed in 77 patients. Mean age at surgery was 30.23$\pm$69.11 months (range 1 to 456). Echocardiograms of all survivors after isolated AVSDs correction were reviewed. LAVVR were evaluated with color doppler echocardiography in 64 survival periodically. On each study, LAVVR severity was graded on a 1 to 4 scale, based upon the size of the regurgitated jet. Result: Mild deterioration of LAVV function was fairly common. LAVVR severity increased by >1 grade in 19 patients (30.2%) during the course of the study. However, the deterioration in LAVVR function occurred primarily between 12 and 24 months postoperatively. After the initial 24 postoperative months, LAVVR worsened on only 8 occasions and in each instance worsened by only 1 grade. Deterioration more than 3+ LAVVR occurred in only 3 patients. And deterioration to 4+ LAVVR was not observed after the initial 24 postoperative months but one. Survival curve analysis predicted a 88.2% of ten-year freedom rate from development of 4+ LAVVR after initial operation of complete AVSDs. Conclusion: Postoperative LAVVR remains fairly stable following AVSDs repair, Serious deterioration is rare after 24 postoperative months, especially after the initial 48 postoperative months. But serial follow-up study with echocariogram was need till 24 postoperative months after repair of complete AVSDs.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.299-304
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• 2009

Background: Although the results of the surgical management for complete atrioventricular septal defect (c-AVSD) have improved, the optimal surgical strategy is still controversial. The aims of this study are to evaluate the outcome of c-AVSD repair and to define the risk factors related to reoperation. Material and Method: We retrospectively reviewed the medical records of 35 patients (8 males and 27 females) who underwent the total correction of c-AVSD from August 1996 to March 2008. The median age at repair was 5.2 months (range: 3 days$\sim$82 months). Sixteen patients (45.7%) were associated with Down syndrome. Prior palliative operations were performed in 4 patients. The one-patch techniques were performed in 3 patients, and the two-patch techniques were done in 32 patients. Result: There was 1 early death (2.9%). The median follow-up period was 68 months (range: $2\sim134$ months) for 34 survivors. There was no late death. Reoperations were performed in 5 patients (14.3%) for severe left atrioventricular valvular regurgitation (AVVR). Nine patients (25.7%) showed left an AVVR of more than grade III. Associated major cardiac anomalies and the use of Gore-Tex patch for ventricular septal closure were the risk factors for postoperative left atrioventricular valve failure and reoperation. Conclusion: In this study, we found that surgical repair of c-AVSD was safe and effective. However, the high reoperation rate after repair remains a problem to be solved.