• Journal of Chest Surgery
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• 제3권1호
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• pp.47-54
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• 1970

This is a report on two cases of aortic prostheses using Nylon tube. (Edwards-Tapp A-G Tube, Chemically treated braided Nylon arterial grafts). Especially, the complications after infection of synthetic graft are discussed with reviewing literature. First case was the patient who came to our hospital with rupture of the right femoral artery at the femoral fossa due to pyogenic necrotic process. After femoral arterial prostheses, good pulsation of dorsal artery of foot was obtained. However, the tube was obstructed after 8 weeks postoperatively due tll the complication of infection. In spite of the tube was removed because of obstruction and foreign body reaction of synthetic graft, an amputation of the leg was not necessary for formation of good collateral circulation. Second case was a case of aortic aneurysmal rupture in thoraco-abdominal junction which developed by the trauma of rib resection for osteomyelitis of the left 12th. rib An implantation of aortic graft was performed at the lowest tho13cic aorta by the way of thoraco-abdominal bypass without arterial pump. However, infection produced pyothorax in the left pleural cavity, exposing the tube within the pyothorax. The rupture of the anastomosed upper line occurred in 8 weeks postoperatively and the patient expired.

• Journal of Chest Surgery
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• 제48권3호
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• pp.217-219
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• 2015

Postpneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy. It occurs more often in children than in adults, and is characterized by respiratory failure resulting from bronchial compression caused by severe mediastinal shift. Various methods have been used to treat PPS, including aortopexy and the insertion of plastic balls, silastic implants, and saline-filled breast prostheses. We describe two cases of PPS corrected with tissue expanders after right pneumonectomy in patients with esophageal atresia.

• Journal of Chest Surgery
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• 제46권2호
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• pp.104-110
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• 2013

Background: We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality. Materials and Methods: A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years). Results: The porcine root group was older than the other groups (freestyle $55.9{\pm}14.3$ years vs. mechanical $46.3{\pm}14.6$ years, homograft $48.1{\pm}14.7$ years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups. Conclusion: Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.

• 한국가시화정보학회지
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• 제4권1호
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• pp.47-55
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• 2006

The left ventricular filling flow is now considered as an indicator which can be used for early diagnosing of cardiovascular diseases. Because the understanding of left ventricular flow physics is critical for this purpose, the downstream flow characteristics of the artificial heart valve are investigated using particle image velocimetry (PIV) method. In this study, we investigated the wake characteristics of flows passing through three different artificial valves (St.Jude medical bileaflet mechanical valve. Bjork-Shiley monostrut mechanical valve and St.Jude medical Biocor bio valve). The downstream flow field has remarkably altered according to the different valves. SJM MHV has the flow field similar to the pulsating circular jet and BS MHV has oblique pulsating jet. SJM BHV shows the similar flow field of clinical data of normal heart.

• Journal of Chest Surgery
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• 제27권12호
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• pp.995-1001
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• 1994

The CarboMedics valve prosthesis is a relatively new. low profile bileaflet prosthesis. During a 6 year period from Aug. 1988 to July 1994. 158 patients had CarboMedics prostheses implanted in the mitral [n=94], aortic [n=25], or aortic and mitral [n=39] in National Medical Center. Hospital mortality was 9.4% and the main cause of death was low output syndrome. Follow up was 96% complete, with 365.4 patient-years and a mean follow up of 30 months [ range 1 to 72 months ] . The overall actuarial 6 year survival rate was 91.61 3.47% and actuarial 6year freedom from all valve related complications was 73.9 7.67%. The linearized incidence of vavle related complications was as follows: thromboembolism 1.37%/patient-year ; valve thrombosis 0.82%/ patient-year ; anticoagulant related hemorrhage 0.85%/patient-year ; perivalvular leakage 0.55%/paitent-year: prosthetic valve endocarditis 0.82%/patient-year ; reoperation 1.37%/patient-year. There were no instances of structural failure. We conclude that the Carbomedics valve has a low rate of complications that further improves the quality of life in patients with heart valve prostheses.

• 대한의용생체공학회:의공학회지
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• 제15권4호
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• pp.489-497
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• 1994

The most serious problems related to the cardiovascular prothesis are thrombosis and hemolysis. It is known that the flow pattern of cardiovascular prostheses is highly correlated with thrombosis and hemolysis. Laser Doppler Anemometry (LDA) is a usual method to get flow pattern, which is difficult to operate and has narrow measure region. Particle Image Velocimetry (PIV) can solve these problems. Because the flow speed of valve is too high to catch particles by CCD camera, high-speed camera (Hyspeed : Holland-Photonics) was used. The estimated maximum flow speed was 5m/sec and maximum trackable length is 0.5 cm, so the shutter speed was determined as 1000 frames per sec. Several image processing techniques (blurring, segmentation, morphology, etc) were used for the preprocessing. Particle tracking algorithm and 2-D interpolation technique which were necessary in making gridrized velocity pronto, were applied to this PIV program. By using Single-Pulse Multi-Frame particle tracking algorithm, some problems of PIV can be solved. To eliminate particles which penetrate the sheeted plane and to determine the direction of particle paths are these solving methods. 1-D relaxation fomula is modified to interpolate 2-D field. Parachute artificial heart valve which was developed by Seoul National University and Bjork-Shiely valve was testified. For each valve, different flow pattern, velocity profile, wall shear stress and mean velocity were obtained.

• Journal of Chest Surgery
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• 제21권5호
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• pp.889-893
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• 1988

We experienced a case of infective endocarditis of aortic valve and tricuspid valve associated with a fistula between aorta and right ventricle. The patient was 35 years old woman and showed severe congestive heart failure. Large and multiple vagetations were found on the valvular surfaces and a fistula was present between aorta and right ventricle. Probably infective endocarditis of aortic valve resulted in annular abscess and as it healed, a fistula was formed and tricuspid valve endocarditis followed. We replaced the aortic valve and tricuspid valve with St. Jude mechanical prostheses, and closed the fistula opening with suture. The postoperative course was smooth and the patient has no problems till now 4 months after operation.

• Journal of Chest Surgery
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• 제33권2호
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• pp.146-150
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• 2000

background: The prognosis after an aortic valve replacment can be affected significantly by the transprosthetic pressure gradient which is determined mainly by the size of the patients body and the prosthesis used. We analyzed the hemodynamic feature of two relatively new prosthese the ATS and the evensized Medtronic-Hall(M-H) valves by measuring the transprosthetic pressure gradient in the cases where small sizes (23mm or smaller) were used. Material and method: There were 94 patients who received whom aortic valve replacement with prosthesis smaller than 23 mm from October 1994 to June 1998. In these patients the transprosthetic pressure gradient clalculated from the pressure half time during postoperative Dopper echocardiographic examination was compared between the prostheses of different sizes. The body surface area of each patient was also taken into consideration. result: The mean pressure gradient and body surface area in each group were 21.7$\pm$10.2 mmHg and 1.52$\pm$0.14m2 in ATS 19mm 11.4$\pm$6.5 mmHg and 1,57$\pm$0.20m2 in M-H 20mm 15.2$\pm$6.3 mmHg and 1.54$\pm$0.13m2 in ATS 21mm 9.3$\pm$2.5 mmHg and 1.63 $\pm$0.14m2 in M-H 22 mm and 12.9$\pm$5.3 mmHg and 1.69$\pm$0.13m2 in ATS 23mm. Conclusion: The 19mm ATS prosthesis showed significant trasprosthetic pressure gradient which is similar to the values previously reported with other bileaflet prosthesesm Close follow-up was needed in terms of exercise capacity and change in left ventiricular geometry. In patients with small aortic valve annulus the 20mm M-H valve is recomendable as an alternative to 19mm bileaflet valves because it has less pressure gradient with similar outer diameter.

• Journal of Chest Surgery
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• 제24권7호
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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.

• Journal of Chest Surgery
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• 제22권3호
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• pp.393-401
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• 1989

Between Dec. 1984, and May, 1988,96 prostheses were implanted in 80 patients at Dept. of Thoracic k Cardiovascular Surgery of National Medical Center. 43 patients had mitral valve replacement, 21 underwent aortic valve replacement, and 15 had double valve replacement [Mitral k Aortic], and 1 had tricuspid valve replacement. Seventy-one cases [88.8 %] were in NYHA Class III or IV. The mean duration of follow up was 22.1 months and follow-up information was available for 74 [92.5 %] of the patients. The overall actuarial survival rate at 45 months was 93.05 % and overall hospital mortality was 10 %, late Mortality was 5 %. The linearlized incidence of thromboembolism [2.4%/pt-yr], thrombotic valve obstruction [1.6 %/pt-yr], anticoagulant related bleeding [0.8 %/pt-yr]. There were no fatal valve related complications. The blood was studied in 40 patients 1 year after valve operation. Hgb and reticulocyte count were within normal values and Serum LDH value was slightly elevated but it was not of clinical significance. In conclusion, Monostrut Bjork-Shiley valve prosthesis to be a reliable valve substitute with an acceptable incidence of complications.