• Journal of Chest Surgery
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• 제18권1호
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• pp.75-78
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• 1985

From April, 1984 to January, 1985, 57 cases of cardiovascular surgeries were performed at Yeung Nam University Hospital consisting 31 cases of open heart surgery and 26 cases of ligating patent ductus arteriosus. Among 31 cases of open heart surgery, all cases are congenital acyanotic heart disease except a case of rheumatic aortic valvular heart diseases taken aortic valve replacement with Bjrk-Shiley 25mm. Only 2 cases of transient hemoglobinuria were complicated. A case of surgical mortality was present died of acute respiratory failure and intractable arrhythmia, which resulting 3.2% of mortality rate.

• Journal of Chest Surgery
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• 제21권2호
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• pp.276-282
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• 1988

Surgery is now the usual mode of therapy in patients with severe valvular heart disease. Until recently, clinicians and pathologists attributed nearly all acquired valvular heart diseases to a rheumatic origin, except some obviously resulting from acute infection and syphilis. Although many clinicians and pathologists describe that the origin of aortic valvular disease is a nonrheumatic origin, we recognize the major origin of aortic valvular disease in Korea as a rheumatic origin. We excised 47 cardiac valves from valvular heart diseased patients and performed anatomical and pathological analysis for its origin and underlying pathology. The purpose of this article is to provide an update for the clinicians of evolving issues related to the pathology of valvular heart disease. But myxomatous origin and infective endocarditis valvulitis will not be covered in detail.

• Journal of Chest Surgery
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• 제21권4호
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• pp.757-760
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• 1988

Double mitral valve orifice is an unusual congenital abnormality, and is rarely of clinical importance. That abnormality not produce hemodynamic deficits, but it has been associated with other congenital heart diseases, especially atrioventricular canal defects, and so it is surgically important condition. After the first report by M.S. Greenfield in 1876, there are only a few reported cases all over the world. We experienced two cases of double mitral valve orifice with atrioventricular canal defect. The small accessory mitral orifice was placed in anterior mitral leaflet as a hole type in both cases. The A-V canal defects are corrected with a one patch technique, but the accessory orifices are left unclosed because there were no mitral regurgitations through the orifice. On the 4th postoperative day, the patients have been performed echocardiography; both had no mitral regurgitation. Both of patients are now being follow-up and we find no specific problems. A small accessory mitral orifice may be left unclosed and rarely produce significant regurgitation, conclusively.

• Journal of Chest Surgery
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• 제31권4호
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• pp.346-352
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• 1998

심장 초음파에 의한 류마티스성의 심장판막질환은 판첨이 융합되고 건삭이 짧아져 판막운동이 제한되는데 융합이 심하면 협착이되고 퇴축이 심하면 폐쇄부전이 일어난다. 이러한 초음파적인 소견과 수술시야에 직접 관찰되는 교련융합과 판엽의 비후, 건삭의 융합과 단축 심하면 석회침착 등의 소견 및 병리조직학적인 소견으로 확인된 류마티스성 심장판막질환에 대한 외과적 치료를 시행한 환자 440명을 대상으로 임상적성적을 분석하였다. 기간내의 총판막수술은 502명에서 시행되었으며 이중 87.3%인 440명이 류마티스성판막증으로 분류되었으며, 여자가 1.3배 많았고 평균년령은 37.8세 였다. 96.3%가 승모판을 침범하였고 대동맥판 19.8%, 삼첨판 16.3%를 침범하였으나 승모판 단독 침범례는 62.5%, 대동맥판 단독은 3.6%, 삼첨판막의 기질적 변화를 보여 외과적 치료를 가한 예는 1.8%에 불과하였다. 수술의 방법으로는 3.9%에서는 판막의 보존적 치료가 가능하였고 96.1%인 323례에서 1개 이상의 인조판막이 사용되었다. 승모판막치환술이 275례, 대동맥판 18례, 70례의 다중판막치환술을 시행하였다. 조기사망율은 보존적치료 예에서 5.9%, 판막치환례에서는 대동맥 5.9%, 승모판 6.0%, 다중판막 19.4%를 기록하였다. 생존례의 90.1%인 364명이 추시관찰이 가능하였는데 총 2890환자년의 추적기간중 뉴욕심장협회기능적 분류상 수술로 평균 2.9도에서 1.3의 상태호전을 보였으며 합병증은 혈전전색 1.3%/환자/년, 출혈성합병증 1.8%환자/년으로 나타났다. 누적생존율은 술 후 1년에 92.7＋/－2.8%, 5년에 88.0＋/－ 4.5%, 10년에 82.3＋/－7.7%였다. 류마티스성질환은 선진국에서는 최근 급격히 감소하고 있다고 하나 저자들의 예에서는 전체판막질환에 대한 수술례의 87.3%를 차지하고 있어 아직도 깊은 관심을 갖고 깊은 연구가 있어야 할 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제59권11호
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• pp.446-450
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• 2016

Purpose: Generally, aspirin is used as a protective agent against thrombogenic phenomenon after pulmonary valve replacement (PVR) using a bioprosthetic valve. However, the appropriate duration of aspirin use is unclear. We analyzed the impact of postoperative duration of aspirin use on the longevity of bioprosthetic pulmonary valves in patients who underwent repair for congenital heart diseases. Methods: We retrospectively reviewed the clinical data of 137 patients who underwent PVR using a bioprosthetic valve between January 2000 and December 2003. Among these patients, 89 were included in our study and divided into groups I (${\leq}12$ months) and II (>12 months) according to duration of aspirin use. We analyzed echocardiographic data from 9 to 11 years after PVR. Pulmonary vale stenosis and regurgitation were classified as mild, moderate, or severe. Results: The 89 patients consisted of 53 males and 36 females. Their mean age was $14.3{\pm}8.9$ years (range, 2.6-48 years) and body weight was $37.6{\pm}14.7kg$ (range, 14-72 kg). The postoperative duration of aspirin use was $7.3{\pm}2.9$ months in group I and $32.8{\pm}28.4$ months in group II. However, no significant difference in sex ratio, age, body weight, type of bioprosthetic valve, and number of early redo-PVRs. In the comparison of echocardiographic data about 10 years later, no significant difference in pulmonary valve function was found. The overall freedom rate from redo-PVR at 10 years showed no significant difference (P=0.498). Conclusion: Our results indicated no benefit from long-term aspirin medication (>6 months) in patients who underwent PVR with a bioprosthetic valve.

• Journal of Chest Surgery
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• 제36권11호
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• pp.812-819
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• 2003

배경: 좌심실 기능부전은 판막수술 후 조기사망 및 장기 생존에 영향을 미치는 중요한 요인의 하나이다. 중등도 이상의 심기능부전 환자에서의 승모판막성형술의 중기 결과에 대해 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2001년 7월까지 좌심실 구혈률이 45% 이하의 심기능부전 환자에서 승모판막성형술을 받은 44명의 환자를 후향적으로 조사하였다. 환자 연령은 46∼14세였고 32명이 NYHA III-IV였다. 승모판막 질환은 페쇄부전 28명, 협착 10명, 혼합형이 5명이었으며 원인은 류머치스성 20명, 퇴행성 14명, 허혈성 5명, 판륜확장 및 선천성이 각 2명, 그리고 심내막염이 1명이었다. 수술시 판륜성형술은 35명(79.6%)에서 시행되었으며 또한 다양한 판첨성형술이 사용되었고 총 52건의 동반수술이 시행되었다. 총체외순환 및 대동맥차단시간은 각각 160$\pm$57분과 112$\pm$45분이었다. 결과: 조기사망은 2명(4.5%)으로 좌심실 기능부전으로 사망하였다. 평균 39개월을 추적한 후 만기사망은 없었다. 심장초음파 검사에서 승모판폐쇄부전은 29명에서 없거나 I도 이하였으며(72.5%) 승모판협착은 35명에서 경도 이하 상태였다(87.5%). 4명이 승모판막 관련질환으로 치환술을 받았다(9.5%). 5년 후 actuarial survival은 100%였으며 승모판막 관련 질환으로 인한 재수술로부터의 자유도는 84$\pm$9%였다. 결론: 중등도 이상의 심한 좌심기능부전 환자들의 승모판막 질환에서 판막성형술 결과 조기 및 중기 생존율과 판막질환으로부터의 재수술률도 양호한 결과를 보임으로써 좌심기능부전 환자들에서 효과적인 치료의 한 방침으로 적용할 수 있다

• Journal of Chest Surgery
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• 제46권4호
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• pp.285-288
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• 2013

Prosthetic valves are being widely used in the treatment of heart valve disease. Prosthetic valve endocarditis (PVE) is one of the most catastrophic complications seen in these patients. In particular, prosthetic valve dehiscence can lead to acute decompensation, pulmonary edema, and cardiogenic shock. Here, we discuss the medical management of late PVE in a patient with a prior history of late and redo early PVE and recurrent dehiscence. According to the present case, we can summarize the learning points as follows. A prior history of infective endocarditis increases the risk of relapse or recurrence, and these patients should be evaluated very cautiously to prevent late complications. Adequate debridement of infected material is of paramount importance to prevent relapse. A history of dehiscence is associated with increased risk of relapse and recurrent dehiscence.

• Journal of Chest Surgery
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• 제31권12호
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• pp.1230-1233
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• 1998

The Cox-Maze procedure was developed as a cure for atrial fibrillation. The recovery rate of both atrial contractility is reported low in the atrial fibrillation associated with mitral valvular heart disease than that of loan atrial fibrillation. We performed the Cox-Maze procedure (Maze III) in three cases who suffered from non-mitral heart diseases associated with atrial fibrillation: A ruptured sinus of Valsalva aneurysm, a ventricular septal defect, and an aortic stenoinsufficiency. The Cox-Maze procedure was performed concomitantly with correction of the underlying heart disease. Conversion to sinus rhythm was achieved in all three patients, and both right and left atrial mechanical activities could be identified echocardiographically after three postoperative months.

• Clinical and Experimental Pediatrics
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• 제60권8호
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• pp.237-244
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• 2017

During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.

• Journal of Chest Surgery
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• 제49권5호
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• pp.350-355
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• 2016

Background: Mitral stenosis (MS) remains one of the important heart diseases. There are many factors that influence the clinical outcomes, and little is known about how left ventricular (LV) dysfunction clinically affects the prognosis of the patient with MS after mitral valve replacement (MVR). We reviewed our clinical experiences of MVR in patients with MS who had LV dysfunction. Methods: Between January 1991 and January 2013, 110 patients with MS who underwent MVR were analyzed and divided into two groups according to ejection fraction (EF). Group 1 ($EF{\leq}45%$) included 13 patients and group 2 (EF>45%) included 97 patients. Results: Thromboembolism occurred in 8 patients after MVR (group 1: n=3, 23.1%; group 2: n=5, 5.2%) and its incidence was significantly higher in group 1 than in group 2 (p=0.014). There were 3 deaths each in groups 1 and 2 during follow-up. The overall rate of cardiac-related death in group 1 was significantly higher than in group 2 (group 1: n=3, 23.1%; group 2: n=3, 3.1%; p=0.007). The cumulative survival rate at 1 and 15 years was 83.9% and 69.9% in group 1 and 97.9% and 96.3% in group 2 (p=0.004). The Cox regression analysis revealed that survival was significantly associated with postoperative stroke (p=0.011, odds ratio=10.304). Conclusion: This study identified postoperative stroke as an adverse prognostic factor in patients with MS after MVR, and a s more prevalent in patients with LV dysfunction. Postoperative stroke should be reduced to improve clinical outcomes for patients. Preventive care should be made in multiple ways, such as management of LV dysfunction, atrial fibrillation, and anticoagulation.