• Journal of Chest Surgery
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• v.13 no.1
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• pp.34-40
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• 1980

Total 193 patients over 16 years of age who have underwent a surgical correction of congenital heart diseases during the period 1964 to September of 1979 were reviewed. 106 patients were male and 87 patients were female. 85 patients were in the ages of 16 years through 20 years. The oldest patient was 54 years old male who had atrial septal defect. The commonest defects were atrial septal defect that accounted for 66 cases [34.2%]. Ventricular septal defect was next one that accounted for 66 cases [34.2%]. Patients with tetralogy of Fallot defects were 34 cases [17.6%]. 25 cases had patent ductus arteriosus [13.0%]. Patients with pulmonary stenosis were 17 cases [8.8%] and transposition of the great arteries cases were 2 cases [1%]. There were 14 cases of operative death in this series. So operative mortality rate was 7.3%. The commonest cause of death was low output syndrome and next was renal failure. This reviewed series reveals the incidence of operable congenital heart defects appearing in adult cardiac surgical patients and an aggressive surgical approach can be justified with low operative mortality like as pediatric age group.

• Journal of Chest Surgery
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• v.33 no.2
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• pp.160-166
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• 2000

Background: The purpose of this study is to evaluate and analyze the surgical results in patients undergoing operations for multiple for multiple valvular heart diseases. Material and method: From April 1982 to June 1997 multiple valve replacement was performed in 150 patients mitral and aortic valve replacement were done in 135 patients mitral and tricuspid valve replacements in 10 patients triple replacements in 4 patients and aortic and tricuspid valve replacement in 1 patient. Of the valves implanted 157 were St. Jude 104 Duromedics 20 Carpenter-Edwards 6 Bjork-Shiley 6 Ionescu-Shiley and 2 Medtronics. Result: The hospital mortality rate was 10.7% (16/150) and the late mortality rate was 7.2% (8/134) The mortality rate was high in early operative period but decreased with time. The causes of death were low cardiac output in 9 sudden death in 3 congestive heart failure in 3 bleeding in 2 cerebral thrombosis in 1 leukemia in 1 multiorgan failure in 1 and so on . The actuarial survival rate excluding operative death was 83.1% at 15 years. Conclusion: With a follow-up now extending to 15 years the multiple valve replacement continues to be reliable procedure with relatively low mortality and morbidity.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1102-1110
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• 1996

Between Oct. 1985 and July 1995, 230 patients underwent mitral valve replacement. There were 77 men and 153 women whose mean age was 35.7 years, range 9 to 62 The concomitant operations were 40 aortic valve replacements(17.4%), 25 tricuspid annuloplasties(10.4%), 8 aortic valve replacements & tricuspid annuloplasties(3.5%), 2 tricuspid valve replacements(0.9%) and others, We used 139 mechanical (76 51. Jude medical, 33 CarboMedics, 30 Sorin) and 91 tissue 386 Carpentier-Edwards, 5 lonescu-Shiley) valves. The early postoperative complications occurred in 28 cases. There were 8 low cardiac output syndrome, 5 pleural effusion, 3 significant arrhythmia, 2 cardiac rupture and others. There were 6 early hospital deaths (2.6%) due to low cardiac output syndrome(2), arrhythmia(2) and ventricul r rupture(2). The cuAmulative notal follow-up period was 764. 4 patient-years with a mean of 4).9 months. The long term follow-up information was available for 212 patients(94.6%). There were 21 cases of valve-related complications. Prosthetic valve failure(10), anti-coagulation related bleeding (5), prosthetic valve endocarditis (4), and thromboembolism (2) occurred at rates of 1.3, 0.7, 0.5, and 0.3%Ipt-yr respectively. Late death occurred In 5 cases (0.7%/pt-yr) associated with prosthetic valve endocarditis (2), heart failure (2) and anti-coagulation related bleeding (1). There was no difference in the rate of freedom from prosthetic valve failure between the mechanical and tissue valve group at 6 years (100%), but there was significant difference at 9 years between the tissue (34.4%) and mechanical valve (100%) group (p=0.032). Actuarial survival rates were 98. 8% in tissue valve. 9).7% in mechanical valve group and 96.6% in total patients at 9 years.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.153-160
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• 1991

Tetralogy of Fallot was repaired by a transatrial-transpulmonary approach in 91 of 250 patients treated surgically [including redo operations] between April 1986 and December 1989. Their age ranged from 6 months to 14 years [mean 39.7 months]. Associated cardiovascular anomalies were right aortic arch [n=22], ASD [n=12], PDA [n=5], persistent left SVC [n=5], and others [n=6]. PA index was measured pre-operatively since 1987 to estimate pulmonary artery size and safe total correction[mean 289$\pm$110mm2/BSA]. Eight patients received previous shunt take down procedure concomitantly. Pulmonary arteriotomy was extended through small pulmonary annulus to a minimal distance upon the right ventricular infundibulum and transannular patch was applied in 38 patients [41.3%], in 31 of them monocuspid patch was utilized. pRV/LV was measured at operation room in 77 patients [mean 0.58$\pm$0.36]. Operative mortality was 6.6% [6/91]. The causes of death were low cardiac output [n=5], arrhythmia[n=1] and respiratory failure [n=1]. At follow-up between 12 months and 57 months [mean 30.8 months] most patients were in New York Heart Association class I without cardiac medication. There was no late death, but reoperations were required in 3 patients to relieve residual right ventricular outflow obstruction. Thus successful repair of tetralogy of Fallot can be accomplished in most patients including infants by transatrial-transpulmonary approach and the better result can be anticipated with respect to postoperative right ventricular function and arrhythmia than the conventional transventricular approach.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.22-29
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• 1987

From Sep. 1978 to Aug. 1986, 44 cases of Fontan operation were performed at Seoul National University Hospital. 1] The diagnoses were TA in 13 [38.6%], UVH in 21 [47.79`], DORV in 3 [6.8%], TGA in 2 [4.5%] and C-ECD with DORY in 1[2.3%]. 2] There were 20 operative deaths [44.5%]. 3] The operative risk factors were early date of operation between 1978 and 1983, young age below 3 years old, direct atriopulmonary anastomosis without roofing, and postoperative high CVP above 25cmH,O. But the relation between operative mortality and various cardiac diseases was absent. 4] survived patients were followed from 1 to 54 months except 3 patients who were lost to follow up. 16 patients were in functional class I and 1 in class II, 2 of the above 17 patients were reoperated due to residual right to left shunt. In remained 4 patients, 3 patients persisted cyanosis after operation and 1 patients died 1 month postoperatively due to pulmonary embolism. 5] As 4 result, the Fontan procedure can be done with a good result for tricuspid atresia and other complex lesions. The operative mortality can be reduced further with a correct anatomical diagnosis preoperatively, rigid operative criteria to pulmonary vascular resistance, direct atriopulmonary anastomosis with roofing, and use of `Venous Assist Device` postoperatively in low cardiac output patients.

• Journal of Chest Surgery
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• v.15 no.3
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• pp.346-354
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• 1982

A Complete transposition of the great arteries combined with V.S.D, A.S.D, dextrocardia, and P.S is a rare congenital anomaly. The patient was a 10 year-old female whose complaints were frequent URI, exertional dyspnea, and cyanosis at rest since birth. Cheat X-ray films showed Dextrocardia ; situs inversus, moderate cardiomegaly, and Characteristic egg-shape heart shadow. E.K.G, Echocardiography, Cardiac Catheterization, and Angio-Cardiography were performed. Open heart Surgery was done under diagnosis of d-TGA, Dextrocardia, V.S.D, A.S.D, and P.S. At the time of Operation, Dextroeardia, T.G.A, Secndum type A.S.D, A.S.D, and P.S. At the time of Operation, Dextroeardia, T.G.A, Secndum type A.S.D. ($2.0{\times}2.0cm$. in diameter), V.S.D. type II ($1.5cm{\times}1.5cm$ in diameter), and pulmonary valvular stenosis were noted. Mustard operation using pericardial Baffle in the atrium for T.G.A. was perforsned. Teflon patch graft for closure of V.S.D. through tricuspid orifice and pulmonary Valvulotomy through pulmonary arteriotomy were performed. The post-op, low cardiac output Syndrome and dysrhythmicawere developed till Postoperative day #7, so that was controlled by inotropic and antiarrhythmic agents. After that, patient's conditions were Uneventful.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.644-656
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• 1984

In Tetralogy of Fallot, the most common congenital cyanotic heart disease, the mortality is decreasing continuously with adequate type and timing of operation. At S.N.U.H., 195 patients were operated from January 1982 to December 1983 and 176 patients among them were analysed in the view of pre-operative pulmonary arterial condition measured by cardiac cineangiogram. The most common associated anomaly was PFO and ASD and they did not affect the postoperative course and mortality. The overall mortality rate was 8.5% in 1982 and 6.8% in 1983 but under 2 years of age, the mortality rate was relatively high as 25% in 1982 and 16.7% in 1983, and when transannular patch widening of Right Ventricular Outflow Tract was used, the mortality rate was 12.5% in 1982 and 27.3% in 1983. Preoperative angiographic measurements of the pulmonary arterial status for prediction of the ratio between the Left Ventricular and Right Ventricular peak systolic pressure were calculated retrospectively according to the Blackstones formula, and the predicted value of PRV/LV greater than 0.6 carried apparently high complication and mortality rate as 16.6% M.R. in 1982 and 11.1 % in 1983. Among postoperative complications, c-RBBB occurred most frequently about 50% but did not influenced to mortality, Low Cardiac Output Syndrome was developed in about 40%. If we select the patient who should have the staged operation including shunt operation and choose the type of RVOT relief, we expect the improvement of postoperative clinical results.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1550-1555
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• 1992

From June 1989 to July 1992, we used centrifugal Biomedicus pump[CBP] in 20 patients In 9 cases, CBP was used as ventricular assistance after heart surgery for those who could not be weaned off bypass even with intra-aortic balloon counter-pulsation and with maximal inotropic support In 8 patients, CBP was used as partial left heart bypass during repair of aortic aneurysms or congenital aortic anomalies. And in 3 patients, CBP was used as vena caval bypass during resection of renal cell carcinoma with tumor extension into the inferior vena cava. In 2 of 9 patients with ventricular assistance, they were weaned off the device successfully after 16 hours and 7 days respectively. But the patients died of intracranial hemorrhage and sepsis, 7 and 29 days after weaning from cardiac support, respectively. In all the patients who underwent aortic of vena caval surgery using CBP as shunt, there were no complications such as postoperative bleeding necessitating reoperation, renal failure or neurologic sequelae. In conclusion, the centrifugal type of ventricular assistance may be potentially life saving treatment modality in patients with severe postoperative low cardiac output syndrome. The CBP can be safely employed for resection of renal cell carcinoma with vena caval tumor extension and for repair of aortic aneurysms.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.526-531
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• 1993

Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

• Journal of Chest Surgery
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• v.24 no.1
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• pp.26-35
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• 1991

From January 1984 to June 1990, 188 patients have undergone cardiac valve replacement [114 MVR, 27 AVR, 47 Multiple valve replacement] with the St. Jude Medical prosthesis. The early mortality rate was 6.9%. The most common cause of early death was low output syndrome. There were no cases of valve-related early death. The risk factors for early death were advanced preoperative NYHA functional class [> IV], and prolonged ECC and ACC time. The 175 early survivors were followed-up for a total 372.7 patient-year over a period of 2 to 74 months [Mean $\pm$SD: 25.6$\pm$18.6 months]. During follow up, 12 patient died and late mortality rate was 6.9%. There were three valve-related late deaths: two were due to valve thrombosis and one was due to hemorrhage. Most late deaths [58%, 7/12] were from cardiac non-valvular causes. Valve-related complications occurred at a linearlized rate of 3.5% /pt-yr. Embolism occurred at a rate of 0.8% /pt-yr. There were three cases of valve thrombosis [0.8% /pt-yr: two fatal]. Hemorrhage due to anticoagulant occurred in 5 patients and a rate of 1.3% pt-yr [one fatal]. Five-year actuarial survival rate was 86.5 $\pm$5.1% and 97% of patient were in NYHA functional class I or II at three months postoperatively.