• Journal of Veterinary Clinics
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• v.29 no.5
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• pp.416-421
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• 2012

A 10-year-old 4-kg spayed female Chihuahua with severe congestive heart failure was referred for surgical treatment. Through several examinations, the dog was diagnosed as severe mitral regurgitation (MR) and moderate TR. Because of the poor prognosis associated with continuation of medical management, surgical repair of the mitral valve was considered as the treatment option for the dog. The mitral valve repair was performed undergoing cardio pulmonary bypass (CPB) circuit. However after mitral repair, the dog was died without recovery from anesthesia. Many risk factors associated with failure of cardiac surgery are included CPB management, hypothermia, organ dysfunction, hemorrhage, hypotension, electrolyte & acid base imbalance, and infection. Although the dog is died from the operation, it is an important to reveal the factors of failure in veterinary clinic. From the case report, causes of failure of mitral valve repair can be considered from the failure of oxygenation and gas exchange by hypothermia and serious hypotension with low heart rate by low cardiac output syndrome (LCOS). Through the several considerations from this case, it is known that coming cardiac surgery for mitral valve repair is required to be more careful for successful operation. Further it can be brought to increase success rate in further operation.

• Journal of Chest Surgery
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• v.4 no.1
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• pp.11-24
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• 1971

Eighty-four cases of mitral commissurotomy were done in this department between October 1958 and September 1970. Therc wcre 54 males and 30 females. Six cases were under the age of 20 years. Prcoperativc embolization occurred in 9. 5% of the cases. consisting of 8. 3% cerebral and 1.2% peripheral embolization. Intraoperative and postoperative cmbolization occurred in 4.7% of the cases, with 1. 2% cerebral and 3.5% peripheral embolism. Two out of three postopeative embolism cases expired, one of which was caused by septic cerebral embolism due to valve vegetation nnd the other by mesenteric embolism. Atrial fibrillation was 1loted ill 43% of the case. Seventy closed mitral commissurotomy was done by left appendegeal approach with finger fracture method or Bailey's guillotine valvotome. Fourteen open mitral commissurotomy cases were done either by right side approach or median sternotomy, three of which were reoperation cases after blind mitral commissurotomy. One out of 14 cases were operated on with open mitral commissurotomy and concomitant open aortic valve bicuspidalization, This case expired due to severe serum hepatitis ten days after operation. Thirty-two per cent of valve calcification was noted during operation and one of which had marked vegetation on the valve cusps too. Operative mortality was 1.4% in blind mitral commissurotomy and 14% in open mitral commissurotomy. Over-all mortality in the entire series was 3.5%. One case among the blind commissurotomy cases expired during operation due to left inferior pulmonary vein laceration and death was caused in two open mitral commissurotomy cases by coronary artery airembolism. Three hospital death occurred in blind operation group, one due to coronary embolism, and two by hepatic failures. Three hospital death among open heart surgery cases were caused by hepatic failure in two and cerebral embolism in one cases. ln most of the survivors improved functional capacity and exercise lolerance were noted.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.49-56
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• 1992

Total 20 cases of reoperation for mitral vavular disease, which had been performed during the period from May 1983 till October 1991, were reviewed. This study contained 1 case of previous balloon valvuloplasty and 1 case of death with bleeding from right ventricle during sternal reenrty. The average time intervals between reoperation and previous operation was 19 years in closed mitral commissurotomy[n=4], 7 years and 2 months in mitral valve replacement[n=10], 1 year and 8 months in mitral valvuloplasty[n=4], 3 years and 10 months in open mitral commissurotomy [n=2]. The cause of reoperation in closed mitral commissurotomy was progression of the disease, and residual stenosis with progression was the cause in open mitral commissurotomy cases. Technical failure might be the cause in the cases of valvuloplasty. In prosthetic valve replacement group the causes of reoperation were primary failure. Also two cases of suggested valve thrombosis and one case of failure of tricuspid annuloplasty was noted in prosthetic valve replacement group. The used valves for reoperation were Ionescue-Shiley in 3 cases, Bjork-Shiley in 6 cases, St. Jude Medical in 2 cases and CarboMedics in 8 cases. The mortality rate was 20%[n=4] and the causes of death were low output syndrome in 1 case, multiple organ failure in 2 cases and bleeding in 1 case during sternal reentry. During follow up 1 case of sudden death was observed.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.200-204
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• 1997

This is a report of a successful management of a patient with infective endocarditis involving native aortic valve, mitral valve, tricuspid valve, and Interventric lar septum. A 16 year-old patient who underwent VSD patch closure, and aortic valvuloplasty at the age of 1 1 years showed Intractable congestive heart failure during antibiotics treatment for infective endocarditis. Operative findings revealed that there were large defect along the previous patch, aortic regurgitation with multiple perforations and vegetations, mitral regurgitation with vegetation, aortic paraannular abscess, interventricular myocardial abscess, and tricuspid regurgitation with perforations and vegetations. We reconstructed the interventricular defect with Dacron patch extending to the aortic valve annulus after radical debridement of all infected or devitalized tissues, and could implant aortic valve by anchoring to the reconstructed Dacron patch. Mitral valve was replaced and tricuspid valve was repaired with patient's own pericardium. The patient was discharged after antibiotics treatment for 6 weeks and in good condition without any sequelae for 12 months.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.92-100
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• 1986

Results of reoperation for tissue valve failure were presented with review of current knowledge. Through January 1986, 19 patients required reoperation: 18 had undergone mitral, 2 aortic, and 1 tricuspid valve. Primary tissue failure was the main cause of tissue valve failure: it occurred in 18 valves [15 mitral, 2 aortic, and 1 tricuspid] at a mean postoperative interval of 54-25 months [range 29-120]. During the same period, 2 patients required reoperation for prosthetic valve endocarditis, 1 for paravalvular leakage. The types of valves failed were 12 lonescu-Shiley valves, 5 Hancock valves, and 1 Carpentier-Edwards valve. All 6 patients younger than 15 years of age at first operation had been implanted with lonescu-Shiley valves and failed after a mean interval of 35 months. In contrast, 11 patients older than 15 years had been implanted with 5 Hancock, 6 lonescu-Shiley, and 1 Carpentier-Edwards valve initially, and eventually failed after mean intervals of 81, 53, 47 months each other. The kinds of valves used at reoperation were 8 lonescu-Shiley, 4 Bjork-Shiley, and 6 St. Jude Medical valves for primary tissue failure cases and 3 lonescu-Shiley valves for the other 3 cases. Overall mortality at reoperation was 10%: 5.6% for primary tissue failure, 50% for prosthetic valve endocarditis. In 15 cases [all mitral] primary tissue failure were caused by calcification associated with or without leaflet destruction or fibrous ingrowth, and in 2 cases [all aortic] caused by cusp perforation and tearing without any evidence of calcification. In conclusion: 1 primary tissue failure is the main cause of reoperation in patients with tissue valve failure; 2. the majority of the failed valves is in mitral position; 3. leaflet calcification is the leading pathology of primary tissue failure; 4, reoperation for tissue valve failure may be a major concern, although the mortality is low; 5. the limited durability of tissue valve suggests its use be restricted to selected cases.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.54-61
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• 1985

One-hundred-and-seven patients were the consecutive cases of double replacement of the mitral and the aortic valves at the same time using the lonescu-Shiley bovine pericardial xenograft valve during the period between May, 1979 and June, 1984. They were 64 males and 43 females, and their ages ranged from 13 to 62 years [mean age, 34.011.9 years]. Eight patients died within 30 days after surgery [operative mortality rate, 7.5%], and 7 others thereafter [late mortality rate, 6.5%; or 4.21%/patient-year]. Ninety-nine early survivors were followed up for a total duration of 166.1 patient-years [mean duration, 20.116.1 months]. Two patients experienced thromboembolic complication with no death [1.20%/patient-year]; five developed prosthetic valve endocarditis [3.01%/patient-year] with one death; and three had a new development of aortic regurgitant murmur and they were, along with a mortality from endocarditis, classified into the cases of tissue valve failure [2.41%/patient-year]. The actuarial survival rate including the operative mortality was 82.24.7% at 6 years after surgery. The probabilities of freedom from thromboembolism and from valve failure were 97.61.7% and 88.67.6% at 6 years respectively. Symptomatic improvement was excellent in most of the cases at the follow-up end, showing the mean of the postoperative NYHA Classes of 1.120.33 from the preoperative one of 2.860.54. These results compares favorably with the ones reported from the major institutions. Clinical results of isolated replacement of the mitral valve and of the aortic valve were previously reported. The clinical results of a total and consecutive patients with replacement of single mitral and single aortic and double mitral and aortic valves on the mortality rate, survival rate, complication frequency, and symptomatic improvement all fully stands for the good therapeutic modalities of the valvular heart diseases with severely damaged lesions.

• Journal of Chest Surgery
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• v.17 no.2
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• pp.212-222
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• 1984

A total of and consecutive 291 patients underwent isolated mitral valve replacement using the Ionescu-Shiley bovine pericardial xenograft valve during the 5-year period between October 1978 and June 1983. Thirty-two patients were the children under 15 years of age. There were 15 deaths within 30 days after surgery [operative mortality, 5.2%]. All early survivors except 6 children were placed on the long-term oral anticoagulation longer than postoperative 3 months. A total follow-up period extended for 398.2 patient-years, and 12 patients died [late mortality, 4.1%, or 3.0%/patient- year]. Ten patients experienced the thromboembolic complication [2.51%/patient-year], occurring in 8 patients within the first 3 postoperative months, and 4 died. Three patients had the late prosthetic valve endocarditis [0.75%/patient-year] and 2 died. The incidence of overall valve failure according to the criteria was 3.01%/patient-year, or 12 patients, and 2 had replacement of the failed bioprostheses [primary tissue failure, 0.5%/patient-year]. The long-term survival rate was 87.8%\ulcorner2.6% at 5 years postoperatively, and 84% of the late survivors were in NYHA Class I at the end of the follow- up. The probability remaining free from thromboembolism and overall valve failure was 89.8%\ulcorner6.3% and 81.2%\ulcorner.8% at 5 years respectively. These clinical results confirm the safety of mitral valve replacement. The only remaining clinical problem is the structural and functional durability of the bovine pericardial xenograft valve, and its use in young patients may be stopped in preference to the mechanical prosthetic valves.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.822-825
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• 2002

The paravalvular leak after redo mitral prosthetic valve replacement is rare but serious complication when it does happen. This condition should be corrected surgically to increase life span and improve symptoms. But simple closure or patch closure of paravalvular leak are not effective in cases of weak annulus or broad defect. We report 3 cases of trido mitral valve replacement using mechanical valve with its sewing ring expanded by a collar of Dacron sheet. The prosthetic sewing ring is anchored on the weak mitral annulus with multiple interrupted sutures, while the Dacron collar is contineuously sutured to the left atrial wall for blood tight sealing. All of the three cases showed event free postoperative course.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.351-365
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• 1988

During one year[1987], 110 cases of open heart surgeries were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, Inje Medical College. And the results were summarized as follows. 1. Among the 110 cases, there were 77 cases of congenital heart diseases and 33 cases of acquired heart diseases. Age range of the congenital patients was 8 months to 30 years with the mean age of 8 years, and acquired patients was 16 to 56 years with the mean age was 32 years. 2. The heart lung machine used for cardiopulmonary bypass was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 50 of membrane type and 60 of bubble type. For all cases GIK[glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 3. Among the 77 congenital anomalies, there were 67 cases of acyanotic patients[ASD: 12, VSD: 50, PS: 1, AP window: 1, Gerbode defect: 1, ECD: 2] and 10 cases of cyanotic patients[TOF: 10], and to all of which the appropriate radical operations were applied. 4. Among the 33 acquired diseases, there were one case of left atrial myxoma, one of annuloaortic ectasia, 20 of mitral valve diseases[MS: 2, MSr: 8, MR: 2, MRs: 8], 9 of double valve diseases[MRs+AR: 1, MRs+ARs: 2, MRs+TR: 1, MSr+TR: 3, MSr+ASr: 1, MSr+ARs: 1], 2 of triple valve diseases[MSr+AR+TR: 1, MSr+ASr+TR: 1]. The left atrial myxoma was removed well with right atriotomy and atrial septal approach. And to the annuloaortic ectasia, Bentall operation was applied with good result. Mitral valve replacement[MVR] was applied to 20 cases of mitral valve diseases, double valve replacement[MVR+AVR] was applied to 6 cases of double valve diseases, MVR & tricuspid annuloplasty[TVA] was applied to 3 cases of mitral 5. The number of replaced valve were 39 in 31 cases. In MVR, 5 of mechanical valves[St. Jude Medical Valve] and 26 of tissue valves[Carpentier-Edward valve] were used. In AVR, 3 of mechanical valves and 5 of tissue valves were used. 6. Postoperative complications were occurred in 23 cases, and among them 21 cases were recovered with intensive cares, but 2 cases were expired[mortality: 1.8%].

• Journal of Veterinary Clinics
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• v.34 no.1
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• pp.54-57
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• 2017

A 1-year-old castrated male Schnauzer dog was presented with heart murmur. Auscultation revealed systolic murmur located at the left heart base (grade 5/6). There were no remarkable findings on thoracic radiographs. Two-dimensional echocardiography revealed subaortic tunnel-like obstruction at the entrance to the left ventricular outflow tract. Anterior mitral valve leaflet appeared to be tethered to septum with minimal motion. Chordae tendineae was abnormally thickened. Color Doppler analysis revealed turbulent flow starting below the aortic valve. Mitral regurgitation was presented during systole. Spectral Doppler recordings revealed high velocity flow through the aorta and mitral regurgitation. Based on echocardiographic examination, the dog was diagnosed with subaortic stenosis concurrent with mitral dysplasia. The patient was medicated with ${\beta}-blocker$ and diuretics. It has been doing well without apparent clinical signs at 2 year after the diagnosis.