• 대한영상의학회지
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• 제81권2호
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• pp.290-301
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• 2020

최근 들어 승모판(mitral valve) 질환에 대해 승모판 성형술(mitral valvuloplasty) 또는 중재 시술을 통하여 인공판막을 넣어주는 시술(transcatheter mitral valve replacement)이 발전하고 있다. 이러한 치료 계획을 위해서는 승모판의 해부학적인 정보를 수술자 혹은 시술자의 관점에서 조금 더 자세하게 알려줄 필요가 있다. 본 리뷰에서는 승모판의 보존 수술 및 중재적 시술의 치료 전 계획을 위한 승모판의 해부학 및 CT를 이용한 승모판막 주변의 평가 방법에 대해 다루고자 한다.

• Journal of Chest Surgery
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• 제28권6호
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• pp.579-582
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• 1995

The extended transseptal approach to the mitral valve replacement has been used for 30 patients. There were 19 women and 11 men. Twenty five patients had rheumatic heart disease, 4 had degenerative valve ,and 1 had valve prolapse. Fifteen of 30 patients had other associated procedure; 10 had aortic valve replacement; 5 had tricuspid annuloplasty. There were no postoperative complications associated with the approaches, ie, no bleeding, no sinus node dysfuction, and no atrioventricular conduction disturbance. Despite division of the sinus node artery, preoperative atrial rhythms[3 sinus rhythms and 27 atrial fibrillations were not changed during postoperative period. The extended transseptal approach provides good mitral valve exposure without inherent complications, and is superior to that of standard approach, so we use it routinely for mitral valve procedure.

• Journal of Chest Surgery
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• 제18권3호
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• pp.446-455
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• 1985

A total and consecutive 156 patients have undergone cardiac valve surgery including 13 closed mitral commissurotomy, 13 open mitral commissurotomy, one mitral annuloplasty, 75 mitral valve replacement, one aortic annuloplasty, 24 aortic valve replacement, 3 tricuspid valve replacement, 25 double valve replacement and one triple valve replacement. 155 prosthetic valves were replaced in a period between September 1976 and August 1985. There were 68 males and 88 females with age range from 8 to 69 yrs [mean 36.5 yr]. Out of replaced valves, 61 was tissue valve including 54 Carpentier-Edwards, and 4 was mechanical valves including 74 St. Jude Medical, and the position replaced was 101 valves for mitral, 46 for aortic and 8 for tricuspid. Single valve replacement in 102 cases, double valve replacement in 25 cases [17 for AVR+MVR, and 8 for MVR+TVR], and only one case was noted in the triple valve replacement. Early mortality within 30 days after operation was noted in 11 cases [7%]; 7 after MVR, 2 after DVR, and each one after open mitral commissurotomy and mitral annuloplasty. Cause of death was valve thrombus, cerebral air embolism, low output syndrome, uncontrollable arrhythmia, parapneumonic sepsis, acute cardiac tamponade and left atrial rupture. 7 late deaths were noted during the follow-up period from 1 to 104 months [average 48 month]; three due to valve and left atrial thrombus formation, two due to CVA from overdose of warfarin, and each one due to congestive heart failure and chronic constrictive pericarditis, Anticoagulants after prosthetic valve replacement were maintained with warfarin, dipyridamole and aspirin to the level of around 50% of normal prothrombin time in 79 cases, and Ticlopidine with aspirin in 47 cases to compare the result of each group. There were 11 major thromboembolic episodes including 3 deaths in the warfarin group. Two cases of CVA due to overdose of warfarin was noted in the warfarin group. In the ticlopidine group, there was only one left atrial thrombus confirmed at the time of autopsy. Among the survived 138 cases, nearly all cases[136 cases] were included in NYHA functional class I and II during the follow-up period. In conclusion, surgical treatment of the cardiac valve disease in 156 clinical cases revealed excellent result with acceptable operative risk and late mortality. Prevention of thrombus formation with anti-platelet aggregator Ticlopidine has better result than warfarin group presently with no specific side effect such as bleeding or gastrointestinal trouble.

• Journal of Chest Surgery
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• 제46권2호
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• pp.124-129
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• 2013

Background: Mitral valve repair for posterior mitral leaflet (PML) prolapse has been considered to be a standard treatment because of its high success rate and high level of patient satisfaction. The aim of this study was to evaluate the clinical results of two different techniques of PML prolapse, quadrangular resection (QR) and chordal replacement (CR). Materials and Methods: The subjects consisted of 56 patients who had undergone mitral valve repair for PML prolapse between November 1997 and December 2010. The patients were divided into two groups according to surgical technique. Among them, 31 patients underwent QR (group QR) and 25 patients had CR (group CR). We reviewed the medical records of the patients retrospectively to compare the clinical outcomes of both groups. Results: After mitral valve repair, the degree of mitral regurgitation (MR) in both groups decreased to the to a mild degree or less and the amount of remnant MR was slightly higher in the CR group but it was not statistically different. Three patients received mitral valve-related reoperation (2 in the QR group and 1 in the CR group). Freedom from mitral valve-related reoperation at 7 years was 93% for the QR group and 96% for the CR group and was not significantly different between the two groups. Conclusion: Both QR and CR showed excellent long-term results and were considered equally effective methods for PML prolapse.

• Journal of Chest Surgery
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• 제49권1호
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• pp.46-49
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• 2016

The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification.

• Journal of Chest Surgery
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• 제13권2호
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• pp.92-99
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• 1980

From 1958 up to the end of April 1980, during the period of 12 years 1640 cardiac surgery cases including 1069 open heart surgery and 304 valve replacement cases, were operated in this Department. There were 1070 congenital anomaly and 570 acquired disease cases. In 1070 congenital anomaly cases 673 acyanotic and 397 cyanotic anomaly patients were noted. In acquired diseases 94 pericardial and 456 valvular cases were found. Among 456 valve cases 189 mitral stenosis, 133 mitral insufficiency, 30 aortic valve lesion, 97 double valve, and 7 triple valve lesion patients were noted. Among 304 valve replacement cases 209 mitral, 34 aortic, 5 tricuspid, 34 aortic with mitral, 20 mitral with tricuspid, and 2 triple valves were replaced. Annual increase `of open heart surgery cases and decrease of operative deaths were remarkable in recent years. In recent years Shiley** oxygenator in pump-oxygenator set up and Ionescu** bovine pericardial xenograft bioprosthesis were used for valve replacement mainly.

• Journal of Chest Surgery
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• 제10권1호
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• pp.156-163
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• 1977

This is a report of a case in which mitral valve replacement was performed using Starr-Edwards ball valve [model 6230] by total cardiopulmonary bypass with total hemodilution prime and moderate hypothermia. The patient was 21 year old girl, and mitral valvular symptoms occurred 5 years ago. According to clinical features of the disease, the patient was classified as the class IV of N.Y.H. A. cla3sification. The preoperative diagnosis of mitral insufficiency was made mainly by left ventriculography of roentgenologic study. The mitral valve was highly deformed due to scar contraction of valve leaflets and shortening of chordae tendineae. After prosthetic valve replacement, no abnormal hemodynamic signs were observed. The postoperative course was uneventful.

• Journal of Chest Surgery
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• 제25권6호
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• pp.661-671
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• 1992

From March 1988 to May 1991, 140 CarboMedics cardiac valve prostheses[75 mitral, 9 aortic and 28 double aortic-mitral] were implanted in 112 consecutive patients[mean age 36.7$\pm$11.6 years, male/female 48/76] by one surgical team operating on adult cardiac patients at Kyoungpook University Hospital Associated Surgical procedures were performed in 19 patients[16.9%]. Total follow up represented 2,345 patient-months[mean 22.4 months] and was 100% complete. Eighty-two patients[73%] were in NYHA functional class IIIor IV preoperatively and 102 patients [95%] were in class I or II postoperatively. Hospital[30 day] mortality was 4.4%, [3/75 mitral, 1/9 aortic, 1/28 double valve replacement] and late death was 1.7%. [1 /74 mitral, 1 /28 double valve replacement] The actuarial survival at 36 months was 94.0% after mitral, 80% after aortic, 92% after double valve replacement, and 93.2% for the total group. The linearized incidence of valve relater death, prosthetic valve thrombosis, anticoagulant related hemorrhage, and reoperation was 1.00%/pt-yr, 0.51%/pt/yr, 0.51%/pt-yr, and 0.51%/pt-yr respectively. The 36 month rates of freedom from valve replated death, thromboembolism, endocarditis, anti-coagulant related hemorrages, and reoperation were 98.75%, 99.08%, 100%, 99.04%, and 99.08% respectively. The 36 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.2%. These fact suggest that the CarboMedics heart valve has excellent short-term result, low incidence of valve-related complications and valve dysfunction, and additional long term follow up study is necessary.

• Journal of Chest Surgery
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• 제54권3호
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• pp.165-171
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• 2021

As a percutaneous technique for the reduction of mitral regurgitation, the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) for transcatheter edge-to-edge repair of the mitral valve was developed in 1998 and first used in 2003. Its main advantage is being less invasive than surgery, because it can be performed through a transcatheter approach without any hemodynamic compromise. Recent studies have shown that this procedure reduces symptoms and improves functional capacity with low complication rates. Two randomized clinical trials have investigated the use of this technique for functional mitral regurgitation. The Korean Ministry of Food and Drug Safety approved its use for degenerative mitral regurgitation in 2019, and this procedure started to be performed in Korea in January 2020. Its use for functional mitral regurgitation was also approved in Korea in 2020. In this article, recent evidence on transcatheter edge-to-edge repair of the mitral valve and our initial experiences in Korea will be reviewed.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1128-1138
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• 1990

The mitral valve is not a simple but a complex structure, mitral valve complex. This complex is composed of mitral orifice, annulus, valve leaflet, chordae tendineae and papillary muscles. There were many controversies about this structures. We studied mitral valve complex in 63 cases of normal Korean adults, such as the circumference of mitral annulus, the intercommissural diameter, height and breadth of the cusps, including commissure, the ratio of rough to clear zone, breadth of the achordal zone, the number of scallops of posterior cusp, the number, length and the pattern of arrangement of the several types of chordae, the number and morphological characteristics of papillary muscles.