• 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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• 제29권1호
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• pp.90-94
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• 1996

1994년 4월부터 1995년 3월까지 승모판폐쇄부전 환자 6명에서 확장성 polytetrafluoroethylene을 사용하여 건삭재건 수술술기인 새로운 건삭형성술을 이용하여 승모판 재건을 시도하였다. 승모판 폐쇄부전의 원인으로는 3명에서 전첨탈출(anterior leaflet prolapse), 나머지 3명은 양첨탈출(both leaflet prolapse)이었다. 6례 환자의 평균연령은 65세(범위 55∼75)였으며, 남성 3명, 여성 3명이었다. 수술 사망례는 없었고, 수술후 합병증 없이 퇴원하여 현재 관찰중이다.

• 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 Yeungnam Medical Science
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• 제30권2호
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• pp.120-123
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• 2013

The common causes of organic mitral regurgitation (MR) include mitral valve prolapse (MVP) syndrome, rheumatic heart disease, and endocarditis. MR also occurs secondary to dilated cardiomyopathy and coronary artery disease. In acute severe MR, the hemodynamic overload often cannot be tolerated, and mitral valve repair or replacement must be performed immediately. We report herein a case of severe MR due to coronary vasospasm that was confirmed via ergonovine echocardiography in a 70-year-old man. He was scheduled to undergo mitral valve surgery, but it did not push through and he was put on medical therapy.

• Clinical and Experimental Pediatrics
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• 제49권11호
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• pp.1223-1226
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• 2006

철적모구성 빈혈은 heme 대사의 이상으로 혈청철의 증가와 소구성 저색소성 빈혈을 보이며, 골수 소견에서 적혈구계 과다형성과 함께 환상 철적모구가 많이 나타나는 것이 특징이다. 저자들은 2세 남아에서 드문 질환인 철적모구성 빈혈과 승모판 탈출증에 의한 승모판 역류가 동시에 있는 증례를 경험하였다. 환아는 철적모구성 빈혈에 의해 수혈에 따른 철분의 과잉 침착과 만성 빈혈에 의한 심계 항진에 의한 심근 기능 장애가 발생할 가능성이 있는데다, 동반된 승모판 탈출증으로 심기능의 장애의 위험이 증가할 것으로 사료된다. 현재 환아는 pyridoxine 투약 후 전신 상태와 혈색소 수치가 안정적으로 유지되고 있다.

• Journal of Chest Surgery
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• 제42권3호
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• pp.292-298
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• 2009

배경: 소아 환자의 승모판막 질환에 대한 외과적 치료는 그 모양의 다양성과 동반된 선천성 심장 기형 등으로 인해 기술적, 임상적으로 어렵다. 본 연구는 선천성 승모판막 폐쇄부전증 환아에서 본원에서 시행한 승모판막 성형 수술의 결과를 평가하였다. 대상 및 방법: 1997년 4월부터 2007년 10월까지 승모판막 폐쇄부전증으로 승모판막 수술을 시행한 소아 환자 22명을 대상으로 후향적으로 분석하였다. 수술 당시 환아의 평균 연령은 5.4세였고, 이 중 12개월 미만의 영아는 4명이었다. 동반된 심기형으로는 심실 중격결손이 13예로 가장 많았고, 그 외에 심방 중격결손과 판막 상부 대동맥 판막 협착증(supravalvar aortic valve stenosis)이 각각 1예 있었으며, 승모판막 페쇄부전증만 단독으로 있는 경우는 7예가 있었다. 수술 전 승모판막 페쇄부전증의 정도는 II, III, IV가 각각 4예, 15예, 3예였고, 그 원인으로 판막 탈출증(leaflet prolapse)이 12예, 판막륜 확장(annular dilatation)이 4예, 제한된 판막 움직임(restrictive leaflet motion)이 5예 있었다. 수술 전후의 페쇄부전증 정도와 승모판막륜의 Z-value를 비교함으로써 그 결과를 평가하였다. 결과: 모든 환자에서 판막 성형술이 가능했고, 수술 후 조기 사망과 만기 사망 모두 얼었다. 19예에서 판막륜 축소술(reduction annuloplasty)을 시행하였고, 18예에서 건삭 축소술(shortening of chordae)이나 판막열 봉합술(cleft closure) 등의 판막 성형술(valvuloplasty)은 추가로 시행하였다. 수술 직후 승모판막 폐쇄부전증의 정도는 줄어들었고(0=10, I=5, II=5, III=2), 승모판막륜의 Z-value도 감소하였다($2.2{\pm}2.1$ vs $0.7{\pm}2.3$, p<0.01). 3.68년의 추적기간 동안 3명의 환아가 승모판막 폐쇄부전증으로 재수술을 받았고, 한명은 재성형술을, 나머지 2명은 승모판막 치환술을 받았으며, 퇴원 시 3명의 환아에서 수술 직 후 보다 폐쇄부전증이 좀 더 진행되었다. 결론: 소아의 승모판막 페쇄부전증에서 일차 수술방법으로 적극적인 승모판막 성형술은 효과적이고 믿을만한 방법이다. 좀 더 좋은 수술 결과를 얻기 위해서는 수술 전 환아의 승모판막의 모양과 기능을 면밀히 파악하고, 다양한 수술적 기법을 적용하는 노력이 필요하겠다.

• Journal of Chest Surgery
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• 제26권4호
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• pp.249-254
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• 1993

Atrial fibrillation is commonly associated with organic mitral valve disease including rheumatic valvular heart diasease or mitral valve prolapse and so forth. Although spontaneous sinus reversion may occur in some patients after mitral valve operation, recurrence of atrial fibrillation is the rule in most of these patients. We have tried to maintain sinus rhythm after mital valve operation with oral quinidine therapy, and we will show the efficacy of this therapy in this report. From January 1986 to August 1992, 60 patients of mitral valvular heart disease, who had had atrial fibrillation preoperatively and gained sinus rhythm postoperatively, were selected for this study. These patients were divided into 2 groups: Control group [n=30] and Quinidine trial group [n=30]. The age,sex, duration of symptoms,left atrial size and other risk factors of the reversion to atrial fibrillation were adjusted to be similar between the two groups. The maintenance rate of sinus rhythm was calculated by Kaplan-Meier method, and the rate was significantly higher in quinidine trial group than in control group [ p=0.0001 ]. Univariate analysis was performed on the risk factors of reversion to atrial fibrillation, and the difference of maintenance rate between the two groups were corrected with this result: the difference was still statistically significant [ p=0.0205 ]. The quinidine levels were measured in postoperative days, and there were no difference of serum quinidine level between the quinidine success group and quinidine failure group. In conslusion, oral quinidine therapy was effective for the maintenance of sinus rhythm after mitral valve operation compared to control group, and there was no correlation between the serum quinidine level and clinical efficacy of quinidine therpy.

• Journal of Chest Surgery
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• 제18권1호
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• pp.62-68
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• 1985

10 patients with mitral regurgitation associated with various congenital cardiac anomalies were treated by reconstructive techniques in the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the period of 2 years from 1982 to 1984. There were mitral valvular cleft in one case, chordae tendineae rupture associated with congenital multiple cardiac-anomalies [VSD, PDA, prolapse of aortic non-coronary cusp through VSD] in one case, elongated chordae tendineae after removal of left atrial myxoma in one case, and mitral annular dilatation associated with VSD in 3 cases, large PDA in 2 cases, aortic regurgitation [bicuspid valve] in one case, and unknown origin in one case. Owing to the various pathology above mentioned, reconstructive surgical approach to mitral incompetence is accordingly complicated and a combination of the following different procedures were properly used case by case, that is, suture of chordae tendineae, shortening of elongated chordae tendineae, closure of VSD, ligation of PDA, aortic valvuloplasty, mitral annuloplasty with mattress suture, etc. All patients were survived and they have been excellent postoperative results.

• Journal of Chest Surgery
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• 제28권1호
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• pp.65-68
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• 1995

Pectus excavatum occasionally occurs in patients who have underlying cardiac disease, especially Marfan syndrome. This report describes a patient with pectus excavatum who had ascending aortic aneurysm with aortic regurgitation and anterior leaflet prolapse of mitral valve. This patient underwent replacement of aortic valve and ascending aorta with 25 mm SJM valved conduit graft[Bentall operation with Cabrol shunt , and mitral valve replacement with SJM 31 mm, the pectus excavatum was corrected at the time of completion of the intracardiac operation with the modified sternal turnover. This procedure offered excellent operative exposure for the inracardiac operation with prevention of low cardiac output after operation due to depressed sternum and maintained chest wall stability resulting good cosmetic chest wall appearance. This patient recovered and discharged in good postoperative result with minimal temporary peroneal nerve palsy in his left leg.

• Journal of Chest Surgery
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• 제46권1호
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• pp.60-62
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• 2013

Quadrangular resection is the gold standard technique for correction of the posterior leaflet prolapse in mitral valve disease. Prompted by the idea that the anterior leaflet of the tricuspid valve corresponds to the posterior leaflet of the mitral valve in its structure and function, we conducted a quadrangular resection of the anterior leaflet of the tricuspid valve in a case of tricuspid endocarditis. Tricuspid regurgitation was well corrected, and the durability of the repair was proven by the patient's freedom from cardiac events for the following 8 years.