• Journal of Chest Surgery
• /
• v.27 no.9
• /
• pp.752-758
• /
• 1994

From July 1983 to December 1992, 145 patients with mitral valvular disease underwent open heart surgery at Chonbuk National University Hospital. Of these patients, 89 patients[61.4%] required mitral valve replacement. 56 patients [38.6 %] had mitral valve repair. There were 32 women and 24 men and the mean age was 34.3 years[range 6 years to 62 years].There were 23 cases of pure mitral stenosis, 19 cases of mitral regurgitation and 14 cases of mixedmitral valvular disease. The mean duration of symptom was 4.53 years and mean mitral valvularorifice diameter[in cases of pure stenosis and mixed mitral valvular lesion] was 0.96 cm. According to the NYHA classification, the distribution of patients preoperatively was as follows; class IIa, 15 patients; class lib, 17 patients; class III, 22 patients; class IV, 2 patients. Four patients[7%] had an embolic history preoperatively. 24 patients[ 43 %] were in atrial fibrillation. In cases of pure mitral stenosis, the technique used included open mitral commissurotomy[21atients], open mitral commissurotomy with mitral annuloplasty[2 patients]. In mixed mitral valvular disease, open mitral commissurotomy[ll patients] and open mitral commissurotomy with mitral annuloplasty[l patient] were performed. In cases of mitral regurgitation, mitral annuloplasty[5 patients], mitral valvuloplasty[6 patients], mitral annuloplasty with valvuloplasty [3 patients] and ring annuloplasty [5 patients] were performed.There was one perioperative death related to acute renal failure and sepsis. One late death was occurred related to heart failure after 10 months postoperatively. One patient required reoperation due to restenosis and no embolic episode was occured. After operation, 34 patients were in NYHA functional class I, 20 patients were in class IIa.

• Journal of Chest Surgery
• /
• v.17 no.3
• /
• pp.389-397
• /
• 1984

Sixty cases of open heart surgery were performed in the Department of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital from July, 1983 to June, 1984. The patients were consisted of 40 [66%] congenital anomalies containing 26 [43%] patients of acyanotic group and 4 [23%] of cyanotic group, and 20 [34%] acquired heart diseases which involved one or more cardiac valves. The male patients were 42 and the female 18. In 20 valvular heart diseases, open mitral commissurotomy was done in 5 patients, mitral valvular replacement with tissue valve in 6, mitral valvular replacement with mechanical valve in 5, mitral valvular replacement with tricuspid annuloplasty in 2, mitral annuloplasty in 1, and mitral and aortic valvular replacements with mechanical valves in 1. The most frequency complication was low cardiac output syndrome occurred in 9, and the next was urethral stenosis, ARDS, and postoperative bleeding, etc. The perioperative mortality was 21% in congenital cyanotic heart disease, 12% in congenital acyanotic heart disease, and 5% in acquired heart disease.

• Journal of Chest Surgery
• /
• v.17 no.1
• /
• pp.59-66
• /
• 1984

After open heart surgery, the patient must be carefully observed and adequately managed for his survival. This report reviewed 10 cases of ventricular septal defect and 12 mitral valvular diseases as hemodynamics early after open heart surgery. For postoperative 24 hours, clinical status was evaluated for left atrial pressure, central venous pressure,DP[LAP-CVP], peak systolic pressure, heart rate, urine amount, and other clinical findings. Especially, on postoperative fourth hour, cardiac output was most decreased, when the changes of monitoring were compared with two groups with or without using cardiotonics. Finally, we concluded as followings; 1.Postoperatively, variation of CVP was noted in VSD, but mitral valvular disease was more variable change of LAP. 2.DP was 1.3\ulcorner.4 cmH2O in VSD, and 6.4\ulcorner.2 cmH2O in mitral valvular disease. 3.Parameter using cardiotonic was CVP in VSD, and LAP in mitral valvular disease.

• Journal of Chest Surgery
• /
• v.2 no.1
• /
• pp.77-84
• /
• 1969

Retrograde left cardioangiographic studies using Amplatz spring coil guide catheter were carried out in 30 cases of acquired mitral valvular diseases. Of these 12 cases were compatible with the clinical diagnosis which were made pre-angiocardiographically. Eighteen out of 30 cases were diagnosed as pure mitral stenosis or mitral insufficiency which had been clinically diagnosed as mitral stenoinsufficiency or mitral stenosis with aortic insufficiency. The rate of difference is 60%. Twenty-five cases or 83% of all cases were operated. Of these 6 cases, the degree of regurgitation through the mitral valves were able to be evaluated cardioangiography and were confirmed by open heart operation. The retrograde left cardioangiography is considered to be a useful tool in conclusive dianosis of clinically equivocal mitral valvular diseases.

• Journal of Veterinary Clinics
• /
• v.18 no.3
• /
• pp.273-278
• /
• 2001

Chronic mitral valvular insufficiency (CMVI) is the most common heart disease in dogs. The prevalence of CMVI is age-dependent. CMVI is usually affected to small to medium size breeds. It is more prevalent in males than females. The characteristic lesions of CMVI are caused by an acquired chronic structural degeneration of the mitral valve defined as endocardiosis or myxomatous degeneration. The main clinical signs are cough, respiratory distress, weakness and pleural effusion and ascites by secondary right-sided heart failure. The most prominent clinical finding is a systolic heart murmur. The thoracic radiography and echocardiography are useful methods in diagnosis of CMVI. Thoracic radiographic findings are left atrial enlargement, left main stem bronchial compression and pulmonary edema. Echocardiography is confirmed to increased left atrial and ventricular dimension, mitral regurgitation, mitral valve thickening and abnormal movement. Thoracic radiography and echocardiography are used to obtain a definite diagnosis of CMVI, and then to study the progression of the condition.

• Journal of Chest Surgery
• /
• v.21 no.2
• /
• pp.270-275
• /
• 1988

The results of the clinical observations on the 76 cases of the mitral valvular heart disease treated in the Department of Thoracic and Cardiovascular Surgery, Chung-nam National University Hospital during the period of 3 years from June, 1983 to July, 1986, are as follows: l. Of 76 cases, 43 were male and 33 were female with sex ratio of 1.3:1. 2. The age of the patient varied widely from 12 years of the youngest to 60 years of the oldest. 3. The main clinical symptoms on admission were dyspnea on exertion[100%], palpitation[42%], generalized weakness[29%], indigestion[18%], hemoptysis[16%]. 4. The preoperative functional levels according to NYHA classification were class II, III, IV in 9%, 63%, 28% respectively. 5. All 76 patients were operated on under direct vision using extracorporeal circulation, open mitral commissurotomy was done in 15 cases, mitral valve replacement in 37 cases, mitral valve replacement and aortic valve replacement in 11 cases, mitral valve replacement and tricuspid annuloplasty in 8 cases. 6. The operative mortality was 11.8% and results of the operation were good and excellent in 65 cases of survivors.

• Journal of Chest Surgery
• /
• v.23 no.2
• /
• pp.245-252
• /
• 1990

To see the change of pulmonary arterial pressure after mitral valve replacement, postoperative cardiac catheterization and echocardiographies were performed in 12 patients of mitral valvular disease with pulmonary hypertension[systolic pulmonary arterial pressure>50 mm Hg]. The mean follow-up duration was 35.4[range: 15-47] months per patient. The following results were obtained. 1] Preoperative systolic pulmonary arterial pressure value of 66.17\ulcorner10.73mmHg decreased significantly to 29.17\ulcorner6.86mmHg postoperatively[p<0.01]. 2] Preoperative Pp/Ps value of 0.67\ulcorner0.13 decreased significantly to 0.28\ulcorner0.06 postoperatively[p<0.01]. 3] Preoperative PAWP value of 29.00\ulcorner4.02mmHg decreased significantly to 9.92\ulcorner4.27 mmHg postoperatively[p<0.01]. 4] Preoperative LAD value of 5.58\ulcorner1.20cm decreased significantly to 4.37\ulcorner0.67cm postoperatively [p<0.01]. In conclusion, pulmonary arterial hypertension secondary to mitral valvular disease could be reduced to normal range after successful mitral valve replacement.

• Journal of Chest Surgery
• /
• v.24 no.4
• /
• pp.382-389
• /
• 1991

The clinical observations on the 63 cases of the mitral valvular heart disease treated in the department of Thoracic and Cardiovascular Surgery, Kosin medical college, during the period of 5 years from January, 1986 to December, 1989, are as follows. 1. Total 63 cases, 23 were male and 40 were female with sex ratio of 1: 1.7. 2. The age distribution was widely varied from 7 years of the youngest to 65 years oldest, average age was 35.3 year old. 3. The main clinical symptom and sign were D.O.E, general weakness, fatigability, palpitation, chest pain, hepatomegaly, pitting edema and both neck vein distension. 4. The preoperative N.Y.H.A functional classification were class II, III, IV in 28%, 54%, 16%. 5. The preoperative diagnosis were MS - 6.3%, MR - 53.9%, MSR - 36.5%, MVP - 3.1%. 6. All 63 patients were operated on the under direct vision using extracorporeal circulation, MVR in 18 cases, MVR and Tricuspid annuloplasty in 24 cases, DVR in 3 cases, DVR and Tricuspid annuloplasty in 5 cases, TVR in 1 case, Mitral annuloplasty in 4 cases, mitral valvuloplasty in 7 cases and mitral commissurotomy in 2 cases 7. The operative mortality was 7.9%, and 5 years actuarial survival rate was 89%.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.649-654
• /
• 1985

After first successful mitral valvotomy by Harken and Bailey in 1948, improvement of surgical technique and cardiac device may last rapidly for several years, but there after many patients deteriorate because of various causes, so incidence of reoperation for cardiac valvular disease has increased time by time. This paper is concerned with 21 patients in whom a second operation has been carried out from Jan. 1963 to Aug. 1984 at the department of Thoracic and Cardiovascular department, National Medical Center. Of 21 patients, 7 were male and 14 were female, and ages ranged from 14 to 37 years The second operation are classified into groups of secondary closed mitral commissurotomy [3 cases], open commissurotomy following closed mitral commissurotomy [1 case], Valve replacement following closed mitral commissurotomy [14 cases] or bioprosthetic valve replacement [3 cases]. Main cause of reoperation was restenosis or steno insufficiency, and that of bioprosthetic valve failure was bacterial endocarditis [1 case], fibrous tissue overgrowth on the Xenograft [1 case] and technical failure [1 case]. Early operative mortality was absent, but during follow-up, 4 patients died, so late mortality was 19.0%, and main cause of death was congestive heart failure.

• Journal of Chest Surgery
• /
• v.26 no.7
• /
• pp.521-525
• /
• 1993

Sixty-three patients who underwent open mitral commissurotomy at Sejong General Hospital during last 10 years from the August, 1983 to June, 1993 were reviewed There were fifty-one women and twelve men, and the mean age was 34.2 years. According to the NYHA classification, the distribution of patient preoperatively was as follows: class I, 5 patients ; class II, 26 patients ; class III, 30 patients ; class IV, 2 patients, and mean duration of symptome was 4.5 years. The mean mitral valvular area measured with echocardiogram preoperatively was 0.92cm2. All patients underwent open mitral commissurotomy and 41 patients required additional procedures for relief of subvalvular stenosis or other valvular disease. There were no operative death. 63 patients had three different types of mitral stenosis : type I, mobile cusps without subvalvular change [21 patients] ; typeII, thickened cusps with subvalvular change [34 patients] ; type III, rigid cusps with severe subvalvular change [8 patients]. The valvular calcification was seen in 11 patients [17%] and 15 patients [24%] had left atrial thrombus. The duration of follow-up was from 1 month to 168 months [mean, 39.6 months] and there were no late death. Six patients required reoperation and one patient had embolic episode. Conclusively,the open mitral commissurotomy represents a safe surgical precedure for treating mitral stenosis, allowing a complete removal of atrial thrombosis if present, and even when associated with subvalvular changes.