• Journal of Chest Surgery
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• v.16 no.4
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• pp.458-469
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• 1983

Between October, 1978, and December, 1982, Glutaraldehyde-stablized pericardial xenografts [Ionescu-Shiley valve] were used for heart valve replacement in 409 patients.[251 mitral, 49 aortic, 11 tricuspid, and 98 multiple valve replacement]. There were 31 early deaths [7.6%], and 371 operative survival were observed for a total of 507.6 years over a period of 1 to 44 months. [mean 17 months]. Actuarial analysis of late results indicates an excepted survival rate at 4 years of 86.25.4% for patients with mitral, 79.37.1% for patients with aortic valve replacement. Actuarial survival rates for total patients at 4 years was 77.88.2%. The rate of systemic embolism has been 1.6% per patient-year for mitral and 1.8% per patient-year for aortic group in the presence of anticoagulation treatment. Among the 6 embolic episodes, 2 patients were died. The incidence of hemorrhagic complication was 1.3% per patient-year for anticoagulated patients. There were 6 confirmed valve failures, five in mitral and one in aortic position. Re-replacement of destructed valve was performed in one patient and others were treated medically. Among the 6 episodes, 3 occurred in children [Below 15 years], it account almost 9 times higher than adult. Our clinical data compare very favorable with those obtained with other available prostheses and tissue valves, but it should be considered to give short-term anticoagulation therapy to hemodynamically stable patients and aortic valve patients, and other prosthetic valve must be considered to use in children.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.479-487
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• 1988

Valve replacements in 82 children, aging up to 15 years[mean 11.67 years] were done at Seoul National University Hospital during 13 years period from 1974 to 1986. The patients were composed of 5] males and 31 females and 50 patients had acquired heart disease and 32 patients congenital heart disease. 75 patients received single valve replacements, 6 patients double valve replacements, 1 patient triple valve replacement, and among all of them, 11 patients redo-replacements. The bioprosthetic valves have been applied to 58 patients and prosthetic valve to 24 patients and the latter was the main artificial valve since 1984. Among the 69 patients who had definite post-operative records, the overall mortality was 27.5%[20.3% was early mortality and 7.2% late mortality] and the overall mortality was lowered to 4.3% since 1984. There were early post-operative complication rate of 26.1% and late complication rate 34.8%, and among the latter, the valve failure rate was 11.4% patient-year, and the thrombo-embolism rate 1.76%/patient-year. 55 patients among the survivals after post-operative 1 month, were received follow-up with various anticoagulating medication for total 2046 patient-months[mini-mum 1 month to maximum 90 month, mean 37.2*25.44 months] and actuarial survival rate was 82*8% at 5 years and valve failure free and thrombo-embolic free survival rate were 61*8% and 90*3% respectively. And among them, valve failure free survival `rate of tissue valve were 91*6% at post-operative 2 years, 78*3% at 3 years, 59*9% at 4 years, 54*10% at 5 years, 53*15% at 6 years, so markedly decreased at 3-5 years post-operatively. These results suggest that cardiac valve replacement in children have been effective therapeutic method though various problems are still remained, and the choice of valve should be prosthetic valve mainly due to its durability at the present.

• 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.8
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• pp.815-818
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• 1997

Prosthetic valve endocarditis(PVE), although uncommon, is associated with significant mortality if the infection spreads into the paravavular structures with later abscess formation. However, combined antibiotic and surgical treatment is often successful. Accurate diagnosis by on echocardiography, effective myocardial protection during operation and increased surgical experience have improved the short-term and long-term outcomes for patients with PVE. A 35-year-old male had a history of replacement of aortic and mitral valve, and tricuspid annuloplasty on August 1994, was admitted due to sudden onset of aphasia, leftward deviation of both eyeballs and spiking fever and diagnosed of having PVE by echocardiography. Reoperation was done after 6weeks of antibiotic treatment. On the operative field, we could notice circumferential vegetation along aortic valve annulus, paravalvular leakage and abscess pocket. The mitral valve amlulus was healthy. The patient underwent redo aortic valve replacement using cryopreserved aortic homograft after radical debridement of infected issue. During the follow up of 7 months period the homograft was well functioning without recurrence of symptoms.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.383-396
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• 2000

Before the advent of early plastic or maxillofacial reconstructive surgery, facial features could only be replaced and mimicked by prosthetic, artificial means. Facial deformity or dysfunction, whether congenital or acquired by trauma or mutilating disease, has long been an area of constant research, development and innovation in many cultures of the world. One of the greatest contributors to the need for maxillofacial prosthetics has been physical conflict and warfare. The use of maxillofacial prostheses is not merely the replacement of a missing or disfigured aspect of the face, but the rehabilitation of that individual back into the society from which they originate. Rehabilitation includes the restoration of the person's self worth and confidence, not just physically but psychologically. In sixteenth century, Ambroise Pare, French military surgeon, first have tried many maxillofacial prosthetics for injured war soldiers with papier-mache, silver, gold and copper. According to patient's demand who lost their maxillofacial figures, maxillofacial personnel have increased and prosthetic's skill have been advanced all of the world. Over the last decade, there has been a very rapid development in technical possibilities to provide patients with facial prostheses retained by skin penetrating implants. This article will present overall history of maxillofacial prostheses and some background information on the materials used from the old world. And to overcome still many limitation of prosthetic, new minds and new ideas for technique and materials should be developed.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.651-654
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• 1996

Recently, we report a surgical experience of one case of acute prosthetic valve failure due to throe- bosis. The patient was 39-year old male who complained of dyspnea and orthopnea for 3 days before admission. The patient had not taken anticoagulant therapy for recent 4 months against medical ad- vice. The limitation of valve motion was revealed on echocardiography. We performed emergency reoperation with thrombectomy and prosthetic valve replacement. The patient had anuncomplicated postoperative course and have been followed up.

• Journal of Chest Surgery
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• v.15 no.2
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• pp.254-258
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• 1982

We have experienced one case of Redo AVR which was performed 13 months after initial operation. The patient had received AVR [Bjork-Shiley disc valve] and MVR [Ionescu-Shiley tissue valve] because of ASI and MSI at March, 1981. During follow up through the OPD, he complained exertional dyspnea and progressive jaundice with hemolytic anemia was also noticed since 1 month prior to readmission. Cardiac catheterization and angiography revealed periaortic valvular leakage due to partial detachment of previously replaced prosthetic aortic valve. Re-replacement of prosthetic aortic valve with Ionescu-Shiley valve was performed and the patient was discharged at 17th POD without any complications.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1049-1051
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• 1999

We performed a reoperation of failed tricuspid mechanical valve in a 63-year-old female patient because the overgrown endothelial pannus had entrapped the prosthetic leaflets. Four years ago, the patient underwent mitral and tricuspid valve replacements with 31 and 33 mm Carbomedics, respectively. The patient showed symptoms of neck vein distention, abdominal distention and peripheral edema. The chest film, echocardiography and cineangiography confirmed the diagnosis of tricuspid valve. During the operation, we found the entrapped leaflets of the tricuspid valve in a partially closed state and the endothelial pannus had overgrown into the leaflets. Carpentier-Edward bovine pericardial valve was inserted and the patient was discharged with no significant events.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.326-330
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• 1996

Despite anticoagulation, systemic embolization and anticoagulant-related hemorrhage are the major drawbacks of heart valve replacement with mechanical prostheses. Among many predisposing factors, inadequacy of anticoagulation is the most important one. Surgery can be reserved for patients who do not response to thrombolytic therapy, We have experienced 3 cases of prosthetic valve thrombosis treated by thrombolytic therapy by use of urokinase and heparin. Two patients fully recovered and returned to their employments and active lives but 1 patient,died of intracerebral hemorrhage and infarction. We report prosthetic valve thrombosis thrombolytic therapy with urokinase and heparin which was detected and serially followed by 2-dimensional echocardiography, cinefluoro copy, and monitoring of Swan-Ganz catherterized pressures.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1354-1357
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• 1992

From May 1984 through December 1991, twelve patients underwent valve replacement for infective endocarditis at National Medical Center. There were 7 male and 5 female, ranged in age 16 to 61[mean 34.1] years. Four had native valve endocarditis, six had prosthetic valve endocarditis and two were associated with congenital heart disease. The indication of surgery was medically intractable congestive heart failure in all patients. 5 patients revealed systemic embolization and 4 patients had uncontrollable sepsis. The causative organism was Streptococcus in 4 patients, Staphylococcus in 1 patient and Pseudomonas in 2 patients. Hospital mortality was 33.3%[4/12]. The main cause of death was low cardiac output due to perioperative myocardial damage and cerebral vascular accident. There were 2 late mortality because of recurrent endocarditis. This review showed much higher mortality in prosthetic valve endocarditis[66.7%] than native valve endocarditis[33.3%].