• Journal of Chest Surgery
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• v.16 no.3
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• pp.349-355
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• 1983

Twenty-seven patients with double-outlet right ventricle underwent complete intracardiac repair between 1978 and 1983, June, at Seoul National University Hospital . Although definite aorto-mitral discontinuity was discovered in 20 patients, both great arteries arose wholly or mostly from the right ventricle in all cases. There were 17 cases with subaortic VSD, 6 with subpulmonic, 2 with doubly-committed, and 2 with non-committed VSD. Pulmonary stenosis was present in 21 patients. Intraventricular baffle repair was applied in 23 patients. Three patients required extracardiac conduit to establish continuity between right ventricle and pulmonary artery, and modified Fontan operation was performed in one patient. Over-all mortality rate was 37.0%, but recently 4 of 15 died [26.7%]. One late death occurred from infective endocarditis. Incremental risk factors were small patient size, subpulmonic or non-committed VSD, presence of PS, coronary artery anomalies, associated valvular lesion and other complicated anomalies. However, great artery relationship, restrictive VSD and transannular patch were not risk factors. No instances of complete heart block occurred. Of the survivors, all showed complete or in complete right bundle branch block and in one patient intermittent ventricular tachycardia had developed. The important cause of death was low cardiac output syndrome.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.17-25
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• 1981

In 1980, 416 cases of open heart surgery were done in this Department with over all operative mortality of 12.3%. 1. There were 288 congenital anomalies consisting of 174 acyanotic and 114 cyanotic varieties, which showed operative mortality of 6.9% and 25.4% respectively. 2. There were 128 cases of acquired lesions, 124 valvular disease and 3 myxoma being the main lesions. 3. There were 128 cases of valve replacement with operative mortality of 7.8%. 4. The most frequently operated anomaly was VSD, 90 pure VSD and 21 cases were associated with one or 2 cardiac anomalies. Over all operative mortality in 111 VSD cases was 8.1% but in 90 pure VSD cases it was 6.7%. 5. Tetralogy of Fallot showed the highest incidence in cyanotic group with 88 cases, consisting of 68 pure and 20 with other cardiac anomalies. Over all mortality in 88 cases was 19.3% but in pure form 16.2%. 6. In 128 valve replacement cases over all mortality was 9.4%. There were 85 mitral, 11 aortic, 2 tricuspid, 21 mitral with aortic, 6 mitral with tricuspid, 3 mitral, aortic, and tricuspid valve replacement cases. For mitral valve replacement operative mortality was 5.9%. 7. Twenty-one cases of babies under 10kg body weight were operated on with over all operative mortality of 28.6%. Sixteen cases of VSD were found with operative mortality of 25%. 8. Among 128 cases of valve replacement 7 were under the age of 15 years and 12 were between 15 and 20 years old. Five pediatric cases underwent mitral valve replacement without mortality, 9 year old boy was the youngest among them. In this Department open heart surgery for infancy and complex anomalies showed still hip operative risk which should be improved in the coming years. For open heart surgery Shiley oxygenators and 2 sets of A-O de-lux 5 head roller pump were utilized exclusively. For valve replacement Ionescu-Shiley bovine pericardial xenografts were mainly used. In pediatric and rural patients Persantin with aspirin regimen was satisfactorily administered for anticoagulation after valve replacement. Routinely Coumadin was administered for one year after valve replacement* In patients who had thrombus on valve sites, chronic atrial fibrillation, and giant left atrium Persantin-Aspirin regimen was used when one year coumadin administration was discontinued.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.595-603
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• 1993

We analysed 60 consecutive patients who got Senning operation for transposition of the great arteries [TGA] with or without ventricular septal defects [VSD]. There were 41 simple TGA [group I] and 19 TGA with VSD [Group II], the operative mortality was 20 % [in group I 4.9 %, group II 52.6 %]. Among the survivors [n=48], the mean follow-up period was 7 years [range, 1 year to 13.5 years] and the actuarial survival rate at 13 years were 95 % in group I and 42 % in group II. Preoperative high left ventricular pressure and high pulmonary arterial pressure affected the surviving [p<0.01]. There occurred various type of arrhythmia like junctional rhythm, first degree atrioventricular [AV] block, sick sinus syndrome and complete AV block, and we inserted 2 permanent pacemakers for these patients. The incidence of arrhythmia were 28.2 % [11/39] in group I and 55.6 % [5/9] in group II, and the actuarial freedom from arrhythmia at 13 years after operation was 66 % [71 % in group I, 44 % in group II]. Increased aortic cross clamping time had affected the development of arrhythmia [p<0.05] which meant the complexity of the operation. The total incidence of left ventricular outflow tract obstruction [LVOTO] was 31.3 % [15/48], but only 3 patients [6.25 %] showed the significant gradient requiring reoperation. The pulmonary venous pathway obstruction [PVO] were found in 3 patients, all in group I, and among them only one required the reoperation. The estimated freedom from PVO was 89 % at 13 years [87 % in group I, 100 % in group II], but we couldn`t find any significant systemic venous obstruction in our series. There occurred 27.1 % [13/48] mild degree tricuspid valve regurgitation without necessary surgical correction. We experienced 14.6 % [7/48] reoperation rate: 3 residual VSD, 3 LVOTO, 1 PVO, 3 atrial baffle leakage. For this high incidence of complication rate after Senning operation and high mortality in TGA with VSD, We do not use this kind of surgical modality any more and do the Jatene operation for all the TGA patients since several years ago.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.516-519
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• 2009

Ventricular septal defect (VSD) complicating an acute myocardial infarction is rather uncommon. However, the outcomes after the development of a VSD are poor with an in-hospital mortality of more than 90% for the medically treated patients. To prevent the recurrence of VSD, many techniques have been reported on for the closure of a postinfarction VSD. In this. report, we present a case of a patient who had a postinfarction VSD due to Prinzmetai's variant angina, and the rupture of the pseudoaneurysm of the left ventricle was successfully treated by the "Sandwich technique".

• Journal of Chest Surgery
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• v.17 no.1
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• pp.59-66
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• 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
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• v.19 no.2
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• pp.238-242
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• 1986

The prognosis of patients with VSD and pulmonary hypertension is at least partially related to the reversibility of pulmonary hypertension after surgery. To predict postoperative pulmonary arterial pressure, immediate postbypass values were compared with preoperative hemodynamic data in 18 surgically closed VSD patients aged 6 to 80 months. The following results were obtained. 2] There was a good correlation between preoperative PP/PS and postoperative PP/PS in patients aged over 24 months [r=0.685, p<0.05], and in patients whose QP/QS were over 2.0 [r=0.686, p<0.01]. 3] There was also a good correlation between pump time and postoperative PP in total patients [r=0.697, p<0.005]. 4] Direct correlations were found between preoperative PP/PS and immediate postbypass PP/PS in patients aged over 24 months and in patients whose QP/QS>2.0, but the effect of CPB would participate in some degree. So it may be necessary to reevaluate their relationship after the effect of CPB have been disappeared.

• Journal of Chest Surgery
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• v.28 no.9
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• pp.857-860
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• 1995

In a 53-year old male with post-infarction ventricular septal defect [VSD , owing to an acute exacerbation of pulmonary edema, respiratory failure developed, and the ventilatory support and intraaortic balloon counterpulsation [IABP were applied. At the following day, operation was performed with the aid of IABP. Under the cardioplumonary bypass, he underwent infarctectomy, trimming of VSD margin, patch closure of VSD and infarctectomy site. Left ventricular free wall rupture was detected during operation, which was confined with pericardial adhesion. Post-operative course was uneventful, and he could be discharged with minimal degree of dyspnea [NYHA class II .

• Journal of Chest Surgery
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• v.15 no.3
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• pp.331-337
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• 1982

Complete TGA is a common congenital cardiovacular anomaly, and without palliative or corrective surgery, the infant born with TGA rarely survives the first year of life. Hemodynamically, recirculated blood flow in the systemic and pulmonary circuit has a key role in systemic arterial oxygen saturation and the status of the pulmonary vascular bed. Recently a d-TGA with VSD and PS, in a 12 year old male patient had been tried for inversion of the ventricular flow with Rastelli operation. An intracardiac tunnel was constructed between the VSD and the aortic orifice to connect the ventricle to the aorta. The right ventricle was connected with the pulmonary circulation by anastomosis of an valved conduit between the right ventricle and the distal end of the pulmonary artery. During the postop, period, the irreversible renal failure, accompanied by metabolic acidosis and pulmonary edema, occured under relative stabilized cardiac performance state. The autopsy was done, which revealed diffuse infarcted area in both kidney and preserved intra & extracardiac graft constructed.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.780-785
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• 1984

We had studied 20 cases of VSD patients whose murmur was sustained after open heart surgery from 1977 to 1984. The postoperative cardiac catheterization was performed on post-op. 20th day. Their ages ranged from 5 to 25 years old. Among them, 4 patients had significant residual shunt which required reoperation. [1 patient; re-op, 3 patient; refused]. Sex ratio was 13:7 in male and female. Associated anomalies were PDA, ASD, Pulmonary stenosis, Mitral insufficiency. Except 1 case, all of them was Kirklin type II VSD. Postoperative complications were I RBBB, residual shunt, cardiac tamponade due to bleeding, wound infection. Preoperative pulmonary artery systolic pressure was highly related to residual shunt in our study. Postoperative LVEDV returned to normal range on the 3rd week.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.765-772
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• 1987

Double-chambered right ventricle [DCRV] as a clinical and anatomic entity was separated from other forms of right ventricle obstruction, and frequently associated with VSD. We experienced surgical treatment of 6 cases of DCRV with VSD. Among them, PDA in a case, PFO in two cases and one case of mild infundibular PS were associated. Preoperative cardiac catheterizations and RV cineangiograms showed about 69 mmHg. of pressure gradient in average between RV inflow and outflow portion, and filling defect by anomalous muscle bundles in the sinus portion of RV. On operation, VSD and other associated anomaly were corrected after resection of anomalous muscle bundle for relief of the obstruction through the vertical RV-tomy site. Postoperative EKG showed complete RBBB, but hemodynamic problems were not developed. Postoperative cardiac catheterizations showed markedly decreased pressure gradient between two chambers, that was about 15 mmHg. in average. Postoperative course was smooth and discharged without any problems.