• Journal of Chest Surgery
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• 제52권1호
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• pp.9-15
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• 2019

Background: Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR. Methods: Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was $32.2{\pm}13.9$ years. The mean follow-up duration was $18.3{\pm}5.8$ years. Results: There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was $13.1{\pm}6.1$ years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively. Conclusion: The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.

• Journal of Chest Surgery
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• 제55권5호
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• pp.413-416
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• 2022

A 32-year-old woman diagnosed with Turner syndrome presented to the hospital for an evaluation of cardiovascular complications. Preoperative computed tomography (CT) and echocardiography showed progression of aortic root and ascending aorta dilatation, as well as a bicuspid aortic valve. There was no evidence of aortic regurgitation. We planned valve-sparing aortic root replacement and ascending aorta replacement with a high risk of aortic rupture. Intraoperatively, we incidentally found a juxtacommissural origin of the right coronary artery (RCA). We performed aortic valve reimplantation using a graft designed with a key-shaped hole to wrap the juxtacommissural-origin RCA by modifying the Florida sleeve technique. Coronary blood flow was patent on postoperative CT angiography, and there was no evidence of aortic regurgitation on postoperative echocardiography. The patient was discharged from the hospital on postoperative day 7 without any complications.

• Journal of Chest Surgery
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• 제21권3호
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• pp.588-593
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• 1988

We experienced a case of interrupted aortic arch[Type A] associated with PDA, VSD, mitral regurgitation and single coronary artery. The patient was 7 years old boy, who showed congestive heart failure[NYHA functional class III]. One stage total correction was performed under profound hypothermia with total circulatory arrest. Aortic continuity was established using PDA with anterior wall of main pulmonary artery flap. VSD was closed with Dacron patch and mitral regurgitation repaired by Reed`s annuloplasty method. The postoperative cardiac catheterization revealed no pressure gradient between ascending aorta and descending aorta, decreased pulmonary artery pressure and trivial residual shunt[Qp/Qs: 1.28]. The aortogram showed good continuity of the aorta without narrowing of the anastomotic site. During the period of 1 year follow up, heart failure symptoms were nearly subsided.

• Journal of Chest Surgery
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• 제35권2호
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• pp.137-140
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• 2002

선천성 심기형 환아들의 장기생존이 향상되면서 소아연령에서의 대동맥판막의 문제는 드물지 않게 경험하게 되며 또한 점차 증가하고 있다. 따라서 소아연령에서도 대동맥판막수술의 필요성이 점차 증가하고 있다. 과거 심장외측통로폰탄술식을 받은 10세 환아가 점차 심해지는 청색증과 운동시 호흡곤란으로 내원하였다. 술전 시행한 심초음파 및 심도자검사에서 간내 측부순환에 의해 간정맥에서 폐 심방으로 체정맥혈류가 유입되고 있었으며 방실판막은 중등도의, 상행대동맥의 확장 및 대동맥륜의 확장으로 인한 대동맥판막의 심한 폐쇄부전을 동반하고 있었다. 수술은 먼저 폐 심방으로 연결되는 간정맥을 결찰하고 체외순환을 가동하고 심정지를 시킨 후 상행대동맥의 축소성형 및 대동맥등 축소화를 포함한 대동맥근 재건술및 방실판막에 대한 성형술을 시행하였다. 술후 환아의 호흡곤란 및 청색증은 상당히 개선되었다.

• Journal of Chest Surgery
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• 제42권6호
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• pp.777-780
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• 2009

교련부 분리는 대동맥판막 탈출증에 의한 대동맥판 역류를 일으키는 매우 드문 질환이다. 판막엽의 손상 없이 교련부 분리(avulsion of commissure)에 의해 발생한 중증 대동맥판 역류 2예를 치험하여 보고하고자 한다. 첫 번째 증례에서 교련부 분리에 의한 중증 대동맥판 역류에 대해 5-0 polypropylene으로 연속 봉합하여 교련부 재부착을 통한 성형술을 시행하였다. 수술 소견에서 판막엽은 정상 이었으나 우관상동맥판과 무관상동맥판 사이의 교련부 분리에 의한 중증 역류가 관찰되었다. 수술 후 특별한 문제 없이 회복하던 환자는 대동맥판 역류의 재발이 관찰되어, 술 후 14일째에 재수술을 시행하였고, 재부착을 시행했던 교련부위가 완전히 재분리 되어 있어, 판막 치환술을 시행하였다. 두 번째 증례도 우관상동맥판과 무관상동맥판 사이의 교련부 분리가 관찰되었으며 판막엽은 정상소견이었다. Pledget으로 보강한 5-0 polypropylene을 이용한 다수의 수평매트리스봉합으로 교련부 재부착을 시도하였으나 판막의 교합이 완벽하지 않아 조직판막으로 치환술을 시행하였다.

• Journal of Yeungnam Medical Science
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• 제6권1호
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• pp.179-184
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• 1989

본원에서는 Marfan씨증후군과 대동맥류, 대동맥판 역류로 진단받은 환자가 1년후 흉통을 주소로 내원하여 대동맥 박리로 이행한 것으로 밝혀져 응급수술을 성공적으로 치룬 1례를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제51권1호
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• pp.61-63
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• 2018

We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.

• Journal of Chest Surgery
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• 제32권6호
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• pp.591-594
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• 1999

대동맥판상부 협착증은 발살바동 상부에서부터 협착이 존재하는 비교적 흔치않은 선천성 질환이다. William 증후군없이 선천적으로 대동맥판 상부 협착증과 대동맥 좌관상판엽의 형성부전으로 인한 대동맥판 폐쇄부전증으로 진단받은 39세 여자환 悶“\ulcorner대동맥판막 치환술 및 Vascutek graft를 이용한 판탈롱 대동맥성형술을 시행 하였다. 환자의 술후경과는 좋았고 술후 9일째 퇴원하였다.

• Clinical and Experimental Pediatrics
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• 제55권7호
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• pp.254-258
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• 2012

Takayasu arteritis is a chronic inflammatory disease of unknown etiology primarily affecting the aorta and its major branches and usually occurring in the second or third decade of life. Here, we report a case of Takayasu arteritis in a 10-month-old patient. The infant presented with signs of congestive heart failure and severe aortic regurgitation. Echocardiography and computed tomography angiography showed an abnormally dilated thoracic and abdominal aorta. The infant was initially treated with prednisolone, followed by commissuroplasty of the aortic valve but neither approach ameliorated the heart failure. The patient was eventually treated with a mechanical aortic valve replacement surgery at the age of 12 months, and her condition stabilized. Although unusual, this case indicates that the diagnosis of Takayasu arteritis should be considered in children with unexplained systemic symptoms, aortic valve regurgitation, and heart failure. Because severe aortic regurgitation may be a fatal complication of Takayasu arteritis, early aortic valve replacement surgery should be considered, even in very young children.

• Journal of Chest Surgery
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• 제30권2호
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• pp.200-204
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• 1997

본 증례는 고유 대동맥 판막, 승모판막, 삼첨판막과 심실중격을 침 범한 심내막염환자의 성공적 치료에 대한 보고이다. 환자는 11세때 심실중격결손폐쇄와 대동맥판막성형술을 받은 16세 남아로서 심내막염으로 항생제치료에도 불구하고 난치성 심부전을 보였다. 수술소견상 이전 수술시 폐쇄한 심실중격폐쇄를 따라 커다란 결손을 보였으며 다발성 천공과 우종을 동반한 대동맥 판막역류, 우종을 동반한 승모판 역류, 대동맥 판륜주위농양, 심실중격의 심근농양, 천공과 우종을 동반한 삼첨 판역류 소견을 보였다. 수술은 모든 감염조직과 괴사조직을 근치적절제후 심실중격결손을 Dacron patch로 폐쇄하면서 대동맥판막륜부위까지 확장보강하였으며, 대동맥판막치환시 확장보강한 Patch에 인공판막을 거치시켜 안전하게 치환할 수 있었다. 승모판막은 치환하였고, 삼첨 판은 자가심낭편으로 재건하였다. 환자는 수술후 6주간 항생제치료후 다른 합병증 없이 건강한 상태로 퇴원하였다.