• Journal of Chest Surgery
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• v.36 no.9
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• pp.646-650
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• 2003

Many surgical techniques for ischemic mitral regurgitation (IMR) have been used with their excellent results and advantages. Here, we report our simple posterior annuloplasty techniques using vascular graft strip with their early results. Material and Method: Twenty two patients (13 male) underwent the operations for IMR (excluding the papillary muscle rupture) from December 2001 to January 2003. Preoperative risk factors were low ejection fraction (<35％, n=9), hypertension (n=13), diabetes (n=9), and renal failure (Cr>2.5, n=4). The wide dissection beneath the both vena cavae and interatrial groove after bicaval cannulation enabled the easy exposure of mitral valve even in the small left atrium. After eight or nine interrupted sutures in posterior annulus for anchoring the 6 mm width vascular graft strip, symmetric (n=8) or asymmetric (n=14) annuloplasty were done. Combined surgeries were CABG (n=21), Dor procedures (n=3), tricuspid valve annuloplasty (n=1), Maze operation (n=1), and aorto-right subclavian artery bypass (n=1). Result: Except for one surgical mortality, all the patients were doing well and the mean grade of regurgitation was decreased from 2.95 to 0.88, however the ejection fraction had not changed significantly just before discharge. Post-operative valve function evaluated before discharge revealed no residual regurgitation in 8 (including 1 patient with mild stenosis due to over reduction), minimal in 11, mild in 2, and mild to moderate regurgitation in 1. One patient who had ischemic cardiomyopathy and renal failure died of the arrhythmia during the hemodialysis. Conclusion: These observations suggest that the annuloplasty with vascular graft strip could be a safe and cost effective techniques for ischemic mitral regurgitation. However, the long term evaluation for the mitral valve function should be defined for the final conclusion.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.139-146
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• 1983

Between 1974 and 1982, 31 patients from 7 to 15 years of age have undergone valve replacement for their acuqired cardiac valvular diseases at Seoul National University Hospital. Furteen patients (45.2%) had a definite history of rheumatic fever and only 4 patients (12.9%) had atrial fibrillation on their preoperative electrocardiograms. Characteristically, the valvular lesions were ones of insufficiency with or without associated stenosis in all patients except only one whose mitral valve was tightly stenotic. Thrity-seven valves were replaced in 31 patietns including a case of successful replacement of his failed xenogragt mitral valve : 4 mechanical valves were used in 3 patients and 33 xenograft valves were used in the remaining 28 patients. The size of the valves were not the major problem at the time of opertion because most of the patients had a dilated heart from disease. There were 3 diaths within 30 days of surgery (9.7% operative mortality rate) and 3 late deaths (9.7% late mortality rate) with an overall mortality rate of 19.4%. Twenty-eight early survivors were followed up for a total of 488 patient-months. Thromboembolic complications occurred in 5 patients with 2 deaths: cmbolic rate of 17.9% or the actuarial embolic incidence of 12.29%/patients-year. four xenograft tissue valves in 4 patients had failed during the period from 19 to 41 months of surgery with an overall valve failure rate of xenograft of 14.3% or the actuarial incidence of 9.84% failure/patient-year. One of these 4 patients had required replacement of his failed mitral xenograft valve which had severe calcification and tissue disruption with primary tissue failure rate of 3.6% or the actuarial incidence of 3.13% failure/patient-year. The actuarial survial including the operative morality was 50.0% at 5 years of surgery. /the actuarial incidence free from thromboembolism in bioprosthetic group was 85.4% at 42 months, while it was 33.4% in mechanicial group at 60 months after operation. The actuarial incidence free from overall valve failur of 100.0% until 18 months after surgery was followed by a rapid decrease during the next 2-year period, and it was only 17.8% at the follow-up end of 42 months after surgery. It was suggested that the major advantage of low thrombogenecity with xenograft valve should be balanced against the high incidence of accelerated valve failure when it is used in children whose age is younger than 15 years old. The possible role of recurrent rheumatic attacks to the early failure of xenograft tissue valve was also discussed.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.106-111
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• 1987

Twenty eight patients with atrial septal defect operated on from May, 1983, to July, 1986 at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, were analyzed retrospectively. Among the 28 patients of atrial septal defect, 8 were male and 20 were female. Their ages ranged from 4.6 years to 52.5 years old with the mean of 15.3 years. The main clinical symptoms on admission were exertional dyspnea [82%], frequent respiratory infection [75%], palpitation [54%] and easy fatigability [25%]. Electrocardiographic findings were as follows: Regular sinus rhythm [100%], RVH [54%], RBBB [25%] and first degree of A-V block [4%]. Hemodynamic studies were performed in all cases and mean pulmonary systolic arterial pressure was 34.1*11.8mmHg. and mean Qp/Qs was 2.6*0.9. All 28 patients were operated under direct vision using extracorporeal circulation. 23 cases were secundum type defect and a single hole was found in 22 cases. The associated cardiovascular anomalies were found in 11 patients: ventricular septal defect in 3, patent ductus arteriosus in 1, partial anomalous pulmonary venous drainage in 2, mitral regurgitation in 2, tricuspid regurgitation in 1, anomalous left atrial septation in 1 and valvular pulmonary stenosis in 1. The defect closed directly in 22 cases and with patches in 6 cases. Postoperative complications were wound infection, arrhythmia bleeding, intracardiac patch detachment, pneumothorax and urethral injury. But there was no operative mortality.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.604-608
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• 1993

Coarctation of aorta is rather common congenital cardiovascular disease in the western contries, but it is known to be less than 2 % in Korea. From June 1986 to December 1992, seven patients of surgically treated coarctation of aorta who were less than 2 years old, were experienced at Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. The patients included six male and one female, with ages in the range of one month and 24 months. Four patients were preductal type and three juxtaductal. Associated cardiac anomalies were present in all patients and they were PDA[6 cases], ASD[3], VSD[2], bicuspid aortic valve[2], aortic stenosis[1], mitral regurgitation[1], and tricuspid regurgitation[1]. The operative procedures were four end to end anastomosis and three subclavian flap aortoplasty. Mean aortic cross clamping times were 37.3 minutes in patients with end to end anastomosis and 30.3 minutes in patients with subclavian flap aortoplasty. There were two operative deaths in patients who were treated with subclavian flap aortoplasty and pulmonary artery banding. One patient who had been treated with subclavian flap aortoplasty was complicated with postoperative mild paraplegia in lower limb. Pulmonary artery banding has been disappointing in our patients, and the data was suggestive that earlier total repair of complicated coarctation might improve survival.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.59-66
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• 1989

Coarctation of aorta, a well known congenital cardiovascular defect, can be recognized in the most instances by simple finding of physical examination. This condition shortens life if untreated, but it can be corrected surgically to render the patient functionally normal. It seems relatively rare in Asian. During Six-Year period from January, 1982 through June, 1988, twenty four consecutive operations for the coarctation of the aorta were performed at Yonsei Medical Center. The patients included 14 males and 10 females in the range, 2 months and 34 years old. Associated Cardiac anomalies were patient ductus arteriosus, ventricular septal defect, mitral valve regurgitation, aortic stenosis, double outlet right ventricle, corrected transposition of great vessel, etc. The preoperative main symptoms were frequent URI and dyspnea. Congestive heart failure was the most common symptom at the group younger than 2 year olds. Operative techniques for the coarctation of the aorta were prosthetic patch aortoplasty in 18 patients, resection & vascular graft interposition in 4, resection and end to-end anastomosis in 2. There was no operative death. Four patients had persistent or paradoxical hypertension, and one had postoperative paraplegia.

• 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.35 no.6
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• pp.475-478
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• 2002

A 45 year old man was admitted for aggravated dyspnea, abdominal distension and poor oral intake. On Echocardiogram, mitral stenosis(severe), tricuspid regurgitaion(IV), and LA thrombus were diagnosed. We used heparin with continuous infusion for prevention of systemic thrombo embolism. On the 11th day of admission, the patient showed thrombocytopenia and we suspected Heparin-induced thrombocytopenia. Hirudin was used in this case as alternative anticoagulant during cardiopulmonary bypass to prevent serious complication of heparin. The patient was recovered without any complication as postoperative bleeding or systemic thromboembolism.

• Tuberculosis and Respiratory Diseases
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• v.41 no.1
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• pp.1-10
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• 1994

Background: Patients with mitral stenosis(MS) have been demonstrated to have a variable degree of pulmonary dysfunction and exercise impairment. The hemodynamic changes of MS can be reversed after percutaneous mitral balloon valvuloplasty(PMV), but the extent and time course of the imporvement in pulmonary function and exercise capacity are not defined. Methods: In order to investigate the early(3 weeks or less)and late(3 months or more) effects of PMV on pulmonary function and determine if the pulmonary dysfunction is reversible even in patients with moderate to severe pulmonary hypertension, we performed the spirometry, measurements of diffusing capacity and lung volumes, and incremental exercise tests in patients with MS before and after PMV. Results: In 46 patients with MS(age: $40{\pm}12$years, male to female ratio: 1:2, mitral valve area: $0.8{\pm}0.2cm^2$) there was a significant increase in FVC(P<0.0025), $FEV_1$(P<0.001), $FEF_{25-75%}$(P<0.001, $FEF_{50%}$(P<0.001), PEF(P<0.0005), MVV(P<0.005), $\dot{V}O_2$max (P<0.0001), and AT(P<0.0001) after average 10 days of PMV. Also there was a significant decrease in DLco(P<0.0001) and DL/VA(P<0.0001). At later($5{\pm}2$months) follow-up in 11 patients, there was no further improvement in any parameters of pulmonary function and exercise test. Twenty nine patients with sinus rhythm were divided into 16 patients with pulmonary arterial pressure(PAP) more than 35mmHg and/or tricuspid regurgitation grade n or more(group A) and 13 patients with PAP less than 35mmHg(group B). Group A Patients had significantly lower FVC(P<0.001), $FEV_1$(P<0.001), DLco(P<0.05), $\dot{V}O_2$ max(P<0.025) and mitral valve area(P<0.025) than group B patients. Group A patients after PMV, showed significant increase in FVC(P<0.001), maximum $O_2$ pulse(P<0.00001) and $\dot{V}O_2$ max(P<0.00025). Both group showed an increase in AT(P<0.0001, P<0.005), but group A showed greater decrease in $\dot{V}E/\dot{V}O_2$ and $\dot{V}E/\dot{V}CO_2$ both at AT(P<0.001, P<0.001) and $\dot{V}O_2$ max(P<0.0001, P<0.0001) after PMV compared with group B. Conclusion: These data suggest that patients with MS can show increased pulmonary function and exercise performance within 1 month after PMV. Patients with moderate to severe pulmonary hypertension had a significant increase in exercise performance compared with those with mild to no pulmonary hypertension and it is thought to be related to a significat decrease of ventilation for a given oxygen consumption at maximum exercise.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.275-280
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• 2006

Background: Aortopulmonary window (APW) is a very rare congenital heart anomaly, often associated with other cardiac anomalies. It causes a significant systemic to pulmonary artery shunt, which requires early surgical correction. Accurate diagnosis and surgical correction will bring good outcomes. The purpose of this study was to describe our 20-year experience of aortopulmonary window. Material and Method: Between March 1985 and January 2005, 16 patients with APW underwent surgical repair. Mean age at operation was $157.8{\pm}245.3$ ($15.0{\sim}994.0$) days and mean weight was $4.8{\pm}2.5$ ($1.7{\sim}10.7$) kg. Patent ductus arteriosus (8), atrial septal defect (7), interruptedaortic arch (5), ventricular septal defect (4), patent foramen ovate (3), tricuspid valve regurgitation (3), mitral valve regurgitation (2), aortic valve regurgitation (1), coarctation of aorta (1), left superior vena cavae (1), and dextrocardia (1) were associated. Repair methods included 1) division of the APW with primary closure or patch closure of aorta and pulmonary artery primary closure or patch closure (11) and 2) intra-arterial patch closure (3). 3) Division of the window and descending aorta to APW anastomosis (2) in the patients with interrupted aortic arch or coarctation. Result: There was one death. The patient had 2.5 cm long severe tracheal stenosis from carina with tracheal bronchus supplying right upper lobe. The patient died at 5th post operative day due to massive tracheal bleeding. Patients with complex aortopulmonary window had longer intensive care unit and hospital stay and showed more morbidities and higher reoperation rates. 5 patients had reoperations due to left pulmonary artery stenosis (4), right pulmonary artery stenosis (2), and main pulmonary artery stenosis (1). The mean follow-up period was $6.8{\pm}5.6$ (57.0 days$\sim$16.7 years)years and all patients belonged to NYHA class 1. Conclusion: With early and prompt correction of APW, excellent surgical outcome can be expected. However, optimal surgical method needs to be established to decrease the rate of stenosis of pulmonary arteries.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.317-323
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• 2009

Background: Although high efficiency of conversion into sinus rhythm has been demonstrated after performing the Cox-Maze procedure in patients with atrial fibrillation associated with mitral valve disease, the changes in the mechanical function and size of the left atrium have not been determined. The aim of the study was to evaluate the effect of the Maze procedure on the left atrial size and contractile transport function. Material and Method: From July 1997 to July 2008, 647 consecutive patients were operated on for chronic atrial fibrillation associated with mitral valve disease. Among these, 211 patients that (1) were able to be followed up for 2 years after surgery, (2) had sustained normal sinus rhythm, regardless of whether they were taking anti-arrhythmic medications and (3) did not have valvular regurgitation greater than grade III or they did not have moderate grade valvular stenosis were selected for evaluation. The left atrial size and contractile transport function were assessed by transthoracic echocardiography at the postoperative base line (1 year) and at regular follow-up periods (2 years, 3 years, 4 years and 6 year). Result: The left atrial dimension was increased and the contractile transport function was decreased during the follow-up period. The longer the follow-up period, the greater was the statistical significance of the left atrial size increase and contractile transport function decrease. Conclusion: In patients who sustain normal sinus rhythm conversion after a Maze III procedure with a mitral valve operation, there is a gradual increase of the left atrial dimensions and a decrease of contractile transport function during the follow-up period. Therefore, scrupulous follow-up is needed for these patients.