• Journal of Chest Surgery
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• 제33권2호
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• pp.193-194
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• 2000

A 45-year-old woman was diagnosed as having chylothorax after a mitral valve replacement for mitral stenosis. direct injury of lymphatics in thymus a ramification of thoracic duct was presumed to be responsibe for this complication. Four weeks of conservative treatment failed and surgical treatment was performed, We report a case of surgical treatment for chlyothorax after and open heart surgery.

• Journal of Cardiovascular Imaging
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• 제31권4호
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• pp.191-199
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• 2023

BACKGROUND: Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS: We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS: A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS: Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.

• Journal of Chest Surgery
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• 제50권6호
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• pp.467-470
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• 2017

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova S OLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

• Journal of Chest Surgery
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• 제12권4호
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• pp.339-345
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• 1979

Mitral valve disease is the most common disease of the acquired heart diseases, and atrial septal defect is also one of common congenital heart diseases. Coexistence of these two lesions is rare, but of great hemodynamic interest. Among 443 cases with mitral valve disease and 90 cases with atrial septal defect experienced in the Department of Thoracic Surgery, Seoul National University Hospital, there were 6 cases with atrial septal defect complicated by mitral valve disease. 1. Of the 6 patients, four were female and two were male. The age was ranged from 18 to 46. 2. Atrial septal defect was ostium secundum type in all cases, and the mitral valvular lesions were regurgitation in four and stenosis in two. Type II ventricular septal defect was also combined in one of the cases. 3. The atrial septal defect was corrected by, primary closure and the mitral valve was replaced with the prosthetic or bioprosthetic valve in all cases. The combined ventricular septal defect was closed using Teflon felt patch. 4. The operative result was good except in one who was expired of bacterial endocarditis 4 months after hospital discharge.

• Journal of Chest Surgery
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• 제30권9호
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• pp.862-868
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• 1997

서울대학교병원 흉부외과에서는 1985년부터 1994년까지 총 9례의 숀 증후군 환자를 치험하였다. 남자 환 아가 떼이었고 여자 환아가 1례이었다. 첫 수술을 시행한 연령은 깨월에서 11세까지로 평균 연령은 33.0 $\pm$ 31.0 개월이었다. 선천성 승모판 협착증 및 대동맥 축착증은 모든 환아에서 존재하였고 승모판 상부 링 및 대동맥하 협착은 각각 4례의 환아에서 발견되었다. 2례의 환아에 있어서는 숀 증후군의 4가지 병변 모두를 가지고 있었다. 3례의 환아에 있어서는 한번에 완전 해부학적 교정술을 시행하였으며 나머지 2례의 환아에 있어서는 개흉술 하에 대동맥 축착증을 교정하고 나중에 정중 흉골 절개 하에 나머지 병변을 교정하는 단계적 수술을 시행하였다. 9례의 환아에 있어서 총 45개의 수술적 치료를 시행하여 1례당 평균 수술적 치료 는 5.0 $\pm$ 0.7개이었다 세번째 수술을 시행한 환아는 2례이었으며 각각 지속적인 승모판 협착으로 승모판 치 환술을 시행한 환아와 지속적인 대동맥 축착으로 대동맥 축착 성형술을 시행한 환아이었다. 한번에 완전 교정술을 시행한 환아와 1차 단계적 수술을 시행한 환아에 있어서 수술 사망률은 없었으나 2차 단계 \ulcorner수술을 시행한 6례중 2례가 사망하여 수술 사망률은 22.2%이었으며 사망한 2례 모두 1차 대동칵 축착증 교정술후 계속되는 심부전 및 인공 호흡기 이탈이 되지 않아 각각 1차 수술 후 9일과 15일 후에 완전 교정술을 시행했던 환아들로 모두 좌심실 형성부전에 의한 심부전으로 사망하였다. 세번째 수술시 사망한 환아는 없었다. 생존한 7례 모두 11개월에서 12년까지(평균 6.7 $\pm$ 3.6년)장기 추적 조사하였으며 모두 뉴욕 심장 협회 활 동도 1군에 속해 있었으며 판막 치환술로 인하여 쿠마딘을 복용하고 있는 환아와 마지막 추적조사시 흉부 X선 사진상 약간의 심비대가 있어 디곡신을 복용하고 있는 환아를 제외하고는 어떤 약도 복용하고 있지 않았 다 결론적으로 숀 증후군은 수술 사망률 및 이환율이 높은 질환이긴 하나 각각의 해부학적 병변의 특징을 잘 파악하여 적절한 치료를 한다면 좋은 장기성적을 기대할 수 있다는 것이다.

• Journal of Chest Surgery
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• 제13권4호
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• pp.405-413
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• 1980

A total of 63 patients [42 males and 21 females] underwent multiple valve replacement with artificial valves between January 1975 and August 1980 at Seoul National University Hospital. There were 38 patients with aortic and mitral valve replacement, 22 with mitral and tricuspid, and 3 with aortic, mitral and tricuspid valve replacement. The valve lesions varied from trivial to severe and most aortic and mitral valves had mixed stenosis and insufficiency, while tricuspid valves had only insufficiency. The patients were severely symptomatic in majority of the cases, and belonged to the Classes III and IV [III:45, IV:16] of the NYHA functional criteria. Hemodynamic studies were performed on all the patients. The mean pulmonary wedge pressure was remarkably increased to 19.8 mmHg in aortic and mitral valve lesions and 18.0 mmHg in mitral and tricuspid valve lesions. The mean pulmonary arterial pressure was also increased, while the cardiac index was reduced. In 1977, the average perfusion time was 245.5 minutes for aortic and mitral valve replacement and 181.6 minutes for mitral and tricuspid valve replacement. It has progressively declined to 169.2 minutes for aortic and mitral valve replacement and 123 minutes for mitral and tricuspid valve replacement in 1980. The average period of aortic occlusion also declined after the use of cardioplegic solution. Twenty deaths occurred among the 63 patients operated upon, an overall mortality rate of 30.8%. The operative mortality has declined with successive year from a level of 66.7% before 1977 to 21.1% in 1980. Fourteen patients suffered from a list of postoperative complications, which eventually resolved with adequate treatment. All the survivors were enjoying the levels of daily life activities greater than those existing before the operation.

• 대한수의학회지
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• 제56권4호
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• pp.261-264
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• 2016

A nine-month-old Pomeranian dog with exercise intolerance and syncope was presented. The dog was depressed with grade 4 systolic murmur on cardiac auscultation. Based on cardiac examination, the dog was diagnosed with severe subaortic stenosis with involvement of the anterior mitral valve. ${\beta}-blocker$ administration was initiated and clinical signs were improved, but not fully resolved. Balloon valvuloplasty was performed and the dog survived for nearly one year without clinical sign and the cardiac troponin I level was normalized. This case describes successful management of severe subaortic stenosis in a small breed dog through balloon valvuloplasty.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1095-1101
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• 1996

1983년 7월부터 1995년 6월까지 전북대학교병원 흉부외과학 교실에서 승모판협착증으로 수술을 시행한 판막치환술 62예와 교련절개술 33예를 패상으로 하였다. 대동맥 판막이나 관상동맥 질환을 동반하거나 중등도 이상의 승모판 폐쇄부전증이 동반된 경우는 본 연구에서 제외하였으며 승모판 협착증에 대한 술식들을 합병증과 재수술, 사망율, 수술후 기능적인 변화에 따라 비교 분석 하였다. 수술전 대상환자의 특성 중 승모판 치환술군에서 심흉곽비가높았던 점 이외에 나이나 성별, NYHA 기능분류, 심전도상 심방세동의 유무, 심초음파 소견에서 두군 간에 의의 있는 차이는 없었다. 수술시 판막 병변의 병리학적 소견은 치환술군에서 더 심하였고(Sellors type IR, 35 in MVR, 1) in OMC 3 판엽의 석회화를 보이는 경우도 많았으나(35 in MVR, 11 in OMC), 판엽의 석 회화가 있었던 46 예 중 11예(23.9%)와 Sellor의 제3형 협착 61예 중 13예(27.1 %)에서 교련절개 술이 가능하였다. 수술후 조기 및 만기사망과 생존율에서 두군 간에 차이는 없었고, 출혈 및 혈전색전증과관련된 조기 및 만기 합병증이 치환술군에서 더 많았으며, 수술후 중장기 추적관찰시 N HA기능분류, EKG, 심흉 곽비, 심초음파 소견(EF, LAD, LWDs, LWDd) 등의 기능상의 변화에서는 두군간에 의의있는 차이를 발견할 수 없었다. 승모판 헙착증의 상호 보완적인 주요술식인 치환술과 교련절개술은 술식에 따른 기능상의 변화와 사망 및 생존율에 의의있는 차이는 없으나 출혈 및 혈전색전증과 관련된 합병증이 치환술군에서 많았고 고도의 협착 및 판막석회화가 존재하는 상황에서도 교련절개술이 가능하였으므로 자연판막의 보전을 위한 노력은 지속되어야 한다.

• Journal of Chest Surgery
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• 제21권1호
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• pp.1-9
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• 1988

The left atrial [LA] dimension and atrial fibrillation [AF] in patients with mitral valvular heart diseases have been thought to be related to hemodynamic burden to the LA depending on severity of stenosis or regurgitation of mitral valve, left ventricular contractility and the heart conditions. If hemodynamic burden persists long, it can affect the LA wall and structural change of the LA wall itself can developed. So the structural change of the LA wall could be thought to be related to the LA dimension and AF. To verify this relation, the LA wall biopsy was performed in 26 patients with rheumatic mitral valvular heart disease at the left atriotomy incision margin which was posterior to the interatrial groove after completion of surgery to the mitral valve such as valve replacement or commissurotomy. Relation of the pathological state of the LA wall to AF and the LA dimension measured by M-mode echocardiography was studied. The conclusions were as follow. 1. There was tendency that degree of fibrosis of myocardium of the LA wall was related to the LA dimension. 2. There was more chance that patients who had severe fibrosis of myocardium of the LA wall had pre and postoperative AF. 3. There was no relation between reduction rate of the LA dimension before and after surgery and degree of fibrosis of myocardium of the LA wall.

• Journal of Chest Surgery
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• 제27권8호
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• pp.656-663
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• 1994

Evaluation of heart function is of importance in assessing the results of valvular heart surgery. Information on volume and functional change of heart chamber can be obtained by cardiac catheterization and echocardiography. We studied 41 patients with mitral stenosis[MS] and 23 patients with mitral regurgitation[MR] using M-mode echocardiography before and after mitral valve replacement[MVR] at Pusan Paik Hospital. Preoperative cardiac catheterization was available in 56 cases, and the results were obtained as follows. 1. In patients with MS, preoperative average LV end-diastolic dimension[EDD] and end-systolic dimension[ESD] were remained within normal range, but postoperative EDD and ESD were significantly decreased[P<0.01]. The preoperative and postoperative LV ejection fraction[EF] were remained within the normal range and no significant change[P>0.05]. The preoperative left atrial dimension[LAD] was enlarged considerably above normal[P<0.01], but was significantly decreased after surgery[P<0.001]. The preoperative LV posterior wall thickness[PWTh] was within normal range, and no significant change after surgery[P>0.05]. 2. In patients with MR, preoperative average end-diastolic dimension[EDD] and end-systolic dimension[ESD] were significantly greater than normal[P<005], but postoperative EDD and ESD were significantly decreased[P<0.01]. The preoperative LV ejection fraction[EF] and fractional shortening[FS] were within normal range, and no significant change after surgery[P>0.05].The preoperative left atrial dimension[LAD] was enlarged considerably above normal [P<0.01], but was significantly decreased after surgery[P<0.001].The preoperative LV posterior wall thickness[PWTh] was within normal range, and no significant change after surgery[P>0.05].