• Journal of Chest Surgery
• /
• v.23 no.2
• /
• pp.245-252
• /
• 1990

To see the change of pulmonary arterial pressure after mitral valve replacement, postoperative cardiac catheterization and echocardiographies were performed in 12 patients of mitral valvular disease with pulmonary hypertension[systolic pulmonary arterial pressure>50 mm Hg]. The mean follow-up duration was 35.4[range: 15-47] months per patient. The following results were obtained. 1] Preoperative systolic pulmonary arterial pressure value of 66.17\ulcorner10.73mmHg decreased significantly to 29.17\ulcorner6.86mmHg postoperatively[p<0.01]. 2] Preoperative Pp/Ps value of 0.67\ulcorner0.13 decreased significantly to 0.28\ulcorner0.06 postoperatively[p<0.01]. 3] Preoperative PAWP value of 29.00\ulcorner4.02mmHg decreased significantly to 9.92\ulcorner4.27 mmHg postoperatively[p<0.01]. 4] Preoperative LAD value of 5.58\ulcorner1.20cm decreased significantly to 4.37\ulcorner0.67cm postoperatively [p<0.01]. In conclusion, pulmonary arterial hypertension secondary to mitral valvular disease could be reduced to normal range after successful mitral valve replacement.

• Journal of Chest Surgery
• /
• v.20 no.1
• /
• pp.92-100
• /
• 1987

On rare occasions, the left atrium may become extremely large in the mitral valvular disease, showing giant left atrium. The giant left atrium frequently produce compressing effects to the adjacent organs, resulting in the postoperative problems with regard to the hemodynamic and respiratory management. We experienced 13 patients with giant left atrium combined with mitral valvular disease from Oct. 1980 through June 1986. Eleven cases underwent mitral valve replacement with left atrial plication and the other 2 cases were underwent mitral valve replacement without left atrial plication. The follow-up period was 19.3 months in average. There were remarkable postoperative improvements in the chest roentgenogram, echocardiogram, lung function test, NYHA functional class in patients who underwent plication procedure. The postoperative mortality was 9% in plication cases and 50% in non-plication cases.

• Journal of Chest Surgery
• /
• v.22 no.6
• /
• pp.951-959
• /
• 1989

Between September, 1972 and September, 1989, total 359 patients were operated for acquired heart disease at Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital. A consecutive series of 293 prosthetic valve replacement was also performed during this period. The results were summarized as follows; 1. There were 141 men and 218 women, whose ages ranged from 6 to 64 years, [mean 35.5 years] 2. Out of 293 cases, mitral valve replacement was 182 cases, aortic valve replacement was 39 cases and double valve replacement was70 cases. 3. Early post-operative death was 30 cases [Mortality; 8.4 %] and late death was 9 cases in the survivors. 4. Re-operation was 30 cases and operative mortality was 10%. 5. Mean post-operative interval was 76 months. [Ranged from 216 months to 2 months] 6. Among re-operation cases, primary prosthetic valve failure was 16 cases and paravalvular leakage was 2 cases. 7. Since January 1988, 79 cases of prosthetic valve replacement were performed and then 1 case was expired. [Mortality; 1.2 %]

• Journal of Chest Surgery
• /
• v.21 no.2
• /
• pp.351-365
• /
• 1988

During one year[1987], 110 cases of open heart surgeries were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, Inje Medical College. And the results were summarized as follows. 1. Among the 110 cases, there were 77 cases of congenital heart diseases and 33 cases of acquired heart diseases. Age range of the congenital patients was 8 months to 30 years with the mean age of 8 years, and acquired patients was 16 to 56 years with the mean age was 32 years. 2. The heart lung machine used for cardiopulmonary bypass was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 50 of membrane type and 60 of bubble type. For all cases GIK[glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 3. Among the 77 congenital anomalies, there were 67 cases of acyanotic patients[ASD: 12, VSD: 50, PS: 1, AP window: 1, Gerbode defect: 1, ECD: 2] and 10 cases of cyanotic patients[TOF: 10], and to all of which the appropriate radical operations were applied. 4. Among the 33 acquired diseases, there were one case of left atrial myxoma, one of annuloaortic ectasia, 20 of mitral valve diseases[MS: 2, MSr: 8, MR: 2, MRs: 8], 9 of double valve diseases[MRs+AR: 1, MRs+ARs: 2, MRs+TR: 1, MSr+TR: 3, MSr+ASr: 1, MSr+ARs: 1], 2 of triple valve diseases[MSr+AR+TR: 1, MSr+ASr+TR: 1]. The left atrial myxoma was removed well with right atriotomy and atrial septal approach. And to the annuloaortic ectasia, Bentall operation was applied with good result. Mitral valve replacement[MVR] was applied to 20 cases of mitral valve diseases, double valve replacement[MVR+AVR] was applied to 6 cases of double valve diseases, MVR & tricuspid annuloplasty[TVA] was applied to 3 cases of mitral 5. The number of replaced valve were 39 in 31 cases. In MVR, 5 of mechanical valves[St. Jude Medical Valve] and 26 of tissue valves[Carpentier-Edward valve] were used. In AVR, 3 of mechanical valves and 5 of tissue valves were used. 6. Postoperative complications were occurred in 23 cases, and among them 21 cases were recovered with intensive cares, but 2 cases were expired[mortality: 1.8%].

• Journal of Chest Surgery
• /
• v.20 no.2
• /
• pp.223-229
• /
• 1987

Doppler echocardiography provides valuable information regarding prosthetic heart valve function rather than structure. There are three methods of expressing the severity of mitral valve obstruction: the transvalvular pressure gradient, effective valve area, and pressure half-time. Of these, the transvalvular pressure gradient [~p] can be determined by the measurement of maximum transvalvular blood flow velocity [V] according to the modified Bernoulli`s equation [gp=4V*]. Eleven patients, who underwent mitral valve replacement with Duromedics mechanical prostheses, and 17 normal persons were investigated. There were significantly higher calculated pressure gradients in prosthetic than normal mitral valves [9.*10*2.22mmHg-vs-3.26*0.99mmHg:p<0,01], and there was a inverse relationship between pressure gradient and prosthetic valve size [11.17*0.%mmHg in size 27mm and 29mm -v- 7.38*1.12mmHg in size 31mm and 33mm; r=0.85, p<0.01] The noninvasive Doppler technique should be useful in the diagnosis of prosthetic valve obstruction.

• Journal of Chest Surgery
• /
• v.17 no.2
• /
• pp.231-243
• /
• 1984

Despite its known limitation in the diagnostic value, the electrocardiography is one of the most common and routine examinations in the management of the patients with cardiac problems. The clinical results of 291 patients who underwent isolated mitral valve replacement from October 1978 to June 1983 were already reported. Their electrocardiograms were studied to assess the value of electrocardiographic examination in following the patients after valve replacement. The patients were divided into 5 groups beforehand according to the types of valve lesion on the bases of preoperative diagnosis and operative findings: Groups I: stenosis, I1: stenosis-dominant mixed, II1: equally mixed, IV: insufficiency-dominant mixed, and V: insufficiency. Their preoperative cardiac rhythm was sinus in 39.2% and atrial fibrillation in 59.1% of the patients. Seventy-three [42.4%] of the patients with atrial fibrillation gained sinus rhythm after operation, occurring in 67 from the day of surgery, and 42 returned to atrial fibrillation while 37 kept sinus rhythm at the follow-up end [mean follow-up period, 13.4\ulcorner1.4 months]. The P waves on the electrocardiograms of the preoperative sinus rhythm in 114 patients were normal in 5.3% and the findings of left atrial enlargement in 94.7% of the cases. They were normal in 42.1% and the findings of left atrial enlargement in 57.9% of the 140 patients with sinus rhythm at the follow-up. The preoperative major chamber enlargement was the right ventricle in Group I while it was the left ventricle in Group V, and it was in-between in Groups II-IV. The postoperative regression of the findings in ventricular enlargement was statistically significant only in Groups I and V. These results may suggest the importance of the serial electrocardiograms in following the patients with mitral valve replacement on the bases of outpatient. The electrocardiographic follow-up data were presented in patients with suspected or proved tissue valve failures.

• Journal of Chest Surgery
• /
• v.24 no.11
• /
• pp.1090-1097
• /
• 1991

Between January 1981 and January 1991, 554 patients underwent prosthetic valve replacement. A bioprosthetic valve was replaced in 238 cases and mechanical valve 316 cases. Thirty-eight patients underwent 40 reoperations for repair or replacement, an average of 53.6 months after initial implantation. There were 21 women and 19 men, aged 12 to 60 years[mean 35.3]. A bioprosthetic valve was implanted in 31 cases and a mechanical valve in 9 cases for initial operation. Indications for reoperation were primary tissue failure in 23 cases[57.5%], endocarditis in 9[22.5%], periprosthetic leak in 4[10%]. and valve thrombosis in 4[10%]. Operations performed included 5 aortic valve replacements, 26 mitral valve replacement, 8 double valve replacements, and 1 thrombectomy. A mechanical valve was replaced in 33 cases[84.6%] and a bioprosthesis in 6[15.4Zo] for reoperation. A second reoperation was required in 2 patients. Surgical mortality was 10% . Among the 34 early survivors followed-up for an average of 19.8 months. there was 1 late death and 3 were lost to follow-up. Among the 30 late survivors being followed up, 28[93.3%] remained in New York Heart Association Class I or II and two in Class III [6.7%].

• Journal of Chest Surgery
• /
• v.16 no.4
• /
• pp.506-510
• /
• 1983

Valve dysfunction can be caused by thickening or contraction of a fibrous sheath covering a cusp of a porcine bioprosthesis, but this is uncommon. This complication appears to more frequent in other bioprostheses, such as fascia late valves and homografts, in which fibrous sheaths seems to grow more rapidly. rapidly. Thus the slow and limited growth of fibrous sheath in porcine bioprostheses is advantageous in this respect. Recently, we experienced a case of valve dysfunction caused by fibrous tissue overgrowth on Hancock mitral xenograft in 45 year old female. 3.5 years ago, the patient was received valve replacement due to mitral stenoinsufficiency. But since 2.5 years elapsed after operation, she has complained of generalized edema and dyspnea, and their symptoms were aggravated progressively. So reoperation was performed under the diagnosis as valve dysfunction of mitral xenograft and newly developed tricuspid insufficiency. Her postoperative courses were good.

• Journal of Chest Surgery
• /
• v.25 no.7
• /
• pp.750-755
• /
• 1992

We report a case of leaflet embolization of central leaflet fracture a 31mm mitral Edw-ards-Duromedics prosthesis. A leaflet was fractured to two segments, a larger one embolized to right common iliac artery and a smaller one to left femoral artery, respectively. Patient was reoperated with 29mm mitral Carbomedics prosthesis and incidentally found of smaller segment in left femoral artery at cannulation site. The embolectomy was done 15 days after cardiac operation through midline abdominal incision, Leaflet escape of a mitral Edward-Duromedics prosthesis is a rare, potentially curable mode of valve failure. After mechanical valve replacement, unexplained heart failure and acute pulmonary edema, mechanical valve failure should be suspected. Correct interpretation of clinical signs, symptoms and fluroscopy should allow early diagnosis of leaflet escape and prompt surgical therapy.

• Journal of Veterinary Clinics
• /
• v.35 no.1
• /
• pp.10-12
• /
• 2018

Mitral regurgitation is the most frequent cause of cardiac disability and death in dogs. A wide range of medical and surgical treatments have been used for mitral regurgitation. Surgical treatments for complete correction of mitral regurgitation include valve repair and valve replacement, which have the advantages of eliminating or correcting the primary cause. Surgical treatments approach the mitral valve via right- or left-side thoracotomy. Aortic root exposure is needed for cardiopulmonary bypass. To compare right-side and left-side approaches, 10 dog cadavers were used in this study. Subsequently, the left-side surgical approach was used in vivo and in conjunction with cardiopulmonary bypass and cardioplegic arrest. Based on the results, and considering ease of access to the aortic root, valve incision site, and visualization of the surgical field, a left-side approach is recommended.