• Journal of Chest Surgery
• /
• 제27권9호
• /
• pp.752-758
• /
• 1994

From July 1983 to December 1992, 145 patients with mitral valvular disease underwent open heart surgery at Chonbuk National University Hospital. Of these patients, 89 patients[61.4%] required mitral valve replacement. 56 patients [38.6 %] had mitral valve repair. There were 32 women and 24 men and the mean age was 34.3 years[range 6 years to 62 years].There were 23 cases of pure mitral stenosis, 19 cases of mitral regurgitation and 14 cases of mixedmitral valvular disease. The mean duration of symptom was 4.53 years and mean mitral valvularorifice diameter[in cases of pure stenosis and mixed mitral valvular lesion] was 0.96 cm. According to the NYHA classification, the distribution of patients preoperatively was as follows; class IIa, 15 patients; class lib, 17 patients; class III, 22 patients; class IV, 2 patients. Four patients[7%] had an embolic history preoperatively. 24 patients[ 43 %] were in atrial fibrillation. In cases of pure mitral stenosis, the technique used included open mitral commissurotomy[21atients], open mitral commissurotomy with mitral annuloplasty[2 patients]. In mixed mitral valvular disease, open mitral commissurotomy[ll patients] and open mitral commissurotomy with mitral annuloplasty[l patient] were performed. In cases of mitral regurgitation, mitral annuloplasty[5 patients], mitral valvuloplasty[6 patients], mitral annuloplasty with valvuloplasty [3 patients] and ring annuloplasty [5 patients] were performed.There was one perioperative death related to acute renal failure and sepsis. One late death was occurred related to heart failure after 10 months postoperatively. One patient required reoperation due to restenosis and no embolic episode was occured. After operation, 34 patients were in NYHA functional class I, 20 patients were in class IIa.

• Journal of Chest Surgery
• /
• 제54권3호
• /
• pp.218-220
• /
• 2021

The simultaneous incidence of infective endocarditis and cervical spondylitis with an epidural abscess is rare, and quadriplegia as a complication after cardiac surgery is very rare. We recently observed quadriplegia after mitral valve replacement in an infective endocarditis patient with cervical spine spondylitis. With early symptom detection, immediate examination, and prompt surgical treatment, the patient successfully recovered without neurological symptoms.

• Journal of Chest Surgery
• /
• 제41권6호
• /
• pp.759-763
• /
• 2008

전폐절제술을 받았던 환자에서 시행하는 심장 수술은 수술 후 합병증과 사망의 위험이 높다. 내원 33년전 폐결핵으로 좌측 전폐절제술을 받았던 71세 남자환자에서 승모판막 치환술 및 삼첨판막륜 성형술을 성공적으로 시행하였기에 증례와 함께 수술 전 후 폐기능 저하의 예방, 수술 중 승모판막의 노출 및 수술 후 발생한 부정맥에 대한 내용을 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제25권1호
• /
• pp.49-56
• /
• 1992

Total 20 cases of reoperation for mitral vavular disease, which had been performed during the period from May 1983 till October 1991, were reviewed. This study contained 1 case of previous balloon valvuloplasty and 1 case of death with bleeding from right ventricle during sternal reenrty. The average time intervals between reoperation and previous operation was 19 years in closed mitral commissurotomy[n=4], 7 years and 2 months in mitral valve replacement[n=10], 1 year and 8 months in mitral valvuloplasty[n=4], 3 years and 10 months in open mitral commissurotomy [n=2]. The cause of reoperation in closed mitral commissurotomy was progression of the disease, and residual stenosis with progression was the cause in open mitral commissurotomy cases. Technical failure might be the cause in the cases of valvuloplasty. In prosthetic valve replacement group the causes of reoperation were primary failure. Also two cases of suggested valve thrombosis and one case of failure of tricuspid annuloplasty was noted in prosthetic valve replacement group. The used valves for reoperation were Ionescue-Shiley in 3 cases, Bjork-Shiley in 6 cases, St. Jude Medical in 2 cases and CarboMedics in 8 cases. The mortality rate was 20%[n=4] and the causes of death were low output syndrome in 1 case, multiple organ failure in 2 cases and bleeding in 1 case during sternal reentry. During follow up 1 case of sudden death was observed.

• Journal of Chest Surgery
• /
• 제50권6호
• /
• pp.467-470
• /
• 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
• /
• 제27권8호
• /
• pp.656-663
• /
• 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].

• Journal of Chest Surgery
• /
• 제10권2호
• /
• pp.315-326
• /
• 1977

From 1958 to October 1977, 294 cases of acquired heart disease were operated. There were 68 cases of pericardium, 3 trauma, 2 foreign body, one cardiac thrombus, 3 atrial myxoma, 2 left atrial and 1 right atrial, 2 Budd-Chiari syndrome, and 214 valvular heart disease. Out of 214 cases of valve operation 73 valves were replaced in 64 patients. Male to female ratio was 1.46: 1. The youngest age was 14 years in male and 18 in female. The oldest was 54 years in male and 52 in female. Fifty-five cases of single valve were replaced, consisting of 47 mitral and 8 aortic valves. There were 9 double valve replacement cases which consist of 7 mitral and aortic and 2 mitral .and tricuspid valves. Six varieties of prosthetic valves, 3 ball and 3 disc types and 3 kinds of xenograft tissue valves were utilized. Beall, BjSrk-Shiley and Starr-Edwards prosthetic valves and Hancock valves were used mainly. For single valve 34. 5% and for double valve replacement 44% mortality were noted. There were 23 operative deaths out of 64 patients, over all mortality rate of 36.9%. Mortality for mitral valve replacement was 29.5%. But in recent 12 consecutive cases one death occurred, showing 8.3% mortality. In earlier days thrombocyte anti-adhesive drug dipyramidole-persantin-aspirin and/or SP 54 were adminstered. But in recent cases after heparinization, coumadin and Persantin were prescribed routinely.

• Journal of Chest Surgery
• /
• 제47권6호
• /
• pp.504-509
• /
• 2014

Background: Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. Methods: We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. Results: In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. Conclusion: We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.

• Journal of Chest Surgery
• /
• 제12권1호
• /
• pp.56-60
• /
• 1979

Replacement of the aortic valve in a normal or large aortic root can be accomplished with ease and safety in most instances. The presence of a narrowed aortic annulus remains a problem in that the replaced smaller prosthetic valve has a significant resting pressure gradient across the orifice. This narrowing causes not only technical difficulties, but also increased mortality and post-op. complication. Therefore this problem deserves special attention. This report presents our experience with a case of a small aortic root caused by rheumatic heart disease [AI and MS]. This is the method of enlargement of the aortic annulus with a woven Dacron patch and replacement of a larger prosthetic aortic valve combined with mitral valve replacement.

• Journal of Chest Surgery
• /
• 제18권3호
• /
• pp.383-390
• /
• 1985

108 cases of open heart surgery were done at our department in 1984. There were 58 male and 50 female patients ranging in age from 20 months to 52 years. 75 cases were congenital heart disease, and 33 cases were acquired heart disease. There were 75 congenital heart anomalies with 5 operative deaths [6.7%], consisting of 62 acyanotic cases with 2 deaths [3.2%] and 13 cases of cyanotic cases with 3 deaths [23.1]. In 33 patients of acquired valvular disease, 29 valves were implanted; 20 mitral valve replacement with 2 death [10%], 2 aortic valve replacement with 1 death [50%], 2 double valve replacement [MVR+AVR] and 2 open mitral commissurotomy plus aortic valve replacement with no death. Postoperative, Warfarin sodium was medicated with checking prothrombin time. Finally, the operative mortality was 9.2% in congenital anomaly, and 9.1% in acquired heart disease, overall mortality rate was 9.3%.