• Journal of Chest Surgery
• /
• 제20권1호
• /
• 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
• /
• 제15권2호
• /
• pp.204-212
• /
• 1982

The presence of left atrial thrombus in mitral stenosis has been reported to be associated with several factors. These are age, sex, presence of atrial fibrillation, episodes of congestave heart failure, calcification of mitral valve, embolic episode, etc. Since none of these single factor has been always related to the presence of left atrial thrombus, related risk factors to left atrial thrombosis were studied in patients with mitral stenosis using chi square test. We had operated on 191 cases of mitral valvular heart disease from Jan. 1978 to June 1981 at Severance Hospital, Yunsei University College of Medicine. The left atrial thrombi were present in 41 cases among 191 cases of mitral valvular heart disease and it was present in 31 cases among 89 cases of pure mitral stenosis. Only 10 cases among 74 cases of mitral stenoregurgitation had left atrlal thrombi, whereas no left atrlal thrombus was found in patients with pure mitral regurgitation. Related risk factors studied herein were sex, episodes of congestive heart failure, atrial fibrillation, pulmonary capillary wedge pressure, mitral valve area calculated by Gorlin and Gorlin`s formula cardiac output and left atrial dimension by echocardiogram. In this study presence of atrial fibrillation was deemed to be one of the most potential risk factors and other factors of age, duration of symptoms, episode of embolization, calclfication of mitral valve, associated aortic and tricuspid valve disease, ejection fraction of left ventricle by cineangiocardiogram and echocardiogram were not significantly related to the presence of left atrlal thrombi in a statistical viewpoint.

• Journal of Chest Surgery
• /
• 제30권10호
• /
• pp.1015-1018
• /
• 1997

개심술 특히 판막 질환의 수술에 있어서 정중 흉부 절개의 방법은 현재까지 가장 널리 사용되는 절개 방 법이다 그러나 최근 들어 판막 질환의 수술시 우측 흉골외측 절개를 이용하여 절개부위를 최소화함으로서 많은 장점을 가질 수 있는 방법이 보고되고 있다. 고려대학교 부속 구로병원에서는 우측 흉골외측 절개와 심방 중격 절개를 이용하여 1례의 승모판막 치환 술을 시행하였는데, 이 방법의 사용시 기존의 정중 흉부 절개의 방법과 비교하여 특이한 합병증이나 어려움 을 경험할 수는 없었고,훌릉한 수술 시야를 확보할 수 있었으며,환자는 수술 절개 부위에 대하여 미용적인 면에서 매우 만족하였다.

• Journal of Chest Surgery
• /
• 제21권1호
• /
• pp.1-9
• /
• 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
• /
• 제23권4호
• /
• pp.659-666
• /
• 1990

We evaluated 68 patients with mitral valve disease who underwent mitral valve replacement from April, 1986, to December, 1988. Among them 20 patients showed increased systolic pulmonary arterial pressure greater than 60 mmHg and postoperative hemodynamic data were obtained in 19 patients average 13 months after mitral valve replacement. The results were as followings. 1. Average pulmonary systolic pressure decreased from 84.8$\pm$4.5 preoperatively to 33. 0$\pm$1.9mmHg postoperatively[P<0.001]. 2. Average pulmonary vascular resistance index decreased from 1425$\pm$148 preoperatively to 287+35.8 dyne * sec * cm2 * m postoperatively[P<0.001]. 3. Average cardiac index rose from 1.927$\pm$0.169 preoperatively to 2.625$\pm$0.159 L/min/m2 postoperatively [P <0.005]. This study shows that pulmonary hypertension and the increased pulmonary vascular resistance index due to mitral valve disease can regress significantly after mitral valve replacement.

• Journal of Chest Surgery
• /
• 제30권4호
• /
• pp.423-427
• /
• 1997

객혈은 승모판막협착증의 영향으로 흔히 발생되지만,많은 양으로 지속적이며 치명$\boxUl$101 곤출친으 확 실히 드물다. 한양대 학교 흉부외과학교실에서는 지속적인 대량 폐출혈로 응급이중판막 재치환술 시행받은 30대 여자의 예를 보고하고자 한다. 환자는 1984년 류마치스성 승모판막 폐쇄부전증으로 판막치환술을(lonescu Shilcy 27mm) 받았으며, 그후 2년후에 삼첨판윤 성형술(Carpcntier's ring 30mm)을 받았다. 1995년 12월 26일 환자는 대량 객혈과 심한 호흡곤란으로 입원하였다. 객혈에 대한 동맥색전술을 포함한 내과적 치료를 시행 받았지만 효과는 없었다. 환자는 응급 이중판막 재치환술(승모판 : St. Jude 29mm, 삼첨판; St. Jude 33mm)을 시 행 받았으며. 술후 24시간이 경과된 후 객혈은 극적으로 조절되었다.

• Journal of Chest Surgery
• /
• 제23권3호
• /
• pp.488-500
• /
• 1990

Author compared the effect of surgical methods between 40 patients who received mitral valve replacement with complete excision of the mitral valve[resected group] and 41 patients who received mitral valve replacement with preservation of posterior chorda tendineae and posterior mitral leaflet[preserved group] from 1985. 2. to 1989. 4. at cardiothoracic department of Pusan National University Hospital.v 1. There was no significant difference between the preserved group and resected group in cardiopulmonary bypass time and aortic cross clamping time and NYHA classification. 2. In preserved group of Mitral stenosis and Mitral regurgitation, the left ventricular functions were much improved after mitral valve replacement than resected group, but there was not so difference between the preserved group and reserved group in Mitral steno-regurgitation. 3. There were remarkable decrease in complication rate in preserved group compared to resected group. And also the death rates were remarkably decreased in preserved group which was 4.9% compared to resected group which was 17.5%. As the preservation of the posterior mitral leaflet and chorda tendineae during mitral valve replacement in mitral valve disease showed significantly improved effects in the maintaining of left ventricular function and reducing the postoperative complication, I assume the preservation of posterior mitral leaflet and chordae during mitral valve replacement will bring better result.

• Journal of Chest Surgery
• /
• 제27권7호
• /
• pp.624-627
• /
• 1994

Congenital coronary arteriovenous fistula is a rare cardiac defect that causes coronary arterial flow to drain into the right cardiac chambers, the pulmonary artery, the coronary sinus, or the left cardiac chambers. The most frequently involved vessel is the right coronary artery. We experienced a case that had a coronary arteriovenous fistula associated with valvular heart disease. With the cardiopulmonary bypass done under hypothermia, mitral valve replacement was accomplished and the fistulas of both proximal and distal portions of the right coronary artery were closed with 3-0 prolene. Postoperative course was uneventful.

• Journal of Chest Surgery
• /
• 제12권4호
• /
• pp.339-345
• /
• 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
• /
• 제24권10호
• /
• pp.967-972
• /
• 1991

Between Feb. 1982 and July 1990, 173 patients [male: 89, female: 84] Who underwent heart valve replacement for acquired valvular heart disease on the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, were reviewed for return to work after heart valve replacement. The replaced valve were mitral [128, 74.0%], aortic[10, 5.8%], mitral & aortic[35, 20.2%]. Two tricuspid valve replacement were excluded. Several important factors influencing the return to work were age, the employment status before surgery, the number of replaced valve, the pre - op NYHA functional class and cardiac function [ejection fraction]. These factors were closely related to the optimal time of heart valve replacement. It can be concluded that the rate of return to work and the quality of life would be improved if valve replacement were performed at an earlier stage of valvular heart disease.