• 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.

• 한국동물위생학회지
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• 제45권1호
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• pp.55-61
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• 2022

In veterinary medicine, a variety of disease are known to cause coagulation abnormalities. Identification of these coagulation abnormalities have been relied on traditional coagulation assays(platelet concentration, aPTT, PT, D-dimer, fibrinogen) which take only a small part of the coagulation pathways rather than global hemostatic capacity. Among of the hypercoagulable diseases, cardiovascular disease, such as mitral valvular disease, was not regarded as the cause of the hypercoagulability. The value of a thromboelastography (TEG) as an early predictor of coagulopathy, especially hypercoagulability, has been founded. It was associated with decreased R and K values, and increased MA and α angle. The objective of this study was to compare thromboelastography results and those of traditional coagulation tests between twenty adult dogs with mitral insufficiency (MVI group) and eleven adult healthy dogs (Healthy group). As a results, MA values in the patients with mitral insufficiency (68.8±7.8 mm) were significantly higher than the normal patients (60.4±4.8 mm) (P value<0.05). Although a little report has been reported in veterinary medicine, platelet activation seems to be related with hypercoagulability in MVI patients in human medicine. The result of this report can support this pathophysiology in veterinary medicine. In addition to traditional coagulation assay, global assessment of coagulopathy using TEG, especially ability to detect hypercoagulability, may be useful for customized treatment in MVI patients. To achieve this, further study is needed to define pathophysiology and effect of medication.

• Journal of Chest Surgery
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• 제9권2호
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• pp.207-214
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• 1976

Operations for cardiac valvular disease has been progressed in various ways. Since 1949 when Lord Russel operated mitral stenosis by closed technique at Johns Hopkins Hospital then much progress has been achieved and that nowadays severely diseased cardiac valve has been replaced by prosthetic valve, which is almost ideal in hemodynamic aspect, but still it has many problems such as thromboembolism, destruction of red blood cell, pressure gradient, and disturbance of left ventricular function, so in case of delicate situations, valve replacement should be decided carefully. Besides prosthetic valve, there are some kinds of reconstructive procedures and these have been resulted in better prognosis than prosthetic valve replacement in selected cases. So, authors have reviewed 61 Cases of cardiac patients who have been operated reconstructive valvular surgery by cardiopulmonary bypass, at Yonsei University, from Jan. 1963 to Mar. 1976. Out of 61 cases, 9 patients were replaced by prosthetic valve and rest of the patients were operated upon in various reconstructive procedures such as commissurotomy, valvotomy, valvuloplasty, and annuloplasty. Twenty cases of congenital heart diseases with valvular lesion, which had been operated for valvular lesion were also included in this statistics. Out of 9 cases of prosthetic valvular replacement five cases of prosthetic valvular replacement was done combined with other reconstructive procedures after attempted valvuloplasty. Comparative prognosis of both procedures are somewhat variable by reporters, average 19% of mortality after reconstructive surgery and 38% of mortality after prosthetic valve replacement in long term results. Most common cause of death in postoperative period was low output syndrome in both cases. It seems that good preoperative evaluation and proper reconstructive surgery will afford good prognosis in selected cardiac valvular diseased patient.

• Journal of Chest Surgery
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• 제19권1호
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• pp.25-34
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• 1986

Recently, radionuclide angiocardiogram is one of the most common procedure for assessment of ventricular performance due to its distinctive advantages such as safety, accuracy, and ease of repeated studies. Also, measurement and comparison between pre and postoperative left ventricular ejection fraction [LVEF] are meaningful for assessing the severity of myocardial damage which occurred during open heart surgery and the status of myocardial recovery. We obtained pre and post operative LVEF using radionuclide angiocardiogram on 30 patients composed of atrial septal defect, ventricular septal defect, cyanotic congenital heart disease, and valvular heart disease who undergone the open heart surgery from March to august 1984. The study revealed that ventricular septal defect and mitral valvular heart disease showed 8.1% and 6.2% decreases of postoperative LVEF, respectively. But, there are little increases of postoperative LVEF in the atrial septal defect and cyanotic congenital heart disease. In ventricular septal defect, each group of Qp/Qs over 2.0 and systolic pulmonary artery pressure over 50mmHg showed significant 17% and 14.7% decreases of postoperative LVEF, respectively. Considering the duration of the aortic cross clamping times and closing methods of VSD, each group of duration over 30 min. and of patch closure showed 13.9% and 14.2% decreases of LVEF between pre and postoperative status respectively which was significant finding statistically.

• Journal of Chest Surgery
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• 제10권2호
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• pp.315-326
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• 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
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• 제2권1호
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• pp.73-76
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• 1969

It is well known that the atrial myxoma is the most common intracardiac tumor which is hardly able to be diagnosed preoperatively and is completely curable if surgical treatment is appropriate. A case of the atrial myxoma, which was misdiagnosed as mitral valvular disease preoperatively and was successfully removed with the aid of the cardiopulmonary bypass, was reported. The common symptoms,signs,diagnostic measures and treatments of the intracardiac tumor were discussed with the review of literatures.

• Journal of Chest Surgery
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• 제11권2호
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• pp.213-226
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• 1978

One hundred cases of open heart surgery were done at this Department in 1977. There were 65 congenital anomaly and 35 acquired diseases. Out of 65 cases of congenital malformation 35 acyanotic and 30 cyanotic cases were found. Fifteen cases of ventricular septal defect and 29 tetralogy of Fallot were noted eight patients expired out of 65 congenital anomaly [12.3%] , 4 out of 35 acyanotic [11. 4%] and 4 among 30 cyanotic anomaly[13.3%]. Among 35 cases of acquired heart disease 3 atrial myxoma [2 left and one right] and 32 valvular lesions were noted. In two cases open mitral commissurotomy, and in 30 valve replacement were done. Twenty-two single valve and 8 double valve replacement were done. Seven patients expired out of 30 patients [23.3%]. Among 22 single valve replacement cases 2 and among 8 double valve 5 died. ~ In eighteen mitral valve replacement cases 2 deaths occurred. One mitral insufficiency patient who expired suffered from severe pulmonary` hypertension [PA=120/67mmHg], tricuspid insufficiency and a large ventricular septal defect. The patient underwent mitral valve replacement, tricuspid annuloplasty and patch closure of ventricular septal defect. Over all mortality rate for 100 open heart surgery cases was 15%. Since 1977 open heart surgery cases were done routinely in this institution and cases are increasing rapidly. With present rapid improvement of economical status and introduction of medical insurance system, open heart surgery will be firmly established in Korea in the very near future.

• Journal of Chest Surgery
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• 제12권1호
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• pp.33-42
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• 1979

The present study reports 41 cases of congenital and acquired heart diseases, who received open heart surgery under extracorporeal circulation [ECC] by Sarns Heart-Lung-Machine [HLM] at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the` period between July 1975 and February 1979. The priming of pump oxygenator was carried out by the hemodilution method using Hartman`s solution, whole blood, and fresh human plasma. The rate of hemodilution was in the average of 50.8 ml/kg. ECC was performed at the average perfusion flow rate of 85.0 ml/kg/min [2.43 L./ kg/2] and at moderate hypothermia. In the total cardiopulmonary bypass, arterial pressure ranged between 55 mmHg and 90 mmHg, but generally maintaining over 70 mmHg. Patient age ranged between 2 and 54 year old, in congenital heart diseases, between 2 and 28, in acquired heart diseases, between 17 and 54 Sex ratio of male to female was 20:21. The cases include a case of pulmonary valvular stenosis, 4 cases of atrial septal defect, 9 cases of ventricular septal defect, 9 cases of tetralogy of Fallot, 5 cases of pentalogy of Fallot, 3 cases of atypical multiple anomalies 7 cases of mitral stenosis or insufficiency, a case of myxoma in left atrium, and a case of ruptured aneurysm of Valsalva`s sinus. The surgical managements were 16 valvulotomy for pulmonary valvular stenosis, 2 Teflon patch graft closure and 5 simple suture closure of atrial septal defect, 16 Teflon patch graft closure and 5 simple suture closure of ventricular septal defect, 12 pericardial patch graft for infundibular stenosis of right ventricle, one anastomosis between left superior vena cava and right atrium, 2 open mitral commissurotomy, 5 mitral valve replacement using Starr-Edward`s ball valve, porcine xenograft by Hancock, by Carpentier-Edward, or Angell-Shiley, one removal of left atrial myxoma, and a repair of ruptured aneurysm of Valsalva`s sinus. Four [9.7%] out 41 cases expired postoperatively and the rest of 37 cases survived with satisfactory results. The causes of death were one coronary embolism in tetralogy of Fallot, 2 postoperative lower cardiac output in atypical multiple anomalies, and one right heart failure in large: ventricular septal defect with pulmonary hypertension.

• 대한핵의학회지
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• 제7권2호
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• pp.27-34
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• 1973

Pulmonary perfusion scan with radioactive $^{113m}In$-iron hydroxide particle was performed in the 25 cases of heart disease which had been diagnosed by cardiac catheterization prior to surgery from July, 1972 to July, 1973 at the Department of Radiology and Nuclear Medicine, Yonsei Medical College. It consists of 7 mitral stenosis, 2 mitral insufficiency, 1 aortic insufficiency, 3 atrial septal defect, 5 ventricular septal defect, 2 patent ductus arteriosus, 1 transposition of great vessel and 4 Tetralogy of Fallot. Findings of pulmonary perfusion scan in relation to hemodynamic data of cardiac catheterization were examined. 1) Out of 10 cases of acquired valvular heart disease, In 6 cases of mitral stenosis and 1 case of aortic insufficiency, radioactivity was increased at both upper lung. This finding is noted when pulmonary wedge or venous pressure was elevated above 22 mmHg and arterial systolic pressure above 33 mmHg. 2) Out of 15 cases of congenital heart disease. In almost all cases of atrial septal defect and ventricular septal defect except 2 cases, radioactivity was even at both entire lung. In 2 cases of patent ductus arteriosus, radioactivity was decreased especially at the left lung. It is observed that in acyanotic congenital heart disease, radioactivity of lung is not related with pulmonary arterial pressure. In 3 cases of Tetralogy of Fallot, radioactivity was even at both entire lung and in 2 of them, extrapulmonary radioactivity of liver or kidney which depends on size of defect and volume of right to left shunt reversible, was noted.

• 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.