• Journal of Chest Surgery
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• v.28 no.8
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• pp.747-753
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• 1995

Patients over 14 years of age who have undergone a surgical correction of a congenital cardiac malformations during period of August 1959 through December 1993 have been reviewed. During this period, there were 6894 cases of congenital cardiac lesions consisting of 4576 acyanotic and 2318 cyanotic cases. Among them, a total of 1389 adults [20.1%with various congenital cardiac malformations, 1126 acyanotic group and 263 cyanotic group were operated on. 677 patients were male and 712 patients were female. There were 444 patients under 20 years of age, 365 patients between 20-24 years, 220 patients between 25-29 years, 138 patients between 30-34 years and 222 patients over 34 years. The most common defects were atrial septal defect which accounted for 500 cases [36.0%and another common malformations were ventricular septal defect [276 cases, 19.9% , patent ductus arteriosus [207 cases, 14.9% , tetralogy of Fallot [185 cases, 13.3%and pulmonary stenosis [44 cases, 3.2%in order of incidence. Overall operative mortality for this series was 2.7% [1.5% of acyanotic group and 7.9% of cyanotic groupcompared with 4.6% of operative mortality of total cases of congenital cardiac malformations [2.9% of acyanotic group and 16.7% of cyanotic group . This reviewed series reveals the incidence of operable congenital heart defects appearing in any adult life and demonstrates that surgical repair can be accomplished with a satisfactory low mortality rate.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.431-443
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• 1983

A hundred and fifty-one patients with congenital heart disease less than 24 months old underwent intracardiac repairs from January 1982 to July 1983, which consists 24.2% of all the patients with congenital heart diseases operated during the same period. There were 98 patients[64.9%] with acyanotic congenital heart disease and 53 patients[35.1%] with cyanotic congenital heart disease, and 55 patients[36.4%] were less than 1 year of age. Twenty-two patients died within 30 days after surgery and 3 patients died after postoperative 30th day: Ventricular septal defect, four of 90 patients; Tetralogy of Fallot, five of 23 patients; Transposition of great arteries, nine of 17 patients; Tricuspid atresia, four of 5 patients; Pulmonary atresia, all of 2 patients; Single ventricle, one of single patients. Over all mortality was 16.6% and mortality of acyanotic congenital heart disease, cyanotic congenital heart disease and patients less then 1 year of age was 4.1%, 39.6% and 20.0% respectively. Still the mortality of cyanotic congenital heart disease is high. Careful preoperative evaluation of the detailed intracardiac anatomy and hemodynamics of the patients and proper selection of surgical treatment yield better clinical results.

• Korean Journal of Radiology
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• v.2 no.3
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• pp.121-131
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• 2001

Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of tetralogy of Fallot, and Senning's and Mustard's operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.250-258
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• 1986

From Aug. 1984 to May 1986, 116 cases of cardiovascular surgery including 85 cases of open heart surgery were performed at Korea Veterans Hospital. There were 108 congenital anomalies and 8 acquired valvular heart diseases. Among 108 congenital malformations 92 operations were done for acyanotic group, and 16 operations for cyanotic group. Thirteen cases of open heart surgery for infants or small children under 10kg of body weight were performed, which occupied 15.3 percent of total open heart surgery done in the same period. Common congenital cardiovascular anomalies were ventricular septal defect [40.7%], patent ductus arteriosus [29.6%], tetralogy of Fallot [12.[%], atrial septal defect [11.1%], and pulmonary stenosis [1.9%] in order of frequency. Valve replacement using lonescu-Shiley or Carpentier-Edwards valve was performed for 8 cases of acquired mitral valve disease, and valve replacement using St. Jude valve was done for a case of patent ductus arteriosus with severe mitral insufficiency. There was no mortality in acyanotic congenital malformations and acquired valve lesions, and 5 cases of mortality in cyanotic congenital malformations. Overall mortality was 4.3 percent for total cases and 5.9 percent for 85 cases of open heart surgery.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1042-1045
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• 1999

Background: Recently, open heart surgerys using homograft are progressively increasing in complex cardiac anomalies, and even though the use of homograft tissues harvested from hearts of transplant recipients and brain-death patients are allowed and their use is increasing, the supply of homograft tissue is very limited. Material and Method: The large diameter homografts are difficult to apply directly for RVOT reconstruction of small neonatal and infant hearts due to the size mismatching. Therefore, were surgically down-sized the large diameter tricuspid homograft into bicuspid conduits by means of a longitudinal incision of the oversized homograft, excision of one cusp, and oversewing of the“Bicuspid homograft”wrapped around a Hega dilator of the appropriate size. Result: 3 patients(Male 1, Female 2: tetralogy of Fallot with pulmonary atresia), ranging in age from 5 months to 4 years and ranging in weight from 5.5Kg to 12.95Kg underwent reconstruction of the RVOT with bicuspid conduits obtained by appropriate tailoring from large-diameter homografts. The mean follow-up period was 4.3 months(range, 2 to 6 months). There were no complications related to the homograft tissues. Conclusion: In the short term follow-up, the bicuspid homografts provided good competence and excellent hemodynamics although a long term follow-up is needed to assess the functions of the bicuspid homografts in RVOT. We believe this technique may be a more effective alternative than the use of synthetic conduits when the use of an appropriate-sized homograft is not possible.

• Journal of Chest Surgery
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• v.11 no.2
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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.

• Clinical and Experimental Pediatrics
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• v.56 no.3
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• pp.101-106
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• 2013

Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.641-648
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• 1988

Between April 9, 1986 and September 2, 1987, 134 patients underwent open heart surgery with hypothermic cardiopulmonary bypass and cold blood cardioplegia. There were 65 patients[48.5%] of acyanotic congenital cardiac anomalies, 19 patients[14.2%] of cyanotic congenital cardiac anomalies, and 50 patients[37.3%] of acquired heart diseases, which included 49 valvular diseases and 1 myxoma. In 84 congenital cardiac anomalies, 44 patients were male and 40 patients were female ranged in age from 2 years to 57 years. In 50 acquired heart diseases, 18 patients were male and 32 patients were female ranged in age from 10 years to 65 years. The common congenital defects operated were VSD in acyanotic cardiac patients, and Tetralogy of Fallot in cyanotic cardiac patients. Among 50 acquired heart diseases, 49 patient underwent operation for cardiac valvular lesions. 33 patients had mitral valve replacement and 7 patients had aortic valve replacement. 1 patient underwent aortic valvuloplasty and 8 patients had double valve replacement. The operative mortality rate was 3.1%[2 out of 65 patients] in acyanotic cardiac patients, 5.3%[1 out of 17 patients] in cyanotic cardiac patients, and 12.0%[6 out of 50 patients] in acquired cardiac patients, with overall mortality rate of 6.7%[9 out of 134 patients].

• Journal of Chest Surgery
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• v.28 no.8
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• pp.754-758
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• 1995

Between February 1987 and April 1994,30 modified Blalock- Taussing shunts[MBTS were carried out at the Department of Thoracic and Cardiovascular Surgery of the Keimyung University Dongsan Medical Center.The operation consists of interposing between the subclavian artery and the pulmonary artery a polytetrafluoroethylene graft.There were 19 boys and 11 girls.The average age at the time of shunt construction was 14 months [range 4 days to 5 years .Seventy-six percent [23/30 were less than 1 year of age.Cardiac defects treated with MBTS included tetralogy of Fallot[10 , pulmonary atresia with ventricular septal defect[8 , pulmonary atresia with intact ventricular septum[4 , uni-ventricular heart[3 , and other complex cardiac anomalies[5 .Prosthesis of 4mm were used in 13 cases, and 5mm in 17.Of the 30 operations, 21 were performed on the right side and 9 on the left side.The hemoglobin level decreased from 21.1 gm/dl preoperatively to 16.3 gm/dl postoperatively and systemic oxygen saturation level increased from 60.5 % preoperatively to 85.4 % postoperatively.In the 30 patients who recieved MBTS, there were one early [3% and three late deaths [10% .Seven patients have had an corrective operation and two patient required second palliative procedure.The remaining patients are awaiting further operation with ingestion of aspirin [5 mg/kg/day as an antiplatelet agent.These results indicate that the MBTS provide excellent palliation at a low operative mortality for most patients.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1038-1044
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• 1995

We have been used cryopreserved homograft valves for right ventricular outflow tract[RVOT reconstruction since November 1993. The homograft valves were harvested from the hearts of brain dead patients or hearts of transplant recipients. There were 12 male and 10 female patients. Their ages ranged from 5 months to 13 years[mean age,39.2 $\pm$ 37.4 months and the weight ranged from 5 to 48kg [mean weight, 13.7$\pm$ 9. l kg . The diagnoses included pulmonary atresia with ventricular septal defect [n=14 , tetralogy of Fallot[n=4 , truncus arteriosus[n=3 , and double outlet right ventricle with pulmonic stenosis[n=l .Monocuspid homograft patches were used for RVOT widening or REV[reparation l`etage ventriculaire operations in 4 patients. We also used homograft as valved conduits for RVOT reconstruction in 17 patients and left ventricular outflow tract reconstruction in anatomically corrected transposition in 1 patient. Among them size-reducing technique [converting a tricuspid valved conduit into a bicuspid valved conduit were applied to six patients for the correction of size mismatching. The mean follow-up period was 10.6 $\pm$ 5.4 months. There was one operative death[4.5% due to bleeding and one reoperation for removal of vegetation on the homograft leaflet. Postoperative echocardiography documented no significant homograft insufficiency and RVOT obstructions.In short-term, the homograft valves provide excellent hemodynamic characteristics, even though further studies are necessary to evaluate the long-term results.