• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.29-29
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• 1995

• Journal of Chest Surgery
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• v.30 no.5
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• pp.506-511
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• 1997

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1234-1237
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• 1998

Patients with aortic root disease, frequently seen in Marfan syndrome have progressive dilatation of the aortic sinuses and dilatation and distortion of the aortic annulus, leading to aortic incompetence. They are currently treated with composite graft replacement of the ascending aorta and aortic valve and reimplantation of the coronary arteries. Recently, we experienced an aortic root replacement with aortic valve preservation in a patient with annuloaortic ectasia. The ascending aorta and sinus was excised except the aortic annulus and aortic valve. The aortic valve was reimplanted inside of a collagen-impregnated tubular Dacron graft. The coronary arteries were also reimplanted. The patient was followed up for six months and reevaluated with the echocardiography. Postoperative Doppler echocardiography revealed normal aortic valve function. With this technique, it is possible to preserve the native aortic valve if the aortic leaflets are anatomically normal.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.556-559
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• 2002

The presense of pectus excavatum in Marfan's syndrome may complicate cardiac operation by making midline sternotomy technically more difficult and limiting the operative exposure of the heart. We operated on a 33 year old male patient with Marfan's syndrome and severe pectus excavatum who had severe mitral regurgitation and moderate aortic regurgitation with 52mm aortic root dilation. The operative field was adequately exposed through a midline sternal incision with two sternal retactors. The patient underwent Bentall operation and mitral valve replacement. The repair of pectus excavatum was performed after completion of CPB and the administration of protamin. Permanent internal stabilization achieved by overlapping of the ends of lower ribs and reinforced with sternal closure wire.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.921-927
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• 2003

Arterial switch operation (ASO) has been the most effective surgical option for transposition of the great arteries. But, the inappropriate dilation of the neoaortic root has been reported and its effect on neoaortic valve function and growth of aorta has not been well documented. Material and Method: Forty-eight patients who underwent cardiac catheterization during follow up after arterial switch operation were included in this study. Arterial switch operation was performed at a median age of 18 days (range 1∼211 days). Preoperative cardiac catheterization was performed in 26 patients and postoperative catheterization was performed in all patients at 15.8$\pm$9.6 months after ASO. Postoperative ratios of the diameters of neoaortic annulus, root and aortic anastomosis against the descending aorta were compared to the size of preoperative pulmonary annular, root and sinotubular junction. Preoperative and operative parameters were analyzed for the risk factors of neoaortic insufficiency. Result: There were two clinically significant neoaortic insufficiencies (grade$\geq$II/IV) during follow up, one of which required aortic valve replacement. Another patient required reoperation due to aortic stenosis on the anastomosis site. Post-operatively, neoaortic annulus/DA ratio increased from 1.33$\pm$0.28 to 1.52$\pm$.033 (p=0.01) and neoaortic root/DA ratio increased form 2.02$\pm$0.40 to 2.56$\pm$0.38 (p<0.0001). However, the aortic anastomosis/DA ratio showed no statistically significant difference (p=0.06). There was no statistically significant correlation between the occurrence of neoaortic insufficiency and neoaortic annulus/DA ratio and neoaortic root/DA ratio. Non-neonatal repair (age>30days) (p=0.02), preopeative native pulmonaic valve stenosis (p=0.01), and bisuspid pulmonic valve (p=0.03) were the risk factors for neoaortic insufficiency in univariate risk factor analysis. Conclusion: After ASO, aortic anastomosis site showed normal growth pattern proportional to the descending aorta, but neoaortic valve annulus and root were disproportionally dilated. Significant neoaortic valve insufficiency rarely developed after ASO and neoaortic annulus and root size do not correlate with the presence of postoperative neoarotic insufficiency. ASO after neonatal period, preoperative native pulmonary valve stenosis, and bicuspid native pulmonic valve are risk factors for the development of neoaortic insufficiency.