• Journal of Chest Surgery
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• v.31 no.4
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• pp.346-352
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• 1998

Rheumatic valvulitis produces at least three distinct pathologic changes, the degree varying widely among the patients: fusion of the valve leaflets at the commissures; fusion and shortening of chordae tendinae: and fibrosis of the leaflets with subsequent stiffening, contraction and calcification. The most extensive changes usually are seen in patients with recurrent attacks of rheumatic fever. We studied on outcome of the surgical treatments of rheumatic valvular diseases that have been experienced for 12 years since 1982 at Pusan National University Hospital. The diagnoses were made by rheumatic fever history, echocardiographic findings, gross operative findings and microscopic findings. Total 502 patients were performed surgery for valvular heart diseases and 440 patients of rheumatic origin have bene analysed. There were more female than male patients as 1.3:1, and the mean age was 37.8 years old. 96.3% of them affected to the mitral valve, 19.8% to aortic valve, 16.3% affected to the tricuspid valve. Most of them underwent valve replacement, and valve repair was done in 3.9% of patients. There were 36 hospital deaths(8.2%) mainly from low cardiac output syndrome, and 15 late deaths equally due to embolism and hemorrhage. Follow up was 90.1% completed(2890 patient- year). Linealized rates of late complication events are follows : thromboembolism 1.3% per patient year; anticoagulant related hemorrhage 0.8% per patient year. Overall actuarial survival including hospital mortality was 92.7＋/-2.9% in 1 year, 88.0＋/-4.5% in 5 year, 82.3＋/-7.7% in 10 year. We conclude that the rheumatic disease is still the most frequent and the most important cause of heart valve disease. So more intensive study is needed in spite of the abrupt decreasing rate of rheumatic fever in U.S.A. and other industrial country.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.899-904
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• 1988

In Behcet syndrome, cardiac involvements are rare and have been reported pericarditis, myocarditis, right heart endocardial fibrosis, right ventricle mural thrombus with pulmonary embolism, active endocarditis, granulomatous endocarditis, conduction disturbance, acute aortic insufficiency, mitral valve prolapse. Our three patients underwent AVR because of aortic insufficiency and ascending aorta enlargement combined with Behcet syndrome. Two patients had mitral regurgitation too. So one underwent MAP and the other underwent MVR concomitantly. One who underwent AVR have been well for 50 months. Another who underwent AVR+MAP and redo AVR due to aortic paravalvular leakage was died of congestive heart failure. The other who underwent AVR+MVR and repeated AVR three times because of aortic paravalvular leakage is in condition of aortic paravalvular leakage. Paravalvular leakage is considered to recur due to progressive dilatation and fragility of aortic root that is the result of pathologic change of Behcet syndrome in it. If Open heart surgery is needed in Behcet`s syndrome during inflammatory reaction is active, postoperative complications such as paravalvular leakage or suture line rupture may be prevented with pre- and postoperative anti-inflammatory management.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.135-142
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• 1991

From January 1980 to December 1989, thirteen patients underwent operation for ventricular septal defect associated with aortic insufficiency in Kyungpook national university hospital. Ten male and three female patients ranged in age from 3 years to 25 years, with an average age of 11.5 years. Aortic cusp prolapse was found in eight cases[61.5%]. The aortic regurgitation was classified by Sellers` method with grade I in 2 cases, grade II in 9 cases, and grade III in 2 cases. Direct suture or patch repair of ventricular septal defect was performed through the right ventricle. Eight cases were treated only by closure of VSD, 3 cases by plication, but two of the letter were reoperated due to the persistent of aortic regurgitation and fungal endocarditis respectively. Aortic valve replacement were performed in 2 cases at the first operation. There was only one late death[7.7%], which was caused by postoperative fungal endocarditis. Follow-up for twelve patients except one death were followed up for 3 months to six years after operation. Residual aortic regurgitation was noted in six cases[46.2%], but the postoperative course of them were uneventful.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1157-1160
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• 1992

Aortic valve repair with the use of tailored autologous pericardial extension to the native cusp was performed in one patient with rheumatic aortic valve incompetence. The patient was a 10-year-old girl with Grade II aortic regurgitation and tiny postoperative recannalization of the patent ductus arteriosus. The left aortic coronary cusp appeared to be a little thickened and a cicatrical shortening of the distance between the free edge of the cusp and its annular attachment. A semilunar shaped patch of autologous pericardium, treated with glutaraldehyde solution[6 minutes in 0.6% solution] was sutured along the free edge of the left coronry cusp. Postoperative recovery was uneventful. Echocardiography 8 months later showed Grade I aortic regurgitation. She is now conducting as usual life.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1041-1047
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• 1992

The consecutive 35 patients underwent isolated aortic valve replacement with the low-profile model of the Ionescu-Shiley pericardial xenograft valve from 1984 to 1991. Operative mortality was 2.9%, and early survivors were followed up for a total 136.1 patient-years[Mean$\pm$SD, 4.00$\pm$2.14 years]. The linearized late mortality was 2.204% /pt-yr. Three patients required rereplacement of the valve with overall valve failure rate of 2.204% /pt-yr: two for endocarditis and one for paravalvular leak. There was no case of primary tissue failure. The linearized annual rates of complication were: thromboembolism 0.735% /pt-yr, bleeding 0.735%pt-yr, and endocarditis 2.204% /pt-yr. The actuarial survival at 8 years of follow-up was 90.4$\pm$5.3%, and the probabilities of freedom from thromboembolism and from rereplacement were 95.6$\pm$4.4% and 88.2$\pm$6.7% at 8 years respectively. Although the low profile Ionescu-Shiley pericardial valve provided favorable clinical performance comparable with the standard model up to 8 years, it needs prolonged follow-up to assess the pattern of its durability.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.304-307
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• 1998

Aneurysm of the sinus of Valsalva on mostly congenital disease that develops more frequently in Orientals, is very low in incidence. In most cases, aneurysm of the sinus of Valsalva extends to intracardiac and results in ruptures into the right ventricle or atrium. The likelihood of extracardiac aneurysm of the sinus of Valsalva is very low. Cases of extracardiac aneurysm are usually accompanied by aortic regurgitation and can cause right ventricle outflow tract obstruction, myocardial ischemia, and myocardial infarction due to compression by aneurysm. Since the aneurysm can rupture in the intrapericardium and cause cardiogenic shock or sudden death, definite diagnosis and management are important. If confirmed, it is preferable operform a surgical correction. We report here, with a literature review, a case where myocardial ischemia and aortic egurgitation caused by aneurysm developed in the left coronary and noncoronary sinus, and were surgically corrected with satisfactory esults.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.445-447
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• 2007

Occlusion of a coronary artery ostium and especially occlusion of the right by an aortic cusp is a rare condition. We experienced an adult patient with occlusion of the right coronary ostium that was due to fusion of the right coronary cusp to the aortic wall along with underlying rheumatic aortic valve stenosis. During the operation, the adherent right coronary cusp was excised. After confirming that the right coronary ostium was patent, the other cusps were removed, and this followed by replacement of the aortic valve with a mechanical valve. The postoperative course was uneventful.

• Journal of Yeungnam Medical Science
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• v.6 no.1
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• pp.179-184
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• 1989

The Marfans syndrome is a generalized connective tissue disease involving eye, musculoskeletal system, cardiovascular system, and inherited autosomal dominant with various expression type. The cardiovascular complications such as aortic aneurysm, aortic dissection, aortic regurgitation, mitral regurgitation and aortic dissection which usually occurs in previously normal sized aorta are poor prognostic factors. However, the aortic dissection which developed in patient with Marfan syndrome and aortic aneurysm was rare. We experienced one case of dissecting aneurysm in patient diagnosed as previous aoritc aneurysm, aortic regurgitation, and Marfan syndrome, receiving successful operation.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.341-346
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• 1999

Background: Thirty children ranging from 3 to 15 years of age underwent cardiac valve replacement at Dongsan Medical Center from 1982 to 1997. Material and Method: There were 16 boys and 14 girls. The mean age was 12.1. The underlying pathological cause for valve replacement was congenital heart disease in 17 children and acquired heart disease in 13. The valve replaced was mitral in 15 children, aortic in 11, tricuspid in 3, and combined aortic and mitral in 1. Twenty-one mechanical and 10 tissue valves were placed: primary mechanical valve have been utilized since 1985. Eight of ten patients with tissue valves have had successful second valve replacements 4 to 11 years after the initial operation. Result: The operative mortality was 6.7%, but mortality was higher among patients less than 5 years of age and patients who had previous cardiac operations. Of the 28 operative survivors, 4 patients were lost to follow-up: the remaining patients were observed for a total of 2091 patient/months(mean 74.7 months, maximum 187 months). There was one late death from dilated cardiomyopathy after mitral valve replacement in 7 year-old patient with atrioventricular septal defect. After the operation, all patients with mechanical valves were placed on a strict anticoagulant regimen with Coumadin. The actuarial survival rate was 96% at the end of the follow-up. No instance of thromboembolism or major bleeding were observed in the survivors. Conclusion: These results indicate that valve replacement can be performed with low mortality in children, and with satisfactory long-term survival.