• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.441-444
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• 2007

Sliding annuloplasty has been used for mitral valve repair in conjunction with posterior leaflet quadrangular resection to avoid systolic anterior motion of the anterior leaflet of the mitral valve. Herein, we report on a case of successful mitral valve repair with using the annular plication technique to facilitate sliding annuloplasty and extensive quadrangular resection was also done for treating a Marfan's syndrome patient who had an extremely redundant leaflet and a severely dilated annulus.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.292-298
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• 2009

Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.401-409
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• 2004

Background: As the rupture of chordae and/or papillary muscle became the main cause of mitral valve regurgitation, mitral reconstructive surgery has a very important role. In this regard, we analyzed the clinical result and postoperative early result of operative treatment performed in our hospital, Material and Method: For this analysis, forty nine patients (male 26, female 23, mean age 49.0$\pm$16.5) who underwent mitral valve operation caused by the rupture of chordae and/or papillary muscle from August 1991 to April 2002 were reviewed. Among forty nine patients, twenty two (44.9%) received mital valve reconstruction and twenty seven (59.2%) received mitral valve replacement. Result: As to the pathological etiology of rupture of mitral and papillary muscle, twenty five cases (51.0%) were nonspecific degeneration, eleven cases (22.4%) were myxomatous degeneration, seven cases (14.3%) were subacute bacterial endocarditis. Three patients suffered mortality after operation (6.1%) and valve replacement was performed again on one patient because of remnant mitral insufficiency after valve reconstruction. The 5-year survival rate after operation for the entire mitral valve regurgitation patients was 81 .4%. We have also compared and analyzed the operation results of a group of patients who underwent valve reconstruction and the other group of patients who underwent valve replacement from thirty six patients who had suffered from mitral valve regurgitation caused by degenerative disease. The mortalities were 0% and 14.3%, respectively and the 5-year survival rates were 90.2% and 64.3%, respectively, but there were no statistical significance. Conclusion: The most common pathological etiology of mitral valve regurgitation caused by rupture of chordae and/or papillary muscle was nonspecific degeneration, In case of degenerative disease is the cause of mitral valve regurgitation, valve reconstruction showed better long-term effects in many respects and better operation results compared to valve replacement.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.175-183
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• 2009

Background: Mitral valve abnormalities in the pediatric population are rare. Mitral valve replacement or pediatric mitral lesions can cause problems such as a lack of growth potential. There re only limited experiences with mitral valve repair at any institution, so the purpose of his study is to evaluate the outcomes of mitral valve repair n pediatric patients. Material and Method: Sixty-four consecutive children (28 males and 36 females) with a mean age of $5.5{\pm}4.7$ years underwent mitral valve repair for treating their congenital mitral valve disease between January 1996 and December 2005. The patients were divided into two groups: group 1 (34 patients (53.1%)) had isolated disease (mitral anomaly with or without trial septal defect or patent ductus arteriosus) and group 2 (30 patients (46.9%)) had complex disease (mitral anomaly with concurrent intracardiac disease, except atrioventricular septal defect). Result: The overall in-hospital mortality was 6.3%; group 1 had 5.9% mortality and group 2 had 10.0% mortality. The postoperative morbidity was 18.8%; group 1 and 2 had 14.7% and 23.3% postoperative morbidity, respectively, and there as no significant difference among the groups. The median follow-up was 4.6 years range: $0.5{\sim}12.2$ years). The 10-year survival rate was 95.3%. The 10-year freedom from re-operation rate was 76.1% with 10 re-operations. The majority of the functional classifications were annular dilatation and leaflet prolapse. A mean of $2.1{\pm}1.1$ procedures per patient were performed. The echocardiography that was done at the immediate postoperative period showed a significant improvement in the mitral valve function. The follow-up echocardiographic results were significantly improved. However, mitral stenosis newly developed over time, and there ere significant differences according to the repair strategies. Conclusion: The patients who underwent mitral valve repair for congenital mitral anomalies showed good results. The follow-up echocardiography revealed satisfactory short-term and long-term results. Close follow-up is necessary to detect the development of postoperative mitral stenosis or regurgitation.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.361-364
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• 2001

자가 폐동맥 판막을 이용한 대동맥 판막 치환술을 항응고제 복용이 필요없고 내구성이 어느정도 입증되어 늘어나고 있으나, 자가 폐동맥 판막을 이용한 승모판막 치환술은 국내에 보고된 예가 없다. 53세 여자 환자로 류마티스성 승모판막 협차가 및 폐쇄부전, 삼첨판막 폐쇄부전, 만성 심방 세동, 그리고 자회전 관상동맥의 폐색등으로 진단받은 환자에서 자가 폐동맥 판막을 이용한 승모판막 치환술 및 maze 술식, 삼천판막 성형술, 관상동맥 우회수술을 시해하였다. 수술후 특별한 문제없이 회복하였으며 술후 시행한 심초음파 검사상 자가 폐동맥 판막의 이상 소견없이 잘 기능하고 있으며 항응고제 복용없이 잘 지내고 있다.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.727-732
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• 2007

Background: The reciptents of aortic valve replacement or a Bentall operation usually display various degrees of mitral regurgitation. When deciding whether or not to correct the mitral regurgitation, one must consider its severity, underlying causes and operative risk. Recently, the operation method for correcting the concomitant mitral regurgitation has been done through aortic root to reduce the operation time and the cardiac trauma. We report our experiences that transaortic mitral valve commissuroplasty done with aortic valve replacement or a Bentall operation has been a simple, less invasive, effective method in the operative management of mitral valve regurgitation without significant organic changes. Material and Method: Between June 2002 and June 2005, twenty patients under-went mitral valve commissuroplasty via the aortic root with aortic valve replacement (n=14) or a Bentall operation (n=7). The mitral valve regurgitation of the patients didn't exceed a moderate (grade 2) degree and there was no significant organic disease. The preoperative diagnosis of MR was established by TTE and intraoperative TEE, and the patients were followed postoperatively by TTE. The operative technique was a simple anterolateral commissuroplasty of the mitral valve with a single mattress suture via the transaortic annular approach after excision of the aortic valve leaflets. Result: The mean patient age was 56.2 years and 65% (n=13) were male. The preoperative MR was mild (grade 1) in 9 (45%), mild to moderate in 8 (40%), and moderate (grade 2) in 3 (15%) patients. There were no operative mortalities. The MR improved in all patients (p=0.002) and the left ventricular ejection fraction (LV EF) improved in 14 (70%) patients (p=0.005). The mean cross-clamp time for the patients who under- went aortic valve replacement with transaortic mitral repair was $62.1{\pm}13.9 min$ and this was $137.5{\pm}7.2 min$ for the patients who underwent a Bentall operation with transaortic mitral repair. Conclusion: For selected patients without significant mitral organic disease, transaortic mitral valve commissuroplasty combined with aortic valve replacement or a Bentall operation may be a feasible, effective method without adding significant aortic cross clamping time and more cardiotomy.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.667-673
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• 2007

Background: Patients with severe aortic valve disease frequently display mitral valve regurgitation (MR). In such patients, the clinical course of MR after isolated aortic valve replacement (AVR) may be important for determining the treatment strategies. After isolated AVR, the change of the concomitant moderate degree or less of MR according to the type of aortic valve disease is not known well. The aim of this study was to analyze the post-operative changes of MR after performing AVR in those patients with severe AS (Group S) and those with severe AR (Group R). Material and Method: We retrospectively evaluated 43 patients with severe aortic disease and a moderate degree or less of mitral valve regurgitation, and these patients underwent isolated aortic valve replacement from January 1996 to June 2005. The patients were divided into two groups: the aortic valve stenosis group (n = 29) and the aortic valve regurgitation group (n = 14). The patients underwent transthoracic echocardiography preoperatively and at 7 days, $6{\sim}10$ months and more than 18 months (mean follow-up duration: 38 months) postoperatively. Result: The mean age was 60.9 years (Group S: 62 years, Group R: 52.5 years) and 60% (Group S=55%, Group R=71%) of the patients were male. The preoperative MR was mild in 29 (67.5%), mild to moderate in 11 (25.5%), and moderate in 3 (6.9%) patients. In the Group S patients, MR improved in 16 (55%) patients at the immediate postoperative days and in 17 (59%) patients at more than 18 months postoperatively. On the other hand, all the Group R patients exhibited earlier improvement. The decrease of LA size had a similar pattern to the MR change, but there were no significant differences in the change of the ejection fraction of the two groups. Conclusion: In the patients with severe aortic valve disease and concomitant low grade MR, the MR after AVR improved earlier and more effectively in the patients with AR than in those patients with AS.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.722-725
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• 2004

Mitral valve surgery is most commonly performed through the left atriotomy via the inter-atrial groove or trans-septal approach. An alternative method for approaching to the mitral valve is via the dome of the left atrium located between the ascending aorta and superior vena cava. Although this approach was described 30 years ago, it has not been popularized in mitral valve surgery. We introduce our recent experiences with mitral valve surgery carried out through the dome of the left atrium with brief review of literature.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.320-328
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• 2008

Background: Numerous surgical devices for mitral repair have been used in the past with good results. In this study we describe a simple annuloplasty technique with using a new device ($Mitracon^{(R)}$). The aim of this study was to assess its efficacy and surgical results with using $Mitracon^{(R)}$. Material and Method: From May 2003 to October 2005, 46 patients (21 women and 25 men (mean age of $51.4{\pm}17.8$ years) with mitral regurgitation from various causes were treated with either the $Mitracon^{(R)}$ (the $Mitracon^{(R)}$ group) or the Capentier Edward rigid ring (the CE group). The median follow-up duration was 18.9 months. Result: The mean grade of mitral regurgitation before and immediately after surgery in the $Mitracon^{(R)}$ group and the CE group decreased from $3.2{\pm}0.8$ to $0.6{\pm}0.7$ and $3.4{\pm}0.7$ to $0.3{\pm}0.5$, respectively. There were no significant changes in the ejection fraction either between the two groups or before and immediately after surgery. No deaths were seen in either group. Early postoperative echocardiography of all 46 patients showed only trivial mitral regurgitation or none at all. Echocardiography at a median of 18.9 months also showed no progression in mitral regurgitation. The mean grade of mitral regurgitation in the $Mitracon^{(R)}$ group at this time point decreased from $3.2{\pm}0.8$ to $0.8{\pm}0.7$ (p<0.05). The CE group also showed a similar degree of decrease from $3.4{\pm}0.7$ to $0.3{\pm}0.6$ (p<0.05). The mitral valve area in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.3{\pm}0.9cm^2$. The mitral valve area in the CE group was $2.7{\pm}0.6cm^2$. The mean mitral pressure gradient in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.1{\pm}1.3$ mmHg. The mean pressure gradient in the CE group was $4.5{\pm}2.1$ mmHg, although any statistical significant difference for this between the groups was not reached. Conclusion: The present study showed the described technique to be safe and effective in the intermediate term. Because long term results are unavailable, a more extensive prospective randomized multicenter trial may be warranted to determine whether this procedure should be generally applied for repair of mitral valve disease.

• Journal of Chest Surgery
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• v.25 no.9
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• pp.921-924
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• 1992

기계판막의 가장 빈번하고 치명적인 결함이 판막혈전이다. 판막혈정의 적절한 조기 치료를 위해서는 조기진단이 선행되어야만 한다. Cineradiography는 조기에 손쉽고, 빠르게 기계판막의 기능장애를 진단하는 방법으로 사료되며 저자들은 42세된 남자 환자에서 29mm Carbomedics 판막으로 승모판막 치환술을 시행한 1례와 58세된 여자 환자에서 승모판막 및 대동맥판막에 각각 25mm, 19mm Carbomedics 판막으로 치환술 후 각각 18개월, 20개월 후 기계판막 혈전이 발생하여 cineradiography로 손쉽게 진단하여 치료하였으므로 보고하는 바이다.