• Journal of Chest Surgery
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• v.29 no.12
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• pp.1347-1353
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• 1996

To assess the long-term results of mitral valve replacement, we reviewed our cases of the 374 patients undergoing mitral valve replacement between March 1982 to February 1992 There were 159 male and 215 female and mean age was 37.8 years. There were 24 hospital deaths(6.4%);the most commonly from low cardiac output syndrome(12 deaths). We used 314 mechanical valves and 60 tissue valves. Most of all were anticoagulated with coumadin maintaining target level of 1.5~3.0 INR of prothrombin time. Follow up was 94% complete(2270 patient-years). There were 12 late deaths 3 due to hemorrhage, 3 due to cerebral embolism and 6 from Overall actuarial survival including hospital mortality, was 82.3% after 10 years of operation Linealized rates of late complication events are follows thromboembolism, 1.3% per patient-year; anti coagulant related hemorrhage, 0.5% per patient year. We analyzed the factors of favorable effect to postoperative course were preoperat ve clinical status including NYHA class, first operation, valve apparatus preservating operation technique, not biggest size of prosthetic valve.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.242-246
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• 1998

From January 1988 to December 1995, 27 patients, 11 men and 16 women, underwent surgical intervention at our institution for prosthetic valve dysfunctions. The mean age was 43.5$\pm$12.2 years. Seventeen(63.0%) patients had the mitral valve replacement, 8(29.6%) the aortic valve, 1(3.7%) the aortic composite graft, and 1(3.7%) the tricuspid valve. Mean follow-up period was 49.5$\pm$30.9 months. In 12 bioprostheses, mean interval between the previous valve replacement and the reoperation was 104.9$\pm$34.9 months. The causes of redo surgery were structural deterioration of the prosthetic valve (12/12, 100%), paravalvular leak (2/12, 16.7%), and prosthetic valve endocarditis(1/12, 8.3%). In 15 mechanical prostheses, the mean interval was 55.2$\pm$43.7 months. The causes of redo surgery were pannus formation (8/15, 53.3%), paravalvular leak(4/15, 26.7%), and valve thrombosis(3/15, 20.0%). Posto- perative complications occurred in 7 patients (25.9%). There was no intraoperative death. But one patient, who received mechanical aortic valve replacement died on the 3rd postoperative day due to low cardiac output and multiorgan failure.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.373-377
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• 1997

Between January, 1991 and May 1995, mitral valve repair was undertaken on 32 patients under 15 years for congenital mitral regurgitation. Mean age was 24.0$\pm$26.1 months(range 3 months to 15 years), 16 patients were male and 16 patients were female associated cardiac anomalies were found in 26 patients (81%), and ventricular septal defects were noted in 18 patients(56%). In regards to pathologic findings, there were annular dilatation(n:7), leaflet prolapse(n=18), cleft leaflet(n=5) and restricted valve motion (n=2). The method of repair consisted of annuloplasty(Modif ed Devega type) in 14, repair of redundunt leaflet in 6, closure of cleft in 5, triangular resection in 2 and splitting of papillary muscle in one. There was no operative mortality and two late deaths occurred as a result of heart failure and sepsis. Tro patients required replacement of the mitral valve after 3 months and 7 months respectivehy because of recurrent mitral regurgitation. Actuarial survival was 92.5% at 46 months and actuarial freedom from reoperation was 95% at 12 months and 92.5% at 46 months. Actuarial freedom from valve repair failure was 68% at 12 months and 61.8% at 46 months. Although valve repair failure rate was high, we believe that mitral valve repair should be of rcrred to children because of low mortality and low reoperation rate.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.703-709
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• 2008

Background: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. Material and Method: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echo-cardiograms to find potential preoperative risk factors. Result: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was $54.5{\pm}14.3$ years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was $4.3{\pm}1.8$ (range $1.1{\sim}8\;cm$)cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down. to the mitral. annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was $5.1{\pm}1.0\;cm$, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was $36.2{\pm}37.5$ months, with recurrence reported in 2(2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. Conclusion: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.862-865
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• 2003

Obstructive intracardiac lesions, like mitral stenosis or insufficiency (MR), by myxomas of the left atrium have been commonly reported, but the attenuation of MR by myxoma combined with coronary artery disease is very rare. We report a 70-year-old female patient whose left atrial myxoma had attenuated moderate MR to mild MR and required mitral valve surgery after removal of the myxoma. She also had coronary artery disease, severe pulmonary hypertension and moderate tricuspid regurgitation due to the mitral valve lesions obstructed by myxoma. The patient underwent removal of myxoma, mitral and tricuspid valve reconstructions, and coronary artery bypass grafting. She was discharged at the postoperative 14 day without any problems.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.559-569
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• 2004

The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.157-163
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• 1996

Between January 1986 and June 1994, 23 patients underwent surgical intervention for infective endocarditis at Wonkwang University Hospital. There were 13 male and 5 female, ran ing in age from 13 to 67(mean 43.7 $\pm$ 5.8) years. 21 had native valve endocarditis and 2 had prosthetic valve endocardits. The most common causative organism was streptococci in 9 patients, and the others were staphylococci in 7 patients and unknown in 7 patients. The infection was in the mitral valve in 10 patients, the aortic valve in 6 patients, the aortic and mitral In 5 patients, 2 in tricuspid. Surgical indications for surgery were intractable congestive heart failure, giant growing vegetation and severe valvular insufficiency. There were 3 perioperative death (13%) and no late death. The main causes of death were cerebral embolism in 2 due to recurrent endocarditis and low cardiac output in 1. By NYHA functional classification, all patients were in class III or IV preoperatively, and all patients were improved postoperatively with HYHA functional classification in class I or II. In conclussion, early operative intervention is life-salving in patients with persistent or progres ive congestive heart failure, irrespective of the activity of the infectious process or the duration of antibiotic therapy.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.290-301
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• 2020

The surgical technique of mitral valvuloplasty or transcatheter mitral valve (MV) replacement has been developed recently. Surgeons and interventionists require detailed anatomical information on the MV for the purpose of treatment planning. In this review, we discussed the anatomic features of the MV on CT and the method of evaluating the MV for treatment planning, as well as its preservation, for interventional procedures.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.252-255
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• 2001

본 30세 여환은 류마치스성 심장판막질환 진단하네 승모판막 및 대동맥판막 치환술 시행후 종격동염 발생하여 지속적 종격동 세척 및 3주간의 항생제 치료후 퇴원하였다. 외래 추적중 다시 감염 및 염증소견 보여 입원하여 혈액배양검사와 흉부전산화 단층촬영시행하였다. 검사상 종격동염의 이후 3주간의 항생제 치료에도 염증 소견이 지속되어 다시 시행한 흉부 전산화단층촬영상 상행대동맥에 거대 가성대동맥류소견보여 재개흉술을 시행하여 초저체온 완전 순환정지 하에 가성대동맥류를 절제한 후, 우심낭편을 이용하여 대동맥 성형술을 시행하였다. 수술후 환자는 순조롭게 회복하였으며 현재 외래에서 추적관리하고 있다.

• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.63-63
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• 1995