• Journal of Chest Surgery
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• v.34 no.2
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• pp.118-124
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• 2001

배경: 승모판막재건술이 승모판막치환술보다 술후 좌심실기능이 보다 향상될 수 있으며 또한 수술사망율과 인공판막에 관련된 합병즈인 혈전색전증, 심내막염 및 항응고제사용에 따른 출혈빈도는 낮다고 하였다. 방법: 1996년 1월부터 2000년 5월까지 승모판막폐쇄부전으로 진단된 환자 87례를 대상으로 재건술군 59례, 치환술군 28례로 나누어 비교분석하였다. 결과: 술전 환자들의 NYHA 기능분류, 흉부 X-선상 심흉곽의 비, 심초음파상 좌심실박출계수는 두 군간에 유의한 차이가 없었다. 원인질환은 양군에서 퇴행성 병변이 가장 많았다. 체외순환시간은 재건술군에서 유의하게 길었으나 수술사망은 양군에서 없었다. 술후 NYHA 기능분류, 흉부 X-선상 심흉곽의 비는 향상되었으나 두 군간에 차이가 없었으며 술후 좌심실박출계수는 두 군에서 감소되었으나 유의한 차이는 없었다. 결론: 이상의 결과로 승모판막폐쇄부전에 대하여 재건술이 치환술처럼 비교적 안전하게 시행될 수 있는 술식으로 사료된다.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.10-15
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• 1999

Background: Mitral valve replacement with chordal preservation in patients with mitral regurgitation has been proved to be beneficial for left ventricular function and for reduction of postoperative complication. However, in patients with mitral stenosis, the effectiveness of the technique is controversial. It is not easy to insert prosthetic valve without left ventricular outflow tract obstruction and prosthetic valve leaflet motion hinderance. Material and Method : Five patients with mitral stenosis and seven patients with mitral stenoinsufficiency underwent mitral valve replacement with preservation of mitral subvalvular apparatus. Thickened and calcified leaflets are made thin by peeling off the thickened and calcified part. Commissurotomy was done and anterior leaflet was incised 2 mm apart from the annulus and then divided into two segments. Anterolateral and posteromedial segments including strut chordae, were reattached to mitral commissural area, respectively. Result: There was no evidence of prosthetic valve dysfunction, paravalvular leakage, left ventricular outflow tract obstruction, complications and operative or late deaths. Conclusion: We conclude that mitral vlave replacement with chordal preservation was safe and effective technique for the patients with mitral stenotic disease.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.928-928
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• 2003

승모판성형술 직후에 시행한 재수술에 대한 연구보고는 많지 않다. 저자들은 승모판성형술 직후 성형술 실패로 판단되는 환자에서 즉시 시행한 재수술 결과에 대해 알아보았다. 대상 및 방법: 1995년 4월부터 2001년 7월까지 세종병원에서 승모판성형술을 받은 환자 중 체외순환 이탈 직후 시행한 경식도초음파 검사에서 승모판막폐쇄부전 혹은 협착이 의미있게 잔존하거나 다른 이유로 재수술이 즉시 필요하였던 18명을 대상으로 후향적으로 조사하였다. 남녀비는 5 : 13이었고 평균 연령은 44세였다. 승모판막 질환은 폐쇄부전 12명, 협착 3명, 그리고 혼합형이 3명이었다. 원인은 류머치스성 9명, 퇴행성 8명, 그리고 심내막염이 1명이었다. 재수술의 원인은 잔존 승모판폐쇄부전 13명, 협착 4명, 그리고 좌심실천공이 1명이었다. 14명(77.8%)에서 재성형술을, 4명에서는 인공기계판막치환술이 시행되었다. 결과: 조기사망은 없었다. 조기결과는 승모판막치환을 한 4명을 제외한 14명 중 13명(92.9%)에서 0-I도의 폐쇄부전을 보였고 협착은 14명 모두 경도 이하 상태였다. 평균 33개월을 추적조사 한 결과 1명이 술 후 4개월 후 심기능부전으로 사망하였다. 승모판폐쇄부전은 9명(64.3%)에서 0-I도를, 승모판협착은 11명(78.6%)에서 경도 이하였고 재수술은 1명에서 시행되었다. 6년 생존율과 재수술로부터의 자유도는 각각 94%와 90%였다. 4년 후 승모판폐쇄부전 및 협착 재발로부터의 자유도는 각각 56%와44%였다. 결론: 승모판막성형술 직후 재수술은 양호한 조기 및 중기 생존율을 보이며 일차성형술 실패 후에도 높은 빈도에서 재성형술이 가능하다. 하지만 재성형술 시 특히 류머치스성 판막질환에서는 판막 기능부전 발생률이 높기 때문에 성형술 후 판막부전의 재발을 줄이기 위해서는 성형술의 적절한 적용 및 적응증 선별이 중요할 것으로 생각된다.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.247-254
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• 1998

A total of 172 cases of MVR using the St. Jude Medical valve was conducted in the period from August 1986 to May 1996. The hospital mortality rate was 3.5% (n=6) and the late mortality rate was 3.3% (n=5). According to the follow-up of 161 surviving patients, the average length of survival was 50.23$\pm$0.27 months. Three cases of prosthetic valve related complication deaths were identified. Two cases could be ascribed to left atrial thrombi and resulting cerebral infarction, and one case was prosthetic valve endocarditis. Two cases were caused by hemorrhagic complications that we presume to have been accompanied by anti-coagulation therapy. The actuarial survival rate of all cases at 10 years was 92.3%. We conclude that good clinical results and a low complication rate could be achieved through mitral valve replacement with the St. Jude Medical valve. We also conclude that mid-term and long-term follow-ups were instrumental and necessary.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.268-272
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• 2008

Paravalvular abscess is defined as infective necrosis of the mitral annulus and surrounding tissue that requires debridement of the necrotic tissue and patch reconstruction before valve implantation. Paravalvular abscess is associated with high operative mortality, postoperative complications, and recurrence. We report here a case of a 59-year old woman that had undergone mitral valvular replacement with a mechanical valve 13 years ago. The patient was determined to have paravalvular leakage due to paravalvular abscess as seen during follow-up. The patient underwent repeat mitral valvular replacement with annular reconstruction. However, the patient with mitral annular reconstruction and valvular replacement on the fifteenth postoperative day due to recurrence of paravalvular leakage. The patient is now receiving follow-up eight months after surgery.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.353-357
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• 1999

Background: Mitral valve replacement(MVR) with chordal preservation in patients with mitral vlavular disease has been proven to be beneficial for left ventricular function and for reduction of postoperative complication. Material and Method: From January 1995 to July 1996, the early postoperative results of mitral valve replacement were compared between 20 patients who underwent chordae resection(classic MVR group) and 10 patients who underwent chordae preservation(preservation MVR group) in the Department of Thoracic and Cardiovascular Surgery, Chunbuk National University Hospital. Result: There was no significant difference between the two groups in age, sex, NYHA functional class, cardiothoracic ratio, echocardiographic finding, cardiopulmonary bypass time and aortic cross clamping time. The difference between preoperative and postoperative cardiothoracic ratio after 3 months was not statistically significant. At echocardiographic left ventricular evaluation, ejection fraction and fractional shortening decreased slightly in the preservation group then preoperative value (p=0.47, p=0.12), however, decreased significantly in the classic MVR group(p=0.03, p=0.04), and were statistically significant between the two groups(p=0.03, p=0.02). Conclusion: We conclude that MVR with chorda preservation seems to have a beneficial effect on postoperative left ventricular performance in mitral valve disease than the classic MVR.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.820-827
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• 2003

Background: Mitral valve repair rather than replacement for mitral regurgitation (MR) offers a number of well-accepted benefits. However, the surgical results of repair for mitral valve endocarditis remain largely unknown. Material and Method: Fourteen patients who underwent mitral valve repair for MR caused by mitral valve endocarditis from April 1995 through October 2001 were reviewed retrospectively. There were 9 male patients and mean age was 32$\pm$10 years. Four patients had previous embolism and 2 had active infections. The grade of MR were III in 6 patients and IV in 8. Operatively, mitral annuloplasty was performed in 12 patients and various valvuloplasty techniques were applied in all patients. One patient had immediate valve replacement due to residual MR after weaning of cardiopulmonary bypass. Result: There was no early operative death. Early postoperative transthoracic echocardiography revealed no or grade I of MR and no or mild mitral stenosis in 13 patients. After the mean follow-up of 36 months, there was no late death, and no or grade I of MR in 11 patients (84.6%) and no or mild mitral stenosis in 12 patients (92.3%). Reoperation required in one patient (7.1%). The cumulative freedom from recurrent MR and valve-related reoperation at 5 years were 91$\pm$9% and 75$\pm$22%, respectively. Conclusion: This study suggests that mitral valve repair for mitral regurgitation caused by endocarditis offers good early and intermediate survival and functional improvement without reinfection, and it is an attractive alternative to valve replacement in selective patients with bacterial endocariditis.

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.118-118
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• 1996

• Journal of Chest Surgery
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• v.29 no.9
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• pp.951-958
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• 1996

Bet een November 1991 and December 1993, twelve patients (Male: 2, Female: 10) who had mitral valve disease without primary pulmonary disease underwent mitral valve replacement. The pulmonary function test (PFT) was performed preoperatively and postoperatively (mean, 9 months after operation). Mitral valve replacement was indicated for mitral stenosis in 9 patients and for mitral insufficiency in 3 patients. Preoperative WHh functional class were 111 in 11 patients and class rV in 1 patient. Postoperatively, ten patients (83 %) were classified into NYHA functional class 1. There was a significant decrease in cardiothoracic ratio (CTR) postoperatively (p< 0.05). The pulmonary function before operation was low compared with predicted values in vital capacity (VC) and forced mid-expiratory flow (FEF 25∼75 %). The FEF 25%-75% and maximal voluntary ventilation (MW) were low compared with predicted values postoperatively. There was no significant difference in the pulmonary function before an after op- eration. Twelve patients were divided into 2 groups according to the early postoperative NYHA functional class. In class I group, the postoperative pulmonary function was significantly improved in 6 parameters (RV, FRC, TLC, FEVI , FEVI /FVC, and FEF 25∼75%), but in class ll group, there was no significant change in the pulmonary function after operation.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.444-447
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• 2003

Sleeve pneumonectomy can be a method of treatment in a selected patient with bronchogenic carcinoma involving carina. A 64 years old male with a history of mitral valve replacement via midsternotomy 13 years ago and resection of papilloma of the vocal cord 2 years ago. The patient was admitted due to blood-tinged sputum. Bronchoscopy and computerized tomogram of the chest revealed 3.5 cm mass at lower margin of the trachea and totally obstructing the left main bronchus. A biopsy revealed squamous cell carcinoma. He underwent left sleeve pneumonectomy through sequential bilateral thoracotomy without cardiopulmonary bypass, and the pathologic stage was T4N0M0 stage IIIB. The patient is being followed through the outpatient clinic in good general condition.