• Journal of Chest Surgery
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• v.32 no.4
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• pp.373-378
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• 1999

Background: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. Material and Method: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. Result: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. Conclusion: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.755-758
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• 2008

We report here on a case of performing a redo-operation for a 65-years-old male patient who had prosthetic endocarditis after reconstruction of the fibrous skeleton due to infective endocarditis 8 years earlier. An aortic annular abscess with a 1cm sized subvalvular abscess and mobile mitral valve vegetation with destruction of the fibrous skeleton was shown on the preoperative echocardiography. An emergency operation was performed due to heart failure. Reconstruction of both the aortic and mitral annuli and the fibrous skeleton was done by using two separate bovine pericardial patches and then mechanical valves were implanted. The postoperative echocardiography shows no paravalvular leakage. The patient has been followed up with no symptoms.

• 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.35 no.11
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• pp.785-791
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• 2002

The results of reoperative valve replacement can be improved if appropriate analysis for the risk of reoperation was achieved. The purpose of our study was to analyze the results of reoperations for failure of bioprosthesis, and to define the risk factors in high-risk populations for reoperative procedures. Material and Method The series of 46 consecutive patients who had undergone first reoperative replacement for failed bioprosthesis between 1993 and 2001 were reviewed retrospectively. Mean age was 42 $\pm$ 12 years, mean body surface area was 1.52 $\pm$0.15 $m^2$. The reoperative procedure comprised of 36 MVR, 8 DVR, and 2 AVR. The first operation comprised of 2 DVR, 1 AVR, and 43 MVR. Factors which were choose to assess a predictor of results in reoperative valve replacement were sex, old age(＞60 years), early age at first operation(＜30 years), long interval between first and redo operation(.15years), poor NYHA functional class(＞3), LV dysfunction(LVEF＜45%), long operation time(＞8hours), endocarditis, combined procedures, and renal insufficiency, Result : Overall mortality was 4.3%(2 cases). The risk factors that influenced postoperative complications and unexpected postoperative results were lower ejection fraction(p＝0.012), older age(p＝0.045), endocarditis(p＝0.023), long operation time above 8 hours(p＝0.027). There was no statistically significant factor influencing hospital mortality. Conclusion : No factor influenced the mortality. Better results could be achieved if reoferation was performed carefully in poor left ventricular function, old aged patient, and with endocarditis. Effort to shorten the operation time would be helpful on postoperative results.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.561-565
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• 2001

Patients who have complex endocarditis with involvement of both the aortic and mitral valves and intervalvular fibrous skeleton are among the most difficult to treat and still have the highest surgical mortality and morbidity rates. We report one case of aortic and mitral valve replacement with reconstruction of the fibrous skeleton performed in a 55-year-old female patient who had an aortic annular abscess and both the aortic and mitral prosthetic valve endocarditis with destruction of the fibrous skeleton. Previously, she had undergone redo double valve replacement\`, Transesophageal echocardiogram showed the paravalvular defect at the noncoronary aortic sinus and abnormal sinus tract along the fibrous skeleton. Emergent operation was performed due to positive blood cultures of staphylococcus epidermidis and persistent sepsis despite appropriate antibiotic therapy. After aortotomy extended to the roof of left atrium, both prosthetic valves and destroyed fibrous skeleton were completely resected and the aortic annular abscess was debrided and closed with a bovine pericardial patch. Reconstructions of both aortic and mitral annuli and the fibrous skeleton were done by using two separate bovine pericardial patches in triangular shape and mechanical valves were implanted. Postoperatively, adequate antibiotic therapies were continued and the patient was discharged at the postoperative 72 days without evidence of recurrence of endocarditis. Transthoracic echocardiogram of the postoperative 8 months shows no paravalvular leakage or recurrence of endocarditis and the patient has been followed up with no symptom.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.347-352
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• 1999

Background: The atrial fibrillation in patients with mitral valvular heart disease is frequently converted to sinus rhythm after the mitral valve surgery. This sinus restoration implies an important meaning in that it not only helps postoperative convalescence in patients with unstable hemodynamics but also reduces the rate of postoperative thromboembolism. Material and Method: We retrospectively analyzed 184 patients who received mitral valve surgery from June 1986 to December 1996 to investigate the trend of rhythm change following mitral valve surgery and thus to clarify the predisposing factors of postoperative sinus rhythm conversion and its maintenance. Result: The sinus rhythm was restored after the operation in 54 out of 139 patients with atrial fibrillation preoperatively(38.8%). However, the atrial fibrillation recurred in 41 patients at the time of discharge showing a recurrence rate of 75.9 percent. The mean duration of sinus rhythm in patients with eventual atrial fibrillation recurrence was 8.2${\pm}$5.9 days. Only 15 patients were in sinus rhythm at the time of late follow-up with the mean follow-up period of 84.4${\pm}$34.7 months. While the age, duration of symptoms, duration of atrial fibrillation, left atral size, and pulmonary artery pressure were thought to be the predisposing factors for sinus conversion after the operation, only the duration of atrial fibrillation and ejection fraction were considered risk factors for the recurrence of the atrial fibrillation following sinus conversion. Conclusion: This study suggests that the early operation is mandatory for the satisfactory result regarding postoperative rhythm. Moreover, additional operative measure in adjunct to the intervention of mitral valve should be considered for the maintenance of restored sinus rhythm as reflected by high postoperative recurrence rate of atrial fibrillation.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.861-869
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• 1991

From August, 1986 to December, 1989, mitral valve replacement was performed in 93 patients. Of the valve implanted, 42 were Duromedics, 35 St. Jude Medical, 15 Carpenter-Edwards and 1 Ionescu-Shiley. The hospital mortality rate was 3.2%[3 patients] and the late mortality rate was 4.3% [4 patients]. The causes of hospital death were LV rupture in 1, renal failure in 1 and hypoxic brain damage in l. The causes of late death were congestive heart failure in 1 and sudden death in 3. Follow-up was done on 78 surviving patients; mean follow-up period was 29.22$\pm$9.09 months. The actual survival rate was 91.8% at 4 years. We concluded, therefore, that good clinical results could be achieved with mitral valve replacement in short-term follow-up, and long-term follow-up is also necessary.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.605-610
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• 1992

Improving intraoperative and postoperative myocardial protection and better construction and design of valvular prosthesis has reduced the mortality of MVR. But, ventricular rupture after MVR occurred occasionally and represented a potentially lethal complication. Transverse midventricular disruption presented as refractory myocardial failure immediately on termination of bypass or later often on initial period of good hemadynamics. From Jan., 1985 through Dec., 1991 131 MVRs were performed as isolated or combined procedures. Rupture of the posterior wall of left ventricle was observed in 2 patients. There were 2 type III ruptures Prevention is of utmost importance, and by taking certain precautions, the chance of ventricular rupture can be reduced. Repair should always be done by patch technique in the aid of the use of cardiopulmonary bypass with cardioplegic arrest. When the laceration is in the middle of the posterior left ventricle, external repair with the pericardial patch can be attempted first.

• Journal of Chest Surgery
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• v.28 no.12
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• pp.1113-1121
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• 1995

From August, 1986 to December, 1993, mitral valve replacement was performed in 178 patients. Of the valve implanted, 114 were St.Jude Medical, 47 Duromedics, 16 Carpenter-Edward and 1 Ionesc-Shiley. The hospital mortality rate was 2.8%[5 patients and the late mortality rate was 7.5%[13 patients . The causes of hospital death were LV rupture in 1, renal failure in 1, cardiac tamponade in 1, valve malfunction in 1 and hypoxic brain damage in 1. The causes of late death were sudden death in 6, congestive heart failure in 4, brain ischemic injury in 3. Follow-up was done on 155 surviving patients : mean follow-up period was 50.94$\pm$8.04 months. The actual survival rate was 88.2% at 8 years. We concluded, therefore, that good clinical results could be achieved with mitral valve replacement in mid-term follow-up, and long-term follow-up is also necessary.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.423-427
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• 1997

Hemoptysis occurs quite frequently as a consequence of mitral stenosis, but massive, lirE threatening pulmonary hemorrhage is distinctly unusual. We report a 30 year old female who underwent cmcrgcncy rcdo double valve replacement for intractable pulmonary hemorrhage. she underwent mitral valve replacement (lonescu Shirley 27 mm) due to rheumatic valvular heart disease in 1984 and tricuspid valve annuloplasty (Carpentier's rlng 30mm) two years later She was admitted for massive hcmoptysis and dyspnea on the 26th of December, 1995. Medical treatment including transarterial embolization was given but was not satisfactory. Emergency valve replacement (Mitral valve , 51. Judc 29mm and tricuspid valve ; 51. Jude 33mm) was performed and hemoptysis was controlled dramatically 24 hours after surgery.