• Journal of Chest Surgery
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• v.34 no.1
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• pp.51-56
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• 2001

배경: 이상적인 판막의 개발이 있기 전에는 가능하다면 원래의 판막을 보수하는 것이 좋을 것이라는 생각이 당연하며 실제 임상연구가들은 기술적으로 가능하다면 판막재건술이 판막치환에 비해 대단히 좋은 임상경과를 취한다고 보고하고 있다. 그러나 판막 치환례에서 수술성적과 임상성적이 오히려 좋게 나타나는 경우 이유가 있을 것이고 그 근본원인은 심실의 기능에 따라 좌우되리라는 가설 하에 이를 규명하고자 하였다. 대상 및 방법: 순수승모판막폐쇄부전증으로 수술 받은 40명의 환자를 대상으로 하여 고전적 판막 치환술을 시행한 12례를 1군으로, 후엽을 보전한 18례를 2군으로 그리고 성형수술을 시행한 10례를 3군으로 나누어 수술전의 심에코 소견을 포함하여 입원시에 시행한 전신상태와 수술 후 4주 이내에 시행한 심에코도의 각종 지표를 시행하였다. 결과: 일반적인 환자의 상태변화로는 1군에 비해 2군, 3군에서는 더 나은 결과를 보였으나, 통계적인 차이는 발견할 수 없었다. 뉴욕 심장협회의 분류에 따라서는 수술전보다 많은 호전이 보였으나 세군간의 유의한 차이는 발견할 수 없었다. 심에코도에 따른 심기능을 비교한 바에 의하면 1군에서는 오히려 나빠졌으며 2군, 3군에서는 수술직후에는 술전에 비해 별 차이가 없으며 회복후에는 모든 지표에서 의미있는 호전을 발견할 수 있었으나, 구별분획에 있어 두 군간에는 수술전, 수술후, 회복후의 상호간의 통계적으로 의미 있는 차이는 발견되지 않았다. 결론: 심기능의 차이가 나므로 승모판막폐쇄부전증에 대한 수술로는 가능한한 판막 성형술이 좋고, 판막 성형술이 불가능한 변형이 많은 경우 판엽 일부를 보전이라도 하는 것이 좋다.

• Journal of Chest Surgery
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• v.40 no.8
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• pp.536-545
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• 2007

Background: Compared to adult patients, mitral regurgitation in pediatric patients is uncommon and it shows a wide spectrum of morphologic abnormalities. We retrospectively evaluated the midterm results of mitral valve repair in pediatric patients. Material and Method: Between December 1993 and August 2006, mitral valve repair was performed in 35 patients who were aged less than 18 years, The mean age was $5.3{\pm}5.3$ years and the mean body weight was $20,0{\pm}16.3\;kg$. 18 patients had associated cardiac anomalies. The most common pathologic finding was leaflet prolapse (n=17). The most common method of repair was the double orifice technique (n=15). Result: There was no early mortality. Eight patients underwent reoperation (24.2%), and five of them required mitral valve replacement. Among the four ring annuloplasty cases, two have developed mitral stenosis. Four out of the 14 double orifice cases required reoperation. One case of early mortality and one case of late mortality occurred in the reoperation cases. The 5-year survival rate and the freedom from reoperation rate were $93.3{\pm}4.6%$ and $76.1{\pm}8.2%$, respectively. The 5-year freedom from mitral valve replacement rate was $83.6{\pm}6.7%$. There was no significant risk factor for reoperation. Conclusion: The midterm results of mitral valve repair are very acceptable in pediatric patients compared to the adult cases, although the reoperation rate is slightly higher.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.60-63
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• 2002

Edwards Duromedics mechanical valve was introduced into clinical use in 1982 and is still being used today after several modifications. Valve-related complications after mechanical valve replacement are thiombo-embolism, endocarditis, valve malfunction, valve leaflet escape and fracture. Incidence of valve leaflet escape is very low. A 40 year-old male patient who had undergone mitral replacement with a 31mm Edwards Duromedics mechanical valve(model

• 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.29 no.10
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• pp.1090-1094
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• 1996

From February 1980 to September 1995, 31 children between 2 months and 15 years of age with mitral valve disease have undergone mitral valve replacement(MVR) at Yonsei Cardiovascular Center and com- plete follow-up has been obtained on 28 patients. There were 10 males and 18 females whose weight ranged from 4.9kg to 56kg. Two patients died early postopeiatively and the overall hospital mortality rate was 7.1%. These two were infants but there were no statistically significant difference in overall mortality among the age groups(p=0.13). The valve related complication rate was 57.1% in children younger than 5 years of age, which showed higher complication rate compared to older patients(p< 0.05). The bioprosthetic valve have been applied in 7 patients, and its 5-year valve failure-free survival rate was 50% . No mechanical valve failu e had occurred in 21 patients. In considering high re-replacement rate of bioprosthetic valve, mechanical valve is recommended despite its possibility of bleeding and thromboembolic complications. However, the consequences of increasing body size and long-term interposition of a rigid prosthesis in a growing heart will require second valve replacement. En conclusion, mitral valve replacement can be performed tilth satisfactory long-term survival in children, although younger mean age of the children has an important influence on early mortality and com- plication rate. And therefore mitral valve replacement in children younger than 5 years of age needs special consideration.

• 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.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.221-225
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• 1998

From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years(mean, 53). Thirteen patients were in New York Heart Association(NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty(16 cases), rectangular resection of posterior leaflet(15 cases), chordal shortening(5 cases), triangular resection of anterior leaflet(2 cases), commissurotomy(2 cases), partial transposition of posterior leaflet(1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.523-528
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• 2005

Background: Investigation of the change of ventricular function and mitral regurgitation after surgical repair of patient with anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is key issue for the better surgical outcome. Material and Method: From April 1986 to July 2002, 12 patients presented with ALCAPA. The median age at repair was 4 months. Surgical methods included left coronary artery transfer to the aorta (10), Takeuchi procedure (1), saphenous vein free graft bypass (1). Mitral valve was repaired in 1. Result: There were 2 hospital death $(16.7\%)$. The mean follow-up period was $7.1\pm4.1$ years (range, 7 months to 13 years). Four patients required postoperative circulatory assist for $2.2\pm1.1$ days and one needed left ventricular assist device (LVAD) for 1day. Postoperative echocardiography demonstrated significant improvements in mean fractional shortening $(33.4\pm9.1\%\;vs\;17.7\pm9.6\%,\;n=10,\;p<0.05);$ left ventricular end diastolic dimension $(33.4\pm7.3\;mm\;vs\;44.8\pm7.0\;mm,\;n=10,\;p<0.05)$ and systolic dimension $(22.2\pm7.5\;mm\;vs\;33.4\pm7.9\;mm,\;n=10,\;p<0.05)$. Severities of mitral regurgitation decreased in all survivors at 1st and 4th year follow-up echocardiography. There were 2 reoperation due to residual MR and right ventricular outflow obstruction (Takeuchi case). Conclusion: Anatomic repair of anomalous left coronary artery from the pulmonary artery offered an excellent surgical results, especially in terms of the recovery of left ventricle function and mitral regurgitation. However, preoperative indications for mitral procedure is to be evaluated.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.308-310
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• 1998

Minimally invasive techniques for various cardiac disease are widely accepted in these days. We report a successful case of reoperative mitral valve replacement approached successfully by a small right parasternal incision.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.705-711
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• 2002

The advantages of mitral valve reconstruction have been well established and so mitral valve reconstruction is now considered as the procedure of choice to correct mitral valve disease. This is the report of intermediate-term results of 38 cases that performed mitral valve reconstruction for valve insufficiency(the total number of mitral valve reconstruction were 49 cases, but 11 cases that performed mitral valve replacement due to incomplete reconstruction were excluded). Material and Method : From March 1991 to March 2001, 38 patients underwent mitral valve repair due to mitral valve regurgitation with or without stenosis. Mean age was 47.6$\pm$14.7 years(range 15 to 70 years) : 11 were men and 27 were women. The causes of mitral valve regurgitation were degenerative in 14, rheumatic in 21, infective in 2 and the other was congenital. Result : According to the Carpentier's pathologic classification of mitral valve regurgitation, 3 were type 1 , 16 were type II and 19 were type III. Surgical procedures were annuloplasty 15, commissurotomy 19, leaflet resection and annular plication 9, chordae shortening 11, chordae transfer 5, new chordae formation 2, papillary muscle splitting 2 and vegetectomy 2. These procedures were combined in most patients. There were 2 early death and the causes of death were respiratory failure, renal failure and sepsis. There was no late death. Valve replacement was done in 6 patients after repair due to valve insufficiency or stenosis 3 weeks, 1, 3, 51, 69, 84months later respectively. These patients have been followed up from 1 to 116 months(mean 43.0 months). The mean functional class(NYHA) was 2.36 pre-operatively and improved to 1.70. Conclusion : In most cases of mitral valve regurgitation, mitral valve reconstruction when technically feasible is effective operation that can achieve stable functional results and low surgical and late mortality.