• Journal of Chest Surgery
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• v.31 no.10
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• pp.939-944
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• 1998

Background: The sugical results of the Cox-Maze procedure (CMP) for lone atrial fibrillation(AF) have proven to be exellent. However, those for AF associated with mitral valve(MV) disease have been reported to be a little inferior. Materials and methods: To assess the efficacy and safety of the CMP as a combined procedure with MV operation, we studied retrospectively our experiences. Between April 1994 and October 1997, we experienced 70 (23 males, 47 females) cases of CMP concomitantly with MV operation. Results: The etiologies of MV disease were rheumatic in 67 and degenerative in 3 cases. The mean duration of AF before sugery was 66$\pm$70 months. Fifteen patients had the past medical history of thromboembolic complications, and left atrial thrombi were identified at operation in 24 patients. Twelve cases were reoperations. Aortic cross clamp (ACC) time was mean 151$\pm$44 minutes, and cardiopulmonary bypass (CPB) time was mean 246$\pm$65 minutes. Concomitant procedures were mitral valve replacement (MVR) in 19, MVR and aortic valve replacement (AVR) in 14, MVR and tricupid annuloplasty (TAP) in 8, MVR with AV repair in 3, MV repair in 11, MVR and coronary artery bypass grafting (CABG) in 2, MVR and AVR and CABG in 1, redo-MVR in 10, redo-MVR and redo-AVR in 2 patients. The rate of hospital mortality was 1.4%(1/70). Perioperative recurrence of AF was seen in 44(62.9%), and atrial tachyarrhythmias in 10(14.3%), low cardiac output syndrome in 4(5.7%), postoperative bleeding that required mediastinal exploration in 4(5.7%) patients. Other complications were acute renal failure in 2, aggravation of preoperative hemiplegia in 1, and transient delirium in 1 patient. We followed up all the survivors for 16.4 months(3-44months) on an average. Sinus rhythm has been restored in 65(94.2%) patients. AF has been controlled by operation alone in 73.9% and operation plus medication in 20.3%. Two patients needed permanent pacemaker implantation; one with sick sinus syndrome, and the other with tachycardia- bradycardia syndrome. Only two patients remained in AF. We followed up our patients with transthoracic echocardiography to assess the atrial contractilities and other cardiac functions. Right atrial contractility could be demonstrated in 92% and left atrial contractility in 53%.We compared our non-redo cases with redo cases. Although the duration of AF was significantly longer in redo cases, there was no differences in ACC time, CPB time, postoperative bleeding amount and sinus conversion rate. Conclusions: In conclusion, the CMP concomitant with MV operation demonstrated a high sinus conversion rate under the acceptable operative risk even in case of reoperation.

• Proceedings of the KTCVS Conference
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• 2004.06a
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• pp.51-54
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• 2004

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.357-365
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• 2005

Background: Patients with mitral regurgitation (MR) in the setting of coronary artery disease have a dismal long-term prognosis whether treated medically or surgically. Moreover, the optimal management of moderate ischemic MR at the time of coronary artery bypass grafting (CABG) remains the subjects of controversy. Thus, the present retrospective study was undertaken to determine whether mitral valve surgery for moderate ischemic MR at the time of CABG would be preferable to CABG alone in terms of clinical outcome. Material and Method: Between January 1997 and December 2003, 34 patients with moderate (Gr 3/4) ischemic MR underwent CABG alone (Group I, n=23) or CABG plus mitral valve surgery (Group II, n=11). Operative mortality, long-term survival and echocardiographic parameters were used to evaluate the efficacy of mitral valve surgery in patients with moderate ischemic MR. The mean follow-up durations of each group were $69.3\pm4.3$ months and $53.1\pm4.9$ months respectively. Result: There was no hospital mortality in both groups. There was one case of late mortality in Group I. The mean number of bypass graft was similar ($3.8\pm1.2\;vs\;3.7\pm1.3$ respectively). Cardiopulmonary bypass time was longer in group II (p=0.014). In group II, all of the patients received mitral annuloplasty using ring. On immediate postoperative echo-cardiogram, mitral regurgitation was reduced more in group II (p=0.002). Echocardiogram performed at last follow-up state showed no difference except the grade of MR between the two groups. Actuarial survival of both groups at 5 years was similar ($95.5\%\;vs\;100\%$, p=0.48). Conclusion: This study shows that in selected patients with moderate ischemic MR, CABG without mitral valve surgery might be sufficient. However, patients with low EF and NYHA functional class pre-operatively had tendency of significant residual MR, so mitral valve surgery should be necessary in these patients, and moreover, MR severity and left ventricle volume decreased more in mitral valve surgery group. Therefore, more large-scale studies are necessary to determine these effects on the ventricular function and long-term survival.

• 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.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1183-1194
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• 1998

Background: From Sept. 1985 to Sept. 1997, 2,000 cases of open heart surgery(OHS) were performed in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. Material and Method: Among the total of 2,000 cases of OHS, 1532 cases were congenital heart disease(CHD) and 468 cases were acquired heart disease(AHD). The age distribution was 9 days(4.0kg) to 68 years in CHD and 11 to 66 years in AHD. In 1532 cases of CHD, there were 1403 acyanotic cases and 129 cyanotic cases. Result: The CHD cases consisted of 940 ventricular septal defects(61.4%), 324 atrial septal defects(21.1%), 112 tetralogy of Fallot(7.3%), 46 pulmonary stenosis(3%), 38 endocardial cushion defects(2.5%), 15 valsalva sinus ruptures(1%), 4 transposition of great arteries (0.3%), 4 double outlet right ventricles(0.3%), and etc. Corrective operations were applied for congenital heart disease with a result of 3.1% hospital mortality. Of 468 AHD, 381 cases were valvular heart diseases, 48 ischemic heart diseases, 12 cardiac tumors, 8 annuloaortic ectasias, 16 dissecting aortic aneurysms and etc. In the 381 valvular heart diseases, there were 226 single valve replacements(36 aortic valve replacements(AVR), 188 mitral valve replacements(MVR), and 2 tricuspid valve replacements(TVR), among these were 71 cases of double valve replacements(AVR & MVR), 54 cases of MVR with tricuspid valve annuloplasty(TVA), and 18 cases of AVR, MVR with TVA. The total implanted prosthetic valves were 466. In MVR, 123 St. Jude Medical valves, 90 Carpentier-Edwards valves, 65 CarboMedics valves, 42 Sorin valves and 16 other valves were used. In AVR, 68 St. Jude Medical valves, 36 CarboMedics valves, 14 Carpentier-Edwards valves and 9 other valves were used. Coronary Artery Bypass Surgery(CABG) were performed in 48 cases. The patterns of bypass graft were 14 patients of single vessel graft, 21 patients of two vessels graft, 10 patients of three vessels graft and 3 patients of four vessels graft. Conclusion: The hospital operation mortality rate of congenital acyanotic, cyanotic and acquired heart diseases were 2.0%, 15.5%, and 5.1% respectively. The overall mortality rate was 3.6%(72/2,000).

• 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.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.43 no.5
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• pp.475-481
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• 2010

Background: We evaluated mid-term results of mitral annuloplasty using a flexible band and a completely rigid ring for mitral valve repair in patients with degenerative mitral regurgitation (MR). Material and Method: From January 2004 to September 2008, 71 patients (M:F=36:35, $55{\pm}13$ years) underwent mitral valve repair with mitral annuloplasty for degenerative MR. Ring annuloplasty was done using a Cosgrove-Edwards flexible band (Group I, n=43) or a Carpentier-Edwards classic ring (Group II, n=28). There were no differences in preoperative characteristics of the participants. Average duration of follow-up was 36 months (range: 2~69 mos). Result: There was no in-hospital mortality. Postoperative morbidity, which included atrial fibrillation (n=7) and low cardiac output syndrome (n=5) in groups I and II were similar. There was one late death in group II. The proportion exhibiting freedom from recurrent mitral regurgitation ($\geq$moderate) at 4 years in Groups I and II were, respectively, 94.5 and 91.8%, (p=0.695). Left ventricular ejection fraction decreased in the early postoperative period ($7{\pm}2$ days) and recovered by last follow-up ($25{\pm}16$ mos; p=0.002). The pattern was similar in groups I and II (p=0.905). Re-operation was performed in 3 patients (1 in Group I and 2 in Group II, p=0.316). Four-year event-free survival (free of adverse valve-related events) was 95.2% for Group I and 92.6% for Group II; this difference was not significant, p=0.646). Conclusion: The type of technique used in mitral annuloplasty to repair the mitral valve repair after degenerative MR did not affect mid-term clinical and functional results.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.60-62
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• 2007

Pulmonary hypoplasia is an entity of pulmonary agenesis. Pulmonary agenesis is a rare congenital anomaly, usually diagnosed soon after birth. It is commonly associated with other anomalies, mainly of the cardiovascular systems. Although it may hasten the death of a child, sometimes it is compatible with normal growth. We report a right lateral thoracotomy approach for mitral valve repair in a young woman with pulmonary hypoplasia, in whom preoperative computed tomography showed severe right side shifting of the mediastinum and total collapse of the right lung.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.855-858
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• 2007

A left ventricular rupture might be one of the most disastrous complications after a mitral valve replacement. An acute atrioventricular groove rupture (type I) was detected in a 54-year-old female diagnosed with a mitral stenosis combined with severe tricuspid regurgitation. She had a prior medical history of an open mitral commissurotomy in Japan at 30 years ago. The surgical findings suggested that the previous procedure was not a simple commissurotomy but a commissurotomy combined with a posteromedial annuloplasty procedure. After a successful mitral valve replacement and a measured (De Vega type) tricuspid annuloplasty, the weaning from a cardiopulmonary bypass was uneventful. However, copious intraoperative bleeding from the posterior wall was detected and the cardiopulmonary bypass was restarted. Exposure of the posterior wall of the left ventricle showed bleeding from the atrioventricular groove 3 cm lateral to the left atrial auricle. Under the impression of a Type I left ventricular rupture, epicardial repair (primary repair of the Teflon felt pledgetted suture, continuous sealing suture using auto-pericardial patch and application of fibrin-sealant) was attempted. Successful local control was made and the patient recovered uneventfully. The patient was discharged at 14 postoperative days without complications. We report this successful epicardial repair of an acute type I left ventricular rupture after mitral valve replacement.