• Journal of Chest Surgery
• /
• v.33 no.11
• /
• pp.863-868
• /
• 2000

배경: Cox-Maze III (CM-III) 술식은 복잡한 심방 절개로 인한 긴 수술시간 때문에 다른 개심 수술과 병행하여 시행하기 어려운 단점이 있다. 대상 및 방법: 저자들은 CM-III 술직을 다음과 같이 변형하여 시행하고 그 임상성적을 분석하였다. \circled1 좌심방이를 절제하는 대신 좌심방이를 외부에서 결찰하고, \circled2 폐정맥 분리 절개선과 좌심방이 사이에 냉동절제술을 시행하며, \circled3 우심방이를 절제하는 대신에 우심방 외측 절개선을 우심방이까지 연장하고, \circled4 후종 우심방 절개 하부에서 우심방 외측을 지나 삼첨판막륜으로 향하는 T-자 절개선을 생략하였다. 저자들이 시행한 변형 술식의 용이성과 효율성을 평가하기 위하여, 우리나라에서도 빈도가 높은 류마치스성 승모판막 질환에서, 전통적인 Cox-III 술식(그룹 I)의 임상결과와, 변형된 CM-III 술식(그룹 II)의 임상결과를 비교하였다. 결과: 그룹 I(n=18)에서 동반된 수술은 승모판막 치환술 10례, 승모판막 성형술3례, 승모판막 치환술과 삼첨판막륜 성형술3례, 승모판막 재치환술 2례 등이었다. 그룹II(n=23)에서 동반된 수술은 승모판막 치환술 7례, 승모판막 성형술 5례, 승모판막 치환술과 삼첨판막륜 성형술 1례, 승모판막 재치환술 10례 등이었다. 그룹 I과 그룹 II에서 평균 대동맥 차단 시간(ACC)은 각각 135$\pm$29분과 104$\pm$18 분, 심패바이패스(CPB) 시간은 각각 240$\pm$33분과 185$\pm$42분이었다. 그룹 I과 그룹 II의 평균 추적 관찰 기간은 각각 47$\pm$14 개월과 29$\pm$4 개월이었다. 그룹 I에서는 16례(88.9%)에서 정상 동율동으로 회복되었고 1례에서 심방세동이 남아 있었으며, 다른 1례는 서맥증후군(sick sinus syndrome)으로 인공 심박조율기를 삽입하였다. 그룹 II에서는 21례(91.3%)에서 정상 동율동으로 회복되었고 2례는 심방세동이 지속되었다. 그룹 I에서 정상동율동으로 회복된 16례는 100%(16/16)에서 우심방의 수축을 심장 초음파검사에서 확인할 수 있었으며, 좌심방의 수축은 75%(12/16)에서 확인할 수 있었다. 그룹 II에서는 정상 동율동으로 회복된 21례 중 100%(21/21)에서 우심방의 수축을 확인할 수 있었으며, 좌심방의 수축은 76.2%(16/21)에서 확인할 수 있었다. 결론: 변형 CM-III 술식은 전통 CM-III 술식에 비하여 ACC time(p<0.005)과 CPB time(p<0.001)을 의미있게 줄이면서도 필적할 만 한 정상 동율동 전환율과 심방 수축력의 회복을 보여주었다.

• Journal of Chest Surgery
• /
• v.37 no.8
• /
• pp.722-725
• /
• 2004

Mitral valve surgery is most commonly performed through the left atriotomy via the inter-atrial groove or trans-septal approach. An alternative method for approaching to the mitral valve is via the dome of the left atrium located between the ascending aorta and superior vena cava. Although this approach was described 30 years ago, it has not been popularized in mitral valve surgery. We introduce our recent experiences with mitral valve surgery carried out through the dome of the left atrium with brief review of literature.

• Journal of Chest Surgery
• /
• v.31 no.11
• /
• pp.1037-1042
• /
• 1998

Background: Among the various techniques for the adequate exposure of the mitral valve, the extended transseptal approach is the essential prerequisite for accurate repair or replacement of the mitral apparatus. But the efficacy and safty of the extended transseptal approach has not determined in Korea yet. Materials and methods: Retrospective data of 80 consecutive patients, operated from September 1992 to July 1997 were reviewed. Seventy- eight patients underwent mitral valve replacement and 2 patients underwent excision of left atrial myxoma. Thirty-eight of 78 patients had other concomitant procedures such as aortic valve replacement(n=22), tricuspid annulopasty(n=14), coronary artery bypass graft(n=1) and closure of ventricular septal defect(n=1). Mean follow up was 23.3±15.0 months and total follow up was 1792 patient-months. Results: The hospital mortality rate was 3.8%(3 patients). Two deaths were due to low cardiac output and one due to postoperative bleeding of coagulopathy. Among the 46 patients who had atrial fibrillation preoperatively, 45 had atrial fibrillation postoperatively and 1 converted to sinus rhythm. All 34 patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after the operation. Mean aortic cross clamping time was 62 minutes for isolated mitral procedure and 90 minutes for concomitant procedures. There were no specific complications related to this approach. Conclusions: We suggest that the extended transseptal approach is an easy and good method for mitral valve surgery, especially in patients with small sized left atrium.

• Journal of Chest Surgery
• /
• v.42 no.6
• /
• pp.710-718
• /
• 2009

Background: The Cox maze procedure has been used as a standard surgical treatment for atrial fibrillation for about 20 years. Recently, the creators have used a bipolar radiofrequency electrode (Cox maze IV procedure) instead of the incision and suture (cut-sew) technique to make atrial ablation lesions for persistent atrial fibrillation. We investigated clinical outcomes for the Cox maze procedure with a bipolar radiofrequency electrode and cryoablator in patients with persistent atrial fibrillation, and compared results with clinical outcomes of the cut-sew procedure. Material and Method: Between April 2005 and July 2007, 40 patients with persistent atrial fibrillation underwent Cox maze IV procedure with a bipolar radiofrequency electrode and cryoablator (bipolar radiofrequency group). Surgical outcomes were compared with those of 35 patients who had the cut-sew technique for the Cox maze III procedure. All patients had concomitant cardiac surgery. Postoperatively, the patients were followed up every 1 to 2 months. Result: At 6 months postoperatively, the conversion rate to regular sinus rhythm was not significantly different between the two groups: 95.0% for the bipolar radiofrequency ablation group; 97.1% for the cut-sew technique (p=1.0). At the end of the follow-up period, the conversion rate to regular sinus rhythm was also not significantly different (92.5% vs. 91.6%, p=1.0). In multivariate analysis using a Cox-regression model, the postoperative atrial dimension was an independent determinant of sinus conversion in the bipolar radiofrequency ablation group (hazard ratio 31, p=0.005). In the Cox-regression model for both groups, atrial fibrillation at 6 months postoperatively (hazard ratio 92.24, p=0.003) and the postoperative left atrial dimension (hazard ratio 16.05, p=0.019) were independent risk factors of continuance or recurrence of atrial fibrillation after Cox maze procedures. Aortic cross-clamp time and cardiopulmonary bypass time were significantly shorter in the radiofrequency group than in the cut-sew group. Conclusion: In the Cox maze procedure for patients with persistent atrial fibrillation, the use of bipolar radiofrequency ablation and a cryoablator is as good as the cut-sew technique for conversion to sinus rhythm. The postoperative left atrial dimension is an independent determinant of postoperative continuance and recurrence of atrial fibrillation.

• Journal of Chest Surgery
• /
• v.31 no.6
• /
• pp.576-580
• /
• 1998

This study is to clarify the results of atrial septal defect(ASD) repair and mitral valve surgery through right anterolateral thoracotomy since 1989, and those of more generalized application of minimal invasive cardiac surgery since August 1997. We retrospectively analyzed the results of open heart surgery(OHS) through other than full sternotomy carried out until October 1997. There were 28 cases of OHS done through right anterolateral thoracotomy(17 cases of ASD, 4 cases of mitral valve repair, 6 cases of mitral valve replacement, and 1 redo mitral and tricuspid valve repalcement) which has demonstrated no surgical mortality or morbidity except only 1 case of reoperation for bleeding. During the period between August and October 1997, we performed near routine application of upper sternotomy or transverse sternotomy in aortic valve cases and routine application of minimal incision in cases with ASD and there was no evidence of early and late complications associated with this approach. We conclude that OHS with the use of minimal incisions is very safe, cosmetically excellent, and superior in terms of the amount of bleeding. The indication for minimal incision, therefore, should be extended afterwards.

• Journal of Chest Surgery
• /
• v.30 no.10
• /
• pp.1015-1018
• /
• 1997

Median sternotomy incision is world-widely used for open heart surgery, especially in valvular heart disease. But recently, minimally invasive approach by the right parasternal incision for valvular heart disease was introduced with the many merits by small incision. We experienced 1 case of mitral valve repalcement by right parasternal incision and extended transseptal approach. This technique has no specific compli ations or problems compared with the median sternotomy and was proven by the excellent exposure. Cosmetically, the patient was satisfied with the incision.

• Proceedings of the KTCVS Conference
• /
• 1998.04a
• /
• pp.23-24
• /
• 1998

• Journal of Chest Surgery
• /
• v.41 no.3
• /
• pp.313-319
• /
• 2008

Background: The Cox maze-III procedure is considered as the most effective surgical treatment for atrial fibrillation. Because this procedure takes a long time and it complicates the concomitant cardiac surgery, some surgeons perform a left atrial maze procedure or pulmonary vein isolation only to reduce the operation time. This study was performed to evaluate how the modified procedures, with using cut-and-sew techniques, can influence the treatment of atrial fibrillation. Material and Method: Between Feb 1999 and June 2005, 40 patients (17 males and 23 females) with organic heart disease and atrial fibrillation underwent the Cox maze-III procedure (23), the left atrial maze procedure (10) or pulmonary vein isolation (7). The cut-an-sew technique was used to ablate the atrial wall, but cryoablation was used instead of the cut-and-sew technique for the coronary sinus and the inferior wall between the pulmonary vein and the mitral annulus. Result: After a mean follow-up period of $50.0{\pm}21.6$ months, all (100%) of the 23 patients who underwent the Cox maze-III procedure had regular sinus or atrial rhythm conversion, and 7(70%) of 10 with a left atrial maze procedure and 4(57.1%) of 7 with pulmonary vein isolation had regular sinus or atrial rhythm conversion (p=0.002). Conclusion: To obtain a high conversion rate from atrial fibrillation to a regular sinus rhythm or a regular atrial rhythm, the standard Cox maze-III procedure should be performed in both atria. The limited modified procedures like the left atrial maze procedure or pulmonary vein isolation may reduce the cure rate of atrial fibrillation.

• Journal of Chest Surgery
• /
• v.37 no.5
• /
• pp.448-451
• /
• 2004

Report of right atrial thrombus complicating pulmonary embolism after cardiac surgery is rare. A 54-year-old woman operated on the atrial septal defect 10 months ago was admitted for left pleuritic pain and dyspnea. Multiple segmental perfusion defects were detected in lung perfusion scan. Transesophageal echocardiography showed a large mobile right atrial mass attached to the free wall of the right atrium with a stalk. Despite the intravenous heparinization for 13 days, follow-up echocardiography revealed the right atrial mass had not diminished in size. The mass which was confirmed as an organizing thrombus was excised under cardiopulmonary bypass. The patient recovered uneventfully and was discharged on warfarin therapy.

• Journal of Chest Surgery
• /
• v.29 no.11
• /
• pp.1207-1211
• /
• 1996

During the recent 10 years, ten patients with ruptured sinus of Valsalva were operated on our institute. Eight patients were congenital but two patients were proved acquired lesions due to bacterial endocarditis. Coexistent cardiac lesions were 4 aortic regurgitations, 2 atrial septal defects, 1 ventricular septal defect, 1 tricuspid regurgitation and 1 mitral regurgitation. In all cases, aneurysms of sinus of Valsalva arose from the right coronary sinus, and they ruptured to right ventricle in 8 patients and to right atrium in 2 patients. We preferred double approach, through both the aorta and the involver. cardiac chamber, The repair of ruptured site was performed Dacron patch graft in 8 patients and simple closure in 2 patients. Operative results were very good in all cases with no surgical mortality.