• Journal of Chest Surgery
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• v.43 no.6
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• pp.614-618
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• 2010

Background: The aim of our study was to assess the extent of regression of left ventricular mass after aortic valve replacement in isolated aortic regurgitation. Material and Method: Retrospective analysis of echocardiographic data was collected preoperative and postoperative 1 year. There were 20 patients (12 males, 8 females, mean age $55.8{\pm}11.8$ years, mean body surface area $1.64{\pm}0.19m^2$) with aortic regurgitation from 2002 through 2007. We studied the change of left ventricular ejection fraction, ventricular septum and left ventricular posterior wall thickness, and left vemtricular muscle index (LVMI). The control group was age matched with normal echocardiographic study results. Patients with combined surgery or infective endocarditis were excluded. Result: Seven cases of tissue valves and thirteen cases of mechanical valve were used. The valve sizes were 21 mm (3 cases), 23 mm (13 cases) and 25 mm (4 cases). The postoperative ($125.5{\pm}42g/m^2$) LVMI has decreased than preoperative LVMI ($212.3{\pm}80g/m^2$, p=0.000) but higher than that of control group ($80.5{\pm}15.9g/m^2$, p=0.000). Postoperative septal wall (systolic/diastolic: $13.5{\pm}3.4mm/17.1{\pm}4.1mm$) and left ventricular posterior wall (systolic/diastolic: $12.9{\pm}3.4mm/16.7{\pm}3.4mm$) thickness were slightly decreased after the valve replacement but was not significantly different than preoperative levels. And postoperative interventricular septal wall and left ventricular posterior wall thickness (systolic/diastolic: $8.6{\pm}1.4mm/12.1{\pm}1.7mm$, systolic/diastolic: $8.4{\pm}1.4mm/13.2{\pm}1.9mm$) were higher than that of the control group (p<0.001). Conclusion: The significant regression of LVMI after aortic valve replacement developed at postoperative one year but the level was higher than control group. The main cause of decreased LVMI is decreased in left ventricular dimension.

• 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.

• Clinical and Experimental Pediatrics
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• v.45 no.2
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• pp.214-222
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• 2002

Purpose : The aim of this study was to evaluate myocardial injury in children treated with adriamycin by echocardiography, which is non-invasive and safe measurement for children. Methods : Left ventricular dimensions, wall stress, and contractile function were determined by echocardiographic methods in 17 patient recepients with adriamycin chemotherapy at rest(group 1) and during stress(group 2). Twenty age-matched normal subjects were established as control group. Results : End-diastolic dimension was decreased in both groups(group 1; $92{\pm}7%$ of normal, group 2; $87{\pm}8%$ of normal, P<0.05). Left ventricular end diastolic volume and wall mass were also decreased in both groups(group 1; $96{\pm}12mL/m^2$ and $145{\pm}18g/m^2$, group 2; $87{\pm}8mL/m^2$ and $137{\pm}16g/m^2$, respectively, P<0.05 and P<0.05) and group 2 showed lower values than group 1. Meridional end systolic stress(ESSm) was increased in both groups but there was no significant difference between the two groups(group 1; $52.6{\pm}6.2g/cm^2$, group 2; $63.5{\pm}8.5g/cm^2$, P<0.05, normal value $45.7{\pm}3.5g/cm^2$). The load-independent relation of rate-corrected circumferential fiber shortening velocity(Vcfc) to ESSm has a significant abnormal change in 7 out of 17(41%) in group 1 and 12 out of 17(71%) in group 2. Conclusion : The load-dependent systolic index, such as fractional shortening, may fail to show abnormality because of the compensatory changes in preload and afterload which can mask the impaired contractility. Therefore, systolic performance also should be monitored by a load-indepedent contractility index such as slope value of the end-systolic pressure-dimension relation and the position of the left ventricular stress-fiber shortening velocity after exercise.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.495-503
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• 1999

Background: We tested the technical feasibility of fetal cardiac bypass and collected baseline data on the fetal hemodynamics and placental functions related to the cardiopulmonary bypass in the fetal lamb model. Material and Method: Eleven fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Eight served as a group in which placenta was excluded from the extracorporeal circulation by clamping the umbilical cord during the bypass(the oxygenator group) and in the remaining three, the placenta worked as the only source of oxygen supply(the placenta group). Observations were made every 10 minute during a 30-minute bypass and 30-minute post bypass period. No prostaglandin inhibitors were used both in ewes and in fetuses. Result: Weights of the fetuses ranged from 1.9 to 5.2 kg. In the oxygenator group, means of arterial pressure, PaO2, atrial pressure, heart rate, and bypass flow rate ranged 69.8 to 82.6 mmHg, 201.7 to 220.9 mmHg, 4.1 to 4.3 mmHg, 169 to 182/min, and 140.3 to 164.0 ml/kg/min, respectively during bypass, but rapid deterioration of the fetal cardiac functions and the placental gas exchange was observed after the cessation of bypass. In the placenta group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of PaCO2 increased from 61.9 to 129.6 mmHg during bypass. Flow rate was suboptimal(74.3 to 97.0 ml/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. Conclusion: In this study, the technical feasibility of fetal cardiopulmonary bypass was confirmed in the fetal lamb model. However, further studies with modifications of the bypass including an addition of prostaglandin inhibitor, an application of the total spinal anesthesia on the fetus, a creation of more concise bypass circuit, and a use of active pump are mandatory to improve the outcome.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.321-328
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• 2007

Background: It is very important to determine the surgical anatomy of the aortic root when performing spreading aortic root preserving heart surgery. This study focuses on the surgical aspect of the aortic root anatomy by performing dissection of Korean cadavers. Material and Method: The subjects were 62 cadavers. We measured the intercommissural distances, heights of the sinuses and the circumference of the sinotubular junction and the aortic annulus. Result: The mean age of death was 61.3 years. The intercommissural distance for the right coronary sinus was $0.73{\pm}2.23mm$, that for the non coronary sinus was $19.34{\pm}2.03mm$, and that for the left coronary sinus was $18.58{\pm}2.15mm$. The height of sinus was $20.59{\pm}2.48mm$ for the right coronary sinus, $18.61{\pm}2.26mm$ for the non coronary sinus and $17.95{\pm}19mm$ for the left coronary sinus. The circumference of the sinotubular junction was $70.73{\pm}5.94mm$ and that of the aortic annulus was $77.94{\pm}5.63mm$. There is no correlation between age and STJ, aortic annulus and the ratio of STJ of aortic annulus respectively (p=0.920, p=0.111, p=0.073). The tilting angle of the sinotubular junction and aortic annulus is from $2.03^{\circ}$ to $7.77^{\circ}$ $(mean=4.90^{\circ})$. Conclusion: The intercommissural distance and the height of the sinus were largest in the right coronary sinus, and the position of the sinotubular junction to the aortic annulus is obliquely tilted levo-posteriorly.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.158-164
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• 2005

Purpose : We reviewed the therapeutic results of various Duct-Occlud coils(pfm AG, $K{\ddot{o}}ln$, Germany) to evaluate the efficacy of the most-recently modified Duct-Occlud coil(Nit-Occlud) in the transcatheter closure of patent ductus arteriosus(PDA), including large defects more than 4 mm in diameter. Methods : Two hundred and five patients who underwent percutaneous PDA occlusion using Duct-Occlud devices from March 1996 to December 2003 were enrolled and four types of Duct-Occlud [Standard(S), Reinforced(R), Reinforced reverse cone(RR) and Nit-Occlud(N)] were used in this study. The patients were followed up by echocardiogram and physical examination before discharge, one month, six months and 12 months after the procedure. Results : The rate of residual shunt according to the type of Duct-Occlud were as follows : S-54%, R-72%, RR-50%, N-14%(P<0.05 compared with other devices) at one month, S-25%, R-44%, RR-37%, N-0%(P<0.05 compared with other devices) at six months, S-8%, R-8%, RR-4%, N-0%(P<0.05 compared with S and R) at 12 months and later. Nit-Occlud coil showed the complete occlusion of PDA after six months of follow-up, even in 12 patients with relatively large PDA(>4 mm). Conclusion : The transcatheter closure of PDA using Duct-Occlud was an effective treatment and our study revealed that a Nit-Occlud coil which showed higher rate of occlusion even in PDA with large diameters over than 4 mm, was a more effective modality compared to previous devices.

• Journal of radiological science and technology
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• v.28 no.4
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• pp.333-340
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• 2005

In this study, the radioprotective effects of Grifola umbellata hot water extracts (Gu-extract) on mice were investigated. Single pre-administration of Gu-extract increased the 40-day survival ratio of irradiated mice from 65.5％ to 78.6％. The growth of 3 week old male mice in the irradiated group was slightly retarded as compared to those of the control and Gu-extract treated mice. The average spleen and thymus weights of the irradiated mice were lower than those of the control and Gu-extract treated mice. The weight reduction of testis in the irradiated mice was significant. While it was relatively slight in the Gu-extract treated mice as compared to that of control mice. No significant difference in the weight was observed in heart, kidney or liver among three groups. The leukocytes of the Gu-extract treated mice did not decrease dramatically as in the irradiated group, but recovery patterns were similar in both groups. Reduction of erythrocytes were similar in both groups but its recovery occurred more rapidly in the extract treated group. The glucose level of the Gu-extract treated group did not change during the period examined, while it was still higher in the irradiated group than the level in the control group in two weeks. The cholesterol levels in the irradiated and the Gu-extract treated groups were higher than that of control group on day 7, but decreased to the level of the control group on day 14. No difference was observed in total protein amount of the serum among the three groups. SDS-polyacrylamide gel electrophoresis of the soluble proteins extracted from various organs did not reveal differences to any extent in all groups except in the livers of the irradiated and extract treated groups, in which some proteins were missing or less present.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.180-192
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• 2007

Background: As determined from the recent investigations of discordant cardiac xenotransplantation, hyperacute rejection occurs mainly at the endothelial cells in donor microvascular systems, but this does not occur at cardiac valve leaflets or at medium-to-large caliber vessels. On the basis of this background, this study was performed to look into the biocompatibility for transplantation of a middle or large diameter xenogenic blood vessel by conducting xenogenic arterial transplantation with the carotid artery in a pig-to-goat model. Material and Method: The experimental group was composed of 10 pairs of pig-to-goat combinations. They were divided into each period of 1 week, and 1, 3, 6 and 12 months. Four carotid artery grafts obtained through collection of the bilateral carotid arteries from two pigs were preserved at $-70^{\circ}C$ without other treatment, and then they were transplanted into the bilateral carotid arteries of two goats. Doppler ultrasonography was done on a periodic basis after transplantation to evaluate the patency of the grafted blood vessel. At the ends of a predetermined period, the grafts were explanted from the goats and they underwent gross examination. Hematoxylin-eosin and Masson's trichrome staining were conducted. In addition, in order to examine the immunological rejection of the grafted xenogenic blood vessel, immunohistochemical staining was conducted with T-lymphocyte indicator and von Willebrand factor. Result: Two goats at the each one-week period and the one-year period died during the experimental period because of a reason unrelated to the experimental procedure, and the remaining 8 goats survived until the end of each experiment period. On Doppler ultrasonography, unilateral carotid artery occlusion was found in a goat, whose period was specified as 3 months, among the 8 survived goats. However, the vascular patency was maintained well and there was no graft that formed aneurysms in the other goats. On gross examination, the region of vascular anastomosis was preserved well, and calcification of the grafted blood vessel was not shown. Histologically, the endothelial cells of the graft disappeared one week after transplantation, and then there was progressive spread of the recipients' endothelial cells from the anastomotic site. The reendothelialization occurred over the whole graft at one month after transplantation. The neointimal thickening and adventitial inflammation became severe by 3 months after transplantation, but this lessened at 6 months and 12 months, respectively. The rate of CD3 positive cells was very low among the infiltrated inflammatory cells. Conclusion: The fresh-frozen xenogenic artery kept its patency without being greatly influenced by xenogenic immune reaction.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.667-673
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• 2007

Background: Patients with severe aortic valve disease frequently display mitral valve regurgitation (MR). In such patients, the clinical course of MR after isolated aortic valve replacement (AVR) may be important for determining the treatment strategies. After isolated AVR, the change of the concomitant moderate degree or less of MR according to the type of aortic valve disease is not known well. The aim of this study was to analyze the post-operative changes of MR after performing AVR in those patients with severe AS (Group S) and those with severe AR (Group R). Material and Method: We retrospectively evaluated 43 patients with severe aortic disease and a moderate degree or less of mitral valve regurgitation, and these patients underwent isolated aortic valve replacement from January 1996 to June 2005. The patients were divided into two groups: the aortic valve stenosis group (n = 29) and the aortic valve regurgitation group (n = 14). The patients underwent transthoracic echocardiography preoperatively and at 7 days, $6{\sim}10$ months and more than 18 months (mean follow-up duration: 38 months) postoperatively. Result: The mean age was 60.9 years (Group S: 62 years, Group R: 52.5 years) and 60% (Group S=55%, Group R=71%) of the patients were male. The preoperative MR was mild in 29 (67.5%), mild to moderate in 11 (25.5%), and moderate in 3 (6.9%) patients. In the Group S patients, MR improved in 16 (55%) patients at the immediate postoperative days and in 17 (59%) patients at more than 18 months postoperatively. On the other hand, all the Group R patients exhibited earlier improvement. The decrease of LA size had a similar pattern to the MR change, but there were no significant differences in the change of the ejection fraction of the two groups. Conclusion: In the patients with severe aortic valve disease and concomitant low grade MR, the MR after AVR improved earlier and more effectively in the patients with AR than in those patients with AS.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.321-328
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• 2003

Background: The St. Jude Medical prosthesis is one of the popularly used artificial prosthesis, therefore the National Medical Center reports the long-term clinical results of patients who underwent prosthetic valve replacement with St. Jude medical valve for 18 years. Material and Method: Between January, 1984 and June, 2002, a series of 163 consecutive patients who had Implanted St. Jude prosthesis at the National Medical Center were reviewed. Mean age was 42.9$\pm$15.1 years and male to female ratio was 69:94. The operative procedure comprised of 87 MVR, 30 AVR, 45 DVR, and 1 TVR. The reoperative procedure comprised of 21 MVR, 2 AVR, and 14 DVR. Follow-up rate was 96.9%, and cumulative follow-up was 823.8 patient-years. Result: Early mortality rate was 7.9% (13 patients), late mortality rate was 8.7% (13 patients) and late mortality due to valve related complication was 47% (7 patients). Actual survival rate at 10 and 18 years were 91.7$\pm$2.1% and 91.0$\pm$1.9%. Linearized Incidence was as follows: thromboembolism, 1.09%/ patient-year; anticoagulant related hemorrhage, 0.36%/patient-year; valve thrombosis, 0.24%/patient-year; paravalvular leakage, 0.12%/patient-year; and prosthetic bacterial endocarditis, 0.12%/patient-year linearized incidence of over all valve related complication was 1.94%/patient-year. Freedom from valve related complication at 10 and 18 years were 89.1$\pm$3.3% and 88.4$\pm$3.9%. Freedom from valve related death at 10 and 18 years were 95.1$\pm$1.2% and 95.1$\pm$1.0%. Valve related complication was related the age of patient, especially anticoagulant related hemorrhage was more common in patients over 60 years of age. Valve related complication, death were higher in DVR than AVR or MVR, and valve related death was higher in reoperation. There was no relationship between valve related complication or death and implant valve of size. Conclusion: The long-term clinical results of patients implanted with St. Jude Mechanical prosthesis was quite satisfactory with a low incidence of valve related complication and mortality.