• 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.1
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• pp.52-54
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• 1998

Recently, several versatile approaches via limited incision have been developed for minimally invasive cardiac surgery. As the incision is limited, it is often dfficult to get a satisfactory operative field, especially for the manipulation of two separate lesions such as simultaneous mitral and aortic valve disease with a single limited incision. Here, we describe a case of successful double valve replacement via ministernotomy, which was followed by two cases of minimally invasive aortic valve replacement via transsternal approach. The operative field was unexceptionally satisfactory and the postoperative patient's acceptance was high. The methodology is described with a review of the relevant literatures.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.204-213
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• 2005

In spite of the improvement in the quality of artificial heart valves and surgical techniques, the incidence of the complications following valve replacement is still high. We reviewed the clinical results of the valve replacements peformed in Korean University Anam Hospital during the last 26 years. Material and Method: The data of 571 patients who received valve replacement between December 1976 and December 2003 were reviewed. Result: There were 304 cases of MVR which was the most common procedure performed. There were 122 cases of AVR, and 111 cases of AVR with MVR. Among the 47 patients who received redo operation 38 cases were redo cases including 31 cases of MVR. $32.5\%$ of the patients who had tissue valve replacement had second valve replacement with 10.2 $\pm$ 3.9 years interval. $24.3\%$ (139/571) of the patients developed valve related complications and cerebral infarction was the highest in frequency. Atrial fibrillation was related with increased complication rates and the mechanical valve replaced group had higher hemorrhagic complication rate than tissue valve replaced group. The operative mortality was $3.68\%$ and the most common cause of the failure was low output syndrome. The operative mortality was higher in the patient group who had valve replacement before the year 1990. The patient group who had mechanical valve replacement had higher operative mortality rate th;3n the tissue valve group. The 5-year survival rate was $92.2\%$ and 10 year survival rate was $85.7\%$. Conclusion: The operative mortality of valve replacement has been improved. The mechnical valve replaced patients had higher hemorrhagic complication rate than the tissue valve replaced patients and more tissue valve replaced patients received redo valve replacement.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.817-824
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• 2007

Background: There are two choices for heart valve replacement-the use of a tissue valve and the use of a mechanical valve. Using a tissue valve, additional surgery will be problematic due to valve degeneration. If the risk of additional surgery could be reduced, the tissue valve could be more widely used. Therefore, we analyzed the risk factors and mortality of patients undergoing repeated heart valve replacement and primary replacement. Material and Method: We analyzed 25 consecutive patients who underwent repeated heart valve replacement and 158 patients who underwent primary heart valve replacement among 239 patients that underwent heart vale replacement in out hospital from January 1995 to December 2004. Result: There were no differences in age, sex, and preoperative ejection fraction between the repeated valve replacement group of patients and the primary valve replacement group of patients. In the repeated valve replacement group, the previously used artificial valves were 3 mechanical valves and 23 tissue valves. One of these cases had simultaneous replacement of the tricuspid and aortic valve with tissue valves. The mean duration after a previous operation was 92 months for the use of a mechanical valve and 160 months for the use of a tissue valve. The mean cardiopulmonary bypass time and aortic cross clamp time were 152 minutes and 108 minutes, respectively, for the repeated valve replacement group of patients and 130 minutes and 89 minutes, respectively, for the primary valve replacement group of patients. These results were statistically significant. The use of an intra aortic balloon pump (IABP) was required for 2 cases (8%) in the repeated valve replacement group of patients and 6 cases (3.8%) in the primary valve replacement group of patients. An operative death occurred in one case (4%) in the repeated valve replacement group of patients and occurred in nine cases (5.1%) in the primary valve replacement group of patients. Among postoperative complications, the need for mechanical ventilation over 48 hours was different between the two groups. The mean follow up period after surgery was $6.5{\pm}3.2$ years. The 5-year survival of patients in the repeated valve replacement group was 74% and the 5-year survival of patients in the primary valve replacement group was 95%. Conclusion: The risk was slightly increased, but there was little difference in mortality between the repeated and primary heart valve replacement group of patients. Therefore, it is necessary to reconsider the issue of avoiding the use of a tissue valve due to the risk of additional surgery, and it is encouraged to use the tissue valve selectively, which has several advantages over the use of a mechanical valve. In the case of a repeated replacement, however, the mortality rate was high for a patient whose preoperative status was not poor. A proper as sessment of cardiac function and patient status is required after the primary valve replacement. Subsequently, a secondary replacement could then be considered.

• 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.25 no.9
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• pp.921-924
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• 1992

기계판막의 가장 빈번하고 치명적인 결함이 판막혈전이다. 판막혈정의 적절한 조기 치료를 위해서는 조기진단이 선행되어야만 한다. Cineradiography는 조기에 손쉽고, 빠르게 기계판막의 기능장애를 진단하는 방법으로 사료되며 저자들은 42세된 남자 환자에서 29mm Carbomedics 판막으로 승모판막 치환술을 시행한 1례와 58세된 여자 환자에서 승모판막 및 대동맥판막에 각각 25mm, 19mm Carbomedics 판막으로 치환술 후 각각 18개월, 20개월 후 기계판막 혈전이 발생하여 cineradiography로 손쉽게 진단하여 치료하였으므로 보고하는 바이다.

• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.48-48
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• 1995

• Journal of Chest Surgery
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• v.30 no.10
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• pp.979-985
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• 1997

Between October 1991 and May 1995, 256 "New Duromedics Valve"(Edward TEKNA Bileaflet Valve) were implanted in 208 adult patients(171 mitral, 82 aortic and 3 tricuspid) with age ranging from 18 years to 70 years(mean 48.2$\pm$ 11.6 years). Postoperative complication rates were 12.2%, but there was none valve related one. Overall early mortality rate were 1.4%(1.6% for MVR, 2.1% for DVR, and none for AVR or TVR) respectively. Follow-up was 99% completed ranging in duration from 2 months to 46 months. There were 6 valve-related late complications(2.9%) with 2 patients with upper gastrointestinal bleeding, 2 with cerebral thxomtioembolism, 1 with valve thrombosis and 1 with valve endocarditis. Freedom from these valve-related major complications were 89.9% at 40 months. There were 5 late deaths(2.4%). one of these late deaths was considered valve-related. Overall actuarial survival rates at 40 months were 95.5%, 96.8% for mitral, 97.1% for aortic, 100% for tricuspid, and 92.0% for double valve replacement respectively. Preoperative New York Heart Association functional class were 2.9, and 1.3 in post-operative state. We have been trying to keep the international normalized ratio(INR) with range of 2.5 to 3.0. The INR of 4 patients of 5 with anticoagulant ralated complications was beyond the range. To reduce the rate of anticoagulant related complications, we felt very strongly that the INR should be kept between 2.5 and 3.0. In our cases, there was no structural failure or significant hemolysis in the absence of periprosthetic leak. This experience encourages us to continue using the "New Duromedics Valve".omedics Valve".uot;.

• 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.34 no.1
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• pp.91-93
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• 2001

기계판막의 비구조적 기능이상은 판막 치환 후 생길 수 있는 심각한 합병증 중의 하나이다. 이러한 기계판막의 비구조적 기능이상은 일반적으로 1) pannus나 조직 혹은 봉합물질에 의한 장애 2) 치환 판막 주위의 틈 3) 부적절한 판막의 크기나 위치, 판막 삽입시의 잘못 등에 의해 생긴다. 저자들은 상대적으로 작은 판막륜을 가진 환자에서 치환 판막의 잘못된 위치로 야기된 pannus 형성에 의한 판막의 기능부전을 경험하였으며, 이 환자에 대해 pannus 제거 후 판막륜 확장술(닉스 술식, Nicks procedure)을 포함한 판막 재치환술을 성공적으로 시행하여 이를 보고하는 바이다.