• Journal of Chest Surgery
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• v.37 no.3
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• pp.220-227
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• 2004

The number of patients with coronary artery disease and peripheral vascular disease are increasing, and the need of small diameter vessel is also increasing. We developed small diameter artificial vessel and experimented in vivo. We got allogenic valve from mongrel dogs, and removed all cells from the allogenic valve. Then, we seeded autologous bone marrow cells onto the decellularized scaffold. After implantation of artificial vessel into the canine carotid artery, we performed angiography regularly. In case of vessel occlusion or at 8 weeks after operation, we euthanized dogs, and retrieved the implanted artificial vessels. Control vessels were all occluded except one (which developed aneurysmal dilatation). But autologous cell seeded vascular graft were patent by 4 weeks in one, by 6 in one and by 8 weeks in two. Histologic examination of patent vessel revealed similar structure to native artery. Tissue-engineered vascular graft manufactured with decellularized allogenic matrix and autologous bone marrow cells showed that tissue engineered graft had similar structure to native artery.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.849-851
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• 2005

Mitral stenosis was developed after Duran ring annuloplasty in two growing children during follow up period of 8 years and 5 years respectively, which may be due to pannus overgrowth and patient's growing. Only removal of pannus and prosthetic ring has resulted in complete relieving of Mitral stenosis. With time, even adult-sized an-nuloplasty ring may induce stenosis in growing children.

• Journal of Chest Surgery
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• v.26 no.9
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• pp.667-676
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• 1993

Boprosthetic cardiac valves fail from biological and metabolic as well as mechanical reasons, and the limited durability is the main factor of marked withdrawal in their clinical use. Starting the use of bioprosthetic valves in 1976, up to the end of 1992, the consecutive 178 patients have undergone re-replacement of glutaraldehyde-treated xenograft valves for primary tissue failure [PTF]among the patients who had initial valve replacement at Seoul national University Hospital. The explanted valves were 69 porcine aortic [51 Hancock, 12 Angell-Shiley and 6 Carentier-Edwards] and 141 bovine pericardial [129 standard-profile and 12 low-profile ionescu-Shiley] valwes, with an overall incidence of PTF of 15.2%. The operative mortality rate of re-replacement was 5.1%. Calcific degeneration and tissue damage in relation to calcification were the most frequent modes of PTF on gross examinatin of the explanted valves resulting hemodynamically in valvular regurgitation. The number of Hancocg porcine and the standard-profile Ionescu-Shiley valves in valves in mitral position failed more often from tissue damage [tears, holes, and loss or destruction of cuspal tissue] than calcification [68.3% vs. 39.0%, p<0.01] with resultant regurgitation in 61%, the Ionescu-Shiley valves in the same position in 53%. The tendency of more calcification than tissue damage[71.3% vs. 33.3%, p<0.001]with stenosis in 53%. The tendency of more calcification and immobility of cusps in the latter group was partly explainable by the inclusion of patients of pediatric age. Observation made in this study suggest : many of bioprosthetic valves would fail from calcification and tissue damage : some fail prematurely because of mechanical stress probably owing to the valve design in construction ; andeven those valves escaped early damage would be subject to calcify in the prolonged follow-up period. In conclusion, at the present time, the clinical use of bioprostheticxenograft valves seems to be quite limited until further improvement in biocompatibility and refinement in valve design in manufacture are achieved.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.161-170
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• 1991

Clinical results with the Mechanical cardiac valves were reviewed for 261 patients who underwent cardiac valve replacement from September, 1985 to July, 1990. of the Mechanical valves used, 156 were Carbomedics, 109 Duromedics, 52 St. Jude and 11 Bjork-Shiley. Overall hospital mortality was 14 out of 261[5,36%]: 9 out of 159[5.66%] for MVR, 1 out of 35[2.86%] for AVR and 4 out of 67[5.96%] for DVR[AVR+MVR]. Two hundred and forty seven operative survivors were followed up for a total 466.8 patient-years, ranged from 1 month to 4.9 years [a mean 1.8 years] and the follow up was 96.0%. There were 12 valve-related complications: three from thromboembolism, three from valve thrombosis, three from prosthetic valve endocarditis, two from paravalvular leak and the other one from hemorrhage. Actuarial rate free from all valve-related complication at 4.9 years was 96$\pm$1.3%. There were 11 late deaths: two from thromboembolism, one from valve thrombosis, one from prosthetic valve endocarditis, one from hemorrhage and the others 6 from non-valve-related complications. Actuarial survival rate at 4.9 years was 94$\pm$2.0%. 96$\pm$3.0% for MVR, 94$\pm$4.2% for AVR and 91$\pm$3.7% for DVR[AVR+MVR]. And there are 7 reoperations: three from paraprosthetic leak, two from prosthetic valve endocarditis and two from valve thrombosis. Actuarial rate free from reoperation at 9 years was 96$\pm$2.9%. On the basis of this 4.9 years of experience, the pyrolytic carbon mechanical valves appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance, low mortality and low thrombogenecity.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.48-54
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• 1987

This report provides follow-up data on 557 patients [73 aortic, 357 mitral, and 127 multiple valve replacements] undergone lonescu-Shiley pericardial Xenograft valve replacement at Seoul National University Hospital between January, 1979 and December, 1985. There were 35 early death [6.3%] and 522 operative survivors were observed, and the cumulative follow-up is 1,140 patient-years [mean: 2.18 years per patient] The thromboembolic complications occurred in 34 cases [3.0% per patient-year] and the rate was 2.1% per patient-year for mitral and 0.3% per patient-year for aortic valve replacement in the presence of anticoagulation therapy. Among the 34 embolic episodes, 9 patients were dead [0.8% per patient-year] and the cause of death were 5 cerebral thromboembolism, 2 pulmonary embolism, and 2 intracerebral hemorrhage due to inappropriate anticoagulation after thromboembolic episode. Actuarial probability [+ SEM] of remaining free of thromboembolism for AVR is 88.1 x 11.1% at 5 years, for MVR 79.1 a 13.4% at 7 years and for multiple valve replacement 77.2 e 5.21% at 7 years. The incidence rate of thromboembolic complications after AVR is not less than that of MVR [0.3 Among the potential thromboembolic risk factors, atrial fibrillation is possible risk factor to increase the thromboembolic complication [0.05 < P < 0.1], but the importance of other factors, such as atrial clot, large left atrial size, mitral position, NYHA functional class, and age is less definite. A careful follow-up and the proper control of anticoagulation without omission, poor control, and arbitrary withdrawal is important for the successful management of the thromboembolic complications and the anticoagulation-related morbidity and mortality.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.350-354
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• 1979

The incidence of congenital aortic valvular stenosis has been known rare, and approximately 3-6% of congenital heart diseases. Recently, we experienced 1 case of congenital aortic valvular stenosis, and which was corrected surgically under extracorporeal circulation successfully. A 11 years old male pt. was admitted to N.M.C. because of dyspnea, dizziness, chest pain and episode of syncope. An auscultation, harsh systolic murmur [Gr. IV/VI] was noted at aortic area and also palpable strong thrill. ECG showed LVH c strain pattern and suspicious LVH finding in simple chest P-A film. In Lt. cardiac catheterization, abrupt pressure change [110mmHg] between LV & Aorta was noted across the aortic valve. And aortic insufficiency was absent, well visualized both coronary arteries and suspicious bicuspid aortic valve in aortography. Valve form was bicuspid, large one was noncoronary cusp and another cusp was Rt. & Lt. coronary cusp which was interpositioned rudimentary commissure. Central aortic orifice was about 5ram in diameter. Valvulotomy was done along the fusioned commissure between noncoronary cusp and Rt. & Lt.coronary cusp, and then short incision was added between Rt. coronary cusp & Lt. coronary cusp. Immediate postoperative course smooth but unknown cardiac arrest was noted in POD second day. Complete recovery was done without sequelae by resuscitation. After operation, clinical symptoms were subsided but systolic murmur [Gr. II/VI] was audible at aortic area, diastolic murmur was absent. ECG showed still remained LVH but much decreased R wave voltage in Lt. precordial leads. Simple chest P-A showed no interval changes compared to preop film. Control Lt. heart catheterization revealed still remained pressure gradient [40ramrig] between LV & Aorta. But much decreased pressure gradient compared to preop pressure gradient [110mmHg].

• Journal of Chest Surgery
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• v.7 no.2
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• pp.189-200
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• 1974

The mitral valve replacement with Beall prosthetic valve was performed on three patients, and double valve replacement. aortic and mitral valve, was performed in this department.1) The preoperative studies about the first case were compatible with mitral steno-insufficency.The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary hypass using hypothermic hemodilution technique. The total perfusion time was eighty minutes. Immediate postoperative course was smooth, but this patient was died of asphyxia due to tracheomalacia complicated after tracheostomy 3 months after operation. Autopsy on this patient revealed that no thrombus and no ball variance could be found, and endothelization on the valve cuff was satisfactory. 2) The preoperative studies on the second case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary bypass using hypothermic hemodilution technigue. The total perfusion time was 123 minutes. This patient was discharged in good condition and follow-up study after 16 months revealed the patient had enjoyed healthy life. 3) The preoperative studies about the third case were compatible with aortic insufficiency and mitral stenoinsufficiency. The diseased valves were replaced with type 2 sutureless Magovern aortic valve and the medium sized Beall mitral prosthesis under cardiopulmonary bypass using hypothermic hemodilution technIque and coronary artery perfusion. The total perfusion time was 155 minutes. This patient was discharged in good condition, but thromboembolism was developed 2 months after discharge. 4) The preoperative studies about the fourth case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve. The total perfusion time was 132 minutes. The atrioventricular block developed just after operation but converted to normal sinus rhythmn on the third postperative day. The preoperative NYHA functional classification IV was converted to Class 1 or 11 at the time of discharge and this patient enjoyed healthy life. Attendum; The fifth case, nineteen years old male with mital insufficiency underwent Beall valve replacement and his course was uneventful 2 weeks after operation.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.673-682
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• 1987

The principal feature of bioprosthetic valve which remains to be completely defined is long-term durability, especially, with regard to the impact of patient age. This report provides extended data regarding valve durability derived from a data base of 515 patients who received lonescu-Shiley bioprosthetic valve between 1978 and 1985; cumulative duration of follow-up was 1562.3 patient-years, with a maximum follow-up duration of 8.7 years. The results of this survey showed as follows: 1] The actuarial freedom from valve failure at 6 years were 43*7% for 0-19 year-old group, 70*1% for 20-39 year-old group and 75*1% for over 40 year-old group separately. 2] Of the causes of valve failure, only the primary tissue failure was markedly influenced by patient`s age [p<0.001], but the prosthetic valve endocarditis was not [p>0.1]. 3] The linealized incidences of primary tissue failure were 7.31% per patient-year in 0-19 year-old group and 0.12% in 20-39 year-old group. 4] The primary tissue failure rate in 0-19 year-old group was 6.36% during first 4 years, but then increased upto 10.95% at postoperative 5 year. Thus we find that in bioprosthetic valve the primary tissue failure is apt to occur when patient is young [especially less than 20 years old] and the postreplacement time passes [especially over 5 years]. The rate of bioprosthesis failure among children and adolescents is clearly higher than that observed in adult patients; however, conclusive quantification of time-related risk for young patient is not yet possible on the basis of existing data. Therefore, the advisability of bioprosthesis implantation in children remains to be determined.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.722-725
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• 1999

Background: To secure a rapid and safe approach which is at the same time cosmetically appealing, we employed the right anterolateral thoracotomy incision for repair of atrial septal defects and valvular heart diseases in the adult. Material and method: Between October 1989 and June 1998, 44 adult patients underwent open heart surgery through right anterolateral thoracotomy at our institution. Operative time, cardiopulmonary bypass time, aortic cross clamp time, blood loss until chest tube removal, length of ICU stay, days to discharge, and survival were compared with those that received cardiac surgery via conventional sternotomy. Result: No significant differences were observed between the two groups. There was no death and no additional morbidity directly related to this approach. Cosmetically satisfying results were obtained with safety using the right anterolateral thoracotomy approach. Conclusion: Our data show that the right anterolateral thoracotomy approach is a safe alternative to conventional median sternotomy as it offers excellent exposure and aesthetically more acceptable wounds while not adding on to the operative risks.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.106-110
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• 2010

Purpose: We report a case of pyogenic arthritis of the shoulder secondary to infective endocarditis. Materials and Methods: A 70 year-old male who had suffered from pyogenic arthritis of the left shoulder secondary to infective endocarditis was treated with artificial valvuloplasty, arthroscopic synovectomy and drainage. Results: Infection was cured and the patient achieved a good functional outcome. Conclusion: Pyogenic arthritis of the shoulder is rarely associated with infective endocarditis. However, if the symptoms are misdiagnosed as musculoskeletal symptoms associated with infective endocarditis, serious complications may arise. As such, musculoskeletal symptoms associated with infective endocarditis should be paid careful attention.