• Journal of Chest Surgery
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• v.13 no.4
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• pp.422-434
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• 1980

Since 1968 up to the end of October 1980, 448 valves were replaced in 354 patients in Seoul National University Hospital. There were 238 mitral, 38 aortic, 7 tricuspid, 45 aortic with mitral, 23 tricuspid with mitral, and 3 triple valve replacement aortic mitral and tricuspid cases. Annual increase of mitral valve replacement cases and decrease of operative maortality were remarkable. Recently operative mortality of mitral valve replacement is about 5%. Sex ratio of mitral valve replacement is almost equal and there were 12 cases of pediatric patients (5%) among 238 cases, and patients under the age of 20 years were 34 (14.3%). Mitral valve replacement was done for 199 single mitral, 38 double valve and one triple valve lesions. Among 238 mitral valve replacement paients left atrial thrombus in 23(9.7%), atrial fibrillation in 132 (55.5%), and reoperation after blind mitral commissurotomy in 12(5%) cases were noted. In recent cases bioprosthetic valves, mainly lonescu-shiley valve were utilized to overcome the difficulties of postoperative late complications in anticoagnuation, especially for the rural patients and pediatric cases, in addition to the hemodynamic advantages of lonesocu valve. Among 354 patients 16 cases were congenital heart anomaly related, 5 ventricular septal defect related aortic and 4 Ebstein related tribuspid valve replacement cases. There were 2 congenital anomaly related mitral valve replacements, one for congenital mitral insufficiency of 7 years old boy and one for corrected transposition of the great vessels associated with mitral insufficiency. Among total 354 valve replacements 49 operative deaths (13.3%) were noted and in 238 mitral valve replacement 24 operative deaths occurred (10.1%). In 39 patients among 354 total valve replacements late complications were found. In 238 mitral valve replacement cases late complications were noted in 26 patients, among whom 16 cases expired. Main late complications were thrombe-embolism, subacute becteerial endocarditis, arrythmia cerebral hemorrhage due to unsatisfactory anticoagulation, and congestive heart failure in the incipient period of valve replacement were also noted. In mitral valve replacement cases long-term survival rate was 83.2% who showed marked clinical improvement. Ther were no evidences of calcification during the 2 years follow-up period for the lonescu-valve replacement cases among 19 pediatric patients. In conclusion 238 cases of mitral valve replacement were done with 24 operative deaths and 26 late complication cases among whom 16 expired. The long term survival was 83.2% of the cases. In pediatric cases in place of coumadin anticoagulation Persantin **** 75 and aspirin were administered after valve replacement. In adult cases who have difficulaties with coumadin anticoagulation and for those even with bioprosthetic heart valve replacement who needs long-term or permanent anticoagulation persantin 75 and aspirin combination regimen were administered with antisfactory results.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.241-249
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• 1977

Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.

• Journal of Chest Surgery
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• v.35 no.12
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• pp.876-881
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• 2002

Acute aortic dissection associated with high mortality rate has an extremely poor prognosis if early diagnosis and treatment are not received. Recently, with advanced computed tomography and echocardiography, diagnostic rate is higher and early operation is possible. Therefore preoperative medical therapy at ER(emergency room) lowered the mortality rate. This study was done to analyze the results with preoperative management at ER and operations, retrospectively. Material and Method: A series of 42 patients treated surgically for acute aortic dissections from 1991 to 2001 were included in this study. There were 18 males and 24 females. Mean age was 51.1 years. The admission course through emergency and outpatient department(OPD) was 34 and 8 respectively. Result: 26 patients underwent ascending aorta replacement-7 combined aortic valve replacements, 7 patients underwent descending aorta replacements and 9 patients received Bentall's operation. At emergency department, 20 patients received antihypertensive drugs and $\beta$-receptor blockers and 6 patients died. 22 patients did not receive antihypertensive and $\beta$-receptor block drugs and 10 patients died. There were 16(38%) overall deaths. Conclusion: Early diagnosis at ER or OPD is essential for acute aortic dissection, and it is important to select the most appropriate noninvasive interventions as possible. Therefore, preoperative drug therapy at ER is suggested according the patient conditions.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.506-511
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• 1997

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.893-901
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• 1994

Forty nine patients [M: 31, F: 18], age from 2 months to 17 years [mean= 4.9 years], underwent operations, from April 1986 to December 1992, for the relief of subvalvular aortic stenosis in normal atrioventricular and ventriculoarterial connections.There were 4 anatomic types of subaortic stenosis : membranous in 29 cases [59.2%], fibromuscular in 11 [22.4%], diffuse tunnel type in 7 [14.3%], and miscellaneous in 2 cases. Thirty four patients [69.4%] had associated cardiac anomalies, of which ventricular septal defect was the most common [27 cases]. Other anomalies were patent ductus arteriosus, coarctation of the aorta, valvular aortic stenosis, double chambered right ventricle [DCRV], infundibular pulmonic stenosis, persistent left superior vena cava, and rigt aortic arch. Mean systolic pressure gradient between the left ventricle and ascending aorta was 26.4$\pm$17.6 mmHg : 13.1$\pm$17.6mmHg in the membranous type, 22.0$\pm$18.4mmHg in the fibromucular type, and 56.1$\pm$38.4mmHg in the diffuse tunnel type. Operative procedures were determined according to the type of subvalvular aortic stenosis : simple excision of subaortic membrane in the membranous type [29 cases], left ventricular myectomy with or without myotomy or fibrous tissue excision in the fibromuscular type [11 cases]. Among the 7 of diffuse tunnel type cases, ventricular myectomy was performed in 2 and a modified Konno operation was performed in 5 . Postoperative follow up was made with periodic echocardiography. The Mean postoperative follow up period was 33.8 months. There were 2 hospital mortalities [4.1%] and 2 late deaths. Residual stenosis remained in 3 cases and recurrence developed in 2 cases during the follow up period. 5 years actuarial survival rate was 91.8$\pm$3.9% and 5 year complication free rate was 72.3$\pm$10.4%. Conclusions : 1. Subvalvular aortic stenosis should be relieved completely as soon as possible when diagnosed, regardless of left ventricular outflow tract pressure gradient. 2. Good results were obtained using only simple excision of subaortic membrane in the membranous type of subaortic stenosis. However, aortoventriculoplasty [modified Konno prodedure] was necessary for good results in the diffuse tunnel type. 3. Periodic postoperative echocardiography was helpful in detecting the progression of residual stenosis and development of new stenosis.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.221-225
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• 1998

From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years(mean, 53). Thirteen patients were in New York Heart Association(NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty(16 cases), rectangular resection of posterior leaflet(15 cases), chordal shortening(5 cases), triangular resection of anterior leaflet(2 cases), commissurotomy(2 cases), partial transposition of posterior leaflet(1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.633-636
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• 2006

The partial endocardial cushion defect including ostium primum atrial septal defect and anterior mitral leaflet cleft, presents less significant clinical symptoms than complete endocardial cushion defect. But, as mitral insufficiency develops, cardiomegaly, congestive heart failure, pulmonary arterial hypypertension appear. So, partial endocardial cushion defect has poor prognosis and is rarely seen in elderly patients. A 67 years old woman admitted at our hospital for operative treatment with partial endocardial cushion defect. She had increased pulmonary pressure of 45/22 mmHg, mean 32 mmHg. She had repair of ostium primum defect with patch, and the mitral valve was treated with valve replacement. Because advanced atrioventricular block developed postoperatively, she received permanent pacemaker.

• Journal of Yeungnam Medical Science
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• v.14 no.2
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• pp.350-358
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• 1997

We studied the effects of adding a single bolus(500 mg) of sodium thiopental to a continuous infusion of low-dose fentanyl on plasma beta-endorphin immunoreactivity(iBE) responses to cardiopulmonary bypass(CPB) in 28 patients undergoing elective coronary artery bypass grafting or valve procedures. Thiopental was injected just prior to the initiation of CPB. The iBE levels and the hemodynamic indices such, as mean arterial pressure, cardiac output and systemic vascular resistance were measured before CPB, at 30 min and again at 60 min after the initiation of the bypass. The results were as follows. After the initiation of CPB, iBE levels increased at 30 min and 60 min(P=0.006, P=0.004 respectively) in the control group, but not in the thiopental group. There were significant differences in the changes of iBE levels between the groups(F=8.7, G-G=0.002, P=0.001). The hemodynamic indices were similar in both groups. In conclusion, pretreatment with thiopental just before the initiation of CPB prevents the stress-induced beta-endorphin response to CPB.

• Journal of Biomedical Engineering Research
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• v.27 no.6
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• pp.418-426
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• 2006

In the artificial heart application, productivity and hemodynamic properties of artificial heart valves are crucial in successiful application to long term in vivo trials. This paper is about manufacture and assessment of trileaflet polymer heart valves using vacuum forming process(VFP). The VFP has many advantages such as reduced fabrication time, reproducibility due to relatively easy and simple process for manufacturing. Prior to VFP of trileaflet polymer heart valves, polyurethane(Pellethane 2363 80AE, Dow Chemical) sheet was prepared by extrusion. The sheets were heated and formed to mold shape by vacuum pressure. The vacuum formed trileaflet polymer heart valves fabrication is composed of two step method, first, leaflet forming and second, conduit forming. This two-step forming process made the leaflet-conduit bonding stable with any organic solvents. Hydrodynamic properties and hemocompatibility of the vacuum formed trileaflet polymer heart valves was compared with sorin bicarbon bileaflet heart valve. The percent effective orifice area of vacuum formed trileaflet polymer heart valves was inferior to bileaflet heart valve, but the increase of plasma free hemoglobin level which reflect blood damage was superior in vacuum formed trileaflet polymer heart valves Vacuum formed trileaflet polymer heart valves has high productivity, and superior hemodynamic property than bileaflet heart valves. Low manufacturing cost and blood compatible trileaflet polymer heart valves shows the advantages of vacuum forming process, and these results give feasibility in in vivo animal trials in near future, and the clinical artificial heart development program.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.289-299
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• 1987

A total of 1,239 patients had cardiac valve replacement using 1,514 substitute valves at Seoul National University Hospital from 1968 to 1986. Of the total substitute vales, 84.9% were the glutaraldehyde-treated xenograft valves. Six hundred ninety-four patients who had 820 bioprosthetic tissue valves were studied for their clinical characteristics. They were a total and consecutive cases to the end of the study. Four hundred sixty-four patients had the lonescu-Shiley pericardial valves: MVR 291, AVR 66 and MVR+AVR 107; 163 had the Hancock porcine valves; 46 had the Angell-Shiley porcine valves; and 21 had the Carpentier-Edwards porcine valves. Five hundred forty patients underwent single valve replacement: MVR 460, AVR 76 and TVR 4; 154 had multiple valve replacement: MVR+AVR 141, MVR+TVR 12 and one triple valve replacement. Additional surgery was necessary in 22.3% of the cases. Operative mortality rate within 30 days of surgery was 6.77% for the total patients: 5.2% and 4.2% with MVR, 13.6% and 12.5% with AVR, and 7.5% and 7.4% with MVR+AVR using the lonescu and the Hancock valves respectively. A linealized annual late mortality rate was 2.56%/patient-year. Six hundred forty-three operative survivors were followed up for a total of 1482.7 patient-years [a mean 27.7 months], and the follow-up rate was 67.7%. The Idealized complication rates were: 2.02% emboli/patient-year, 0.94% bleeding/patient-year, 1.21% endocarditis/patient-year, and 3.84% overall valve failure/patient-year. A linealized rate of primary tissue failure was 0.87%/patient-year. Actuarial survival rates including the operative mortality were: 87.8*2.6%, 82.3*4.9% and 82.2*4.7% with MVR, AVR and MVR+AVR using the lonescu valves at 4 years after surgery respectively; and they were 88.0*4.1% with MVR at 8 years, 82.3*4.9% with AVR at 4 years and 84.9*7.0% with MVR+AVR at 6 years after surgery using the Hancock valves respectively. Probabilities of freedom from thromboembolism were 89.8*6.3% with MVR using the lonescu valves at postoperative 5 years and 89.2*3.8% with MVR using the Hancock valves at postoperative 7 years, and 93.3*3.9% with AVR using the lonescu valves at postoperative 5 years. None had embolic complication after AVR using the Hancock valves. Probabilities of freedom from valve failure [according to the Stanford criteria] were 81.0*7.1% with MVR using the lonescu valves at postoperative 4 years and 57.4*12.5% with MVR using the Hancock valves at postoperative 9 years. These clinical results prove the excellent antithrombogenicity of the glutaraldehyde-treated xenograft substitute valves and confirm the previously speculated rate of tissue failure. At the present situation, it may be concluded that there is a room for the further development of more durable bioprosthetic valves.