• Journal of Chest Surgery
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• v.32 no.4
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• pp.358-363
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• 1999

Background: Recently, many cardiac centers have been using aprotinin to reduce operative bleeding in cardiac operations using cardiopulmonary bypass. A variety of reports have confirmed the effectiveness of the drug in cardiac operations. In addition to the operations which could be considered to cause severe operative bleeding such as redo operation, long cardiopulmonary bypass operation and etc, the use of aprotinin is increasing in the field of primary cardiac operations. Varying doses of regimen have been introduced since the first report by Royston et al, and also various opinions on the effectiveness and safeness of the each regimen have been reported. We reviewed our own experience of the full dose aprotinin regimen(Hammersmith regimen) retrospectively. Material and Method: From October 1994 to February 1998, 40 cases of cardiac operative patients were randomized into two groups: aprotinin group(20 patients) which received a full dose aprotinin regimen and control group(20 patients) which did not receive aprotinin. To evaluate the degree of bleeding decrease, we analysed and compared the amount of postoperative 6 hours and 24 hours bleeding in the each group. To confirm the renal dysfunction, we measured the postoperative creatinine level. Result: In the amount of postoperative 6 hours bleeding, a statistically significant bleeding decrease was demonstrated in the aprotinin group compared to the control group(aprotinin group: 186${\pm}$40cc, control group:409${\pm}$69cc, P=0.010). Similar result was observed in the postoperative 24 hours(aprotinin group:317${\pm}$53cc, control group: 671${\pm}$133cc, P=0.024). Conclusion: We concluded that full dose regimen of aprotinin can remarkably reduce postoperative bleeding in cardiac operations without significant renal dysfunctions.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.722-725
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• 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
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• v.30 no.4
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• pp.428-431
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• 1997

We experienced a casts of prosthetic mitral paravalvular leak after redo DVR. As far as nonstructural dysfunction is concerned, the prosthetic paravalvular leak is not the result of prosthetic valve endocarditis, but is due to technical difficulties at the time of operation, either residual calcification or poor native tissue. Occasionally paravalvular leaks, particulary around mitral prostheses, may be silent. Paravalvular leaks are usually repaired when there is significant anemia or hemodynamic compromise. At reoperation, some of theses leaks can be repaired simply by patch losure around the paravalvular leak without placing additional suture or explanting the valve.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.365-367
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• 2001

매우 드물게 발생하지만 대동맥판막수술중에 우관상동맥의 급성폐색은 우심실부전을 일으켜 매우 치명적인 결과를 초래할 수 있다. 심한 대동맥 판막부전증을 가진 67세 여자 환자에서 19 mm Hancock II 조직판막을 이용하여 대동맥판막치환술을 시행한 후 심폐기에서 이탈하는 과정주에 우심실부전이 발견되었으며, 우관상 동맥의 폐색을 의심하여 우측 내흉동맥을 사용하여 관상동맥 우회수술을 시행하였고 이후에 심폐기에서 순조롭게 이탈할 수 있었다. 수술후 9일째 시행한 관상동맥 조영술에서 우관상동맥 근위부에 색전에 의한 폐색을 확인할 수 있었다. 이에 저자들은 우관상동맥의 폐색으로 인한 우심부전증이 우관상동맥우회수술후에 회복된 증례를 보고하고자 한다.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.637-640
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• 2007

Papillary fibroelastoma is a rare benign cardiac tumor with an elevated risk for embolization and most papillary fibroelastomas do not cause symptoms. In this report, we describe a case of previous undiagnosed masses of the aortic valve that were incidentally found on intraoperative transesophageal echocardiography during coronary artery bypass surgery. Upon surgery, masses were found on the left and right aortic cusps and the pathological findings were consistent with a papillary fibroelastoma.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.677-679
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• 1989

Recently, we have experienced a case of acute thrombotic obstruction of the St. Jude Medical cardiac valve in the mitral position of the Heart. We will discuss about the incidence, recognition and preventive measurement of the thrombotic St. Jude Medical valve with the review of literatures.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.785-791
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• 2002

The results of reoperative valve replacement can be improved if appropriate analysis for the risk of reoperation was achieved. The purpose of our study was to analyze the results of reoperations for failure of bioprosthesis, and to define the risk factors in high-risk populations for reoperative procedures. Material and Method The series of 46 consecutive patients who had undergone first reoperative replacement for failed bioprosthesis between 1993 and 2001 were reviewed retrospectively. Mean age was 42 $\pm$ 12 years, mean body surface area was 1.52 $\pm$0.15 $m^2$. The reoperative procedure comprised of 36 MVR, 8 DVR, and 2 AVR. The first operation comprised of 2 DVR, 1 AVR, and 43 MVR. Factors which were choose to assess a predictor of results in reoperative valve replacement were sex, old age(＞60 years), early age at first operation(＜30 years), long interval between first and redo operation(.15years), poor NYHA functional class(＞3), LV dysfunction(LVEF＜45%), long operation time(＞8hours), endocarditis, combined procedures, and renal insufficiency, Result : Overall mortality was 4.3%(2 cases). The risk factors that influenced postoperative complications and unexpected postoperative results were lower ejection fraction(p＝0.012), older age(p＝0.045), endocarditis(p＝0.023), long operation time above 8 hours(p＝0.027). There was no statistically significant factor influencing hospital mortality. Conclusion : No factor influenced the mortality. Better results could be achieved if reoferation was performed carefully in poor left ventricular function, old aged patient, and with endocarditis. Effort to shorten the operation time would be helpful on postoperative results.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.759-763
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• 2008

Cardiac surgery in patients with a prior pneumonectomy has a high prevalence of postoperative complications and mortality. We have successfully performed a mitral valve replacement and tricuspid annuloplasty in a 71-year-old man who had a left pneumonectomy 33 years previously due to pulmonary tuberculosis. We report this case with a literature review on the issue of the prevention perioperative pulmonary impairment, the technique of mitral valve exposure during surgery and postoperative rhythm disturbance.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.602-613
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• 2010

Background: As life expectancy has been increased, the cardiac valve disease has been increased. In past, mechanical valve for valve replacement surgery was used widely, but it has many weaknesses, such as hemorrhage, teratogenic effect caused by warfarin, acute mechanical failure, taking warfarin during life, etc. So, the tissue valve is used widely and researches for durability of tissue valve are in progress. Tissue valves being used are all imported in Korea, and there is a lack of information on its geometry and design. So, we studied the geometry of porcine aortic and pulmonary valve, and tried to suggest theoretical basis for making the aortic and pulmonary valve. Material and Method: We harvested aortic and pulmonary valves of 25 pigs and measured the geometry of valve at fresh and glutaraldehyde (GA) fixed state. In each group, we measured the diameter of the base, diameter of commissure, valve height, commissural height, etc. Also, for making implantable porcine and bovine pericardial valve, we designed the valve stent form, thickness, height, and leaflet size, form, thickness by different size of valve. Result: The aortic and pulmonary valve geometry and ratio were measured in each group. The right coronary cusp of aortic valve and right facing cusp of pulmonary valve was bigger than other cusps and non coronary cusp was smaller than others (RCC: NCC : LCC=1 : 0.88 : 1). Valve height was correlated to the leaflet size. We designed the outer diameter of stented porcine aortic valve from 19 mm to 33 mm and designed stent height and width, using previous measured ratio of each structure, stent thickness, working thickness (for making valve). Also, we designed the size of stent and form for stented bovine pericardial valve, considering diameter of valve, leaflet length, height and leaflet minimum coaptation area. Conclusion: By measuring of 25 pig's aortic and pulmonary valve geometry and ratio, we can make theoretical basis for making implantable stented porcine valve and bovine pericardial valve in various size. After making implantable valve using these data, it is necessary to do in vivo and in vitro researches, furthermore.

• Journal of Chest Surgery
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• v.34 no.1
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• pp.57-63
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• 2001

배경: 대동맥판막협착증 환자는 판막질환으로 인한 만성적인 후부하의 증가에 대한 보상성 좌심실 심근비후가 일어나게 된다. 대동맥 판막 치환 후 좌심실 심근 비후의 감소가 이루어지는 것으로 알려져 있으나 21mm이하의 작은 인공판막으로 치환시 좌심실 심근 변화에 대해 논란이 있다. 대상 및 방법: 1994년 9월부터 1998년 7월까지 한림대학교 강동성심병원 흉부외과에서 대동맥판막협착증으로 진단받고 판막치환술을 시행한 20명을 대상으로 하였다. 환자는 남녀 각각 13명, 7명이며 평균나이 61$\pm$13.8세 체표면적은 평균 1.57$\pm$0.14m$m^2$이었다. 환자의 추적관찰은 수술 전, 수술 후 초기(평균 10.4일) 및 수술 후 만기(평균 29.9개월)에 심초음파로 시행하였다. 환자들은 사용된 판막에 따라 2개의 군(1군;21mm 이하, 2군;23mm이상)으로 나누었다. 결과: 모든 군에서 NYHA Functional class의 유의한 감소가 있었다. 좌심실 구추률은 수술 전후 1군은 유의한 차이가 없었으나 2군에서는 유의한 차이가 있었다. 그러나 수술 전 좌심실 구출률이 2군에서 1군에 비해 유의하게 감소되어 있었다(p=0.044). 좌심실근량지수는 1군은 수술후 초기에 유의한 감소가 없었으나 수술후 만기에는 유의한 감소를 보여주었다. 그러나 2군은 수술후 초기와 만기에 모두 유의한 감소를 보여주었다. 결론: 21 mm이하 군과 23 mm이상 군 모두 임상적 호전이 있었다. 그러나 19 mm판막군이 2례로 적어 19 mm 판막의 사용시 환자의 나이와 체표면적, 운동량을 고려하여 신중한 판막선택이 고려된다.