• Journal of Chest Surgery
• /
• v.37 no.4
• /
• pp.328-334
• /
• 2004

There are only limited numbers of reports about long-term results of tricuspid valve replacement(TVR) with bioprosthetic and mechanical prostheses. We analyzed risk factors for tricuspid valve replacement and compared long-term clinical results of bioprosthetic and mechanical valves in tricuspid position. Material and Method: We reviewed 77 cases of TVR, which were performed between October 1978 and December 1996. Mean age was 38.8 15.9 years. Bioprostheses were implanted in 26 cases and mechanical prostheses were implanted in 51 cases. Result The operative mortality was 15.6% and late mortality was 12.3%. Survival for bioprosthetic and mechanical valve group at 5, 10 and 13 years was 81.3% vs. 100%, 66.1% vs. 100%, 60.6% vs. 100% (p=0.0175). Free from valve related re-operation for bioprosthetic and mechanical valve group at 5, 10 and 13 years was 100% vs. 93.9%, 100% vs. 93.9% and 58.3% vs. 93.9% (p=0.3274). Linealized incidences of valve related re-operation for bioprosthetic and mechanical valve group was 2.27 %/patient-years and 1.10 %/patient-years. Risk factor analysis showed that presence of preoperative ascites, hepatomegaly larger than 2 finger breaths, poor preoperative NYHA functional class and number of tricuspid valve replacement were risk factors for early mortality, and the use of bioprosthetic valve and number of open heart surgery were risk factors for late mortality. Conclusion: Long-term survival of mechanical valve was superior to bioprosthetic valve in tricuspid position. We recommend mechanical valve in tricuspid position if the patient can be closely followed up.

• Journal of Chest Surgery
• /
• v.36 no.4
• /
• pp.273-276
• /
• 2003

We report a surgical case of 39-year-old male with a pseudoaneurysm of the left ventricle. Four years ago, the patient underwent aortic and mitral valve replacements with mechanical valves and abscess removal for infective endocarditis with annular abscess. Recent echocardiography demonstrated a communication between left ventricle and abscess pocket, and the size of pocket increased further at the follow-up echocardiography. The patient underwent patch closure of the defect between left ventricle and pseudoaneurysm located at the aortomitral fibrous continuity, under the cardiopulmonary bypass and cardioplegia. The postoperative course was uneventful and the patient was discharged on the 9th postoperative day.

• Journal of Chest Surgery
• /
• v.30 no.2
• /
• pp.200-204
• /
• 1997

This is a report of a successful management of a patient with infective endocarditis involving native aortic valve, mitral valve, tricuspid valve, and Interventric lar septum. A 16 year-old patient who underwent VSD patch closure, and aortic valvuloplasty at the age of 1 1 years showed Intractable congestive heart failure during antibiotics treatment for infective endocarditis. Operative findings revealed that there were large defect along the previous patch, aortic regurgitation with multiple perforations and vegetations, mitral regurgitation with vegetation, aortic paraannular abscess, interventricular myocardial abscess, and tricuspid regurgitation with perforations and vegetations. We reconstructed the interventricular defect with Dacron patch extending to the aortic valve annulus after radical debridement of all infected or devitalized tissues, and could implant aortic valve by anchoring to the reconstructed Dacron patch. Mitral valve was replaced and tricuspid valve was repaired with patient's own pericardium. The patient was discharged after antibiotics treatment for 6 weeks and in good condition without any sequelae for 12 months.

• Journal of Chest Surgery
• /
• v.37 no.1
• /
• pp.50-55
• /
• 2004

Background: Transcranial Doppler ultrasonography (TCD) can detect microembolic signals (MES) in the patients with a potential embolic source. Clinical significance of MES has not been demonstrated in patients with prosthetic mechanical heart valves. We studied the correlation between cerebral thromboemoblic events after the mechanical heart valve surgery (MHVS) and residual MES during TCD monitoring with 100% oxygen inhalation in patients with mechanical heart valves. Material and Method: Twenty patients with previous cerebral thromboemoblic events after MHVS and a sex- and age-matched control group (n=30) were studied. TCD monitoring was performed from unilateral middle cerebral artery. After baseline monitoring for 20 minutes, 61 of oxygen was inspired for 40 minutes. Result: The site of valve and the duration after MHVS of the patients did not differ from those of controls. During baseline monitoring, there was no significant difference in MES prevalence or counts compared to controls. During oxygen inhalation, patients showed a higher MES prevalence (55%, 27.6%, p=0.045) and a more frequent MES counts (p=0.027) compared to controls. Conclusion: TCD monitoring with oxygen inhalation may be useful to differentiate clinically significant MES in patients with mechanical heart valve.

• Proceedings of the KTCVS Conference
• /
• 1993.06a
• /
• pp.81-81
• /
• 1993

• Proceedings of the KTCVS Conference
• /
• 1996.10a
• /
• pp.8-8
• /
• 1996

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

• Journal of Chest Surgery
• /
• v.43 no.4
• /
• pp.417-420
• /
• 2010

As higher mortality rate and frequent incidence of morbidity, early surgical treatment is generally recommended for the multivalvular endocarditis. A 46-year-old female presented with high fever. Echocardiography showed the vegetation on pulmonic valve, tricuspid valve and mitral valve with a ventricular septal defect. Emergency operation was conducted due to uncontrolled infection. We present a clinical success of this rare case with review of the medical literature.

• Journal of Chest Surgery
• /
• v.32 no.6
• /
• pp.588-590
• /
• 1999

It is now generalized to perform cardiac surgery in the patients with end-stage renal disease. The growing number of patients with chronic renal failure wake us up to the need to prepare for proper management. There are not only the prevalence of coronary artery disease, but also a great amount of valve dysfunction exist in this group. Peritoneal dialysis may be one of the obstacles for cardiopulmonary bypass but it is not a great hindrance in cardiac surgery with careful preparation and well organized perioperative care. The author has performed mitral valve replacement in a 33-year-old anuric female patient with chronic renal failure and severe mitral insufficiency. Preoperatively, the patient was kept in adequate fluid and electrolyte balance using peritoneal dialysis. Peritoneal dialysis continued and regulated according to the laboratory data in this patient during and after the surgery. She recovered well showing an uneventful course and was discharged on postoperative 1 th day.

• Proceedings of the KTCVS Conference
• /
• 1998.10a
• /
• pp.177-177
• /
• 1998