• Journal of Chest Surgery
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• v.30 no.9
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• pp.891-898
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• 1997

Between May 1984 and January 1996, 130 patients were replaced cardiac valve using 150 St. Jude Medical prosthetic valves(42 aortic, 68 mitral, 20 aortic and mitral valve replycements). Follow-up was 97.6% complete. The early mortality rate was 5.4%, and late mortality rate was 4.9%. The valve-related late mortality rate was 3.3%. Of late complications, there were 6 anticoagulant related hemorrhages, 4 thromboembolisms and 1 paravalvular leakage. Linearized rates of late complication and valve-related late mortality were as follows: total late complications, .1.68o per patient-year: anticoagulant related hemorrhages, 0.92% per patient-year: thromboembolism, 0.61% per patient-year: paravalvular leakage, 0.15% per patient-year: reoperation, 0.15% per patient-year: and valve-related late mortalities, 0.61% per patient-year. Actuar al event free rate at 10 years was 87.4 $\pm$ 3.2%. The overall actuarial survival rate was 90.4$\pm$2.7% at 5 years, 87.5$\pm$3.3% at 10 years. Ninety eight percent of the survivors were in the New York Heart Association functional class I or II at the end of follow-up. There was significant improvement of cardiothoracic ratio. In conclusion, this study suggests the excellent durability of the St. Jude Medical Heart valve and remarkable functional benefit for the majority of the patients. However, prosthesisrelated complications are still common. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.113-116
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• 2014

A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.1
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• pp.584-592
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• 2020

The purpose of this study is to explore the relationship between warfarin-related knowledge, self-efficacy, and medication adherence among patients who underwent heart valve replacement surgery. The patients who underwent heart valve surgery and warfarin therapy were included in this study. The data was collected by administering questionnaires, and the data was then analyzed using the SPSS WIN 22.0 program. There was a positive relationship between warfarin-related knowledge and the adherence to medication (r=.285, p=004). Medication adherence was also positively correlated with warfarin-related knowledge (r=.250, p=.046) and self-efficacy (r=.292, p=.019) for elderly patients under 70 years of age. Further, medication adherence of elderly patients over 70 years of age was correlated with only warfarin-related knowledge (r=.358, p=.032). The results of this study show that in order to improve medication adherence, elderly people should be provided with warfarin-related knowledge through individually tailored education and nursing interventions that strengthen self-efficacy, as well as the knowledge that is needed in the elderly group under 70 years old.

• Journal of Chest Surgery
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• v.27 no.1
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• pp.1-8
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• 1994

Allograft cardiac valves have been used for over 30 years to replace diseased cardiac valves, reconstruct right or left ventricular outflow tract. With increasing its requirement, the establishment of a viable bank capable of maintaining the viability of graft over a prolonged period would be desirable. The method for determining the viability of allograft by metabolic assay technique using radiolabeled aminoacids has been used recently. An experimental study was done for evaluation of viability of cardiac allograft which was preserved for 14 days at 4oC in nutrient medium[fresh preservation] by metabolism assay technique using 3H-glycine. Also, the effectiveness of low concentration antibiotic solution[CLPV] for sterilization was evaluated. The effectiveness of CLPV solution for sterilization of allograft was perfect. Pre-treatment cultured organisms were not cultured after treatment at all in every cases. The viability of allograft after sterilization was reduced to 66.4%[aortic wall], 74.7%[pulmonary wall], 76.3%[aortic valve], 67.9%[aortic wall]. And after the fresh preservation for 14 days, the viability was reduced to 14.7%, 18.5%, 17.7%, 19.0%, respectively.In conclusion, viability of allograft was reduce to 71.3[66.4-76.3]% after sterilization and 17.5[14.7-19.0]% after fresh preservation. And sterilization effect of CLPV solution was satisfactory.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1090-1094
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• 1996

From February 1980 to September 1995, 31 children between 2 months and 15 years of age with mitral valve disease have undergone mitral valve replacement(MVR) at Yonsei Cardiovascular Center and com- plete follow-up has been obtained on 28 patients. There were 10 males and 18 females whose weight ranged from 4.9kg to 56kg. Two patients died early postopeiatively and the overall hospital mortality rate was 7.1%. These two were infants but there were no statistically significant difference in overall mortality among the age groups(p=0.13). The valve related complication rate was 57.1% in children younger than 5 years of age, which showed higher complication rate compared to older patients(p< 0.05). The bioprosthetic valve have been applied in 7 patients, and its 5-year valve failure-free survival rate was 50% . No mechanical valve failu e had occurred in 21 patients. In considering high re-replacement rate of bioprosthetic valve, mechanical valve is recommended despite its possibility of bleeding and thromboembolic complications. However, the consequences of increasing body size and long-term interposition of a rigid prosthesis in a growing heart will require second valve replacement. En conclusion, mitral valve replacement can be performed tilth satisfactory long-term survival in children, although younger mean age of the children has an important influence on early mortality and com- plication rate. And therefore mitral valve replacement in children younger than 5 years of age needs special consideration.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.559-569
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• 2004

The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

• Journal of Cardiovascular Imaging
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• v.31 no.2
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• pp.108-115
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• 2023

BACKGROUND: Minimizing contrast dose and radiation exposure while maintaining image quality during computed tomography angiography (CTA) for transcatheter aortic valve replacement (TAVR) is desirable, but not well established. This systematic review compares image quality for low contrast and low kV CTA versus conventional CTA in patients with aortic stenosis undergoing TAVR planning. METHODS: We performed a systematic literature review to identify clinical studies comparing imaging strategies for patients with aortic stenosis undergoing TAVR planning. The primary outcomes of image quality as assessed by the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were reported as random effects mean difference with 95% confidence interval (CI). RESULTS: We included 6 studies reporting on 353 patients. There was no difference in cardiac SNR (mean difference, -1.42; 95% CI, -5.71 to 2.88; p = 0.52), cardiac CNR (mean difference, -3.83; 95% CI, -9.98 to 2.32; p = 0.22), aortic SNR (mean difference, -0.23; 95% CI, -7.83 to 7.37; p = 0.95), aortic CNR (mean difference, -3.95; 95% CI, -12.03 to 4.13; p = 0.34), and ileofemoral SNR (mean difference, -6.09; 95% CI, -13.80 to 1.62; p = 0.12) between the low dose and conventional protocols. There was a difference in ileofemoral CNR between the low dose and conventional protocols with a mean difference of -9.26 (95% CI, -15.06 to -3.46; p = 0.002). Overall, subjective image quality was similar between the 2 protocols. CONCLUSIONS: This systematic review suggests that low contrast and low kV CTA for TAVR planning provides similar image quality to conventional CTA.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.971-976
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• 1996

From March 1988 to October 1992, 201 CarboMedics cardiac valve prostheses (150 mitral, 50 aortic and 1 tricuspid) were implanted in 166 consecutive patients (mean age 38 years, male/female 66/100) by one surgical team operating on adult cardiac patients at Kyungpook University Hospital. Total follow up represen:toed 6646 patient-months (mean 40mon1hs) and follow up rate was 96%. One hundred and twenty-four patients (74.7 %) were in NYHA functional class 111 or tV preoperatively and 164 patients (98.7 %) were in class I or ll postoperatively. Hospital mortality was 4.2 % and late death was 4.2%. The actuarial survival at 78 months was 89.4%. The linearized incidence of valve related death, prosthetic valve thrombosis, anticoagulant related hemorrhage, non-structural dysfunction and reoperation was 0.72%/pt-yr, 0.18%/pt-yr, 0.18%trapt-yr, 0.18 %/pt-yr and 0. 36%/pt-yr respective y. The 78 month rates of freedom from valve related death, prosthetic valve thrombosis, anticoagulant related hemorrhage, non-structural dysfunction and reoperation were 94.9%, 99.4%, 99.4%, 98.6 % and 97.9 % respectivly. The 78 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.9%. These fact suggest that the CarboMedics cardiac valve has execellent result, low incidence of valve-ie-lated complications and no structural deterioration, and long term follow up study is necessary.

• 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.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.285-290
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• 2020

Background: This study was conducted to evaluate the hemodynamic performance and the incidence of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) using bovine pericardial valves (Carpentier-Edwards Perimount Magana and Magna Ease). Methods: In total, 216 patients (mean age, 70.0±10.5 years) who underwent AVR using stented bovine pericardial valves and had follow-up echocardiography between 3 months and 2 years (mean, 12.0±6.6 months) after surgery were enrolled. The implanted valve sizes were 19, 21, 23, and 25 mm in 32, 56, 99, and 29 patients, respectively. Results: On follow-up echocardiography, the mean transvalvular pressure gradients for the 19-mm, 21-mm, 23-mm, and 25-mm valves were 13.3±4.4, 12.6±4.2, 10.5±3.9, and 10.2±3.7 mm Hg, respectively. The effective orifice area (EOA) was 1.25±0.26, 1.54±0.31, 1.81±0.41, and 1.87±0.33 ㎠, respectively. These values were smaller than those suggested by the manufacturer for the corresponding sizes. No patients had PPM, when based on the reference EOA. However, moderate (EOA index ≤0.85 ㎠/㎡) and severe (EOA index ≤0.65 ㎠/㎡) PPM was present in 56 patients (11.8%) and 9 patients (1.9%), respectively, when using the measured values. Conclusion: Carpentier-Edwards Perimount Magna and Magna Ease bovine pericardial valves showed satisfactory hemodynamic performance with low rates of PPM, although the reference EOA could overestimate the true EOA for individual patients.