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Clinical experience of open heart surgery -70 cases- (개심술 70예의 임상경험)

  • 조광현
    • Journal of Chest Surgery
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    • v.19 no.4
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    • pp.644-662
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    • 1986
  • Seventy cases of open heart surgery were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, Inje College, from Oct. 1985 to Oct. 1986. And the results were summarized as follows. 1. Among the 70 cases, there were 48 cases of congenital heart anomalies and 22 cases of acquired rheumatic valvular heart diseases. Age range of the congenital patients was 7 months to 31 years with the mean age of 10 years, and the acquired patients was 18 to 62 years with the mean age of 40 years. 2. The heart-lung machine used for cardiopulmonary bypass was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 5 of membrane type and 65 of bubble type. For all cases GIK [glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 3. Among the 48 congenital anomalies, there were 12 cases of ASD group, 29 of VSD group, 3 of ECD, 3 of TOF and one of PDA + MR, and to all of which the appropriate radical operations were applied. 4. Among the 22 acquired valvular diseases, there were 11 cases of mitral valve diseases [MS; 4, MSr; 3, MRs; 4], 3 cases of aortic valve diseases [AR:1, ARs;1, ASr;1], 4 cases of double valve diseases [MRs+TR; 3, MRs+ARs; 1] and 4 cases of triple valve diseases [MSr+ASr+TR; 3, MSr+Ar+TR; 1]. To all the diseased mitral and aortic valves, artificial valve replacement was applied except one [As], in which valve plication was applied. And to all the diseased tricuspid valve, DeVega annuloplasty was applied. 5. The number of replaced artificial valves were 29 in 25 patients [congenital; 3, acquire; 22]. In MVR, 6 of mechanical valves [St. Jude Medical valve; 6] and 15 of tissue valves [Carpentier-Edward valve; 11, lonescu-Shiley valve; 4] were used. In AVR, 6 of mechanical valves [St. Jude Medical valve; 6] and 2 of tissue valves [Carpentier-Edward valve; 2] were used. 6. Postoperative complications were occurred in 12 cases. Among them 11 cases were recovered with intensive cares, but one patient [VSD + Fistula of Valsalva sinus] was expired with low cardiac out put syndrome.

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Cardiac valve replacement in patient less than 16 years of age (16세 미만에서의 심장판막치환술)

  • Kim, Eung-Jung;Seo, Gyeong-Pil;Lee, Yeong-Gyun
    • Journal of Chest Surgery
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    • v.19 no.1
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    • pp.108-115
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    • 1986
  • During 12 years period from 1974 to 1985, 76 valve replacement procedures were performed at Seoul National University Hospital in 67 pediatric patients aging up to 15 years [mean 12.3 years] and it was 7.3% of total valve replacement procedures in same period. Sixty seven patients were composed of 44 males and 23 females. Of the 67 patients, 43 patients had acquired valve lesions and 24 patients congenital valve lesions. Sixty cases received single valve replacement, 7 cases double or triple valve replacement and 9 cases redo-valve replacement. Sixty seven patients received 84 valves [65 bioprosthetic valves and 19 prosthetic valves by] 76 operations, Sixty three of 65 bioprosthetic valves had been replaced before 1983 and 15 of 19 prosthetic valves in recent 2 years. Eleven patients [14.6%] died within one month post-operatively and 8 patients [10.5%] during the follow-up period with the overall mortality rate of 25.1%. There were early post-operative complication of 23 cases [30.3%] and late post-operative complication of 27 cases [35.3%] with the total complication rate of 65.8%. In 58 patients received bioprosthetic valves, there were 14 cases of restenosis of replaced valves. Of the 14 cases of bioprosthetic valve restenosis, 8 cases received redo-valve replacement procedures without mortality in 1 5/12-5 years after initial operation but 4 cases died without reoperation and 2 cases lost during follow-up. The overall mortality and complication rate were still high but they markedly decreased during recent 2 years. So, in spite of its containing many problems, valve replacement in children is becoming safe and useful procedure in whom valve reconstructive procedures are impossible.

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Structural Stability of High-temperature Butterfly Valve Using Interaction Analysis

  • Lee, Moon-Hee;Son, In-Soo
    • Journal of the Korean Society of Industry Convergence
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    • v.23 no.6_1
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    • pp.881-888
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    • 2020
  • A butterfly valve is a valve that adjusts flow rate by rotating a disc for about 90° with respect to the axis that is perpendicular to the flow path from the center of its body. This valve can be manufactured for low-temperature, high-temperature and high-pressure conditions because there are few restrictions on the used materials. However, the development of valves that can be used in a 600℃ environment is subject to many constraints. In this study, the butterfly valve's stability was evaluated by a fluid-structured interaction analysis, thermal-structure interaction analysis, and seismic analysis for the development of valves that can be used in high-temperature environments. When the reverse-pressure was applied to the valve in the structural analysis, the stress was low in the body and seat compared to the normal pressure. Compared with the allowable strength of the material for the parts of the valve system, the minimum safety factor was approximately 1.4, so the valve was stable. As a result of applying the design pressures of 0.5 MPa and 600℃ under the load conditions in the thermal-structural analysis, the safety factor in the valve body was about 3.4 when the normal pressure was applied and about 2.7 when the reverse pressure was applied. The stability of the fluid-structure interaction analysis was determined to be stable compared to the 600℃ yield strength of the material, and about 2.2 for the 40° open-angle disc for the valve body. In seismic analysis, the maximum value of the valve's stress value was about 9% to 11% when the seismic load was applied compared to the general structural analysis. Based on the results of this study, the structural stability and design feasibility of high-temperature valves that can be used in cogeneration plants and other power plants are presented.

Measurment of Fluid Film Thickness on The Valve Plate in Oil Hydraulic Axial Piston Pumps (Part II : Spherical Design Effects)

  • Kim Jong-Ki;Kim Hyoung-Eui;Lee Yong-Bum;Jung Jae-Youn;Oh Seok-Hyung
    • Journal of Mechanical Science and Technology
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    • v.19 no.2
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    • pp.655-663
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    • 2005
  • Tribological characteristics in the sliding parts of oil hydraulic piston pumps are very important in increasing overall efficiency. In this study, the fluid film between the valve plate and the cylinder block was measured by using a gap sensor and the mercury-cell slip ring unit under real working conditions. To investigate the effect of the valve shape, we designed three valve plates each having a different shape. One of the valve plates was without bearing pad, another valve plate had bearing pad and the last valve plate was a spherical valve plate. It was noted that these three valve plates observed different aspects of the fluid film characteristics between the cylinder block and the valve plate. The leakage flow rates and the shaft torque were also investigated in order to clarify the performance difference between these three types of valve plates. From the results of this study, we found that the spherical valve plate estimated good fluid film patterns and good performance more than the other valve plates in oil hydraulic axial piston pumps.

Design optimization of a nuclear main steam safety valve based on an E-AHF ensemble surrogate model

  • Chaoyong Zong;Maolin Shi;Qingye Li;Fuwen Liu;Weihao Zhou;Xueguan Song
    • Nuclear Engineering and Technology
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    • v.54 no.11
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    • pp.4181-4194
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    • 2022
  • Main steam safety valves are commonly used in nuclear power plants to provide final protections from overpressure events. Blowdown and dynamic stability are two critical characteristics of safety valves. However, due to the parameter sensitivity and multi-parameter features of safety valves, using traditional method to design and/or optimize them is generally difficult and/or inefficient. To overcome these problems, a surrogate model-based valve design optimization is carried out in this study, of particular interest are methods of valve surrogate modeling, valve parameters global sensitivity analysis and valve performance optimization. To construct the surrogate model, Design of Experiments (DoE) and Computational Fluid Dynamics (CFD) simulations of the safety valve were performed successively, thereby an ensemble surrogate model (E-AHF) was built for valve blowdown and stability predictions. With the developed E-AHF model, global sensitivity analysis (GSA) on the valve parameters was performed, thereby five primary parameters that affect valve performance were identified. Finally, the k-sigma method is used to conduct the robust optimization on the valve. After optimization, the valve remains stable, the minimum blowdown of the safety valve is reduced greatly from 13.30% to 2.70%, and the corresponding variance is reduced from 1.04 to 0.65 as well, confirming the feasibility and effectiveness of the optimization method proposed in this paper.

Four Year Experience with Valve Replacement of Valvular Heart Diseases (심장판막 치환술후 단기 추적성적)

  • 류한영
    • Journal of Chest Surgery
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    • v.23 no.6
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    • pp.1180-1190
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    • 1990
  • 96 patients underwent cardiac valve replacement for valvular heart diseases consecutively between February 1986 to February 1990 in the Department of Thoracic and Cardiovascular Surgery of Yeungnam University Hospital. The follow up period was between 6 months and 4.5 years postoperatively[mean 23.4$\pm$13.1 months]. 75 cases got mitral valve replacement, 6 cases, aortic valve replacement, 15 cases, double valve replacement. 30[31.2%] patients were male and 66[68.8%] were female and the age ranged from 14 to 66 years old. Early hospital death within 30 days postoperation were 5 patients[5.2%], consisting of by low cardiac output in 2, infective endocarditis in 1, multiple organ failure with sepsis in 1 patient. There was no late postoperative death. Most common early postoperative complication was wound disruption [8.7%] and then low cardiac output, pneumothorax, pleural effusion in order. Most common late postoperative complications were minor bleeding episodes[8.7%] related to anticoagulant therapy which were consisted of frequent epistaxis in 3, gum bleeding in 2, hemorrhagic gastritis in 1, hypermenorrhea in 1, hematoma in right arm in 1 patient. Valve-related complications included valve thrombosis [1.6%/ patient-year], valve failure due to pannus formation[1.1% /patient-year], prosthetic valve endocarditis[1, 1%o/patient-year] and minor anticoagulant hemorrhage[4.4% /patient-year]. 5 cases of reoperations were performed in 4 patients due to valve failure and all of them were in the mitral positions[2.7% /patient-year]. Cardiothoracic ratios in the chest X-ray decreased at the 6th month and 1st year postoperation in all patients. But in New York Heart Association[NYHA] functional class IV, no change in cardiothoracic ratio was found between 6 months and 1 year postoperation. In the echocardiogram, the size of the cardiac chambers decreased, but ejection fraction increased postoperatively in each functional class. In the electrocardiogram, decreases were found in the incidence of atrial fibrillation, left atrial enlargement, left ventricular hypertrophy with right bundle branch block increasing postoperatively in each functional class. The actuarial survival rate was 98.4% for all patients, 98.7% for mitral valve replacement, 83.8% for aortic valve replacement, and 80% for double valve replacement at the end of a 4.5 year follow up period. Meanwhile the actuarial freedom rate was 91.5% for prosthetic valve endocarditis, 91.6% for thromboembolism, 89.0% for prosthetic valve failure and 83.7% for minor anticoagulant hemorrhage. Preoperative NYHA class III and IV were 75% of all patients, but 95% of all patients were up graded to NYHA class I and II postoperatively.

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Annual Open Heart Surgery: Report of 416 Cases in 1980 (연간 개심술 416례 보고 [1980 년도])

  • 이영균
    • Journal of Chest Surgery
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    • v.14 no.1
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    • pp.17-25
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    • 1981
  • In 1980, 416 cases of open heart surgery were done in this Department with over all operative mortality of 12.3%. 1. There were 288 congenital anomalies consisting of 174 acyanotic and 114 cyanotic varieties, which showed operative mortality of 6.9% and 25.4% respectively. 2. There were 128 cases of acquired lesions, 124 valvular disease and 3 myxoma being the main lesions. 3. There were 128 cases of valve replacement with operative mortality of 7.8%. 4. The most frequently operated anomaly was VSD, 90 pure VSD and 21 cases were associated with one or 2 cardiac anomalies. Over all operative mortality in 111 VSD cases was 8.1% but in 90 pure VSD cases it was 6.7%. 5. Tetralogy of Fallot showed the highest incidence in cyanotic group with 88 cases, consisting of 68 pure and 20 with other cardiac anomalies. Over all mortality in 88 cases was 19.3% but in pure form 16.2%. 6. In 128 valve replacement cases over all mortality was 9.4%. There were 85 mitral, 11 aortic, 2 tricuspid, 21 mitral with aortic, 6 mitral with tricuspid, 3 mitral, aortic, and tricuspid valve replacement cases. For mitral valve replacement operative mortality was 5.9%. 7. Twenty-one cases of babies under 10kg body weight were operated on with over all operative mortality of 28.6%. Sixteen cases of VSD were found with operative mortality of 25%. 8. Among 128 cases of valve replacement 7 were under the age of 15 years and 12 were between 15 and 20 years old. Five pediatric cases underwent mitral valve replacement without mortality, 9 year old boy was the youngest among them. In this Department open heart surgery for infancy and complex anomalies showed still hip operative risk which should be improved in the coming years. For open heart surgery Shiley oxygenators and 2 sets of A-O de-lux 5 head roller pump were utilized exclusively. For valve replacement Ionescu-Shiley bovine pericardial xenografts were mainly used. In pediatric and rural patients Persantin with aspirin regimen was satisfactorily administered for anticoagulation after valve replacement. Routinely Coumadin was administered for one year after valve replacement* In patients who had thrombus on valve sites, chronic atrial fibrillation, and giant left atrium Persantin-Aspirin regimen was used when one year coumadin administration was discontinued.

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The Design of Suction and Discharge Valve of Automotive Swash Plate Type Compressor (자동차용 사판식 압축기의 흡, 토출밸브 설계)

  • Lee, Geon-Ho;Kwon, Yun-Ki
    • The KSFM Journal of Fluid Machinery
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    • v.9 no.2 s.35
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    • pp.13-18
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    • 2006
  • This paper was studied to design Process considered flexibility and reliability of suction and discharge valves. Flexibility and reliability of valves are main important factors in compressor valves design. And they are incompatible with efficiency of compressor. In this study, we have performed the optimal design of CO2 compressor valves to consider these factors. At first, we analyzed performance simulation of compressor to obtain optimal flexibility level of valves. From this simulation, we could get some important data at valve design like the optimal natural frequency and the height of retainer. After that we studied to reliability of valves corresponding to optimal flexibility level by finite element method. For each case bending stress and natural frequency were obtained by it. Also we investigated the fatigue stability to obtain optimal valve shape that ensured to reliability.

Valve Replacement: Report of 100 Cases (심장 판막 이식 100례 보고)

  • 이영균
    • Journal of Chest Surgery
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    • v.11 no.2
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    • pp.199-212
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    • 1978
  • One hundred cases of cardiac valve replacement were done at this Department in the period from June 1968 to May 15, 1978. Seventy-one cases of mitral, 12 aortic, and one tricuspd valve were replaced. There were 16 cases of double valve replacement, 10 aortic with mitral and 6 mitral with tricuspid valve replacement. Prosthetic valves-Beall, Bjoerk-Shiley, Starr-Edwards, Wada-Cutter, Magovern-Cromie, and Smeloff-Cutter valves-were used. But in recent years bioprosthetic valves-Hancock, Carpentier-Edwards, and Angell-Shiley valves-were used mainly due to the difficulties of postoperative anticoagulation, especially for the rural Korean patients. Over all operative mortality was 2896, 26.2% for single and 37.5% for double valve replacement cases. There were 4 postoperative thrombo-embolism cases with 2 deaths. Four postoperative subacute bacterial endocardities cases with 2 deaths were noted. Three cases of postoperative congestive heart failure succumbed. Two cases of peri valvular leakage, one of which needs reopration, were found. There were 28 operative and 9 late deaths, leaving 63 long-tel m survivors, who showed marked improvements.

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Trends of cardiac valve surgery in life insurance ('09~'11) (보험가입자 심장판막 수술 변화 추이분석 ('09~'11))

  • Park, Yoojung;Moon, Kitae;Kim, Youngeun
    • The Journal of the Korean life insurance medical association
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    • v.32 no.2
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    • pp.28-32
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    • 2013
  • We studied trends of cardiac valve surgery using insurance data. 368 persons were included our study. We studied whether there are frauds or not. Only 4 cases were done at less than 1year from an insurance contract. We reviewed medical records of all persons. We could find the type of valve disease in 211 cases. The findings are atrial valve 40.1%, mitral valve 34.6% and others 25.3%. When we divided by materials of surgery, mechanical valves were used in 68.8% of men and 70.6% of woman. The main causes of valve disease were infection(55.1%). And degenerative valve disease 32% and congenital valve disease were 13%. We cannot find definite evidence of insurance frauds in the cardiac valve surgery. But there are some limitation in data analysis.

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