• Journal of Chest Surgery
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• v.49 no.6
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• pp.489-492
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• 2016

The original valve-sparing procedures for aortic root aneurysms were remodeling and reimplantation of the aortic root. The remodeling technique provides more physiologic movement of the cusps within 3 reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles. However, the durability of remodeling has been a matter of concern due to the high rate of aortic insufficiency when annular dilation is not addressed. Therefore, a modified approach was developed, combining a physiologic remodeling of the root with a subvalvular annuloplasty. This case report highlights the first case of successful aortic root remodeling with external subvalvular ring annuloplasty in Korea.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.744-747
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• 2000

Pulmonic autograft replacement of the aortic valve(Ross procedure) has been to have potential for growth in children, no complication of antiocagulation, and enhanced durability. Therefore, Ross operation is indicated in the young, in patients with an active life style, and when anticoagulation is contraindicated. However, late autograft valve has occurrd more frequently in patients with significant size discrepancy between the pulmonay valve annulus and the aortic valve annulus. In order to resolve this problem, we performed aortic annuloplasty with Duran ring for more accurate and strong reinforcement. We report a case using the Duran ring as a method of aortic annuloplasty during Ross procedure.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.882-888
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• 1988

A case of Annuloaortic Ectasia associated with Marfan syndrome and mitral regurgitation is treated surgically by Bentall`s method and mitral annuloplasty. The Annuloaortic Ectasia is frequently accompanied with Marfan syndrome, its definition is simply explained as the following; the marked dilatation of the sinuses of Valsalva and the aortic annulus as well as the huge aneurysm of the ascending aorta. As the operative finding, the intimal tearing was shown as circular and the both coronary ostia were changed the position into high up. The patient was taken a corrective operation replacing the ascending aorta and aortic valve with a composite graft[St. Jude medical valve 29mm, woven Dacron tubular graft 31mm]. The both coronary ostia were reimplanted on the graft with 4-0 prolene by continuous suture. Mitral annuloplasty was performed. After the operation, the patient developed both spontaneous pneumothorax, he improved state by the closed thoracostomy. He has been doing well, postoperatively.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.446-455
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• 1985

A total and consecutive 156 patients have undergone cardiac valve surgery including 13 closed mitral commissurotomy, 13 open mitral commissurotomy, one mitral annuloplasty, 75 mitral valve replacement, one aortic annuloplasty, 24 aortic valve replacement, 3 tricuspid valve replacement, 25 double valve replacement and one triple valve replacement. 155 prosthetic valves were replaced in a period between September 1976 and August 1985. There were 68 males and 88 females with age range from 8 to 69 yrs [mean 36.5 yr]. Out of replaced valves, 61 was tissue valve including 54 Carpentier-Edwards, and 4 was mechanical valves including 74 St. Jude Medical, and the position replaced was 101 valves for mitral, 46 for aortic and 8 for tricuspid. Single valve replacement in 102 cases, double valve replacement in 25 cases [17 for AVR+MVR, and 8 for MVR+TVR], and only one case was noted in the triple valve replacement. Early mortality within 30 days after operation was noted in 11 cases [7%]; 7 after MVR, 2 after DVR, and each one after open mitral commissurotomy and mitral annuloplasty. Cause of death was valve thrombus, cerebral air embolism, low output syndrome, uncontrollable arrhythmia, parapneumonic sepsis, acute cardiac tamponade and left atrial rupture. 7 late deaths were noted during the follow-up period from 1 to 104 months [average 48 month]; three due to valve and left atrial thrombus formation, two due to CVA from overdose of warfarin, and each one due to congestive heart failure and chronic constrictive pericarditis, Anticoagulants after prosthetic valve replacement were maintained with warfarin, dipyridamole and aspirin to the level of around 50% of normal prothrombin time in 79 cases, and Ticlopidine with aspirin in 47 cases to compare the result of each group. There were 11 major thromboembolic episodes including 3 deaths in the warfarin group. Two cases of CVA due to overdose of warfarin was noted in the warfarin group. In the ticlopidine group, there was only one left atrial thrombus confirmed at the time of autopsy. Among the survived 138 cases, nearly all cases[136 cases] were included in NYHA functional class I and II during the follow-up period. In conclusion, surgical treatment of the cardiac valve disease in 156 clinical cases revealed excellent result with acceptable operative risk and late mortality. Prevention of thrombus formation with anti-platelet aggregator Ticlopidine has better result than warfarin group presently with no specific side effect such as bleeding or gastrointestinal trouble.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.133-136
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• 2002

A 28 year-old male who had received Konno procedure twelve years ago with 23mmmechanical aortic valve and bovine pericardium with which his small aortic annulus, ventricular septum and right ventricular outflow tract had been enlarged was transferred due to sudden congestive heart failure. There were perforations on aortic and interventricular portion of bovine pericardial patch above and below the aortic valve, respectively, which was calcified and denaturated severely. The perforations seemed to be attributed to the cracks, resulting from mobility of mechanical aortic valvc itself and stiffness of calcified and denaturated bovine patch. We performed a redo Konno procedure applying PTFE patch.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.61-63
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• 2018

We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.

• Journal of Chest Surgery
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• v.17 no.2
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• pp.223-230
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• 1984

Since January 1977 to the end of September 1982, total 60 Ionescu-Shiley pericardial xenograft heart valves were implanted for valve replacement in 50 patients at the Han Yang University Hospital. The operative procedures were as follow: Mitral valve replacement [MVR] in 25 patients, Mitral valve replacement [MVR] and Tricuspid valve [TV] annuloplasty in 7 patients, Aortic valve replacement [AVR] in 8 patients, Aortic valve replacement [AVR] and Mitral valve replacement [MVR] in 8 patients. Aortic valve replacement [AVR] and Mitral valve replacement [MVR] and Tricuspid valve [TV] annuloplasty in 2 patients. To evaluate the immediate hemodynamic changes after valve replacements, the pressures of each cardiac chamber and ulmonary artery were checked before and after valve replacement on the operation table. Right ventricle [RV] pressure was decreased from 52.09\ulcorner6.71 to 45.57\ulcorner5.03 mmHg, Pulmonary artery [PA] pressure was decreased from 45.97\ulcorner2.69 to 41.00\ulcorner3.99 mmHg, and Left atrium [LA] pressure was decreased from 30.33\ulcorner13.02 to 22.76\ulcorner.97 mmHg before and after valve replacement. In MVR group, RV pressure was decreased from 49.17\ulcorner7.89 to 43.14\ulcorner4.14 mmHg, PA pressure was decreased from 44.67\ulcorner3.18 to 38.67\ulcorner2.85 mmHg, and LA pressure was decreased from 31.46\ulcorner13.47 to 21.91\ulcorner.17 mmHg. In AVR group, RV pressure was decreased from 53.0\ulcorner7.44 to 44.71 \ulcorner3.24 mmHg, PA pressure was decreased from 34.83\ulcorner0.73 to 31.86\ulcorner.36 mmHg, and LA pressure was not changed. In double valve replacement [MVR and AVR] group, RV pressure was decreased from 57.50\ulcorner3.82 to 42.50\ulcorner.80 mmHg, PA pressure was decreased from 51.17\ulcorner1.42 to 43.33\ulcorner4.53mmHig, and LA pressure was decreased from 34.33\ulcorner2.09 to 25.50\ulcorner0.21 mmHg. But in the group where MVR and TV annuloplasty were performed, preoperative RV and PA pressure were markedly increased and no pressure decrease in RV and PA noticed after valve replacement. This study shows good immediate postoperative hemodynamic results after valve replacement using Ionescu-Shiley xenograft valve except in the cases of MVR and TV annuloplasty and advanced disease with pulmonary hypertension.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.780-784
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• 1996

The localized form of subaortic stenosis shows a spectrum of pathological lesions varing from dis- crete membrane to a thickened flbromuscular collar. Aortic valve is commonly involved late in the pro- cess resulting in regurgitation. Because of the likelihood o the progressive obstruction and aortic regurgitation, early elective oper- ation should be considered for the patient with subaortic stenosis. We experienced a case of localized fibromuscular subaortic stenosis associated with aortic regurgi- tation. Excision of the fibromuscular ridge and septal myectomy-myotomy relieved the subaortic seen- osis. Regurgitant aortic valve was repaired by peeling away the Hbrotic tissue on the cusps and subcommissural annuloplasty at the each commissural area. On postoperative echocardiographic examination, the systolic pressure gradient between left ventricle and aorta decreased markedly and the aortic regurgitation was not detected at all.

• Journal of Chest Surgery
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• v.26 no.12
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• pp.909-914
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• 1993

Complete and optimal visualization of the mitral apparatus is a prerequisite for accurate repair or replacement of the mitral valve. A vertical left atriotomy just posterior to the interatrial groove is the most commonly used approach. However,exposure can be difficult under certain circumstances,such as small left atrium or reoperation. Other approaches have been advocated to deal with this difficult situations. We used an extended transseptal approach in 10 patients and good clinical results and excellent educational effects were obtained. The extended transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly,allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. Right atrial and septal incisions are joined at the superior end of the interatrial septum and extended across the dome of the left atrium to the left atrial appendage. The mitral valve was replaced in all 10 patients. Four of 10 patients had other simultaneous valve procedure: one had aortic valve replacement: 2 underwent tricuspid annuloplasty: 1 had aortic valve replacement and tricuspid annuloplasty. There was no hospital death and complication. Among the 5 patients who had atrial fibrillation preoperatively,4 had atrial fibrillation postoperatively,1 converted to sinus rhythm. The five patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after replacement. A review of our results with this approach confirms the efficacy and safty of this method. So we recommanded this approach for routine mitral valve procedure,especially difficult situations,such as a small left atrium or the redo operation.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.62-68
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• 1985

10 patients with mitral regurgitation associated with various congenital cardiac anomalies were treated by reconstructive techniques in the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the period of 2 years from 1982 to 1984. There were mitral valvular cleft in one case, chordae tendineae rupture associated with congenital multiple cardiac-anomalies [VSD, PDA, prolapse of aortic non-coronary cusp through VSD] in one case, elongated chordae tendineae after removal of left atrial myxoma in one case, and mitral annular dilatation associated with VSD in 3 cases, large PDA in 2 cases, aortic regurgitation [bicuspid valve] in one case, and unknown origin in one case. Owing to the various pathology above mentioned, reconstructive surgical approach to mitral incompetence is accordingly complicated and a combination of the following different procedures were properly used case by case, that is, suture of chordae tendineae, shortening of elongated chordae tendineae, closure of VSD, ligation of PDA, aortic valvuloplasty, mitral annuloplasty with mattress suture, etc. All patients were survived and they have been excellent postoperative results.