• Journal of Chest Surgery
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• 제28권9호
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• pp.829-836
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• 1995

Ninety-one adult patients underwent three different methods of annuloplasty and compared them by the amount of tricuspid regurgitation. Group I [n=17 is Kay method, Group II [n=46 is modified Kay method and Group III [n=28 is De Vega and modified De Vega method. Preoperative and postopeative size of the liver and its function, the cardiothoracic ratio, EKG and echocardiogram were analyzed. The follow up was done for all the patients [mean 20.0$\pm$ 8.5 months . The postoperative size of the liver, the postoperative cardiothoracic ratio and the postoperative systolic pressure of the right ventricle decreased significantly compared to preoperative size, ratio and pressure [p=0.0001, p=0.0001, p=0.0001 . But there were no differences between the groups. The results of annuloplasty revealed that tricuspid regurgitation improved postoperatively [p=0.0001 even though there was no statistically significant differences in relation to the methods of annuloplasty. The right ventricular systolic pressure and the amount of regurgitation decreased significantly during the postoperative period by performing 3 different methods of annuloplasty, although we could not find the differences between the three different methods.

• Journal of Chest Surgery
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• 제26권3호
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• pp.196-203
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• 1993

Fourty-five cases of operation were performed for the correction of tricuspid regurgitation [TR] in Pusan National University Hospital between 1982 and 1991.The mean age of the patients was 32.6 years and female was dominant[M:F=1:2.2].Isolated tricuspid regurgitation was rare and 43 patients underwent concomitant other valvular operation including mitral valve replacement. Functional cause was in 39 cases and organic lesions were found in 6 cases. Operative methods were Kay annuloplasty[29], De Vega annuloplasty[12], and tricuspid valve replacement[4]. Ring annuloplasty was not performed. Operative mortality rate was 11.1%[5/45] and late mortality rate was 6.7%[2/30]. The tricuspid valve surgery itself was not a serious risk factor for hospital death and no heart block nor thrombosis was complicated. By echocardiogram early[within 30 days] and late [mean:4.9years] changes of postoperative TR were evaluated. De Vega annuloplasty seemed to bring better late result than Kay annuloplasty[p<0.05]. In four patients with late severe TR,previously replaced tissue valve degeneration[2], pulmonary hypertension[1] and rheumatic TR[1] were the possible causes. This experience suggests that De Vega annuloplasty can be a reliable method in the majority of patients with moderate-to-severe functional TR.

• Journal of Chest Surgery
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• 제45권1호
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• pp.19-23
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• 2012

Background: A ring implantation in the tricuspid annulus requires many interrupted mattress sutures for correction of tricuspid regurgitation (TR). In this study, tricuspid ring annuloplasty was performed by 2-0 polypropylene continuous suture instead of multiple interrupted 2-0 polyester mattress sutures, and the efficacy of the method was evaluated. Materials and Methods: This study included 20 patients who underwent tricuspid ring annuloplasty by continuous suture between May 2009 and July 2010. Four of the patients had an isolated TR, and the rest had a left-sided cardiac lesion. The concomitant tricuspid annuloplasty was performed after the left-sided heart surgery was completed and a Duran flexible ring prosthesis was used. Results: There was no perioperative mortality or conduction problem. More than a moderate degree of TR was improved to less than a mild degree after the procedure. After the ring annuloplasty, the right atrial volume decreased from $123.7{\pm}69.2mL$ to $74.5{\pm}37.4mL$, and the mean right atrial pressure was lowered from $18.7{\pm}12.2mmHg$ to $8.9{\pm}5.5mmHg$. Conclusion: The continuous "over and over" suture may be a useful procedure for fixing the ring to the annulus and making an intentional annular placation in performing tricuspid ring annuloplasty.

• Journal of Chest Surgery
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• 제24권4호
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• pp.323-330
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• 1991

Residual significant tricuspid regurgitation after mitral valve operation may significantly increase postoperative morbidity and mortality. However, routine techniques to detect tricuspid regurgitation preoperatively and postoperatively are not accurate. Doppler echocardiography was performed preoperatively and postoperatively to assess its ability to evaluate and quantify the severity of tricuspid regurgitation. In 34 patients with tricuspid regurgitation secondary to mitral valvular disease the tricuspid regurgitations were semiquantified on a scale of 1 to 3+. The 34 patients were divided into two groups on the basis of severity of tricuspid regurgitation as assessed by preoperative Doppler echocardiography. Group I [8 patients] had mild[1+] regurgitation, and group II [26 patients] had moderate to severe[2 ~ 3%] tricuspid regurgitation. In all studied patients, preoperative Doppler echocardiographic studies for the degree of tricuspid regurgitation were correlated with clinical symptoms[including NYHA class] and hemodynamics[JVP and right ventricular systolic pressure], and used as the indicator to determine whether tricuspid annuloplasty should be performed or not. Patients with significant tricuspid regurgitation[group II ] had greater preoperative right ventricular systolic pressures and NYHA classes, although there was no correlation between them. The 8 patients with mild[1+] tricuspid regurgitation[group I ] didn`t undergo any procedure for the tricuspid regurgitation and their postoperative Doppler echocardiographic studies showed the less than mild[0 ~ 1+] tricuspid regurgitation, and the 26 patients with significant[>2+] tricuspid regurgitation, and the 26 patients with significant[>2+] tricuspid regurgitation[group II ] underwent tricuspid annuloplasty for the tricuspid regurgitation and the postoperative Doppler echocardiographic studies showed the findings similar to group I except 1 patient who underwent Carpentier`s ring annuloplasty and had severe right ventricular failure. Therefore, preoperative Doppler echocardiography can accurately assess the relative severity of tricuspid regurgitation. Importantly, postoperative Doppler echocardiography could conveniently determine the effect of tricuspid annuloplasty for the patients with significant tricuspid regurgitation. Doppler echocardiography may be an important diagnostic method both for evaluating the degree of residual tricuspid regurgitation after left heart operation as well as for determining which patients should undergo tricuspid valve repair.

• Journal of Chest Surgery
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• 제26권11호
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• pp.827-832
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• 1993

From Jan 1982 through Dec.1991, thirty-three DeVega`s tricuspid annuloplasties were performed in association with mitral and combined mitral and aortic valve disease. Preoperatively,all of the patients were in NYHA functional class III or IV.There were one early death and 4 patients died during follow up period of 18 to 138 months [ mean follow up : 67.3 months ]. Nine patients required reoperation because of biological mitral valve failure at 4.7 to 11 years after tricuspid annuloplasty[TAP]. Among these patients,2 cases needed for reoperation of TAP due to loosening of suture material. Twenty four [86%] of the survivors were in NYHA functional class I or II after TAP.The actuarial survival rate for the TAP was 74% at 138 months. Rt atrial pressure of 9 reoperation cases were significantly decreased [P<0.05] compared with initial Rt.atrial pressure [ Mean period; 93.6 months].Doppler echocardiographic studies for tricuspid regurgitation were performed in 15 cases after TAP [Mean period: 42.3 months].These results showed significantly reduced [P<0.01] tricuspid annulus diameter and tricuspid regurgitation distance [ P<0.05 ].Our surgical experience that the DeVega`s TAP is a simple,safe,effective procedure and resulted in good hemodynamic improvement with moderate to severe functional tricuspid regurgitation.

• Journal of Chest Surgery
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• 제30권5호
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• pp.533-536
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• 1997

이화여자대학교 흉부외과에서는 매우 드물게 발생하는 흉부둔상에 의한 삼첨판막 역류증 환자에 있어서 mE를 사용하여 새로운 건삭을 만들어 주고 판막링을 이용하여 판막륜 성형술을 시행하여 좋은 결과를 얻었기에 보고하는 바이다. 환자는 3층 높이의 건물에서 떨어져서 응급실을 방문했으며 심에코 검사상 전유두근의 파열에 의한 심한 삼 첨판막 역류증의 소견을 보였으나 증상이 경미하여 퇴원하였다. 그러나 호흡곤란 및 심비대가 증가하여 외 상후 4개월에 수술을 시행하였으며 수술후 시행한 심에코상 삼첨판막 역류증은 보이지 않았고 호흡곤란도 사라졌다.

• Journal of Chest Surgery
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• 제41권4호
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• pp.489-491
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• 2008

52세 남자 환자가 교통사고 후 응급실로 내원하였다. 심초음파 상 전엽건삭 파열에 의해 발생한 중증도 이상의 삼첨판 역류가 보였다. 삼첨판 폐쇄부전에 대한 수술을 권유하였으나 증상이 없어 환자가 거부하였다. 이년 후 환자는 경미한 전신 부종과 호흡곤란으로 다시 내원하였다. 심초음파 상 심한 삼첨판 역류와 판막륜 확장이 보였다. 이에 본원에서는 인공 건삭과 판륜성형링을 이용한 판륜 성형술을 사용하여 외상 후 발생한 삼첨판 폐쇄부전증을 치료하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제40권5호
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• pp.376-379
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• 2007

51세 환자가 3개월 전에 심장 자상으로 본원에 입원하여 심장봉합수술을 받았다. 이후 별다른 소견 없이 지내다가 약 2개월 전부터 발생된 호흡곤란을 주소로 내원하였다. 심장초음파상 심한 삼첨판막 페쇄부전이 관찰되었으며 삼첨판막의 건삭치환술과 판윤 성형술을 실시하였다. 이에 저자들은 심장 자상 후에 발생된 삼첨판막 폐쇄부전을 판막성형술로 치료하였기에 증례보고를 하는 바이다.

• Journal of Chest Surgery
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• 제18권3호
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• pp.391-397
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• 1985

Ebstein`s anomaly is a rare congenital cardiac malformation and characterized by downward displacement of an abnormal tricuspid valve cusps. But until now, the ideal surgical correction is still controversial. We present a case of Ebstein`s anomaly experienced lately. The patient was 13 year old girl with the complaints of dyspnea on exertion, fatigability and cyanosis. Echocardiography revealed downward displacement of septal leaflet of tricuspid valve and atrialized right ventricle. Cardiac catheterization and cineangiography revealed ASD and large right atrium. During operation, the atrialized right ventricle was plicated and tricuspid annuloplasty was done. And the two secundum type ASD`s were closed by direct suture closure. The patient`s postoperative course was uneventful and discharged on the 24th postoperative days.

• Journal of Chest Surgery
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• 제51권2호
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• pp.92-99
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• 2018

Background: We evaluated the early clinical outcomes of tricuspid valve annuloplasty (TAP) with the Tri-Ad annuloplasty ring for functional tricuspid regurgitation (TR). Methods: From January 2015 to March 2017, 36 patients underwent TAP with a Tri-Ad ring for functional TR. To evaluate the early clinical outcomes of TAP with the Tri-Ad ring, we conducted a propensity score-matched analysis comparing the Tri-Ad and $MC^3$ tricuspid annuloplasty rings (n=34 in each group). The follow-up duration was $11.0{\pm}7.07$ months. Results: There was 1 case of operative mortality (2.8%) and no cases of late mortality. Postoperative complications occurred in 15 patients (41%), including acute kidney injury in 6 patients (16%), bleeding requiring reoperation in 4 patients (11%), and low cardiac output syndrome in 4 patients (11%). There were no ring-related complications, such as atrioventricular block or ring dehiscence. The TR grade decreased significantly (from $2.03{\pm}1.06$ to $1.18{\pm}0.92$, p<0.01), as did the systolic pulmonary artery pressure (from $43.53{\pm}13.84$ to $38.00{\pm}9.72mm\;Hg$, p=0.03). There were no cases of severe residual TR, but moderate TR was observed in 3 patients, all of whom had severe TR preoperatively. Severe preoperative TR was also associated with moderate in the univariate analysis (p<0.01). In the propensity score-matched analysis comparing the Tri-Ad and $MC^3$ rings, there was no significant difference in early clinical outcomes. Conclusion: TAP with the Tri-Ad ring corrected functional TR effectively and provided good early clinical and echocardiographic results without ring-related complications. However, severe preoperative TR was associated with moderate or severe residual TR in the immediate postoperative period. A follow-up study is necessary to confirm the stability of this procedure.