• Journal of Chest Surgery
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• v.25 no.11
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• pp.1346-1353
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• 1992

From Febrary 1984 to July 1992, 138 cases of multiple valve replacements were performed at the Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University. There were 81 females and 57 males, and their ages ranged from 19 to 60 years [mean age, 40.1$\pm$10.9 years]. Thirteen of these patients had undergone previous cardiovascular procedures, with an average of 76.3 months between procedures[range, 3 to 180 months]. Mitral and aortic valve replacement were done in 135 patients, 2 underwent triple valve replacement and 1 underwent mitral and tricuspid valve replacement. Associated procedures were necessary in 20 patients[14.5%]. The operative mortality was 5.8% and the most common cause was low cardiac output. Late follow-up of 83% has been accomplished in 130 early survivors, with a late mortality of 5.9%. The late mortality was due to valve thrombosis in 2 patients, cerebral infarction in 1, heart failure in 1, arrhythmia in 1, and bleeding in l. Of those patients who survived, New York Heart Association functional class improved significantly[from 70% class III and IV before to 88% class I and II after]. Actuarial survival rate including all deaths was 88.8% at 8 years. The follow-up studies revealed that thromboembolism, reoperation and bleeding rate were 1.2%/patient-year, 0.85% /patient-year and 0.57%/patient-year at 8 years postoperatively. We concluded that valve thrombosis, embolism, and anticoagulant-related hemorrhage were the main risk factors of longterm survival of patients.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.641-648
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• 1988

Between April 9, 1986 and September 2, 1987, 134 patients underwent open heart surgery with hypothermic cardiopulmonary bypass and cold blood cardioplegia. There were 65 patients[48.5%] of acyanotic congenital cardiac anomalies, 19 patients[14.2%] of cyanotic congenital cardiac anomalies, and 50 patients[37.3%] of acquired heart diseases, which included 49 valvular diseases and 1 myxoma. In 84 congenital cardiac anomalies, 44 patients were male and 40 patients were female ranged in age from 2 years to 57 years. In 50 acquired heart diseases, 18 patients were male and 32 patients were female ranged in age from 10 years to 65 years. The common congenital defects operated were VSD in acyanotic cardiac patients, and Tetralogy of Fallot in cyanotic cardiac patients. Among 50 acquired heart diseases, 49 patient underwent operation for cardiac valvular lesions. 33 patients had mitral valve replacement and 7 patients had aortic valve replacement. 1 patient underwent aortic valvuloplasty and 8 patients had double valve replacement. The operative mortality rate was 3.1%[2 out of 65 patients] in acyanotic cardiac patients, 5.3%[1 out of 17 patients] in cyanotic cardiac patients, and 12.0%[6 out of 50 patients] in acquired cardiac patients, with overall mortality rate of 6.7%[9 out of 134 patients].

• Journal of Chest Surgery
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• v.22 no.1
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• pp.42-49
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• 1989

A total of 420 pyrolytic carbon mechanical valves were implanted in 336 patients from January, 1984, through Jung, 1988. Of the valves implanted, 131 were Bjork-Shiley, 250 St-Jude, and 39 Duromedics. The cumulative follow-up was 398 patient-years with a mean follow-up of 14.4 months per patients. Among 336 patients, 175 had mitral, 68 aortic, 82 multiple, 10 tricuspid, and one pulmonary valve replacement. The hospital mortality figures were 9 of 336[2.67%] in all, 5 of 175[2.85%] in isolated mitral, 1 of 68[1.47%] in isolated aortic and 3 of 82[3.65%] in multiple valve replacement. The causes of hospital mortality were myocardial failure in 5, sepsis in 2, bleeding in 1, cerebral embolism in l. There was no late valve related mortality. The actuarial survival rate at 4.5years was 99.4*0.1%. The complications occurred in 15 of 336[4.46%]; 7 of 175[4.0%] in isolated mitral, 4 of 68[5.88%] in isolated aortic, and 4 of 82[4.89%] in multiple valve replacement. The causes of complications were thromboembolism in 4, hemorrhage in 4, paravalvular leakage in 4, hepatitis in 2, and complete AV block in l. Actuarial probability of survival at 4.5 years was 95.0*0.1%. The low mortality and complications encourage us to applicate these valves to any patient including children and young women.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.263-267
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• 1995

A total and consecutive 87 patients underwent aortic valve replacement[AVR with the St. Jude Medical prosthesis between 1984 and 1993. Age ranged from 14 to 66 years[mean:38.6$\pm$ 14.0 years .Twenty-one patients [24.1% had undergone previous valve replacement. There were 8 early deaths with an operative mortality rate of 9.2% [7.6% for primary AVR and 14.3 % for re-replacement AVR . Seventy-nine early survivors were,followed for a total of 309.1 patient-years[mean:3.9$\pm$ 2.5 years . A late mortality rate was 5.1% [4 patients or a linearized incidence of 1.294 %/patient-year. All were anticoagulated with coumadin to maintain the international normal ized ratio[INR between 1.5 and 2.5. One patient experienced thromboembolism[0.324%/patient-year , and none did bleeding. Endocarditis occurred in one[0.324%/patient-year . Paravalvular leak was the most frequent complication and was experienced by 8 patients[2.588%/patient-year , and 5 of them required re-replacement AVR[1.618 %/patient year of reoperation rate . There was no structural failure of the prosthesis. Actuarial survival including operative death was 83.9%$\pm$ 4.6% at 10 years.The actuarial estimates of freedom from thromboembolism and of freedom from late death and all complications were 95.1% $\pm$ 4.8 % and 81.4% $\pm$ 6.1%, respectively, at 10 years. These clinical results suggest that less intensive anticoagulation may be allowed for patients of AVR with the St. Jude Medical valve with low incidences of both thromboembolic and bleeding complications.

• Journal of Chest Surgery
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• v.27 no.9
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• pp.759-763
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• 1994

Between November 1990 and December 1993, 9 patients underwent surgical intervention for acute active endocarditis at Gyeongsang National University Hospital. All the patients were operated on within the first six weeks after onset of symptoms for various reasons. Surgical indications for early surgery were heart failure, systemic septic emboli, new murmur and growing vegetation. Most common infecting organism was Staphylococcus[55 %], and the others were Streptococcus, anaerobes, Candida and unknown in 1 case. The infection was in the mitral valve in 5 patients, the aortic valve in 2, the aortic and mitral in 1, and the aortic and pulmonary in 1. There was one operative death[11 %] and no late death. Preoperative Functional Class were II in 4 patients, III in 5 and after surgery all the patients improved to Class I. We conclude that early surgical intervention in acute active endocarditis is effective in most instances.

• Journal of Chest Surgery
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• v.13 no.2
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• pp.100-104
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• 1980

Simultaneous triple valve replacements were performed in two patients on January and April 1980 at Seoul National University Hospital. The first case was 17 years old male patient with a history of exertional dyspnea for 7 years. He was in class III by the NYHA functional classification and diagnosed as aortic insufficiency, mitral steno-insufficiency and tricuspid insufficiency. The second case was 46 years old male patient suffered from exertional dyspnea for 5 years, He was in class IV and diagnosed as aortic stenoinsufficiency, mitral stenoinsufficiency and tricuspid insufficiency. Triple valve replacements were performed under the deep hypothermia and pharmacologic cardiac arrest with aortic cross clamping for 80 minutes to 159 minutes. Total extracorporeal circulation time were 197 and 176 minutes respectively. The postoperative courses were uneventful.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.48-54
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• 1987

This report provides follow-up data on 557 patients [73 aortic, 357 mitral, and 127 multiple valve replacements] undergone lonescu-Shiley pericardial Xenograft valve replacement at Seoul National University Hospital between January, 1979 and December, 1985. There were 35 early death [6.3%] and 522 operative survivors were observed, and the cumulative follow-up is 1,140 patient-years [mean: 2.18 years per patient] The thromboembolic complications occurred in 34 cases [3.0% per patient-year] and the rate was 2.1% per patient-year for mitral and 0.3% per patient-year for aortic valve replacement in the presence of anticoagulation therapy. Among the 34 embolic episodes, 9 patients were dead [0.8% per patient-year] and the cause of death were 5 cerebral thromboembolism, 2 pulmonary embolism, and 2 intracerebral hemorrhage due to inappropriate anticoagulation after thromboembolic episode. Actuarial probability [+ SEM] of remaining free of thromboembolism for AVR is 88.1 x 11.1% at 5 years, for MVR 79.1 a 13.4% at 7 years and for multiple valve replacement 77.2 e 5.21% at 7 years. The incidence rate of thromboembolic complications after AVR is not less than that of MVR [0.3 Among the potential thromboembolic risk factors, atrial fibrillation is possible risk factor to increase the thromboembolic complication [0.05 < P < 0.1], but the importance of other factors, such as atrial clot, large left atrial size, mitral position, NYHA functional class, and age is less definite. A careful follow-up and the proper control of anticoagulation without omission, poor control, and arbitrary withdrawal is important for the successful management of the thromboembolic complications and the anticoagulation-related morbidity and mortality.

• Journal of Chest Surgery
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• v.11 no.4
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• pp.535-540
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• 1978

Between January 1974 and November 1978, 23 cases of double valve replacement were done in the Department of Thoracic Surgery, Seoul National university Hospital. All had symptoms of rheumatic valvular heart disease and belonged to functional class III or IV according to NYHA classification. Among 23 cases, mitral and aortic valves were replaced in 14, and mitral and tricuspid valves in 9 cases. Six operative deaths [26%] and 4 late deaths [23%] were found. In the former group 5 and in latter one operative death were noted. Main cause of operative death was low cardiac output syndrome due to myocardial failure. Among 4 late deaths, 2 were caused by thromboembolism, one by bacterial endocarditis, and one by arrhythmia.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.347-350
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• 1988

Recent advances in the managements of chronic renal failure have increased the number of the candidates for cardiac operation in patients with chronic renal disease. There have been reports that the operative mortality of the open cardiac surgery in patients with end stage renal diseases was equal to that of the patients with normal renal function. Aortic valve replacement and mitral annuloplasty was successfully performed in a patient with chronic renal failure, and the pre-and postoperative managements are presented.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.676-680
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• 2000

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.