• Journal of Chest Surgery
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• v.20 no.3
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• pp.512-519
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• 1987

In the department of chest surgery of Pusan National University hospital cardiac valve surgery was done in 118 cases from March, 1982, to June, 1986. Among these, 90 were mitral valve replacement, 9 mitral commissurotomy, 5 mitral valvuloplasty, 4 aortic valve replacement, 4 double valve replacement, 4 mitral annuloplasty, one mitral annuloplasty with commissurotomy and valvuloplasty. 48 were male and 70 were female and age distribution ranged from 6 to 57 years [mean 30.6 years]. Early death within 30 days after operation was 14 cases: 10 had mitral valve replacement, 2 double valve replacement and 2 mitral annuloplasty respectively. Confirmed causes of death were low cardiac output syndrome in 9 cases, congestive heart failure in one case, cardiac tamponade in one case, malfunction of valve in one case, cardiac rupture in one case and renal failure in one case. The 104 cases were followed up for a total 190 years and range was from 2 to 54 months [Mean*SD: 21.9*16.5 months]. During follow-up period, 2 late deaths were developed: one was due to subdural hematoma and the other was congestive heart failure combined with fulminant hepatitis. Anticoagulation therapy was done with warfarin to the level of 20 to 40% of normal prothrombin time in 53 cases, dipyridamole and aspirin in 18 cases, or ticlopidine hcl in 15 cases. The frequency of bleeding due to anticoagulation therapy was 1.0% episodes per patient-years: one was in warfarin group and another was in dipyridamole and aspirin group. Among the studied 102 cases, 93 cases [91.2%] of patients were in NYHA class I or II during follow up period.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.133-139
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• 1977

Two cases of congenital aneurysm of sinus of Valsalva, ruptured into the right ventricle, and associated with ventricular septal defects, were undergone intracardiac repair with the aid of extracorporeal circulation using Bentley bubble oxygenator and moderate hypothermia. Case 1. A 20 year old male, with the chief complaints of palpitation and dyspnea, was admitted to Kyungpook National University Hospital on Dec. 16, 1976. Continuous machinery murmur was heard best at left 3rd. intercostal space along the sternal border. Retrograde aortography disclosed aneurysm of the right coronary cusp, which ruptured into the right ventricle. Utilizing cardiac bypass and moderate hypothermia, the right ventricle was opened and aneurysm was closed by direct sutures. Associated ventricuar septal defect was directly ,closed and suture line was reinforced by Dacron patch. Total bypass time was 112 minutes and total aortic cross clamping time was 37 minutes. Assist ventilation was carried out for 28 hours postoperatively. His postoperative course was smooth except removal o1 substernal hematoma and he was .discharged on 24th postoperative day. Case 2. A 28 year old man was admitted to our Hospital on June 9, 1976. two weeks prior to this admission, suddenly he had collapsed while he was walking on the street. Following `this episode, palpitation, dyspnea on exertion and frequent respiratory infection developed. Grade IV systolic murmur was heard best at 3rd intercostal space along the sternal border. Retrograde aortography confirmed the diagnosis of rupture of aneurysm of the sinus Valsalva ruptured into the right ventricle. Under the cardiopulmonary bypass the right ventricle was opened and ruptured aneurysm and infracristal ventricular septal defect were directly closed and reinforced with Dacron patch. Postoperative course was uneventful and he was discharged on 14th postoperative day. The pathogenesis of aneurysm of the sinus Valsalva and mode of diagnosis were discussed. Principle of surgical repair was presented.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.194-198
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• 2010

Intramural hematoma of the aorta (IMH) is the precursor or a variant of a classic aortic dissection where hemorrhage occurs within the aorta wall in the absence of an initial intimal tear. IMH has a high rate of mortality and morbidity. The optimal therapy for IMH is uncertain, yet the involvement of the ascending aorta is usually considered as an indication for surgery due to the associated risk of rupture or cardiac tamponade. We report here on a case of a 71-year-old man who presented with syncope. Because of misdiagnosis, he underwent computed tomography (CT) after 5 hrs from arriving to the ER. Computed tomography of the aorta revealed intramural hematoma of the ascending aorta with cardiac tamponade. He also had vascular complications such as acute renal failure and visceral ischemia. We performed emergency graft replacement of the total arch and ascending aorta. He was discharged without complication on postoperative day 14.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.172-175
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• 2010

A 61-year-old man presented with chest pain and ST elevation, and he underwent coronary angiography under the impression of acute myocardial infarction. Coronary intervention under intra-aortic balloon pumping was necessary due to his hemodynamic instability from the acute total occlusion of a large obtuse marginal branch. In spite of successful intervention, the cardiogenic shock persisted, and so extracoporeal membranous oxygenation was performed to treat this. Afterwards, the cardiogenic shock still persisted, and the auscultatory and echocardiographic findings revealed severe acute mitral valve regurgitation. Emergency mitral valve replacement was then performed. The ECMO and IABP were removed on the $2^{nd}$ postoperative day. The patient was discharged on the $48^{th}$ postoperative day.

• BMB Reports
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• v.52 no.2
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• pp.145-150
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• 2019

Endothelial dysfunction-induced lipid retention is an early feature of atherosclerotic lesion formation. Apoptosis of vascular smooth muscle cells (VSMCs) is one of the major modulating factors of atherogenesis, which accelerates atherosclerosis progression by causing plaque destabilization and rupture. However, the mechanism underlying VSMC apoptosis mediated by endothelial dysfunction in relation to atherosclerosis remains elusive. In this study, we reveal differential expression of several genes related to lipid retention and apoptosis, in conjunction with atherosclerosis, by utilizing a genetic mouse model of endothelial nitric oxide synthase (eNOS) deficiency manifesting endothelial dysfunction. Moreover, eNOS deficiency led to the enhanced susceptibility against pro-apoptotic insult in VSMCs. In particular, the expression of aggrecan, a major proteoglycan, was elevated in aortic tissue of eNOS deficient mice compared to wild type mice, and administration of aggrecan induced apoptosis in VSMCs. This suggests that eNOS deficiency may elevate aggrecan expression, which promotes apoptosis in VSMC, thereby contributing to atherosclerosis progression. These results may facilitate the development of novel approaches for improving the diagnosis or treatment of atherosclerosis.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.463-471
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• 2003

The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.34-40
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• 2009

Background: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. Material and Method: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. Result: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr ${\geq}$1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. Conclusion: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.287-291
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• 2006

Purpose : Aneurysms of sinus valsalva are rare anormalies thought to be primarily congenital in origin, progressing into death by acute heart failure in cases of rupture. Surgical correction is the only method of treatment. With these clinical implications, we reviewed the clinical characteristics and surgical results of patients with ruptured sinus of valsalva aneurysm. Methods : Between January 1991 and February 2004, 17 patients with ruptured sinus of valsalva aneurysm were retrospectively reviewed for their clinical symptoms, physical findings, past history, coexistent cardiac anormalies, surgical results, and mid-term prognosis. Results : The 17 patients included 13 men and four women, with a mean age of 30 years(10-59 years). Preoperatively accompanying cardiac anormalies were ventricular septal defect(VSD, eight cases of doubly committed juxta-arterial VSD) and aortic insufficiency(11 cases). During operations, patterns of fistulous tracts were found to be right colonary sinus-right ventricle in 13 patients, right coronary sinus-right atrium in one, noncoronary sinus - right ventricle in two, noncoronary sinus - right atrium in one, and VSD was noticed in 14 patients(all were doubly committed juxta-arterial in type). The defects were closed with a patch in 13 patients, without a patch in four, with concommitant aortic valve replacement in four and with aortic valvuloplasty in two. There were no mortalities during operations or the mid-term follow-up periods($40{\pm}49$ months). Conclusion : Because, at least in Orientals, VSD(especially doubly committed juxta-arterial) was accompanied in large numbers of patients with aneurysms of sinus valsalva, preoperative evaluations of this congenital heart disease should be made very careful. And we may need to revise the algorithm of treatment policy in small sized doubly committed juxta-arterial VSD.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.277-280
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• 2008

Tuberculous aortitis is a very rare disease. Furthermore, it is all the more rare for it to be complicated by the development of an aortic aneurysm or the formation of aorto-bronchial fistula. If it is complicated by rupture of the aorta, mortality is very high. If the patient didn't contract tuberculosis, but was expectorating blood, we would have to carry out a chest CT promptly, in order to make a rapid and accurate diagnosis of this disease. A 46-year-old male patient was admitted due to the sudden onset of intermittent hemoptysis and chest discomfort. CT scans of the chest showed an aneurysmal change to the descending thoracic aorta, and the formation of an aorto-bronchial fistula, which originated from this aneurysm and communicated with its left lower lobe. We operated with an artificial vessel graft interposition of the descending thoracic aorta and a left lower lobectomy. Because the diagnosis was of tuberculosis, we started anti-Tbc medication and long term anti-Tbc medication was recommended.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1183-1194
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• 1998

Background: From Sept. 1985 to Sept. 1997, 2,000 cases of open heart surgery(OHS) were performed in the Department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. Material and Method: Among the total of 2,000 cases of OHS, 1532 cases were congenital heart disease(CHD) and 468 cases were acquired heart disease(AHD). The age distribution was 9 days(4.0kg) to 68 years in CHD and 11 to 66 years in AHD. In 1532 cases of CHD, there were 1403 acyanotic cases and 129 cyanotic cases. Result: The CHD cases consisted of 940 ventricular septal defects(61.4%), 324 atrial septal defects(21.1%), 112 tetralogy of Fallot(7.3%), 46 pulmonary stenosis(3%), 38 endocardial cushion defects(2.5%), 15 valsalva sinus ruptures(1%), 4 transposition of great arteries (0.3%), 4 double outlet right ventricles(0.3%), and etc. Corrective operations were applied for congenital heart disease with a result of 3.1% hospital mortality. Of 468 AHD, 381 cases were valvular heart diseases, 48 ischemic heart diseases, 12 cardiac tumors, 8 annuloaortic ectasias, 16 dissecting aortic aneurysms and etc. In the 381 valvular heart diseases, there were 226 single valve replacements(36 aortic valve replacements(AVR), 188 mitral valve replacements(MVR), and 2 tricuspid valve replacements(TVR), among these were 71 cases of double valve replacements(AVR & MVR), 54 cases of MVR with tricuspid valve annuloplasty(TVA), and 18 cases of AVR, MVR with TVA. The total implanted prosthetic valves were 466. In MVR, 123 St. Jude Medical valves, 90 Carpentier-Edwards valves, 65 CarboMedics valves, 42 Sorin valves and 16 other valves were used. In AVR, 68 St. Jude Medical valves, 36 CarboMedics valves, 14 Carpentier-Edwards valves and 9 other valves were used. Coronary Artery Bypass Surgery(CABG) were performed in 48 cases. The patterns of bypass graft were 14 patients of single vessel graft, 21 patients of two vessels graft, 10 patients of three vessels graft and 3 patients of four vessels graft. Conclusion: The hospital operation mortality rate of congenital acyanotic, cyanotic and acquired heart diseases were 2.0%, 15.5%, and 5.1% respectively. The overall mortality rate was 3.6%(72/2,000).