• Journal of Chest Surgery
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• 제25권5호
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• pp.550-554
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• 1992

The selection of an appropriate surgical technique for repair of aneurysm of the ascending aortia with aortic insufficiency is unsettled. The etiology of the disease process has been the best indicator for the type of repair. Placement of a supracoronary graft[seperate graft and valve] is a compromise if the coronary ostia are displaced cephalad by the aneurysm, where as insertion of a valved conduit is difficult and unnecessary if the coronary ostia are normally placed. A 53 year old female patient underwent primary repaiar of proximal dissected layer and aortic valve replacement with 24mm carbomedics, The operative findings consisted of a supravalvular intimal tear, cicumferential dissection, dilated aortic annulus and normal position of coronary ostia. She is good physical activity now llmonths posoperatively.

• Journal of Chest Surgery
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• 제36권12호
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• pp.921-927
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• 2003

동맥전환술은 대혈관전위증의 가장 효과적인 수술 방법이 되어왔다. 그러나 동맥전환술 후 신생대동맥근부가 과도하게 확장되는 현상이 보고되었으며, 이에 따른 신생대동맥판막의 기능과 대동맥의 성장에 미치는 영향에 대해서는 잘 알려져 있지 않다. 본 연구에서는 신생대동맥판막과 대동맥의 수술 후 크기의 변화와 신생대동맥판막의 기능 및 기능에 영향을 미치는 요인을 조사하였다. 대상 및 방법: 대동맥전환술을 받고 추적관찰기간 중 심도자술을 시행 받은 48명의 환자들이 연구 대상이 되었으며, 동맥전환술은 나이 중앙값 생후 18일(1∼211일)에 시행받았다. 수술 전 심도자술은 26명의 환자에서 시행되었고, 수술 후 15.8$\pm$9.6개월에 모든 환자에서 심도자술을 시행하였다. 수술 후의 하행대동맥에 대한 신생대동맥륜, 대동맥근부과 대동맥문합부위의 직경 비율을 수술 전의 폐동맥륜, 근위부 및 동관경계부위의 크기와 비교하였다. 수술 전과 수술 시의 변수에 대한 신생대동맥판막폐쇄부전의 위험인자를 분석하였다. 결과: 추적관찰 중 2명의 환자에서 중등도 이상의(grade$\geq$II/IV) 대동맥판막폐쇄부전이 있었으며 이 중 1명은 대동맥판막치환술이 필요하였다. 1명의 환자에서 대동맥문합부 협착으로 재수술이 필요하였다. 수술 후 neoaortic annulus/DA 비는 1.33$\pm$0.28에서 1.52$\pm$0.33로 증가하였고(p=0.01), neoaortic root/DA 비도 2.02$\pm$0.40에서 2.56$\pm$0.38로 증가하였다(p<0.0001). 그러나 aortic anastomosis/DA 비는 통계적으로 유의한 차이는 없었다(p=0.06). 신생대동맥판폐쇄부전의 발생과 neoaortic annulus/DA 비, neoaortic root/DA 비율에는 통계적으로 유의한 상관관계는 없었다. 신생아기 이후의 교정(나이>30일)(p=0.02), 수술 전 폐동맥판막협착(p=0.01)과 이엽성폐동맥판막(p=0.03)이 단일변수 분석에서 대동맥판막폐쇄부전의 위험인자이었다. 결론: 동맥전환술 후 대동맥문합부는 하행대동맥의 성장에 비례하는 정상 성장을 보이나 신생대동맥판막륜과 대동맥근부는 이상 확장을 보였다. 신생대동맥판막륜과 대동맥근부의 크기는 대동맥폐쇄부전과 직접적으로 연관되어 있지 않았으며, 임상적으로 의미 있는 대동맥판막폐쇄부전은 동맥전환술 후 드물게 발생했다. 신생아기 이후의 동맥전환술, 수술 전 폐동맥협착, 이엽성 폐동맥판막이 신생대동맥판막 폐쇄부전의 위험인자였다.

• Journal of Chest Surgery
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• 제24권4호
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• pp.352-356
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• 1991

From April, 1981, to April, 1990, 20 male and 7 female patients ranging in age from 17 to 63, were operated on for aortic insufficiency with an aneurysm of the ascending aorta. Ten patients were in New York Heart Association functional class II, 7 in class III, and ten in class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with composite graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft. In 15 patients an uncomplicated annulo-aortic ectasia existed, and in 12 an aortic dissection; three of the latter group were operated during the acute phase. 17 patients showed typical Marfan syndrome, and 3 patients showed severe ascending aortic aneurysm secondary to the aortic valve disease. The overall operative mortality was 7%[2 deaths]. Those 2 deaths occurred following emergency operation due to associated aortic dissection, but no death during elective operation. All survivors have been followed-up during a period ranging 1 to 108 month[average 34 months]. There was no late mortality. Among the survivors, clinical improvement is readily apparent[2,3 in class I, 2 in class II ]. In conclusion, the treatment of aortic insufficiency associated with an aneurysm of the ascending aorta by insertion of a composite graft and reimplantation of the coronary arteries through an intermediate Dacron tube is a reliable method with low mortality and excellent results.

• Journal of Chest Surgery
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• 제13권2호
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• pp.92-99
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• 1980

From 1958 up to the end of April 1980, during the period of 12 years 1640 cardiac surgery cases including 1069 open heart surgery and 304 valve replacement cases, were operated in this Department. There were 1070 congenital anomaly and 570 acquired disease cases. In 1070 congenital anomaly cases 673 acyanotic and 397 cyanotic anomaly patients were noted. In acquired diseases 94 pericardial and 456 valvular cases were found. Among 456 valve cases 189 mitral stenosis, 133 mitral insufficiency, 30 aortic valve lesion, 97 double valve, and 7 triple valve lesion patients were noted. Among 304 valve replacement cases 209 mitral, 34 aortic, 5 tricuspid, 34 aortic with mitral, 20 mitral with tricuspid, and 2 triple valves were replaced. Annual increase `of open heart surgery cases and decrease of operative deaths were remarkable in recent years. In recent years Shiley** oxygenator in pump-oxygenator set up and Ionescu** bovine pericardial xenograft bioprosthesis were used for valve replacement mainly.

• Journal of Chest Surgery
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• 제24권2호
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• pp.135-142
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• 1991

From January 1980 to December 1989, thirteen patients underwent operation for ventricular septal defect associated with aortic insufficiency in Kyungpook national university hospital. Ten male and three female patients ranged in age from 3 years to 25 years, with an average age of 11.5 years. Aortic cusp prolapse was found in eight cases[61.5%]. The aortic regurgitation was classified by Sellers` method with grade I in 2 cases, grade II in 9 cases, and grade III in 2 cases. Direct suture or patch repair of ventricular septal defect was performed through the right ventricle. Eight cases were treated only by closure of VSD, 3 cases by plication, but two of the letter were reoperated due to the persistent of aortic regurgitation and fungal endocarditis respectively. Aortic valve replacement were performed in 2 cases at the first operation. There was only one late death[7.7%], which was caused by postoperative fungal endocarditis. Follow-up for twelve patients except one death were followed up for 3 months to six years after operation. Residual aortic regurgitation was noted in six cases[46.2%], but the postoperative course of them were uneventful.

• Korean Circulation Journal
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• 제48권11호
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• pp.964-973
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• 2018

The burden of valvular heart disease (VHD) is increasing with age, and the elderly patients with moderate or severe VHD are notably common. When to operate in asymptomatic patients with VHD remains controversial. The controversy is whether early surgical intervention should be preferred, or a watchful waiting approach should be followed. The beneficial effects of early surgery should be balanced against operative mortality and long-term results. Indications of early surgery in each of the VHD will be discussed in this review on the basis of the latest American and European guidelines.

• Journal of Chest Surgery
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• 제27권12호
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• pp.1036-1041
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• 1994

Emergency operation was performed in a patient with severe aortic insufficiency caused by type A acute aortic dissection with aberrant high take-off origin of single coronary artery. The single coronary artery was found to arise from an unusual position high in the ascending aorta. Dissection was begun in the aortic root and involved the single coronary ostium. Valve competance was restored by resuspension of the commissures. the false lumen was obliterated with strips of Teflon felt and surgical glue. The aortic tissues were firmly reinforced and sutured. The proximal aortic stump was anatomically reconstructed, and fortunately the aortic valve was preserved and coronary reimplantation avoided. The patient was discharged at postoperative 13 days without specific complications. Postoperative course during the 18 months follow-up was uneventful.

• Journal of Chest Surgery
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• 제18권3호
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• pp.456-460
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• 1985

A case of Annuloaortic Ectasia associated with Marfan syndrome was treated by replacement of aorta and aortic valve with a valved conduit. A 26 years old man had suffered from palpitation and precordial pain. He had stigmata of Marfan`s syndrome. Aortogram and 2-D echocardiogram confirmed aneurysm of the ascending aorta with aortic insufficiency. Surgery was performed under the moderate hypothermia to 28oC. There was marked dilatation of the aortic annulus as well as sinus of Valsalva, with displacement of the coronary ostia. Aortic valve and aneurysm was replacement with 25mm, woven Dacron tubular graft, to which a 25mm, S.T. Jude Medical valve had been previously sutured. Right & left coronary ostia were anastomosed to the graft with the use of 3O Nylon pledget suture. The patient had a satisfactory post operation period with out specific complication.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1084-1087
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• 1989

Subannular aortic aneurysm is a word-wide rare disease entity occurring predominantly in young black men. In Korea, there has been no report. We report one patient, 46 years old man, who had been operated urgently because of acute aortic insufficiency and aortic valvular vegetation after antibiotics treatment of Subacute bacterial endocarditis for 6wks. At the operative field, We found the bulging aneurysmal mass between the aorta and superior vena cava above the right pulmonary artery, which has subannular communicating opening into the left ventricular cavity, beneath the anterior commissure of the bicuspid aortic valve. Pathologic findings are consistent with "portion of vascular wall with features of aneurysm.* The patients survived aortic valve replacement and patch closure of subannular aneurysm, with no symptoms at one-year postoperative follow-up.w-up.

• Journal of Chest Surgery
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• 제37권1호
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• pp.88-91
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• 2004

Takayasu씨 동맥염 환자에서 대동맥판막 폐쇄부전은 종종 발생하는 합병증이다. 급성 및 진행성 염증으로 대동맥의 뇌혈관 분지에 협착 또는 폐쇄를 가진 환자에서 실신 등의 허혈성 뇌증상은 대동맥판막 폐쇄부전증의 합병으로 더 악화될 수 있다. 양측 경동맥의 폐쇄와 양측 척추동맥의 협착, 우관상동맥의 폐쇄, 대동맥판막 폐쇄부전증으로 실신 및 호흡곤란을 호소하는 34세 남자 환자에서 수술 전후에 스테로이드의 투여, 양측 쇄골하 동맥에 스텐트의 삽입 및 대동맥판막 치환술로써 증상의 호전을 가져올 수 있었다.