• Journal of Chest Surgery
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• v.42 no.6
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• pp.777-780
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• 2009

We reported here on 2 cases of aortic regurgitation (AR) that were due to avulsion of the aortic valve commissure. Aortic valvuloplasty was attempted in both cases. In the 1st case, valvuloplasty was performed with reattaching the commissure using the 5-0 polypropylene continuous suture technique. However, aortic regurgitation recurred and this lead to reoperation on the postoperative $14^{th}$ day. The intraoperative finding revealed a completely re-detached commissure that required mechanical valve replacement. In the second case, we attempted to reattach the commissure using pledgetted multiple transverse mattress sutures with 5-0 polypropylene. Because the leaflet coaptation was incomplete, the aortic valve was replaced with a tissue valve.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.422-434
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• 1980

Since 1968 up to the end of October 1980, 448 valves were replaced in 354 patients in Seoul National University Hospital. There were 238 mitral, 38 aortic, 7 tricuspid, 45 aortic with mitral, 23 tricuspid with mitral, and 3 triple valve replacement aortic mitral and tricuspid cases. Annual increase of mitral valve replacement cases and decrease of operative maortality were remarkable. Recently operative mortality of mitral valve replacement is about 5%. Sex ratio of mitral valve replacement is almost equal and there were 12 cases of pediatric patients (5%) among 238 cases, and patients under the age of 20 years were 34 (14.3%). Mitral valve replacement was done for 199 single mitral, 38 double valve and one triple valve lesions. Among 238 mitral valve replacement paients left atrial thrombus in 23(9.7%), atrial fibrillation in 132 (55.5%), and reoperation after blind mitral commissurotomy in 12(5%) cases were noted. In recent cases bioprosthetic valves, mainly lonescu-shiley valve were utilized to overcome the difficulties of postoperative late complications in anticoagnuation, especially for the rural patients and pediatric cases, in addition to the hemodynamic advantages of lonesocu valve. Among 354 patients 16 cases were congenital heart anomaly related, 5 ventricular septal defect related aortic and 4 Ebstein related tribuspid valve replacement cases. There were 2 congenital anomaly related mitral valve replacements, one for congenital mitral insufficiency of 7 years old boy and one for corrected transposition of the great vessels associated with mitral insufficiency. Among total 354 valve replacements 49 operative deaths (13.3%) were noted and in 238 mitral valve replacement 24 operative deaths occurred (10.1%). In 39 patients among 354 total valve replacements late complications were found. In 238 mitral valve replacement cases late complications were noted in 26 patients, among whom 16 cases expired. Main late complications were thrombe-embolism, subacute becteerial endocarditis, arrythmia cerebral hemorrhage due to unsatisfactory anticoagulation, and congestive heart failure in the incipient period of valve replacement were also noted. In mitral valve replacement cases long-term survival rate was 83.2% who showed marked clinical improvement. Ther were no evidences of calcification during the 2 years follow-up period for the lonescu-valve replacement cases among 19 pediatric patients. In conclusion 238 cases of mitral valve replacement were done with 24 operative deaths and 26 late complication cases among whom 16 expired. The long term survival was 83.2% of the cases. In pediatric cases in place of coumadin anticoagulation Persantin **** 75 and aspirin were administered after valve replacement. In adult cases who have difficulaties with coumadin anticoagulation and for those even with bioprosthetic heart valve replacement who needs long-term or permanent anticoagulation persantin 75 and aspirin combination regimen were administered with antisfactory results.

• 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.51 no.6
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• pp.399-402
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• 2018

A 61-year-old woman who presented with claudication and dyspnea on exertion was found to have severe calcified narrowing of the descending aorta and severe insufficiency of the aortic valve. These findings were compatible with Takayasu arteritis. To treat these hemodynamic abnormalities, extra-aortic bypass surgery combined with replacement of the aortic valve and ascending aorta-to-hemiarch replacement was performed through a separated upper hemi-sternotomy and limited median laparotomy. We present our successful surgical experience with this case.

• Clinical and Experimental Pediatrics
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• v.55 no.7
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• pp.254-258
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• 2012

Takayasu arteritis is a chronic inflammatory disease of unknown etiology primarily affecting the aorta and its major branches and usually occurring in the second or third decade of life. Here, we report a case of Takayasu arteritis in a 10-month-old patient. The infant presented with signs of congestive heart failure and severe aortic regurgitation. Echocardiography and computed tomography angiography showed an abnormally dilated thoracic and abdominal aorta. The infant was initially treated with prednisolone, followed by commissuroplasty of the aortic valve but neither approach ameliorated the heart failure. The patient was eventually treated with a mechanical aortic valve replacement surgery at the age of 12 months, and her condition stabilized. Although unusual, this case indicates that the diagnosis of Takayasu arteritis should be considered in children with unexplained systemic symptoms, aortic valve regurgitation, and heart failure. Because severe aortic regurgitation may be a fatal complication of Takayasu arteritis, early aortic valve replacement surgery should be considered, even in very young children.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.113-117
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• 2002

With an increasing awareness of the limitations of both mechanical prostheses and bioprostheses, aortic valvuloplasty has gained attention as an alternative procedure for aortic valve disease. Material and Method: Eight consecutive patients underwent aortic valvuloplasty caused by leaflet prolapse between June 1799 to June 2000. Mean age of the patients was 18.4$\pm$12.6 year. Four paitents(50%) were male. Six patients had tricuspid valves and ventricular septal defect and two patients had bicuspid valves. The extent of aortic insufficiency was 3.5$\pm$0.5 by preoperative Doppler echocardiography. The technique involved triangular resection of the free edge of the prolapsed leaflet, annular plication at the commissure, and resection of a raphe when present in bicuspid valves. Result: There was no in-hospital mortality or morbidity. Mean follow-up was complete at 11.973.6months. There was no late mortality or morbidity. The amount of the severity of aortic insufficiency, as assessed by echocardiography preoperatively, postoperatively and at late follow-up was 3.5$\pm$0.5, 0.6$\pm$0.5 and 0.8$\pm$0.6, respectively(p value : 0.01). There was one patient with grade 2/4 aortic insufficiency and in the other patients, grade 1/2 or trivial aortic insufficiency were detected with late echocardiograms. Conclusion: Triangular resection in the patients with aortic leaflet prolapse offers a good early clinical result, but long-term follow-up is necessary.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.164-167
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• 2005

Quadricuspid aortic valve is a rare congenital abnormality but it is well recognized as the cause of significant aortic regurgitation. We describe 5 patients who underwent surgery for severe aortic regurgitation associated with quadricuspid valve. In all patients, this abnormality had been incidentally detected during surgery. Two of the patients had infective endocarditis. In accordance with the Hurwitz and Roberts classification, two valves were type d, two were type a, and one was type c.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1222-1225
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• 1998

Aortic valve replacement in young patients has its problems. Biologic prosthetic valves degenerate and need replacement. Metalic prosthetic valves are more durable, however, anticoagulation which has its inherent problems is inevitable. The use of Ross procedure in young patients is gaining wider acceptance. The need of foreign pulmonary valve in right ventricular outflow tract(RVOT) will require reoperation due to RVOT obstruction, later. To overcome this problem, we reimplanted the native aortic valve in the pulmonary position in 21 year old female patient operated on utilizing the Ross procedure for aortic insufficiency. We experienced that the diseased aortic valve worked well in the pulmoanry position because of low pulmonary artery pressure and resistance.

• Journal of Chest Surgery
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• v.52 no.2
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• pp.109-111
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• 2019

We report the case of a female patient who underwent late reoperation following endocarditis surgery. The patient first underwent surgery at 22 years of age for endocarditis with aortic and tricuspid insufficiency. She underwent aortic root replacement with a homograft and tricuspid valve replacement with a tissue valve. Coronary artery bypass using the internal thoracic artery and ligation of the left main coronary artery were performed. Ten years later, failure of the homograft and the tricuspid valve developed. In the second operation, the patient underwent a successful Bentall operation and tricuspid valve replacement with a mechanical valve under deep hypothermia and retrograde cold cardioplegia without drainage.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.305-313
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• 1985

Surgical therapy for dissection of the aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. Recently, a new method of treatment with an intraluminal graft that requires no end-to-end anastomosis has been developed. Of the four patients with dissecting aneurysm of the aorta treated by inserting sutureless ringed intraluminal graft at the Department of Thoracic and Cardiovascular Surgery, S.N.U.H., three were DeBakey type I [one with associated aortic insufficiency] and the other was DeBakey type III. Suspected etiology of the dissection was Marfan`s syndrome in one and hypertension in the others. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta [type A] and simple aortic crossclamping was used for the patient with dissecting aneurysm of the descending aorta. The basic technique consists of inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in patient with aortic insufficiency associated with dissection of the ascending aorta. There were no hospital deaths and one patient with type III dissecting aneurysm developed postoperative paraparesis and renal insufficiency which was resolved. Follow-up has been from 1 month to 16 months with no evidence of prosthetic problems, such as erosion, migration, or thrombosis.