• Journal of Chest Surgery
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• v.28 no.7
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• pp.704-707
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• 1995

The use of the patient`s pulmonary valve for replacement of the patient`s diseased aortic valve was introduced and developed by Mr. Donald Ross. The long term benefits of having a normal, fully viable, trileaflet semilunar valve in aortic position was demonstrated. A 38 year old male had histories of failures of previously implanted aortic prosthetic valves twice and evidence of progressive heart failure. At operation, aortic root abscess was found; the abscess extension to adjacent structures and partial valve dehiscence had occurred. The patient underwent replacement of the aortic root with autologous pulmonary valve, autologous pericardial patch repair of left ventricuar outflow tract and recontruction of the right ventricular outflow tract and pulmonary artery with prosthetic valved conduit. Postoperatively, the patient recovered well. Postoperative doppler echocardiography demonstrated minimal central regurgitation in new aortic valve. Aortic root replacement with pulmonary autograft in a patient of recurrent aortic root abscess and false aneurysm of left ventricuar outflow tract was experienced and reported with follow up echocardiography.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1556-1562
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• 1992

Forty two consecutive patients who had had valve replacement with St. Jude Medical prosthesis were studied on a view point of intravascular hemolysis. Patients were consisted of 14 mitral valve replacement, and 7 aortic valve replacement, and 21 double, mitral and aortic, valve replacement. Serum LDH, indirect bilirubin, GOT, hemoglobin levels and ret-iculocyte count were pursued in postopeative 1st day, 3rd day, 7th day, 14th day and 21th day. Postoperatively, all patients were not detected paravalvular leakage on the ech-ocardiographical study. The patients with double valve replacement revealed higher levels of LDH on postopeative 14th day[P<0 05] than those with single valve replacement. Among the patients with single valve replacement, the patients with aortic valve replacement revealed slightly higher levels of entire postopeative data, but considered insignificant. There was correlation between the severity of hemolysis and the size of replaced aortic valve. In the postoperative LDH levels, the patients with small sized-aortic valve[less than 21mm in diameter] replacement revealed higher levels of postoperative 3rd day, 7th day and 14th day than those with large size[more than 23mm in diameter]. The patients with high level LDH of greater than 800 WU /L on postoperative 7th day were 61.9%[26 of 42]. The high LDH frequency of DVR was 71.4%[15 of 21], MVR 50.0%[7 of 14] and AVR, 57.1%[4 of 7]. The level of LDH declined gradualiy thereafter through postoperative 3 weeks. In conclusion, intravascular hemolysis after prosthetic valve replacement was dependent on position of valve replacement and size of valve. And this study supports the conventional valve selection and usage in our hospital. The patients with subclinical hemolysis after valve replacement should be placed on a close observation.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.164-168
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• 1988

Between November, 1984, and May, 1986, 93 patients underwent combined valvular and coronary artery operation. They were 70 male and 23 female, the age ranging from 29 to 82. From this population 89 patients underwent single valve replacement and 4 patients underwent double valve replacement. Patients with mitral valve disease were in the majority present in the age group between 50 till 70, where as in the group after 60 years, patients with aortic valve disease were dominant. The main indication for aortic valve replacement was aortic stenosis and the indication for mitral valve replacement was equal between mitral stenosis and mitral incompetence, the later was due to papillary dysfunction after myocardial infarction. Dyspnea was a very frequent symptom and it was found in nearly all patients. 28 patients had a previous myocardial infarction and severe left ventricular dysfunction. The grafts were placed prior to valve replacement and periods of myocardial ischemia were kept at a minimum by maintaining coronary perfusion throughout the operation. It is our opinion that simultaneous valve replacement and myocardial revascularization does not increase the risk of cardiac valve replacement substantially.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.405-413
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• 1980

A total of 63 patients [42 males and 21 females] underwent multiple valve replacement with artificial valves between January 1975 and August 1980 at Seoul National University Hospital. There were 38 patients with aortic and mitral valve replacement, 22 with mitral and tricuspid, and 3 with aortic, mitral and tricuspid valve replacement. The valve lesions varied from trivial to severe and most aortic and mitral valves had mixed stenosis and insufficiency, while tricuspid valves had only insufficiency. The patients were severely symptomatic in majority of the cases, and belonged to the Classes III and IV [III:45, IV:16] of the NYHA functional criteria. Hemodynamic studies were performed on all the patients. The mean pulmonary wedge pressure was remarkably increased to 19.8 mmHg in aortic and mitral valve lesions and 18.0 mmHg in mitral and tricuspid valve lesions. The mean pulmonary arterial pressure was also increased, while the cardiac index was reduced. In 1977, the average perfusion time was 245.5 minutes for aortic and mitral valve replacement and 181.6 minutes for mitral and tricuspid valve replacement. It has progressively declined to 169.2 minutes for aortic and mitral valve replacement and 123 minutes for mitral and tricuspid valve replacement in 1980. The average period of aortic occlusion also declined after the use of cardioplegic solution. Twenty deaths occurred among the 63 patients operated upon, an overall mortality rate of 30.8%. The operative mortality has declined with successive year from a level of 66.7% before 1977 to 21.1% in 1980. Fourteen patients suffered from a list of postoperative complications, which eventually resolved with adequate treatment. All the survivors were enjoying the levels of daily life activities greater than those existing before the operation.

• Journal of Chest Surgery
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• v.56 no.6
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• pp.435-444
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• 2023

Background: Edwards Intuity is recognized as a relatively contraindicated bioprosthesis for bicuspid aortic valve disease. This study compared the early echocardiographic and clinical outcomes of rapid-deployment aortic valve replacement for bicuspid versus tricuspid aortic valves. Methods: Of 278 patients who underwent rapid-deployment aortic valve replacement using Intuity at Seoul National University Hospital, 252 patients were enrolled after excluding those with pure aortic regurgitation, prosthetic valve failure, endocarditis, and quadricuspid valves. The bicuspid and tricuspid groups included 147 and 105 patients, respectively. Early outcomes and the incidence of paravalvular leak were compared between the groups. A subgroup analysis compared the outcomes for type 0 versus type 1 or 2 bicuspid valves. Results: The bicuspid group had more male and younger patients. Comorbidities, including diabetes mellitus, hypertension, chronic kidney disease, and coronary artery disease, were less prevalent in the bicuspid group. Early echocardiographic evaluations demonstrated that the incidence of ≥mild paravalvular leak did not differ significantly between the groups (5.5% vs. 1.0% in the bicuspid vs. tricuspid groups, p=0.09), and the early clinical outcomes were also comparable between the groups. In the subgroup analysis between type 0 and type 1 or 2 bicuspid valves, the incidence of mild or greater paravalvular leak (2.4% vs. 6.7% in type 0 vs. type 1 or 2, p=0.34) and clinical outcomes were comparable. Conclusion: Rapid-deployment aortic valve replacement for bicuspid aortic valves demonstrated comparable early echocardiographic and clinical outcomes to those for tricuspid aortic valves, and the outcomes were also satisfactory for type 0 bicuspid aortic valves.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.89-100
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• 1975

Sixteen cases of cardiac valve replacements have been done in this department since 1970. Twelve cases of mitral valve replacement were done with Beall valve, 2 cases of aortic valve replacement with Starr-Edwards and Magoven valve and 2 cases of double valve replacement using Beall valve for mitral and Magovern valve for aortic. Three patients [18.8%] died during operation. Two cases [12.5%] of hospital mortality occurred because of congestive heart failure and asphyxia due to tracheomalacia 3 months after operation. Follow-up studies from two to 27 months showed excellent results except three cases of late mortality [18.8 %]. Thromboembolism occurred in two double valve replacement patients[12.5%]who were fatal.

• Journal of Chest Surgery
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• v.12 no.1
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• pp.56-60
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• 1979

Replacement of the aortic valve in a normal or large aortic root can be accomplished with ease and safety in most instances. The presence of a narrowed aortic annulus remains a problem in that the replaced smaller prosthetic valve has a significant resting pressure gradient across the orifice. This narrowing causes not only technical difficulties, but also increased mortality and post-op. complication. Therefore this problem deserves special attention. This report presents our experience with a case of a small aortic root caused by rheumatic heart disease [AI and MS]. This is the method of enlargement of the aortic annulus with a woven Dacron patch and replacement of a larger prosthetic aortic valve combined with mitral valve replacement.

• Journal of Chest Surgery
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• v.52 no.5
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• pp.368-371
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• 2019

A unicuspid aortic valve is a rare congenital malformation that frequently presents with valvular dysfunction and dilatation or aortic aneurysm, requiring combined aortic valve surgery and aortic repair. Some patients show severe valve calcification extending into the interventricular septum, possibly resulting in damage to the conduction system during debridement for valve replacement. We present a rare case of severe aortic stenosis with a unicommissural unicuspid aortic valve diagnosed by preoperative transesophageal echocardiography in a 36-year-old man. After composite graft replacement of the aortic valve, aortic root, and ascending aorta, a permanent pacemaker was placed because of postoperative complete heart block.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.514-521
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• 1990

Patient with aortic valvular disease have increased left ventricular work and greater myocardial oxygen demand, which may aggravate the effect of concomitant coronary artery disease. Thus in patient who repair aortic valve replacement, concomitant aortocoronary bypass surgery is often performed when angiographically significant coronary artery disease is present. This approach is supported by reports that revascularization does not increase operative risk when associated coronary artery disease is present and significantly reduce the occurrence of late sudden death. Recently we have experienced one case of aortic valve replacement concomitant with aorta-coronary bypass surgery. The patient was 56 year-old male and admitted with complaint of anterior chest pain especially during his exercise. He was diagnosed as aortic valve stenosis and regurgitation [GIII] with proximal right main coronary artery occlusion We performed aortic valve replacement with aorta coronary bypass surgery by use of saphenous vein. Post operative course was uneventful and chest pain was relieved. Post operative coronary angiogram disclosed good patency of grafted vessel.

• Journal of Chest Surgery
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• v.24 no.3
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• pp.265-270
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• 1991

Since advent of the prosthetic cardiac valve replacement, much efforts for accurate assessing value function in-vivo have been attempted. To evaluate the postoperative functional and morphological status of the replaced cardiac valve prosthesis, 33 patients with valve replacement were studied by transthoracic and transesophageal 2-dimensional echocardiac imaging as well as by color Doppler flow velocity imaging. Twenty four patients had mitral valve replacement. 6 patients had aortic valve replacement and 3 patients had both mitral and aortic valve replacement. There were 34 mechanical and 2 biological prosthesis. Comparing to transthoracic echocardiography, transesophageal approach showed transvalvular regurgitant jet flow amid the prosthetic mitral valve ring during. systole and much clear visualization of cardiac chamber behind prosthesis which could give shadowing effect to ultrasound beam. According to the quantitative grading by the length and area of mitral regurgitant flow, 24 out of 27 mitral valves revealed mild degree regurgitation considered as physiological after prosthetic bileaflet valve replacement and the other 3 valves including 2 biological prosthesis had moderate degree regurgitation which was regarded as pathologic one. 2 cases of left atrial thromboses and 1 case of paravalvular leakage which were not visible by transthoracic approach were identified by transesophageal echocardiography in patients with mitral valve replacement and patients with aortic valve replacement respectively. We conclude that in patients with prosthetic mitral valve replacement, transesophageal 2-dimensional imaging with color Doppler can suggest reliable information beyond that available from the transthoracic access even though it gives patient some discomfort to proceed.