• Journal of Chest Surgery
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• 제25권1호
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• pp.57-65
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• 1992

St.Jude Medical cardiac valve replacement was performed in 322 patients: 191 had mitral, 58 had aortic, 72 had double valve and 3 had tricuspid valve replacement. Motality rate in early period was 2.8%[9 patients]. The most common cause of early death was low cardic output syndrome. Follow up extended from 1 to 90 months[mean: 34 months] in 292 patients among 313 in all surviving patients [93.6%]. There were thrombolic complications in eighteen patients. The probability of free from thromboembolism at 5 yerars in MVR, AVR and DVR were 84.7%, 91.8% and 90.2% respectively. And also, actuarial event free rate at 5 years in MVR, AVR and DVR were 80.1%, 82.2%, and 81.4% respectively. There were fourteen late death during follow up period: six from thromboembolism, one from hemorrhage and the others from non valve related -or unknown complications. The acturial survival rate at 5 years were 93.1% in mitral, 92.1% in aortic and 97.1% in double valve replacement. In conclusion, the performance of the St. Jude Mecanical valve compares most favorably with other artificial valves. But it remains still hazards of mechanical prosthesis such as thromboembolism and anticoagulant related hemorrhage.

• Journal of Chest Surgery
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• 제35권2호
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• pp.102-112
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• 2002

배경: 본 연구는 대동맥근부를 침범한 상행대동맥류 환자에서 composite valve graft를 이용한 대동맥근부 치 환술 결과를 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2001년 6월가지 composite valve graft를 이용한 대동맥근부 치환술 환자 56명을 대상으로 후향적으로 조사하였다. 대동맥판막 폐쇄부전은 50명(89%), Mafan증후군이 18명(32%), 그리고 이엽성 대동맥판막이 7명(12.5%)에서 동반되었다. 진단은 대동맥판륜 확장증 30명(53.6%), 대동맥 박리증 13명(23.2%), 대동맥근부를 침범한 상행대동맥류 11명(17.6%), 그리고 대동맥염이 2명(3.6%)이였다. 대동맥 파열로 인한 심낭 압전 및 심인성 쇽은 2명에서 있었으며 과거에 심장이나 상행대동맥 수술을 받은 환자는 9명(16%)이었다. 근부치환술시 사용된 수술방법button술식 51명(91%), 변형 Cabrol 술식 4명, classic Bentall 술식을 1명에서 시행하였다. 동반수술은 대동맥궁 치환술 24명(43%), 관상동맥우회술 8명(14.3%), 승모판 성형술 2명 및 재치환술 1명, 기타 7명이었다. 평균 순환정지, 체외순환및 대동맥차단 시간은 각각 21$\pm$14분(6-60분), 186$\pm$68분과 132$\pm$42분이었다. 결과: 조기 사망은 1명(1.8%)에서 있었고 술후 합병증으로는 심기능 부전이 16명(28.6%), 출혈로 인한 재수술 7명(12.5%), 심낭삼출 2명, 그리고 기타가 6명이었다. 술후 생존자 55명중 53명(96.4%)에서 평균 23.2$\pm$18.7개월(1-75개월)을 추적하였다. 만기 사망은 외상성 뇌출혈로 사망한 1명을 포함해 2명(3.8%)이었으며 대동맥근부 치환술과 관련한 만기 사망률은 1.9%였다. 한편 술후 1년과 6년 survival rate는 각각 98.1$\pm$1.9%와 93.275.1%였다. 대동맥근부 치환술과 관련한 합병증으로 재수술이 2명에서 시행되었으며(3.8%), 1년과 6년 후 재수술로부터의 freedom rate는 각각 97.872.0%와 65.3$\pm$26.7%였다. 잔여 대동맥에 대한 수술은 술전에 동반된 흉복부대동맥류의 확장으로 2명에서 흥복부대동맥류 치환술을 시행하였다.

• Journal of Chest Surgery
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• 제24권11호
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• pp.1133-1137
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• 1991

Congenital coronary arteriovenous fistula is relatively uncommon and often associated with additional congenital and acquired heart disease. If coronary arteriovenous fistula is suspected, the diagnosis can be made readily by cardiac catheterization and selective coronary arteriography. Surgical treatment is very satisfactory, with a low mortality and apparent good long term result. Recently, we experienced one case of congenital coronary arteriovenous fistula which was associated with aortic stenosis and regurgitation. The tortuous fistula tract was noted between the left anterior descending coronary artery and the main pulmonary artery. Under the cardiopulmonary bypass, aortic valve replacement[Carbomedics 23mm] and suture closure of the draining orifice of coronary arteriovenous fistula in the main pulmonary artery just above the pulmonary valve were performed, Postoperative hospital course was uneventful and the patient was discharged postoperative 9th day without any problems.

• Journal of Chest Surgery
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• 제31권10호
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• pp.1009-1013
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• 1998

대동맥근부를 포함한 대동맥 판막 심내막염은 적극적인 내과적 및 외과적 치료를 해도 염증의 재발이나 사망률이 높은 질환이다. 자가폐동맥판막을 이용하여 전대동맥근부치환술은 이식편이 생체 조직이고, 면역학적으로도 안전한 조직이라 술후 항응고요법이 요구되지 않는 술식이다. 저자들은 38세된 여자환자에서 대동맥근부를 포함한 대동맥 판막 심내막염 환자에서 Ross술식을 이용하여 성공적으로 치험하였고 수술후 3개월간 추적중 양호한 상태이다.

• Journal of Chest Surgery
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• 제30권4호
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• pp.419-422
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• 1997

복합적인 좌심실유출로협착이 있는 환자에서는 여러종류의 대동맥심실성형술이 치료의 옵션이다 소아에서 대동맥심실성 형술시 폐동맥자가판막은 판막치환의 재료로써 매우 희망적 이라고 하겠다. 세종병원 흉부외과는 선천성대동맥헙 착, 대동맥 폐쇄부전, 그리고 심한 좌심실기능부전이 있는 6개월된 여아 1례에서 폐동맥자가판막을 이용한 대동맥심실성형술을 시행하여 좋은 결과를 얻었기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제55권5호
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• pp.388-396
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• 2022

Background: In this study, we present recent trends in heart valve surgery in Korea through analyses of data from the Korea Heart Valve Surgery Registry (KHVSR). Methods: We enrolled 8,981 patients who were registered in the KHVSR from 2017 to 2020. Yearly trends in patients' baseline characteristics, surgical profiles, and early mortality rates were explored. The observed/expected mortality ratio (O/E ratio), calculated from the actual mortality in the KHVSR and the predicted mortality estimated using the EuroSCORE II, was also analyzed. Results: The proportion of aortic valve surgery significantly increased from 56.8% in 2017 to 60.3% in 2020. The proportion of all combined procedures and minimally invasive surgery significantly increased over the 4-year study period. The operative mortality rate was 2.9% in the entire cohort, while mitral valve repair showed the lowest mortality risk (0.9%). The mortality rates of isolated aortic valve replacement (AVR) significantly decreased from 2.1% in 2017 to 0.8% in 2020 (p=0.016). Overall, the O/E ratio was 0.784 (95% confidence interval [CI], 0.677-0.902) demonstrating significantly lower actual mortality risks than expected based on the EuroSCORE II. In particular, the O/E ratios were as low as 0.364 (95% CI, 0.208-0.591) for isolated AVR. Conclusion: The recent data from the KHVSR showed increasing trends for complex procedures and minimally invasive surgery in heart valve surgery in Korea, and demonstrated remarkably low risks of operative mortality.

• Journal of Chest Surgery
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• 제15권2호
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• pp.238-242
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• 1982

The incidence of annuloaortic ectasia has known rare, and approximately 5-10% of aortic regurgitation. The patient was 44 years old male who complained exertional dyspnea and left anterior chest pain. He had done Lt. side 2 stage thoracoplasty for pulmonary tuberculosis about 20 years ago at Dept.of Chest surgery of National Medical Center. At that time, there was no abnormal findings in cardiovascular system. The preoperative aortic cineangiogram showed pear shaped dilatation [7.3 cm x 6.8 cm] of aortic mot with aortic valve regurgitation but left ventricular ejection function was fair. Preop. ventilatory function test showed mixed type pulmonary insufficiency. Recently, we corrected surgically, by AVR with Carpentier-Edwards Bioprosthesis [29mm] & supracoronary Woven Dacron graft [29mm x 5cm] replacement, with good clinical result for follow up 6 months.

• Journal of Chest Surgery
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• 제43권6호
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• pp.627-634
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• 2010

배경: 조직판막의 내구성은 심장 판막 수술에서 기계판막과 조직판막을 선택하는 중요한 기준이 된다. 본 연구는 조직판막이 사용된 대동맥판막치환술의 중기성적을 분석해 보았다. 대상 및 방법: 이 연구는 1990년 3월부터 2009년 3월까지 조직판막을 이용하여 대동맥판막치환술을 시행한 380명의 환자들을 대상으로 하였다. 술 후 평균 관찰 기간은 $46.7{\pm}40.8$월(0~196개월)이었으며 외래 경과 기록과 의무기록을 통하여 후향적으로 분석하였다. 결과: 총 380명의 환자에서 389예의 수술이 시행되었으며 환자들의 평균 연령은 $69{\pm}9$세, 남녀 비는 227 : 162였다. 조기 사망은 15명 (3.9%)이었다. 1년, 5년, 10년 생존율은 92.3%, 78.1%, 54.2%였다. 재수술의 l년, 5년, 10년 회피율(Freedom from reoperation)은 98.4%, 97.1%, 91.7%였으며 구조적 판막 손상 1년, 5년, 10년의 회피율(Freedom from structural valvular deterioration)은 96.1%, 92.3%, 88.0%였다. 수술 전 위험인자의 다변량 분석에서 젊은 나이 (p<0.001)가 재수술의 위험인자였으며 수술 후 판막 부하 최고속도(p=0.034)와 젊은 나이(p=0.029)가 구조적 판막 손상의 위험인자였다. 고령(p=0.001), 장시간의 심폐기사용(long bypass time) (p=0.035), 관상동맥 우회술을 동시에 실시한 경우(concomitant CABG) (p=0.003), 술 전 중등도 이상의 좌심실 기 능부전(Left ventricular ejection fraction, LVEF<40%) (p=0.003)이 조기 사망의 위험인자였으며 술 전 신기능저하(estimated glomerular filtration rate, eGFR<60 mL/min) (p=0.025)와 지속적인 좌심실비대(persistent left ventricular hypertrophy, LVH) (p=0.032)가 만기 사망의 위험인자였다. 결론: 이 연구를 통해 조직판막을 이용한 대동맥판막치환술은 재수술과 구조적 판막 손상 회피율 등의 측면에서 만족할 만하다고 할 수 있으며, 향후 더 많은 환자에서 보다 장기적인 연구가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제28권6호
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• pp.579-582
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• 1995

The extended transseptal approach to the mitral valve replacement has been used for 30 patients. There were 19 women and 11 men. Twenty five patients had rheumatic heart disease, 4 had degenerative valve ,and 1 had valve prolapse. Fifteen of 30 patients had other associated procedure; 10 had aortic valve replacement; 5 had tricuspid annuloplasty. There were no postoperative complications associated with the approaches, ie, no bleeding, no sinus node dysfuction, and no atrioventricular conduction disturbance. Despite division of the sinus node artery, preoperative atrial rhythms[3 sinus rhythms and 27 atrial fibrillations were not changed during postoperative period. The extended transseptal approach provides good mitral valve exposure without inherent complications, and is superior to that of standard approach, so we use it routinely for mitral valve procedure.

• Journal of Chest Surgery
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• 제23권4호
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• pp.667-675
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• 1990

From June, 15th, 1987 to June, 14th, 1989, 105 Duromedics bileaflet cardiac valve prostheses were implanted in 81 patients. Mitral valve replacement was done in 42 patients, 7 underwent aortic valve replacement, 28 underwent double valve replacement, & 4 patients underwent triple valve replacement. Concomitantly used valves were 13 cases; 11 cases were St. Jude Medical valves[M: SJM #29 X4, #27 X5, #25 X 1, T: SJM #33] & two cases were Carpentier Edwards bioprostheses[T: C - E #31X2]. The early mortality rate[within 30 days] was 3.7%[2 patients] & the late mortality rate was 7.4%[3 patients]. Follow-up was done on 72 surviving patients; mean follow-up period was 21.17$\pm$5.36 months. Anticoagulant-related hemorrhage was observed in two patients, possible prosthetic valvular endocarditis was observed in one patient and other specific valve-related complications were none. We concluded, therefore, that good clinical results & a low complication rate could be achieved with Duromedics bileaflet valve in short-term follow-up, & long-term follow-up was also necessary.