• Journal of Chest Surgery
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• 제16권4호
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• pp.476-484
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• 1983

Ventricular septal defect[VSD] associated with aortic regurgitation[AR] represents 2 to 7.5% of all VSD which is most common congenital heart disease. The aortic valve may by normal in infants with VSD, but the aortic regurgitation may be developed in these patients later. The aortic valve became fibrotic, thickened, deformed and prolapsed, so these late deformities require to be corrected with plication, valvuloplasty or aortic valve replacement [AVR]. There are some controversy between the early repair of VSD alone and the late repair of VSD and aortic valve till now. From December 1971 to August 1983, we had experienced 24 patients of VSD associated with AR which constitute 6.5% of our total patients with VSD. The VSD was subpulmoary [type I] in 14[58.3%], subcristal [type II] in 8[33.3%], atrioventricular canal type[type III] in 1, and combine of type I and II in 1. Patch repair of VSD was made in 15 patients and direct suture of small VSD in 9.14 patients had aortic plication of valvuloplasty and 9 had AVR accompanying VSD repair, and 1 patient had VSD closure alone. The postoperative courses of these patients were uneventful except in some cases. A patient who was undertaken AVR with Starr-Edwards ball valve and VSD closure, died due to left ventricular failure and low cardiac output syndrome. Follow up shows, in 14 patients with aortic plication or valvuloplasty, AR was developed in 9. In 9 AVR, there were two later complications which were paravalvular leakage in one and re-AVR due to subacute bacterial endocarditis in another.

• Journal of Chest Surgery
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• 제40권3호
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• pp.232-235
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• 2007

외상성 대동맥판막 손상 환자에게 대동맥 판막 성형술과 대동맥 판막 치환술로 각각 치료한 2예를 보고한다. 한 명은 18세 남자 환자로 대동맥 판막 성형술을 시행하였으나 수술 후 5년째 중등도의 잔존한 대동맥판막폐쇄부전증으로 추적관찰 중이며 다른 64세 남자 환자는 기계판막 치환술 후 관찰 중이다. 신중하게 선택된 일부의 환자를 제외한 외상성 대동맥판막폐쇄부전증에는 판막치환술을 우선적 수술 방법으로 귄유한다.

• Journal of Chest Surgery
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• 제52권5호
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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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• 제51권1호
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• pp.61-63
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• 2018

We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.

• Journal of Chest Surgery
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• 제28권7호
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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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• 제33권9호
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• pp.748-751
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• 2000

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root(Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.

• Journal of Chest Surgery
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• 제46권3호
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• pp.212-215
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• 2013

A 79-year-old man was admitted to Samsung Changwon Hospital due to chest pain and dyspnea. The ejection fraction was 31% and mean pressure gradient between the left ventricle and aorta was 69.4 mmHg on echocardiography. Chest computed tomography showed severe calcification of the ascending aorta. Aortic valve replacement was successfully performed using a thoracic endovascular aortic repair balloon catheter without classic aortic cross clamping. The patient was discharged on the eleventh postoperative day.

• Journal of Chest Surgery
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• 제37권6호
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• pp.492-498
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• 2004

목적: 저자들은 본 연구에서 제I형 심실중격결손 환자에서 대동맥판막 병변 발생의 위험인자와 수술후 대동맥판막병변의 진행 양상과 수술 결과를 분석하여 제I형 심실중격결손의 수술시기와 치료전략을 확립하고자 하였다. 대상 및 방법 1991년 1월부터 2000년 12월까지 제I형 심실중격결손 또는 이에 동반된 대동맥판막병변에 대한 수술을 시행한 310예의 환자군을 대상으로 하였다. 환자의 평균연령은 73.7$\pm$114.7 (1∼737)개월이었으며 평균체중은 20.5$\pm$18.8 (3∼95) kg이었다. 진단 당시 대동맥 병변이 없는 경우가 186예(60%)였고 경도의 대동맥판폐쇄부전이 동반된 경우가 83예(27%), 중등도의 대동맥판폐쇄부전이 동반된 경우가 25예(8%), 중증 대동맥판폐쇄부전이 동반된 경우가 16예(5%)였다. 295예의 환자는 일차수술에서 동맥하심실중격결손만을 폐쇄하거나 (279예) 동시에 대동맥판막성 형술을 시행하거나 (5예), 대동맥판막치환술을 시행하였다(11예). 15예의 환자는 일차로 심실중격결손에 대해 수술을 받았던 환자 중 이차로 대동맥판막성형술을 시행하거나(4예), 대동맥판막치환술을 시행하였다(11예). 대동맥판폐쇄부전의 발생에 영향을 주는 위험인자를 분석하기 위하여 수술 당시 환자의 나이, 대동맥판막탈출증의 동반 여부, Qp/Qs, 수축기폐동맥압, 심실중격결손의 크기, 수축기 폐동맥압/체동맥압비 등을 분석대상 위험인자로 포함시켰다. 수술 당시 나이가 대동맥판폐쇄부전 발생에 미치는 영향을 보기 위해 환자군을 0∼1세(Group A: 102예), 1∼6 세(Group B: 136예), 6∼20세(Group C: 31예)로 나누었다. 대동맥판막의 수술방법에 따른 만기 수술 성적의 비교를 위해 대동맥판막성형술을 시행받은 9예와 대동맥판막치환술을 시행받은 22예의 술후 대동맥판막 기능을 비교하였다. 결과: 제I형 심실중격결손 환자에서 수술 당시 고연령, 대동맥판막탈출증 동반, 높은 Qp/Qs, 수축 기고폐동맥압 등이 대동맥판폐쇄부전 발생의 위험인자로 밝혀졌다(p<0.05, Table 2). 특히 수술 당시 연령이 높을수록 술 전 대동맥판폐쇄부전의 빈도가 높았으며 술 후 대동맥판폐쇄부전이 새로 발생하거나 진행하는 빈도가 높았다(p<0.05, Table 1, Fig. 1). 수술 당시 연령이 높은 환자에 대하여 판막대치술이 아닌 판막성형술을 한 경우 잔존 대동맥판폐쇄부전이 남는 경우가 의미있게 높았다 (p<0.05, Fig. 2). 결론: 결론적으로 대동맥판막의 병변 진행이나 발생을 억제하기 위하여 제I형 심실중격결손증에 대해서는 조기 수술이 권장되며 조기수술이 안 되어 병변의 진행이 심해지면 대동맥판막성형술의 완벽한 결과를 기대하기 어려운 경우가 적지 않으므로 병변이 심한 경우 대동맥판막대치술도 수술방법의 선택목록에 포함시켜야 한다.

• Journal of Chest Surgery
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• 제48권5호
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• pp.364-367
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• 2015

Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation. We report the case of a patient with Behcet's disease presenting with contained aortic rupture around the aortic root. The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment. An emergency operation was performed, consisting of aortic root replacement (ARR) using a composite valved conduit and the replacement of the hemiarch. ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.

• Journal of Chest Surgery
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• 제45권3호
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• pp.141-147
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• 2012

Background: Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods: A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results: The mean follow-up duration was $4.9{\pm}3.1$ years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of $4.4{\pm}2.5$ years of echocardiographic follow-up (p<0.001). Conclusion: Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.