• Journal of Chest Surgery
• /
• 제56권4호
• /
• pp.255-261
• /
• 2023

Background: The surgical threshold for bicuspid aortic valve (BAV)-related aortopathy is a matter of debate due to its uncertain etiology and prognosis. This study investigated the prognosis of unrepaired BAV aortopathy in patients undergoing surgical aortic valve replacement (SAVR). Methods: We retrospectively analyzed data from 720 patients (age, 60.8±11.5 years; 246 women) who underwent SAVR for BAV disease without aortic repair between 2005 and 2020 at Asan Medical Center. The clinical endpoints were defined as occurrences of sudden death, aortic dissection or rupture, and elective aortic repair. To estimate postoperative changes in the dimensions of the unrepaired aorta, the individual annual aortic expansion rate was calculated. Multiple linear regression models were used to evaluate the risk of aortic expansion. Results: The mean ascending aortic diameter was 39.5±4.6 mm, and 299 patients (41.5%) had a baseline ascending aorta diameter >40 mm. During 70.0±68.3 months of follow-up, the mean annual aortic expansion rate was 0.39±1.96 mm/yr, no aortic dissection or rupture was observed, and sudden deaths were reported in 12 patients (0.34% per person-year). Linear regression analysis revealed no significant correlation between the baseline ascending aortic diameter and postoperative aortic expansion (R²=0.004, β=-0.84, p=0.082). Conclusion: In selected patients undergoing SAVR for a BAV (<55 mm), the risk of adverse aortic events was very low. As this observation contradicts current practice guidelines advocating for proactive aortic replacement in dilated ascending aortas measuring >45 mm, the study results need further validation by studies involving larger populations or randomized controlled trials.

• Journal of Chest Surgery
• /
• 제23권3호
• /
• pp.514-521
• /
• 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
• /
• 제44권4호
• /
• pp.292-293
• /
• 2011

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

• Journal of Chest Surgery
• /
• 제25권10호
• /
• pp.1157-1160
• /
• 1992

Aortic valve repair with the use of tailored autologous pericardial extension to the native cusp was performed in one patient with rheumatic aortic valve incompetence. The patient was a 10-year-old girl with Grade II aortic regurgitation and tiny postoperative recannalization of the patent ductus arteriosus. The left aortic coronary cusp appeared to be a little thickened and a cicatrical shortening of the distance between the free edge of the cusp and its annular attachment. A semilunar shaped patch of autologous pericardium, treated with glutaraldehyde solution[6 minutes in 0.6% solution] was sutured along the free edge of the left coronry cusp. Postoperative recovery was uneventful. Echocardiography 8 months later showed Grade I aortic regurgitation. She is now conducting as usual life.

• Journal of Chest Surgery
• /
• 제31권12호
• /
• pp.1234-1237
• /
• 1998

Marfan 증후군과 같은 대동맥 질환의 경우 대동맥동 및 대동맥륜의 점진적인 확장 및 변형이 발생하여 대동맥판막의 폐쇄부전을 초래한다. 이런 경우 대부분 상행대동맥과 대동맥 판막을 composite graft의 형태로 치환하고 여기에 관상동맥을 문합하는 술식이 적용되어왔다. 본 증례는 Marfan 증후군이 동반된 22세 남자 환자로 대동맥 근부 확장과 승모판막 부전이 있었다. 수술은 대동맥 판막 및 좌심실유출로의 일부를 보존하면서 상행대동맥 및 Valsalva동의 동맥류를 제거하고, 대동맥 판막 및 관상동맥을 인조혈관에 다시 문합하는 술식을 적용하였다. 술후 심초음파 검사상 대동맥 판막의 기능은 정상이었다. 대동맥륜 확장증에 있어서 대동맥 판막이 정상적인 해부학적 구조를 가진다면 이상의 술식을 적용함으로써 자신의 대동맥 판막은 보존하면서 대동맥 근부를 치환할 수 있으리라 생각된다.

• Journal of Chest Surgery
• /
• 제37권10호
• /
• pp.833-838
• /
• 2004

배경: 선천성 이엽성 대동맥판막질환에 대한 성형술은 술 후 조기 성적에서는 매우 우수하다고 알려져 있으나 중기 및 장기 성적에 대해서는 논란이 되고 있는 실정이다. 대상 및 방법: 판막 성형술의 중기 성적을 알아보기 위해 1994년부터 2003년까지 선천성 이엽성 대동맥판막질환으로 판막성형술을 시행받은 22명의 환자들의 임상기록 및 심초음파 검사들을 후향적으로 분석하였다. 결과: 남자가 17명, 여자가 5명이었으며 평균 연령은 41$\pm$14세였다. 이엽성 판막의 폐쇄부전이 대부분(91%=20/22)의 환자에서 주 병변이었다. 수술 방법들로는 붙어 있는 공통 판막엽의 해리(release)가 19예(86%)에서 시행되었으며, 이탈된 판막엽에 대한 수술로는 채기 절제 및 일차봉합술이 11예(50%), 판엽줄임술(plication) 후 심막으로 보강한 것이 6예(27%), 판막엽만 줄인 3예(14%)가 있었다. 두꺼워진 판막엽을 깎은 것이(slicing) 12예(55%)에서 사용되었으며, 교련부위의 성형술은 8예(36%), 교련부위절개술이 6예(27%)에서 시행되어 평균 환자당 2.8개의 술식이 사용되었다. 수술 사망은 없었으며 모든 환자를 술 후 평균 38$\pm$17개월간 추적 관찰하였다. 추적기간 중 1명의 환자가 술 후 2개월에 성형술 봉합의 풀림에 의한 급성 대동맥판막 폐쇄부전으로 대동맥 판막 치환술을 받았다. 환자들의 기능적 상태는 (NYHA functional class)는 술 전 평균 1.9$\pm$0.6에서 술 후 1.2$\pm$0.5로 의미있게 개선되었으며(p<0.01), 심초음파 검사상 좌심실의 수축기말/이완기말 용적도 각각 45$\pm$9 mm, 67$\pm$10 mm에서 37$\pm$10 mm, 56$\pm$10 mm로 의미있게 줄어들었다(p<0.05). 대동맥 판막의 폐쇄부전 정도는 술 전 3.1$\pm$1.2에서 심폐기 이탈 직후에 0.9$\pm$0.7로 의미있게 줄었으나 추적 관찰 중 1.8$\pm$1.1로 증가하는 양상을 보였다. 중등도 이상의 폐쇄부전이 없이 생존할 확률은 술 후 1년에 89.7%, 3년에 89.7%, 4년에 39.9%로 나타나 중기 이후에 판막기능의 악화가 빨라지는 경향을 보였다. 결론: 선천성 이엽성 대동맥판막질환 성형술의 중기 성적은 임상적으로는 초기의 우수한 상태를 유지하였으나, 성형된 대동맥 판막의 장기적 내구성은 장담할 수 없었다.

• Journal of Chest Surgery
• /
• 제38권12호
• /
• pp.856-859
• /
• 2005

생후 19일 된 남아가 안면 청색증과 과호흡을 주소로 내원하였다. 심 초음파 소견 상 B형의 대동맥 궁 단절과 후방 부정열형의 심실 중격 결손, 대동맥 판 협착을 보였다. 수술은 양심실 교정을 시행하였으며, 대동맥 판과 폐동맥 판 모두를 좌심실 유출로로 이용하고 신 대동맥 궁을 재건하고 Goretex graft를 이용하여 우심실 유출로를 재건하는 새로운 방법으로 하였다. 술 후 좌심실 유출로와 우심실 유출로 모두 협착없이 잘 유지되었다.

• Journal of Chest Surgery
• /
• 제47권3호
• /
• pp.283-286
• /
• 2014

A 61-year-old man was diagnosed with aortic stenoinsufficiency with periannular abscess, which involved the aortic root of noncoronary sinus (NCS) that invaded down to the central fibrous body, whole membranous septum, mitral valve (MV), and tricuspid valve (TV). The open complete debridement was executed from the aortic annulus at NCS down to the central fibrous body and annulus of the MV and the TV, followed by the left ventricular outflow tract reconstruction with implantation of a mechanical aortic valve by using a leaflet of the half-folded elliptical bovine pericardial patch. Another leaflet of this patch was used for the repair of the right atrial wall with a defect and the TV.

• Journal of Chest Surgery
• /
• 제46권5호
• /
• pp.353-356
• /
• 2013

A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.

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