• Journal of Chest Surgery
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• v.17 no.1
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• pp.3-11
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• 1984

Prosthetic valve replacement has resulted in marked improvement in the functional status of many patients with valvular heart disease. But valve failure from various causes has necessitated re-replacement of prosthetic valve in some of these patients. This selective group of patients has many inherent problems. This report presents our experience with seven patients who received re-replacement of prosthetic valve in the Seoul National University Hospital from 1981, to 1983. The patients included one woman and six men in the range of 9 and 49 years old. As the first valve operations, there were five MVR using tissue valves, one DVR [Bjork-Shiley and Ionescu-Shiley valve] and one case of modified Bentall operation with composite graft [Ionescu-Shiley valve]. Reoperations on prosthetic valve failure were performed 17 to 54 months after the first operation [mean 34 months]. Amon8 seven patients, there were two cases of prosthetic valve endocarditis and five cases of primary tissue failure. Gross calcification of the xenograft was found in two children with Ionescu-Shiley valve. All except one had relatively successful operative results. The unsuccessful one died intraoperatively from low output syndrome.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.500-505
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• 1986

Eight patients received operation for ascending aortic aneurysm and aortic regurgitation associated with Marfan`s syndrome from January 1984 to July 1986 at Seoul National University Hospital. The patients` age ranged from 29 to 51 years [mean 37.3 years]. Five patients were male and three were female. All of them showed some stigmata of skeletal system in Marfan`s syndrome. Three patients had dissecting aneurysm and five patients had fusiform aneurysm of ascending aorta. Two patients had concomitant fusiform aneurysm of abdominal aorta. All patients showed aortic regurgitation of grade III to IV. One patient received insertion of intraluminal ringed graft and resuspension of aortic valve, and seven patients received modified Bentall operation [Carol`s method]. There was no hospital death and all showed functional improvement in the 7.4 patient-years follow-up period.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.158-163
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• 1988

12 Patients with thoracic aortic aneurysm were operated between May 1985 to Sept. 1987 at the our department, Hanyang University Hospital. We retrospectively evaluated the surgical results and considered diagnosis, surgical approach and perioperative problems of thoracic aortic aneurysm. There are 9 males and 3 females in the patients. The age ranged from 23 to 61 years with the mean age at 40.6 years. The cause of the aneurysm was atherosclerosis in 5, Marfan`s syndrome in 4, syphilis In 1, trauma in 1 and annuloaortic ectasia in 1 case. According to DeBakey`s classification, Type I was 1 case, Type II was 5 cases and Type III was 6 cases. Among 6 patients with ascending aortic aneurysm, Bentall`s operation in 4 cases and ascending aorta reconstruction using to Dacron Tube Graft in 2 cases were performed successfully. 6 cases with descending aortic aneurysm were managed by prosthetic graft replacement. Chylothorax was observed in 1 patient and postoperative hemorrhage necessitating reopening of the chest occurred in 4 of operative survivors. There were 2 hospital deaths; one patient was dead during the operation and one patient was dead during the post-operative course due to low cardiac output syndrome

• Journal of Chest Surgery
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• v.27 no.1
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• pp.31-35
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• 1994

Dissecting aortic aneurysm is a life threatening condition which necessitates prompt diagnosis and management. Between January 1987 and September 1993,58 patients was admitted to our department. Mean age at admission was 53 years.[range 25-82]. Clinical findings included chest pain in 48 cases[83%],renal failure in 12[20%],aortic insufficiency in 11[19%] and stroke in 9[15%]. Predisposing factors were hypertension in 50 cases[86%],Marfan`s syndrome in 6[10%] and diabetes melitus in 1 [2%]. 23 patients[ type A 13,type B 10 ] underwent surgical treatment. Surgical technique for type A included graft replacement of ascending aorta in 7 cases,graft replacement and aortic valve resuspension in 3,and Bentall`s operation in 3 cases. Type B patients were operated when specific indications applied. There were three [Two in type A and 1 in type B] deaths in the operation group and nine [ 5 in type A and 4 in type B] deaths in the medical group. These results support our current policy in the treatment of dissecting aortic aneurysm.

• 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.30 no.12
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• pp.1197-1204
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• 1997

Between April 1981 and June 1996, 65 patients had aortic root replacement at our institution. Disease entities were pure aortic annuloectasia in 31 patients(47.7%), Stanford type A aortic dissection with annuloectasia in 8(43.1%), atherosclerotic aneurysm with aortic regurgitation in 4(6.2%), and paravalvular leakage after aortic valve replacement in 2(3.1 %). 34 patients(52.3%) had the clinical stigmata of the Marfan syndrome. The operative procedures were Bentall operation in 61 patients(93.8%); 3 of conventional procedure and 58 of Cabrol's modification, aortic valve-sparing operation in 2(3.1 %), and root replacement with homograft in 2(3.1%). Hospital deaths occurred in 3 patients(4.8%) because of uncontrolled bleeding(1) and bypass weaning failure due to low cardiac output(2), and all had emergency operation with Cabrol's procedure. Postoperative complications developed in 19(29.2%) patients and most of them were transient. Surviving 62 patients have been followed up to cumulative total 315.0 patient-years(mean 60.2 $\pm$42.4 months). Late deaths occurred in 7 patients(11.3%), aneurysmal changes of remaining aorta were detected in 12 patients(19.4%). Actuarial survival rate at 10 years was 72.0 $\pm$ 9.7%, and the subsequent aortic operation-free rate at 10 years was 68.0$\pm$ 8.9% In a multivariate analysis, Marfan syndrome, emergency operation, preoperative dissection, combined arch replacement, and total circulatory arrest emerged as significant risk factors for hospital death or subsequent aortic operation. Over 60 years of age was the only risk factor for late death. Our 16 years'cummulative experience shows that aortic root replacement, mainly by means of Cabrol's procedure, can be applied successfully to variety of aortic root disease. However, long-term follow up will be needed to determine the late result of aortic valve-saving operation and root replacement with homograft. When dissection is present or the distal native aorta is diseased in'Marfan patients, close follow-up is necessary because of the subsequent aneurysmal change of remaining aorta.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.506-511
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• 1997

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.578-584
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• 2004

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1212-1217
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• 1996

From Dec. 1993 to May 1995, 9 male and 5 female patients ranging in age from 25 to 65 years, were operated on for ascending aorta and/or aortic arch diseases. Six patients had acute aortic dissection, type A(ruptured in 4 cases); four had ruptured ascending aortic aneurysm; three had annuloaortic ectasia(ruptured in 1 cases); one had aortic arch aneurysm. The diagnostic procedures were echo cardiography and dynamic CT scan in all patients having acute dissection or rupture. The aortic angiography was performed in two cases. Indications for operations were rupture in five cases, acute aortic dissection in five cases, severe congestive heart failure in two cases, progressive aortic insufficiency in one case and impending rupture in one case. The emergent repair was performed in ten cases(71%). The surgical treatment consisted of 6 Cabrol operations, a Cabrol operation combined with arch replacement, a modified Bentall operation, 4 replacement of ascending aorta, a replacement of aortic arch, and a replacement of ascending aorta and aortic arch. Complications were a hypoxic encephalopathy, two atrial fibrillations, a sternal deheiscence, and a mediastinitis. Two early mortality(14%) were due to intractable bleeding and multiple organ failure, and one late mortality(7%) was due to ventricular arrhythmia. In eleven survivors, follow-up period was from 2 months to 12 months and the course was uneventful.

• Journal of Chest Surgery
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• v.48 no.5
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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.