• Journal of Chest Surgery
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• 제56권6호
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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.

• 한국가시화정보학회지
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• 제21권1호
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• pp.12-17
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• 2023

Aortic valve stenosis is a heart valve disease caused by the accumulation of calcium in the valve, which can divide into tricuspid aortic valve (TAV) stenosis and bicuspid aortic valve (BAV) stenosis depending on the shape of natural valve. In this study, pig heart-based TAV and BAV ex vivo models were fabricated, and the flow characteristics behind a valve were analyzed using 4D flow MRI. Flow behind normal TAV was uniformly distributed, while BAV asymmetrically opened with an eccentric strong jet. Especially, BAV ex vivo model exhibited a secondary flow in the region where the valve closed. In addition, BAV had a 26% higher peak velocity while maintaining similar stroke volume compared with normal TAV. This study would be helpful for understanding the flow characteristics for BAV AS patients.

• Journal of Chest Surgery
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• 제56권4호
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• pp.255-261
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• 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
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• 제20권2호
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• pp.300-308
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• 1987

Clinical and pathologic data were reviewed in 20 patients who had have surgery for isolated aortic valvular heart disease between April 1978 and April, 1987. Hospital mortality was 10%, with no additional late mortality during a mean follow-up period of 24.1 months. Prosthetic valve failure developed in 3 patients and two had reoperation. Niety four percent of the survivors who were in NYHA Funtional class III or IV before operation are now in class I or II. Ninety percent of all patients are still alive at a maximum follow up of 9 years. The clinical histories, gross and histologic examination of valves estabilished the causes for isolated aortic valve disease: 3 rheumatic, 2 congenital bicuspid, 2 hypertention, 2 aortitis and each one case of floppy valve, medial cystic necrosis of aorta, bacterial endocarditis. But etiology was unknown in 8 cases. Sixteen patietns had myxoid degeneration, defined as significant disruption of the valve fibrosa and its replacement by acid mucosaccharides and cystic changes. Myxoid degeneration was also the primary pathologic abnormality in the patients with 2 hypertention, 2 rheumatic, 1 aortitis, 1 bacterial endocarditis, 1 floppy valve, 1 congenital bicuspid. The patients with myxoid degeneration of uncertain origin were 8. Histologic finding of all of them revealed nonspecific patients with myxoid degeneration of uncertain orgin were 8. Histologic finding of all of them revealed nonspecific chronic valvulitis with myxoid degeneration. This finding may indicate that the etiology w uld be infectious.

• 대한영상의학회지
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• 제84권6호
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• pp.1324-1336
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• 2023

목적 이첨 대동맥 판막의 아형과 판막 석회화의 정도에 따른 심장 CT와 경흉부심초음파의 이첨 대동맥 판막 진단 능력을 비교해 보고자 한다. 대상과 방법 대동맥 판막 치환술 전 심장 CT와 경흉부 심초음파를 시행한 266명의 환자(이첨 대동맥 판막, 106명; 삼첨 대동맥 판막, 166명)를 후향적으로 포함하였다. 심장 CT를 이용하여 판막의 모양을 평가하였고, 관상동맥 칼슘 측정 CT를 이용하여 판막의 칼슘 정도를 정량화하였다. 대동맥 판막은 융합형과 2-대동맥동형 아형으로 분류하였다. 심장 CT와 경흉부 심초음파의 진단정확도는 수술 소견을 대비표준으로 하여 계산하였다. 결과 CT는 이첨 대동맥 판막을 진단함에 있어서 경흉부 심초음파보다 민감도, 음성 예측도, 정확도에서 통계적으로 유의하게 높은 값을 보여주었다(각각 p < 0.001, p < 0.001, p = 0.003). 경흉부 심초음파는 판막의 석회화가 증가할수록 민감도가 감소하는 경향을 보였다. CT와 경흉부 심초음파 간의 진단 오류율은 2-대동맥동형 아형에서 10.9%, 융합형 아형에서 28.3%였다(p = 0.044). 결론 심장 CT는 이첨 대동맥 판막을 진단함에 있어 경흉부 심초음파보다 높은 진단능을 보여주며, 특히 판막 석회화가 심하거나 융합형의 아형인 환자에서 이첨 대동맥 판막을 진단하는데 도움을 줄 수 있다.

• Journal of Chest Surgery
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• 제49권6호
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• pp.443-450
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• 2016

Background: Although unique aortic pathology related to bicuspid aortic valve (BAV) has been previously reported, clinical implications of BAV to aortopathy risk have yet to be investigated. We looked for potential differences in matrix protein expressions in the aortic wall in BAV patients. Methods: Aorta specimens were obtained from 31 patients: BAV group (n=27), tricuspid aortic valve (TAV) group (n=4). The BAV group was categorized into three subgroups: left coronary sinus-right coronary sinus (R+L group; n=13, 42%), right coronary sinus-non-coronary sinus (R+N group; n=8, 26%), and anteroposterior (AP group; n=6, 19%). We analyzed the expression of endothelial nitric oxide synthase (eNOS), matrix metalloproteinase (MMP)-9, and tissue inhibitor of matrix metalloproteinase (TIMP)-2. Results: Based on the mean value of the control group, BAV group showed decreased expression of eNOS in 72.7% of patients, increased MMP-9 in 82.3%, and decreased TIMP in 79.2%. There was a higher tendency for aortopathy in the BAV group: eNOS $(BAV:TAV)=53%{\pm}7%:57%{\pm}11%$, MMP-9 $(BAV:TAV)=48%{\pm}10%:38%{\pm}1%$. The AP group showed lower expression of eNOS than the fusion (R+L, R+N) group did; $48%{\pm}5%$ vs. $55%{\pm}7%$ (p=0.081). Conclusion: Not all patients with BAV had expression of aortopathy; however, for patients who had a suspicious form of bicuspid valve, aortic wall biopsy could be valuable to signify the presence of aortopathy.

• Journal of Chest Surgery
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• 제51권5호
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• pp.322-327
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• 2018

Background: This study evaluated the early and long-term outcomes of surgical aortic valve replacement (AVR) in elderly patients in the era of transcatheter aortic valve implantation. Methods: Between 2001 and 2018, 94 patients aged ${\geq}75years$ underwent isolated AVR with stented bioprosthetic valves for aortic valve stenosis (AS). The main etiologies of AS were degenerative (n=63) and bicuspid (n=21). The median follow-up duration was 40.7 months (range, 0.6-174 months). Results: Operative mortality occurred in 2 patients (2.1%) and paravalvular leak occurred in 1 patient. No patients required permanent pacemaker insertion after surgery. Late death occurred in 11 patients. The overall survival rates at 5 and 10 years were 87.2% and 65.1%, respectively. The rates of freedom from valve-related events at 5 and 10 years were 94.5% and 88.6%, respectively. The Society of Thoracic Surgeons (STS) score (p=0.013) and chronic kidney disease (p=0.030) were significant factors affecting long-term survival. The minimal p-value approach demonstrated that an STS score of 3.5% was the most suitable cut-off value for predicting long-term survival. Conclusion: Surgical AVR for elderly AS patients may be feasible in terms of early mortality and postoperative complications, particularly paravalvular leak and permanent pacemaker insertion. The STS score and chronic kidney disease were associated with long-term outcomes after AVR in the elderly.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1084-1087
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• 1989

Subannular aortic aneurysm is a word-wide rare disease entity occurring predominantly in young black men. In Korea, there has been no report. We report one patient, 46 years old man, who had been operated urgently because of acute aortic insufficiency and aortic valvular vegetation after antibiotics treatment of Subacute bacterial endocarditis for 6wks. At the operative field, We found the bulging aneurysmal mass between the aorta and superior vena cava above the right pulmonary artery, which has subannular communicating opening into the left ventricular cavity, beneath the anterior commissure of the bicuspid aortic valve. Pathologic findings are consistent with "portion of vascular wall with features of aneurysm.* The patients survived aortic valve replacement and patch closure of subannular aneurysm, with no symptoms at one-year postoperative follow-up.w-up.

• Journal of Chest Surgery
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• 제37권10호
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• pp.833-838
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• 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
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• 제52권2호
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• pp.100-104
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• 2019

Shone complex is a rare congenital disorder that involves 4 obstructive lesions of the left heart, as follows: parachute mitral valve, supravalvular mitral ring, subaortic stenosis, and coarctation of the aorta. Incomplete forms with 2 or 3 of these lesions in adult patients have been rarely reported in the literature, meaning that insufficient general data exist concerning the surgical strategy and clinical follow-up. Herein, we report the case of a 31-year-old woman with a diagnosis of incomplete form of Shone complex with parachute mitral valve and coarctation of the aorta who underwent successful single-stage surgical repair.