• Journal of Chest Surgery
• /
• 제51권1호
• /
• pp.15-21
• /
• 2018

Background: Prosthetic valve endocarditis (PVE) is a serious complication of cardiac valve replacement, and many patients with PVE require reoperation. The aim of this study was to review our institutional 20-year experience of surgical reoperative valve replacement in patients with PVE. Methods: A retrospective study was performed on 84 patients (mean age, $54.8{\pm}12.7years$; 51 males) who were diagnosed with PVE and underwent reoperative valve replacement from January 1995 to December 2016. Results: PVE was found in 1 valve in 61 cases (72.6%), and in 2 or more valves in 23 cases (27.4%). The median follow-up duration was 47.3 months (range, 0 to 250 months). Postoperative complications occurred in 39 patients (46.4%). Reinfection occurred in 6 cases, all within 1 year. The freedom from reinfection rate at 5 years was $91.0%{\pm}3.5%$. The overall survival rates at 5 and 10 years were $64.4%{\pm}5.8%$ and $54.3%{\pm}7.3%$, respectively. In stepwise multivariable Cox proportional hazard models, older age (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.05 to 2.10; p=0.027) and cardiopulmonary bypass (CPB) time (HR, 1.03; 95% CI, 1.00 to 1.01; p=0.033) emerged as independent risk factors for death. Conclusion: Older age and a longer CPB time were associated with an increased risk of overall mortality in PVE patients.

• Journal of Chest Surgery
• /
• 제49권3호
• /
• pp.165-170
• /
• 2016

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

• Journal of Chest Surgery
• /
• 제51권6호
• /
• pp.367-375
• /
• 2018

Background: It is unclear whether mitral valve (MV) repair for degenerative mitral regurgitation (MR) provides the same advantages in the elderly that it does in the general population. Methods: From 1994 to 2016, 188 elderly patients (mean age, $68.3{\pm}5.50years$) underwent MV repair (n=153) or MV replacement (n=35) for primary degenerative MR. Early and long-term outcomes were compared before and after propensity score matching (PSM). Results: Before PSM, there was a significant difference in operative mortality (p=0.011). Overall survival and freedom from cardiac-related death (CRD) at 5, 10, and 15 years were significantly higher in patients who underwent MV repair (p=0.039 and p=0.007, respectively). In the multivariable analysis, MV replacement was an independent risk factor of CRD. After PSM, operative mortality was not significantly lower in patients who underwent MV repair (p=0.125). Overall survival and freedom from CRD at 5, 10, and 15 years showed no significant difference between the 2 groups in the PSM cohort (p=0.207, p=0.47, respectively). There was no significant difference in freedom from reoperation before or after PSM (p=0.963 and p=0.575, respectively). Conclusion: MV repair for primary degenerative MR might be a valid option in the elderly population if successful repair is possible.

• Journal of Chest Surgery
• /
• 제20권2호
• /
• pp.404-410
• /
• 1987

An 18-day-old male neonate with hypoplastic left heart syndrome underwent surgical intervention by modification of the Norwood procedure on September 23, 1986. Hypoplastic left heart syndrome is a serious congenital cardiac anomaly that has a fatal outlook if left untreated. Included in this anomaly are [1] aortic valve atresia, and hypoplasia of the ascending aorta and aortic arch, [1] mitral valve atresia or hypoplasia, and [3] diminutive or absent left ventricle. Patent ductus arteriosus is essential for any survival, and there is usually a patent foramen ovale. Coarctation of the aorta is frequently associated with the lesion.z With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the ductus arteriosus was excised. The main pulmonary artery was divided immediately below its branches, and the distal stump of the divided pulmonary artery was closed with a pericardial patch. The aortic arch was incised, and a 1 5mm tubular Dacron prosthesis was inserted between the main pulmonary artery and the aortic arch. A 4mm shunt of polytetrafluoroethylene graft was established between the new ascending aorta and the right pulmonary artery to provide controlled pulmonary blood flow. Following rewarming, the heart started to beat regularly, but the patient could not be weaned from cardiopulmonary bypass. At autopsy, the patient was found to have hypoplasia of the aortic tract complex with mitral atresia and aortic atresia. A secundum atrial septal defect was noted. Right atrial and ventricular hypertrophy was present, and the left ventricle was entirely absent. Although unsuccessful in this case report, continuing experience with hypoplastic left heart syndrome will lead to an improvement in result.

• Journal of Yeungnam Medical Science
• /
• 제38권2호
• /
• pp.95-106
• /
• 2021

Infections involving the heart are becoming increasingly common, and a timely diagnosis of utmost importance, despite its challenges. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently introduced diagnostic tool in cardiology. This review focuses on the current evidence for the use of FDG PET/CT in the diagnosis of infective endocarditis, cardiac implantable device infection, left ventricular assist device infection, and secondary complications. The author discusses considerations when using FDG PET/CT in routine clinical practice, patient preparation for reducing physiologic myocardial uptake, acquisition of images, and interpretation of PET/CT findings. This review also functions to highlight the need for a standardized acquisition protocol.

• Journal of Chest Surgery
• /
• 제29권4호
• /
• pp.444-448
• /
• 1996

작은 인공판막주위 누출에 의한 용혈성 빈혈은 인공판막 치환술후올수 있는 합병증중의 하나이다. 경도의 용혈은 대개 기계 판막으로 대동맥 판막 치환술을 시행했을 때 생기 지만, 드물게는 승모판막 치환 술 후에 생 기도 더욱 드물게 조직판막 치환술 후에도 생 긴다 조직판막 치환술후에 용혈성 빈혈은 거의 생기지 않는다. lonescu-Shiley 심낭판막 치환술을 받은 환자에서 용혈성 빈혈은 승모판막에서는 없었고, 대동맥판막 에서 주로 발생하였다고 보고되 어 왔다. 41세 여자환자가 갑자기 진한적색뇨가생겨 본원에 입원하였다. 이 환자는 10년전 승모판막 폐쇄부전증으로 승모판막 치환술(lonescu-Shiley판막 27mm)을 받았던 병 력 이 있다. 심초음파검사상 판막을 통한 경도의 승모판막 폐쇄부전과 함께 판막의 비후가 관찰되었으나 판막주 위를 통해 세어나오는 판막주위 누출의 소견은 관찰할 수 없었다. 말초혈액도말검사상정적혈구성 정색소성 빈혈을 보였다. 혈액 및 요 검사에서 심한 용혈소견이 보였다. 51. Jude Medical 양엽 판막(size 27mm)으로 승모판막 치환술을 시행하였다. 수술시 lonescu-Shiley 판막에 판엽의 석 회화와 뒤틀림 ( istortion)이 있었고, 술자위 치 에서 1시 방향에 직경 5mm의 작은 판막주위 누출이 발견되었으며 이것이 용혈성 빈혈의 원인으로 생각되었다. 승모판 막 재치환술후 용혈소견은 완전히 사라졌다. 저자들은 작은 인공판막주위 누출에 의한 심한 용혈성 빈혈이 발생한 1예를 경험하였기에 문헌고찰 과 함께 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제45권1호
• /
• pp.19-23
• /
• 2012

Background: A ring implantation in the tricuspid annulus requires many interrupted mattress sutures for correction of tricuspid regurgitation (TR). In this study, tricuspid ring annuloplasty was performed by 2-0 polypropylene continuous suture instead of multiple interrupted 2-0 polyester mattress sutures, and the efficacy of the method was evaluated. Materials and Methods: This study included 20 patients who underwent tricuspid ring annuloplasty by continuous suture between May 2009 and July 2010. Four of the patients had an isolated TR, and the rest had a left-sided cardiac lesion. The concomitant tricuspid annuloplasty was performed after the left-sided heart surgery was completed and a Duran flexible ring prosthesis was used. Results: There was no perioperative mortality or conduction problem. More than a moderate degree of TR was improved to less than a mild degree after the procedure. After the ring annuloplasty, the right atrial volume decreased from $123.7{\pm}69.2mL$ to $74.5{\pm}37.4mL$, and the mean right atrial pressure was lowered from $18.7{\pm}12.2mmHg$ to $8.9{\pm}5.5mmHg$. Conclusion: The continuous "over and over" suture may be a useful procedure for fixing the ring to the annulus and making an intentional annular placation in performing tricuspid ring annuloplasty.

• Journal of Chest Surgery
• /
• 제31권12호
• /
• pp.1165-1171
• /
• 1998

배경 : 인공판막치환술을 받은 환자에서 인공판막의 기능부전이나 합병증으로 재치환술의 빈도가 증가하고있는 추세이다. 본 논문은 인공심장판막에 대한 재치환술시 위험인자를 분석하여 향후 수술성적을 향상시키는데 도움을 얻고자 하였다. 대상 및 방법: 1985년 1월부터 1996년 7월까지 계명대학교 흉부외과학교실에서 인공심장판막질환에 대한 재치환술을 받은 124예에 대하여 술전 임상적 소견 및 수술성적을 중심으로 분석하였다. 이중 3예는 2차로 재치환술은 받은 경우였다. 심장판막재치환술의 원인으로 조직판막자체의 구조적 실패가 96례(77.4%)로 가장 많았고 판막혈전증 16례(12.9%), 심내막염 7례(5.6%), 판막주위누출 5례(4.1%)가 있었다. 결과: 심장판막재치환술의 병원사망률은 8.9%였고, 술후 사망원인으로는 저심박출증이 가장 많았다(70.6%). 생존군과 사망군의 비교에서는 NYHA functional class, 혈중 크레아티닌 수치, LVSD, 체외순환시간이 사망군에서 유의하게 높았다(p < 0.05). 재치환술후 병원사망의 술전 위험인자들로는 LVSD, NYHA functional class IV, 혈중 크레아티닌 수치 등이었으며( p < 0.05), 연령이나 성별, 흉부 엑스선상 심흉곽의 비 등은 위험인자가 되지 못하였다. 결론: 술전의 임상적 소견중 LVSD, NYHA functional class, 혈중 크레아티닌 수치 등이 재치환술후의 예후를 추측할 수 있는 술전 인자라는 것을 알 수 있었다. 그리하여 심장판막재치환술은 심장 및 신기능이 악화되기 이전에 가능한한 조기에 시행하는 것이 바람직하리라 생각된다.

• Journal of Chest Surgery
• /
• 제43권6호
• /
• pp.627-634
• /
• 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
• /
• 제30권9호
• /
• pp.891-898
• /
• 1997

1984년 5월부터 1996년 1월까지 전북대학교병원 흉부외과에서 130명의 환자에게 51. Jude MEdical기계판막을 이용하여 판막 치환수술을 시행하였다. 승모판 치환술, 대동맥판 치환술, 동시에 승모판 치환술 및 대동맥 판 중복치 환술을 받은 환자는 각각 68례, 42례, 20례이었다. 조기사망은 7례로 전체 환자의 5.4%에서 발생하 였고 조기합병증은 17례(13.1%)에서 발생하였다. 1996년 12월까지 97.6%에서 추적 관찰하였고 추적기간은 최소 5.5개월에서 최대 153.5개월로 평균 63.6$\pm$27.6개월(5.3$\pm$2.3년)이었고 총 추적기간은 678.7환자-년이었다. 판막관련 만기사망은 6례(4.9%)의 만기사망 중 4례(3.3%)이었다. 판막관련 만기 합병증은 11례(9.1%)에서 발 생하였는데 혈전색증(6계), 출혈(4례), 판막주위누출(Irll)이 발생하였다. 판막관련 합병증 발생률(Linearized rate)은 1.68%/환자-년, 항응고제와 관련된 출혈은 0.92%/환자-년, 혈전색증은 0.61%/환자-년, 판막주위 누출은 0.15%/환자-년의 발생빈도를 보였고 재수술률은 0.15%/환자-년(재수술은 1례), 판막관련 만기사망은 0.61%/환자-년의 발생빈도를 보였다. 10년간 합병증이 발생하지 않을 확률은 87.4 \ulcorner.2%이었다. 술후 심흉곽비와 뉴욕 심장학회(NYHA) 기능분류는 수술전후에 뚜렷하게 개선되었다. 수술후 생존율은 5년, 10년에 각각 90.4$\pm$ 2.7%, 87.5$\pm$3.3%이었다.