• Journal of Chest Surgery
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• 제18권3호
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• pp.407-413
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• 1985

Ruptured aneurysms of the sinus Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Five patients underwent operative treatment in Catholic Medical Center in recent 2.5 year period. Three patients were male and two patients were female, ages ranged from 20 to 54 years. Bacterial endocarditis was suspected or proved in 3 patients. In 3 patients in our series had a ruptured congenital aneurysms and in 2 patients acquired aneurysms by bacterial endocarditis. Associated cardiac lesions were common; such as aortic insufficiency in 3 patients, atrial septal defect in 2 patients, mitral stenoinsufficiency in 1 patient and tricuspid insufficiency in 1 patient. All aneurysmal ruptures of the sinus Valsalva arose from right coronary sinus and in 4 patients ruptured into right ventricle and in 1 patient into right atrium. Surgical techniques consisted of direct closure 4 in patients and closure with Dacron patch in 1 patient. And we preferred double approach, that is, through both the aorta and the involved cardiac chamber in cases in whom aortic insufficiency was present. So additional aortic valve replacement performed in 2 patients due to severe aortic insufficiency and aortic valvuloplasty performed in 1 patient. One patient who underwent direct closure of ruptured sinus Valsalva and double valve replacement died due to low cardiac output syndrome just after the operation. Operative results were relatively good in remainders.

• 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.

• 한국임상수의학회지
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• 제32권4호
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• pp.338-342
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• 2015

12살 중성화 수컷 Miniature Schnauzer 견이 4일 동안 식욕부진, 구토, 기면과 고열로 내원하였다. 혈액 및 혈청검사에서는 백혈구 증가증, 혈소판감소증, 저혈당증, 저알부민혈증, 고빌리루빈혈증, 간효소치의 증가를 보였다. 복부초음파 검사에서 담낭의 고에코성의 불규칙한 벽의 비후 소견이 두드러지고, 심초음파 검사에서 대동맥 및 승모판의 증식성 변화와 역류를 보였다. 초음파유도하에 경피적담낭첨자술을 통하여 담즙을 흡인하고 배양하여 E.coli 감염을 확인하였다. 따라서 세균성 담낭염과 병발한 심내막염을 진단하였다. 항생제 감수성 검사를 통한 적절한 항생 요법과 적극적인 입원 치료를 통하여 패혈증에서 회복이 되었다.

• Journal of Chest Surgery
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• 제30권2호
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• pp.200-204
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• 1997

본 증례는 고유 대동맥 판막, 승모판막, 삼첨판막과 심실중격을 침 범한 심내막염환자의 성공적 치료에 대한 보고이다. 환자는 11세때 심실중격결손폐쇄와 대동맥판막성형술을 받은 16세 남아로서 심내막염으로 항생제치료에도 불구하고 난치성 심부전을 보였다. 수술소견상 이전 수술시 폐쇄한 심실중격폐쇄를 따라 커다란 결손을 보였으며 다발성 천공과 우종을 동반한 대동맥 판막역류, 우종을 동반한 승모판 역류, 대동맥 판륜주위농양, 심실중격의 심근농양, 천공과 우종을 동반한 삼첨 판역류 소견을 보였다. 수술은 모든 감염조직과 괴사조직을 근치적절제후 심실중격결손을 Dacron patch로 폐쇄하면서 대동맥판막륜부위까지 확장보강하였으며, 대동맥판막치환시 확장보강한 Patch에 인공판막을 거치시켜 안전하게 치환할 수 있었다. 승모판막은 치환하였고, 삼첨 판은 자가심낭편으로 재건하였다. 환자는 수술후 6주간 항생제치료후 다른 합병증 없이 건강한 상태로 퇴원하였다.

• Journal of Chest Surgery
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• 제11권4호
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• pp.535-540
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• 1978

Between January 1974 and November 1978, 23 cases of double valve replacement were done in the Department of Thoracic Surgery, Seoul National university Hospital. All had symptoms of rheumatic valvular heart disease and belonged to functional class III or IV according to NYHA classification. Among 23 cases, mitral and aortic valves were replaced in 14, and mitral and tricuspid valves in 9 cases. Six operative deaths [26%] and 4 late deaths [23%] were found. In the former group 5 and in latter one operative death were noted. Main cause of operative death was low cardiac output syndrome due to myocardial failure. Among 4 late deaths, 2 were caused by thromboembolism, one by bacterial endocarditis, and one by arrhythmia.

• Pediatric Infection and Vaccine
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• 제23권3호
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• pp.229-235
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• 2016

최근 전 세계적으로 메티실린내성 황색포도알균(methicillin-resistant Staphylococcus aureus [MRSA])에 의한 감염성 심내막염의 빈도가 증가하는 추세이다. 저자들은 12세 여아가 침습적 치과 치료 이후에 발생한 MRSA에 의한 감염성 심내막염 1예를 경험하였기에 보고하는 바이다. 환아가 경부강직을 나타내어 시행한 뇌척수액 검사상 세포 증가증 소견이 보였고 세균성 수막염을 의심하여 항생제 치료를 시작하였으며, 입원 3병일째 혈액 배양검사에서 MRSA가 검출되었다. 심장 초음파상 승모판막의 전엽에 붙어있는 증식조직이 증명되어 항생제 치료 후 호전되어 퇴원하였다. 개정된 심내막염 예방을 위한 가이드라인에서는 오직 고위험군에서만 치과 처치 전에 예방적 항생제 요법을 권장하고 있다. 본 증례는 승모판 탈출증 이외에 고위험군이 없었던 환아에서 잇몸의 출혈을 유발하는 치과 치료를 받은 이후에 발병한 감염성 심내막염의 경우로서, 이후 12개월간 감염성 심내막염의 재발은 없었다.

• Journal of Chest Surgery
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• 제16권4호
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• pp.498-505
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• 1983

It has been over 20 years since successful operations of Cardiac valves at the Department of Thoracic and Cardiovascular surgery, college of medicine, Yonsei University. About six hundreds of patients with severely symptomatic valvular heart disease have had valve operations with complete loss or sharp decrease in their cardiac symptoms since 1956. As the number of cardiac patient increases, reoperation on valves assumes greater importance. To define the group of patients undergoing reoperations on valves and the factors influencing their survival, we have reviewed our experiences of the reoperation on valves at the Yonsei University, Severance Hospital. This is a report of 29 cases which was undergone secondary or more surgery for valvular heart disease from 1966 to 1983. The primary operations includes 159 cases of open heart surgery from 1966 to 1975 and 476 cases from 1976 to march, 1983. The secondary operations are classified into groups of secondary valvuloplasty or valvotomy [8 cases], prosthetic valve replacement following valvuloplasty or valvotomy [14 cases] and prosthetic valve rereplacement [2 case] for such as calcification, degeneration and perforation of the cusps and paravalvular leakage, of the bioprosthetic valves. The leading indication for reoperation of mitral valve was restenosis or stenoinsufficiency, The indications of aortic valve replacement was active bacterial endocarditis, medically uncontrollable prosthetic endocarditis or paravalvular leakage. Overall death rate of the reoperation was 17.4% [5 death among the 29 patients] and the leading causes of death were myocardial failure, arrhythmia, cerebral embolism, acute renal failure due to low output syndrome. And it was followed by sepsis associated with active prosthetic endocarditis. The death rate of reoperation was 4.3% in the elective cases except urgent cases and the death rate of overall cardiac valve except reoperation cases was 4.1% in the last two years. Although the general mortality of reoperation was high, both mortality rates were comparable except emergency cases due to urgent preoperative patient’s condition.

• Journal of Chest Surgery
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• 제26권8호
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• pp.638-642
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• 1993

Congenital coronary arteriovenous fistula is relatively uncommon and widespread use of echocardiogram and selective coronary angiogram are being recognized with increasing frequency. The right coronary artery is most commonly involved and the fistulous communication is most common to right ventricle. Surgical correction is strongly recommended to prevent the development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and pulmonary hypertension, as well as coronary aneurysm formation, with subsequent rupture or embolism. We report two cases of coronary arteriovenous fistula originated from right coronary artery terminated in the right ventricle. These 8 year-old female and 7 year-old male patients had surgical interventions using cardiopulmonary bypasses.

• Journal of Chest Surgery
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• 제26권8호
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• pp.643-645
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• 1993

It is generally acknowledged that congenital coronary artery fistula is an abnormal communication of the coronary artery with the right ventricle, right atrium,left atrium and left ventricle. In young people the symptoms are unusual , but significant symptoms and complications appear among the older age group such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension. Therefore, early surgical treatment is recommended. We experienced a case of coronary arteriovenous fistula that was involving the circumflex branch of the left coronary artery with the right ventricle. It was 10mm in diameter with multiple vegetation. We repaired the fistula under extracoporeal circulation. The patient was discharged in a healthy condition twelve days after operation .

• Journal of Chest Surgery
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• 제11권4호
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• pp.373-377
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• 1978

Aneurysmal rupture of sinus Valsalva is known as one of rare cardiac disease and not controlled with medical treatment. We experienced 9 cases which were composed with 7 case of male and 2 cases of female during last 15 years. 7 cases were ruptured into right ventricle from right. coronary sinus and 2 cases were ruptured into right atrium from non-coronary sinus. The diagnosis was made with cardiac catheteriza1icn and cineangiccardicgram but 2 cases were misdiagnosed with only cardiac catheterization. All cases were corrected under cardiopulmonary bypass with means of direct suture with tdlon pledget by transatrial or transventricular approach. All were not confirmed in it's origin because of no history, no evidences of syphilis, TB, or bacterial endocarditis and only fibrosis in pathologic report. In postoperative course, 1 case had postoperative bleeding and 1 case was sufferd from left hemiplegia due to may be air embolism. Follow up study revealed all patient go on their usual life well with good improvement at this present time.