• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.523-528
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• 2005

Background: Investigation of the change of ventricular function and mitral regurgitation after surgical repair of patient with anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is key issue for the better surgical outcome. Material and Method: From April 1986 to July 2002, 12 patients presented with ALCAPA. The median age at repair was 4 months. Surgical methods included left coronary artery transfer to the aorta (10), Takeuchi procedure (1), saphenous vein free graft bypass (1). Mitral valve was repaired in 1. Result: There were 2 hospital death $(16.7\%)$. The mean follow-up period was $7.1\pm4.1$ years (range, 7 months to 13 years). Four patients required postoperative circulatory assist for $2.2\pm1.1$ days and one needed left ventricular assist device (LVAD) for 1day. Postoperative echocardiography demonstrated significant improvements in mean fractional shortening $(33.4\pm9.1\%\;vs\;17.7\pm9.6\%,\;n=10,\;p<0.05);$ left ventricular end diastolic dimension $(33.4\pm7.3\;mm\;vs\;44.8\pm7.0\;mm,\;n=10,\;p<0.05)$ and systolic dimension $(22.2\pm7.5\;mm\;vs\;33.4\pm7.9\;mm,\;n=10,\;p<0.05)$. Severities of mitral regurgitation decreased in all survivors at 1st and 4th year follow-up echocardiography. There were 2 reoperation due to residual MR and right ventricular outflow obstruction (Takeuchi case). Conclusion: Anatomic repair of anomalous left coronary artery from the pulmonary artery offered an excellent surgical results, especially in terms of the recovery of left ventricle function and mitral regurgitation. However, preoperative indications for mitral procedure is to be evaluated.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.787-792
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• 2004

Even though there well developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Material and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%, All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96,3% of the cases. Mortality rate was 5.6％ and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 G1 bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.693-698
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• 2005

Background: Sinus valsalva aneurysm (SVA) is a rare disease, and it is frequently accompanied by ventricular septal defect and aortic valve regurgitaion. For treatment of SVA, several surgical mordalities were applied, but there was no report on the long-term result after surgical repair in Korea. We reviewed our 28 years of experiences and analyzed the long-term results after treatment of sinus valsalva aneurysm with or without rupture. Material and Method: Between March 1974 and February 2002, 81 patients were operated under the impression of sinus valvsalva aneurysm or sinus valsalva aneurym rupture. Retrospectively we reviewed the patients' record. Mean age of patients was $29.2\pm11.5$ and there were 49 males. Accompanyng diseases were as follows: VSD in 50, PDA in 2, Behcet's disease in 2, TOF in 1, RVOTO in 1, AAE in 1. Seventy-seven $(95\%)$ patients had sinus valsalva rupture and in 14 patients, subacute bacterial endocarditis was accompanied. Degree of aortic valve regurgitation was as follows: grade I: 8, II: 10, III: 9, IV: 4. Most common rupture site was right coronary sinus (66 patients, $81\%$) and most common communication site was right ventricle (53 patients). In repair of sinus valsalva rupture, patch was used in 37 patients, and direct suture was done in 38 patients. Result: There was one surgical death $(1.2\%)$. Follow up was done in 78 patients $(97.5\%)$, mean follow up period was $123.3\pm80.9(3\~330\;months)$. During the follow up period, 3 patients died $(3.8\%)$. One patient died of heart failure, another patient died of arrhythmia and the other one died of unknown cause. In two patients, complete atrio-ventricular block was developed during follow up period, and there was no operation related event or complication. Kaplan-Meier survival analysis revealed $92.5\pm3.5\%$ survival at 15 and 27 years and it seems to be satisfactory. Conclusion: Long-term surgical results and survival is satisfactory after repair of sinus valsalva aneurysm with or without rupture.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.961-969
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• 2003

The purpose of this study was to evaluate the fate of left atrioventricular valve regurgitation(LAVVR) following repair of complete atrioventricular septal defects (AVSDs). Material and Method: Between July 1984 and March 2002, repair of complete AV defects were performed in 77 patients. Mean age at surgery was 30.23$\pm$69.11 months (range 1 to 456). Echocardiograms of all survivors after isolated AVSDs correction were reviewed. LAVVR were evaluated with color doppler echocardiography in 64 survival periodically. On each study, LAVVR severity was graded on a 1 to 4 scale, based upon the size of the regurgitated jet. Result: Mild deterioration of LAVV function was fairly common. LAVVR severity increased by >1 grade in 19 patients (30.2%) during the course of the study. However, the deterioration in LAVVR function occurred primarily between 12 and 24 months postoperatively. After the initial 24 postoperative months, LAVVR worsened on only 8 occasions and in each instance worsened by only 1 grade. Deterioration more than 3+ LAVVR occurred in only 3 patients. And deterioration to 4+ LAVVR was not observed after the initial 24 postoperative months but one. Survival curve analysis predicted a 88.2% of ten-year freedom rate from development of 4+ LAVVR after initial operation of complete AVSDs. Conclusion: Postoperative LAVVR remains fairly stable following AVSDs repair, Serious deterioration is rare after 24 postoperative months, especially after the initial 48 postoperative months. But serial follow-up study with echocariogram was need till 24 postoperative months after repair of complete AVSDs.

• Journal of Chest Surgery
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• v.38 no.4 s.249
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• pp.291-300
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• 2005

One-stage repair of aortic arch anomalies and intracardiac defects through median sternotomy has been recently adopted by many institutions since it is known to be safer than the staged repair. The early and midterm results of the one-stage repair of aortic arch anomalies and intracardiac defects were retrospectively evaluated. Material and Method: 45 patients who underwent one-stage repair of aortic arch anomalies and intracardiac defects performed by one surgeon from January 1996 to July 2003 were included in this retrospective study. The median age of repair was 16 days (range, 3 days$\~$23.7 months) and the mean weight was $3.62\;\pm\;1.30 kg$. Thirty one $(68.9\%)$ had coarctation and 14 $(31.1\%)$ had interrupted aortic arch. Associated intracardiac anomalies were VSD in 31 patients (VSD group), TGA or Taussig-Bing anomaly in 10 (TGA group), and others in 4 (ASD in 1, aortopulmonary window 1, truncus arteriosus 1, aortic and mitral stenoses 1, miscellaneous group). The arch obstruction was repaired with end-to-side anastomosis in 23 patients and end-to-end anastomosis in 22. Result: Overall postoperative hospital mortality was $22.2\%\;(10/45);\;16.1\%$ (5/31) in VSD group, $40\%$ (4/10) in TGA group, and$25\%$ (1/4) in miscellaneous group. There was no mortality in VSD group since 1998, and the mortality in TGA group has remarkably reduced since technical modification for coronary transfer was adopted $(75\%\;vs\;16.7\%)$. There was no postoperative seizure or other neurological complications. Postoperative aortic restenosis occurred in 5 patients $(5/35,\;14.3\%)$. Two patients underwent balloon aortoplasty with successful results. There was no reoperation. There was one late death caused by pneumonia 5 months after the operation. Two-year actuarial survival rate including operative death was $72.9\%$. Conclusion: The operative mortality of one-stage repair has been reduced with time and aortic restenosis rate was also acceptable. We concluded that this procedure is a reproducible procedure for aortic arch anomalies associated with intracardiac defects.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.299-304
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• 2009

Background: Although the results of the surgical management for complete atrioventricular septal defect (c-AVSD) have improved, the optimal surgical strategy is still controversial. The aims of this study are to evaluate the outcome of c-AVSD repair and to define the risk factors related to reoperation. Material and Method: We retrospectively reviewed the medical records of 35 patients (8 males and 27 females) who underwent the total correction of c-AVSD from August 1996 to March 2008. The median age at repair was 5.2 months (range: 3 days$\sim$82 months). Sixteen patients (45.7%) were associated with Down syndrome. Prior palliative operations were performed in 4 patients. The one-patch techniques were performed in 3 patients, and the two-patch techniques were done in 32 patients. Result: There was 1 early death (2.9%). The median follow-up period was 68 months (range: $2\sim134$ months) for 34 survivors. There was no late death. Reoperations were performed in 5 patients (14.3%) for severe left atrioventricular valvular regurgitation (AVVR). Nine patients (25.7%) showed left an AVVR of more than grade III. Associated major cardiac anomalies and the use of Gore-Tex patch for ventricular septal closure were the risk factors for postoperative left atrioventricular valve failure and reoperation. Conclusion: In this study, we found that surgical repair of c-AVSD was safe and effective. However, the high reoperation rate after repair remains a problem to be solved.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.267-273
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• 2002

Background: We performed a phase IV clinical trial to examine the usefulness of a continuous infusion of nicardipine hydrochloride to control hypertension in patients with acute aortic dissection. material and Method: Systolic/diastolic blood pressure, and heart rate were monitored before and after the intravenous administration of nicardipine in 31 patients with aortic diseases. The period of nicardipine administration in each patient was from 3 to 14 days. Efficacy was evaluated by determining the average amount of blood pressure reduction on the 3rd day of drug administration. The dosage of another antihypertensive agent was slowly tapered down, and ultimately replaced by the test drug. Result: 28 patients were diagnosed as acute aortic dissection, 2 patients as rupture of the aortic arch aneurysm, and 1 patient as traumatic aortic rupture. Mean age was 53.9 $\pm$ 14.9(29~89) years, and 21 patients(67.7%) were male. 14 patients(32.3%) had complications associated with underlying aortic disease: aortic insufficiency in 7, hemopericardium in 6, acute renal failure in 1, paraplegia in 1, lower extremity ischemia in 1, and hemothorax in 1. The time needed to reach the target blood pressure was within 15 minutes in 16, from 15 to 30 minutes in 10, from 30 to 45 minutes in 3 and from 45 to 60 minutes in 2, and their baseline average systolic, diastolic, and mean arterial blood pressures(mmHg) were 147$\pm$23, 82.3$\pm$ 18.6, and 104 $\pm$ 18, respectively. Average systolic, diastolic, and mean arterial blood pressures(mmHg) on the third day of nicardipine infusion were 119$\pm$ 12, 69$\pm$9, and 86$\pm$8, and they all showed statistically significant decrease(p<0.05). The average systolic, diastolic, and mean arterial blood pressure(mmHg) after the discontinuation of the nicardipine infusion were 119 $\pm$ 15, 71 $\pm$ 14, and 86$\pm$ 13, respectively. No significant difference was observed between the average pressures measured on the third day and those measured after the discontinuation of the nicardipine infusion, and no definite side effects were observed during the study period. Conclusion: Nicardipine hydrochloride was both effective and safe at controlling blood pressure in patients with acute aortic dissection.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.831-836
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• 2007

Background: Cardiac injuries are the most commonly overlooked injuries in patients who die from trauma. Patients who survive blunt cardiac rupture or penetrating injuries are rare and the incidence is not well defined. Many patients require urgent or emergency operations and operative mortality is very high. Material and Method: A retrospective review of 26 patients with cardiac injuries due to thoracic trauma undergoing emergency thoracotomy from January 1997 to December 2005. Result: There were 17 male and 9 female patients, with a mean age of $45.3{\pm}16.2\;(range:\;17{\sim}80)$. Thirteen patients (50%) were injured in motor vehicle accidents, and five patients (19%) in motorcycle accidents. Six patients (23%) were injured by knives, and two patients (8%) were injured by falling. Anatomic injuries included right atrium (12 [46%]), left atrium (1 [4%]), right ventricle (5 [19%]), left ventricle (5 [19%]), and cardiac chambers (2 [7%]). Diagnosis was made by computer tomography in 12 patients and sonography in 14 patients. The average times from admission to operating room was $89.2{\pm}86.7\;min\;(range:\;10{\sim}335)$. The average time for diagnosis was $51.3{\pm}13.6\;min\;(range:\;5{\sim}280)$. The mean Revised Trauma Score (RTS) was $6.7{\pm}0.8$, and the Glasgow Coma Scale (GCS), was $12.8{\pm}2.8$. The overall mortality rate was 12% (3 out of 26 patients). Conclusion: The mortality rate from cardiac injury is very high. The survival rate can be increased only by a high index of suspicion, aggressive expeditious diagnostic evaluation, and prompt appropriate surgical management.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.825-830
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• 2007

Background: Minimally invasive cardiac surgery appears to offer certain advantages such as earlier postoperative recovery and a greater cosmetic effect than that achieved through conventional sternotomy. However, this approach has not yet been widely adopted in Korea to replace complex open heart surgery such as mitral valve reconstruction. This study compared the results of robot assisted minimally invasive mitral valve repair with those results of conventional sternotomy. Material and Method: From December 1993 to December 2005, 520 consecutive patients underwent mitral valve reconstruction for mitral regurgitation in our institution. These patients were subdivided according to those whose surgery used the conventional sternotomy approach (Group S, n=432) and those who underwent minimally invasive right anterior thoracotomy (Group M, n=88); we then compared the clinical results of both groups. When we performed minimally invasive right thoracotomy, we used a robot (AESOP 3000) and made an incision less than 5 cm. Result: Our study patients in both groups were similar for their age, gender and preoperative ejection fraction. There were two hospital mortalities in group S. but there was no mortality in the group M patients. Significant reductions in the ICU stay and the postoperative hospital stay were observed in the group M patients compared with the group S patients. However, both the bypass time and the aortic cross-clamp time were significantly longer in the group M patients. In spite of the confined incision in the group M patients, there were no limitations on the mitral valve repair techniques. There was a similar frequency of postoperative significant residual mitral regurgitation in both groups. Conclusion: In this study, the minimally invasive mitral valve repair showed comparable early results with the conventional sternotomy patients. We will now need long-term follow-up of these patients who underwent minimally invasive mitral valve repair, but we anticipate that based on the results of this study, we will begin to routinely perform minimally invasive cardiac surgery as out primary approach for mitral valve reconstruction.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.869-875
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• 1997

Perimembranous ventri ular septal defects(PMVSDS) are the most common type of ventricular septal defects(VSDs) and consist morphologically of deficiency of the membranous septum and variable portions of the adjacent muscular septum. Repair of VSD has begun via a right ventriculotomy. Even with this exposure, however, it mght lead to ventricular dysfunction. Transatrial exposure of VSDs is luiown to a versatile approach to PMVSDS and even malaligunent defects can be repaired by this method. Although transatrial exposure can be improved by taking down'the atrioventricular valve at the annulus, surgeons have been hesitant to do so because of concern for valvular competence. Therefore, this study was undertaken to clarity the effects of transamlular approach of tricuspid valve (TATV) at operation of PMVSD. During last 5 years, twenty eight cases from 96 patients of PMVSD were closed by TATV and follow up study was done from 3 months to 33 months and results were obtained as follows. 1. Age at operation was fr m 4 months to 38 years and most patients(17, 62%) were above 5 years. 2. Preoperative pulmonary-systemic flow ratio(QPIQS) was ranged from 1 to 2.8 and 22 patients(79%) were less than 2. 3. Peak systolic pulmonary artery pressure was below 30mmHg in 8, 30-50mmHg in 17, above 50mmHg in 3 patients and 25 patients(89%) were less than 50mmHg. 4. Preoperative tricuspid regurgitation(TR) is none in 12, trivial in 6, mild in 3, moderate in 5, severe in 2 patients but postoperative TR was none in 18, trivial in 6, mild in 4 patients, so TR in most patients had decreased or not. 5. Indications for operation were based on the presence of a significant shunt. However, in patients with small shunts, indications for operation were included additional factors, tricuspid valve pouch, RVOT obstruction(right ventricular outflow tract obstruction), subacute bacterial endocarditis and associated anomalies. 6. There were no hospital deaths and residual shunts in postoperative echocardiography. Therefore TATV is especially a good method in PMVSn where patients have trcuspid valve pouch. And it is a safe and effective technique that improves exposure for PMVSD repair and does not adversely affect tricuspid valvular competence.