• Journal of Chest Surgery
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• v.46 no.4
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• pp.285-288
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• 2013

Prosthetic valves are being widely used in the treatment of heart valve disease. Prosthetic valve endocarditis (PVE) is one of the most catastrophic complications seen in these patients. In particular, prosthetic valve dehiscence can lead to acute decompensation, pulmonary edema, and cardiogenic shock. Here, we discuss the medical management of late PVE in a patient with a prior history of late and redo early PVE and recurrent dehiscence. According to the present case, we can summarize the learning points as follows. A prior history of infective endocarditis increases the risk of relapse or recurrence, and these patients should be evaluated very cautiously to prevent late complications. Adequate debridement of infected material is of paramount importance to prevent relapse. A history of dehiscence is associated with increased risk of relapse and recurrent dehiscence.

• Journal of Chest Surgery
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• v.54 no.3
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• pp.165-171
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• 2021

As a percutaneous technique for the reduction of mitral regurgitation, the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) for transcatheter edge-to-edge repair of the mitral valve was developed in 1998 and first used in 2003. Its main advantage is being less invasive than surgery, because it can be performed through a transcatheter approach without any hemodynamic compromise. Recent studies have shown that this procedure reduces symptoms and improves functional capacity with low complication rates. Two randomized clinical trials have investigated the use of this technique for functional mitral regurgitation. The Korean Ministry of Food and Drug Safety approved its use for degenerative mitral regurgitation in 2019, and this procedure started to be performed in Korea in January 2020. Its use for functional mitral regurgitation was also approved in Korea in 2020. In this article, recent evidence on transcatheter edge-to-edge repair of the mitral valve and our initial experiences in Korea will be reviewed.

• Journal of the Korean Society of Visualization
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• v.22 no.1
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• pp.40-48
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• 2024

This study presents an in-vitro model designed to simulate mitral valve regurgitation, aiming to compare the quantification results between Proximal Isovelocity Surface Area(PISA) and 4D Flow MRI on both fixed and valve annulus tracking(VAT) views. The in-vitro model replicates the dynamic conditions of the mitral valve in a pulsatile environment, utilizing a piston pump set at 60 bpm. Through systematic experiments and analysis, the study evaluates the accuracy and effectiveness of PISA and 4D Flow MRI in assessing regurgitation severity, considering both fixed and valve annulus tracking. The displacement length measured in echo closely resembled that of optical measurements, making it advantageous for structural analysis. VAT-4D flow MRI exhibited the smallest deviation from actual flow rate values, establishing it as most accurate method for quantitative regurgitation assessment.

• Journal of Chest Surgery
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• v.33 no.5
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• pp.391-397
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• 2000

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

• Journal of Veterinary Clinics
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• v.40 no.1
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• pp.31-37
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• 2023

Vertebral left atrial size (VLAS) is an important indicator to predict myxomatous mitral valve degeneration (MMVD) in dogs. When the caudal margin of cardiac silhouette and the dorsal margin of caudal vena cava (CdVC) could not be seen exactly, another way to evaluate VLAS is needed. The objective of this study was to assess whether a new modified VLAS (m-VLAS) could be used as an indicator to predict MMVD in 57 small breed dogs with MMVD. The m-VLAS was also used to classify American College of Veterinary Internal Medicine staging groups and left heart enlargement confirmed with echocardiograph (EchoLHE) groups. The m-VLAS was measured as the distance from the ventral aspect of the carina to the dorsal aspect of the intersection of the cardiac silhouette and the farthest LA caudal margin, not the CdVC, followed by drawing the same line beginning at the cranial edge of T4. Based on VLAS values and m-VLAS values measured for dogs with MMVD, correlations between these values and left heart enlargement groups were then evaluated. There were significant differences in both the VLAS and the m-VLAS between EchoLHE groups. The AUC of the ROC curve of the m-VLAS to detect EchoLHE was higher than that of the VLAS. The optimal cutoff value for the m-VLAS was >2.7, which had a higher specificity (86.84%) than the VLAS specificity (71.05%). This study reveals that a new m-VLAS is a more specific indicator than the VLAS for predicting left side heart enlargement in small breed dogs. Therefore, the m-VLAS can be used as a clinically useful radiographic measurement alternative to or better than the VLAS.

• Journal of Chest Surgery
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• v.11 no.2
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• pp.194-198
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• 1978

Congenital aortic stenosis, a relatively uncommon congenital heart disease, may cause heart failure and may be fatal. In recent years, increased clinical awareness and improved diagnostic and operative technique has made accurate diagnosis and successful treatment possible. Recently we experienced 2 cases of congenital aortic stenosis, and which was corrected surgically. The first case was 9 years old boy, and second case was 16 years male. Preoperative diagnosis was entertained by angiography and cardiac catheterization in both cases. In each case, aortic valve opening was widened by incision along the fused commissure between the combined left and right coronary cusp on one side, and the noncoronary cusp on the other side. Post-op. pressure gradient between the aorta and left ventricle markedly reduced, in the first case, 50mmHg, and in the 2nd case, 55mmHg.Both patients discharged with good results 2 weeks after open heart surgery.

• Journal of Veterinary Clinics
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• v.34 no.4
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• pp.268-271
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• 2017

A 1.3 year-old Castrated male Bedlington terrier (10.0 kg of body weight) was presented with heart murmur and occasional coughing. Diagnostic imaging studies revealed supravalvular pulmonic stenosis (maximal velocity 2.91 m/s) from abnormal membranous structure (aperture) distal to the pulmonary valve in the main pulmonary artery. Further study also revealed pulmonic regurgitant (1.82 m/s of peak velocity, 13.2 mmHg of pressure gradient) jets started from the abnormal membranous structure. Since the dog had no obvious clinical signs related to heart failure, no interventional therapy including balloon dilation was considered in this case. Instead, medical treatment for preventing further deterioration of clinical signs related to PS was done with enalapril. This case report described a rare case of type III supravalvular PS in a dog, which has never been reported. Further deterioration of clinical signs has yet been recognized after medical treatment.

• Journal of Veterinary Clinics
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• v.21 no.1
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• pp.83-86
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• 2004

A 4 year old mixed female dog was presented dyspnea, anorexia and syncope. In blood smear test, a lot of heartworm larvae were observed. In thoracic radiography, "reverse D" shape was observed. So, this case was considered with heartworm disease. In echocardiography, marked left heart hypertrophy was presented. In M-mode view, aortic valvular stenosis was found. After mongrel dog died, aortic valvular stenosis was reconfirmed in necropsy. After all, the dog died of pulmonary edema because of aortic valvular stenosis caused left heart failure.t failure.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.680-683
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• 2002

Infective endocarditis that involves the right side of the heart has been estimately 5% of all cases of infective endocarditis. It has been shown that about 70% of right-sided heart infective endocarditis cases have preexisting congenital heart disease or acquired valvular lesion. It would occur in intravenous drug users or end-stage renal disease patients with indwelling venous dialysis catheter. Antibiotic therapy is more effective in the right and, when it fails, the consequence of valve disruption and emboli are less. Patients receiving long-term hemodialysis are a unique population with regard in the risk of bacteremia and subsequent infective endocarditis. We experienced one case of the active infective endocarditis with right atrial vegetation without tricuspid or pulmonary valve involvement in patient with end-stage renal disease receiving long-term hemodialysis, who needed surgical correction after medical treatment failure. Then we reported it with references that right-sided heart infective endocarditis is rare, but difficult to diagnose, life-threatening because of delayed medical treatment.

• Korean Journal of Radiology
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• v.23 no.6
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• pp.581-597
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• 2022

Left ventricular (LV) wall thickening, or LV hypertrophy (LVH), is common and occurs in diverse conditions including hypertrophic cardiomyopathy (HCM), hypertensive heart disease, aortic valve stenosis, lysosomal storage disorders, cardiac amyloidosis, mitochondrial cardiomyopathy, sarcoidosis and athlete's heart. Cardiac magnetic resonance (CMR) imaging provides various tissue contrasts and characteristics that reflect histological changes in the myocardium, such as cellular hypertrophy, cardiomyocyte disarray, interstitial fibrosis, extracellular accumulation of insoluble proteins, intracellular accumulation of fat, and intracellular vacuolar changes. Therefore, CMR imaging may be beneficial in establishing a differential diagnosis of LVH. Although various diseases share LV wall thickening as a common feature, the histologic changes that underscore each disease are distinct. This review focuses on CMR multiparametric myocardial analysis, which may provide clues for the differentiation of thickened myocardium based on the histologic features of HCM and its phenocopies.