• Journal of Chest Surgery
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• 제28권9호
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• pp.822-828
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• 1995

This paper reports 15 native valve endocarditis cases had surgical operation in the past 10 years at the department of Cardiovascular and Thoracic Surgery, Chonbuk National University Hospital. In this study, 10 cases out of 15 were in class I or II by the New York Heart Association functional classification. None of the cases had a history of taking addictive drugs. Five cases were congenital heart disease, three cases were rheumatic heart disease and two cases were degenerative heart disease. Thus 10 cases had the underlying disease. All cases had antibiotics treatment for 3 to 6 weeks before operation. In the culture test, only four cases were positive in the blood culture and one case was positive in the excised valve culture. Organisms on blood and valve culture were Streptococcus epidermis, Streptococcus viridans, Staphylococcus aureus and Staphylococcus epidermidis. In the 10 cases without ventricular septal defect, the aortic valve was involved in four, mitral in four, both in two and involved valves in the 5 cases with ventricular septal defect were tricuspid in three, pulmonic in two. Eight cases had operation because they showed moderate congestive heart failure due to valvular insufficiency and vegetation with or without embolism. Seven cases had operation because they showed persistent or progressive congestive heart failure and/or uncontrolled infection. Five cases with ventricular septal defect underwent the closure of ventricular septal defect, vegetectomy and leaflet excision of the affected valves without valve replacement. In the cases without ventricular septal defect, the affected valves were replaced with St. Jude mechanical prosthesis. Postoperative complications were recurrent endocarditis in two, embolism in one, allergic vasculitis in two, spleen rupture in one and postpericardiotomy syndrome in one. At the first postoperative day, one case died of cerebral embolism. At the 11th postoperative month, one case died of recurrent endocarditis and paravalvular leakage in spite of a couple of aortic valve replacement. In the survived cases[13 cases in this study , all cases but one became class I or II by the New York Heart Association functional classification.

• Journal of Chest Surgery
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• 제27권8호
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• pp.664-668
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• 1994

A total of 217 patients underwent single mitral valve replacement [MVR] with the St. Jude Medical valve between September 1984 and the end of 1992. There were 86 males and 131 females with a mean age of 34.6 $\pm$ 14.4 years[range 5 months-61 years]. A previous valve replacement had been performed in 46 patients [21.2 %]. An early mortality rate was 7.4 % [5.2 % in primary MVR; and 15.2 %in re-replacement MVR]. Early survivors of 201 patients were followed up for a total of 934.5 patient-years[mean 4.7 $\pm$ 2.1years]. A late mortality rate was 2.5 % or 0.54%/patient-year. The linearized rates of thromboembolism, valve thrombosis and anticoagulation-related bleeding were 1.301 %, 0.214 % and 0.428 %/patient-year, respectively. The actuarial survival including operative mortality was 89.9 % $\pm$ 2.1% at postoperative 10 years. The freedom from thromboemolism was 91.3 %$\pm$ 2.5% and the actuarial estimate of incidence free from late deaths and all complications were 80.9 % $\pm$ 3.8 % at 10 years. There were no mechanical failures. In summary, the St. Jude Medical prosthesis performed satisfactorily with an acceptable rate of late complications.

• Journal of Chest Surgery
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• 제24권2호
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• pp.171-181
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• 1991

Result of St. Jude Medical valve replacement are presented in 106 patients who underwent operation from January 1985 through July 1989. The patient were 52 males and 56 females. Total 136 of St. Jude Medical valves were implanted; 91 in mitral position, 45 in aortic position. The hospital mortality rate was 5.7%o[6 patients] and the late mortality rate was 2.0%[2 patients]. The causes of death were low cardiac output in 5, iatrogenic right ventricular rupture in 1, heart failure in 1, ventricular arrhythmia in l. And, the causes of valve related complication were anticoagulant related hemorrhage in 5 patients[0.03% /patient-year] and thromboembolism[0.01% /patient-year] in 2 patients. In conclusion, the performance of the St. Jude Medical valve compare most favorably with other artificial valves. But it remains still hazards of mechanical prosthesis such as thromboembolism and anticoagulant related hemorrhage.

• Journal of Chest Surgery
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• 제31권11호
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• pp.1031-1036
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• 1998

연구배경 : Medtronic-Hall 기계판막은 세계적으로 흔히 쓰이고 있으나, 우리 나라에는 그에 대한 임상연구가 되어 있지 않다 재료 및 방법 : 1986년 3월부터 1990년 5월까지 Medtronic-Hall 기계판막을 이용한 인공 심장판막 치환 환자 50례를 대상으로 하였다. 환자의 평균 연령은 35세였고 남녀비는 17:33이었다. 결과 : 판막 병변의 원인은 류마티스성이 43례로 대부분을 차지했고 38명의 환자에서 승모판 치환술을 7명에서 중복판막치환술을 그리고 5명의 환자에서 대동맥판막 치환술을 시행하였다. 술전 NYHA 기능 분류는 Class III 혹은 Class IV가 91.5%였지만 술후는 ClassI혹은 Class II가 87.2%로 호전된 양상을 보였다. 심장초음파 검사상 좌심방내경, 수축말기 및 확장말기 좌심실내경은 술후 모두 감소하였고 심박출률은 증가하였다. 술후 합병증은 출혈 3례, 저심박출 증후군 2례, 혈전색전증 1례, 전격성 간염 1례가 있었고 병원 사망례는 3례였다. 혈전색전증의 발생률은 1.5%/환자.년이었고 5년 생존률은 93.65$\pm$0.71%, 10년 생존률은 88.27$\pm$6.4%였다. 결론 : 이상에서 Medtronic-Hall 기계판막은 판막에 관련된 합병증 발생률이 낮고 판막의 내구성도 뛰어나며 혈역학적 수행능력이 타 기계판막에 뒤떨어지지 않는 판막으로 확인되었다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.247-248
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• 1998

The effect of unattached valve leaflet on flow field downstream of a floating and flapping polyurethane heart valve prosthesis was investigated. With a triggering system and a time-delay circuit the instantaneous velocity field downstream of the valve was measured by particle image velocimetry (PIV) in conjunction with the opening posture of a flexible valve leaflet during a cardiac cycle. Reynolds shear stress distribution was calculated from the velocity fields and wall shear stress was directly measured by hot-film anemometry (HFA). The floating motion of the valve leaflet resulted in the reduction of pressure drop and recirculating flow region downstream of the valve.

• Journal of Chest Surgery
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• 제29권5호
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• pp.504-509
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• 1996

대동맥 판 치환술시 봉합법으로써 단순봉합(simple interrupted suture), 8자형 봉합(figure of eight su- ture), 수평 석상봉합법 (horizontal mattress suture method) 등이 이용되고 있다. 그러나 심내막염에 의 해 판륜이 손상되거나 퇴행성 변성으로 판륜이 약화된 환자들에서는 본봉합법으로대동맥판 치환이 어려 울 수 있고,치환후 판막주위 누출등의 합병증이 발생할수 있다. 저자들은 1993년 6월부터 1995년 6월 까지 심내막염에 의한 대동맥판 환자 4례,퇴행성 판막환자 3례,류마티스성 판막병변 환자 1례에서 수직 석상봉합법 (vertical mattress suture method)으로 기계판막(mechanical valve)을 판륜 상연에 위치시 키는 술식을 시행하였다. . 2례에서 농양으로 판륜이 결손되어 자가심막편을 이용하여 결손부위를 봉합하였다. 판막 치환을 위 해 2-0 polyester 봉합사를 이용했고, 봉합사를 지지하는 테프론 조각을 심실쪽에 위치시키고 침사가 심 실쪽에서 발살바동쪽으로 통과하도록 하는 수직 석상봉합법을 이용하였다. 본 수술방법으로 최소한 19mm기계판막의 사용은 완전히 배제할 수 있었다. 술후 평균 13.3개월에 심에코 검사로 추적 관찰한 \ulcorner과, 판막운동의 이상은 발생하지 않았으며, 판막자체에서 발생하는 압력 경사는 3례에서 6mmHg이 하였고 5례에서 20내지 40mmHg였다 이와같은 결과에서 판륜이 손상되거나 약화된 대동맥판 환자에 서 판막치환술시 수직 석상 봉합법을 이용하여 기계판막을 판륜상연에 위치시키므로써 수술이 용이하 고 술후 합병증을 감소시킬 수 있을 것으로 사료된다.

• Journal of Yeungnam Medical Science
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• 제31권2호
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• pp.144-147
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• 2014

Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.

• Journal of Chest Surgery
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• 제27권2호
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• pp.114-121
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• 1994

St. Jude Medical cardiac valve replacement was performed in 135 consecutive patients from Aug.1986 to Dec. 1991.72 had mitral, 28 had aortic, 1 had tricuspid and 34 had double valve replacement. The hospital mortality rate was 4.4% & the late mortality rate was 3.7 %. Follow-up was done on 115 surviving patients:mean follow-up period was 29.78 $\pm$ 18.32 months. Paravalvular leakage was observed in two patients, possible prosthetic valvular endocarditis wasobserved in one patient and other specific valve-related complications were none. The overall actuarial survival rate at 6 years were 91.6% in total, 96.4% in aortic, 95.5 % in mitral and 81.9 % in double valve replacement.We concluded, therefore that good clinical results and a low complication rate could be achieved with St. Jude Medical valve in short-term follow-up & long-term follow-up was also necessary.

• Journal of Chest Surgery
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• 제36권5호
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• pp.321-328
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• 2003

배경: St. Jude 기계판막은 보편적으로 사용되고 있는 기계판막 중의 하나로 국립의료원에서 18년간 St. Jude기계판막으로 판막 치환술을 시행받은 환자들의 장기 임상성적을 보고하고자 한다. 대상 및 방법: 1984년 2월부터 2002년 6월까지 국립의료원에서 St. Jude 기계판막으로 판막 치환술을 시행받은 163명의 연속적인 환자들을 대상으로 하였다. 대상환자의 평균 연령은 42.9$\pm$15.1세였고 남녀 각 각 69명과 94명이었다. 승모판막 치환이 87예, 대동맥판막 치환 30예, 승모판막 및 대동맥판막 치환이 45예 그리고 기타의 경우가 1예였으며, 재수술의 경우는 각각 16예, 1예 그리고 14예였다. 추적률은 96.9%였고, 전체 누적 추적기간은 823.8환자-년이었다. 결과: 조기 사망률은 7.98% (13/163)이었고 만기 사망률은 8.7% (13/150)였으나 이 중 판막 관련 합병증에 의한 사망은 4.7% (7/150)이었다. 대상환자들의 생존율은 10년과 18년 각각 91.8$\pm$2.1% 및 91.0$\pm$1.9%이었다. 혈색전증의 발생률은 1.09%/환자-년, 항응고제와 관련된 출혈의 발생률은 0.36%/환자-년, 혈전으로 인한 판막 폐쇄의 발생률은 0.24%/환자-년, 판막주위 누출 발생률은 0.12%/환자-년, 판막으로 인한 심내막염의 발생률은 0.12%/환자-년으로 판막과 관련된 전체 합병증의 발생률은 1.94%/환자-년이었다. 판막과 관련된 전체 합병증이 없을 확률은 10년과 18년 각 89.1$\pm$3.3%과 88.4$\pm$3.2%이며, 판막과 관련된 사망이 없을 확률은 10년과 18년 각 95.1$\pm$1.2%과 95.111.1%이었다. 판막 관련 합병증의 발생은 연령과 관계가 있었으며, 특히 항응고제와 관련된 출혈의 경우에는 60세 이상의 고령에 많았다. 치환된 판막의 종류나 판막의 크기와는 무관하였으나 다중판막 치환술이 시행되는 경우에는 판막 관련 합병증의 발생률 및 사망률이 모두 높았고, 재수술의 경우 판막 관련 합병증에 의한 사망률이 높았다. 결론: St. Jude기계판막을 이용하여 판막 치환술을 시행한 환자들의 장기간 추적 결과 판막과 관련된 합병증 및 사망률이 낮아 안정적인 기계판막으로 판단된다.

• 대한의용생체공학회:의공학회지
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• 제13권4호
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• pp.285-298
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• 1992

An analysis of the dynamics in the closing phase of the occluder of a mechanical monoleaflet heart valve prosthesis is presented. The dynamic analysis of the fluid in the vicinity of the occluder was based on the control vo]use approach. The backflow velocity of the fluid was computed by applying the continuity, Bernoulli's and momentum equations in the unsteady state. By considering the fluid pressure and gravity as external forces acting on the occluder, the moment equilibrium on fine occluder was employed to analyze the motion of the occluder during closing and the force of impact between the occluder and the guiding struts. Occluder comes to rest after several oscillations in about 10-18 msec after the Inltiaton of closing. As the aortic pressure increases, the occludes closes faster and comes to the final resting position earlier and the impact force increases also. But backflow is not af footed by the variation of the aortic pressure. With decreasing time delay of the ventricle pressure, the occluder closes faster and impact force Increases. The computed magnitudes of the occluder tiP velocities as well as the backflow of the fluid during the closing phase using this model were in agreement with previously reported experimental measurements.