• Title/Summary/Keyword: Leaflet

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Application of Homograft in the Surgical Correction of Complex Congenital Cardiac Malformations (선천성 복잡 심기형 환자의 외과적 교정술시 동종이식편의 적용에 관한 연구)

  • 지현근
    • Journal of Chest Surgery
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    • v.28 no.11
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    • pp.1038-1044
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    • 1995
  • We have been used cryopreserved homograft valves for right ventricular outflow tract[RVOT reconstruction since November 1993. The homograft valves were harvested from the hearts of brain dead patients or hearts of transplant recipients. There were 12 male and 10 female patients. Their ages ranged from 5 months to 13 years[mean age,39.2 $\pm$ 37.4 months and the weight ranged from 5 to 48kg [mean weight, 13.7$\pm$ 9. l kg . The diagnoses included pulmonary atresia with ventricular septal defect [n=14 , tetralogy of Fallot[n=4 , truncus arteriosus[n=3 , and double outlet right ventricle with pulmonic stenosis[n=l .Monocuspid homograft patches were used for RVOT widening or REV[reparation l`etage ventriculaire operations in 4 patients. We also used homograft as valved conduits for RVOT reconstruction in 17 patients and left ventricular outflow tract reconstruction in anatomically corrected transposition in 1 patient. Among them size-reducing technique [converting a tricuspid valved conduit into a bicuspid valved conduit were applied to six patients for the correction of size mismatching. The mean follow-up period was 10.6 $\pm$ 5.4 months. There was one operative death[4.5% due to bleeding and one reoperation for removal of vegetation on the homograft leaflet. Postoperative echocardiography documented no significant homograft insufficiency and RVOT obstructions.In short-term, the homograft valves provide excellent hemodynamic characteristics, even though further studies are necessary to evaluate the long-term results.

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Double Outlet Left Atrium: A rare form of the atrioventricular septal defect with malposition of the atrial septum (좌심방 양심실 연결증 [DOLA])

  • Lee, Jae-Won;Seo, Gyeong-Pil
    • Journal of Chest Surgery
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    • v.18 no.2
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    • pp.273-278
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    • 1985
  • The case of a patient with abnormal position of the atrial septum resulting in a left atrium with two atrioventricular valves and a disconnected right atrium is presented with review of related articles. Anatomic details showed atrial situs solitus and a left sided cardiac apex. The right atrium received both venae cavae and a coronary sinus. No AV valve was found in the right atrium, and the floor of this chamber was placed above the posterior wall of right ventricular chamber. The atrial septum with secundum ASD was displaced to right anteriorly at its lower portion and inserted to right of tricuspid annulus. The tricuspid and mitral valve configuration was that of so-called partial ECD, i.e. mitral cleft with large anterior mitral leaflets. The ventricular septum was intact and both ventricular chambers were equally well developed with normal relationships. Surgical repair of this anomaly was performed by resecting the abnormally positioned lower part of the atrial septum, repairing the cleft of the anterior mitral leaflet, and septating the atrium for diverting the systemic and pulmonary venous blood to RV and LV, respectively.

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Asymptomatic Isolate Tricuspid Regurgitation with Chordae Tendineae Rupture Caused by Blunt Chest Injury

  • Kim, Min Hee;Kang, Hyun Jae;Jung, Byung Chun;Lee, Bong Ryeol;Jung, Ho Jin;Lee, Jun Young;Bae, Soo Hyun;Shin, Dong Woo
    • Journal of Yeungnam Medical Science
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    • v.30 no.2
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    • pp.112-115
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    • 2013
  • The incidence and importance of tricuspid valve regurgitation after a blunt chest injury has risen with the increase in the number of automobile accidents and steering wheel traumas. This kind of injury has been reported more frequently in the last decade because of the better diagnostic procedures and understanding of the pathology. However, tricuspid valve regurgitation following a blunt chest injury can still be easily missed because most patients do not show symptoms at the time of the trauma. A 55-year-old male patient presented himself at our facility after suffering a chest injury from an automobile accident. His transthoracic echocardiography (TTE) revealed severe tricuspid valve regurgitation due to the prolapse of his anterior valve leaflet. We report a case of asymptomatic tricuspid regurgitation that developed after a blunt chest injury.

Surgical Treatment of Infective Endocarditis (감염성 심내막염에 대한 외과적치료)

  • Wang, Ok-Bo;Park, Ju-Cheol
    • Journal of Chest Surgery
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    • v.25 no.10
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    • pp.1055-1060
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    • 1992
  • Clinical experience of 21 patients with infective endocarditis was reviewed. Endocarditis involved the left-sided valve in 16 cases, the right-sided valve in 2, and PDA in the remaining 3 patients. Valve abnormalities included leaflet perforation in 9 patients, chordal rupture in 2,; annular abscess in 6; and aorticoleft atnal perforation in 2. Sixteen patients underwent valve replacement[aortic valve replacement in 7 patients, mitral replacement in 4 and double valve replacement in 5], two had VSD closure with pulmonary valve excision, three had ductus arteriousus closure. The patients were classified into two groups. I ] Healed endocarditis group: including the patients who had completed a planned cou-rseof antibiotic therapy[N=10], II ] Active endocarditis group: patients in which operations were performed prior to completetion of antibiotic treatment course[N=11]. The indications for operation included congestive heart failure, embolism, and persistent sepsis. Organisms were predominantly streptococcus[N=5] and staphylococcus [N=4] followed by candida, moraxella, and E-coli. By NYHA functional classification, all patients were in Class III or IV preoperatively. There was only one operative mortality in patient from group II. All patients substantially, improved postoperatively with NYHA classification in class I or II. This study shows that early surgical intervention in patients with active endocarditis has desirable outcome.

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Mitral Valve Reconstruction; Result of Operation Using Prosthetic Ring (승모판막 재건술;인공판륜[prosthetic ring]을 이용한 수술례)

  • 이재원
    • Journal of Chest Surgery
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    • v.26 no.3
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    • pp.191-195
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    • 1993
  • Among 25 consecutive cases having undergone mitral valve surgery between March 1991 and June 1992 in Gill General Hospital, 11 patients[44%] who had undergone mitral valve reconstruction using prosthetic rings is evaluated and presented. Patients` mean age is 43 + 19 years[range:16-72], and they are consisted with 4 males and 7 females. Mitral valve insufficiency is due to degenerative disease in 6 cases[55%] and rheumatic disease in 5 patients[45%]. Carpentier`s functional classification I is 2 cases, II is 6 cases, and III is 2 cases. Surgical techniques include prosthetic ring annuloplasty[11 patients, 100%], chorda shortening[6, 55%], leaflet mobilization[4,36%], new chorda formation[2, 18%], chorda transposition[1, 9%] commissurotomy[3, 27%], and papillary muscle splitting[3, 27%]. Average number of mitral anatomic lesions per patient are 2.7 and we used average 2.8 procedures upon mitral valve apparatus per patient. There were no surgical mortality and no late valve related admission during the mean follow up period of 17 months. The mean functional class[NYHA] is 2.81 preoperatively and improved to 1.10 postoperatively. Doppler echocardiography showed much improvement from grade II MR [1 case], grade III MR [1 case] and 9 cases of grade IV MR to 6 cases of patients showed no MR, only trace MR in 4 cases, and grade I MR was found only in one patient with NYHA functional class II postoperatively. The postoperative mean mitral valve area is $2.10+0.28cm^2$. We conclude that mitral reconstruction is a predictable and stable operation.

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Effect of Foot Care Education for Patients with Rheumatoid Arthritis Involving the Feet (족부에 침범한 류마티스 관절염 환자에게 적용한 발 관리 교육의 효과)

  • Kim, Seong Kyong;Kim, Hee Seung
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.21 no.1
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    • pp.7-17
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    • 2014
  • Purpose: The purpose of this study was to evaluate effects of foot care education on foot pain, foot care compliance, and disability of daily living for people with rheumatoid arthritis involving the feet. Methods: This study was conducted as a randomized controlled trial. The participants were 49 patients, including 24 in the experimental group and 25 in the control group. The experimental treatment was the provision of foot care education leaflets and 20-minute 1:1 explanations of the content of the leaflet. After 2 weeks, foot care compliance was confirmed by phone call. The experimental effects were assessed by measuring changes in foot pain, foot care compliance, and disability of daily living using a pre test before the foot care education and a post test, 1 month after the foot care education. Results: Foot pain and disability of daily living in the experimental group decreased more than that of the control group. Foot care compliance in experimental group increased more than that of the control group. Conclusion: Results indicate that this foot care education program is an effective intervention to decrease foot pain and the disability of daily living, and increase the foot care compliance in patients with rheumatoid arthritis involving the feet.

The Effects of a Self-care Management Program for Patients with Diabetic Foot Ulcers (당뇨병성 족부 궤양을 가진 환자의 자가 관리 프로그램 적용 효과)

  • Kim, Jung Yoon;Cheon, Eui-Young
    • Journal of Korean Biological Nursing Science
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    • v.18 no.2
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    • pp.78-86
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    • 2016
  • Purpose: Diabetic foot ulcers are significant problems in diabetes mellitus and often result in lower extremity amputation. This study was conducted to evaluate the effects of a self-care management program on Korean patient's self-efficacy, self-care behavior, size of the wound, and wound related pain. Methods: This study was a quasi-experimental study of pre-test and post-test design in a non-equivalent control group. The intervention strategies of the self-care management program consisted of individual intervention (education, practice and demonstration), computer animation, and face-to-face counseling. There were thirty seven patients, and 20 were assigned to the experimental group while the other 17 were assigned to the control group. The experimental group was given a self-care management program. The control group received information on diabetic mellitus care by means of a leaflet. The data was analyzed using descriptive statistics, a chi-square test, an independent t-test, and a Mann-Whitney test. Results: There were significant differences in self-care behavior and wound related pain. Conclusion: A Self-care program is an effective way to increase patient's self-care ability. This program is highly applicable to diabetic foot ulcer patients in various settings.

Detection of Perivalvular Abscess with Late Gadolinium-Enhanced MR Imaging in a Patient with Infective Endocarditis

  • Ryu, Seong-Yoon;Kim, Hae Jin;Kim, Sung Mok;Park, Sung-Ji;Choe, Yeon Hyeon
    • Investigative Magnetic Resonance Imaging
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    • v.20 no.1
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    • pp.75-79
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    • 2016
  • We report a case of perivalvular abscess in a 66-year-old man with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. No clinical features suspicious of infective endocarditis were noted, however, transthoracic echocardiography revealed non-specific echogenic focal wall thickening at mitral-aortic intervalvular fibrosa. Perivalvular abscess in the aortic valve was demonstrated as focal wall thickening between the anterior mitral leaflet and the non-coronary cusp of the aortic valve with peripheral enhancement and central low signal intensity on LGE CMR imaging. Other features suggestive of infective endocarditis, such as neither vegetation nor valvular perforation were present. The perivalvular abscess did not grow after intensive intravenous antibiotics therapy, and the patient was discharged without surgical treatment. CMR with LGE provided an early accurate diagnosis of perivalvular abscess. The diagnosis of perivalvular abscess using LGE CMR imaging was not previously reported in Korea.

The Effects of Comprehensive Education Program on Anxiety, Uncertainty and Athletic Performance of Patients undergo Spinal Nerve Block (척추 신경차단술 환자를 위한 포괄적 교육 프로그램이 불안, 불확실성 및 운동수행에 미치는 효과)

  • Kim, Seon Hee;Lee, Eun Sook
    • Korean Journal of Adult Nursing
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    • v.29 no.2
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    • pp.143-153
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    • 2017
  • Purpose: Purpose of the study was to identify the effect of the Comprehensive Education Program (CEP) on intra-procedure anxiety, post-procedure uncertainty and athletic performance of back strengthening of patients undergo spinal nerve block (SNB). Methods: The participants (experimental group=33, control group=33) were recruited from a university hospital in G metropolitan city. Data were collected from July to November 2015. The experimental group was individually provided with a booklet/motion picture about the SNB and back strengthening exercise training before the SNB. This group also received a leaflet about back strengthening exercise post SNB. The Anxiety-Visual Analog Scale (A-VAS), the Mishel adapted uncertainty scale and newly created knowledge scale/athletic performance checklist were utilized as our study tools. Results: Intra-procedure anxiety score (F=25.70, p<.001), post-procedure uncertainty score (F=82.56, p<.001), post-procedure knowledge score (F=14.63, p<.001) and athletic performance rate of back strengthening (p=.003) of the experimental group showed statistically significant differences in comparison with the control group. Conclusion: This CEP is a cost and time-effective intervention for patients who undergo spinal injections, so it should be actively utilized as an educational management strategy in outpatient.

Multiple Cardiac Papillary Fibroelastoma of the Aortic Valve (대동맥 판막에 위치한 다발성 심장 유두상 섬유탄력종)

  • Seo, Hong-Joo;Na, Chan-Young;Yu, Jai-Kun
    • Journal of Chest Surgery
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    • v.41 no.4
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    • pp.496-498
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    • 2008
  • Cardiac papillary fibroelastomas are the second most common primary cardiac tumor. This tumor is usually benign and it involves the cardiac valve. However, most cardiac papillary fibroelastomas originate from a single site, and the incidence of cardiac papillary fibroelastomas originating from multiple sites is very rare (5%). A 55-year-old woman who presented with momentary dizziness and syncope was evaluated by performing echocardiography. Multiple tumors attached to the aortic valve were noted. The mass was removed freely without leaving any defect on the aortic valve leaflet. After the recovery period, the patient is currently being followed up at the outpatient department.