• Journal of Chest Surgery
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• 제56권6호
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• pp.394-402
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• 2023

Background: The optimal choice of valve substitute for aortic valve replacement (AVR) in pediatric patients remains a matter of debate. This study investigated the outcomes following AVR using mechanical prostheses in children. Methods: Forty-four patients younger than 15 years who underwent mechanical AVR from March 1990 through March 2023 were included. The outcomes of interest were death or transplantation, hemorrhagic or thromboembolic events, and reoperation after mechanical AVR. Adverse events included any death, transplant, aortic valve reoperation, and major thromboembolic or hemorrhagic event. Results: The median age and weight at AVR were 139 months and 32 kg, respectively. The median follow-up duration was 56 months. The most commonly used valve size was 21 mm (14 [31.8%]). There were 2 in-hospital deaths, 1 in-hospital transplant, and 1 late death. The overall survival rates at 1 and 10 years post-AVR were 92.9% and 90.0%, respectively. Aortic valve reoperation was required in 4 patients at a median of 70 months post-AVR. No major hemorrhagic or thromboembolic events occurred. The 5- and 10-year adverse event-free survival rates were 81.8% and 72.2%, respectively. In univariable analysis, younger age, longer cardiopulmonary bypass time, and smaller valve size were associated with adverse events. The cut-off values for age and prosthetic valve size to minimize the risk of adverse events were 71 months and 20 mm, respectively. Conclusion: Mechanical AVR could be performed safely in children. Younger age, longer cardiopulmonary bypass time and smaller valve size were associated with adverse events. Thromboembolic or hemorrhagic complications might rarely occur.

• Journal of Chest Surgery
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• 제18권4호
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• pp.663-666
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• 1985

Whatever a surgeon choose aortic prosthesis in aortic stenosis, it will always provoke some degree of obstruction to flow due to its smaller effective orifice area to tissue annulus. Occasionally, we meet small aortic annulus to his or her body surface area in aortic valve replacement. The small annulus remains a problem in that both tissue and mechanical prosthesis have significant pressure gradients between LV and aorta in resting or exercising states. In these circumstances, diverse surgical procedures, such as tilting disc prosthesis, supraannular position of aortic prosthesis, and enlargement of aortic root [including aortoventriculoplasty, translocation of aortic valve, & double outlet of LV by valved conduit], were applied. We experienced one case of aortic stenosis with small aortic annulus. Systolic pressure gradients between LV & aorta were 90 mmHg. Diameter of annulus was 19 mm. So we performed patch enlargement of aortic root by Manouguian and AVR with St. Jude medical valve 23 mm.

• Journal of Chest Surgery
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• 제51권2호
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• pp.100-108
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• 2018

Background: The question of which type of prosthetic aortic valve leads to the best outcomes in patients in their 60s remains controversial. We examined the hemodynamic and clinical outcomes of aortic valve replacement in sexagenarians according to the type of prosthesis. Methods: We retrospectively reviewed 270 patients in their 60s who underwent first-time aortic valve replacement from 1995 to 2011. Early and late mortality, major adverse valve-related events, anticoagulation-related events, and hemodynamic outcomes were assessed. The mean follow-up duration was $58.7{\pm}44.0$ months. Results: Of the 270 patients, 93 had a mechanical prosthesis (mechanical group), and 177 had a bioprosthesis (tissue group). The tissue group had a higher mean age and prevalence of preoperative stroke than the mechanical group. The groups had no differences in the aortic valve mean pressure gradient (AVMPG) or the left ventricular mass index (LVMI) at 5 years after surgery. In a sub-analysis limited to prostheses in the supra-annular position, the AVMPG was higher in the tissue group, but the LVMI was still not significantly different. There was no early mortality. The 10-year survival rate was 83% in the mechanical group and 90% in the tissue group. The type of aortic prosthesis did not influence overall mortality, cardiac mortality, or major adverse valve-related events. Anticoagulation-related events were more common in the mechanical group than in the tissue group (p=0.034; hazard ratio, 4.100; 95% confidence interval, 1.111-15.132). Conclusion: The type of aortic prosthesis was not associated with hemodynamic or clinical outcomes, except for anticoagulation-related events.

• 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 Chest Surgery
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• 제21권5호
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• pp.889-893
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• 1988

We experienced a case of infective endocarditis of aortic valve and tricuspid valve associated with a fistula between aorta and right ventricle. The patient was 35 years old woman and showed severe congestive heart failure. Large and multiple vagetations were found on the valvular surfaces and a fistula was present between aorta and right ventricle. Probably infective endocarditis of aortic valve resulted in annular abscess and as it healed, a fistula was formed and tricuspid valve endocarditis followed. We replaced the aortic valve and tricuspid valve with St. Jude mechanical prostheses, and closed the fistula opening with suture. The postoperative course was smooth and the patient has no problems till now 4 months after operation.

• Journal of Chest Surgery
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• 제21권4호
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• pp.706-710
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• 1988

Intravascular hemolysis occurs in the majority of patient with mechanical valve prosthesis. The primary cause is mechanical trauma to red cells from turbulent blood flow through the prosthesis. Degree of hemolysis is dependent upon the type, size and material of valve and aggravated by paravalvular leakage. Clinically important hemolytic anemia is required medical management or consideration of reoperation. In severe hemolysis, reoperation is recommended without delay when seems to be renal failure. In this case, postoperative severe mechanical hemolysis was developed immediately after aortic valve replacement with St. Jude medical valve in a 13 year-old male patient. Neither significant paravalvular leakage nor valvular dysfunction was found through redo, but the mechanical valve was strongly suspected the cause of severe hemolysis. The St. Jude Medical valve was changed with Ionescu-Shiley bioprosthesis and any significant clinical problems were not noted through the postoperative course.

• Journal of Chest Surgery
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• 제47권3호
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• pp.283-286
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• 2014

A 61-year-old man was diagnosed with aortic stenoinsufficiency with periannular abscess, which involved the aortic root of noncoronary sinus (NCS) that invaded down to the central fibrous body, whole membranous septum, mitral valve (MV), and tricuspid valve (TV). The open complete debridement was executed from the aortic annulus at NCS down to the central fibrous body and annulus of the MV and the TV, followed by the left ventricular outflow tract reconstruction with implantation of a mechanical aortic valve by using a leaflet of the half-folded elliptical bovine pericardial patch. Another leaflet of this patch was used for the repair of the right atrial wall with a defect and the TV.

• Journal of Chest Surgery
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• 제40권3호
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• pp.232-235
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• 2007

외상성 대동맥판막 손상 환자에게 대동맥 판막 성형술과 대동맥 판막 치환술로 각각 치료한 2예를 보고한다. 한 명은 18세 남자 환자로 대동맥 판막 성형술을 시행하였으나 수술 후 5년째 중등도의 잔존한 대동맥판막폐쇄부전증으로 추적관찰 중이며 다른 64세 남자 환자는 기계판막 치환술 후 관찰 중이다. 신중하게 선택된 일부의 환자를 제외한 외상성 대동맥판막폐쇄부전증에는 판막치환술을 우선적 수술 방법으로 귄유한다.

• Journal of Chest Surgery
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• 제33권4호
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• pp.285-289
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• 2000

Background: For AVR using conventional prosthetic valves in adult patients with a narrow aortic root, aortic root enlargement is necessary to reduce postoperative pressure gradient across the aortic valve (ΔP). An evaluation of early and mid-term results of aortic root enlargement with AVR and echocardiographic follow up of ΔP and left ventricular function was performed. Method: From Aug. 1991 to Feb. 1998, eighteen patients aged 17 to 59 years(mean, 38$\pm$12 years) underwent Manouguian procedure with AVR. Aortic annular circumstance was enlarged 10.0mm to 18.0mm(mean, 12.6$\pm$6.3mm). Eight patients(44.0%) had NYHA class III status before operation, and seven cases of them underwent concomitant MVR. Valve pathology was ASr in 6 cases, AS in 4 cases, nd ASr+MSr in 8 cases. Replaced valve size was 21mm in 8 cases and 23 mm in 10 cases, and St. Jude Medical mechanical valve was used in 10 cases and Carbomedics in 8 cases. Result: Follow-up duration was 6 to 57 months (mean, 26$\pm$18 months), and total follow-up was 287 patient-year. There were one hospital death and one late death, therefore, actuarial survival rate was 85.7% at 56 months. Peak ΔP wad decreased significantly at postoperative mid-term period as 13$\pm$5mmHg, compared with thepreoperative one (42$\pm$8mmHg) (p<0.01). LVM(gm/$m^2$) was also diminished as 35.8%(115$\pm$36gm/$m^2$)at postoperative mid-term period, compared with preoperative one (179$\pm$56gm/$m^2$)(p<0.05). Conclusion: There were no specific complications related to the procedure. And we could have adequate enlargement of aortic annulus to suitable prosthetic valve that have no effect of patient-prosthese mismatch.

• Journal of Chest Surgery
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• 제42권6호
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• pp.777-780
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• 2009

교련부 분리는 대동맥판막 탈출증에 의한 대동맥판 역류를 일으키는 매우 드문 질환이다. 판막엽의 손상 없이 교련부 분리(avulsion of commissure)에 의해 발생한 중증 대동맥판 역류 2예를 치험하여 보고하고자 한다. 첫 번째 증례에서 교련부 분리에 의한 중증 대동맥판 역류에 대해 5-0 polypropylene으로 연속 봉합하여 교련부 재부착을 통한 성형술을 시행하였다. 수술 소견에서 판막엽은 정상 이었으나 우관상동맥판과 무관상동맥판 사이의 교련부 분리에 의한 중증 역류가 관찰되었다. 수술 후 특별한 문제 없이 회복하던 환자는 대동맥판 역류의 재발이 관찰되어, 술 후 14일째에 재수술을 시행하였고, 재부착을 시행했던 교련부위가 완전히 재분리 되어 있어, 판막 치환술을 시행하였다. 두 번째 증례도 우관상동맥판과 무관상동맥판 사이의 교련부 분리가 관찰되었으며 판막엽은 정상소견이었다. Pledget으로 보강한 5-0 polypropylene을 이용한 다수의 수평매트리스봉합으로 교련부 재부착을 시도하였으나 판막의 교합이 완벽하지 않아 조직판막으로 치환술을 시행하였다.