• Journal of Chest Surgery
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• 제20권4호
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• pp.760-764
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• 1987

Fifty seven patients underwent repair of a partial atrioventricular septal defect from January 1980 to December 1986. The ostium primum atrial septal defect was closed with autologous or bovine pericardium. The cleft in the anterior mitral leaflet was present in 53 cases, absent in 4 cases. Of the 53 cases with a cleft in the anterior mitral leaflet, 48 received suture repair of the cleft, 3 received mitral valve replacement. There was no hospital death and all the patients were followed-up for a mean period of 26.4 months. Four required permanent pacemaker implantation due to complete heart block, and one of them died of sudden malfunction of pacemaker. Two received reoperation due to significant residual mitral insufficiency. Suture repair of the cleft in the anterior mitral leaflet resulted in significant decrease in degree of mitral regurgitation. During follow-up period 49 patients were in NYHA class I, 7 patients were in NYHA class II. This report suggests that excellent result can be achieved from repair of the partial atrioventricular septal defect by managing the left A-V valve as a bileaflet structure.

• 한국임상수의학회지
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• 제18권3호
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• pp.273-278
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• 2001

Chronic mitral valvular insufficiency (CMVI) is the most common heart disease in dogs. The prevalence of CMVI is age-dependent. CMVI is usually affected to small to medium size breeds. It is more prevalent in males than females. The characteristic lesions of CMVI are caused by an acquired chronic structural degeneration of the mitral valve defined as endocardiosis or myxomatous degeneration. The main clinical signs are cough, respiratory distress, weakness and pleural effusion and ascites by secondary right-sided heart failure. The most prominent clinical finding is a systolic heart murmur. The thoracic radiography and echocardiography are useful methods in diagnosis of CMVI. Thoracic radiographic findings are left atrial enlargement, left main stem bronchial compression and pulmonary edema. Echocardiography is confirmed to increased left atrial and ventricular dimension, mitral regurgitation, mitral valve thickening and abnormal movement. Thoracic radiography and echocardiography are used to obtain a definite diagnosis of CMVI, and then to study the progression of the condition.

• Journal of Chest Surgery
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• 제16권1호
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• pp.55-64
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• 1983

A hundred and eleven patients of mitral valvular heart disease, who were operated at Seoul National University Hospital, were analysed with echocardiogram before and after operation during the period from November 1979 to February 1982. Twenty-eight patients had mitral stenosis and eighty-three mitral regurgitation. In patients with mitral stenosis, right ventricular end-diastolic volume was in normal range at preoperative and postoperative period. But the left ventricular end-systolic volume was slightly increased preoperatively to 35.4mm and decreased to 33.5mm on immediate postoperative period and 32.5mm after a year later. The left ventricular end-diastolic volume was 50.5mm preoperatively and fell to 46.8mm postoperatively. Ejection fraction was normal preoperatively and postoperatively without changes. Left atrial size fell significantly from 50ram to 37.6mm at the time of late follow-up study. With mitral regurgitation, right ventricular end-diastolic volume was also normal preoperatively and postoperatively. The left ventricular end-systolic volume was increased to 41.9mm and decreased to 31.6mm postoperatively with statistic significance. Left ventricular end-diastolic volume fell from 58.5mm to 45.7mm significantly at the time of late follow-up period. Ejection fraction was also within normal range and had no changes postoperatively. Left atrial size fell from 54.8mm to 45.5mm on a year later [ p value less than 0.01 ]. When atrial fibrillation, the left atrial dimension was increased as 54.9mm compared with 46.8mm of no atrial fibrillation patients.

• Journal of Chest Surgery
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• 제39권7호
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• pp.549-552
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• 2006

심각한 허혈성 심근병증(ischernic cardiomyopathy, ICMP)에 동반된 승모판 폐쇄부전증에 있어서 심장이식이 여의치 않은 상황에서의 수술적 치료로는 경색이 아닌 부위의 심근(viable myocardium)에 대한 관상동맥 우회술(coronary revascularization)과 좌심실 용적 축소술(LV reduction), 승모판 재건술(mitral reconstruction)이 그 중심으로 자리잡고 있다. 허혈성 심근병증에 있어서 승모판 폐쇄 부전은 다양한 병인으로 나타나며, 그 중 판막륜의확장 외에도 유두근의 전위가 중요한 원인으로 지적되고 있다. 본원에서는 승모판 폐쇄 부전증을 동반한 좌 주 관상동맥을 포함한 심한 관상동맥질환과 허혈성 심근병증 환자에 대한 관상동맥 우회술과 함께, 좌심실 절개를 통한 승모판 뒤판엽 성형술(posterior mitral annuloplasty), 유두근 단축술(Papillary muscle plication)의 수술적 치험을 보고하고자 한다.

• Journal of Chest Surgery
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• 제43권5호
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• pp.475-481
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• 2010

배경: 퇴행성 승모판막역류증으로 승모판막성형술을 받은 환자들 중에서 partial flexible band를 이용한 경우와 complete rigid ring을 이용한 경우의 중기 성적을 비교해 보고자 하였다. 대상 및 방법: 2004년 1월부터 2008년 9월 사이에 단독 승모판막역류증으로 승모판막수술을 받은 112명의 환자 중 퇴행성 질환으로 확진되고, 승모판막성형술 및 승모판막륜 링 삽입술을 시행 받은 71명의 환자(남:여=36:35, $55{\pm}13$세)를 대상으로 하였다. 환자들을 승모판막륜성형술에 partial flexible band를 이용한 I군(43명)과 Complete rigid ring을 이용한 II군(28명)으로 나누어 단기 및 중기 성적을 비교하였다. 두 군 간의 수술 전 특성에는 유의한 차이가 없었다. 추적관찰 기간의 중앙값은 36개월(2~69개월)이었다. 결과: 수술관련 사망은 없었으며, 심방세동(n=7), 저심박출 증후군(n=5)과 같은 수술 관련 합병증의 발생은 두 군 간 발생률의 차이가 없었고, II군에서 만기 사망이 1예 있었다. 4년 승모판막역류재발 자유 생존률은 I군과 II군에서 각각 94.5%와 91.8%였다(p=0.695). 좌심실 구출율은 수술 후 조기($7{\pm}2$일)에는 저하 되었고, 최종 추적관찰 시점($25{\pm}16$개월)에서 회복되었다(p=0.002). 이런 변화 추세는 양군에 차이가 없었다(p=0.905). 재수술은 3명의 환자(I군에서 1예, II군에서 2예, p=0.905)에서 시행되었다. 4년 판막 관련 사건 자유 생존률은 두 군 간에 차이가 없었다(I군 95.2% vs II군 92.6%, p=0.646). 결론: 승모판막륜 성형술에 사용되는 판막륜 링의 종류는 퇴행성 승모판막 역류증에 대한 승모판막 성형술의 중기 임상성적 및 기능결과에는 영향을 주지 않았다.

• Journal of Chest Surgery
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• 제23권2호
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• pp.236-244
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• 1990

To improve the prognosis of mitral valve replacement surgery, analysis and evaluation of pre and intra operative risk factors will be very much valuable. Author studied 205 cases of mitral valve replacement from Feb 1982 to June 1989 for the risk factors of hospital death. 90 patients were male and 115 were female, and age was from 16 to 59 years, Mitral stenosis dominant lesions were 91 cases and regurgitation 114. Suspected risk factors were NYHA functional class, cardiothoracic ratio, implanted valve type and size, operation time, age and sex, thrombus in left atrium, atrial fibrillation, aortic cross clamping time, left ventricular end diastolic and systolic dimension, nephropathy, hepatopathy and respiratory insufficiency. Statistic analysis was performed by X2 test between survivors and death group. Statistical significances as pre and intraoperative risk factors of hospital death after mitral valve replacement were confirmed in those presence of AF on the EKG, NYHA functional class[>IV], cardiothoracic ratio[>70%], and implanted valve size[>33mm]

• Journal of Chest Surgery
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• 제54권5호
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• pp.419-421
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• 2021

Fracture of prosthetic valve leaflets in the absence of traumatic injury is very rare. Leaflet fracture can cause acute pulmonary edema and cardiogenic shock and is potentially life-threatening, requiring emergency surgery. Thus, a leaflet fracture must be diagnosed quickly and accurately. We present the case of a 46-year-old man with CarboMedics prosthetic aortic and mitral valve replacements implanted 24 years previously. The patient presented at our emergency department with abrupt dyspnea and fever. We diagnosed severe mitral valve regurgitation with anterior leaflet fracture. The patient underwent venoarterial extracorporeal membrane oxygenation and delayed mitral valve replacement. The foreign body was removed step by step because the diagnosis was missed. Two pieces of broken leaflets were found in the left common iliac artery and left external iliac artery. The patient was treated successfully and remains asymptomatic 1 year following surgery.

• Journal of Chest Surgery
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• 제11권3호
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• pp.316-320
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• 1978

This report presents a case of patent ductus arteriosus complicated with total left lung atelectasis and mitral regurgitation. Her mother complained growth retardation and exertional dyspnea. The 3 year old girl had large patent ductus arteriosus [Qp/Qs=5.6] which resulted in moderate pulmonary hypertension, left atrial hypertrophy and enlargement, consequently the left main bronchus was compressed between the dilated left atrium and aorta. We would like conclude the cause of mitral regurgitation as the result of annular dilatation secondary to left atrial enlargement rather than congenital associated to patent ductus arteriosus. 3 weeks later from ligation of patent ductus arteriosus, the left atrial dimension was markedly reduced echocardiographically [from 3.9cm to 2.7cm], and the left lung progressively aerated by halves.

• Journal of Chest Surgery
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• 제30권7호
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• pp.719-723
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• 1997

저자들은 대동맥 판막치환술 후 생긴 대동맥 판막 주위 누출과 관련된 대동맥동류의 심실 중격 박리를 경험하였다. 37세 남자 환자가 호흡 곤란의 증가를 주소로 응급실을 통하여 입원하였다. 그는 6년전 대동맥판 폐쇄 부전과 승모판 폐쇄 부전으로 인공 기계 판막(Carbomedic 23mm와 31mm)으로 치환 수술을 받고 정기적으로 추적 검진 중이었다. 진단은 경흉부및 경식도 심초음파로 이루어졌고, 대동맥 조영술로 확인되었다. 폐동맥판 동종이식편(Pulmonary homoyaft)를 사용하여 대동맥 판막 치환술을 다시 시행하였다. 심실중격내의 낭 입구에서 3-0 prolene을 사용하여 심근 내막, 외막과 homograft muscle shoulder를 한꺼번에 연속 봉합하였다. 술후 경과는 양호하여 환자는 수술 후 11일째 퇴원하였다.

• Journal of Chest Surgery
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• 제39권1호
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• pp.64-67
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• 2006

제1 대각지 단독 폐쇄에 의한 승모판막 전방 유두근의 파열은 매우 드물다. 66세 여자환자가 심근경색에 이은 심인성쇼크로 전원되었는데, 심초음파 및 관상동맥 조영술 결과 제1 대각지의 완전폐쇄와 승모판막 전방 유두근 파열 및 심한 승모판막 폐쇄부전증이 발견되어 응급 승모판막치환술 및 관상동맥 우회술 후 특별한 문제없이 회복하였다.