• Journal of Chest Surgery
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• 제10권1호
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• pp.156-163
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• 1977

This is a report of a case in which mitral valve replacement was performed using Starr-Edwards ball valve [model 6230] by total cardiopulmonary bypass with total hemodilution prime and moderate hypothermia. The patient was 21 year old girl, and mitral valvular symptoms occurred 5 years ago. According to clinical features of the disease, the patient was classified as the class IV of N.Y.H. A. cla3sification. The preoperative diagnosis of mitral insufficiency was made mainly by left ventriculography of roentgenologic study. The mitral valve was highly deformed due to scar contraction of valve leaflets and shortening of chordae tendineae. After prosthetic valve replacement, no abnormal hemodynamic signs were observed. The postoperative course was uneventful.

• Journal of Chest Surgery
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• 제23권4호
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• pp.659-666
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• 1990

We evaluated 68 patients with mitral valve disease who underwent mitral valve replacement from April, 1986, to December, 1988. Among them 20 patients showed increased systolic pulmonary arterial pressure greater than 60 mmHg and postoperative hemodynamic data were obtained in 19 patients average 13 months after mitral valve replacement. The results were as followings. 1. Average pulmonary systolic pressure decreased from 84.8$\pm$4.5 preoperatively to 33. 0$\pm$1.9mmHg postoperatively[P<0.001]. 2. Average pulmonary vascular resistance index decreased from 1425$\pm$148 preoperatively to 287+35.8 dyne * sec * cm2 * m postoperatively[P<0.001]. 3. Average cardiac index rose from 1.927$\pm$0.169 preoperatively to 2.625$\pm$0.159 L/min/m2 postoperatively [P <0.005]. This study shows that pulmonary hypertension and the increased pulmonary vascular resistance index due to mitral valve disease can regress significantly after mitral valve replacement.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1113-1121
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• 1995

From August, 1986 to December, 1993, mitral valve replacement was performed in 178 patients. Of the valve implanted, 114 were St.Jude Medical, 47 Duromedics, 16 Carpenter-Edward and 1 Ionesc-Shiley. The hospital mortality rate was 2.8%[5 patients and the late mortality rate was 7.5%[13 patients . The causes of hospital death were LV rupture in 1, renal failure in 1, cardiac tamponade in 1, valve malfunction in 1 and hypoxic brain damage in 1. The causes of late death were sudden death in 6, congestive heart failure in 4, brain ischemic injury in 3. Follow-up was done on 155 surviving patients : mean follow-up period was 50.94$\pm$8.04 months. The actual survival rate was 88.2% at 8 years. We concluded, therefore, that good clinical results could be achieved with mitral valve replacement in mid-term follow-up, and long-term follow-up is also necessary.

• Journal of Chest Surgery
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• 제48권5호
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• pp.328-334
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• 2015

Background: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods: In this study, we assessed 15 patients (mean age, $47.7{\pm}9.7years$; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was $13.5{\pm}7years$. The mean preoperative Wilkins score was $9.4{\pm}2.6$. Results: The mean mitral valve area obtained using planimetry increased from $1.16{\pm}0.16cm^2$ to $1.62{\pm}0.34cm^2$ (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from $202.4{\pm}58.6ms$ to $152{\pm}50.2ms$ (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from $9.4{\pm}4.0mmHg$ to $5.8{\pm}1.5mmHg$ (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period ($39{\pm}16months$). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467-64.866). Conclusion: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

• Journal of Chest Surgery
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• 제25권5호
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• pp.518-525
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• 1992

50 months experience with St-Jude Medical Cardiac Valve Prosthesis The St. Jude Medical valve has become our mechanical valvular prosthesis of choice because of favorable hemodynamic results that associated with marked clinical improvement and low incidence of thromboembolism. The data for this study was collected from April 1986 to May 1990, four years period. There were total of 110 patients[female 53, male 58] in this series with 22 isolated aortic valve, 66 isolated mitral valve, 20 double valve, 2 tricuspid valve replacement. The mean follow up time was 23 months. Postoperatively, 77% of cases were in New York Heart Association[NYHA] functional class I, and mild and moderate symptoms[NYHA II ] were present in 20% and there were very few patients remaining in higher functional classifications. In postoperative echocardiographic study showed marked improved cardiac function. The overall early mortality was 5.4% and was higher after double[13.3%] and mitral valve replacement[5.6%] and the late mortality was one case after mitral valve replacement due to endocarditis. The cause of death in early mortality was attributed to heart failure, acute renal failure, sepsis, etc.

• Journal of Chest Surgery
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• 제16권4호
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• pp.458-469
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• 1983

Between October, 1978, and December, 1982, Glutaraldehyde-stablized pericardial xenografts [Ionescu-Shiley valve] were used for heart valve replacement in 409 patients.[251 mitral, 49 aortic, 11 tricuspid, and 98 multiple valve replacement]. There were 31 early deaths [7.6%], and 371 operative survival were observed for a total of 507.6 years over a period of 1 to 44 months. [mean 17 months]. Actuarial analysis of late results indicates an excepted survival rate at 4 years of 86.25.4% for patients with mitral, 79.37.1% for patients with aortic valve replacement. Actuarial survival rates for total patients at 4 years was 77.88.2%. The rate of systemic embolism has been 1.6% per patient-year for mitral and 1.8% per patient-year for aortic group in the presence of anticoagulation treatment. Among the 6 embolic episodes, 2 patients were died. The incidence of hemorrhagic complication was 1.3% per patient-year for anticoagulated patients. There were 6 confirmed valve failures, five in mitral and one in aortic position. Re-replacement of destructed valve was performed in one patient and others were treated medically. Among the 6 episodes, 3 occurred in children [Below 15 years], it account almost 9 times higher than adult. Our clinical data compare very favorable with those obtained with other available prostheses and tissue valves, but it should be considered to give short-term anticoagulation therapy to hemodynamically stable patients and aortic valve patients, and other prosthetic valve must be considered to use in children.

• Journal of Chest Surgery
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• 제17권2호
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• pp.171-176
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• 1984

Successful correction of the partial form of atrioventricular[AV] canal is now readily achievable. The most challenging technical features of this anomaly are the associated mitral valvular deformity and the frequent inability to obtain mitral competence. Residual mitral incompetence after repair of mitral cleft figures importantly in the causes of early and late failure. So, accurate and complete repair of the mitral valve cleft might be important. Determination of residual severe mitral regurgitation after repair is desirable to permit mitral valve replacement at the time. We have experienced one case of severe mitral regurgitation which was occurred 6 months after repair of partial form of A-V canal [ASD primum] in 22 years old virgin. Pre-op. left ventriculogram revealed severe mitral regurgitation in this patient. We preferred to perform mitral valve replacement with St. Jude valve in this patient at March 1984. Post-op. course was uneventful to now for 5 months and we report this case, review and discuss the literatures.

• Journal of Chest Surgery
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• 제25권6호
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• pp.661-671
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• 1992

From March 1988 to May 1991, 140 CarboMedics cardiac valve prostheses[75 mitral, 9 aortic and 28 double aortic-mitral] were implanted in 112 consecutive patients[mean age 36.7$\pm$11.6 years, male/female 48/76] by one surgical team operating on adult cardiac patients at Kyoungpook University Hospital Associated Surgical procedures were performed in 19 patients[16.9%]. Total follow up represented 2,345 patient-months[mean 22.4 months] and was 100% complete. Eighty-two patients[73%] were in NYHA functional class IIIor IV preoperatively and 102 patients [95%] were in class I or II postoperatively. Hospital[30 day] mortality was 4.4%, [3/75 mitral, 1/9 aortic, 1/28 double valve replacement] and late death was 1.7%. [1 /74 mitral, 1 /28 double valve replacement] The actuarial survival at 36 months was 94.0% after mitral, 80% after aortic, 92% after double valve replacement, and 93.2% for the total group. The linearized incidence of valve relater death, prosthetic valve thrombosis, anticoagulant related hemorrhage, and reoperation was 1.00%/pt-yr, 0.51%/pt/yr, 0.51%/pt-yr, and 0.51%/pt-yr respectively. The 36 month rates of freedom from valve replated death, thromboembolism, endocarditis, anti-coagulant related hemorrages, and reoperation were 98.75%, 99.08%, 100%, 99.04%, and 99.08% respectively. The 36 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.2%. These fact suggest that the CarboMedics heart valve has excellent short-term result, low incidence of valve-related complications and valve dysfunction, and additional long term follow up study is necessary.

• Journal of Chest Surgery
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• 제20권3호
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• pp.512-519
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• 1987

In the department of chest surgery of Pusan National University hospital cardiac valve surgery was done in 118 cases from March, 1982, to June, 1986. Among these, 90 were mitral valve replacement, 9 mitral commissurotomy, 5 mitral valvuloplasty, 4 aortic valve replacement, 4 double valve replacement, 4 mitral annuloplasty, one mitral annuloplasty with commissurotomy and valvuloplasty. 48 were male and 70 were female and age distribution ranged from 6 to 57 years [mean 30.6 years]. Early death within 30 days after operation was 14 cases: 10 had mitral valve replacement, 2 double valve replacement and 2 mitral annuloplasty respectively. Confirmed causes of death were low cardiac output syndrome in 9 cases, congestive heart failure in one case, cardiac tamponade in one case, malfunction of valve in one case, cardiac rupture in one case and renal failure in one case. The 104 cases were followed up for a total 190 years and range was from 2 to 54 months [Mean*SD: 21.9*16.5 months]. During follow-up period, 2 late deaths were developed: one was due to subdural hematoma and the other was congestive heart failure combined with fulminant hepatitis. Anticoagulation therapy was done with warfarin to the level of 20 to 40% of normal prothrombin time in 53 cases, dipyridamole and aspirin in 18 cases, or ticlopidine hcl in 15 cases. The frequency of bleeding due to anticoagulation therapy was 1.0% episodes per patient-years: one was in warfarin group and another was in dipyridamole and aspirin group. Among the studied 102 cases, 93 cases [91.2%] of patients were in NYHA class I or II during follow up period.

• Journal of Chest Surgery
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• 제11권3호
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• pp.281-295
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• 1978

Last year in this department 100 cases of open heart surgery were done annually. This year 200 cases of open heart surgery were scheduled. During the first 6 months of this year 112 open heart surgery cases were done with 13 deaths [11.6%]. There were 72 cases of cougenital malformation with 9 operative deaths [12.5%], consisting of 23 acyanotic cases with one death [4.5%] and 49 cases of cyanotic cases with 8 deaths [16.3%]. Out of 40 tetralogy of Fallot, 6 cases expired [15%]. For 39 cases of acquired valvular heart disease and one Ebstein anomaly valves were replaced with 4 operative deaths [10%]. Single valve replacement in 33 with 3 operative deaths and double valve replacement in 7 cases with one death were noted. Two patients expired among 28 mitral valve replacement cases [7.1%]. Among 7 double valve replacement patients, consisting of 3 mitral and aortic and 4 mitral and tricuspid valve replacement one case expired. In a case of Ebstein anomaly, tricuspid valve was replaced with plication of atrialized right ventricle successfully. The operative result was excellent.