• Journal of Chest Surgery
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• 제19권1호
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• pp.92-100
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• 1986

Results of reoperation for tissue valve failure were presented with review of current knowledge. Through January 1986, 19 patients required reoperation: 18 had undergone mitral, 2 aortic, and 1 tricuspid valve. Primary tissue failure was the main cause of tissue valve failure: it occurred in 18 valves [15 mitral, 2 aortic, and 1 tricuspid] at a mean postoperative interval of 54-25 months [range 29-120]. During the same period, 2 patients required reoperation for prosthetic valve endocarditis, 1 for paravalvular leakage. The types of valves failed were 12 lonescu-Shiley valves, 5 Hancock valves, and 1 Carpentier-Edwards valve. All 6 patients younger than 15 years of age at first operation had been implanted with lonescu-Shiley valves and failed after a mean interval of 35 months. In contrast, 11 patients older than 15 years had been implanted with 5 Hancock, 6 lonescu-Shiley, and 1 Carpentier-Edwards valve initially, and eventually failed after mean intervals of 81, 53, 47 months each other. The kinds of valves used at reoperation were 8 lonescu-Shiley, 4 Bjork-Shiley, and 6 St. Jude Medical valves for primary tissue failure cases and 3 lonescu-Shiley valves for the other 3 cases. Overall mortality at reoperation was 10%: 5.6% for primary tissue failure, 50% for prosthetic valve endocarditis. In 15 cases [all mitral] primary tissue failure were caused by calcification associated with or without leaflet destruction or fibrous ingrowth, and in 2 cases [all aortic] caused by cusp perforation and tearing without any evidence of calcification. In conclusion: 1 primary tissue failure is the main cause of reoperation in patients with tissue valve failure; 2. the majority of the failed valves is in mitral position; 3. leaflet calcification is the leading pathology of primary tissue failure; 4, reoperation for tissue valve failure may be a major concern, although the mortality is low; 5. the limited durability of tissue valve suggests its use be restricted to selected cases.

• Journal of Chest Surgery
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• 제29권2호
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• pp.164-170
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• 1996

From January 1986 to June 1993, 12 patients Aad required reoperation: 9 had undergone mitral and 3 aortic valve replacement. Five were male and 7 female, and ages ranged from 29 to 61 years. Replacement of the prosthetic heart valve was performed at a mean interval of 98 $\pm$ 1 months after the Hrst operation. In aortic valve replacement patients the mean interval was 115 $\pm$ 2 months and in mitral valve replacement patients 98 $\pm$ 4 months. Primary tissue failure was the most frequent reason of replacement (10 patients) followed by valve thrombosis (1 patient) and prophylactic replacement (1 patient) in order. The most pronounced pathology of the failed prosthetic heart valves seen in the primary tissue failure group was calcification, perforation, shrinkage and tearing of the cusps. There was one early operative death (8.3%) due to intractable low cardiac output and acute renal failure. Eleven early survivors had successful operative results and there was no late death.

• Journal of Chest Surgery
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• 제21권1호
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• pp.1-9
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• 1988

The left atrial [LA] dimension and atrial fibrillation [AF] in patients with mitral valvular heart diseases have been thought to be related to hemodynamic burden to the LA depending on severity of stenosis or regurgitation of mitral valve, left ventricular contractility and the heart conditions. If hemodynamic burden persists long, it can affect the LA wall and structural change of the LA wall itself can developed. So the structural change of the LA wall could be thought to be related to the LA dimension and AF. To verify this relation, the LA wall biopsy was performed in 26 patients with rheumatic mitral valvular heart disease at the left atriotomy incision margin which was posterior to the interatrial groove after completion of surgery to the mitral valve such as valve replacement or commissurotomy. Relation of the pathological state of the LA wall to AF and the LA dimension measured by M-mode echocardiography was studied. The conclusions were as follow. 1. There was tendency that degree of fibrosis of myocardium of the LA wall was related to the LA dimension. 2. There was more chance that patients who had severe fibrosis of myocardium of the LA wall had pre and postoperative AF. 3. There was no relation between reduction rate of the LA dimension before and after surgery and degree of fibrosis of myocardium of the LA wall.

• Journal of Chest Surgery
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• 제40권12호
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• pp.859-862
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• 2007

심장 판막엽에 발생하는 혈관종은 극히 드문 질환으로 최근까지 문헌에 보고된 것은 총 5례가 전부이며 아직까지 국내문헌에는 보고된 바가 없다. 건강하던 46세 여자가 갑자기 발생한 좌측 안면마비와 수부 감각이상을 주소로 내원하였다. 신경학적 검사에서는 이상 소견이 없었으며 심장초음파에서 승모판막 전엽에 위치한 종괴가 발견되어 종괴를 포함한 승모판막 전엽의 일부를 절제한 후 자가심낭을 이용하여 승모판막성형을 시행하였다. 병리조직 검사상 승모판막 전엽에 발생한 혈관종으로 판명되어 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제14권3호
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• pp.285-290
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• 1981

Bacterial endocarditis is a well-recognized complication of prosthetic valve replacement. Postoperative fungal endocarditis of aortitis has been reported with increasing frequency. Aspergillus endocarditis or aortitis following open heart surgery has been reported in several patients. The difficulty in the diagnosis of this type of infection, the problems of therapy of prosthetic valve endocarditis0 and the relative ineffectiveness of antifungal agents account for the high mortality. Recently, we have experienced a patient with aspergillus aortitis after replacement of mitral valve. The diagnosis was finally established by histotogical examination of emboli removed from the femoral artery. The patient died after second open heart surgery for replacement of ascending aorta.

• Journal of Chest Surgery
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• 제16권4호
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• pp.526-532
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• 1983

This is a report of one case of Loffler`s eosinophilic endocarditis associated with mitral insufficiency and LV thrombi treated surgically at the department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital. This patient was a 42 year old female and she has complains of dyspnea, palpitation, orthopnea and generalized edema. Above symptoms has been going for 4 months and NYHA classification was IV. On examination, blood eosinophil was 45 to 50% [WBC-9800 ]. MI and LV thrombi were confirmed by LV ventriculography and echocardiography. Pulmonary congestion and congestive cardiac failure were diagnosis by X-Ray examination, EKG finding and clinical feature and others there were no organic functional disturbance. Mitral valve replacement was performed with Ionescu-Shiley pericardial valve [29mm] replacement. Adjust thumb sized grayish brown colored two thrombi were excluded, lodged in the apex and septal endocardium of LV. Endocardial fibrosis was reliably confirmed under the gross pathology in the heart. The patient had smooth postoperative course and there were no operative complication.

• 한국가시화정보학회지
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• 제16권2호
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• pp.31-37
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• 2018

Ischemic mitral regurgitation (IMR) is the primary mitral valve (MV) pathology in the aftermath of myocardial infarction as a consequence of regional left ventricular (LV) remodeling. We investigated the effect of asymmetric papillary muscle (PM) displacement and annular dilation on IMR development. Virtual MV modeling was performed to create a normal human MV. Asymmetric PM displacement, asymmetric annular dilation, and the combination of these two pathologic characteristics were modeled. Dynamic finite element evaluation of MV function was performed across the complete cardiac cycle for the normal and three different IMR MV models. While the normal MV demonstrated complete leaflet coaptation, each pathologic MV model clearly revealed deteriorated leaflet coaptation and abnormal stress distributions. The pathologic MV model having both asymmetric PM displacement and annular dilation showed the worst leaflet malcoaptation. Simulation-based biomechanical evaluation of post-ischemic LV remodeling provides an excellent tool to better understand the pathophysiologic mechanism of IMR development.

• Journal of Chest Surgery
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• 제18권1호
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• pp.62-68
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• 1985

10 patients with mitral regurgitation associated with various congenital cardiac anomalies were treated by reconstructive techniques in the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the period of 2 years from 1982 to 1984. There were mitral valvular cleft in one case, chordae tendineae rupture associated with congenital multiple cardiac-anomalies [VSD, PDA, prolapse of aortic non-coronary cusp through VSD] in one case, elongated chordae tendineae after removal of left atrial myxoma in one case, and mitral annular dilatation associated with VSD in 3 cases, large PDA in 2 cases, aortic regurgitation [bicuspid valve] in one case, and unknown origin in one case. Owing to the various pathology above mentioned, reconstructive surgical approach to mitral incompetence is accordingly complicated and a combination of the following different procedures were properly used case by case, that is, suture of chordae tendineae, shortening of elongated chordae tendineae, closure of VSD, ligation of PDA, aortic valvuloplasty, mitral annuloplasty with mattress suture, etc. All patients were survived and they have been excellent postoperative results.

• Journal of Chest Surgery
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• 제43권4호
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• pp.356-363
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• 2010

배경: 승모판막의 석회화는 죽상경화와 밀접한 연관관계가 있는 것으로 알려져 있다. 그러나, 승모판막 질환에서 혈관 죽상경화에 중요한 역할을 하는 것으로 알려진 Connexin43 매개에 의한 Gap junction의 신호전달의 변화는 잘 알려져 있지 않다. 따라서, 저자들은 승모판막의 퇴행성 변화과정이 Gap junction을 통한 세포간 신호전달의 변화와 연관이 있을 것이라고 가정하였다. 대상 및 방법: 뉴질랜드산 토끼 20마리를 2군으로 나눈후, 1군(10마리)에서는 정상식이를 시행하였고, 2군(10마리)에서는 1% 콜레스테롤식이를 12주간 시행하였다. 각군의 토끼들의 혈장에서 총 콜레스테롤, 중성지방, 저밀도 콜레스테롤, 고밀도 콜레스테롤 수치를 측정하였으며, 승모판막을 절제하여 Connexin43, 근육섬유모세포 그리고 대식세포에 대한 면역조직화학염색을 시행하였으며, Connexin43에 대한 정량적 검사를 위하여 Real-time Reverse Transcriptase polymerase chain reaction (real time RT-PCR)을 시행하였다. 결과: 면역조직화학염색에서 근육섬유모세포와 대식세포의 발현은 콜레스테롤 식이를 시행한 군의 승모판막에서 증가되었으며, Connexin43의 발현도 콜레스테롤 식이군에서 증가되어 있었다. RT-PCR을 이용한 정량적 검사에서 Connexin43의 발현은 콜레스테롤 식이군에서 의미있게 증가되어 있었다(p<0.01). 결론: 고콜레스테롤혈증이 유발된 토끼의 승모판막의 변화는 초기 죽상경화와 유사한 과정을 보이며, Connex43의 발현이 증가되었다. 따라서 고콜레스테롤혈증에서의 승모판막질환은 증가된 Connexin43매개 Gap junction을 통한 세포간 신호전달의 변화가 중요한 역할을 한다고 생각된다.

• Journal of Chest Surgery
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• 제40권10호
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• pp.667-673
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• 2007

배경: 심한 대동맥 판막 질환을 가진 환자에서 많은 경우에 승모판막 폐쇄부전을 동반한다. 이런 환자들에서 대동맥 판막 수술 후 남겨지는 승모판막 폐쇄부전의 변화는 수술 등의 치료 과정을 결정하는 데 중요하다. 그러나 대동맥 판막 형태에 따른 대동맥 판막 치환술 후 중등도 이하의 승모판막 폐쇄부전의 변화는 잘 알려져 있지 않다. 본 연구에서는 중등도 이하의 승모판막 폐쇄부전을 동반한 대동맥 판막 협착(Group S)과 폐쇄부전(Group R)을 갖는 두 환자군에서 대동맥 판막 치환술 후 승모판막 폐쇄부전의 변화를 추적 비교해 보았다. 대상 및 방법: 연구 대상은 본 병원에서 1996년 1월에서 2005년 5월까지 대동맥 판막 치환술을 받고 중등도 이하의 승모판막 폐쇄부전을 수술을 하지 않은 환자 43명을 대상으로 하였다. 대상 환자들은 대동맥 판막 협착군(n=29)과 대동맥판막 폐쇄부전군(n=14)으로 나뉘었다. 추적검사 방법은 수술 후 7일, 수술 후 $6{\sim}10$개월 그리고 18개월 이후에 시행한 경흉부 심초음파 결과로 하였으며 평균 추적기간은 38개월이었다. 결과: 평균나이는 60.9세(Group 5=62세, Group R=52.5세)였으며 60% (Group S=55%, Group R=71%)가 남자 환자였다. 수술 전 승모판막 폐쇄부전의 정도는 경도가 29 (67.5%)명이었고 경도와 중등도 사이가 11 (25.5%)명이었으며 중등도가 3 (6.9%)명이었다 Group S에서 승모판 폐쇄부전 정도가 수술 후 수 일 내에 16 (55%)명에서 만 호전을 보였고 수술 후 18개월 후에 시행된 검사에서는 17 (59%)에서 호전을 보였다. 반면에 Group R의 모든 환자에서 조기에 승모판막 폐쇄부전의 호전을 나타냈다. 좌심방 크기감소는 승모판막 폐쇄부전의 호전에 따라 감소하였으나 좌심실 구출률은 두 군에서 의미 있는 차이가 없었다. 결론: 심한 대동맥 판막 질환과 동반된 중등도 이하의 승모판막 폐쇄부전이 있는 환자에서 대동맥 판막치환술 후 승모판막 폐쇄부전의 호전은 대동맥 판막 협착증의 환자보다 대동맥 판막 폐쇄부전 환자에서 보다 조기에 잘 이루어진다.