• Journal of Chest Surgery
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• 제27권4호
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• pp.313-317
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• 1994

Surgical treatment is possible for the obstructive form of hypertrophic cardiomyopathy and transaortic left ventricular septal myectomy and myotomy has been the procedure of choice. If coexisting intrinsic mitral valve disease exists, mitral valve replacement has been performed. But abnormal systolic anterior motion of anterior mitral leaflet[SAM] with intrinsic normal mitral valve disease is the typical feature of IHSS and we prefer not to replace mitral valve. 3 patients underwent transaortic myotomy and myectomy for IHSS with mitral regurgitation. 2 patients of them have coexisting intrinsic mitral valve diseases such as mitral valve vegetation and chorda rupture. Concomittent mitral valve replacement were performed. 1 patient shows SAM of mitral anterior leaflet but has intrinsic normal mitral valve morphologically and transepicardial echocardiogram and direct monitoring of pressure gradient during the operative procedure gives better information for subsided mitral regurgitation. Post operative course during the 12 months follow-up was uneventful.

• 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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• 제33권1호
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• pp.32-37
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• 2000

Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

• Journal of Chest Surgery
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• 제54권3호
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• pp.165-171
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• 2021

As a percutaneous technique for the reduction of mitral regurgitation, the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) for transcatheter edge-to-edge repair of the mitral valve was developed in 1998 and first used in 2003. Its main advantage is being less invasive than surgery, because it can be performed through a transcatheter approach without any hemodynamic compromise. Recent studies have shown that this procedure reduces symptoms and improves functional capacity with low complication rates. Two randomized clinical trials have investigated the use of this technique for functional mitral regurgitation. The Korean Ministry of Food and Drug Safety approved its use for degenerative mitral regurgitation in 2019, and this procedure started to be performed in Korea in January 2020. Its use for functional mitral regurgitation was also approved in Korea in 2020. In this article, recent evidence on transcatheter edge-to-edge repair of the mitral valve and our initial experiences in Korea will be reviewed.

• Journal of Chest Surgery
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• 제44권4호
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• pp.285-287
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• 2011

A 53-year-old man presenting with dyspnea and chest pain was diagnosed with acute myocardial infarction secondary to occlusion of the left circumflex coronary artery. Urgent revascularization by percutaneous stenting was successfully performed. However, the post-echocardiography revealed a ruptured papillary muscle that was causing severe mitral regurgitation and aggravation of congestive heart failure. The patient subsequently underwent mitral valve repair with papillary muscle re-implantation. Postoperative echocardiography showed a competent mitral valve without residual stenosis or regurgitation. The patient was discharged from the hospital with an uneventful recovery and has been doing well on outpatient follow up.

• Journal of Chest Surgery
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• 제55권3호
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• pp.239-242
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• 2022

Papillary muscle rupture with severe acute mitral regurgitation is a rare complication of acute myocardial infarction (AMI) that causes pulmonary congestion and cardiogenic shock. Moreover, it has a poor prognosis. Surgical intervention, including revascularization, is indicated; however, surgical mortality remains high. We report the case of an 85-year-old woman with cardiogenic shock from severe acute mitral regurgitation, in whom a hybrid intervention, combining percutaneous coronary intervention with mitral valve replacement via minithoracotomy, was performed after post-infarction papillary muscle rupture. She was discharged in a favorable clinical condition. We describe a novel hybrid intervention for treating a rare complication of AMI, which could minimize surgical invasion in elderly patients, prevent disuse syndrome after the intervention, and improve prognosis. However, mitral valve surgery via minithoracotomy for emergency cases requires technical proficiency, as well as collaboration with other healthcare professionals, and the choice to perform this procedure requires careful consideration.

• Journal of Chest Surgery
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• 제57권5호
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• pp.496-499
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• 2024

Calcification of the mitral valve annulus is common in patients on dialysis. The growing number of individuals receiving dialysis has been accompanied by an increase in cases necessitating surgical intervention for mitral valve annulus calcification. In this report, we present a severe case characterized by bulky calcification of the mitral annulus, which was managed with mechanical mitral valve replacement. A 61-year-old man on dialysis presented with chest pain upon exertion that had persisted for 3 months. Cardiac echocardiography revealed severe mitral stenosis and regurgitation, accompanied by cardiac dysfunction. During surgery, an ultrasonic aspiration system was employed to remove the calcification of the mitral valve annulus to the necessary extent. Subsequently, a mechanical mitral valve was sutured into the supra-annular position. To address the regurgitation, the area surrounding the valve was sewn to the wall of the left atrium. Postoperative assessments indicated an absence of perivalvular leak and demonstrated improved cardiac function. The patient was discharged on postoperative day 22. We describe a successful mitral mechanical valve replacement in a case of extensive circumferential mitral annular calcification. Even with severe calcification extending into the left ventricular myocardium, we were able to minimize the decalcification process. This approach enabled the performance of mitral mechanical valve replacement in a high-risk patient on dialysis, thus expanding the possibilities for cardiac surgery.

• Journal of Chest Surgery
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• 제48권1호
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• pp.7-12
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• 2015

Background: Mitral regurgitation is one of the leading causes of cardiovascular morbidity in pediatric patients with Marfan syndrome. The purpose of this study was to contribute to determining the appropriate surgical strategy for these patients. Methods: From January 1992 to May 2013, six patients with Marfan syndrome underwent surgery for mitral regurgitation in infancy or early childhood. Results: The median age at the time of surgery was 47 months (range, 3 to 140 months) and the median follow-up period was 3.6 years (range, 1.3 to 15.5 years). Mitral valve repair was performed in two patients and four patients underwent mitral valve replacement with a mechanical prosthesis. There was one reoperation requiring valve replacement for aggravated mitral regurgitation two months after repair. The four patients who underwent mitral valve replacement did not experience any complications related to the prosthetic valve. One late death occurred due to progressive emphysema and tricuspid regurgitation. Conclusion: Although repair can be an option for some patients, it may not be durable in infantile-onset Marfan syndrome patients who require surgical management during infancy or childhood. Mitral valve replacement is a feasible treatment option for these patients.

• Journal of Chest Surgery
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• 제55권2호
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• pp.177-179
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• 2022

Barlow's disease with mitral annular calcification encompassing the subvalvular apparatus, including the valve leaflet and chordae, is extremely rare, and mitral valve repair in such cases is challenging. We report a case of a 60-year-old woman with mitral valve regurgitation that was successfully controlled by resecting the rough zone of P2 and calcifications on the excess leaflet regions and subvalvular apparatus, while retaining the calcification of P3 and implanting artificial chordae and an annuloplasty ring. Mitral valve repair for such cases requires an individualized and compounded surgical strategy for the technique to treat Barlow's disease and manage calcification to control mitral regurgitation.

• Journal of Chest Surgery
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• 제23권3호
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• pp.488-500
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• 1990

Author compared the effect of surgical methods between 40 patients who received mitral valve replacement with complete excision of the mitral valve[resected group] and 41 patients who received mitral valve replacement with preservation of posterior chorda tendineae and posterior mitral leaflet[preserved group] from 1985. 2. to 1989. 4. at cardiothoracic department of Pusan National University Hospital.v 1. There was no significant difference between the preserved group and resected group in cardiopulmonary bypass time and aortic cross clamping time and NYHA classification. 2. In preserved group of Mitral stenosis and Mitral regurgitation, the left ventricular functions were much improved after mitral valve replacement than resected group, but there was not so difference between the preserved group and reserved group in Mitral steno-regurgitation. 3. There were remarkable decrease in complication rate in preserved group compared to resected group. And also the death rates were remarkably decreased in preserved group which was 4.9% compared to resected group which was 17.5%. As the preservation of the posterior mitral leaflet and chorda tendineae during mitral valve replacement in mitral valve disease showed significantly improved effects in the maintaining of left ventricular function and reducing the postoperative complication, I assume the preservation of posterior mitral leaflet and chordae during mitral valve replacement will bring better result.