• 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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• 제25권12호
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• pp.1556-1562
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• 1992

Forty two consecutive patients who had had valve replacement with St. Jude Medical prosthesis were studied on a view point of intravascular hemolysis. Patients were consisted of 14 mitral valve replacement, and 7 aortic valve replacement, and 21 double, mitral and aortic, valve replacement. Serum LDH, indirect bilirubin, GOT, hemoglobin levels and ret-iculocyte count were pursued in postopeative 1st day, 3rd day, 7th day, 14th day and 21th day. Postoperatively, all patients were not detected paravalvular leakage on the ech-ocardiographical study. The patients with double valve replacement revealed higher levels of LDH on postopeative 14th day[P<0 05] than those with single valve replacement. Among the patients with single valve replacement, the patients with aortic valve replacement revealed slightly higher levels of entire postopeative data, but considered insignificant. There was correlation between the severity of hemolysis and the size of replaced aortic valve. In the postoperative LDH levels, the patients with small sized-aortic valve[less than 21mm in diameter] replacement revealed higher levels of postoperative 3rd day, 7th day and 14th day than those with large size[more than 23mm in diameter]. The patients with high level LDH of greater than 800 WU /L on postoperative 7th day were 61.9%[26 of 42]. The high LDH frequency of DVR was 71.4%[15 of 21], MVR 50.0%[7 of 14] and AVR, 57.1%[4 of 7]. The level of LDH declined gradualiy thereafter through postoperative 3 weeks. In conclusion, intravascular hemolysis after prosthetic valve replacement was dependent on position of valve replacement and size of valve. And this study supports the conventional valve selection and usage in our hospital. The patients with subclinical hemolysis after valve replacement should be placed on a close observation.

• Journal of Chest Surgery
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• 제30권4호
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• pp.390-395
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• 1997

1986년 5월부터 1996년 5원까지 총 269명(조직판막70례, 금속판막 232례)의 판막 치환술 환자중 판막의 재치환술이 필요했던 12례를 분석 하였다. 승모판 재치환술이 9례, 대동맥 판막 치환이 3례로 연령범 위는 16세에서 68세까지로 50대 이후가 가장 많았다. 초인공판막치환후 재 수술이 필요했던 숭모판막의 경우 평균 87.6개월, 대동맥판막의 경우 36.7개월로서, 대부분의 경우 운동시 호흡곤란이 주증상이었으며 원인으로서는 판막자체의 구조적 실패 5례, 심내막염 2례였으며 재치환술에 사용된 판막은 기계판막 11례, 조직판막 1례로 수술후 사망률은 17% (2/12)였고 술후 심내막염 및 폐렴에 의한 호흡부전으로 사망하였다.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1001-1012
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• 1989

In 1968, Carpentier and his associates introduced glutaraldehyde as a compound for preparing cardiac tissue valve, and this technique has provided a considerably more suitable and durable tissue valve substitute. To increase further durability of valve tissue, Reis and his colleagues designed a flexible stent to reduce the stress on the heterogeneous tissue valve mounted. However with the advent of more innovative mechanical valve currently, many bioprosthetic valves are being substituted by mechanical valves at our department of cardiothoracic surgery because of bioprosthetic valve failure. Main cause of bioprosthetic valves failure were calcification or/and tear of tissue valves. The purpose of this retrospective study is to clarify the relationship between the patients clinical profile during implantation of tissue valves and pathologic features of the failed bioprosthetic valve. From March, 1982 through June, 1988, 53 bioprosthetic heart valves that had been ex-planted from 45 patients at the department of cardiac surgery of Yonsei University Hospital were subjected to this study. The patients were 10 to 65 year-old [mean age: 30.3 yr] with 17 males and 28 females. Re-replacements of prosthetic valves were carried out twenty nine in mitral position, eight in aortic position and eight in both aortic and mitral position simultaneously. The grading and location for calcification of valves were verified by radiograms. The calcification of the explanted valves leaflets was graded from 0 to 4 plus according to Cipriano and associates method. The types of tear and perforation of leaflet were classified into four types as Ishihara has adopted initially in 1981. In younger age group under thirty three years, explanted tissue valves were significantly more affected in terms of grades of severity of valve calcification as compared with older age group [p < 0.035]. Valve calcification appeared more severe in male as compared to female [p< 0.002]. Ionescu-Shiley bovine pericardial bioprosthetic valves showed more severe calcification than Hancock porcine tissue valves [p< 0.035]. Calcium deposit was found very prevalent at the area of commissural attachment [86 % of all]. Type I of valve rupture was shown to be related with simultaneous calcification. However, the relation of explanted valve position, duration of implanted prosthetic valve, atrial fibrillation and anticoagulant therapy to the severity of bioprosthetic valve calcification were not significantly clear statistically [p > 0.05].

• Journal of Chest Surgery
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• 제47권6호
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• pp.504-509
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• 2014

Background: Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. Methods: We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. Results: In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. Conclusion: We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1102-1110
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• 1996

1955년 9월 부터 1995년 7월까지 230례의 승모판치환수술이 시행되었다. 이 중 남자는 77명 여자가 153명이 었고 평균 연령은 35.7였다. 동반된 수술은 대동맥 판막치 환술(40례), 삼첨 판윤성 형술(25례), 대동맥판치환술+삼첨판성형술(8례),삼첨판치환술(2례)등이 있었다. 139례의 기계판막과 91개의 조직판막이 치환되었으며, 판막의 크기와 사용된 수는 31 mm(75개), 29mm(66개), 33mm(46개), 27mm(29개) 및 25mm(14개) 등이었다. 수술전 NYHA 기능적 등급은 II(76례), III(123례), IV(31례)였으며 술후 I(175례), II(49례) 등으로 호전되었다. 술후 조기 합병증은 28에서 발생하였으며 저심박출증씨 8례로 가장 많았다. 조기사망은 6례 (2.6%)였으며 사망원인은 저심박출증(2례), 부정맥(2례), 심장파열(2례) 등이 었다. 총 추적 기간 누계는 764.4 환자-년이었으며 평균추적 기간은 43.9개월이었다. 판막과 유관한 장기 합병증은 21례에서 발생하였으며 이중 판막파괴가 10례(1.3%1환자-년), 항응혈제 출혈 5례(0.7%/환자-년), 심내막염 4례(0.5%1환자-년) 혈색전증 2례(0.3%/환자-년) 등이었고 심장에 연유한 사망은 5례(0.7%/환자-년)에서 발생하였다. 9년 장기추적중 합병증 및 사망비발생률이 판막 상호간에 유의한 차가 없었으나 판막파괴비 발생률이 기계 판막(100%)과 조직 판막(34.4%) 사이에 유의한 차가 있었다(p=0.032). 9년간 보험통계적 생존률은 96.6%였다.

• Journal of Chest Surgery
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• 제37권4호
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• pp.369-372
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• 2004

인공판막 혈전에 의한 관상동맥 폐쇄 후 발생하는 급성심근경색은 드물지만 치명적인 질환으로 환자들의 생존율을 높이기 위해서는 빠른 진단과 적절한 치료가 중요하다 본원에서는 기계승모판막 혈전에 의한 좌전하행지의 폐쇄로 급성심근경색이 발생한 환자 1예에서 중재시술 및 항혈전요법 후 승모판 재치환술을 성공적으로 시행하였기에 증례 보고하는 바이다.

• Journal of Chest Surgery
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• 제18권1호
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• pp.54-61
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• 1985

One-hundred-and-seven patients were the consecutive cases of double replacement of the mitral and the aortic valves at the same time using the lonescu-Shiley bovine pericardial xenograft valve during the period between May, 1979 and June, 1984. They were 64 males and 43 females, and their ages ranged from 13 to 62 years [mean age, 34.011.9 years]. Eight patients died within 30 days after surgery [operative mortality rate, 7.5%], and 7 others thereafter [late mortality rate, 6.5%; or 4.21%/patient-year]. Ninety-nine early survivors were followed up for a total duration of 166.1 patient-years [mean duration, 20.116.1 months]. Two patients experienced thromboembolic complication with no death [1.20%/patient-year]; five developed prosthetic valve endocarditis [3.01%/patient-year] with one death; and three had a new development of aortic regurgitant murmur and they were, along with a mortality from endocarditis, classified into the cases of tissue valve failure [2.41%/patient-year]. The actuarial survival rate including the operative mortality was 82.24.7% at 6 years after surgery. The probabilities of freedom from thromboembolism and from valve failure were 97.61.7% and 88.67.6% at 6 years respectively. Symptomatic improvement was excellent in most of the cases at the follow-up end, showing the mean of the postoperative NYHA Classes of 1.120.33 from the preoperative one of 2.860.54. These results compares favorably with the ones reported from the major institutions. Clinical results of isolated replacement of the mitral valve and of the aortic valve were previously reported. The clinical results of a total and consecutive patients with replacement of single mitral and single aortic and double mitral and aortic valves on the mortality rate, survival rate, complication frequency, and symptomatic improvement all fully stands for the good therapeutic modalities of the valvular heart diseases with severely damaged lesions.

• Journal of Chest Surgery
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• 제11권3호
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• pp.303-315
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• 1978

During the full 10-year period from June 1968 through June 1978, 112 consecutive patients underwent isolated or double valve replacement. A total of 130 valves were used in aortic, mitral or tricuspid positions: 63 prosthetic valves in 56 and 67 glutaraldehyde-preserved porcine aortic valves in 56 patients. There were 31 early and 9 late deaths with a cumulative mortality rate of 35.7 percent. Eighty-five patients survived longer than 10 days postoperatively were studied for the occurrence of thromboembolism and complications related to anticoagulant therapy. At the end of follow-up period, 68 patients were on Coumadin; 74 were on Persantin with or without Coumadin; 11 were off any antithrombotic drugs with 6 of them being off electively after 6 months of tissue valve replacement. Thromboembolism occurred in 7 [8.2%] of 85 patients or 10.9%/patient-year. Embolic rates were as follows: one of 18 patients anticoagulated [5.6%] or 6.1%/patient-year and 4 of 16 patients not anticoagulated [25.0%] or 17.8%/patient-year for the prosthetic valve replacement; and one of 40 patients anticoagulated [2.5%] or 7.9%/patient-year and one of 11 patients not anticoagulated [9.1%] or 7.9%/patient-year for tissue valve replacement. Three complications of major bleeding were experienced by 3 patients during the follow-up period, being related to Coumadin therapy. The importance of proper anticoagulation were stressed for the successful management of patients after cardiac valve replacement, both prosthetic and tissue valves.

• Journal of Chest Surgery
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• 제17권4호
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• pp.672-677
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• 1984

Thromboembolism is a major cause of morbidity and death following implantation of cardiac prosthetic devices. Effective systemic anticoagulation is very important. The presence of thrombus can often be detected by pulmonary edema associated with the disappearance of valve clicks. 2-D echocardiography and phonocardiography are also valuable tools. The most common treatment is reoperation and replacement after discovery early. We have experienced one death of fatal thromboembolism after St. Jude valve replacement was done in 48 years old male diagnosed of severe mitral stenosis. He was treated with warfarin, aspirin, ticlopidine for 10 weeks but died suddenly. At autopsy, valve dysfunction was seen due to organic thrombus arising from atrial septum and confirmed with microscopic findings.