• Journal of Chest Surgery
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• v.20 no.1
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• pp.48-54
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• 1987

This report provides follow-up data on 557 patients [73 aortic, 357 mitral, and 127 multiple valve replacements] undergone lonescu-Shiley pericardial Xenograft valve replacement at Seoul National University Hospital between January, 1979 and December, 1985. There were 35 early death [6.3%] and 522 operative survivors were observed, and the cumulative follow-up is 1,140 patient-years [mean: 2.18 years per patient] The thromboembolic complications occurred in 34 cases [3.0% per patient-year] and the rate was 2.1% per patient-year for mitral and 0.3% per patient-year for aortic valve replacement in the presence of anticoagulation therapy. Among the 34 embolic episodes, 9 patients were dead [0.8% per patient-year] and the cause of death were 5 cerebral thromboembolism, 2 pulmonary embolism, and 2 intracerebral hemorrhage due to inappropriate anticoagulation after thromboembolic episode. Actuarial probability [+ SEM] of remaining free of thromboembolism for AVR is 88.1 x 11.1% at 5 years, for MVR 79.1 a 13.4% at 7 years and for multiple valve replacement 77.2 e 5.21% at 7 years. The incidence rate of thromboembolic complications after AVR is not less than that of MVR [0.3 Among the potential thromboembolic risk factors, atrial fibrillation is possible risk factor to increase the thromboembolic complication [0.05 < P < 0.1], but the importance of other factors, such as atrial clot, large left atrial size, mitral position, NYHA functional class, and age is less definite. A careful follow-up and the proper control of anticoagulation without omission, poor control, and arbitrary withdrawal is important for the successful management of the thromboembolic complications and the anticoagulation-related morbidity and mortality.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.458-472
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• 1987

A heart supplies bloods of about 15, 000 liters to each human organ in a day. A normal function of heart valves is necessary to this act of heart. The disease of heart valve develops to a narrowness of a closure, resulting in an abnormal circulation of bloods. In an attempt to eliminate the affliction of heart valves, the operation method to repair with artificial heart valves has been developed and saved numerous patients over past 30 years. This replacement operation has been performed since early 1960`s in Korea, but all the artificial heart valves used are imported from abroad with very high costs until recent years. The artificial heart valve using pyrolytic carbon has been developed at KAIST, which was proved to be stable in the mechanical performance and durability. Therefore, the in viva performance of this valve was examined through animal tests. The artificial heart valves used in this study are tilting disc type valves, in which the disc were made of graphite coated with pyrolytic carbon and the cages were made of titanium. In viva testings of these valves were performed in 12 dogs, in which right ventriculo-pulmonary arterial [Croup I] or inter-aortic [Croup IV] valved conduit was implanted using polytetrafluoroethylene conduits containing KAIST valve and aortic valve [Group II] or pulmonary valve [Croup III] was replaced by a KAIST valve with a 21mm or 19mm tissue annulus diameter. In group I and II, pre-and post-operative transvalvular pressure gradient was measured and compared with other prosthetic valves. During post operative period laboratory examination was performed including hemoglobin, hematocrit, red cell count, white cell, lactic acid dehydrogenase and platelet. The eight surviving dogs were sacrificed and autopsy was performed at 2, 6, and 8 weeks. KAIST valve has low transvalvular gradient and relatively high orifice area. Average ventriculo-aortic peak systolic transvalvular gradient was 14 mmHg in 21 mm valve and 19 mmHg in 19 mm valve. The valve has slight intravascular hemolysis effect. Thrombogenic effect of low polishing quality and eddy currents around small orifice is high. The valve has vulnerability of disc movement. These animal tests suggest that the improvement of the heart valve design, surface polishing state and prescription methods.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.602-613
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• 2010

Background: As life expectancy has been increased, the cardiac valve disease has been increased. In past, mechanical valve for valve replacement surgery was used widely, but it has many weaknesses, such as hemorrhage, teratogenic effect caused by warfarin, acute mechanical failure, taking warfarin during life, etc. So, the tissue valve is used widely and researches for durability of tissue valve are in progress. Tissue valves being used are all imported in Korea, and there is a lack of information on its geometry and design. So, we studied the geometry of porcine aortic and pulmonary valve, and tried to suggest theoretical basis for making the aortic and pulmonary valve. Material and Method: We harvested aortic and pulmonary valves of 25 pigs and measured the geometry of valve at fresh and glutaraldehyde (GA) fixed state. In each group, we measured the diameter of the base, diameter of commissure, valve height, commissural height, etc. Also, for making implantable porcine and bovine pericardial valve, we designed the valve stent form, thickness, height, and leaflet size, form, thickness by different size of valve. Result: The aortic and pulmonary valve geometry and ratio were measured in each group. The right coronary cusp of aortic valve and right facing cusp of pulmonary valve was bigger than other cusps and non coronary cusp was smaller than others (RCC: NCC : LCC=1 : 0.88 : 1). Valve height was correlated to the leaflet size. We designed the outer diameter of stented porcine aortic valve from 19 mm to 33 mm and designed stent height and width, using previous measured ratio of each structure, stent thickness, working thickness (for making valve). Also, we designed the size of stent and form for stented bovine pericardial valve, considering diameter of valve, leaflet length, height and leaflet minimum coaptation area. Conclusion: By measuring of 25 pig's aortic and pulmonary valve geometry and ratio, we can make theoretical basis for making implantable stented porcine valve and bovine pericardial valve in various size. After making implantable valve using these data, it is necessary to do in vivo and in vitro researches, furthermore.

• Journal of Chest Surgery
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• v.16 no.4
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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.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.144-147
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• 2014

Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.183-190
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• 1979

A 23-year-old male patient complained dyspnea on exertion and orthopnea since December 1977. On examination, he was tall and slender. There was grade IV/VI to-and-fro murmur on the left sternal border especially on Erb`s point. The liver was descended 2 fingers breadth below right costal margin. There were no signs of Marfan`s syndrome. Echocardiography demonstrated partial closure of aortic valve and dilated aortic root with enlargement of ascending aorta. Left heart cardiac catheterization revealed moderately elevated pulmonary wedge pressure and right ventricular pressure. The left ventricular end diastolic pressure was markedly elevated to 26 mmHg. On aortography, the aortic regurgitation was severe and it was belonged to angiographically Grade IV. The aortic valve was replaced with Carpentier-Edwards valve without excision and replacement of ascending aorta, under the impression of rheumatic valvular heart disease. After closure of aortotomy, blood pressure was transiently elevated and bleeding from the site of inserting air vent needle of ascending aorta was developed. The bleeding was not controlled by any means. On postmortem microscopic study, the histologic changes were strikingly limited to the ascending aorta from the region of the aortic valve ring.

• Journal of Chest Surgery
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• v.25 no.7
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• pp.750-755
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• 1992

We report a case of leaflet embolization of central leaflet fracture a 31mm mitral Edw-ards-Duromedics prosthesis. A leaflet was fractured to two segments, a larger one embolized to right common iliac artery and a smaller one to left femoral artery, respectively. Patient was reoperated with 29mm mitral Carbomedics prosthesis and incidentally found of smaller segment in left femoral artery at cannulation site. The embolectomy was done 15 days after cardiac operation through midline abdominal incision, Leaflet escape of a mitral Edward-Duromedics prosthesis is a rare, potentially curable mode of valve failure. After mechanical valve replacement, unexplained heart failure and acute pulmonary edema, mechanical valve failure should be suspected. Correct interpretation of clinical signs, symptoms and fluroscopy should allow early diagnosis of leaflet escape and prompt surgical therapy.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.440-443
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• 1996

Some tricuspid valve endocarditis can be controlled effectively with specific antibiotic treatment. However, surgical intervention Is necessary when there are continuing sepsis, moderate or severe heart failure, multiple pulmonary emboli, and echocardiographycally demonstrated vegitations. We are repoting a 19 year-old male patient who was admitted for the treatment of infective endocarditis. He previously had an operation for ventriculer septal defect (perimembranous type) about 9 years ago . An echocardiogram showed a large vegetation on the anterior cusp area and a left to right shunt through VSD, which was previously closed with dacron patch. A valve replacement in addition to antibiotic therapy was recommended for the patient. The patient underwent on operation : tricuspid valve replacement was done with 51. Jude medical valve prosthesis (33 mm), and in addition to above procedure, removal of vegetation and direct closure of VSD were done Postoperative echocardiogram showed that replaced tricuspid valve functioned well and vegeta ion and shunt flow were not observed. The patient recovered without complication and discharged at Postoperative day 25. Early aggressive surgical intervention is indicated to optimize surgical results, and this case seems to be a typical right sided bacterial endocarditis, which is caused by residual VSD. We are reporting a case of tricuspid valve endocarditis with a review of the literature. (Korean J Thorax Cardiovasc Surg 1996 ; 29: 440-3)

• Journal of Chest Surgery
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• v.17 no.3
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• pp.362-370
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• 1984

The term corrected transposition of great arteries [hereafter referred to as corrected TGA] of the heart in which there is both a discordant atrio-ventricular relationship and transposition of the great vessels. Usually situs solitus is present, while the ventricles are inverted showing an l -loop. The great vessels are transposed and in the l-position so that the pulmonary artery arises from the right-sided morphological left ventricle and the anteriorly l- transposed aorta arises from the left-sided morphological right ventricle yielding an SLL pattern. In the majority of cases, associated lesions are common. The most frequent are ventricular septal defect, obstruction to the pulmonary outflow tract, tricuspid valve incompetence and atrio-ventricular conduction abnormalities. In the rare cases, no associated conditions are present and hemodynamic pathways are normal. In the report, we present one case of a 20 year-old male having corrected TGA associated with severe tricuspid valve incompetence, was corrected by tricuspid valve replacement, directly developed a supra-ventricular tachycardia but was controlled by calcium-entry blocker, verapamil, successfully.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.42-49
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• 1989

A total of 420 pyrolytic carbon mechanical valves were implanted in 336 patients from January, 1984, through Jung, 1988. Of the valves implanted, 131 were Bjork-Shiley, 250 St-Jude, and 39 Duromedics. The cumulative follow-up was 398 patient-years with a mean follow-up of 14.4 months per patients. Among 336 patients, 175 had mitral, 68 aortic, 82 multiple, 10 tricuspid, and one pulmonary valve replacement. The hospital mortality figures were 9 of 336[2.67%] in all, 5 of 175[2.85%] in isolated mitral, 1 of 68[1.47%] in isolated aortic and 3 of 82[3.65%] in multiple valve replacement. The causes of hospital mortality were myocardial failure in 5, sepsis in 2, bleeding in 1, cerebral embolism in l. There was no late valve related mortality. The actuarial survival rate at 4.5years was 99.4*0.1%. The complications occurred in 15 of 336[4.46%]; 7 of 175[4.0%] in isolated mitral, 4 of 68[5.88%] in isolated aortic, and 4 of 82[4.89%] in multiple valve replacement. The causes of complications were thromboembolism in 4, hemorrhage in 4, paravalvular leakage in 4, hepatitis in 2, and complete AV block in l. Actuarial probability of survival at 4.5 years was 95.0*0.1%. The low mortality and complications encourage us to applicate these valves to any patient including children and young women.