• Journal of Cardiovascular Imaging
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• 제31권4호
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• pp.191-199
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• 2023

BACKGROUND: Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS: We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS: A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS: Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.

• Journal of Chest Surgery
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• 제17권3호
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• pp.346-355
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• 1984

77 cases of Aortic Valve Replacement, which were composed of 64 rheumatic valvular heart disease and 13 combined congenital heart disease, were operated at Seoul National University Hospital for Aortic valvular disease during the period from June 1968 to December 1983. Among these 64 rheumatic aortic valvular heart disease cases, 8 patients were expired during and immediate after operation and overall mortality rate was 12.5%. For more precise remarks, these patients were divided into two periodic groups, 1st period [from 1968 to 1976] and 2nd [from 1977 to 1983] when annual open heart surgery were over 100 cases, and in 1st period three of four patients were died and in 2nd period five of sixty patients were died and its mortality rate was 8.3%. There were 12 cases of postoperative complication, which were 3 cases of remaining other valvular heart disease required MVR, 2 paravalvular leaks [one of them got Redo AVR], 4 thromboembolism or problem of anticoagulant therapy, 2 late death due to SBE with replaced valve failure and one functional AS with small sized valve. Operative death was affected by pump-time and aortic cross-clamping time, heart size, Ejection Fraction, LVEDP and symptom duration, and other many factors may influence the survival rate. Improved operative technique and myocardial protection and meticulous evaluation of the preoperative patient status will make the AVR safer.

• Journal of Chest Surgery
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• 제21권2호
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• pp.276-282
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• 1988

Surgery is now the usual mode of therapy in patients with severe valvular heart disease. Until recently, clinicians and pathologists attributed nearly all acquired valvular heart diseases to a rheumatic origin, except some obviously resulting from acute infection and syphilis. Although many clinicians and pathologists describe that the origin of aortic valvular disease is a nonrheumatic origin, we recognize the major origin of aortic valvular disease in Korea as a rheumatic origin. We excised 47 cardiac valves from valvular heart diseased patients and performed anatomical and pathological analysis for its origin and underlying pathology. The purpose of this article is to provide an update for the clinicians of evolving issues related to the pathology of valvular heart disease. But myxomatous origin and infective endocarditis valvulitis will not be covered in detail.

• 대한한방내과학회지
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• 제22권3호
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• pp.463-469
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• 2001

Valvular heart disease is one of the main current of cardiac problems and has many problems must be solved by sequelae and complications, etc. Rheumatic Mitral Stenosis is mainly attacked by rheumatic fever and developed by process of treatment of mitral valve or formation of trace. The purpose of this study is to examine the efficacy of oriental treatment for Cerebral Infarction with Rheumatic Mitral Stenosis. At the time of visiting ER, he was shown the symptoms of dull mentality, Rt. hemiplegia, global aphasia, dysphagia, chest discomfort, insomnia, dyspnea, etc, It showed that Atrial fibrillation in EKG monitoring, Atrial fibrillation, Rheumatic Mitral Stenosis, Ejection-Fraction slope 60% in Cardiac echography, Lt. atrial hypertrophy, Rt. atrial hypertrophy, Rt. ventricular hypertrophy with pulmonary congestion in chest X-ray. From the view of oriental diagnostic criteria. We classified the patient's clinical conditions and treated accordingly. As a result of treatment, symptoms were markedly improved and he was discharged. Further elaboration of oriental diagnostic classification could possibly lead to the fundamental treatment.

• Journal of Chest Surgery
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• 제20권2호
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• pp.300-308
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• 1987

Clinical and pathologic data were reviewed in 20 patients who had have surgery for isolated aortic valvular heart disease between April 1978 and April, 1987. Hospital mortality was 10%, with no additional late mortality during a mean follow-up period of 24.1 months. Prosthetic valve failure developed in 3 patients and two had reoperation. Niety four percent of the survivors who were in NYHA Funtional class III or IV before operation are now in class I or II. Ninety percent of all patients are still alive at a maximum follow up of 9 years. The clinical histories, gross and histologic examination of valves estabilished the causes for isolated aortic valve disease: 3 rheumatic, 2 congenital bicuspid, 2 hypertention, 2 aortitis and each one case of floppy valve, medial cystic necrosis of aorta, bacterial endocarditis. But etiology was unknown in 8 cases. Sixteen patietns had myxoid degeneration, defined as significant disruption of the valve fibrosa and its replacement by acid mucosaccharides and cystic changes. Myxoid degeneration was also the primary pathologic abnormality in the patients with 2 hypertention, 2 rheumatic, 1 aortitis, 1 bacterial endocarditis, 1 floppy valve, 1 congenital bicuspid. The patients with myxoid degeneration of uncertain origin were 8. Histologic finding of all of them revealed nonspecific patients with myxoid degeneration of uncertain orgin were 8. Histologic finding of all of them revealed nonspecific chronic valvulitis with myxoid degeneration. This finding may indicate that the etiology w uld be infectious.

• Journal of Chest Surgery
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• 제31권4호
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• pp.346-352
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• 1998

심장 초음파에 의한 류마티스성의 심장판막질환은 판첨이 융합되고 건삭이 짧아져 판막운동이 제한되는데 융합이 심하면 협착이되고 퇴축이 심하면 폐쇄부전이 일어난다. 이러한 초음파적인 소견과 수술시야에 직접 관찰되는 교련융합과 판엽의 비후, 건삭의 융합과 단축 심하면 석회침착 등의 소견 및 병리조직학적인 소견으로 확인된 류마티스성 심장판막질환에 대한 외과적 치료를 시행한 환자 440명을 대상으로 임상적성적을 분석하였다. 기간내의 총판막수술은 502명에서 시행되었으며 이중 87.3%인 440명이 류마티스성판막증으로 분류되었으며, 여자가 1.3배 많았고 평균년령은 37.8세 였다. 96.3%가 승모판을 침범하였고 대동맥판 19.8%, 삼첨판 16.3%를 침범하였으나 승모판 단독 침범례는 62.5%, 대동맥판 단독은 3.6%, 삼첨판막의 기질적 변화를 보여 외과적 치료를 가한 예는 1.8%에 불과하였다. 수술의 방법으로는 3.9%에서는 판막의 보존적 치료가 가능하였고 96.1%인 323례에서 1개 이상의 인조판막이 사용되었다. 승모판막치환술이 275례, 대동맥판 18례, 70례의 다중판막치환술을 시행하였다. 조기사망율은 보존적치료 예에서 5.9%, 판막치환례에서는 대동맥 5.9%, 승모판 6.0%, 다중판막 19.4%를 기록하였다. 생존례의 90.1%인 364명이 추시관찰이 가능하였는데 총 2890환자년의 추적기간중 뉴욕심장협회기능적 분류상 수술로 평균 2.9도에서 1.3의 상태호전을 보였으며 합병증은 혈전전색 1.3%/환자/년, 출혈성합병증 1.8%환자/년으로 나타났다. 누적생존율은 술 후 1년에 92.7＋/－2.8%, 5년에 88.0＋/－ 4.5%, 10년에 82.3＋/－7.7%였다. 류마티스성질환은 선진국에서는 최근 급격히 감소하고 있다고 하나 저자들의 예에서는 전체판막질환에 대한 수술례의 87.3%를 차지하고 있어 아직도 깊은 관심을 갖고 깊은 연구가 있어야 할 것으로 생각된다.

• Journal of Chest Surgery
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• 제27권12호
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• pp.984-988
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• 1994

Between 1981 and 1992, 22 children from 1 to 15 years of age have undergone cardiac valve replacements at National medical center. The patients were composed of 14 males and 8 females and 7 patients had congenital heart disease and 15 patients had rheumatic heart disease. Three of these 15 patients have had second valve replacement due to prosthetic valve failure[PVF]. Single valve replacement were 20[Aortic 3 cases, Mitral 17 cases] and double valve replacments were 2. The overall mortality was 22.7 %. Actuarial survival rate was 77.28 $\pm$ 8.92 % and Complication free rate was 67.68$\pm$15.56%. The pediatric valve replacements can now be performed at a low operative risk although various problems are still remained and the choice of valve is prosthetic valve mainly due to its durability at the present time.

• 대한간호학회지
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• 제16권3호
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• pp.38-66
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• 1986

Based on the statistical data of FKMIS during five years from 1981 to 1985, the major findings of studying on the treatments of employee's modical insurance covered people were made as follows. 1. During five years, the total number of trratment case was increased 25.14% annually, and so doubled. The consultation rate was increased from 2.086 to 2.856, showng annual increase of 8.17% and total increase of 36.91%. In the cafe, of in-patient, the rate was from 0.056 to 0.602, . showing annual increase of 2.58%. And in out-patient, the rate was from, 2.030 to 2.794, showing annual increase of 8.31%. The male: female ratio of treatment case was changed from 1 : 1.1 to 1 : 1.2. 2. Case of chronic disease was on the increase .every year. The ratio of medical expenditure of that disease to the total medical expenditure was increased from 22.99% in 1984 to 25.0% in 1985. 3. As a whole, the consultation rate of circulatory disease was increased from 26.10 in 1981 to 46.53 in 1985, showing an nual increase of 15.55 %. The rate of in-patient was increased from 2.06 to 2.94, showing annual increase of 9.30%. The rate of out-patient wag from. 24.04 to 43.59, showing annual increase of 16.04%. 4. The duration (days) of circulatory disease in 1985 by types is as follows. In the case of in-patient, rheumatic fever rheumatic heart disease, (22. 67), ischaemic disease (17.39), cerebrovascular disease (17.18), disease of pulmonary circulation and other from of heart disease (15.82), hypertensive disease (13.18), other disease of circulatory disease(11.55). In the case of out-patient, visiting day (11.57 day) and medical expenditure per case (7,853 won) is lower than that of other diseases (4.39 day, 4,361 won). 5. Cases of circulatory chronic disease were two times as many as those of non-chronic disease. Incidence of the out-patient was shown higher than that of in-patient. In the case of duration per case, the chronic disease(12.92 days) was longer that of non-chronic disease (9.8 day). 6. The male: female ratio of chronic rheumatic heart disease is 34.56 : 65.44 (in-patient) and 34. 67 : 65.33 (out-patient). The consultation rate(case per 1,000 persons) was increased from 1.11 in 1983 to 1.30 in 1985, showing annual increase of 8.22 %. The duration, visiting day, was decreased slightly, but medication day wasincreased from 13.93 in 1983 to 16.72 in 1985, showing annual increase of 9.56%. 7. The male: female ratio of hypertensive disease (case) was 39.36 : 60.64(in-patient) and 40.67 : 59.33 (out-patient). The consultation rate was increased from 19.59 in 1983 to 25.36 in 1985, showing annual increase of 13.78%. Duration, visting day was decreased slightly, but medication day was increased from 11.82 in 1983 to 12.77 in 1985, showing annual increase of 3.94%. 8. The male： female ratio of chronic pulmonary-ischaemic heart disease (case) was 48.90 : 51.10 (in-patient) and 43.66 : 56.34 (out-patient). The consultation rate of chronic pulmonary-ischaemic heart disease was increase from 0.69 in 1983 to 1. 12 in 1985, showing annual increase of 27.40％. Duration, visiting day, was decreased from 2.67 in 1983 to 2.36 in 1985, and medication day was decreased from 0.69 in 1983 to 1.12 in 1985, showing annual decrease of 2.09%. 9. The male: female ratio of cerebrovascular disease (case) was 47.90 : 52.10 (in-patient) and 52.28 : 47.72 (out: patient). The consulatation rate was increased from 2.12 in 1983 to 2.89 in 1985, showing annual increase of 16.76%, Duration, visiting day, was decreased slightly, but medication day was increased from 12. 67 in 1983 to 13.85 in 1985, showing annual increase of 4.55%. 10. In case of artery and capillary disease, the male: female ratio of case was 61.80 : 38.20 (in-patient) and 51.77 : 48.23 (out-patient). But durntion, visiting day, was increased from 3.45 in 1983 to 3.60 in 1985, showing annual increase of 2.15 % and the medication day was increased from 10. 06 to 10.18, showing annual increase of 0.59%.

• Journal of Chest Surgery
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• 제39권9호
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• pp.681-691
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• 2006

배경: 본 연구에서는 류마티스성 승모판막질환과 동반된 만성 심방세동의 치료에서 냉동절제술을 이용한 변형 maze 술식들의 동율동 회복률 및 중기 결과에 대해 알아보고자 하였다. 대상 및 방법: 2000년 3월부터 2004년 2월까지 류마티스성 승모판막질환과 동반된 만성 심방세동 환자에서 승모판막수술과 동시에 냉동절제술을 이용하여 변형 maze술을 받은 177명의 환자를 대상으로 Cox-maze III (CM군, n=88), Kosakai-maze (KM군, n=63), 그리고 Left atrial maze (LA군, n=26) 세 군으로 분류하여 수술 전, 후 결과 및 동율동 회복률과 중기 결과에 대해 후향조사하였다. 결과: 술 후 병원 사망은 CM군 2명(2.3%)과 KM군 1명(1.6%)을 포함한 3명(1.7%)에서 있었으며 술 후 합병증 발생률에서 세군 간에 차이는 없었다. 총 체외순환 및 대동맥차단 시간은 CM군에서 다른 두 군에 비해 유의하게 길었다(p<0.0001). 생존자 174명에서 평균 $22.4{\pm}15.1$개월($1\sim52.6$개월)을 추적조사한 결과 만기 사망은 CM군 1명(0.6%)에서 있었다. 마지막 추적조사에서 동율동 회복률은 전체환자의 79.9%, CM군 77.9%, KM군 80.7% 그리고 LA군에서는 84.6%였다(p=0.743). 술 후 4년 동안 뇌졸중으로부터의 자유도는 CM군 $84.6{\pm}9.4%$, KM군 $95.0{\pm}:4.9%$ 그리고 LA군에서는 $92.9{\pm}6.9%$였다(p=0.916). 결론: 류마티스성 승모판막질환과 동반된 만성 심방세동 치료에서 승모판막수술과 동반하여 시행하는 냉동절제술을 이용한 변형 maze 술식들은 비교적 안전하게 시행될 수 있으며 심방세동 치료에 효과적이다.

• Journal of Chest Surgery
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• 제18권1호
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• pp.75-78
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• 1985

From April, 1984 to January, 1985, 57 cases of cardiovascular surgeries were performed at Yeung Nam University Hospital consisting 31 cases of open heart surgery and 26 cases of ligating patent ductus arteriosus. Among 31 cases of open heart surgery, all cases are congenital acyanotic heart disease except a case of rheumatic aortic valvular heart diseases taken aortic valve replacement with Bjrk-Shiley 25mm. Only 2 cases of transient hemoglobinuria were complicated. A case of surgical mortality was present died of acute respiratory failure and intractable arrhythmia, which resulting 3.2% of mortality rate.