• Journal of Chest Surgery
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• 제11권2호
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• pp.194-198
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• 1978

Congenital aortic stenosis, a relatively uncommon congenital heart disease, may cause heart failure and may be fatal. In recent years, increased clinical awareness and improved diagnostic and operative technique has made accurate diagnosis and successful treatment possible. Recently we experienced 2 cases of congenital aortic stenosis, and which was corrected surgically. The first case was 9 years old boy, and second case was 16 years male. Preoperative diagnosis was entertained by angiography and cardiac catheterization in both cases. In each case, aortic valve opening was widened by incision along the fused commissure between the combined left and right coronary cusp on one side, and the noncoronary cusp on the other side. Post-op. pressure gradient between the aorta and left ventricle markedly reduced, in the first case, 50mmHg, and in the 2nd case, 55mmHg.Both patients discharged with good results 2 weeks after open heart surgery.

• Journal of Chest Surgery
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• 제13권4호
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• pp.455-461
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• 1980

This is one case report of surgically treated ventricular septal defect [VSD] with aortic insufficiency [AI] at department of thoracic and cardiovascular surgery, Hanyang university hospital. He had had progressive dyspnea on exertion and palpitation for 3 years prior to admission to our hospital. On examination, the blood pressure was 120/0 mmHg and the pulse rate 88 times/min. Bobbing motion of the head, Water hammer pulse, Corringan`s pulse, Quincke`s pulse and to and fro murmur were present. The heart murmur was consistent with .VSD and AI. Cardiomegaly was seen in chest X-ray. EKG, echocardiogram, aortogram and right heart catheterization was performed. On Sep. 9, 1980, open heart surgery was performed under the impression of VSD with AI. Infracrystal type VSD measuring 2 x 1.5 cm in diameter was closed with Teflon patch graft through the transverse ventriculotomy. AI was due to prolapsed, elongated right coronary and noncoronary cusp, especially noncoronary cusp. The prolapsed, elongated aortic leaflets were plicated by placing three 8-figure sutures between the free edge and the base of the leaflet [Frater`s method] through a transverse aortotomy. Postoperatively, he made an uneventful recovery, his blood pressure was 120/70 mmHg and showed no signs AI or residual shunt at discharge.

• Journal of Chest Surgery
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• 제17권2호
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• pp.244-249
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• 1984

Surgical treatment of partial endocardial cushion defect was accomplished in Feb. 1984 in this department. The 5 year old male patient had history of frequent upper respiratory tract infection and since his age of 3 years dyspnea on exertion and palpitation were noted but there were no cyanosis and clubbing. A thrill was palpable on the apex and grade IV/IV harsh systolic ejection murmur and diastolic murmur was audible on it. Liver was palpable about 3 finger breadths and no ascites. Chest X-ray revealed increased pulmonary vascularity, moderate cardiomegaly [C-T ratio; 0.69], and enlarged left atrium. EKG showed first degree heart block, RVH, LVH, and LAD. Echocardiogram showed paradoxical ventricular septal movement and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted left to right shunt [Qp:Qs:2.1:1 ] and moderate pulmonary hypertension [60/40 mmHg]. Left ventriculogram showed mitral regurgitation [Grade III/IV] and filling of left atrium and right atrium nearly same time. Operative findings were: 1.Primum type atrial septal defect [3x2 cm] 2.Cleft on the anterior leaflet of mitral valve. 3.No interventricular communication and cleft of tricuspid valve leaflet. The mitral cleft was repaired with 4 interrupted sutures. The primum type atrial septal defect was closed with Dacron patch intermittently at endocardial cushion and continuously remainder. The post operative course was uneventful and discharged on 22nd postoperative day in good general conditions.

• Journal of Chest Surgery
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• 제20권4호
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• pp.798-802
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• 1987

Origin of both great vessels from morphological left ventricle [DOLV] is a rare cardiac anomaly which embryologic possibility has been explained by differential conal development concept and differential canal absorption concept. Recently we had surgical experience of DOLV in 4 month-age infant weighing 5.7Kg. The chief complaints on admission were cyanosis and anoxic spell during severe crying, and right heart catheterization and right ventriculogram were performed but incorrect diagnosis was made. The operative procedures were ligation of patent ductus arteriosus, patch closure of subaortic VSD aligning aorta and pulmonary artery with left ventricle, suture closure of proximal pulmonary artery and valve and the use of extracardiac valved conduit [Carpentier-Edward l4mm] from right ventricle to distal pulmonary artery. Postoperative course was uneventful and discharged in the good condition.

• Journal of Chest Surgery
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• 제20권2호
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• pp.411-415
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• 1987

We have experienced a rare case of traumatic ventricular septal defect caused by fall down injury. The patient suffered from congestive heart failure after trauma and represented new developing typical murmur. Cardiac catheterization revealed a large left-to-right shunt at the ventricular level and a 4.4:1 ratio of pulmonary to systemic flow. Left ventricular angiogram also showed ventricular septal defect low in the muscular septum. At operation, the right ventricle and pulmonary artery were found to be moderately dilated. A marked systolic thrill was palpable over the right ventricle near the apex. Through a small left ventriculotomy an oval defect, 2x.3 cm with a firm scarred margin, was found in the lower muscular ventricular septum. This defect was repaired using Dacron patch and ventriculotomy was closed with long strip of Teflon felt. Postoperative course was uneventful and discharged in good condition.

• Journal of Chest Surgery
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• 제12권2호
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• pp.119-126
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• 1979

This is one case report of the extremely rare congenital cardiac malformation, Double-outlet of left ventricle in corrected transposition of great arteries. 11-year-old boy complained acrocyanosis and exertional dyspnea, the parents noticed cyanosis since birth. Physical examination revealed acrocyanosis, clubbed fingers and toes, G-III pansystolic murmur on 2nd and 3rd ICS, LSB. Right heart catheterization revealed significant $O_2$ jump in ventricular level. Right and left ventriculography showed the both catheters arriving in the same ventricle i.e. anterior chamber, morphological left ventricle was in right and anterior position, simultaneous visualization of aorta and pulmonary artery and aorta locating anterior and right side of pulmonary artery. Echo cardiogram surely disclosed interventricular septum. Conclusively it was clarified that the patient has Double-outlet of left ventricle and corrected transposition of great arteries [S.L.D.]. Operation was performed to correct the anomalies under extracorporeal circulation with intermittent moderate hypothermia. Right-sided ventriculotomy disclosed the following findings. 1. Right-sided ventricle was morphological left ventricle. 2. Left-sided ventricle was morphological right ventricle. 3. Right side atrioventricular valve was bicuspid. 4. Left side atrioventricular valve was tricuspid. 5. Aortic valve was superior, anterior and right side of pulmonary valve. 6. Subpulmonary membranous stenosis. 7. Non-committed ventricular septal defect. We made a tunnel between VSD and aorta with Teflon patch so that arterial blood comes through VSD and the tunnel into aorta. After correction the patient needed assisted circulation for 135 min. to have adequate blood pressure. Postoperatively by any means, adequate blood pressure could not be maintained and expired in the evening of operation day.

• Journal of Chest Surgery
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• 제27권5호
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• pp.353-363
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• 1994

From January 1978 to December 1992, 59 patients of double chambered right ventricle were repaired. Surgical correction consisted of closure of the ventricular septal defect and resection of anomalous muscle bundles through right ventriculotomy [Group I ; 34 patients] or right atriotomy [Group II ; 25 patients]. Between these two groups, there was no difference in the operation time and the postoperative results. All patients survived. In group I, hemodynamically significant residual ventricular septal defect was found in three and reoperations were necessary. In one patient, subacute bacterial endocarditis developed postoperatively. In group II, complete atrioventricular block developed in one and mediastinitis in two. Follow-up period was from 2 to 75 months [mean 17.1 months]. There was no late death. All patients have remained in sinus rhythm except one patient. Careful evaluation of echocardiographic and catheterization data preoperatively and careful examination of the anatomy intraoperatively are necessary so that double chambered right ventricle should not be overlooked, because most ventricular septal defects are now closed through the right atrium. Repair of double chambered right ventricle is also easily performed through the atrial approach. Transatrial repair should be considered as an alternative to the transventricular approach in patients with this congenital heart defect. Successful surgical correction of double chambered right ventricle is expected with excellent long term results.

• Journal of Chest Surgery
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• 제29권5호
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• pp.559-563
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• 1996

We have experienced a patient, 16 year-old male, with ventricular septal defect with tricuspid recur- gitation due to blunt chest trauma. He suffered from congestive heart failure after the trauma. Echocardiogram and cardiac catheterization revealed left to right shunt at the ventricular level (muscu- far portion of interventricular septum) and tricuspid regurgitation. At the time of the operation, marked systolic thrill was palpable over the rlght ventricle near the apex and a chorda tendina was seen sharply ruptured just near the medial papillary muscle. We repaired the ventricular septal defect with a Dacron patch and chordal reconstruction with autologous pericardium. The postoperative course was uneventful and the patient was discharged in good condition.

• 대한핵의학회지
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• 제20권2호
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• pp.47-52
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• 1986

A noninvasive procedure for diagnosis and quantitation of right-to-left intracardiac shunts will enhance the management of patients with cyanotic congenital heart disease. This study describes an application of radionuclide (RN) angiocardiography for quantitation of right-to-left shunt amount. Gamma variate model was fitted to radionuclide data recorded over the carotid artery. Data analysis was performed retrospectively in 35 patients who underwent cardiac catheterization within a week from the day of RN angiocardiography. Thirty one of the patient had right-to-left shunts and 4 of them had left-to-right shunts. Both the radionuclide and Fick measurements correlated well (r=0.93, 0.93, 0.89, p<0.01 in each measurements). Therefore, RN angiocardiography data may be used for accurate calculation of right-to-left shunts in cyanotic congenital heart disease patients.

• Journal of Chest Surgery
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• 제11권2호
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• pp.185-193
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• 1978

Between April 1976 and March 1978, six cases of tricuspid valve replacement were done in the Department of Thoracic Surgery, Seoul National University Hospital. There were 4 men and 2 women and the age of the patients ranged from 17 years of the youngest to 48 years of the oldest. Most of them had characteristic symptoms of tricuspid valve disease, such as a systolic murmur audible over the lower sternum and varying with respiration, pulsatile and distended neck vein, and an enlarged and pulsatile liver. Preoperative functional levels according to NYHA Calcification were class III in 4 cases, and class IV in 2 eases. Most of the cases showed moderate to severe cardiomegaly in chest films and elevated right atrial pressure on preoperative right heart catheterization. Five of them underwent concomittent mitral valve replacement and one pulmonary valvotomy. All of them showed tricuspid insufficiency resulted from massive dilatation of annulus, destructive lesions of valve structure, or both anomalies. One postoperative hospital death was encountered and the cause of death was low out-put syndrome. All survivors showed clinical improvement and cardiomegaly regressed and left hospital in a good condition . *Attendum; Recently 2 more cases of tricuspid valve replacement with mitral valve replacement were done after this review.