• Journal of Chest Surgery
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• v.12 no.1
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• pp.33-42
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• 1979

The present study reports 41 cases of congenital and acquired heart diseases, who received open heart surgery under extracorporeal circulation [ECC] by Sarns Heart-Lung-Machine [HLM] at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital during the` period between July 1975 and February 1979. The priming of pump oxygenator was carried out by the hemodilution method using Hartman`s solution, whole blood, and fresh human plasma. The rate of hemodilution was in the average of 50.8 ml/kg. ECC was performed at the average perfusion flow rate of 85.0 ml/kg/min [2.43 L./ kg/2] and at moderate hypothermia. In the total cardiopulmonary bypass, arterial pressure ranged between 55 mmHg and 90 mmHg, but generally maintaining over 70 mmHg. Patient age ranged between 2 and 54 year old, in congenital heart diseases, between 2 and 28, in acquired heart diseases, between 17 and 54 Sex ratio of male to female was 20:21. The cases include a case of pulmonary valvular stenosis, 4 cases of atrial septal defect, 9 cases of ventricular septal defect, 9 cases of tetralogy of Fallot, 5 cases of pentalogy of Fallot, 3 cases of atypical multiple anomalies 7 cases of mitral stenosis or insufficiency, a case of myxoma in left atrium, and a case of ruptured aneurysm of Valsalva`s sinus. The surgical managements were 16 valvulotomy for pulmonary valvular stenosis, 2 Teflon patch graft closure and 5 simple suture closure of atrial septal defect, 16 Teflon patch graft closure and 5 simple suture closure of ventricular septal defect, 12 pericardial patch graft for infundibular stenosis of right ventricle, one anastomosis between left superior vena cava and right atrium, 2 open mitral commissurotomy, 5 mitral valve replacement using Starr-Edward`s ball valve, porcine xenograft by Hancock, by Carpentier-Edward, or Angell-Shiley, one removal of left atrial myxoma, and a repair of ruptured aneurysm of Valsalva`s sinus. Four [9.7%] out 41 cases expired postoperatively and the rest of 37 cases survived with satisfactory results. The causes of death were one coronary embolism in tetralogy of Fallot, 2 postoperative lower cardiac output in atypical multiple anomalies, and one right heart failure in large: ventricular septal defect with pulmonary hypertension.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.607-612
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• 1997

Between March 1963, and December 1994, fifty-three patients with a ruptured aneurysm of sinus of Vasalva(RSV) were operated. The RSV originated from the right coronary sinus in 43 patients(81%), from the non coronary sinus in 7 patients(13%), and from combined sinuses in 2 patients. The RSV from the right coronary sinus mainly drained to the right ventricle(81.4%), and the RSV from the non coronary sinus mainly drained to the right atrium(71.4%). Recently, we are using patch to repair the RSV through a double approach. During the operation, concomitant . procedures were performed; 32 Patch repairs of VSD, 14 aortic valvuloplasty, 10 aortic valve replacement, 2 tricuspid valvuloplasty, and one Bentall's procedure. During the follow up period between 1 and 31 years(mean 8 years, 94% follow up), there were 2 late deaths and 14 late complications. Actuarial 10-year survival rate .was 95%, and 10-year actuarial freedom from late event was 53 %. Factor analysis revealed that the combined SBE is a risk factor of late event. Actuarial freedom from failure of aortic valvuloplasty was 55% at 9 years. Although surgical repair of RSV achieved excellent long term survival, aortic regurgitation and endocarditis revealed significant risk factor in long-term results. Therefore, more attention should be required in patients of RSV associated with aortic regurgitation or endocarditis.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.321-328
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• 2007

Background: It is very important to determine the surgical anatomy of the aortic root when performing spreading aortic root preserving heart surgery. This study focuses on the surgical aspect of the aortic root anatomy by performing dissection of Korean cadavers. Material and Method: The subjects were 62 cadavers. We measured the intercommissural distances, heights of the sinuses and the circumference of the sinotubular junction and the aortic annulus. Result: The mean age of death was 61.3 years. The intercommissural distance for the right coronary sinus was $0.73{\pm}2.23mm$, that for the non coronary sinus was $19.34{\pm}2.03mm$, and that for the left coronary sinus was $18.58{\pm}2.15mm$. The height of sinus was $20.59{\pm}2.48mm$ for the right coronary sinus, $18.61{\pm}2.26mm$ for the non coronary sinus and $17.95{\pm}19mm$ for the left coronary sinus. The circumference of the sinotubular junction was $70.73{\pm}5.94mm$ and that of the aortic annulus was $77.94{\pm}5.63mm$. There is no correlation between age and STJ, aortic annulus and the ratio of STJ of aortic annulus respectively (p=0.920, p=0.111, p=0.073). The tilting angle of the sinotubular junction and aortic annulus is from $2.03^{\circ}$ to $7.77^{\circ}$ $(mean=4.90^{\circ})$. Conclusion: The intercommissural distance and the height of the sinus were largest in the right coronary sinus, and the position of the sinotubular junction to the aortic annulus is obliquely tilted levo-posteriorly.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.353-356
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• 2013

A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.340-346
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• 1988

The surgical treatment of annuloaortic ectasia falls into two basic categories, depending on the management of the coronary artery ostia and the sinus of Valsalva. The conventional method, first suggested by Groves, Wheat and their associates, employs a supracoronary graft for the treatment of aneurysm and conventional valve replacement. A more radical approach, that of Bentall and DeBono, uses a valve conduit from the aortic annulus to the distal extent of the aneurysm. This latter technique requires reimplantation of the coronary artery ostia for reestablishment of coronary artery blood flow. Recently we experienced a case of annuloaortic ectasia to which we applied the Bentall operation with the good postoperative result, and now we report this with literature review.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.680-686
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• 1989

Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta which originates just distal to the level of the origin of the coronary arteries. It may occur in several different anatomical form. Three type have been described; the hourglass, the hypoplastic and the membranous type, each term identifying the gross characteristic of the lesion causing by the aortic obstruction. Non cardiovascular condition commonly associated with supravalvular aortic stenosis are mental retardation, facial anomalies, hypercalcemia, etc. The diagnosis can be established preoperatively by left heart catheterization and selective angiography. Recently, we experienced a case of multiple localized supravalvular aortic stenosis involving, just above the sinus Valsalva and just proximal of the innominate artery. The surgical correction which was performed by a vertical incision across the each narrowing of aorta with replacement of diamond shaped double velour Woven Dacron patch under the CPB. He was discharged without any event.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.456-460
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• 1985

A case of Annuloaortic Ectasia associated with Marfan syndrome was treated by replacement of aorta and aortic valve with a valved conduit. A 26 years old man had suffered from palpitation and precordial pain. He had stigmata of Marfan`s syndrome. Aortogram and 2-D echocardiogram confirmed aneurysm of the ascending aorta with aortic insufficiency. Surgery was performed under the moderate hypothermia to 28oC. There was marked dilatation of the aortic annulus as well as sinus of Valsalva, with displacement of the coronary ostia. Aortic valve and aneurysm was replacement with 25mm, woven Dacron tubular graft, to which a 25mm, S.T. Jude Medical valve had been previously sutured. Right & left coronary ostia were anastomosed to the graft with the use of 3O Nylon pledget suture. The patient had a satisfactory post operation period with out specific complication.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.188-192
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• 1995

A 50 year old man with acute aortic dissection DeBakey type I, involving right coronary artery and aortic valve, underwent replacement of the ascending aorta and aorto-right coronary bypass grafting. The operative findings showed a large transverse intimal tear was at about 4cm above the aortic valve. The dissection extended out into the proximal right coronary artery. And we found that the right coronary artery originated from the left sinus of Valsalva, run transversally in the aortic wall, with partial rupture. Postoperatively he had no ischemic cardiac symptoms and neurologic complications. He was discharged on postoperative 9th day with good result.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.780-783
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• 2003

Pacemaker lead-related infective endocarditis is an uncommon, but serious complication. We report a case of a 45-year-old man who had symptom of intermittent high fever and rupture of sinus Valsalva that developed after a redo aortic valve replacement and transvenous permanent pacemaker implantation. Positive blood cultures of streptococcus viridans and transesophageal echocardiography showing a large mobile vegetation on pacemaker lead and tricuspid valve lead to the diagnosis of pacemaker lead-related infective endocarditis. Initial antibiotic therapy followed by surgical extraction of the pacemaker lead and wide debridement of infective tissues including multiple vegetations was required. Postoperative antibiotic therapy was continued for 4 weeks. The postoperative course has been uneventful. The patient is totally asymptomatic and is doing well up to now.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.220-238
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• 1976

Six cases of congenital heart disease were operated on by means of cardiopulmonary bypass between December, 1975 and April, 1976. Two cases of ventricular septal defects (VSD), two cases of VSD, associated with ruptured aneurysm of sinus Valsalva, two cases of atrial septal defects (ASD) and one case of pulmonic stenosis with patent ductus arteriosus were operated. Sarns roller pumps and Bentley Temptrol oxygenators were used for extracorporeal circulation. Pump oxygenator was primed with Ringer's lactate solution, 5% dextrose in water, mannitol, and ACD blood. Flow rate ranged from 2.0 to $2.4L/M^2/min$. Bicarbonate was added to the oxygenator with estimated amount as 15 mEq/L/hr. Venous catheters were introduced into superior and inferior vena cava, and oxygenated blood was returned to the body through aortic cannula inserted into ascending aorta. Moderate hypothermia ($30^{\circ}C$) was induced by core cooling. Aorta was cross clamped for 15 minutes and released for 3 minutes, and repeated clamping when necessary. Atrial and ventricular septal efects were closed by direct sutures. Aneurysms of sinus Valsalva ruptured into the right ventricle were repaired through right ventriculotomy by d:rect closure with Dacron patch reinforcement. Cardiopulmonary bypass time varied from 66 to 209 minutes, and aorta cross clamping time ranged from 13 to 56 minutes. Postoperative bleeding was minimal except one case who needed for evacuation of substernal hematoma. Intra- and postoperative urinary output was satisfactory. Acid-base balance, partial pressure of $O_2$, electrolytes, and hematological changes during intra- and post-perfusion period remained at the acceptable ranges. No mortality was experienced.