• Journal of Chest Surgery
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• v.24 no.4
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• pp.404-420
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• 1991

Surgical treatment of congenital and acquired heart disease preceded the development of accurate techniques for diagnosis, heart lung machine and cardiopulmonary bypass, intraoperative myocardial protection, operative techniques and cardiac anesthesia. For 5 years from Sep. 1985 to Sep. 1990, six hundred cases of open heart surgeries [OHS] were performed in the department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. The results were summarized as follows. 1. The annual number of OHS[cases per year] was above 100 since 1987, and the increasing rate of cases was 23.5% per year since 1986. 2. Among the total 600 cases, there were 470 cases of congenital heart diseases and 130 cases of acquired. Age range of the congenital patients was 8 months to 44 years with the mean age of 10 years, and acquired patients was 16 to 56 years with the mean age of 36 years. 3. Among the 470 congenital anomalies, there were 429 cases of acyanotic and 41 cyanotic patients. Totally, VSD was 286 cases[60.6%], ASD 103 cases[21.9%], TOF 35 cases [7.4%], PS 20 cases [4.1%], ECD 12 cases [2.0%], Ebstein`s anomaly 3 cases [0.6%], Valsalva sinus rupture 3 cases [0.6%] and others. The appropriate one stage radical operations were applied to the all congenital cases with the result of 2.6% immediate postoperative hospital mortality rate. 4. Among the 130 acquired cases, there were 122 cases of valvular heart diseases, 6 of heart tumors [5 myxoma, one malignant histiocytoma], one of LA thrombus and one of annuloaortic ectasia. Cardiac tumors and LA thrombus were removed through the atrial septal approach. Bentall procedure was adopted to the annuloaortic ectasia case. AVR, MVR and TVA [DeVega procedure] were applied to 120 valve diseases, and there were also one of OMC and one of MVA[Jerome-Kay procedure]. 5. Among the 120 valve replacement cases, there were 87 of single valve replacement cases [AVR: 8, MVR: 79], 11 of double valve replacement [AVR+MVR: 11], 12 of MVR+TVR and 10 of MVR+AVR+TVA. The total number of implanted prosthetic valves were 141. In MVR, 45 of St. Jude Medical valves, 63 of Carpentier-Edward valves and 4 of Ionescu-Shiley valves were used. In AVR, 18 of St. Jude Medical valves and 11 of Carpentier-Edward valves were used. in MVR, 29mm and 31mm sized valves were used mostly and In AVR, 23mm sized valves were used mostly. 6. Postoperatively many kinds of complications were occurred. Among them, wound problems [30 cases], low output syndrome [29 cases], arrhythmia [20 cases], pleural effusion and pneumothorax [13 cases] were occurred frequently. The postoperative immediate hospital mortality was 3.0% in total [congenital 2.6%, acquired 4.6%].

• Journal of Chest Surgery
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• v.30 no.2
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• pp.152-157
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• 1997

From August 1986 until June 1995, single aortic valve replacement was performed in 65 patients at the Chonnam National University Hospital. worthy-eight were male and 17 were female patients, ranging from 19 to 68 years of age(median : 43 years). The causes of the valve lesions were rheumatic in 29 patients (44.6%), bicuspid aortic valve in 6 patients (6.2%), endocarditis in 6 patients(6.2%), unknown in others. Concomitant surgical procedures were performed in 10 patients : repair of congenital defect in 5, pericardiectomy in 1, coronary artery bypass grafting in 1, noncoronary sinus plication in 1, Valsalva sinus aneurysmectomy in 1, subaortic membrane resection in 1 Used valves were 51. Jude-Medical valve in 42, Duromedics valve in 22, Bjork-Shiley valve in 2, Carpentier-Edward valve in 1. There were 3 hospital deaths (4.6%), and 2 late deaths (3.2%). Follow-up was 95.2% complete. The 10-year acturlal survival rate was 85.3%. Postoperative complications were low cardiac utput in 8, arrythmia in 5, valve related hemolysis in 1, cerebral infarction in 1, and gastrointestinal bleeding in 2. Reoperation was performed in 4 for surgical bleeding, in 3 for paravalvular leak. The mean improvement in New York Heart Association functional class is from 2.79 $\pm$ 0.66 preoperatively to 1.25 $\pm$ 0.49 postoperatively(p < 0.001) The change of cardiothoracic ratio from preoperative to postoperative is 0.57 $\pm$ 0.06 to 0.54 $\pm$ 0.05 (p < 0.05). The left ventricular ejection fraction change is not significant perioperatively. There are no mechanical failures. This early and intermediate-term follow-up suggests that in adults in whom valve repair is not possible, the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and a low rate of thromboembolic event.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.368-372
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• 1999

Background: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. Material and Method: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. Result: The proportion of the skin incision length to the sternal length was 63.1${\pm}$3.9%(5.2∼11cm, mean 7.3cm) in children, and 55.0${\pm}$3.5%(10∼13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. Conclusion: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.483-488
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• 2005

Aortic valve-sparing procedures could reduce valve-related morbidity, but may increase operative risks; therefore, these procedures could not be performed routinely. We attempted to find out the early results while focusing on the operative risks associated with these procedures in our hospital. Material and Method: From May 1996 to July 2003, 26 patients underwent these procedures including 15 patients with Marfan syndrome and 1 patient with Behcet disease. There were 17 men and 9 women with mean age of $37.9\pm19.2$ years (range: 6 months-74 years). Ten patients had ascending aortic dissection, 18 patients had more than moderate degree of aortic valve insufficiency (AI). Two types of valve-sparing procedures were performed: valve reimplantation in 14 and root remodeling in 12 patients. Associated procedures were performed as follows: aortic valve plasty in 6, mitral valve plasty in 5, hemi-arch replacement in 4, total arch replacement in 2, coronary artery bypass surgery in 1 and Maze procedure in 1 patient(s). Result: In four patients, valve-sparing procedures were converted to Bentall procedures during operation. Including these patients, there was no operative deaths, 3 patients underwent re-operation due to bleeding, 1 patient had permanent pacemaker. The median duration of ICU stay was 45.5 hours, the median duration of hospital stay was 10.5 days. In 22 patients excluding 4 converted patients, intraoperative transesophageal echocardiogram (TEE) showed less than mild degree of AI in all except one who had not received intra-operative TEE in the beginning and showed moderate degree of AI at discharge. The mean duration of follow-up was $21.2\pm27.4$ months. All patients were alive except one who died during other departmental surgery. In 3 patients, more than moderate degree of AI was recurred, but there were no reoperation. Conclusion: Aortic valve-sparing procedures could be performed relatively safely in selected patients who had annuloaortic ectasia.