• Journal of Chest Surgery
• /
• v.11 no.2
• /
• pp.185-193
• /
• 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.

• Journal of Chest Surgery
• /
• v.11 no.4
• /
• pp.428-432
• /
• 1978

Between Jan. and Oct. 1978, mitral valve Replacement had been performed on eight patients using porcine aortic valve mounted on flexible polypropylene or Egyloil wire and Dacron covered stent. Mitral valve replacement was performed on five, mitral valve replacement with tricuspid valve replacement on two, and mitral valve replacement with tricuspid valve annuloplasty on 1 patient using five Carpentier and five Hancock Xenograft. Overall operative deaths were 2 cases. All other 6 cases did well after surgery and improved. No systemic thromboembolism occurred without anticoagulant-No valve failure took place. The results are satisfactory.

• Journal of Chest Surgery
• /
• v.13 no.4
• /
• pp.405-413
• /
• 1980

A total of 63 patients [42 males and 21 females] underwent multiple valve replacement with artificial valves between January 1975 and August 1980 at Seoul National University Hospital. There were 38 patients with aortic and mitral valve replacement, 22 with mitral and tricuspid, and 3 with aortic, mitral and tricuspid valve replacement. The valve lesions varied from trivial to severe and most aortic and mitral valves had mixed stenosis and insufficiency, while tricuspid valves had only insufficiency. The patients were severely symptomatic in majority of the cases, and belonged to the Classes III and IV [III:45, IV:16] of the NYHA functional criteria. Hemodynamic studies were performed on all the patients. The mean pulmonary wedge pressure was remarkably increased to 19.8 mmHg in aortic and mitral valve lesions and 18.0 mmHg in mitral and tricuspid valve lesions. The mean pulmonary arterial pressure was also increased, while the cardiac index was reduced. In 1977, the average perfusion time was 245.5 minutes for aortic and mitral valve replacement and 181.6 minutes for mitral and tricuspid valve replacement. It has progressively declined to 169.2 minutes for aortic and mitral valve replacement and 123 minutes for mitral and tricuspid valve replacement in 1980. The average period of aortic occlusion also declined after the use of cardioplegic solution. Twenty deaths occurred among the 63 patients operated upon, an overall mortality rate of 30.8%. The operative mortality has declined with successive year from a level of 66.7% before 1977 to 21.1% in 1980. Fourteen patients suffered from a list of postoperative complications, which eventually resolved with adequate treatment. All the survivors were enjoying the levels of daily life activities greater than those existing before the operation.

• Journal of Chest Surgery
• /
• v.34 no.9
• /
• pp.680-685
• /
• 2001

Background: Tricuspid valve replacement is very rarely performed procedure and its long-term result is not yet satisfactory. Moreover, it is not well known whether bioprosthesis or mechanical prosthesis is the best selection for artificial valve. We reviewed 72 cases of tricuspid valve replacements in 71 patients between January 1989 and December 1998, trying to analyze the overall results and risk factors for mortality and morbidity. Material and Method: Average age of the patients at the time of operation was 42$\pm$13 years(range 16 to 65 years) and the sex ratio of male versus female was 32/39. Primary diagnosis consisted of 50 cases of aquired valvular heart disease and 18 cases of congenital heart disease, such as Ebstein’s anomaly. 4 cases had isolated tricuspid valve regurgitation. Implanted valves were 69 mechanical prosthesis and 3 bioprosthesis. Concomitant mitral or aortic valve replacements were performed in 50 cases. One patient received concomittant pulmonary valve replacement. Result: There were 7(9.72%) operative deaths and 7(13.0%) late deaths. Actuarial survival at 10 years was 59.2$\pm$7.2%. Prosthetic tricuspid valve thrombosis occurred 11 times in 5 patients. Reoperation for prosthetic tricuspid valve failure was performed in 1 patient. In this case, examination of the explanted prostheses showed that the tricuspid stenosis was the result of valve thrombosis. Among the 47 survivors, 46 patients(98%) were in functional class I or II. Conclusion: In our ten-year experience of tricuspid valve replacement, mortality and morbidity were satisfactory. Mechanical prosthesis in tricuspid position showed comparable clinical results as bioprosthesis.

• Journal of Chest Surgery
• /
• v.22 no.6
• /
• pp.1036-1043
• /
• 1989

Seventy eight patients underwent operation for combined multiple valve disease, with an overall early mortality of 14.1 % from January, 1983 to September, 1988 in the department of thoracic and cardiovascular surgery of Pusan National University Hospital. All of the above cases had combined multiple valve procedures. There were 33 mitral valve replacements and tricuspid annuloplasties, 33 aortic and mitral valve replacements, 5 aortic and mitral valve replacements with tricuspid annuloplasties, 3 aortic valve replacements and mitral annuloplasties, 1 open mitral commissurotomy and tricuspid annuloplasty and, 1 mitral valve replacement and primary closure of tricuspid valve cleft, 1 mitral valve replacement and aortic commissurotomy, 1 mitral, aortic and tricuspid valve replacement were done. 44 were male and 34 were female and the age distribution was from 14 to 57 with mean 38 year old. According to NYHA[New York Heart Association] classification, 49 patients were class I, 19 patients were class Il and 10 were class IV. Average perfusion time was 205.3 minutes. The live patients perfusion time was 178.7 minutes while that of dead ones was 272.0 minutes. Early deaths within 30 days from operation were 11 cases, 6 of which were due to low cardiac output, 3 were acute renal failure and 2 were cardiac rupture. The 65 patients were followed up from 2 to 30 months for a total 20.6 patient years. 1 patient committed suicide because of postoperative depression 1 year after operation. All of the survivors were enjoying their daily life and their NYHA class was superior to the preoperative ones.

• Journal of Chest Surgery
• /
• v.52 no.2
• /
• pp.109-111
• /
• 2019

We report the case of a female patient who underwent late reoperation following endocarditis surgery. The patient first underwent surgery at 22 years of age for endocarditis with aortic and tricuspid insufficiency. She underwent aortic root replacement with a homograft and tricuspid valve replacement with a tissue valve. Coronary artery bypass using the internal thoracic artery and ligation of the left main coronary artery were performed. Ten years later, failure of the homograft and the tricuspid valve developed. In the second operation, the patient underwent a successful Bentall operation and tricuspid valve replacement with a mechanical valve under deep hypothermia and retrograde cold cardioplegia without drainage.

• Journal of Chest Surgery
• /
• v.25 no.8
• /
• pp.826-831
• /
• 1992

Ebstein`s anomaly is characterized by a downward displacement of a malformed tricuspid valve, The ideal surgical management of Ebstein`s anomaly is not yet established. Recently we experience one case of Ebstein`s anomaly, which was treated sussessfully by partial artificial annulus formation, and tricuspid valve replacement with St. Jude Medical valve. We have achieved excellent results with mechanical valve replacement and partial artificial annulus formation using wessex pericardial patch. On follow up for 4 years, the patient is well and in functional class I.

• Journal of Chest Surgery
• /
• v.27 no.10
• /
• pp.838-845
• /
• 1994

From April, 1982 to December, 1992, multiple valve replacement was performed in 100 patients. Mitral and aortic valve replacement were done in 86 patients, 9 underwent mitral and tricuspid valve replacement, 4 patients underwent triple valve replacement and 1 patient underwent aortic and tricuspid valve replacement. Of the valve implanted, 100 were St. Jude, 64 Duromedics, 19 Carpentier-Edwards, 13 Bj rk-Shiley, 6 Ionescu-Shiley, and 2 Medronics.The hospital mortality rate was 15%[15 patients] and the late mortality rate was 7%[7 patients], the mortality rate was high in early operative period but decreased with time[20% at 1986, 18.2% at 1987, 9.5% at 1988, 11.1% at 1989, 12.5% at 1990, 11.8% at 1991, 0% at 1992]. The causes of death were low cardiac output in 8, sudden death in 3, CHF in 3, bleeding in 2, cerebral thromboembolism in 1, leukemia in 1, multiorgan failure in 1 and so on. The actuarial survival rate excluding operative death was 73% at 10 years.

• Journal of Chest Surgery
• /
• v.37 no.4
• /
• pp.328-334
• /
• 2004

There are only limited numbers of reports about long-term results of tricuspid valve replacement(TVR) with bioprosthetic and mechanical prostheses. We analyzed risk factors for tricuspid valve replacement and compared long-term clinical results of bioprosthetic and mechanical valves in tricuspid position. Material and Method: We reviewed 77 cases of TVR, which were performed between October 1978 and December 1996. Mean age was 38.8 15.9 years. Bioprostheses were implanted in 26 cases and mechanical prostheses were implanted in 51 cases. Result The operative mortality was 15.6% and late mortality was 12.3%. Survival for bioprosthetic and mechanical valve group at 5, 10 and 13 years was 81.3% vs. 100%, 66.1% vs. 100%, 60.6% vs. 100% (p=0.0175). Free from valve related re-operation for bioprosthetic and mechanical valve group at 5, 10 and 13 years was 100% vs. 93.9%, 100% vs. 93.9% and 58.3% vs. 93.9% (p=0.3274). Linealized incidences of valve related re-operation for bioprosthetic and mechanical valve group was 2.27 %/patient-years and 1.10 %/patient-years. Risk factor analysis showed that presence of preoperative ascites, hepatomegaly larger than 2 finger breaths, poor preoperative NYHA functional class and number of tricuspid valve replacement were risk factors for early mortality, and the use of bioprosthetic valve and number of open heart surgery were risk factors for late mortality. Conclusion: Long-term survival of mechanical valve was superior to bioprosthetic valve in tricuspid position. We recommend mechanical valve in tricuspid position if the patient can be closely followed up.

• Journal of Chest Surgery
• /
• v.21 no.4
• /
• pp.700-705
• /
• 1988

A case of congenital tricuspid stenosis in 24 year old male patient is presented. The lesion was successfully corrected with prosthetic valve replacement and closure of atrial and ventricular septal defects. Especially, this is the first reported case of successful large prosthetic valve replacement to a small annulus in tricuspid valve.