• Title/Summary/Keyword: Valve Block

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Four Year Experience with Valve Replacement of Valvular Heart Diseases (심장판막 치환술후 단기 추적성적)

  • 류한영
    • Journal of Chest Surgery
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    • v.23 no.6
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    • pp.1180-1190
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    • 1990
  • 96 patients underwent cardiac valve replacement for valvular heart diseases consecutively between February 1986 to February 1990 in the Department of Thoracic and Cardiovascular Surgery of Yeungnam University Hospital. The follow up period was between 6 months and 4.5 years postoperatively[mean 23.4$\pm$13.1 months]. 75 cases got mitral valve replacement, 6 cases, aortic valve replacement, 15 cases, double valve replacement. 30[31.2%] patients were male and 66[68.8%] were female and the age ranged from 14 to 66 years old. Early hospital death within 30 days postoperation were 5 patients[5.2%], consisting of by low cardiac output in 2, infective endocarditis in 1, multiple organ failure with sepsis in 1 patient. There was no late postoperative death. Most common early postoperative complication was wound disruption [8.7%] and then low cardiac output, pneumothorax, pleural effusion in order. Most common late postoperative complications were minor bleeding episodes[8.7%] related to anticoagulant therapy which were consisted of frequent epistaxis in 3, gum bleeding in 2, hemorrhagic gastritis in 1, hypermenorrhea in 1, hematoma in right arm in 1 patient. Valve-related complications included valve thrombosis [1.6%/ patient-year], valve failure due to pannus formation[1.1% /patient-year], prosthetic valve endocarditis[1, 1%o/patient-year] and minor anticoagulant hemorrhage[4.4% /patient-year]. 5 cases of reoperations were performed in 4 patients due to valve failure and all of them were in the mitral positions[2.7% /patient-year]. Cardiothoracic ratios in the chest X-ray decreased at the 6th month and 1st year postoperation in all patients. But in New York Heart Association[NYHA] functional class IV, no change in cardiothoracic ratio was found between 6 months and 1 year postoperation. In the echocardiogram, the size of the cardiac chambers decreased, but ejection fraction increased postoperatively in each functional class. In the electrocardiogram, decreases were found in the incidence of atrial fibrillation, left atrial enlargement, left ventricular hypertrophy with right bundle branch block increasing postoperatively in each functional class. The actuarial survival rate was 98.4% for all patients, 98.7% for mitral valve replacement, 83.8% for aortic valve replacement, and 80% for double valve replacement at the end of a 4.5 year follow up period. Meanwhile the actuarial freedom rate was 91.5% for prosthetic valve endocarditis, 91.6% for thromboembolism, 89.0% for prosthetic valve failure and 83.7% for minor anticoagulant hemorrhage. Preoperative NYHA class III and IV were 75% of all patients, but 95% of all patients were up graded to NYHA class I and II postoperatively.

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Heart Valve Replacement With Ionescu-Shiley Valves: Report Of 265 Cases (IonescuShiley 판막 사용 심장판막이식술[265례 보고])

  • Lee, Yung-Kyoon;Kim, Sam-Hyun
    • Journal of Chest Surgery
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    • v.14 no.4
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    • pp.369-380
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    • 1981
  • In this department 504 cases of valve replacement were done since 1968 to the end of October 1981. Since October 31, 1978 to the end of October 1981 ,333 Ionescu-Shiley bovine pericardial xenograft bioprosthetic cardiac valves were replaced in 265 patients. There were 149 males and 116 female. Ages ranged from 2 to 63 years with 25 cases under 15 years of age. Among 265 cases of Ionescu valve replacement there were 157 MVR, 36 VAR, 6 TVR, 45 MVR+ AVR, 16 MVR+TVR and 5 MVR+AVR+TVR cases with mortality of 5.7%, 8.3%, 16.7%, 8.9%, 18.8% and 20% for each group respectively. Over all mortality rate in 265 Ionescu valve replacement cases was 7.9% with 21 total deaths. Main causes of operative deaths were due to LCOS in 7, bleeding in 5, arrhythmia in 3, air embolism in 2,and heart block in 2 cases. There were 12 late complications with 6 deaths. Over all long-term survival rate was 89.8%. MVR showed the highest long-term survival rate with 92.4%, and MVR+AVR+TVR the lower with 80% lower with 80%.Average follow-up period was 14 month duration. Twenty five congenital anomaly cases were operated with Ionescu-valve replacement that consisted of 7 VSD+AI, and 5 Ebstein anomaly cases with over all operative mortality of 16% and late mortality of 14.3% among 21 operative survivors. There were 25 Ionescu valve replacement cases in pediatric patients under the age of 15 years, with 4 operative deaths. Fourteen MVR, 7 AVR, and 3 TVR cases were found. Even though long-term follow-up study was short in postoperative period with total of 33~.0 months among 244 operative survivors ranging one to 36 months, the late survivors showed beneficial long-term results two thromboembolic episodes in 244 patients were found. More cases and longer term follow-up study are warranted for valve replacement in pediatric and TVR cases with Ionescu-valves which have advantageous hemodynamic structures compared with other bio-prosthetic heart valves.

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A Review of Total Correction in 48 Cases of Tetralogy of Fallot (Fallot 사징증(四徵症) 외과적(外科的) 완전교정(完全矯正)에 대한 임상적(臨床的) 고찰(考察))

  • Suh, Kyung Phill
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.198-206
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    • 1976
  • A Total of Forty eight patients underwent open-heart surgery for correction of tetralogy of Fallot at the Seoul National University Hospital from January 1974 to October 1976, with an overall survival rate of 77 per cent. Operative mortality varied according to severity of the lesion, age of the patient, nature of previous surgical treatment and presence or absence of an outflow tract patch across the pulmonary valve ring. Eleven patients died in the early postoperative period and thirty seven patients were discharged from the hospital alive. A patch of the right ventricular outflow tract and pulmonary annulus was required to relieve pulmonic stenosis in 24 patients. There were 10 deaths in this group (42%) as compared to 1 death in the group of 24 patients who were corrected without a patch. Operative mortality was especially higher when an inlay patch was placed across the pulmonary valve ring. This may be related to the possibly greater anatomic severity of these cases and to the longer operating time when a patch was used. The electrocardiogram showed right ventricular hypertrophy in 35 cyanotic patients. Intraventricular conduction was normal in 34 patients before operation. It was normal postoperatively in only 5 of 34 patients in this group who survived surgery. Complete right bundle branch block appeared at operation in 21 patients, and 8 patients developed incomplete right bundle branch block. Major causes of death were progressive cardiac failure (4), Complete atrioventricular dissociation (3), bleeding (2), cardiac tamponade (1), and sudden cardiac arrest (1)

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Development and Verification of Analytical Model of a Pilot Operated Flow Control Valve for 21-ton Electric Excavator (21톤급 전기 굴삭기용 파일럿 작동식 유량제어 밸브의 해석모델 개발 및 검증)

  • Kim, D.M.;Nam, Y.Y.;Seo, J.H.;Jang, J.S.
    • Journal of Drive and Control
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    • v.12 no.3
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    • pp.52-59
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    • 2015
  • An electro hydraulic poppet valve (EHPV) and a variable orifice poppet are assembled in a single block, which is referred to as a RHINO but is also generally called a pilot-operated flow control valve. In this study, we analyzed the structure and the operating principle for a RHINO applied in a 21-ton electric excavator system. The RHINO was experimentally tested to measure the dynamic responses and the pressure energy loss. In this test, we investigated the variation in the conductance coefficient according to the increase in the supply pressure under a constant current and a variation in the flow rate according to the increase in the current. Then, the geometrical shapes and the spring stiffness of the RHINO were considered to develop an analysis model. The characteristics (current-force and hysteresis) for the solenoid based on the experimental data were reflected in the analysis model that was developed, and the reliability of the analysis model was also verified by comparing the experimental and analytical results. The developed model is thus considered to be reliable for use in a wide range of applications, including optimum design, sensitivity analysis, parameter tuning, etc.

Leakage Reduction through Establishment of Block System in Jeju City (제주시 상수도 관망 블록시스템 구축을 통한 누수 저감)

  • Cha, Joonho;Kim, Jinkeun
    • Journal of Korean Society of Water and Wastewater
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    • v.26 no.5
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    • pp.693-703
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    • 2012
  • Leakage in water supply system can cause water resources loss in addition to the water quality degradation. In this research, leakage reduction after establishment of a block system in the area with leakage rate of 69.0 % was investigated using EPANET simulation. The average water pressure for the research area was $5.17kgf/cm^2$ which was relatively high, and several sites were deviated from recommended water pressure ranges(i.e., 1.5 ~ $7.1kgf/cm^2$). However, the average water pressure in the area was reduced to 3.81 and $3.49kgf/cm^2$ after the introduction of block system with a water pressure relief valve(PRV) setting of 3.0 and $2.5kgf/cm^2$, respectively. Under the installation of a PRV with regulating pressure of $2.5kgf/cm^2$, the predicted leakage was reduced from $4,420.3m^3/d$ to $3,028.1m^3/d$, which was equivalent to the leakage reduction from 31.0 % to 23.5 %.

Surgical correction of partial endocardial cushion defect: one case report (부분심내막상 결손증의 교정수술치험 1)

  • 기노석
    • Journal of Chest Surgery
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    • v.17 no.2
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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.

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Result of Surgical Treatment for Infective Endocarditis (심내막염의 수술적 치료 성적에 관한 보고)

  • Kim, S.H.;Ahn, H.;Kim, C.W.
    • Journal of Chest Surgery
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    • v.23 no.2
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    • pp.370-376
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    • 1990
  • From April, 1981, through March, 1989, 30 patients had received valve replacements and 1 patient had received foreign body removal for infective endocarditis at Seoul National University Hospital. There were 22 male and 9 female patients, ranged in age from 22 to 59 [mean 34.9] years. Twenty-three had native valve endocarditis, 7 had prosthetic valve endocarditis and 1 had infected transvenous permanent pacemaker electrode in right heart. Twenty-four required operation during active phase of disease and 7 during inactive phase. The infecting organism was Streptococcus in 10 patients, Staphylococcus in 5 patients, both Staphylococcus and Streptococcus in 1 patient, E. coli in 2 patients, and Candida in 1 patient. Indications for Surgery were congestive heart failure in 20, systemic emboli in 5, combination of both in 3, congestive heart failure with uncontrolled sepsis in 2, and complete heart block in 1 patient. Hospital mortality was 9.7% [3/31], and all were the patients who received emergency operation. There were 2 late mortality [7.7 %] due to acute myocardial infarction and recurrent endocarditis. This report suggests that the surgical treatment can be achieved with acceptable low mortality and morbidity in medically intractable congestive heart failure, emboli and sepsis.

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Surgical Treatment of Partial Atrioventricular Septal Defect (부분 방실중격결손증의 외과적 치료)

  • 최준영
    • Journal of Chest Surgery
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    • v.20 no.4
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    • pp.760-764
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    • 1987
  • Fifty seven patients underwent repair of a partial atrioventricular septal defect from January 1980 to December 1986. The ostium primum atrial septal defect was closed with autologous or bovine pericardium. The cleft in the anterior mitral leaflet was present in 53 cases, absent in 4 cases. Of the 53 cases with a cleft in the anterior mitral leaflet, 48 received suture repair of the cleft, 3 received mitral valve replacement. There was no hospital death and all the patients were followed-up for a mean period of 26.4 months. Four required permanent pacemaker implantation due to complete heart block, and one of them died of sudden malfunction of pacemaker. Two received reoperation due to significant residual mitral insufficiency. Suture repair of the cleft in the anterior mitral leaflet resulted in significant decrease in degree of mitral regurgitation. During follow-up period 49 patients were in NYHA class I, 7 patients were in NYHA class II. This report suggests that excellent result can be achieved from repair of the partial atrioventricular septal defect by managing the left A-V valve as a bileaflet structure.

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A Microcomputer-Based Control System for Green House (I) -Water Management- (시설원예(施設園藝)에 있어서 재배관리(栽培管理)의 자동화(自動化) 시스템에 관(關)한 연구(硏究) (I) -물관리 자동화(自動化)-)

  • Lee, K.M.;Park, K.S.
    • Journal of Biosystems Engineering
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    • v.11 no.1
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    • pp.31-36
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    • 1986
  • As a part of study on automatic control system for green houses, an automatic irrigation system was developed by using microcomputer. For the study, gypsum block was used as a sensing device of soil moisture and its data was designed to transfer to microcomputer through A/D converter. Also, software which be able to control the irrigation time and flow rate by the solenoid valve was developed. This system was tested by using practical data and the following results were summarized. 1. Since the gypsum was very accurate in addition with chiep and easy to manufacture, it turned out to be a very good device to detect the soil moisture in this system. 2. Also, solenoid valve was very excellent device for controlling the water flow rate since its control error is less then 1% when the irrigation time is over 100 seconds.

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