• Journal of Chest Surgery
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• v.26 no.4
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• pp.266-270
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• 1993

Aortic valve insufficiency with ventricular septal defect is usually treatment by plication of prolased cusps. We have performed the aortic valvuloplasty by the Trusler`s method in 14 patients of ventricular septal defect associated with aortic insufficiency. The reoperations were performed in the 4 cases[29%] due to recurrent aortic insufficiency after aotic valvuloplasty. Two patients underwent aoritc valvular replacements for the tears of repaired aortic cusps after primary aortic valvuloplasty for aortic insufficiency. The other two patients had aortic valvuloplasties again. Death occured in one case of aortic valvular replacements. The cause of death was low cardiac output syndrome soon after aortic valvular replacement for recurrent aortic insufficiency .

• Journal of Chest Surgery
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• v.45 no.4
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• pp.205-212
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• 2012

Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.

• Journal of Chest Surgery
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• v.12 no.1
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• pp.50-55
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• 1979

The development of aortic insufficiency radically alters the physical findings which are generally associated with ventricular septal defect that was not hemodynamically significant, and the combination of the two lesions produces a typical clinical picture, that may be serious and life-threatening when it is left untreated. Therefore, the selection of patients, type and timing of surgical treatment is considered to be important. Among 114 cases of ventricular septal defect treated surgically utilizing cardiopulmonary bypass in the Department of Thoracic Surgery, Seoul National University Hospital, 7 cases were associated with aortic insufficiency. 1. Five cases were male, and 2 cases were female. Ages were from 4 years to 24 years, and mean age was 11.9 years. 2. In all cases, ventricular septal defect was closed with Teflon patch. In a case, a aortic valvuloplasty and in another, a aortic valve replacement with Hancock valve 23 mm., 5 months after the closure of ventricular septal defect were done. 3. Four cases were type I ventricular septal defect by Kirklin`s classification, 3 cases were type II ventricular septal defect, and diameters of ventricular septal defect were from 3.5 cm. to 0.7 cm. A PDA. was combined to a type I ventricular septal defect. 4. In 5 cases, herniation of the aortic cusp through the ventricular septal defect and in a case, annulus dilatation on the aortic valve was noted. 5. Two cases with type I ventricular septal defect and severe pulmonary hypertension expired. A re-opened case with type II ventricular septal defect expired. 6. Four cases were alive, and all of them show decrease of pulse pressure and aortic insufficiency.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.899-904
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• 1988

In Behcet syndrome, cardiac involvements are rare and have been reported pericarditis, myocarditis, right heart endocardial fibrosis, right ventricle mural thrombus with pulmonary embolism, active endocarditis, granulomatous endocarditis, conduction disturbance, acute aortic insufficiency, mitral valve prolapse. Our three patients underwent AVR because of aortic insufficiency and ascending aorta enlargement combined with Behcet syndrome. Two patients had mitral regurgitation too. So one underwent MAP and the other underwent MVR concomitantly. One who underwent AVR have been well for 50 months. Another who underwent AVR+MAP and redo AVR due to aortic paravalvular leakage was died of congestive heart failure. The other who underwent AVR+MVR and repeated AVR three times because of aortic paravalvular leakage is in condition of aortic paravalvular leakage. Paravalvular leakage is considered to recur due to progressive dilatation and fragility of aortic root that is the result of pathologic change of Behcet syndrome in it. If Open heart surgery is needed in Behcet`s syndrome during inflammatory reaction is active, postoperative complications such as paravalvular leakage or suture line rupture may be prevented with pre- and postoperative anti-inflammatory management.

• Journal of Chest Surgery
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• v.33 no.5
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• pp.391-397
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• 2000

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

• Journal of Chest Surgery
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• v.26 no.11
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• pp.821-826
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• 1993

Between January 1983 and December 1992, we had experienced 79 patients of ventricular septal defect [ VSD ] associated with aortic insufficiency [AI] which constitute 4.6 % of total numbers of VSD. The mean age of the patients was 10.2 years with a range of 1 to 35 years and the average degree of aortic insufficiency classified by Sellers was 2.1. The type of VSD was subpulmonic in 57 patients and perimembranous in 22. Most common pathologic finding causing AI was prolapse of right coronary cusp [ 54 cases ; 71.4% ] ,followed by prolapse of both right and non-coronary cusp[ 12 cases ; 7.9% ]. VSD closure alone was performed in 51 patients and their mean age was 7.7 years [ ranged 1 to 13 years ]. VSD closure and aortic valve reconstruction was performed in 22 patients, VSD closure and aortic valve replacement in 6 patients, and the mean age of the patients was 14.5 years [ ranged 2 to 28 years ], 20.4 years [ ranged 18 to 35 years ] respectively. There was no hospital mortality. All patients were followed up from 1 month to 9 year 4 months [average; 21.4 months ] and there was one late death. Our data suggests that, early closure of VSD without any manipulation on the valve may be sufficient procedure to improve or at least withhold progression of AI in children and furthermore patients with VSD associated AI should be corrected promptly after diagnosis.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.407-413
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• 1985

Ruptured aneurysms of the sinus Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Five patients underwent operative treatment in Catholic Medical Center in recent 2.5 year period. Three patients were male and two patients were female, ages ranged from 20 to 54 years. Bacterial endocarditis was suspected or proved in 3 patients. In 3 patients in our series had a ruptured congenital aneurysms and in 2 patients acquired aneurysms by bacterial endocarditis. Associated cardiac lesions were common; such as aortic insufficiency in 3 patients, atrial septal defect in 2 patients, mitral stenoinsufficiency in 1 patient and tricuspid insufficiency in 1 patient. All aneurysmal ruptures of the sinus Valsalva arose from right coronary sinus and in 4 patients ruptured into right ventricle and in 1 patient into right atrium. Surgical techniques consisted of direct closure 4 in patients and closure with Dacron patch in 1 patient. And we preferred double approach, that is, through both the aorta and the involved cardiac chamber in cases in whom aortic insufficiency was present. So additional aortic valve replacement performed in 2 patients due to severe aortic insufficiency and aortic valvuloplasty performed in 1 patient. One patient who underwent direct closure of ruptured sinus Valsalva and double valve replacement died due to low cardiac output syndrome just after the operation. Operative results were relatively good in remainders.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.251-264
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• 1976

Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

• Journal of Chest Surgery
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• v.13 no.2
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• pp.100-104
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• 1980

Simultaneous triple valve replacements were performed in two patients on January and April 1980 at Seoul National University Hospital. The first case was 17 years old male patient with a history of exertional dyspnea for 7 years. He was in class III by the NYHA functional classification and diagnosed as aortic insufficiency, mitral steno-insufficiency and tricuspid insufficiency. The second case was 46 years old male patient suffered from exertional dyspnea for 5 years, He was in class IV and diagnosed as aortic stenoinsufficiency, mitral stenoinsufficiency and tricuspid insufficiency. Triple valve replacements were performed under the deep hypothermia and pharmacologic cardiac arrest with aortic cross clamping for 80 minutes to 159 minutes. Total extracorporeal circulation time were 197 and 176 minutes respectively. The postoperative courses were uneventful.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.135-142
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• 1991

From January 1980 to December 1989, thirteen patients underwent operation for ventricular septal defect associated with aortic insufficiency in Kyungpook national university hospital. Ten male and three female patients ranged in age from 3 years to 25 years, with an average age of 11.5 years. Aortic cusp prolapse was found in eight cases[61.5%]. The aortic regurgitation was classified by Sellers` method with grade I in 2 cases, grade II in 9 cases, and grade III in 2 cases. Direct suture or patch repair of ventricular septal defect was performed through the right ventricle. Eight cases were treated only by closure of VSD, 3 cases by plication, but two of the letter were reoperated due to the persistent of aortic regurgitation and fungal endocarditis respectively. Aortic valve replacement were performed in 2 cases at the first operation. There was only one late death[7.7%], which was caused by postoperative fungal endocarditis. Follow-up for twelve patients except one death were followed up for 3 months to six years after operation. Residual aortic regurgitation was noted in six cases[46.2%], but the postoperative course of them were uneventful.