• Journal of Chest Surgery
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• v.18 no.2
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• pp.265-272
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• 1985

Congenital aneurysm of sinus of Valsalva is one of the rare congenital heart disease, which is usually asymptomatic until rupture. The aneurysm usually ruptures into a cardiac chamber and produces an aorto-intracardiac fistula. Ruptured aneurysm is a grave lesion in that it causes heart failure and subsequent death. If, however, it is discovered in its early stages and operated on properly, it can be corrected with considerable success. Form January 1975 through December 1984, 18 consecutive patients with congenital aneurysm of sinus of Valsalva underwent corrective surgery using total cardiopulmonary bypass in our department of Thoracic Surgery. 1. The incidence was about 0.9% of surgical cases of congenital heart disease during that period. 2. 13 were males and 5 females, with ages ranging 12 years to 52 years. 3. Associated anomalies were VSD in 14, infundibular PS in 1, aberrant muscle band in RVOT in 1, and secondary aortic insufficiency in 9. 4. 17 were suggested to arise from right coronary sinus and 1 from noncoronary sinus; Among 17, 12 ruptured into right ventricle, and one from noncoronary sinus into right atrium. 5. Surgical correction was performed by means of direct suture closure with combined pledget or patch graft after aneurysm resection, and associated lesions were also corrected simultaneously. 6. There was only one case of operative mortality, and all the other patients were relatively uneventful in their follow-up studies.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.151-156
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• 1985

A clinical analysis was done on 50 cases of ventricular septal defect, operated from April 1981 to March 1984 at the department of Thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. Among 50 cases, 34 cases were males and 16 cases were females. Their age ranged from 1 to 26 years and the mean age was 9.7 years. The main symptoms at admission were frequent upper respiratory infection [50%], exertional dyspnea [42%] and palpitation [34%]. In anatomical classification by Kirklin, type I constituted 20%, type II 76%, type IV 4%. Associated congenital cardiac lesions were pulmonic stenosis [6 cases], patent foramen ovale [5 cases], aortic insufficiency [3 cases] and persistent left superior vena cava [1 case]. When a normal electrocardiogram pattern was present, Qp/Qs, Rp/Rs and pulmonary artery systolic pressure and Pp/Ps were relatively low. Among cases of above 1 cm2/M2 BSA in size of defect, Pp/Ps and pulmonary artery systolic pressure were increased than the cases of below 1 cm2/M2 BSA [P=0.01]. The postoperative right bundle branch block was occurred in 21 cases [75%] among 28 cases of right ventriculotomy approach. The operative mortality was 2% [1 case] among 50 cases and complication rate was 14% [7 cases].

• Journal of Chest Surgery
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• v.18 no.2
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• pp.157-164
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• 1985

Our series comprised 68 patients of ventricular septal defect who underwent open heart surgery at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, from January, 1980 to September, 1984. Of the 68 patients, 47 patients were male [69.1%] and 21 patients were female [30.9%]. Their age ranged from 3 years to 27 years, and the mean age was 10.1 years. Upon Kirklin`s anatomical classification, type I constituted 29.4%, type II 69.1%, type III 1.5%, and type IV 1%. The cardiac anomalies associated with ventricular septal defect were 21 in all; 5 PS, 4 Aortic insufficiency, 2 ASD, 4 Patent foramen ovale, and 1 Patent ductus arteriosus. Upon the data of cardiac catheterization, most of the patients had Qp/Qs of 1.4-1.8, Pp/Ps of 0.25 or less and Rp/Rs of 0.25 or less. There was no significant correlationship between the rate of operative complication & mortality and the increase of Qp/Qs, Pp/Ps, and Rp/Rs. The values of Qp/Qs, Pp/Ps and Rp/Rs were correspondingly increased according to increment of the defect size. 20 patients developed postoperative complications, such as 4 acute respiratory failure, 3 reexploration due to massive bleeding, 1 low cardiac output, 1 patch detachment, and 2 air embolism. Operative mortality rate was 7.4% [5 cases] among 68 patients.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.630-640
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• 1988

We clinically evaluated 222 cases of ventricular septal defect which we experienced at Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital between July 1981 and March 1988. These patients were occupied 46.2% of all congenital heart disease operated on its same period. Of 222 cases, 132 patients were male and 90 patients were female. Their age distribution ranged from 8 months to 34 years of age and their mean age was 10.3 years. Among these patients, 86 patients had associated cardiac anomalies, which were patent foramen ovale 43 cases[19.5%], Atrial septal defect 18 cases[8.1%], patent ductus arteriosus 8 cases[3.6%], aortic insufficiency 7 cases[3.2%], infundibular pulmonary stenosis 5 cases[2.3%] and etc. There was statistically significant correlationship between VSD size and Qp/Qs, Rp/Rs, Pp/Ps respectively. All cases were operated under cardiopulmonary bypass and 157 patients[70.7%] would be corrected through right atrial approach. 158 patients[71.2%] underwent closure of ventricular septal defect with primary closure and the remained patients[28.8%] with patch closure. In anatomical classification by Kirklin, type I constituted 23.4%, type II 73.4%, type III 0.5%, type I and type II 1.4%, and type II and type III 1.4%. Important postoperative EGG changes were noted in 57 cases[25.7%] and incomplete right bundle branch block was most common[12.6%]. 54 patients[24.3%] developed minor and major postoperative complications and 9 patients died of several complications and overall operative mortality was 4.1%.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.63-66
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• 2015

We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy.

• Journal of Veterinary Clinics
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• v.38 no.6
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• pp.310-314
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• 2021

Compared to the other chemodectoma, aortic body tumors, the carotid body tumor is rarer and more often malignant. In the present case, a 12-year-old, intact female Shih-tzu dog presented to the hospital with a right ventral cervical mass. The mass was diagnosed by immunohistochemical staining with chromogranin A (CgA) as a carotid body tumor. The cervical mass and metastasized lymph node were removed by surgical resection. Because the dog had valvular heart disease, chemotherapy with carboplatin was initiated over 6 months to prevent metastasis and recurrence as an adjunctive treatment. After over two years of management, tumor metastasis and recurrence were not observed until recently. This report shows that proper management and chemotherapy as an adjunctive therapy can treat carotid body tumors in elderly dogs with concurrent heart disease.

• Journal of Chest Surgery
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• v.56 no.1
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• pp.56-58
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• 2023

Untreated severe tricuspid regurgitation (TR) is associated with poor outcomes. Functional TR occurs secondary to dilatation of the annulus and tethering of the leaflets. Ring annuloplasty alone can correct most cases, but is insufficient in cases of severe annular dilatation due to severe leaflet tethering. In such cases, a tricuspid edge-to-edge technique may be an option. However, stitching of the leaflet tips alone is likely to result in tearing of the leaflets. Approximation of the durable chordae tendineae is considered helpful for this problem. Herein, we present the case of a 39-year-old man who had undergone open-heart surgery for acute type A aortic dissection 13 months earlier. A right mini-thoracotomy approach with a beating-heart strategy was used, which did not require unnecessary pericardial adhesiolysis and dissection. This technique had the advantage of reducing the operation time and the risk of bleeding. To summarize, we present a case of tricuspid valve repair in a high-risk patient with severe leaflet tethering that was successfully managed using these methods.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.32-37
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• 2000

Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.510-513
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• 2003

Annuloaortic ectasia, aortic regurgitation(AR), and ventricular septal defect(VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hapoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.578-584
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• 2004

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.