• Journal of Chest Surgery
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• v.21 no.6
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• pp.1117-1123
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• 1988

Prolapse of the aortic valve is the main cause of insufficiency of the aortic valve as a complication of ventricular septal defect. Aortic insufficiency gets worse by the progress of prolapse of aortic valve due to lack of support of the valve and the hemodynamic effect of blood flow through the ventricular septal defect. This produces typical clinical picture, that may be serious and threatening when it is untreated. Type and timing for the surgical treatment of the ventricular septal defect with aortic insufficiency is considered. Among 113 ventricular septal defect, 9 patients of ventricular septal defect with associated aortic insufficiency were experienced from June. 1983 to June 1988 at the Department of Thoracic and Cardiovascular Surgery, Chon-Buk University Hospital. Male was 6 patients and female was 3 patients. Ages were from 7 years to 24years. 5 patients were from 10 to 19 years age. 3 patients were below 10 years age. The ratio of pulmonary blood flow to systemic f low [Qp/Qs] was 1.53 and in pulmonary vascular resistance, normal or slight increase was 7 patients, moderate 1 patient, and severe 1 patient. Ventricular septal defect was subpulmonic in 5 patients and infracristal in 4 patients. Prolapse of right coronary cusp was 7 patients, right and non coronary cusp 1 patient and non coronary cusp 1 patient. Teflon patch closure of ventricular septal defect was undertaken in 3 patients and primary closure in 1 patient. Among the 4 patients of defect closure alone, one patient performed valve replacement 7 months later due to progressive regurgitation and cardiac failure and the result was good. The other 3 patients were good result. Closure of ventricular septal defect and aortic valvuloplasty performed in 4 patients. 2 patients of these required valve replacement for the sudden intractable cardiac failure and died due to low cardiac output. The cause of intractable cardiac failure was tearing of repaired valve at the fixed site. The other 2 patients were good result. Closure of ventricular septal defect and valve replacement performed in 1 patient with good result.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.475-478
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• 1986

Syphilitic aortic aneurysm is a rare lesion today. We experienced a case of huge syphilitic ascending aortic aneurysm with aortic insufficiency. Surgical correction was done by replacement of ascending aorta with woven Dacron graft and aortic valve replacement under cardiopulmonary bypass. There is no abnormality in postoperative aortography. The postoperative course was uneventful.

• Journal of Yeungnam Medical Science
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• v.30 no.2
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• pp.101-104
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• 2013

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder caused by a germline mutation of the VHL gene. It is a multi-systemic disorder that is predisposed to benign or malignant tumors of visceral organs such as hemangioblastoma of the central nervous system, renal cell carcinoma, retinal angioma and pheochromocytoma. We report herein a case of VHL disease that initially manifested with aortic valve insufficiency.

• Journal of Chest Surgery
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• v.8 no.1
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• pp.69-74
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• 1975

Twenty-nine cases of ventricular septal defect operated in this department during the period from 1969 to May 1975 were presented. Out of 29 cases, there were 20 cases of type II defects, 8 cases of type I, and one case of type III, and the last case was multiple defect. The anomalies associated with ventricular septal defect were eight in all; three patent ductus arteriosus, one atrial septal defect, one tricuspid insufficiency and an aortic insufficiency. Over all mortality was 17%. The causes of death were complete heart block in a case, respiratory distress due to excessive administration of morphine in one, low cardiac output in two and perforation of the aortic annulus after repair of the ventricular septal defect associated with aortic insufficiency.

• Journal of Chest Surgery
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• v.26 no.6
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• pp.457-462
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• 1993

We retrospectively studied 34 patients who underwent operations of ascending aortic aneurysm and aortic valve replacement from August 1979 to July 1992 at the Yonsei Cardiovascular Center. Eight patients underwent supracoroanry non-composite graft replacement and separate aortic valve replacement[group I]. Twenty six patients underwent valved composite graft replacement with reimplantation of coronary arteries[group II]. Two cases in group II died within 1 month after the operation. Among the 32 survivors 28 patients have been followed up for an average of 59 months ranging from 1 months to 159 months. During the follow up periods, a pseudoaneurysm around the ascending aorta and a newly developed dissecting aneurysm in remaining aorta were noted in group II. There were 6 late deaths: 2 cases in group I and 4 cases in group II. Three cases among the 6 late deaths have stigmata of Marfan`s syndrome[1 cases in group I and 2 case in group II]. There was no statistically significant difference in actuarial survival rates between group I and group II[p > 0.05]. This study suggests that non-composite supracoronary graft interposition with separate aortic valve replacement is a safe surgical technique in patients who have normal aortic annulus and normal position of coronary ostia. However in degenerative disease such as cystic medial necrosis, composite graft replacement is recommended because this procedure eliminates entire abnormal tissue.But it seems to be important that the suture technique and strict follow-up in patients with diseased aortic wall.

• Journal of Chest Surgery
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• v.24 no.4
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• pp.352-356
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• 1991

From April, 1981, to April, 1990, 20 male and 7 female patients ranging in age from 17 to 63, were operated on for aortic insufficiency with an aneurysm of the ascending aorta. Ten patients were in New York Heart Association functional class II, 7 in class III, and ten in class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with composite graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft. In 15 patients an uncomplicated annulo-aortic ectasia existed, and in 12 an aortic dissection; three of the latter group were operated during the acute phase. 17 patients showed typical Marfan syndrome, and 3 patients showed severe ascending aortic aneurysm secondary to the aortic valve disease. The overall operative mortality was 7%[2 deaths]. Those 2 deaths occurred following emergency operation due to associated aortic dissection, but no death during elective operation. All survivors have been followed-up during a period ranging 1 to 108 month[average 34 months]. There was no late mortality. Among the survivors, clinical improvement is readily apparent[2,3 in class I, 2 in class II ]. In conclusion, the treatment of aortic insufficiency associated with an aneurysm of the ascending aorta by insertion of a composite graft and reimplantation of the coronary arteries through an intermediate Dacron tube is a reliable method with low mortality and excellent results.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.192-200
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• 1990

The results of conventional operative resection of diffuse subaortic stenosis[tunnel subaortic stenosis] have been less than satisfactory. We have performed modified Konno operation to enlarge the outflow tract of both ventricle with a patch in three patients with diffuse tunnel subaortic stenosis in the department of Thoracic and Cardiovascular Surgery, Seoul National University Children`s Hospital. Preoperative left ventricular aortic pressure gradients were 135 mmHg, 50 mmHg, 80 mmHg respectively in these patients. After right ventriculotomy, the septotomy was done and extended beyond the limit of the stenosis and fibrous and/or muscular tissue was removed from each edge of septal incision. After adequate widening of the tunnel subaortic stenosis with various patches, right ventricle was closed primarily or with prosthetic patches successfully. One patient who was diagnosed as complete atrioventricular septal defect had complete AV block preoperatively and was implanted permanent pacemaker, and others who were sinus rhythm preoperatively have no serious postoperative rhythm disturbance. One patient developed mild postoperative aortic insufficiency and one who had preoperative aortic insufficiency has still same grade of aortic insufficiency after operation. All had good postoperative hemodynamics without any postoperative residual pressure gradient.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.305-313
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• 1985

Surgical therapy for dissection of the aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. Recently, a new method of treatment with an intraluminal graft that requires no end-to-end anastomosis has been developed. Of the four patients with dissecting aneurysm of the aorta treated by inserting sutureless ringed intraluminal graft at the Department of Thoracic and Cardiovascular Surgery, S.N.U.H., three were DeBakey type I [one with associated aortic insufficiency] and the other was DeBakey type III. Suspected etiology of the dissection was Marfan`s syndrome in one and hypertension in the others. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta [type A] and simple aortic crossclamping was used for the patient with dissecting aneurysm of the descending aorta. The basic technique consists of inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in patient with aortic insufficiency associated with dissection of the ascending aorta. There were no hospital deaths and one patient with type III dissecting aneurysm developed postoperative paraparesis and renal insufficiency which was resolved. Follow-up has been from 1 month to 16 months with no evidence of prosthetic problems, such as erosion, migration, or thrombosis.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.113-117
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• 2002

With an increasing awareness of the limitations of both mechanical prostheses and bioprostheses, aortic valvuloplasty has gained attention as an alternative procedure for aortic valve disease. Material and Method: Eight consecutive patients underwent aortic valvuloplasty caused by leaflet prolapse between June 1799 to June 2000. Mean age of the patients was 18.4$\pm$12.6 year. Four paitents(50%) were male. Six patients had tricuspid valves and ventricular septal defect and two patients had bicuspid valves. The extent of aortic insufficiency was 3.5$\pm$0.5 by preoperative Doppler echocardiography. The technique involved triangular resection of the free edge of the prolapsed leaflet, annular plication at the commissure, and resection of a raphe when present in bicuspid valves. Result: There was no in-hospital mortality or morbidity. Mean follow-up was complete at 11.973.6months. There was no late mortality or morbidity. The amount of the severity of aortic insufficiency, as assessed by echocardiography preoperatively, postoperatively and at late follow-up was 3.5$\pm$0.5, 0.6$\pm$0.5 and 0.8$\pm$0.6, respectively(p value : 0.01). There was one patient with grade 2/4 aortic insufficiency and in the other patients, grade 1/2 or trivial aortic insufficiency were detected with late echocardiograms. Conclusion: Triangular resection in the patients with aortic leaflet prolapse offers a good early clinical result, but long-term follow-up is necessary.

• Journal of Chest Surgery
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• v.25 no.5
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• pp.550-554
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• 1992

The selection of an appropriate surgical technique for repair of aneurysm of the ascending aortia with aortic insufficiency is unsettled. The etiology of the disease process has been the best indicator for the type of repair. Placement of a supracoronary graft[seperate graft and valve] is a compromise if the coronary ostia are displaced cephalad by the aneurysm, where as insertion of a valved conduit is difficult and unnecessary if the coronary ostia are normally placed. A 53 year old female patient underwent primary repaiar of proximal dissected layer and aortic valve replacement with 24mm carbomedics, The operative findings consisted of a supravalvular intimal tear, cicumferential dissection, dilated aortic annulus and normal position of coronary ostia. She is good physical activity now llmonths posoperatively.