• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 춘계학술대회
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• pp.218-218
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• 2009

• 한국임상수의학회지
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• 제33권3호
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• pp.155-159
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• 2016

Four dogs were brought to the Veterinary Medicine Teaching Hospital of Seoul National University (VMTH SNU) with a history of hind limb ataxia, three with pain, one without pain. Three of the four showed weak to absent femoral pulses and cold extremities. Thromboembolism was identified by ultrasonography in the external and/or internal iliac arteries. A thrombolytic agent, recombinant tissue plasminogen activator (rt-PA), was administered (0.5-1 mg/kg, every 60-120 min, 3-5 doses). Two dogs (Cases 2 and 3), which were instantly provided rt-PA treatment, survived 6 and 17 months, respectively, although hematemesis and hematochezia were observed during treatment. In the other two dogs (Cases 1 and 4), rt-PA was administered 4 and 28 days after the appearance of pelvic limb symptoms, which may have limited the benefits of the treatment. When rt-PA treatment is instituted instantly and the side effects are monitored thoroughly during treatment, a good prognosis might be expected in canine aortic thromboembolism. For this reason, we suggest that rt-PA treatment should be initiated immediately if thromboembolism is identified.

• Journal of Chest Surgery
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• 제25권1호
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• pp.57-65
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• 1992

St.Jude Medical cardiac valve replacement was performed in 322 patients: 191 had mitral, 58 had aortic, 72 had double valve and 3 had tricuspid valve replacement. Motality rate in early period was 2.8%[9 patients]. The most common cause of early death was low cardic output syndrome. Follow up extended from 1 to 90 months[mean: 34 months] in 292 patients among 313 in all surviving patients [93.6%]. There were thrombolic complications in eighteen patients. The probability of free from thromboembolism at 5 yerars in MVR, AVR and DVR were 84.7%, 91.8% and 90.2% respectively. And also, actuarial event free rate at 5 years in MVR, AVR and DVR were 80.1%, 82.2%, and 81.4% respectively. There were fourteen late death during follow up period: six from thromboembolism, one from hemorrhage and the others from non valve related -or unknown complications. The acturial survival rate at 5 years were 93.1% in mitral, 92.1% in aortic and 97.1% in double valve replacement. In conclusion, the performance of the St. Jude Mecanical valve compares most favorably with other artificial valves. But it remains still hazards of mechanical prosthesis such as thromboembolism and anticoagulant related hemorrhage.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1041-1047
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• 1992

The consecutive 35 patients underwent isolated aortic valve replacement with the low-profile model of the Ionescu-Shiley pericardial xenograft valve from 1984 to 1991. Operative mortality was 2.9%, and early survivors were followed up for a total 136.1 patient-years[Mean$\pm$SD, 4.00$\pm$2.14 years]. The linearized late mortality was 2.204% /pt-yr. Three patients required rereplacement of the valve with overall valve failure rate of 2.204% /pt-yr: two for endocarditis and one for paravalvular leak. There was no case of primary tissue failure. The linearized annual rates of complication were: thromboembolism 0.735% /pt-yr, bleeding 0.735%pt-yr, and endocarditis 2.204% /pt-yr. The actuarial survival at 8 years of follow-up was 90.4$\pm$5.3%, and the probabilities of freedom from thromboembolism and from rereplacement were 95.6$\pm$4.4% and 88.2$\pm$6.7% at 8 years respectively. Although the low profile Ionescu-Shiley pericardial valve provided favorable clinical performance comparable with the standard model up to 8 years, it needs prolonged follow-up to assess the pattern of its durability.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 춘계학술대회
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• pp.214-214
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• 2009

• Journal of Chest Surgery
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• 제49권5호
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• pp.397-400
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• 2016

Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an anomalous increase in platelet production. Many patients with ET are asymptomatic. Few studies have reported ET-associated thromboembolism in large vessels such as the aorta. We report a patient with ET who presented with peripheral embolism from an abdominal aortic thrombus and developed acute limb ischemia. The patient underwent aortic replacement successfully. The patient's platelet count was controlled with hydroxyurea, and no recurrence was noted over 2 years of follow-up.

• Journal of Chest Surgery
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• 제8권2호
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• pp.89-100
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• 1975

Sixteen cases of cardiac valve replacements have been done in this department since 1970. Twelve cases of mitral valve replacement were done with Beall valve, 2 cases of aortic valve replacement with Starr-Edwards and Magoven valve and 2 cases of double valve replacement using Beall valve for mitral and Magovern valve for aortic. Three patients [18.8%] died during operation. Two cases [12.5%] of hospital mortality occurred because of congestive heart failure and asphyxia due to tracheomalacia 3 months after operation. Follow-up studies from two to 27 months showed excellent results except three cases of late mortality [18.8 %]. Thromboembolism occurred in two double valve replacement patients[12.5%]who were fatal.

• Journal of Chest Surgery
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• 제44권3호
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• pp.220-224
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• 2011

Background: We investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement. Materials and Methods: Seventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)$^{(R)}$ dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively. Results: The observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were $97.10{\pm}2.02%$ at 5 years, $84.30{\pm}5.22%$ at 10 years, and $67.44{\pm}12.14%$ at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, $1.86{\pm}0.14$ vs. thromboembolic group, $1.50{\pm}0.28$, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, $49.04{\pm}9.47$ days vs. thromboembolic group, $65.89{\pm}44.88$ days, p<0.01). Conclusion: To prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.

• Journal of Chest Surgery
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• 제11권3호
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• pp.303-315
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• 1978

During the full 10-year period from June 1968 through June 1978, 112 consecutive patients underwent isolated or double valve replacement. A total of 130 valves were used in aortic, mitral or tricuspid positions: 63 prosthetic valves in 56 and 67 glutaraldehyde-preserved porcine aortic valves in 56 patients. There were 31 early and 9 late deaths with a cumulative mortality rate of 35.7 percent. Eighty-five patients survived longer than 10 days postoperatively were studied for the occurrence of thromboembolism and complications related to anticoagulant therapy. At the end of follow-up period, 68 patients were on Coumadin; 74 were on Persantin with or without Coumadin; 11 were off any antithrombotic drugs with 6 of them being off electively after 6 months of tissue valve replacement. Thromboembolism occurred in 7 [8.2%] of 85 patients or 10.9%/patient-year. Embolic rates were as follows: one of 18 patients anticoagulated [5.6%] or 6.1%/patient-year and 4 of 16 patients not anticoagulated [25.0%] or 17.8%/patient-year for the prosthetic valve replacement; and one of 40 patients anticoagulated [2.5%] or 7.9%/patient-year and one of 11 patients not anticoagulated [9.1%] or 7.9%/patient-year for tissue valve replacement. Three complications of major bleeding were experienced by 3 patients during the follow-up period, being related to Coumadin therapy. The importance of proper anticoagulation were stressed for the successful management of patients after cardiac valve replacement, both prosthetic and tissue valves.

• Journal of Chest Surgery
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• 제28권7호
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• pp.666-670
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• 1995

A total of and consecutive 87 patients underwent concomitant double mitral and aortic valve replacement with the St. Jude Medical prosthesis between January 1985 and December 1993. They were 44 males and 43 females with the ages ranging from 18 to 59 years[mean$\pm$SD: 40.9$\pm$9.5 years . Fifteen patients[17.2% had a history of previous cardiac valve replacement. There were 2 early deaths[2.3% , and 85 early survivors were followed up for a total of 352.6 patient-years[mean$\pm$SD: 4.1 $\pm$2.6 years . All were anticoagulated with coumadin keeping the target international normalized ratio within the range of 1.5 and 2.5. There was a single late death[late mortality of 0.284%/patient-year . Thromboembolism was the most frequent complication[1.985%/patient-year , and bleeding related to anticoagulation was experienced in one patient [0.284%/patient-year . The incidences of prosthetic valve endocarditis and of paravalvular leak were also low[0.284%/patient-year, respectively . The survival including operative mortality was 96.1%$\pm$2.2% at 10 years. The actuarial probabilities of freedom from thromboembolism and from all events were 77.9%$\pm$11.1% and 72.4%$\pm$10.7%, respectively, at 10 years. There was no structural failure of the prosthesis. Results from a series of clinical studies suggest strongly that the use of lower intensity of anticoagulation therapy lowers the thromboembolic as well as bleeding rates in patients with the ST. Jude Medical prosthesis.