• Journal of Chest Surgery
• /
• 제49권6호
• /
• pp.421-426
• /
• 2016

Background: Median sternotomy is the standard approach for atrial septal defect (ASD) closure. However, minimally invasive cardiac surgery (MICS) has been introduced at many centers in adult/grown-up congenital heart patients. We retrospectively reviewed the results of right anterolateral thoracotomy compared with conventional median sternotomy (CMS) for ASD closure at Seoul National University Hospital. Methods: We retrospectively analyzed 60 adult patients who underwent isolated ASD closure from January 2004 to December 2013 (42 in the CMS group, 18 in the MICS group). Preoperative, operative, and postoperative data were collected and compared between the 2 groups. Results: The MICS group was younger (44.6 years vs. 32.4 years, p=0.002) and included more females (66.7% vs. 94.4%, p=0.025) than the CMS group. Operation time (188.4 minutes vs. 286.7 minutes, p<0.001), cardiopulmonary bypass time (72.7 minutes vs. 125.8 minutes, p<0.001), and aortic cross-clamp time (25.5 minutes vs. 45.6 minutes, p<0.001) were significantly longer in the MICS group. However, there were no significant differences in morbidity and mortality between groups. Only chest tube drainage in the first 24 hours (627.1 mL vs. 306.1 mL, p<0.001) exhibited a significant difference. Conclusion: MICS via right anterolateral thoracotomy is an alternative choice for ASD closure. The results demonstrated similar morbidity and mortality between groups, and favored MICS in chest tube drainage in the first 24 hours.

• Journal of Chest Surgery
• /
• 제54권1호
• /
• pp.45-52
• /
• 2021

Background: Atrial septal defect (ASD) is the most common congenital heart disease. However, the details of cardiac chamber remodeling after surgery are not well known, although this is an important issue that should be analyzed to understand long-term outcomes. Methods: Between November 2017 and January 2019, cardiac magnetic resonance imaging was performed preoperatively, at a 1-month postoperative follow-up, and at a 1-year postoperative follow-up. Cardiac chamber volume, valve regurgitation volume, and ejection fraction were measured as functions of time. Results: Thirteen patients (10 men and 3 women) were included. The median age at surgery was 51.4 years. The preoperative median ratio of flow in the pulmonary and systemic circulation was 2.3. The preoperative mean right ventricular (RV) end-diastolic volume index (EDVi) and RV end-systolic volume index (ESVi) had significantly decreased at the 1-month postoperative follow-up (p<0.001, p=0.001, respectively). The decrease in the RVEDVi (p=0.085) and RVESVi (p=0.023) continued until the postoperative 1-year follow-up, although the rate of decrease was slower. Tricuspid valve regurgitation had also decreased at the 1-month postoperative follow-up (p=0.022), and continued to decrease at a reduced rate (p=0.129). Although the RVEDVi and RVESVi improved after ASD closure, the RV volume parameters were still larger than the left ventricular (LV) volume parameters at the 1-year follow-up (RVEDVi vs. LVEDVi: p=0.016; RVESVi vs. LVESVi: p=0.001). Conclusion: Cardiac remodeling after ASD closure is common and mainly occurs in the early postoperative period. However, complete normalization does not occur.

• Journal of Chest Surgery
• /
• 제55권1호
• /
• pp.55-60
• /
• 2022

Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

• Journal of Chest Surgery
• /
• 제23권1호
• /
• pp.16-21
• /
• 1990

From November 1978 through June 1989, 33 patients aged 3 months to 27 years [mean 9.7 years] underwent repair of intracardiac defects associated with corrected transposition. Five patients had had previous palliative surgery. Operation were performed in 31 for ventricular septal defect, 22 for pulmonary outflow tract obstruction, 16 for atrial septal defect, and 5 for anatomical tricuspid valve regurgitation. Pulmonary outflow tract obstruction was relieved by pulmonary valvotomy in 9, Rastelli procedure in 5, modified Fontan procedure in 3, and by REV procedure in 5 patients recently. Early mortality was 21.2%[7/33] and no late mortality during follow up period. Two had residual pulmonary outflow tract obstruction and one residual VSD. In eight patients, transient arrhythmia was found but soon returned to sinus rhythm. Five patients developed complete heart block and 2 were given permanent pacemaker insertion. There were 8 RBBB, 1 LBBB and one second degree atrioventricular block patients, but all showed no clinical significance. This report suggests that surgical repair of intracardiac defects associated with corrected transposition can be achieved with acceptable low risk. Though the mortality is still high, we can improved the result by advancing surgical technique, knowledge of the special conduction system, and by improving postoperative care.

• Journal of Chest Surgery
• /
• 제50권2호
• /
• pp.78-85
• /
• 2017

Background: Closure of a secundum atrial septal defect (ASD) is possible through surgical intervention or device placement. During surgical intervention, concomitant pathologies are corrected. The present study was conducted to investigate the outcomes of surgical ASD closure, to determine the risk factors of mortality, and establish the effects of concomitant disease correction. Methods: Between October 1989 and October 2009, 693 adults underwent surgery for secundum ASD. Their mean age was $40.9{\pm}13.1years$, and 199 (28.7%) were male. Preoperatively, atrial fibrillation was noted in 39 patients (5.6%) and significant tricuspid regurgitation (TR) in 137 patients (19.8%). The mean follow-up duration was $12.4{\pm}4.7years$. Results: There was no 30-day mortality. The 1-, 5-, 10-, and 20-year survival rates were 99.4%, 96.8%, 94.5%, and 81.6%, respectively. In multivariate analysis, significant preoperative TR (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.09 to 3.16; p=0.023) and preoperative age (HR, 1.04; 95% CI, 1.01 to 1.06; p=0.001) were independent risk factors for late mortality. The TR grade significantly decreased after ASD closure with tricuspid repair. However, in patients with more than mild TR, repair was not associated with improved long-term survival (p=0.518). Conclusion: Surgical ASD closure is safe. Significant preoperative TR and age showed a strong negative correlation with survival. Our data showed that tricuspid valve repair improved the TR grade effectively. However, no effect on long-term survival was found. Therefore, early surgery before the development of significant TR mat be beneficial for improving postoperative survival.

• Clinical and Experimental Pediatrics
• /
• 제50권10호
• /
• pp.970-975
• /
• 2007

목 적 : 본 연구는 경피적 심방중격결손 폐쇄술 시 TTE 및 TEE를 이용하여 측정한 결손의 크기와 BOD과의 차이를 분석하고 이에 영향을 줄 수 있는 혈역학적 및 해부학적인 요인에 대해 알아보고자 하였다. 방 법 : 2003년 5월부터 2004년 6월까지 본원에서 연세대학교 심장혈관병원 소아심장과에서 이차공 심방중격결손 진단 하에 경피적폐쇄술을 시행받은 78명의 환자(남자 20명, 여자 58명, 평균연령 $18{\pm}17.4$세)를 대상으로 하였다. 각 환자에서 TTE와 TEE를 시행하여 결손의 크기 및 주변구조들(대동맥, 상대정맥, 하대정맥, 승모판연, 심방후벽)과의 거리를 측정하였고 시술 시 TEE 유도 하에 BOD를 측정하여 상관 관계와 관련 요인을 분석하였다. 결 과 : BOD와 TTE로 측정한 직경의 차이는 흉골연 단축상에서 $4.8{\pm}3.6mm$, 흉골하 장축상에서는 $5.4{\pm}3.2mm$였고 BOD와 TEE상 직경과의 차이는 단축상에서 $3.6{\pm}2.2mm$, 장축상에서 $4.2{\pm}3.1mm$였다. 선형회귀분석을 통한 BOD와 TTE상 직경의 회귀방정식은 흉골연 단축상에서 Y=1.12X+3.86(R2=0.82, P< 0.01), 흉골하 장축상 (또는 심첨 4방상)에서 Y=1.01X+5.32(R2= 0.83, P<0.01)(Fig. 4), BOD와 TEE상 직경의 회귀방정식은 단축상에서 Y=1.02X+3.88(R2=0.89, P<0.01), 장축상에서 Y=1.05X+3.60(R2=0.83, P<0.01)였다. BOD와 TTE 및 TEE 상의 결손의 직경의 차이는 환자의 나이가 많을수록, 결손과 심방 후벽까지의 길이가 길수록, 승모판연까지의 거리가 길수록, TTE상 결손의 직경 및 심방중격의 길이가 길수록 통계학적으로 의미 있게 증가하였다(P<0.05). 결 론 : 심방중격결손의 BOD는 TTE 및 TEE상의 직경의 크기로 어느 정도 예측이 가능하며 심초음파상 결손의 크기 및 주변 구조들과의 거리와 결손의 위치에 따라 BOD가 더 크게 측정될 것으로 예상할 수 있어 경피적 기구 폐쇄가 가능한 환자의 선정, 시술에 따른 어려움의 예측과 시술 시 적정성의 판단에 도움이 될 수 있을 것으로 생각된다.

• Journal of Chest Surgery
• /
• 제21권4호
• /
• pp.700-705
• /
• 1988

A case of congenital tricuspid stenosis in 24 year old male patient is presented. The lesion was successfully corrected with prosthetic valve replacement and closure of atrial and ventricular septal defects. Especially, this is the first reported case of successful large prosthetic valve replacement to a small annulus in tricuspid valve.

• Journal of Chest Surgery
• /
• 제28권4호
• /
• pp.340-345
• /
• 1995

Between 1983 and 1993, 250 patients over 16 years of age who had undergone a surgical correction of a congenital cardiovascular disease were reviewed. 222 patients were divided into acyanotic group and 28 patients were cyanotic group. The most common defects were atrial septal defect [96 patients and ventricular septal defect [95 patients . There were 128 patients in the third decade, 71 patients under 20 years of age, 40 patients in the fourth decade and 11 patients over 40 years of age. The male to female ratio was 1.05:1. Operative mortality was 6.8% [4.1% in the acyanotic group and 26.8% in the cyanotic group and the most common cause of death was low cardiac output syndrome.

• Journal of Cardiovascular Imaging
• /
• 제31권4호
• /
• pp.180-187
• /
• 2023

BACKGROUND: Two-dimensional (2D) transesophageal echocardiography (TEE) is commonly used for assessing patients undergoing transcatheter atrial septal defect (ASD) device closure. 3D TEE, albeit providing high resolution en-face images of ASD, is used in only a fraction of cases. We aimed to perform a comparative analysis between 3D and 2D TEE assessment for ASD device planning. METHODS: This was a prospective, observational study conducted over a period of one year. Patients deemed suitable for device closure underwent 2D and 3D TEE at baseline. Defect characteristics, assessed separately in both modalities, were compared. Using regression analysis, we aimed to derive an equation for predicting device size using 3D TEE parameters. RESULTS: Thirty patients were included in the study, majority being females (83%). The mean age of the study population was 40.5 ± 12.05 years. Chest pain, dyspnea and palpitations were the common presenting complaints. All patients had suitable rims on 2D TEE. A good agreement was noted between 2D and 3D TEE for measured ASD diameters. 3D TEE showed that majority of defects were circular in shape (60%). The final device size used had high degree of correlation with 3D defect area and circumference. An equation was devised to predict device size using 3D defect area and circumference. The mean device size obtained from the equation was similar to the actual device size used in the study population (p = 0.31). CONCLUSIONS: Device sizing based on 3D TEE parameters alone is equally effective for transcatheter ASD closure as compared to 2D TEE.

• Clinical and Experimental Pediatrics
• /
• 제56권4호
• /
• pp.176-181
• /
• 2013

Purpose: Apical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO). Methods: We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side. Results: The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients. Conclusion: Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.