• Journal of Chest Surgery
• /
• v.36 no.10
• /
• pp.780-783
• /
• 2003

Pacemaker lead-related infective endocarditis is an uncommon, but serious complication. We report a case of a 45-year-old man who had symptom of intermittent high fever and rupture of sinus Valsalva that developed after a redo aortic valve replacement and transvenous permanent pacemaker implantation. Positive blood cultures of streptococcus viridans and transesophageal echocardiography showing a large mobile vegetation on pacemaker lead and tricuspid valve lead to the diagnosis of pacemaker lead-related infective endocarditis. Initial antibiotic therapy followed by surgical extraction of the pacemaker lead and wide debridement of infective tissues including multiple vegetations was required. Postoperative antibiotic therapy was continued for 4 weeks. The postoperative course has been uneventful. The patient is totally asymptomatic and is doing well up to now.

• Journal of Chest Surgery
• /
• v.21 no.5
• /
• pp.889-893
• /
• 1988

We experienced a case of infective endocarditis of aortic valve and tricuspid valve associated with a fistula between aorta and right ventricle. The patient was 35 years old woman and showed severe congestive heart failure. Large and multiple vagetations were found on the valvular surfaces and a fistula was present between aorta and right ventricle. Probably infective endocarditis of aortic valve resulted in annular abscess and as it healed, a fistula was formed and tricuspid valve endocarditis followed. We replaced the aortic valve and tricuspid valve with St. Jude mechanical prostheses, and closed the fistula opening with suture. The postoperative course was smooth and the patient has no problems till now 4 months after operation.

• Journal of Chest Surgery
• /
• v.27 no.10
• /
• pp.838-845
• /
• 1994

From April, 1982 to December, 1992, multiple valve replacement was performed in 100 patients. Mitral and aortic valve replacement were done in 86 patients, 9 underwent mitral and tricuspid valve replacement, 4 patients underwent triple valve replacement and 1 patient underwent aortic and tricuspid valve replacement. Of the valve implanted, 100 were St. Jude, 64 Duromedics, 19 Carpentier-Edwards, 13 Bj rk-Shiley, 6 Ionescu-Shiley, and 2 Medronics.The hospital mortality rate was 15%[15 patients] and the late mortality rate was 7%[7 patients], the mortality rate was high in early operative period but decreased with time[20% at 1986, 18.2% at 1987, 9.5% at 1988, 11.1% at 1989, 12.5% at 1990, 11.8% at 1991, 0% at 1992]. The causes of death were low cardiac output in 8, sudden death in 3, CHF in 3, bleeding in 2, cerebral thromboembolism in 1, leukemia in 1, multiorgan failure in 1 and so on. The actuarial survival rate excluding operative death was 73% at 10 years.

• Journal of Chest Surgery
• /
• v.28 no.6
• /
• pp.579-582
• /
• 1995

The extended transseptal approach to the mitral valve replacement has been used for 30 patients. There were 19 women and 11 men. Twenty five patients had rheumatic heart disease, 4 had degenerative valve ,and 1 had valve prolapse. Fifteen of 30 patients had other associated procedure; 10 had aortic valve replacement; 5 had tricuspid annuloplasty. There were no postoperative complications associated with the approaches, ie, no bleeding, no sinus node dysfuction, and no atrioventricular conduction disturbance. Despite division of the sinus node artery, preoperative atrial rhythms[3 sinus rhythms and 27 atrial fibrillations were not changed during postoperative period. The extended transseptal approach provides good mitral valve exposure without inherent complications, and is superior to that of standard approach, so we use it routinely for mitral valve procedure.

• Proceedings of the KOSOMBE Conference
• /
• v.1993 no.11
• /
• pp.99-103
• /
• 1993

A monoleaflet polymer artificial heart valve which showed the remarkable improvement in pressure drop compared with other types of artificial valve was designed to decrease the deflection in vertical direction and the displacement or the valve tip in horizontal direction. Stress distribution change was studied as the location of the supporting members or the valve frame changed. And it was found that using the valve tip horizontal displacement the minimum valve thickness could be obtained in order to prevent the gap between the valve tip and the frame wall.

• Journal of Chest Surgery
• /
• v.27 no.6
• /
• pp.444-450
• /
• 1994

From June 1984 to February 1994, cardiac valve replacement was performed in 108 patients. The distribution of patients was ranged from 13 to 64 year-old age[mean 39.48 1.24] and 51 patients were male, 57 patients were female [male:female=1:1.1]. 64 patients had mitral valve replacement, 27 patients underwent aortic valve replacement and 17 patients were performed double[mitral & aortic] valve replacement. Total 125 artificial cardiac valves were used, mechanical valves were 51 valves and tissue valves were 74 valves. The duration of follow-up was 473.41 patient-year[mean 4.79 3.29 patient-year] and the information of follow-up was available for 99 patients[92%]. The actuarial survival rates including the operative mortality was 89.5% & 88.3 at postoperative fourth & ninth year. The probability of freedom from overall valve failure, thromboembolism and bacterial endocarditis were 77.5%, 89.2% and 95.6% at ninth year after cardiac valve replacement.

• Journal of Chest Surgery
• /
• v.20 no.3
• /
• pp.512-519
• /
• 1987

In the department of chest surgery of Pusan National University hospital cardiac valve surgery was done in 118 cases from March, 1982, to June, 1986. Among these, 90 were mitral valve replacement, 9 mitral commissurotomy, 5 mitral valvuloplasty, 4 aortic valve replacement, 4 double valve replacement, 4 mitral annuloplasty, one mitral annuloplasty with commissurotomy and valvuloplasty. 48 were male and 70 were female and age distribution ranged from 6 to 57 years [mean 30.6 years]. Early death within 30 days after operation was 14 cases: 10 had mitral valve replacement, 2 double valve replacement and 2 mitral annuloplasty respectively. Confirmed causes of death were low cardiac output syndrome in 9 cases, congestive heart failure in one case, cardiac tamponade in one case, malfunction of valve in one case, cardiac rupture in one case and renal failure in one case. The 104 cases were followed up for a total 190 years and range was from 2 to 54 months [Mean*SD: 21.9*16.5 months]. During follow-up period, 2 late deaths were developed: one was due to subdural hematoma and the other was congestive heart failure combined with fulminant hepatitis. Anticoagulation therapy was done with warfarin to the level of 20 to 40% of normal prothrombin time in 53 cases, dipyridamole and aspirin in 18 cases, or ticlopidine hcl in 15 cases. The frequency of bleeding due to anticoagulation therapy was 1.0% episodes per patient-years: one was in warfarin group and another was in dipyridamole and aspirin group. Among the studied 102 cases, 93 cases [91.2%] of patients were in NYHA class I or II during follow up period.

• Journal of Chest Surgery
• /
• v.20 no.2
• /
• pp.404-410
• /
• 1987

An 18-day-old male neonate with hypoplastic left heart syndrome underwent surgical intervention by modification of the Norwood procedure on September 23, 1986. Hypoplastic left heart syndrome is a serious congenital cardiac anomaly that has a fatal outlook if left untreated. Included in this anomaly are [1] aortic valve atresia, and hypoplasia of the ascending aorta and aortic arch, [1] mitral valve atresia or hypoplasia, and [3] diminutive or absent left ventricle. Patent ductus arteriosus is essential for any survival, and there is usually a patent foramen ovale. Coarctation of the aorta is frequently associated with the lesion.z With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the ductus arteriosus was excised. The main pulmonary artery was divided immediately below its branches, and the distal stump of the divided pulmonary artery was closed with a pericardial patch. The aortic arch was incised, and a 1 5mm tubular Dacron prosthesis was inserted between the main pulmonary artery and the aortic arch. A 4mm shunt of polytetrafluoroethylene graft was established between the new ascending aorta and the right pulmonary artery to provide controlled pulmonary blood flow. Following rewarming, the heart started to beat regularly, but the patient could not be weaned from cardiopulmonary bypass. At autopsy, the patient was found to have hypoplasia of the aortic tract complex with mitral atresia and aortic atresia. A secundum atrial septal defect was noted. Right atrial and ventricular hypertrophy was present, and the left ventricle was entirely absent. Although unsuccessful in this case report, continuing experience with hypoplastic left heart syndrome will lead to an improvement in result.

• Journal of Veterinary Science
• /
• v.24 no.3
• /
• pp.47.1-47.7
• /
• 2023

Del-Nido cardioplegia (DNc) is a single-dose cardioplegia that is widely used in human medicine because of its long duration. In this report, we describe two cases of open-heart surgery with cardiopulmonary bypass (CPB) using DNc. One dog was diagnosed with partial atrioventricular septal defect, and the other dog was diagnosed with myxomatous mitral valve disease stage D. Both dogs were treated with open-heart surgery with DNc to induce temporary cardiac arrest. No complications from DNc were observed, and the patients were discharged. Veterinary heart surgeons should consider DNc as an option for temporary cardiac arrest during open-heart surgery with CPB.

• Journal of Chest Surgery
• /
• v.32 no.3
• /
• pp.307-309
• /
• 1999

Warfarin-induced skin necrosis is a rare complication caused by transient hypercoagulable state. This state is a result of rapid decline of the protein C activity relative to that of coagulation factor II, IX, and X during initiation of oral anticoagulant therapy. We experienced a case of warfarin-induced skin necrosis involving both breasts in a patient who underwent double valve replacement 1 month before. Warfarin was replaced to a low- molecular weight heparin and the necrotic breast lesion was healed spontaneously. Low-dose warfarin was restarted and gradually increased, after which a low molecular weight heparin discontinued..