• Journal of Chest Surgery
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• v.33 no.4
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• pp.316-319
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• 2000

Double-outlet left ventricle with ventricular septal defect and pulmonary stenosis was conventionally repaired with extracardiac conduit or pulmonary artery translocation. Here, we report an anatomically repaired double-outlet left ventricle without extracardiac conduit or pulmonary artery translocation in an 11 month old patient who had undergone palliative systemic-pulmonary shunt at a nonatal period. The location of ventricular septal defect, both great arteries and coronary arteries made it possible to reconstruct the right ventricular outflow tract using on-lay patch after incision and undercutting the tissue between the ventriculotomy and the pulmonary arteriotomy.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.148-155
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• 1977

The clinical findings with cardioangiography and successful surgical treatment of a 10 year old girl with double-outlet right ventricle is reported at The Dept. of Thoracic and Cardiovascular Surgery, Korea University Hospital, College of Medicine. The patient has been suffered from intermittent cyanosis, palpitation, and exertional dyspnea since 1 year after NFSD, and a holosystolic ejection murmur of grade 4 at the left 3rd intercostal space with mild cyanosis of the lips was the only physical findings at the time of this admission. Cardiac catheterization revealed ventricular septal defect with left to right shunt of 43% and right to left shunt of 10.2%. On cardioangiography from the left ventricle revealed all of the left ventricular outflow shunted into the right ventricle through the large ventricular septal defect, and the aorta originated from the infundibular chamber of the right ventricle with left, anterior sided pulmonary artery. The atria, viscera, and ventricles were normally located, and right ventricular out-flow was narrowed with infundibular hypertrophy and pulmonary valvular stenosis. Surgical correction was accomplished by closure of the ventricular septal defect in such a way that left ventricular outflow was routed via a Teflon felt prosthetic tunnel to the aorta, and pulmonary valvulotomy with infundibulectomy Was done to pass Hegar`s dilator No. 15 for reconstruction of the right ventricular outflow tract. The patient tolerated complete repair and has continued to improve over a period of three months after operation with normal school life. Details of the disease and method of repair are presented with related references.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.576-580
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• 1994

For 26 months since August 1991, 10 consecutive patients with congenital left ventricular outflow tract obstruction underwent corrective surgery in Pusan Paik Hospital. Their ages ranged from 2 to 18 years. There were 6 male and 4 female patients. According to stenotic site, obstruction were classified into supravalvular [n = 5], subvalvular [n = 4], valvular stenosis [n = 1]. We have performed patch enlargement of ascending aorta [n = 2], supravalvular membrane resection and patch enlargement of ascending aorta [n = 3], subvalvular membrane resection [n = 2], subvalvular membrane resection and left ventricular myectomy [n = 2] and aortic annuloplasty with Dacron patch and aortic valve replacement [n = 1]. Preoperative mean value of systolic pressure gradient were 85.0 $\pm$29.2mmHg[supravalvular], 70.0mmHg[valvular], 72.5 $\pm$ 22.5mmHg[subvalvular], and 78.5 $\pm$ 24.3mmHg[total]. Postoperative mean value of systolic pressure gradient were 31.0 $\pm$ 8.9mmHg[supravalvular], 0mmHg[valvular], 15.0 $\pm$ 10.8mmHg[subvalvular], and 21.5 $\pm$ 13.9mmHg[total]. Postoperative systolic pressure gradient was decreased significantly[p = 0.001]. Postoperative course and short-term follow up results were good except one case of transient heart failure.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.19-23
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• 1985

There are several factors influencing post-operative mortality in Tetralogy of Fallot, such as degree of RV outflow tract obstruction, combined anomaly, and age of the patient. Another factor is preoperative left ventricular volume reported by Kirklin and Graham in 1978. From March to September, 1984, 10 patient with Tetralogy of Fallot have been taken biplane cinecardioangiography [LAO and RAO projection] for measuring left ventricular volume by area-length method. The mean age of the patients was 84.9 [S.D.] and 3 males and 7 females were there. Mean value of left ventricle was 62.9ml/m2, which was no statistically difference from normal value. [p value=0.08]. In conclusion, though this study suggests that there is some decrease of left ventricular end-diastolic volume in Tetralogy of Fallot preoperatively as compared with normal individuals, further evaluation is needed to make it confirmatory with more number of patients and lesser range of age of the patients submitted to the study.

• Journal of Chest Surgery
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• v.33 no.10
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• pp.777-784
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• 2000

Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. Material and Method: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. Result: After surgical correction peak aortic gradient fell from 58.4${\pm}$17.6, to 23.7${\pm}$17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6${\pm}$24.3 to 143.7${\pm}$27.1 mmHg and from 1.78${\pm}$0.4 to 1.76${\pm}$0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10${\pm}$0.2, to 1.27${\pm}$0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2${\pm}$24.9 to 57.1${\pm}$27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. Conclusion ; We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.

• Journal of Veterinary Clinics
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• v.29 no.5
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• pp.384-390
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• 2012

Echocardiographic measurements of cardiac output, including the modified Simpson's method, Automated Contour Tracking(ACT) method, and left ventricular outflow method are well described methods of evaluating cardiac function due to its reliability and the benefits of its non-invasive technique in human medicine. The purpose of this study was to evaluate the accuracy of an echocardiography estimate of cardiac output in isoflurane-anesthetized beagle dogs and was to compare the ACT method to the other methods used in measurement of cardiac output. In healthy beagle dogs, cardiac output results by echocardiography estimate methods showed an excellent correlations with those by the thermodilution method (The modified Simpson's method : r = 0.815, $r^2=0.665$, y = 0.434x + 0.311 ; ACT method : r = 0.86, $r^2=0.748$, y = 0.391x + 0.242 ; ventricular outflow method : r = 0.691, $r^2=0.478$, y = 0.593x + 0.242). Among the results obtained, the ACT method showed the highest correlation coefficient. In conclusion, our study demonstrated that echocardiography estimate methods did not prove to be suitable in accurately measuring absolute cardiac output values but showed an excellent correlation with thermodilution method. Therefore, by using the measurement of cardiac output as supplemental data, echocardiography estimate methods can be used for detection and correction of hemodynamic disturbances during emergency and anesthesia in veterinary practice.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.911-920
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• 2003

In this study, we analyzed the long-term surgical outcome of partial atrioventricular septal defects during the past 17 years at Seoul National University Hospital. Material and Method: A retrospective analysis on mortality, survival, and reoperation and their risk factors was done in 93 patients who underwent surgical correction of partial atrioventricular septal defects between April 1986 and December 2002. 32 patients were male and 61 were female with a median age of 68 months (3∼818 months) and a mean follow-up period of 108 months (1∼200 months). Result: There were 4 operative deaths (4.3%) and one mortality during the follow-up period. 3, 5, 10, and 15 year actuarial survival rates were 95.7%, 94.3%, 94,3%, and 94.3%, respectively. After the surgical correction, left atrioventricular valve Incompetence was improved in 61patients (67.7%), remained same as the preoperative status in 14 patients (15.1%), and was aggravated in 12 patients (12.9%). Reoperation was performed in 8 patients (9.0%) after a mean interval of 38.6 months (3∼136 months). Freedom from reoperation rates at 3, 5, 10, and 15 years after surgical correction were 94.0%, 91.4%, 91.4%, and 88,2%, respectively Reasons for reoperation were 7 left atrioventricular valve incompetence, 2 left ventricular outflow tract obstruction, a residual atrial septal defect, a left atrioventricular valve stenosis, and a right ventricular failure. Left ventricular outflow tract obstruction was the only statistically significant factor. In ten patients, significant arrhythmia was developed and three of them were supraventricular arrhythmia. Complete atrioventricular block occurred in 7 patients and permanent pacemakers were implanted in six of them. Conclusion: Surgical corrections of partial atrioventricular septal defects were performed with low operative mortality. Since left atrioventricular valve incompetence was the most common cause of reoperation and left ventricular outflow tract obstruction was the only risk factor for reoperation, a precise estimation of the left atrioventricular valve morphology and the structure of left ventricular outflow tract are needed. Although left ventricular outflow tract obstruction rarely developed, reoperation was frequently required and resection of subaortic tissue could be peformed but the possibility of recurrence was high, so modified Konno operation could be performed with satisfactory results. Complete atrioventricular block developed frequently in early periods, but was overcome with a precise anatomical understanding of conduction system and experience.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1038-1044
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• 1995

We have been used cryopreserved homograft valves for right ventricular outflow tract[RVOT reconstruction since November 1993. The homograft valves were harvested from the hearts of brain dead patients or hearts of transplant recipients. There were 12 male and 10 female patients. Their ages ranged from 5 months to 13 years[mean age,39.2 $\pm$ 37.4 months and the weight ranged from 5 to 48kg [mean weight, 13.7$\pm$ 9. l kg . The diagnoses included pulmonary atresia with ventricular septal defect [n=14 , tetralogy of Fallot[n=4 , truncus arteriosus[n=3 , and double outlet right ventricle with pulmonic stenosis[n=l .Monocuspid homograft patches were used for RVOT widening or REV[reparation l`etage ventriculaire operations in 4 patients. We also used homograft as valved conduits for RVOT reconstruction in 17 patients and left ventricular outflow tract reconstruction in anatomically corrected transposition in 1 patient. Among them size-reducing technique [converting a tricuspid valved conduit into a bicuspid valved conduit were applied to six patients for the correction of size mismatching. The mean follow-up period was 10.6 $\pm$ 5.4 months. There was one operative death[4.5% due to bleeding and one reoperation for removal of vegetation on the homograft leaflet. Postoperative echocardiography documented no significant homograft insufficiency and RVOT obstructions.In short-term, the homograft valves provide excellent hemodynamic characteristics, even though further studies are necessary to evaluate the long-term results.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.442-447
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• 1980

A 8-year-old boy underwent surgical correction of complete transposition S.D.D. of great arteries combined with subaortic ventricular septal defect and pulmonary stenosis [infundibular and valvular]. The operation consisted of an internal baffling connecting the left ventricle to the aorta through the ventricular septal defect. The pulmonary stenosis was corrected with the method of external connection, the right ventricle to the pulmonary artery using the conduit valve [20 mm] contained Hancock due to abnormal distribution of left coronary artery of which conduit due to abnormal distribution of left coronary artery of which the circumflex branch crossed the portion of right ventricular outflow tract. This case was suitable for corrective surgery-Rastelli operation-and the patient`s condition in very good until present [post-operative 5 months].

• Journal of Chest Surgery
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• v.41 no.4
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• pp.476-479
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• 2008

The Rastelli operation has been a standard procedure for repairing complete transposition of the great arteries combined with a ventricular septal defect and pulmonary stenosis. Yet this procedure has several shortcomings, including the risk of incurring left ventricular outflow tract obstruction on long-term follow-up. In this regard, aortic translocation has recently been regarded as a potent alternative to Rastelli's operation. We report here on a case of complete transposition of the great arteries that was combined with an inlet-extended perimembranous ventricular septal defect and pulmonary stenosis in a 2-year-old boy. All the problems were successfully repaired using the aortic translocation technique. Postoperative echocardiography showed a straight and wide left ventricular outflow tract.