• Journal of Chest Surgery
• /
• 제22권2호
• /
• pp.220-224
• /
• 1989

In candidates for aortic valve replacement [AVR]it is our primary intention to implant the largest possible vale prosthesis of at least 23 mm in diameter in patients with severe valvular aortic stenosis. However, in many patients there is an additional subvalvular asymmetric septal hypertrophy which in some cases may cause an postextrasystolic increase of the LV-aortic gradient. Another component of the aortic stenosis syndrome is a narrow valvular ring, or a combination of both. After complete removal of the diseased valve and decalcification the narrow aortic ring [< 23 mm] can be widened firstly by transaortic subvalvular septal myectomy- [TSM] thus unfolding the left ventricular outflow tract[LVOT]and secondly by extending the oblique aortic incision into the aortic valve ring or further down into the anterior leaflet of the mitral valve. The sub-and supra-valvular defect will be closed by patch enlargement of the aortic root [PEAR] using autologous pericardium. These techniques allow a considerable enlargement of the valvular ring of about 4 to 10 mm in circumference. In a retrospective study using a computerized program, 847 patients with AVR [1980-1984]were reviewed to evaluate the intraoperative hemodynamic results mainly concerning relief of the transvalvular gradient. In 626 patients AVR was performed, 151 patients had double valve replacement [AVR+MVR], and 70 patients had AVR plus additional surgical procedures. Concentrating on the AVR-group [n=626] there were 103 patients with TSM, 24 patients with PEAR and 20 patients with TSM+PEAR which demonstrated that in a total, of 147 patients of this groups [23.5%] an additional procedure was necessary. The Statistical evaluation of the intraoperative pressure measurements before and after AVR in relation to the size of the implanted prostheses indicated the lowest preoperative mean gradient in patients with AVR alone, the highest in patients who afforded TSM plus PEAR. However, after AVR the mean gradients in all three groups were very low [mean 5 to 10 mmHg]. These data indicate that in patients with a narrow aortic ring and additional considerable ASH, TSM and PEAR are suitable techniques to enlarge the aortic root to enable the implantation of an adequate aortic valve prosthesis. Long-term controls have shown that autologous pericardium is a qualified graft material for the ascending aorta.

• Journal of Chest Surgery
• /
• 제13권4호
• /
• pp.364-374
• /
• 1980

Twenty-two patients were selected for evaluation of pre-and postoperative pulmonary function. These patients were performed open cardiac surgery with the extracorporeal circulation from March 1979 to July 1980 at the Department of Thoracic and Cardiovascular Surgery, Kyungbook National University Hospital. Patients were classified with ventricular septal defect 5 cases, atrial septal defect 5 cases, tetralogy of Fallot 5 cases, mitral stenosis 4 cases, rupture of aneurysm of sinus Valsalva 1 case, left atrial myxoma I case, and aortic insufficiency 1 case. The pulmonary function tests were performed and listed: [1] respiratory rate, tidal volume [TV], and minute volume[MV], [2] forced vital capacity [FVC] and forced expiratory volume[FEV 0.5 & FEV 1.0], [3] forced expiratory flow [FEF 200-1200 ml & FEF 25-75%]. [4] Maximal voluntary ventilation [MVV], [5] residual volume [RV] and functional residual capacity[FRC], measured by a helium dilution technique. Respiratory rate increased during the early postoperative days and tidal volume decreased significantly. These values returned to the preoperative levels after postoperative 5-6 days. Minute volume decreased slightly, but essentially unchanged. Preoperative mean values of the forced vital capacity, functional residual capacity and total lung capacity decreased [63.2%, 87.2% & 77.3% predicted, respectively], and early postoperatively these values decreased further [19.6%, 76.0% & 38.0% predicted], but later progressively increased to the preoperative levels. In residual volume, there was no decline in the preoperative mean values [100.9% predicted] and postoperatively the value rather increased [106.3-161.7% predicted]. Forced expiratory volume [FEV 0.5 & FEV 1.0] and forced expiratory flow [FEF 200-1200 ml & FEF 25-75%] also revealed significant declines in the early postoperative period. There was no significant difference in values of the spirometric pulmonary function tests, such as FEF 1.O and FEF 25-75% between successful weaning group [17 cases] extubated within 24 hrs post-operatively and unsuccessful weaning group [5 cases] extubated beyond 24 hrs. Static compliance and airway resistance measured for the two cases during assisted ventilation, however, any information was not obtained. Long term follow-up pulmonary function studies were carried out for 8 cases in 9 months post-operatively. All of the results returned to the pre-operative or to normal predicted levels except FVC, FEV 1.0, and FEF 25-75% those showed minimal declines compared to the pre-operative figures.

• Journal of Chest Surgery
• /
• 제26권9호
• /
• pp.667-676
• /
• 1993

Boprosthetic cardiac valves fail from biological and metabolic as well as mechanical reasons, and the limited durability is the main factor of marked withdrawal in their clinical use. Starting the use of bioprosthetic valves in 1976, up to the end of 1992, the consecutive 178 patients have undergone re-replacement of glutaraldehyde-treated xenograft valves for primary tissue failure [PTF]among the patients who had initial valve replacement at Seoul national University Hospital. The explanted valves were 69 porcine aortic [51 Hancock, 12 Angell-Shiley and 6 Carentier-Edwards] and 141 bovine pericardial [129 standard-profile and 12 low-profile ionescu-Shiley] valwes, with an overall incidence of PTF of 15.2%. The operative mortality rate of re-replacement was 5.1%. Calcific degeneration and tissue damage in relation to calcification were the most frequent modes of PTF on gross examinatin of the explanted valves resulting hemodynamically in valvular regurgitation. The number of Hancocg porcine and the standard-profile Ionescu-Shiley valves in valves in mitral position failed more often from tissue damage [tears, holes, and loss or destruction of cuspal tissue] than calcification [68.3% vs. 39.0%, p<0.01] with resultant regurgitation in 61%, the Ionescu-Shiley valves in the same position in 53%. The tendency of more calcification than tissue damage[71.3% vs. 33.3%, p<0.001]with stenosis in 53%. The tendency of more calcification and immobility of cusps in the latter group was partly explainable by the inclusion of patients of pediatric age. Observation made in this study suggest : many of bioprosthetic valves would fail from calcification and tissue damage : some fail prematurely because of mechanical stress probably owing to the valve design in construction ; andeven those valves escaped early damage would be subject to calcify in the prolonged follow-up period. In conclusion, at the present time, the clinical use of bioprostheticxenograft valves seems to be quite limited until further improvement in biocompatibility and refinement in valve design in manufacture are achieved.

• Journal of Chest Surgery
• /
• 제9권2호
• /
• pp.207-214
• /
• 1976

Operations for cardiac valvular disease has been progressed in various ways. Since 1949 when Lord Russel operated mitral stenosis by closed technique at Johns Hopkins Hospital then much progress has been achieved and that nowadays severely diseased cardiac valve has been replaced by prosthetic valve, which is almost ideal in hemodynamic aspect, but still it has many problems such as thromboembolism, destruction of red blood cell, pressure gradient, and disturbance of left ventricular function, so in case of delicate situations, valve replacement should be decided carefully. Besides prosthetic valve, there are some kinds of reconstructive procedures and these have been resulted in better prognosis than prosthetic valve replacement in selected cases. So, authors have reviewed 61 Cases of cardiac patients who have been operated reconstructive valvular surgery by cardiopulmonary bypass, at Yonsei University, from Jan. 1963 to Mar. 1976. Out of 61 cases, 9 patients were replaced by prosthetic valve and rest of the patients were operated upon in various reconstructive procedures such as commissurotomy, valvotomy, valvuloplasty, and annuloplasty. Twenty cases of congenital heart diseases with valvular lesion, which had been operated for valvular lesion were also included in this statistics. Out of 9 cases of prosthetic valvular replacement five cases of prosthetic valvular replacement was done combined with other reconstructive procedures after attempted valvuloplasty. Comparative prognosis of both procedures are somewhat variable by reporters, average 19% of mortality after reconstructive surgery and 38% of mortality after prosthetic valve replacement in long term results. Most common cause of death in postoperative period was low output syndrome in both cases. It seems that good preoperative evaluation and proper reconstructive surgery will afford good prognosis in selected cardiac valvular diseased patient.

• Journal of Chest Surgery
• /
• 제31권8호
• /
• pp.770-775
• /
• 1998

배경: 심방중격결손증은 선천성심질환중 가장 흔한 질환중의 하나이며 성인에서 진단되는 선천성 심질환 의 30%를 차지한다. 상당수의 환자들이 성인이 될때까지 별다른 증상이 없이 잘 지내기도 하고, 40∼50대에 사망 하는 경우가 많지만, 더 오래 사는 경우도 흔히 발견된다. 가장 흔한 사망원인은 주로 우심부전이나 부정맥이다. 대상 및 방법: 강북삼성병원 흉부외과에서는 1988년부터 1997년 6월까지 총33례의 심방중격결손증을 수술 하였으며, 그중 31례가 성인 심방중격결손증이었다. 동반질환은 삼첨판 폐쇄부전이 2례, 폐동맥판 협착증, 승모판 폐쇄부전 및 삼첨판 폐쇄부전, 그리고 관상동맥질환이 각각 1례였다. 결과: 모든환자에서 첩포봉합술이나 직접봉합술을 이용하여 수술하였으며, 수술후 경과는 모두 양호하였다. 수술후 심전도와 혈류역학, 및 심초음파검사상 호전을 보였다. 결론: 성인의 심방중격결손증은 60세이상의 고령일지라도 폐동맥고혈압이나 우심부전, 부정맥등을 예방 하기 위한 적극적인 외과교정술을 시행하여야 한다

• Journal of Chest Surgery
• /
• 제17권3호
• /
• pp.371-380
• /
• 1984

Corrected transposition of the great arteries [C-TGA] is one of the rare congenital heart disease in which there is both a discordant atrioventricular relationship and transposition of the great vessels. With this arrangement, systemic venous blood passes through the right atrium into the morphologic left ventricle and out the pulmonary artery. Pulmonary venous blood returns to the left atrium, flows into the morphologic right ventricle and out the aorta. Thus, in the rare case when no additional cardiac anomaly is present, a hemodynamically normal heart exists. But more often they are symptomatic as a result of one or several of the commonly associated defects. This paper describes 13 patients who underwent repair of one or more cardiac anomalies associated with corrected transposition at SN UH, from June 1976 through June 1984. 1.8 were males and 5 females, with ages ranging from 3 years to 27 years. 2. Segmental anatomy was {S,L,L} in 12, or {I,D,D} in 1. 3.Associated anomalies were ventricular septal defect in 10, pulmonary outflow tract obstruction in 6, tricuspid insufficiency in. 4, atrial septal defect in 3, subaortic stenosis in 1, mitral insufficiency in 1, and patent ductus arteriosus in 1. 4.None had complete heart block preoperatively, and 3 developed complete heart block intraoperatively. But one of them recovered sinus rhythm on the postoperative 7th day spontaneously. 5.There were 3 cases of hospital morality. But there was no morality since Dec. 1980. 6.Patients with single ventricle, hypoplastic ventricle or those who had palliative surgery alone are not included in this review.

• Journal of Yeungnam Medical Science
• /
• 제5권2호
• /
• pp.101-110
• /
• 1988

영남대학교 의과대학 흉부외과학 교실에서는 1984년 4월부터 1988년 9월까지 459예의 심장혈관 환자들을 대상으로 수술하여 다음과 같은 성석을 얻었다. 1. 전 459예중 개심술이 355예였고 비개심술이 104예였다. 2. 환자의 연령은 최저 생후 1일에서 최고 65세까지였다. 3. 남녀비는 1:1.3으로 여자에서 조금 많은 분포를 보였다. 4. 개심술중 선천성 심장질환이 270예, 후천성 심질환이 85예로 선천성 심질환이 월등히 많았다. 5. 선천성 심장혈관 질환중 심실중격결손증이 38.7%로 가장 많았고 그 다음이 동맥관개존증, 심방중격결손증, 활로씨 사증후군, 폐동맥 협착증의 순이었다. 6. 수술후 합병증은 60예에서 관찰되었으나 전예에서 경쾌퇴원하였다. 7. 술후 사망은 전체 심장혈관 질환 459예중 15예로 3.3%를 보였고 개심술로 인한 사망은 355예중 14예로 3.9%였다.

• Journal of Chest Surgery
• /
• 제28권6호
• /
• pp.565-570
• /
• 1995

Seventy-three patients with isolated total anomalous pulmonary venous connection the patients associated with other major cardiac anomalies such as single ventricle, DORV[Double Outlet Right Ventricle and large VSD[Ventricular Septal Defect were excluded were underwent surgical repair from January 1980 through October 1993. There were 45 boys and 28 girls. The mean age at operation was 19.9 months[range 6 days to 24 years and mean body weight was 7.1kg[range 2.6kg to 45kg . The anomalous locations of connection were supracardiac in 38, cardiac in 21, infracardiac in 5, and mixed in 9. In 38 patients[52% , the venous drainage was obstructed. The obstruction ratios according to the connection type were as follows: 53%[28/38 in supracardiac, 52%[11/21 in cardiac, 100%[5/5 in infracardiac, 22%[2/9 in mixed type. The associated cardiac anomalies were persistent left SVC[2 , tricuspid valve regurgitation[3 , cor triatriatum[1 , and mitral cleft[1 . And associated noncardiac anomalies were imperforate anus[1 and Neil Weightman syndrome[1 . The operative mortality was 23%. The causes of death were pulmonary hypertensive crisis, perioperative myocardial failure, pneumonia with sepsis, arrhythmia and etc. The statistically significant factors in postoperative mortality were the pulmonary venous obstruction and age [p<0.01 . The operative mortality was high in groups of age under 1 month and pulmonary venous obstruction. The mean follow-up was 27.1 months. There were two late deaths. The first patient was three months old boy with supracardiac type and severe obstructive symptoms. The postoperative echocardiography was showed anastomotic stenosis and reoperations were performed twice but the patients expired due to pneumonia and sepsis. The second patient was three month old boy with supracardiac type and total correction was done and was doing well postoperatively. Eight years later, he expired suddenly due to arrhythmia. But all the other patients were in NYHA Fc I and received no medications. The 5-year survival rate excluding early expired patients is 97.1 $\pm$ 0.03 %. In conclusion, although the operative mortality of total anomalous pulmonary venous connection was relatively high compared to other major cardiac anomalies, we could expect excellent long-term results by early surgical correction.

• Journal of Chest Surgery
• /
• 제25권8호
• /
• pp.863-870
• /
• 1992

The low profile Ionescu-Shiley pericardial xenograft valve had been initially introduced to have improved hemodynamic performance and expected superior durability, However, subsequent clinical reports and laboratory studies have repeatedly indicated early failure of the valve from mechanical reasons in valve design, A total and consecutive 169 patients underwent isolated MVR with the low profile Ionescu-Shiley valve at Seoul National University Hospital from November 1984 to October 1989 [Group ISLM]. Five patients [3.0%] died within 30 days of surgery, and early survivors were followed up for 734.9 patient-years [Mean$\pm$SD, 4.9$\pm$2.0 years], Late mortality rate was 0.136% /patient-year [pt-yr], Linearized incidences of major complications were: 0.953% embolism /pt-yr; 0.680% bleeding /pt-yr; 0.272% endocarditis /pt-yr; and 0, 408% primary tissue failure [PTF] /pt-yr, The actuarial survival was 99.4$\pm$0.6%, and probabilities of from thromboembolism and from PTF were 90.7$\pm$4.6% and 95.9$\pm$2.6% at 8 years, respectively These results were compared with the clinical data from the 291 patients of isolated MVR with the standard Ionescu-Shiley valve at the same hospital during the period between October 1978 and June 1983 [Group ISUM], Group ISUM included 11% of patients younger than 15 years of age, whereas Group ISLM did no patient of this age. The mean age at the time of surgery was significantly younger in Group ISUM than one in Group ISLM [P<0.001]. Differences were not statistically significant in operative mortality, mean follow-up period and linearized incidences of thromboembolism, bleeding and endocarditis, between two groups, However, the linearized rate of PTF was lower [P<0.001] and probabilities of freedom fro PTF higher [P<0.001] in Group ISLM at least up to postoperative 8 years. While the features of PTF of the standard valve was predominantly degeneration with calcification and stenosis, the ones of the low profile valve was cusp tear and incompetence. It remains, however, to be seen whether the low profile valve fails mostly from mechanical reason, and further follow-up will still be necessary to determine the differences in mode of PTF of two valves.

• Journal of Chest Surgery
• /
• 제34권4호
• /
• pp.356-360
• /
• 2001

일시적 혹은 단기간의 심폐보조는 여러 형태의 심부전에서 널리 이용되어 왔다. 이 중 체외막산소화장치는 고식적 치료에 반응없는 환자에서 주로 사용되는데, 소아에서는 자주 이용되어 왔으나 성인에서는 그 적응증이 명확하지 않았으며 결과도 만족스럽지 못했다. 환자는 승모판 협착증을 가진 32세의 여자로 제왕절개술후 발생한 폐부종으로 내원하였다. 내원시 환자는 쇽상태로 강심제, 폐혈관확장제, 이뇨제등에 반응이 없었다. 우측 대퇴정-동맥캐뉼라를 통하여 14시간동안 체외막산소화장치를 이용하였으며, 환자상태는 가동 즉시 호전을 보였다. 이후 양측판막치환술을 시행하였고 수술 후에도 체외막산호화장치를 지속하였다. 체외막산호화장치는 수술시간을 포함하여 모두 62시간동안 가동하였으며, 이탈(weaning)은 안정된 혈류역학, 호전된 폐부종, 기저질환의 교정등을 통하여 성공적으로 이루어졌다. 환자는 판막수술 후 30일째 특별한 합병증없이 퇴원하였다.