• Journal of Chest Surgery
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• v.34 no.9
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• pp.680-685
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• 2001

Background: Tricuspid valve replacement is very rarely performed procedure and its long-term result is not yet satisfactory. Moreover, it is not well known whether bioprosthesis or mechanical prosthesis is the best selection for artificial valve. We reviewed 72 cases of tricuspid valve replacements in 71 patients between January 1989 and December 1998, trying to analyze the overall results and risk factors for mortality and morbidity. Material and Method: Average age of the patients at the time of operation was 42$\pm$13 years(range 16 to 65 years) and the sex ratio of male versus female was 32/39. Primary diagnosis consisted of 50 cases of aquired valvular heart disease and 18 cases of congenital heart disease, such as Ebstein’s anomaly. 4 cases had isolated tricuspid valve regurgitation. Implanted valves were 69 mechanical prosthesis and 3 bioprosthesis. Concomitant mitral or aortic valve replacements were performed in 50 cases. One patient received concomittant pulmonary valve replacement. Result: There were 7(9.72%) operative deaths and 7(13.0%) late deaths. Actuarial survival at 10 years was 59.2$\pm$7.2%. Prosthetic tricuspid valve thrombosis occurred 11 times in 5 patients. Reoperation for prosthetic tricuspid valve failure was performed in 1 patient. In this case, examination of the explanted prostheses showed that the tricuspid stenosis was the result of valve thrombosis. Among the 47 survivors, 46 patients(98%) were in functional class I or II. Conclusion: In our ten-year experience of tricuspid valve replacement, mortality and morbidity were satisfactory. Mechanical prosthesis in tricuspid position showed comparable clinical results as bioprosthesis.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.10-17
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• 1983

Valve replacement in children, aging up to 15 years [Mean 11.g years], has been done at Seoul National University Hospital over the past 14 years since 1968. Fifty-one patients have received 59 artificial valves: 55 bioprosthetic and 4 prosthetic valves. Thirty-one patients [60.8%] had rheumatic heart disease and the remainder [39.2%] had congenital heart disease. Forty-two patients [82.4%] survived operation: 9 patients [17.7%] died within one monfi3 postoperatively and 4 patients [7.8%]during the follow-up period with the overall mortality rate of Thromboembolic complication occurred in 3 patients with 2 deaths: 5.9% embolic rate or 4.68% emboli per patient-year. One patient who had been on coumadin anticoagulation died from cerebral hemorrhage. One mitral Ionescu-Shiley valve failed 19 months after first replacement and this was successfully re-replaced with the same kind of valve. Actuarial survival rate was 59.9% at 4 years after surgery. Thromboembolism-free and valve failure-free survivals were 80.0% and 93.1% respectively. These clinical results in the pediatric age group suggested that valve replacement in children was a serious undertaking with a higher mortality rate than in adults. However, the main superiority on the low thrombogenecity of the xenograft valve over the mechanical one warrants its continuing use until the question of its durability would otherwise be answered by a further study of clinical follow-up.

• Journal of Chest Surgery
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• v.28 no.7
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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.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.54-58
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• 2016

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.63-66
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• 2015

We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.70-74
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• 1999

Thrombosis in valve or left atrium after mechanical mitral valve replacement causes prosthetic valve dysfunction or thromboembolism. Early and adequate therapy is very important but clinically not easy. Thrombolysis can avoid reoperation-related risks and act as an optimal therapy for prosthetic valve thrombosis. This report describes three patients who were treated by using low molecular weight heparin (LMWH) and wafarin. Two patients, including one pregnant woman, had prosthetic valve thrombosis and immobility of valve leaflets, and one patient with recent cerebral infarction due to thromboembolism had thrombus in left atrium. Fraxiparine 0.3 cc (7,500 ICU AXa) was administrated subcutaneously twice or triple daily. At discharge, thrombosis in valve and left atrium were completely or near totally lysed and valve leaflets were normally mobile. During the period of thrombolysis and follow up, there were no complications in all patients.

• Journal of Chest Surgery
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• v.33 no.5
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• pp.391-397
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• 2000

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

• Journal of Chest Surgery
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• v.14 no.4
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• pp.369-380
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• 1981

In this department 504 cases of valve replacement were done since 1968 to the end of October 1981. Since October 31, 1978 to the end of October 1981 ,333 Ionescu-Shiley bovine pericardial xenograft bioprosthetic cardiac valves were replaced in 265 patients. There were 149 males and 116 female. Ages ranged from 2 to 63 years with 25 cases under 15 years of age. Among 265 cases of Ionescu valve replacement there were 157 MVR, 36 VAR, 6 TVR, 45 MVR+ AVR, 16 MVR+TVR and 5 MVR+AVR+TVR cases with mortality of 5.7%, 8.3%, 16.7%, 8.9%, 18.8% and 20% for each group respectively. Over all mortality rate in 265 Ionescu valve replacement cases was 7.9% with 21 total deaths. Main causes of operative deaths were due to LCOS in 7, bleeding in 5, arrhythmia in 3, air embolism in 2,and heart block in 2 cases. There were 12 late complications with 6 deaths. Over all long-term survival rate was 89.8%. MVR showed the highest long-term survival rate with 92.4%, and MVR+AVR+TVR the lower with 80% lower with 80%.Average follow-up period was 14 month duration. Twenty five congenital anomaly cases were operated with Ionescu-valve replacement that consisted of 7 VSD+AI, and 5 Ebstein anomaly cases with over all operative mortality of 16% and late mortality of 14.3% among 21 operative survivors. There were 25 Ionescu valve replacement cases in pediatric patients under the age of 15 years, with 4 operative deaths. Fourteen MVR, 7 AVR, and 3 TVR cases were found. Even though long-term follow-up study was short in postoperative period with total of 33~.0 months among 244 operative survivors ranging one to 36 months, the late survivors showed beneficial long-term results two thromboembolic episodes in 244 patients were found. More cases and longer term follow-up study are warranted for valve replacement in pediatric and TVR cases with Ionescu-valves which have advantageous hemodynamic structures compared with other bio-prosthetic heart valves.

• The Journal of the Korean dental association
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• v.18 no.8 s.137
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• pp.639-644
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• 1980

In cases with maxillary lateral incisor missing, the problems were usually treated by the choice between space opening for prosthetic lateral incisor replacement and space closure with cuspid sub stitution for the alteral insicors. The decision of the choice could be perplexing in evaluation of the individual case. Therefore, various diagnostic criteria, such as occlusion, dental esthetics, canine position and inclination, tooth size relationship, maxillary lip length, and skeletal relation had to be evaluated. On the basis of this diagnostic information, the treatment planning could be established. A case was shown to illustrate the treatment of patient with congenitally maxillary lateral incisor missing.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.229-232
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• 1980

Approximately 5 percent of infective endocarditis are limited to the right side of the heart, the tricuspid valve being the usual site of involvement. Usually there is no underlying cardiac disease, and the vegetations occur on previously normal tricuspid leaflets. This paper reports a case of bacterial endocarditis involving the bio-tricuspid valve in a patient with tetralogy of Fallot, and who required prosthetic valve replacement in addition to surgical therapy for the congenital lesions.