• Journal of Chest Surgery
• /
• v.27 no.7
• /
• pp.576-580
• /
• 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
• /
• v.26 no.7
• /
• pp.521-525
• /
• 1993

Sixty-three patients who underwent open mitral commissurotomy at Sejong General Hospital during last 10 years from the August, 1983 to June, 1993 were reviewed There were fifty-one women and twelve men, and the mean age was 34.2 years. According to the NYHA classification, the distribution of patient preoperatively was as follows: class I, 5 patients ; class II, 26 patients ; class III, 30 patients ; class IV, 2 patients, and mean duration of symptome was 4.5 years. The mean mitral valvular area measured with echocardiogram preoperatively was 0.92cm2. All patients underwent open mitral commissurotomy and 41 patients required additional procedures for relief of subvalvular stenosis or other valvular disease. There were no operative death. 63 patients had three different types of mitral stenosis : type I, mobile cusps without subvalvular change [21 patients] ; typeII, thickened cusps with subvalvular change [34 patients] ; type III, rigid cusps with severe subvalvular change [8 patients]. The valvular calcification was seen in 11 patients [17%] and 15 patients [24%] had left atrial thrombus. The duration of follow-up was from 1 month to 168 months [mean, 39.6 months] and there were no late death. Six patients required reoperation and one patient had embolic episode. Conclusively,the open mitral commissurotomy represents a safe surgical precedure for treating mitral stenosis, allowing a complete removal of atrial thrombosis if present, and even when associated with subvalvular changes.

• Journal of Chest Surgery
• /
• v.30 no.11
• /
• pp.1125-1127
• /
• 1997

Subvalvular aortic stenosis developed after patch closure of perimembranous'VSD is rarely reported. A 18-month-old, 8 kg child with this complication after VSD closure 8 months ago in other hospital has been treated medically and was admitted to this hospital because of severe cardiomegaly and sign of heart failure. Cardiac catheterization revealed 55 mmHg of pressure gradient between aorta and LV cavity. We report one successful redo case of surgically relieved subvalvular aortic stenosis in a child after patch closure of perimembranous VSD.

• Journal of Chest Surgery
• /
• v.49 no.6
• /
• pp.489-492
• /
• 2016

The original valve-sparing procedures for aortic root aneurysms were remodeling and reimplantation of the aortic root. The remodeling technique provides more physiologic movement of the cusps within 3 reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles. However, the durability of remodeling has been a matter of concern due to the high rate of aortic insufficiency when annular dilation is not addressed. Therefore, a modified approach was developed, combining a physiologic remodeling of the root with a subvalvular annuloplasty. This case report highlights the first case of successful aortic root remodeling with external subvalvular ring annuloplasty in Korea.

• Journal of Chest Surgery
• /
• v.55 no.2
• /
• pp.177-179
• /
• 2022

Barlow's disease with mitral annular calcification encompassing the subvalvular apparatus, including the valve leaflet and chordae, is extremely rare, and mitral valve repair in such cases is challenging. We report a case of a 60-year-old woman with mitral valve regurgitation that was successfully controlled by resecting the rough zone of P2 and calcifications on the excess leaflet regions and subvalvular apparatus, while retaining the calcification of P3 and implanting artificial chordae and an annuloplasty ring. Mitral valve repair for such cases requires an individualized and compounded surgical strategy for the technique to treat Barlow's disease and manage calcification to control mitral regurgitation.

• Journal of Chest Surgery
• /
• v.28 no.4
• /
• pp.395-397
• /
• 1995

Over a 12 months period, we treated 2 cases with discrete subaortic stenosis caused by membranous band. In one patient, who was 19 years old woman, the echocardiograms showed the discrete membrane and idiopathic hypertrophic subaortic stenosis [IHSS . She underwent transaortic myotomy and mymectomy simultaneously band resection. Other case of 11 year old boy with discrete subaortic stenosis only underwent membrane resection. Both patients had an uneventful hospital course, but 19 year old woman showed remained pressure gradient in follow up echocardiograms.

• Journal of Veterinary Clinics
• /
• v.18 no.4
• /
• pp.452-454
• /
• 2001

A two-month-old female Yorkshire terrier was referred to the Veterinary Teaching Hospital, College of Veterinary Medicine, Kyungpook national University. The patient was presented with a history of dyspnea, cough, exercise intolerance and abdominal distension, but she was appetence. In physical examination the puppy was coughed on slight tracheal compression. Rectal temperature, pulse and respiratory rate were normal, and grade 3/6 systolic murmur heard at the left heart base. The murmur was crescendo-decrescendo. Electrocardiography showed sinus arrhythmia, right-ventricular hypertrophy pattern, and right axis deviation. Thoracic radiography revealed cardiomegaly, bulging of the main pulmonary artery, and enlarged left side heart. Abdominal radiography revealed abdkominal distention. Echocardiography showed hypertrophy of right ventricle and turbulence in the pulmonary artery in parasternal oblique view. Subvalvular pulmonic stenosis was diagnosis based upon the clinical signs, physical examination, electrocardiography, radiography and echocardiography. We treated the patient with furosemide, enalapril and $\beta$-blocker. After the clinical signs of cough, abdominal distension and dyspnea were disappeared, she was on just $\beta$-blocker for prevention of occurrence of congestive heart failure. Now she was recovered her health, and she is not on any medication.

• Journal of Chest Surgery
• /
• v.20 no.4
• /
• pp.710-714
• /
• 1987

Over the past 6 years, from July, 1981. through June, 1987., 14 consecutive patient with congenital aortic stenosis underwent corrective surgery in our department of Thoracic and Cardiovascular Surgery. The patient ranged in age from 1 to 20 years. There were 8 male and 6 female patients. According to the operative findings, stenotic site was valvular stenosis [5 cases], subvalvular stenosis [5 cases], supravalvular stenosis [2 cases], valvular and supra valvular stenosis [1 case]. We have performed valvotomy and commissurotomy [5 cases]. Resection of subvalvular membrane [3 cases], patch enlargement of Ascending aorta [2 cases], LV myotomy [2 cases], valvotomy and excision of membrane [1 case], patch enlargement of ascending aorta and valve ring [1 case]. There was one hospital mortality [7.1%]. He died of C-I bleeding and sepsis on the 25th postoperative day. All survivors showed improvement in NYHA functional class in the 160 patient/month follow up period.

• Journal of Chest Surgery
• /
• v.27 no.11
• /
• pp.893-901
• /
• 1994

Forty nine patients [M: 31, F: 18], age from 2 months to 17 years [mean= 4.9 years], underwent operations, from April 1986 to December 1992, for the relief of subvalvular aortic stenosis in normal atrioventricular and ventriculoarterial connections.There were 4 anatomic types of subaortic stenosis : membranous in 29 cases [59.2%], fibromuscular in 11 [22.4%], diffuse tunnel type in 7 [14.3%], and miscellaneous in 2 cases. Thirty four patients [69.4%] had associated cardiac anomalies, of which ventricular septal defect was the most common [27 cases]. Other anomalies were patent ductus arteriosus, coarctation of the aorta, valvular aortic stenosis, double chambered right ventricle [DCRV], infundibular pulmonic stenosis, persistent left superior vena cava, and rigt aortic arch. Mean systolic pressure gradient between the left ventricle and ascending aorta was 26.4$\pm$17.6 mmHg : 13.1$\pm$17.6mmHg in the membranous type, 22.0$\pm$18.4mmHg in the fibromucular type, and 56.1$\pm$38.4mmHg in the diffuse tunnel type. Operative procedures were determined according to the type of subvalvular aortic stenosis : simple excision of subaortic membrane in the membranous type [29 cases], left ventricular myectomy with or without myotomy or fibrous tissue excision in the fibromuscular type [11 cases]. Among the 7 of diffuse tunnel type cases, ventricular myectomy was performed in 2 and a modified Konno operation was performed in 5 . Postoperative follow up was made with periodic echocardiography. The Mean postoperative follow up period was 33.8 months. There were 2 hospital mortalities [4.1%] and 2 late deaths. Residual stenosis remained in 3 cases and recurrence developed in 2 cases during the follow up period. 5 years actuarial survival rate was 91.8$\pm$3.9% and 5 year complication free rate was 72.3$\pm$10.4%. Conclusions : 1. Subvalvular aortic stenosis should be relieved completely as soon as possible when diagnosed, regardless of left ventricular outflow tract pressure gradient. 2. Good results were obtained using only simple excision of subaortic membrane in the membranous type of subaortic stenosis. However, aortoventriculoplasty [modified Konno prodedure] was necessary for good results in the diffuse tunnel type. 3. Periodic postoperative echocardiography was helpful in detecting the progression of residual stenosis and development of new stenosis.

• Journal of Chest Surgery
• /
• v.22 no.2
• /
• 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.