Surgical Management of Aortic Valve Injury after Nonpenetrating Trauma / 대한흉부외과학회지

We present 2 cases of patients who underwent surgical repair and replacement of an injured aortic valve that was secondary to nonpenetrating trauma. Primary repair was undertaken on an 18-year old boy, but he had persistent moderate aortic regurgitation for five years after surgery. Another 64-year old man was treated successfully with surgical replacement of the aortic valve via employing a prosthetic mechanical valve. Attempts at valvuloplasty for the treatment of traumatic aortic valve injury have not been uniformly successful, and prosthetic valve replacement is recommended for repair, except for highly selected cases.

Twenty-year Experience of Mitral Valve Replacement with the St. Jude Medical Mechanical Valve Prosthesis / 대한흉부외과학회지

BACKGROUND: A retrospective study was conducted to analyze the results of St. Jude Medical mitral valve replacement at the Chonbuk National University Hospital since the initial implant in May 1984. MATERIAL AND METHOD: Between May of 1984 and December of 1996, 95 patients underwent MVR with the St. Jude Medical mechanical valve prosthesis at Department of Medical Science of Chonbuk National University Hospital and follow-up ended in May of 2004. RESULT: Age ranged from 19 to 69 years. Follow-up (mean+/-standard deviation) averaged 10.6+/-4.2 year. Thirty-day operative mortality was 4.2% (4/95). Nine late deaths have occurred and actuarial survival was 90.5+/-3.0%, 87.9+/-3.4% and 83.2+/-4.6% at 5, 10 and 20 years, respectively. Probability of freedom from valve-related death was 95.5+/-2.1%, 94.3+/-2.4% and 91.0+/-3.9% at 5, 10 and 20 years, respectively. Seven patients have sustained thromboembolic events (1.05%/patient-year). Fifteen patients had anticoagulation related hemorrhage (3.56%/patient-year). There was no structural valve deterioration. Probability of freedom from all complications was 82.0+/-3.9%, 71.3+/-4.8% and 42.4+/-10.5% at 5, 10 and 20 years, respectively. CONCLUSION: We confirm the effective and excellent durability of the St. Jude Medical prosthesis in the mitral position with a low event rate at long-term follow-up. It also demonstrates the commonly encountered practical difficulty of adjusting the anticoagulation protocol in patients with prosthetic mitral valves.

Myocardial Hamartoma Involving the Posterior Left Ventricular Wall: Surgical Experience of One Case / 대한흉부외과학회지

A 16 year-old boy was admitted to our department because of mild chest discomfort and mild dyspnea. A mass involving posterior wall of the left ventricle near posterior mitral annulus was found on echocardiography and cardiac MRI. Total excision of the mass was performed via posterior ventriculotomy under the cardiopulmonary bypass. The pathologic diagnosis revealed mature cardiac myocyte hamartoma. There was no evidence of arrhythmia and tumor recurrence during the 1 year of follow up after the surgery.

Concomitant Operation of Pulmonary Resection and Redo Double Valve Replacement: 1 case report / 대한흉부외과학회지

Patients with concomitant surgical diseases of the heart and lungs are a therapeutic challenge to cardiothoracic surgeons. A 59-year-old woman underwent right middle lobectomy for lung cancer and redo double valve replacement with tricuspid annuloplasty simultaneously. Concomitant operation is a safe procedure and might allow prompt correction of both conditions, thereby sparing the patient a second major thoracic procedure with its attendant risks.

Coarctation of the Aorta Associated with Chronic Thoracic Aortic Aneurysm: A case report / 대한흉부외과학회지

A 49-year-old woman had thoracic back pain for several years. Chest CT scan and MRI angiography revealed descending thoracic aortic aneurysm with a maximum diameter of 69 mm. Thoracic aortography showed not only the aortic aneurysm, but also coarctation of descending thoracic aorta at the level of aortic hiatus of the diaphragm. Intercostal artery arising Adamkiewicz artery was found in descending thoracic aortic aneurysm just above the coarctation. The aneurysm with coarctation of the aorta was successfully repaired with prosthetic graft replacement under left atrio-femoral bypass.

Mitral Valve Reconstruction in Mitral Insufficiency: Intermediate-Term Results / 대한흉부외과학회지

BACKGROUND: The advantages of mitral valve reconstruction have been well established and so mitral valve reconstruction is now considered as the procedure of choice to correct mitral vlave disease. This is the report of intermediate-term results of 38 cases that performed mitral valve reconstruction for valve insufficiency(the total number of mitral valve reconstruction were 49 cases, but 11 cases that performed mitral valve replacement due to incomplete reconstruction were excluded). MATERIAL AND METHOD: From March 1991 to March 2001, 38 patients underwent mitral vlave repair due to mitral valve regurgitation with or without stenosis. Mean age was 47.6+/-14.7 years(range 15 to 70 years) : 11 were men and 27 were women. The causes of mitral valve regurgitation were degenerative in 14, rheumatic in 21, infective in 2 and the other was congenital. RESULT: According to the Carpentier's pathologic classification of mitral valve regurgitation, 3 were type I, 16 were type II and 19 were type III. Surgical procedures were annuloplasty 15, commissurotomy 19, leaflet resection and annular plication 9, chordae shortening 11, chordae transfer 5, new chordae formation 2, papillary muscle splitting 2 and vegetectomy 2. These procedures were combined in most patients. There were 2 early death and the causes of death were respiratory failure, renal failure and sepsis. There was no late death. Valve replacement was done in 6 patients after repair due to valve insufficiency or stenosis 3 weeks, 1,3,51,69,84months later respectively. These patients have been followed up from 1 to 116 months(mean 43.0 months). The mean functional class(NYHA) was 2.36 pre-operatively and improved to 1.70. CONCLUSION: In most cases of mitral valve regurgitation, mitral valve reconstruction when technically feasible is effective operation that can achieve stable functional results and low surgical and late mortality.

Coronary Artery Fistula Associated with Atrial Septal Defect: Report of one case / 대한흉부외과학회지

We present a case of coronary artery fistula originating from the proximal left anterior descending artery draining into the main pulmonary artery,which was associated with atrial septal defect.The patient was a 56 year old male who was admitted for exertional dyspnea and abdominal distension.Echocardiogram and selective coronary arteriogram revealed a atrial septal defect and fistulous connection.The patient underwent surgery under the cardiopulmonary bypass with fibrillating heart.The pericardial patch closure of atrial septal defect and internal obliteration of the fistula termination site in the main pulmonary artery were performed.Postoperative hospital courses were uneventful without any specific complication and the patient was discharged without problem.

Mucosal Resection in the Corrosive Esophageal Stricture: A new technique / 대한흉부외과학회지

Balloon dilatation is a popular method in corrosive esophageal stricture but swallowing difficulty due to recurrent or intractable stricture even in the repeated dilatation needs a esophageal reconstruction. Stomach, colon or jejunum has been used for the prosthesis of esophagus. Many problems such as leakage in anastomosis site, stricture, reflex, adhesion, strangulation, and engrafted esophageal cancer are associated with the remnant esophageal stricture in the esophago-gastrostomy and esophageal bypass surgery. Easy and reproduceable method of operation with lower complication and without functional disability is needed. A new operation method of mucosal resection and plasty is introduced in the corrosive esophageal stricture that are not relieved by repeated dilatation.

Diagnostic Thoracoscopy in the Pleural Effusion / 대한흉부외과학회지

BACKGROUND: A pleural effusion is not a disease entity but a clincial sign of systemic or pleural disease. Although the diagnosis of pleural effusion can often be done by toracentesis and pleural needle biopsy the yeild of positive diagnosis is low.

Clinical Study of Prosthetic Heart Valve Replacement with CarboMedics / 대한흉부외과학회지

BACKGROUND: The CarboMedics prosthetic heart valve was produced in an attempt to improve the existing valve designs and was especially concerned with easily the implantation and further reduction of turbulence. Precise positioning of the valve in situ was achieved by the abilityof the valve to rotate relative to the sewing ring. Improved monitoring is possible due to increased radiopacity and the dacron sewing ring is coated with carbon to reduce pannus overgrowth. The leaflets have an opening angle of 78 degrees that apparently allows a rapid synchronous closure The aim of this study was to analyze the clinical performance of the CarboMedics valve prostheses(45 mitral 13 aortic and 7 double aortic-mitral valve replacement) were implanted in 65 patients(mean age 48.75+/-9.74 years) RESULT: The operative mortality was 3.1%(2/65) causes of death were low cardiac output syndrome. Total follow up was 1831 patient-months and mean follow up was 29.06+/-10.97 months/patient. No structural failure hemorrhage valve thrombosis and late death have been observed. Embolism occurred at a rate of 0.65%/Patient-year. Actuarial survival and thrombombolism free rate at 36 months were 96.9% and 98.4% respectively. CONCLUSIONS: The CarboMedics valve stands for low valve related complicatons.

Characteristics of hypoxia-induced ANP Secretion in Perfused Beating Atria / 대한흉부외과학회지

BACKGROUND: Cardiac atrium is an endocrine gland secreting a family of natriuretic peptides. The secretion of atrial natriuretic peptide(ANP) had been shown to be controlled by variable factors. The change in atrial dynamics have been considered as one of the most prominent stimuli for the stimulation of ANP secretion. Hypoxic stress has been shown to increase cardiac ANP secretion. However, the mechanism by which hypoxia increases ANP secretion cardiac ANP secretions. However, the mechanism by which hypoxia increases ANP secretion has not to be defined. Therefore, the purpose of the present study was tow-fold: to develop a protocol to defined the effect of hypoxia on ANP secretion in perfused beating rabbit atria and to clarify the mechanism responsible for the accentuation by hypoxia of ANP secretion. MATERIAL AND METHOD: Experiments have been done in perfused beating rabbit atria. ANP was measured by radioimmunoassay. RESULT: Hypoxic stimulus with nitrogen decreased atrial stroke volume. The decrease in atrial stroke volume recovered basal level during the period of recovery with oxygen. ANP secretion and the concentration of perfusate ANP in terms of extracellular fluid(ECF) translocation which reflects the rate of myocytic release of ANP were increased by hypoxia and returned to basal levels during the recovery. Changes in ECF translocation paralleled by hypoxia and returned to basal levels during the recovery. Changes in ECF translocation paralleled to that of atrial stroke volume. At the start of recovery in atrial storke volume, ECF tranalocation incrased for several minutes. The above responses were stable and reproducible. Glibenclamide treatment prevented the recovery in atrial stroke volume. Increments by hypoxia of ANP secretion and ANP concentration were suppressed by glibenclamide. CONCLUSIONS: These results indicate that hypoxia incrased atrial myocytic ANP release and that the mechanism responsible for the accentuation is partially related to the change in K+ATP channel activity.

Mitral Valve Replacement with Chordal Preservation in Mitral Stenotic Disease / 대한흉부외과학회지

BACKGROUND: Mitral valve replacement with chordal preservation in patients with mitral regurgitation has been proved to be beneficial for left ventricular function and for reduction of postoperative complication. However, in patients with mitral stenosis, the effectiveness of the technique is controversial. It is not easy to insert prosthetic valve without left ventricular outflow tract obstruction and prosthetic valve leaflet motion hinderance. MATERIAL AND METHOD: Five patients with mitral stenosis and seven patients with mitral stenoinsufficiency underwent mitral valve replacement with preservation of mitral subvalvular apparatus. Thickened and calcified leaflets are made thin by peeling off the thickened and calcified part. Commissurotomy was done and anterior leaflet was incised 2 mm apart from the annulus and then divided into two segments. Anterolateral and posteromedial segments including strut chordae, were reattached to mitral commissural area, respectively. RESULT: There was no evidence of prosthetic valve dysfunction, paravalvular leakage, left ventricular outflow tract obstruction, complications and operative or late deaths. CONCLUSION: We conclude that mitral vlave replacement with chordal preservation was safe and effective technique for the patients with mitral stenotic disease.

Clinical Result of the Patent Ductus Arteriosus in the Premature Infants / 대한흉부외과학회지

BACKGROUND: This study is to suggest the optimal method as a treatment for the patent ductus arteriosus in the premature infants. MATERIAL AND METHOD: Between April 1994 and April 1997, 45 premature infants with evidence of a hemodynamically significant patent ductus arteriosus associated with cardiopulmonary compromise underwent indomethacin therapy, surgical treatment, or both. Thirty-nine infants received indomethacin and twelve infants among them were surgically ligated because of indomethacin failure(5) or complications(7). Six infants, who weighed less than 1,500 gm at birth, were referred for primary surgical ligation because of contraindication to indomethacin therapy. RESULT: The failure rate of indomethacin therapy was 43%(17/39) and the complications(13/39, 33%) to the indomethacin were associated with a high morbidity and mortality. Among the infants who underwent ligation, there were no failures and complications related to the operation. This data suggests that in the premature neonate with a hemodynamically significant PDA, (1) indomethacin therapy is associated with a high failure rate and significant complications, (2) surgical duct closure is associated with minimal morbidity. CONCLUSION: Although the results of this study cannot suggest the optimal management for PDA in premature infants, primary surgical ligation may be considered. However, long-term studies will be needed to confirm this later.

Infantile Lobar Emphysema with Ventricular Septal Defect: one case report / 대한흉부외과학회지

Infantile lobar emphysema is an uncommon disease affecting newborns and infants with varying degree of respiratory distress, lobar overaeration, mediastinal shift and herniation. Although the etiology of the condition is most commonly idiopathic, there is a clear association with congenital heart disease, particularly in the presence of pulmonary hypertension due to left to right shunt. Sites of predilection are the left main bronchus, the left upper and right middle bronchi. This report describes a two-week-old boy who had right middle lobe emphysema with large ventricular septal defect. At first, patch closure of perimembranous ventricular septal defect was performed. Postoperatively, the patient required continuing assisted ventilation and the lobar emphysema was not improve. One week following the initial operation, right middle lobectomy was successfully performed and the patient was weaned from artificial ventilator on the 5th postoperative day. The patient was discharged with good general condition on the 45th postoperative day.

The Effect of Chordae Preservation in Mitral Valve Replacement / 대한흉부외과학회지

BACKGROUND: Mitral valve replacement(MVR) with chordal preservation in patients with mitral vlavular disease has been proven to be beneficial for left ventricular function and for reduction of postoperative complication. MATERIAL AND METHOD: From January 1995 to July 1996, the early postoperative results of mitral valve replacement were compared between 20 patients who underwent chordae resection(classic MVR group) and 10 patients who underwent chordae preservation(preservation MVR group) in the Department of Thoracic and Cardiovascular Surgery, Chunbuk National University Hospital. RESULT: There was no significant difference between the two groups in age, sex, NYHA functional class, cardiothoracic ratio, echocardiographic finding, cardiopulmonary bypass time and aortic cross clamping time. The difference between preoperative and postoperative cardiothoracic ratio after 3 months was not statistically significant. At echocardiographic left ventricular evaluation, ejection fraction and fractional shortening decreased slightly in the preservation group then preoperative value (p=0.47, p=0.12), however, decreased significantly in the classic MVR group(p=0.03, p=0.04), and were statistically significant between the two groups(p=0.03, p=0.02). CONCLUSION: We conclude that MVR with chorda preservation seems to have a beneficial effect on postoperative left ventricular performance in mitral valve disease than the classic MVR.

Postoperative Evaluation for Ventricular Septal Defect Associated with Aortic Valvular Prolapse / 대한흉부외과학회지

BACKGROUND: From January 1989 to December 1996, we analyzed 22 cases of ventricular septal defect associated(VSD) with aortic valvular prolapse. MATERIAL AND METHOD: The mean age of the patients was 7 years with a range of 6 months to 22 years . Thirteen patients were male and 9 were female. The types of VSD were Kirklin type I in 13 , Kirklin type II in 8 and Kirklin type I+II in one. RESULT: The preoperative echocardiographic findings were aortic valvular prolapse in 10 patients, aortic valvular prolapse associated with aortic regurgitation in 6, and only aortic regurgitation in 2. Aortic valvular prolapse were found in operation field in 4 that was not be in preoperative echcardiography. Preoperative mean Qp/Qs, systolic PAP, systolic RVP were 1.48+/-0.42, 27.9+/-9.87, 32.9+/-10.87 mmHg, respectively. Twenty patients underwent patch closure of VSD, and two patients with moderate aortic regurgitation and prolapsed of the aortic valve underwent patch closure of VSD and aortic valvuloplasty. Short and long term echocardiographic follow-up in 8 patients who had preoperative aortic regurgitation were found to have improved or not aggravated by performing VSD patch closure only and patch closure with valvuloplasty in 2. Twelve patients who had only preoperative aortic valvular prolapse had no change in prolapsed valve in postoperative echocardiography. CONCLUSION: Early closure of VSD with patch is necessary in VSD with aortic valvular prolapse even in associated with mild regurgitation. But in moderate regurgitation, VSD closure with valvuloplasty is recommended.

The Risk Factors of Morbidity and Mortality after Pulmonary Resection / 대한흉부외과학회지

BACKGROUND: Surgical resection offers the potential care in patients with carcinoma of the lung whose tumors are amenable to resection, those with infections destroyed lung discase or congenital lung disease prediction of risk factors to influencing outcome after thoracic operations offers important benefits. Physicians anticipating those patients most prone to complications can provide special attention aimed at reducing morbidity and mortality. MATERIAL AND METHOD: We have retrospectively reviewed hospital records of 153 patients undergoing pulmonary resection for neoplastic and inflammatory destroyed lung disease between 1994 and 1998 to identify predictors of outcome. The mean age was 54.3+/-10.6years. Ninety-six patients(62%) had malignant lung disease and 47 patients(30%) had destroyed lung desease and 10(7%) had congenital or other lung desease. RESULT: Of the 153 resections performed 118 were lobectomies, 29 were pneumonectomies, 6 were segmentectomies, Seven of the 153 patients died during their hospital stay(4.5%). The most significant predietors of in-hospital mortality were presence of concomittent medical disease (P<0.001) and patients age 70 years or over(P<0.003). There were 67 postoperative complication occurring in 57 patients. Operation related complications were in 50 patients (32%), respiration related were in 14(9.1%) and cardiovascular related were in 1(0.6%) and other complications were in 2 patients(1.3%). The most significant predictors of postoperative morbidity was patients age 70 years or over(P<0.004). CONCLUSION: concomitant medical disease and patients age 70 years or over were very predictive value of postoperative mortality, also the patients age 70 years or over was significant preoperative value of postoperative morbidity.

Report of Eight Cases of Cor Triatriatum / 대한흉부외과학회지

Cor triatriatum is a rare congenital heart disease that is often lethal in children if not correctly identified and properly managed, Characteristically an anomalous membrane divides the left atrium into two chambers one located posterosuperiorly which is connected to the common pulmonary venous trunk and the other anteroinferiorly which is connected to the left atrial appendage and the mitral valve. Eight patients with Cor triatriatum were been seen at our hospital from 1984 to 1999. The clinical presentation diagnostic evaluation and surgical results are outlined in this retrospective review. Resection of the obstructing anomalous atrial membrane was performed using a hypothermic cardiopulmonary bypass in all cases. Right atriotomy was performed in all patients and left atriotomy was performed in a patient who had poor preoperative general conditions and serious cardiac defects(TAPVR & hypoplastic left ventricle) died of low cardiac output during the immediate postoperative period. The postoperative course has been excellent in the remaining. Cor triatriatum is amenable to surgical repair with excellent results when diagnosed early and in those who are not complicated by other complex cardiac anomalies.

Leiomyoma of the Trachea / 대한흉부외과학회지

Leiomyoma is extremely rare benign tumor of the trachea. A case of leiomyoma of the trachea is described in a 36-year-old man. The patient had a brief history of asthma-like symptoms. Computed tomography of the chest revealed the ovoid lower trachea mass, which was occupying about 80% of the tracheal lumen. At fiberoptic bronchoscopy highly vascularized round mass was seen on the membranous portion of the lower trachea. The tumor was excised by segmental sleeve resection and end-to-end anastomosis of the trachea was performed. Postoperative course was uneventful and bronchoscopic findings showed clear healing of the anastomotic site.

Clinical Study of Primary Chest Wall Tumors / 대한흉부외과학회지

Between January 1979 and August 1996, resection of a primary chest wall tumor was done in 51 patients. The mean age of the patients was 36.1 years (2 to 69 years). A palpable mass was the most common symptom (32 patients, 62.7%). The tumor was malignant in 11 patients (21.6%) and benign in 40 patients (78.4%). The tumors in 32 patients (62.7%) had developed from the bony or the cartilaginous wall and in 19 patients (37.3%) from soft tissue. Thirty seven of the patients with benign tumors were treated by excision (three of the patients: wide resection and reconstruction) without recurrence or death, and they are currently free from disease. Most malignancies (8 patients) were treated by wide resection and chest wall reconstruction. Five of them are currently alive. The chest wall reconstruction with Marlex mesh, Prolene mesh, or Teflon felt was done in five of the patients with malignant tumors.