Results of heart transplantation in Korea / 대한내과학회지

BACKGROUND: Heart transplantation is a definite treatment modality of the patients with end-stage heart failure. Heart transplantation has been performed in Korea since 1992, and currently it is an established procedure for the management of terminal heart failure. The purpose of this study is to clarify the Korean status of heart transplantation. METHODS: Six major heart transplantation centers' 137 cases during the period November 1992 through May 1999 are analyzed to evaluate the general demographics, underlying heart diseases, postoperative management, complications, and survival. RESULTS: The mean age of the patients is 37 years old, and the mean follow-up period is 25 months (1 day - 80 months, median 20 months). Most common underlying disease related to heart failure is cardiomyopathy (86%). Total 16% of patients underwent cellular rejection of ISHLT (International Society of Heart and Lung Transplantation) grade 3A or more within 1 year after transplantation. The most common type of clinical infection is bacterial (18%), and the most common organism is Herpes zoster virus (6.4%). Graft coronary artery disease examined by coronary angiography detected in 3.7% of recipients within 12 months after transplantation. One, 2, 3, and 5-year overall survival rates of recipients are 81% , 72%, 71%, and 62%, respectively. CONCLUSION: Distribution of underlying heart diseases and the frequency of graft coronary artery disease of Korean heart transplantation recipients were different from those of the western patients. Although the history of heart transplantation in Korea is relatively short, the early and long-term results are comparable with well-established centers.

Midterm Results of Mitral Valve Repair by the New Chordae Formation Technique / 대한흉부외과학회지

BACKGROUND: The optimal treatment for mitral regurgitation from leaflet prolapse or multiple leaflet pathology is not yet established. Recently, new chordae formation(NC) with olytetra-fluoroethylene(PTFE) has become increasingly popular. The aims of the current study was to see the effects of new chordae formation on mitral alvuloplasty. MATERIAL AND METHOD: From January 1994 to december 1999 322 patients receiving itral valvuloplasty were divided into two groups in which 144 patients(Group I) received NC and 178 patients(group II) received mitral valvuloplasty without NC. Echocardiograms were performed in the immediate postoperative period, at 6 months and 1 year after surgery and annually thereafter. RESULT: Mitral valvuloplasty was performed for mitral regurgitation in 95%(322/ 337) of the patients and the mean followup period was 27+/-20.6 months of which follow-up was complete for 95.4%(306/ 322). The degree of mitral regurgitation in both groups I and II improved from 3.8+/-0.4 to 1.3+/-0.9 and 3.6+/-0.3 to 1.1+/-0.7, respectively. There was also no significant difference in the mean mitral area or transvavular pressure gradient across the mitral valve. The overall early and late mortality rates were 0.9%(3) and 1.2%(4), also showing no significant difference between the two groups. The late survival rate(97.8+/-1.6 vs 97.7+/-1.6%), freedom from structural degeneration 93.7+/-3.6 vs 90.7+/-3.4%) freedom from reoperation(99.3+/-0.7 vs 96.6+/-1.8%), freedom from thromboembolism, freedom infective endocarditis, and valve related complications showed no significant difference between the two groups. CONCLUSION: Mitral valvuloplasty with NC not only resulted in an increase in the volume of mitral reconstruction(r=0.98, p<0.01) but enhanced urability and stability comparable to currently established methods. Mitral valvuloplasty with NC was especially effective in the treatment of pan valvular pathology, commissural lesions and multiple leaflet pathology which would otherwise have been difficult to treat with current methods.

Coronary Artery Bypass Surgery in Patients with End-Stage Renal Disease / 대한흉부외과학회지

BACKGROUND: As cardiac disorders, especially coronary artery disease is increasing in end-stage renal disease patients, the indications for coronary artery bypass surgery are increasing now. They have high risks for postoperative morbidity and mortality after coronary artery bypass surgery. MATERIAL AND METHOD: Between March of 1996 and May of 2000, medical records of 25 patients with end-stage renal disease who underwent coronary artery bypass surgery at Asan medical center were reviewed retrospectively. We reviewed the short-term results of preoperative risk factors, preoperative renal function, perative methods, operation results, hospital course, postoperative morbidity and mortality. RESULT: Preoperative creatinine clearance was 12.68+/-5 ml/min and serum creatinine level was 6.18+/-3 mg/dL(range 1.7-14. 4). Preoperatively, 11 patients(44%) received dialysis and the others(14 patients, 56%) were not supported by dialysis due to adequate urine output. Of the non-dialysis patients(14 cases), 8 patients were newly supported by dialysis, perioperatively. Of the preoperative hemodialysis patients(9 cases), two patients changed dialysis method postoperatively to peritoneal dialysis. Operative mortality occured in 2 patients(8%) and the causes of death were sepsis from aspiration pneumonia and mediastinitis, and postoperative bleeding and mediastinitis, respectively. Postoperative complications were developed in 14 patients(56%). There were 2 cases(8%) late mortalities and the cause of death was catheter-induced peritonitis. The actuarial survival rates in hospital survivals at 4 years was 82+/-13%. CONCLUSION: The coronary artery bypass surgery of end-stage renal disease patients were performed with acceptable mortality(8%). However , because the morbidity and mortality from morbidity were very frequent, perioperative prevention of infectious complications and careful patient management are very important.

Postcardiotomy Biventricular Assist Device in Adult Heart Disease / 대한흉부외과학회지

A 65-year-old male patient with preoperative severe left ventricular dysfunction and mitral and tricuspid insufficiency went into low cardiac output and failure to wean, biventricular assistance was provided with centrifugal pumps. The patient survived the ordeal. This is the first reported case of a survival after biventricular assistance using the centrifugal pump.

Capillary Hemangioma of the Right Ventricle: A Case Report / 대한흉부외과학회지

Cardiac capillary hemangioma is an extremely rare benign tumor. We report a case of 13 year old male patient who was admitted for dyspnea. After we confirmed the right ventricular mass with moderate flow obstruction by echocardiogram, we performed complete resection of the mass through the right atrium and identified the capillary hemangioma with pathologic examination. Therefore, we report the case with literature review.

Spontaneous Non-Traumatic Rupture of the Thoracic Aorta: 1 case report / 대한흉부외과학회지

Spontaneous non-traumatic rupture of thoracic aorta is a vary rare, life-threatening condition for which emergency surgery is indicated. We eport a case of spontaneous aortic rupture diagnosed with computed tomogram and transesophageal echocardiogram which was successfully treated by emergency hemi-arch replacement.

Mitral Valve Replacement with a Pulmonic Autograft / 대한흉부외과학회지

The pulmonic autograft as a replacement for the diseased aortic valve has become increasingly popular due to the potential to do away with anticoagulation and superior durability. There has not been any case of mitral valve replacement with pulmonic autograft reported in Korea. A 53-year-old female patient with rheumatic mitral steno-insufficiency, chronic atrial fibrillation, tricuspid insufficiency, and obstruction of the left circumflex artery, received mitral valve replacement using pulmonic autograft, maze procedure, tricuspid valvuloplasty and coronary artery bypass. The postoperative course was uneventful with a well functioning pulmonic autograft in the mitral position on echocardiogram. She is currently doing well without anticoagulation.