ABSTRACT
BACKGROUND AND OBJECTIVES: Recently, in mitral valve surgery, valvuloplasty or valve repair was successfully introduced to improve postoperative left ventricular function and to decrease operative mortality. However, the real impact of this technique on daily practice in Korea was not systematically assessed. MATERIALS AND METHOD: The operative methods, postoperative death, follow-up results and their contributing factors were analysed among patients who underwent mitral valve surgery at our institution. RESULTS: 1) From June 1989 to December 1996, 416 patients (186 males, mean age 48+/-13 years) underwent mitral valve surgery. Dominant mitral stenosis (MS) was the main pathology in 167 patients; dominant mitral regurgitation (MR) and balanced mitral stenoinsufficiency (MSR) in 197 and 52 respectively. 2) In MS, valve replacement was performed in 91% whereas commissurotomy in 9%. However, in MR, the rates of valve repair surgery has increased up to 60% of the total surgical procedures for the past three years. 3) The overall operative mortality was 4% (18/416). It was significantly lower in valve repair compaired with valve replacement (0% vs. 6%; p=0.003). In MS, factors associated with high mortality were longer cardiopulmonary bypass and aortic cross clamp time. In MR, high mortality was associated with diabetes, endocarditis, valve replacement and longer cardiopulmonary bypass time. 4) The 7-year late survival among operative survivors was 95+/-2% in MS, which was singnificantly higher than that in MR (80+/-6%, p=0.04). 5) In MR, the 4-year cardiac event-free survival among operative survivors (absence of cardiac death, reoperation, bleeding, endocarditis, thromboembolism, or development of heart failure) was significantly higher in valve repair group than in valve replacement (84+/-7 vs. 76+/-5%; p=0.03). CONCLUSION: The overall outcomes of recent mitral valve surgery were satisfactory. In MR, valve repair surgery seemed to be an established method to decrease operative mortality and long-term complications.
Subject(s)
Humans , Male , Cardiopulmonary Bypass , Death , Disease-Free Survival , Endocarditis , Follow-Up Studies , Heart , Hemorrhage , Korea , Mitral Valve Insufficiency , Mitral Valve Stenosis , Mitral Valve , Mortality , Pathology , Reoperation , Survivors , Thromboembolism , Ventricular Function, LeftABSTRACT
Between December 1993 and March 1996, 75 patients had undergone subannular procedures in mitral valve reconstruction. Their mean age was 45 years and they consisted of 28 males and 47 females. The cause of mitral disease in 75 patients were classified as follow : 29 cases were degenerative, 40 cases were rheumatic, 3 cases were congenital, 2 cases were infectious and 1 case was ischemic. Average number of mitral anatomical lesion per patient was 3.1 and we used average 1.5 procedures on subannular structure in mitral valve per patient. Subannular procedures were chordae shortening 21, chordae transfer 22, new chordae formation 20, papillary muscle splitting 33, shortening of papillary muscle 2. Intraoperative transesophageal echocardiography was carried out for providing an immediate and accurate assessment of the adequacy of the reconstruction. There was no operative death. Patients have been followed up from 2 to 29months, mean 12.5. There were two failures that necessitated reoperation. The mean functional class(NYHA) was 3.19 preoperative and improved to 1.12. postoperatively. After mitral valve repair, the patients were improved hemodynamic, echocardiographic data. In conclusion, subannular procedure in mitral valve repair when feasible is stable and safe with a low prevalence of reoperation.
Subject(s)
Female , Humans , Male , Echocardiography , Echocardiography, Transesophageal , Heart Valve Diseases , Hemodynamics , Mitral Valve , Papillary Muscles , Prevalence , ReoperationABSTRACT
Heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in humans was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 50 cases have been performed in Korea. A total of 20 patients underwent orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The purpose of this study is to evaluate the early results and the follow-up course of 20 cases of heart transplantation done in Asan Medical Center. The average age of 20 patients was 39.9+/-11.8 years old(20~58). The mean follow-up duration was 14.4+/-11.2 months(1~41). All patients are alive till now. The blood type was identical in 14 and compatible in 6 patients. The original heart disease was dilated cardiomyopathy in 16, valvular heart disease in 2, ischemic cardiomyopathy in 1, and giant cell myocarditis in 1 patient. HLA cross matching for recipient and donor was done in 18 cases and the results were negative for T-cell and B-cell in 16 patients, positive for warm B-cell in 2 patients. Among 6 loci of A, B, and DR, one locus was matched in 8 cases, 2 loci in 5 cases, and 3 loci matched in 1 case. The number of acute allograft rejection averaged 2.8+/-0.5(0~6) per case and the number of acute allograft rejection requiring treatment averaged 1.0+/-0.9(1~3) per case. The time interval from operation to the first acute rejection requiring treatment was 35.5+/-20.4 days(5~60). Acute humoral rejection was suspected strongly in 1 case and was successfully treated. The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 17.5+/-6.8(9~32)% to 58.9+/-2.0(55~62)% after heart transplantation. Temporary pacing was needed in 5 patients over 24 hours but normal sinus rhythm appeared within 7 days in all cases. One patient has been taken permanent pacemaker implantation due to complete AV block appearing 140 days after heart transplantaion. One patient had cyclosporine-associated neurotoxicity during the immediate postoperative period and was recovered after 27 hours. The heart transplantation of Asan Medical Center is on a developing stage but the early result is comparable to that of well established centers in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in patients with terminal heart failure.
Subject(s)
Humans , Allografts , Atrioventricular Block , B-Lymphocytes , Cardiomyopathies , Cardiomyopathy, Dilated , Echocardiography , Follow-Up Studies , Giant Cells , Heart Diseases , Heart Failure , Heart Transplantation , Heart Valve Diseases , Heart , Korea , Myocarditis , Postoperative Period , Stroke Volume , T-Lymphocytes , Tissue DonorsABSTRACT
Heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in humans was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 50 cases have been performed in Korea. A total of 20 patients underwent orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The purpose of this study is to evaluate the early results and the follow-up course of 20 cases of heart transplantation done in Asan Medical Center. The average age of 20 patients was 39.9+/-11.8 years old(20~58). The mean follow-up duration was 14.4+/-11.2 months(1~41). All patients are alive till now. The blood type was identical in 14 and compatible in 6 patients. The original heart disease was dilated cardiomyopathy in 16, valvular heart disease in 2, ischemic cardiomyopathy in 1, and giant cell myocarditis in 1 patient. HLA cross matching for recipient and donor was done in 18 cases and the results were negative for T-cell and B-cell in 16 patients, positive for warm B-cell in 2 patients. Among 6 loci of A, B, and DR, one locus was matched in 8 cases, 2 loci in 5 cases, and 3 loci matched in 1 case. The number of acute allograft rejection averaged 2.8+/-0.5(0~6) per case and the number of acute allograft rejection requiring treatment averaged 1.0+/-0.9(1~3) per case. The time interval from operation to the first acute rejection requiring treatment was 35.5+/-20.4 days(5~60). Acute humoral rejection was suspected strongly in 1 case and was successfully treated. The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 17.5+/-6.8(9~32)% to 58.9+/-2.0(55~62)% after heart transplantation. Temporary pacing was needed in 5 patients over 24 hours but normal sinus rhythm appeared within 7 days in all cases. One patient has been taken permanent pacemaker implantation due to complete AV block appearing 140 days after heart transplantaion. One patient had cyclosporine-associated neurotoxicity during the immediate postoperative period and was recovered after 27 hours. The heart transplantation of Asan Medical Center is on a developing stage but the early result is comparable to that of well established centers in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in patients with terminal heart failure.
Subject(s)
Humans , Allografts , Atrioventricular Block , B-Lymphocytes , Cardiomyopathies , Cardiomyopathy, Dilated , Echocardiography , Follow-Up Studies , Giant Cells , Heart Diseases , Heart Failure , Heart Transplantation , Heart Valve Diseases , Heart , Korea , Myocarditis , Postoperative Period , Stroke Volume , T-Lymphocytes , Tissue DonorsABSTRACT
Primary cardiac tumors in infancy and childhood are rare, with fibromas being the second most common tumor after rhabdomyomas. Although cardiac fibromas are characteristically benign intramural tumors, they may exhibit exhibit expansile growth resulting in obstruction, valvular dysfunction, as well as other problems so early diagnosis and successful surgical excision are important. We report a case of cardiac fibroma in a 2 month-old male infant. He presented with generalized cyanosis from birth. Echocardiography showed oval round large mass filing the right atrium and ventricle which infiltrated into the lateral wall of the ventricle. Partial excision of the tumor was done after another echocardiogram showed a pericardial effusion and restriction of blood flow to the right ventricle due to the tumor. The resected tumor was ovoid, gray-tan, slightly firm and measuring 5x3x2.5 cm. Histologically, the tumor was composed of spindle-shaped fibroblasts and hyalinized fibrous tissue interdigitating with the surrounding myocardium.
Subject(s)
Infant , Child , Male , Female , HumansABSTRACT
BACKGROUND: The heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in human was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 25 cases have been performed in Korea. The purpose of this study is to evaluate the early results and the follow-up course of 9 cases of heart transplantation done in Asan Medical Center. METHODS: Total 9 patients had orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The No. of male patients was 7 and the average age of 9 patients was 41 years old(20-51). The preoperation status was status I in 5 patients and status II in 4 patients. The mean follow-up duration was 9.5 months(2-26). All patients are alive till now. RESULTS: 1) The blood type was identical in 6 and compatible in 3 patients. 2) The original heart disease was dilated cardiomyopathy in 7, ischemic cardiomyopathy in 1 and giant cell myocarditis in 1 patient. 3) IgG Ab for CMV was positive in all recipients and donors and igM Ab for CMV was positive in only one reipient. The serial cultures for CMV shell vial method have been negative till now. 4) HLA cross matching for recipient and donor was done in 8 cases and the results were all negative for T-cell and B-cell. Among 6 loci of A, B and DR, one locus was matched in 4 cases and 2 loci was matched in 2 cases. 5) The No. of acute allograft rejection per case was average 3.7(1-6) and the No. of acute allograft rejection requiring treatment was average 1.4(1-3) per case. The time interval from operation to the first acute rejection requiring treatment was 40 days(5-60). Acute humoral rejection was supected strongly in 1 case and was successfully treated. 6) The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 15%(10-24) to 59%(45-70%) after heart transplantation. 7) Temporary pacing was needed in 2 parients over24 hours but normal sinus rhythm was appeared within 7 day in all cases. One patient had permanent pacemaker due to complte AV block appeared 140 days after heart transplantaion. CONCLUSION: The heart transplantation of Asan Medical Center is on developing stage but the early result is comparable to that of well established center in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in parients with terminal heart failure.