Aortic Valve Replacement Using Continuous Suture Technique in Patients with Aortic Valve Disease

BACKGROUND: The continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes. MATERIALS AND METHODS: Between October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used. RESULTS: There were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients. CONCLUSION: The simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used.

Postintubation Tracheal Ruptures: A case report

Tracheobronchial ruptures (TBR) rarely complicate surgical procedures under general anesthesia. Seemingly uneventful intubations can result in injury to the trachea, which often manifests as hemoptysis and subcutaneous emphysema. We present 2 patients with postintubation TBR who were treated surgically and discuss considerations in the management of this potentially lethal injury.

Extraanatomic Aortic Bypass through a Median Sternotomy in a Patient with Coarctation of Aorta Associated with Annuloaortic Ectasia: A case report / 대한흉부외과학회지

Coarctation of the aorta is frequently associated with intracardiac disease. It is very difficult to decide on the best method for surgically treating adult patients with these combined heart diseases. We performed single-stage repair via a modified Bentall operation and by creating an intrapericardial ascending-descending aortic bypass through a median sternotomy in a patient with coarctation of the aorta and annuloaortic ectasia, and the latter was associated with aortic valve regurgitation.

Modified Bentall Operation and the Double Sewing Ring Technique: 2 case reports / 대한흉부외과학회지

The Bentall-DeBono operation is the technique of choice for aortic root replacement. When the patients have contraindications for lifelong anticoagulation, the biologic Bentall operation may be a good option. However, complex reoperation may be required when bioprosthetic degeneration occurs. For this reason, a new technique for simple reoperation after the Bentall operation has recently been performed by some surgeons. We performed a similar technique in two patients with aortic root dilation and for whom aortic valve sparing techniques could not be performed because of an unrepairable valve contour, we think this modification seems to be simple and reproducible for reoperation.

Mid-term and Long-term Outcomes of Posterior Plication Annuloplasty (Modified Davila Annuloplasty) for Functional Tricuspid Regurgitation / 대한흉부외과학회지

BACKGROUND: Many types of tricuspid annuloplasty are used in surgical correction of functional tricuspid regurgitation (FTR). We evaluated the mid-term and long-term outcomes in patients treated with a posterior annular plication technique (a modified Davila technique) for FTR. MATERIAL AND METHOD: Between January 1991 and August 2006, 58 adult patients (male, 22; female, 36) with FTR of grade 2/4 or more or with tricuspid annular dilatation of more than 5.0 cm in diameter, even with an FTR of less than grade 2, had received a posterior annular placation. Preoperatively, 26 patients (44.8%) had a grade 3 or more FTR. All patients had received a mitral valve replacement, and 20 (34.5%) had concomitant aortic valve replacement. RESULT: During the mean follow-up period of 101.4+/-51.6 months, FTR disappeared or remained trivial in 28 patients (49.1%), was grade 2~3 (> or =grade 2 and

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.

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.

Clinical Comparison of Complications Between Cervical and Thor acic Esophagogastrostomy After Resection of Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: For resection of esophageal cancer, esophagogastrostomy caused serous multiple complications such as leakage of anastomosis site, stenosis, recurrence of cancer, etc. Especially, accoding to the anastomosis site of esophagogastrostomy, patients in post operation state was felt various subjective symptom, multiple complications and longer hospital periods, etc. Therefore, there was a demand for comparison and analysis of complication between cervical and thoracic esophagogastrostomy. MATERIAL AND METHOD: From January 1995 to May 1999, 55patients with esophageal cancer underwent cervical esophagogastrostomy(23patients) or thoracic esophagogastrostomy(32patients). Cancer was grouped according to the postoperative staging(I--5pt, II--27pt, III--23pt) by the AJCC classification and location: upper thoracic(3pt), middle(34pt) and lower(18pt). Cancer was mostly squamous cell carcinoma except 2 adenocarcinoma. Fifty five patients were male with average age of 59 years for cervical anastomosis and 55 years for thoracic anastomosis. The staple anastomosis was done in one cervical anastomosis patient and 23 thoracic anastomosis patients. RESULT: There was one mortality from cervical anastomosis and two from thoracic anastomosis. Fourty six complications(respiratory and digestive system, etc..) occurred in 15cervical anastomosis patients and 37 complication in 13thoracic anastomosis patients. In 23cervical esophagogastrostomy patients, 11patients had moderate to severe dysphagea during swallowing. However, only 2thoracic anastomosis patients experienced this dysphagea. The postoperative hospital stay was above 20days in 18 cervical anastomosis patients, and in 13thoracic anastomosis patients. CONCLUSION: Among esophageal tumor cases, respiratory, digestive, infection and other complications did occur after esophagogastric anastomosis. Particularly, mortality rate secondary to respiratory complication was high. Anastomotic leakage was more frequent in manual anastomosis than in staple anastomosis, and was also seen more frequently among cervical anastomosis than among thoracic anastomosis. In the cases of cervical anastomosis, the patients complained more of dysphagea while their hospital stays were significantly long.

Long Term Results of Valve Replacement with the St. Jude Medical Heart Valves: Thirteen Year Experience / 대한흉부외과학회지

Between May 1984 and January 1996, 130 patients were replaced cardiac valve using 150 St. Jude Medical prosthetic valves(42 aortic, 68 mitral, 20 aortic and mitral valve replacements). Follow-up was 97.6% complete. The early mortality rate was 5.4%, and late mortality rate was 4.9%. The valve-related late mortality rate was 3.3%. Of late complications, there were 6 anticoagulant related hemorrhages, 4 thromboembolisms and 1 paravalvular leakage. Linearized rates of late complication and valve-related late mortality were as follows: total late complications, 1.68% per patient-year: anticoagulant related hemorrhages, 0.92% per patient-year: thromboembolism, 0.61% per patient-year: paravalvular leakage, 0.15% per patient-year: reoperation, 0.15% per patient-year: and valve-related late mortalities, 0.61% per patient-year. Actuarial event free rate at 10 years was 87.4+/-3.2%. The overall actuarial survival rate was 90.4+/-2.7% at 5 years, 87.5+/-3.3% at 10 years. Ninety eight percent of the survivors were in the New York Heart Association functional class I or II at the end of follow-up. There was significant improvement of cardiothoracic ratio. In conclusion, this study suggests the excellent durability of the St. Jude Medical Heart valve and remarkable functional benefit for the majority of the patients. However, prosthesis- related complications are still common. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.

The Result of the Surgical Treatment for Non-small Cell Lung Cancer / 대한흉부외과학회지

Recently, primary lung cancer has increased markedly in incidence and prevalence in korea. From July 1979 to June 1996, 183 patients were diagnosed and operated for primary non-small cell lung cancer, and evaluated clinically. 1. There were 164 males and 19 females(M:F=8.6:1), and the peak incidence of age was 50th and 60th decade of life(73.7%). 2. Most of symptoms were respiratory, whitch were cough(44.8%), chest pain(30.1%), dyspnea(20.8%), hemoptysis or blood tinged sputum(19.7%), sputum(15.3%), and asympto- matic cases were 12.0%. 3. Histopathologically, sguamous cell carcinoma was 68.9%, adenocarcinoma 19.7%, bronchioloalveolar cell carcinoma 2.2%, adenosguamous cell carcinoma 1.6%, and large cell carcinoma 7.7%. 4. In the operation, pneumonectomy was 41.0%, lobectomy 42.1%, bilobectomy 13.1%, segmentectomy or wedge resection 1.6%, and explore tharacotomy 2.2%, and the overall resectability was 97.8%. 5. Postoperative complications were developed in 31.9%, and operative mortality was 1.6%. 6. In postoperative stagings, stage I was 38.3%, stage II 14.8%, stage III a 31.1%, and stage III b 15.8%. 7. The overall cumulative survival rates were 1 year 77.8%, 3 year 42.7%, and 5 year 39.5%. The 5 year survival rate according to stage were stage I 53.0%, stage II 46.5%, stage III a 28.2%, and stage III b 13.8%(p0.05).

Mitral Valve Replacement / 대한흉부외과학회지

From July 1983 to December 1993, total 112 consecutive mitral valve replacement in 107 patients were performed in patient with mitral valvular abnormalites. To estimate the risk factor related to operative death, all patient's perioperative data were reviewed retrospectively. Except 20 patients received concomitant aortic valve replacement and 2 patients had incomplete data, 85 patients were included in this study. Mean age was 37.3+/-13.1 years ranging from 13 to 72 years. Thirty-seven patients were male and fourty-eight patients were female. Mean follow-up durations were 51.1+/-33.8 months ranging from 6 months to 11 years. Patients in this study showed improvement in mean NYHA functional clssification, from 3.02+/-0.73 to 1.78+/-0.55, and also in cardiothoracic ratio, from 0.61+/-0.09 to 0.58+/-0.08 at 6 months follow-up after operation. Operative complications were detected in 23 patients(27.1%) and common postoperative complications were rhythm disturbance in 7 cases, pulmonary complications in 6 cases and low cardiac output syndrome in 6 cases. Early mortality was 10.6% ( n=9 ) and most common cause of death was congestive heart failure due to low cardiac output syndrome. Main cause of our higher operative mortality than other study was that operative mortality in the initial period of our mitral surgery was high (5 operative deaths among 19 mitral valve replacement from July 1983 to December 1985 ). Actuarial survival was 80.8% at 5 years, 71.8% at 11 years including operative deaths. Actuarial freedom from anticoagulant-related bleeding was 85.3% at 5 years, 78.3% at 11 years. 95.1% at 5 years and 88.8% at 11 years among the patient in this study were free from thromboembolism, and 97.5% at 5 years and 75.1% at 11 years were free from reoperation. Preoperative cardiothoracic ratio and patient's age were statistically significant operative risk factors.

Chest Wall Giant Malignant Peripheral Nerve Sheath Tumor: One case report / 대한흉부외과학회지

A case of chest wall malignant peripheral nerve sheath tumor(MPNST) was reported in the U.S.A by Mark and coworkers(1991), but none in kerea. MPNST accounts for approximately 10% of all soft tissue sarcoma, mostly in patients between 20 and 50 years of age. MPNST arises in association with a major nerve trunk, including the sciatic nerve, brachial plexus, and sacral plexus and the most common anatomical site is the proximal portion of the upper and lower extremity and trunk. Surgical treatment is local excision of mass in low grade sarcoma but enblock resection is necessary in high grade sarcoma. We experienced multiple huge low grade MPNST on left chest wall of a 50 years old man. The tumor and invalved chest wall were removed, and the chest wall defect(15 X 8 cm) was reconstructed with Teflon. Postoperative course was unevenful.

A clinical evaluation of mediastinoscopy / 대한흉부외과학회지

No abstract available.

Bronchial rupture following blunt chest trauma: 1 case report / 대한흉부외과학회지

No abstract available.

An experimental study of gallbladder sclerosis with 10% phenol in rabbits

To evaluate a new reliable sclerosant of the gallbladder, we attempted gallbladder ablation with 10% phenol, and the results compared with those from using 95% ethanol which had been used previousy as gallbladder sclerosing agent in laboratory animals in other reports. After laparotomy, ligation of the cystic dusts with silk and cannulation of gallbladder with 18 gauge angiocatheter were done. Then, transcatheter administration of two different scleroing agents was performed in 8 rabbits respectively and normal saline in four rabbits as a control. Additionally, preliminary washing with each agent were implemented to prevent the dilutional effect of residual bile and bleeding. All animals survived without complication. Eight animals were used for each agent, four each being sacrified two weeks and six weeks after adminstration of sclerosing agents respectively. In our results, 10% phenol was more effective than 95% ethanol in denuding the gallbladder epithelium and promoting fibrosis of gallbladder wall, And it was relatively safe in regard to the dilutional effect of residual fluid and bleeding during procedure. Toxic effects on the liver evaluated by examination of histologic specimen were non-specific except for edematous swelling on some cases, which had also been observed on others including control group. 10% phenol can be considered to be a promosing sclerosant for gallbladder ablation, but further study of its toxicity is needed before its application on human gallbladder.

A Case of Williams Elfin Facies Syndrome

No abstract available.