Low-intensity Oral Anticoagulation Versus High-intensity Oral Anticoagulation in Patients with Mechanical Bileaflet Prosthetic Heart Valves / 대한흉부외과학회지

BACKGROUND: All the patients with mechanical valves require warfarin therapy in order to prevent them from developing thromboembolic complications. According to the ACC/AHA practice guidelines, after AVR with bileaflet mechanical prostheses in patients with no risk factors, warfarin is indicated to achieve an INR of 2.0 to 3.0. After MVR with any mechanical valve, warfarin is indicated to achieve an INR of 2.5 to 3.5. But in our clinical experience, bleeding complications (epistaxis, hematuria, uterine bleeding, intracerebral hemorrhage etc.) frequently developed in patients who maintained their INR within this value. So, we retrospectively reviewed the patients with bileaflet mechanical heart valve prosthesis and we determined the optimal anticoagulation value. MATERIAL AND METHOD: From January 1984 to February 2007, 311 patients have been followed up at a national medical center. We classified the AVR patients (n=60) into three groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II and an INR from 2.5 to 3.0 in Group III. We classified the MVR (n=171) and DVR (n=80) patients into four groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II, an INR from 2.5 to 3.0 in Group III and an INR from 3.0 to 3.5 in Group III. We compared the groups for their thromboembolic and bleeding complications by means of the Kaplan Meier method. RESULT: In the AVR patients, 2 thromboembolic complications and 4 bleeding complications occurred and the log rank test failed to identify any statistical significance between the groups for thethromboembolic complication rate, but groups I and II had lower bleeding complication rates than did group III. Thirteen thromboembolic complication and 15 bleeding complication occurred in the MVR and DVR patients, and the log rank test also failed to identify statistical significance between the groups for the thromboembolic complication rate, but groups I and II had lower bleeding complication rates that did groups III and IV. CONCLUSION: The thromboembolic complication rate was not statistically different between groups I and II and groups III and IV, but the bleeding complication rates of groups I and II were lower than those of groups III and IV. So this outcome encouraged us to continue using our low intensive anticoagulation regime, that is, an INR of 1.5 to 2.5.

The Surgical Treatment for Aorto-cutaneous Fistula after Open Heart Surgery: A case report / 대한흉부외과학회지

Aorto-cutaneous fistula is a rare complication after performing open heart surgery, but if this develops, it is a fatal condition. So, prompt diagnosis and aggressive surgical treatment is needed. We report here on a patient who had two mechanical double valves placed during heart surgery and she was treated for repeated sternal wound infections for about 5 years. She visited the ER due to abrupt bleeding at the sternal wound. She was diagnosed as having an aorto-cutaneous fistula by performing an aortogram and we then performed cardio-pulmonary bypass surgery. The patient is currently doing well and is under follow up 24 months after the repair.

Redo CABG through a Left Posterolateral Thoracotomy: A case report / 대한흉부외과학회지

We report there on a 46-year-old male patient whose angina recurred after a coronary bypass graft (CABG). Occlusion of the first diagonal branch was found on performing a coronary angiogram (CAG), and this occlusion had not previously been present. So, a redo-off pump CABG was performed via a left posterolateral thoracotomy. The anastomosis was made between the descending thoracic aorta and the diagonal branch by using the right radial artery. On the Multi-detector computerized tomography (MDCT) coronary angiogram conducted after the operation, it was confirmed that there was no abnormality in the anastomosis site. A Redo-CABG was successfully performed via left posterolateral thoracotomy in the patient whose disease was only at the diagonal branch.

Surgical Results for Treating Postpneumonectomy Empyema with BPF by Using an Omental Pedicled Flap and Thoracoplasty / 대한흉부외과학회지

BACKGROUND: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. MATERIAL AND METHOD: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: 45.9+/-9 years). The patients were followed up for a mean of 58 months (median: 28 months, range: 6~169). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema. RESULT: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). CONCLUSION: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to TB-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.

Clinical Analysis of Arteriovenous Fistula in Chronic Renal Failure Patients / 대한흉부외과학회지

BACKGROUND: Owing to the fact that the average life span has increased and the progress in medical science has been made, the number of patients with chronic renal failure (CRF) who have to take hemodialysis (HD) has been going up gradually. Accordingly, it is considered to be as a significant issue to obtain blood vessels which can be used repetitively and supply enough blood flows. Therefore, there have been various kinds of study on an inosculation rate andfactors influencing it following an arteriovenous fistula (AV fistula) and lots of studies are ongoing for the purpose of escalating the inosculation rate. The authors analyzed the effects of short-term result, age, sex, diabetes and hypertension on arteriovenous inosculations in 134 anatomical snuffbox operated subjects among the patients who have taken an AV fistula at this center. MATERIAL AND METHOD: Based on 134 patients who underwent an AV fistula at the department of thoracic surgery of this center from July, 2000 to May, 2004, the difference in arteriovenous inosculation rate was compared and analyzed depending on age (discriminated by 65-year-old), sex and the condition of the presence or absence of diabetes and hypertension. Correlation analyses were conducted for each parameter and statistical tests were performed by using SPSS for windows Release 11.0.1, which were determined to be statistically significant if p value was below 0.05. RESULT: The total number of operations was 169 including 35 of re-operations. The male/female rate was 70:64 (52%:48%). The average age was 56.3+/-12.26 years and there were 33 (24%) old aged patients above 65-year-old; there were 103 (71%) patients with hypertension and 90 (67%) patients with diabetes. Overall arteriovenous inosculation rate was 93+/-2.4%, 91+/-2.7%, 89+/-3.0% at 6, 12, 24 months, respectively. The arteriovenous inosculation rate of above 65-year-old patient group was 85+/-4.8%, 80+/-5.8%, 80+/-5.8% and below 64-year-old patient group's was 85+/-4.8%, 80+/-5.8%, 80+/-5.8% at given time points, respectively, which showed higher inosculation rate in below 64-year-old patient group with a statistical significance (p=0.0034). However, no statistical significance was found between the patients with hypertension and diabetes and the patients with no complication. In addition, there was no statistical significance in inosculation rate between male and female. CONCLUSION: The arteriovenous inosculation ratewas higher in the treated patient below 64-year-old than in the treated patient above 65-year-old. Thus it is advantageous for increase in long-term inosculation rate to obtain hemodialysis routes at an early age. The conditions of sex and the presence or absence of diabetes and hypertension do not make statistically significant effect on the arteriovenous inosculation rate.

Case Report of Partial Endocardial Cushion Defect with Mild Pulmonary Hypertension in Old Age / 대한흉부외과학회지

The partial endocardial cushion defect including ostium primum atrial septal defect and anterior mitral leaflet cleft, presents less significant clinical symptoms than complete endocardial cushion defect. But, as mitral insufficiency develops, cardiomegaly, congestive heart failure, pulmonary arterial hypertension appear. So, partial endocardial cushion defect has poor prognosis and is rarely seen in elderly patients. A 67 years old woman admitted at our hospital for operative treatment with partial endocardial cushion defect. She had increased pulmonary pressure of 45/22 mmHg, mean 32 mmHg. She had repair of ostium primum defect with patch, and the mitral valve was treated with valve replacement. Because advanced atrioventricular block developed postoperatively, she received permanent pacemaker.

Case Report of Partial Endocardial Cushion Defect with Mild Pulmonary Hypertension in Old Age / 대한흉부외과학회지

The partial endocardial cushion defect including ostium primum atrial septal defect and anterior mitral leaflet cleft, presents less significant clinical symptoms than complete endocardial cushion defect. But, as mitral insufficiency develops, cardiomegaly, congestive heart failure, pulmonary arterial hypertension appear. So, partial endocardial cushion defect has poor prognosis and is rarely seen in elderly patients. A 67 years old woman admitted at our hospital for operative treatment with partial endocardial cushion defect. She had increased pulmonary pressure of 45/22 mmHg, mean 32 mmHg. She had repair of ostium primum defect with patch, and the mitral valve was treated with valve replacement. Because advanced atrioventricular block developed postoperatively, she received permanent pacemaker.

Lung Cancer Incidentally Found on Surgery of Spontaneous Pneumothorax: A case report / 대한흉부외과학회지

Spontaneous pneumothorax is rarely occurred as an initial sign of primary lung cancer. As a lot of these cases have already advanced, even then surgical resection is performed, the prognosis is often undesirable. We happened to find a ruptured cavity on a 65-year-old male patient who had suffered from pulmonary tuberculosis in the past, while performing VATS bullectomy for simple spontaneous pneumothorax. Then, as a result of frozen biopsy, it was diagnosed as squamous cell cancer. Because the tumor was infiltrated from the upper lobe into the lower lobe passing by fissure, we should remove by pneumonectomy and the pathologic stage was found stage I (T2N0M0). When we made an follow-up observation for one year and a half, there was neither relapse nor complication. When there appears spontaneous pneumothorax to the high risk group for lung cancer who were smokers over forty-year old, with chronic bronchitis or pulmonary emphysema, it needs to have a closer observation on a base lung disease such as lung cancer through chest CT, and it is also necessary to make more active approach by performing the surgical operation through a thoracoscopy when there is a continued air release.

Curved Axillary Thoracotomy in Patent Ductus Arteriosus / 대한흉부외과학회지

Muscle sparing thoracotomy is known as alternative of posterolateral thoracotomy because of less postoperative pain, preservation of muscle power and better cosmetic outcome. Curved axillary thoracotomy (CAT) is a type of muscle sparing thoracotomy. Between July 2003 and August 2004, 5 patients diagnosed as pure patent ductus arteriosus (PDA) treated by CAT and we reviewed results retrospectively by clinical record. The operative procedures were ligation of ductus in 4 cases and division of ductus in 1 case. There were no postoperative complication. Curved axillary thoracotomy is considerable alternative for surgical treatment of PDA with merits of muscle sparing effect and cosmetic benefit.

The Use of Greater Saphenous Vein In Situ Graft in Arterial Occlusive Disease of Lower Extremity / 대한흉부외과학회지

BACKGROUND: Distal anastomosis using artificial vascular graft is difficult when luminal size mismatch occurred owing to severe occlusion of popliteal artery and its branches. So we reconstructed blood flow to ischemic lower limb by using autologous greater saphenous vein in situ graft (GSVISG) as vascular graft material. MATERIAL AND METHOD: From July 2000 to July 2005, 26 patients treated using GSVISG. We analyzed clinical results retrospectively by chart review. RESULT: There was no in hospital or early postoperative death and 6 late deaths occurred during follow up period. Postoperative complications were 5 cases of early graft obstruction, 2 cases of wound dehiscence, 1 case of graft aneurysmal change, 1 case of seroma formation at inguinal wound and 1 case of graft injury during valvulotomy. Overall patency rate during follow up period was 69.3%. CONCLUSION: Greater saphenous vein in situ graft is acceptable vascular graft for arterial occlusive disease of lower extremity.

Clinical Analysis of the Early Result of Coronary Artery bypass Graft / 대한흉부외과학회지

BACKGROUND: Recently, coronary artery obstructive disease and coronary artery bypass graft surgery have increased, and the operative result has been improved. We reviewed 154 cases of coronary artery bypass graft surgery from Jan. 1985 to Jun. 2004. MATERIAL AND METHOD: We reviewed 148 patients, 154 cases of coronary artery bypass surgery from Jan. 1985 to Jun. 2004. This investigation is designed to illustrate the preoperative diagnosis, severity of disease, operative method, the kind of used bypass graft used, number of distal anasomosis, associated surgery, and postoperative morbidity and mortality. RESULT: There were 84 males, 64 females and the average age was 58.9+/-8.3 years old. Preoperative clinical diagnosis were unstable angina in 97 cases (63.0%), stable angina in 31 cases (20.1%), acute myocardial infarction in 12 cases (7.8%) and postinfartion angina in 14 cases (9.1%). Preoperative angiographic diagnosis were three-vessel disease in 68 (44.2%), two-vessel disease in 39 (25.3%), one-vessel disease in 35 (22.7%), and left main disease in 12 (7.8%) cases. There were 78 cases of on-pump coronary artery bypass graft surgery and 76 cases of off-pump coronary artery bypass graft surgery. The total distal anastomoses number was 319, mean number of anastomoses was 2.06+/-0.96. There were 10 concomitant procedures. Postoperative intra-aortic balloon pump was used in 21 (13.6%) cases, but only 4 cases were used at off-pump coronary artery bypass surgery. Total early mortality was 7.8%. The mortality was decreased as 4.5% from Jan. 2001 to Jun. 2004. Post operative complication was perioperative myocardial infarction in 9 cases (5.8%), low cardiac output syndrome in 17 cases (11%), and arrhythmia in 30 cases (19.5%) cases. CONCLUSION: Since 1985, The result of coronary artery bypass graft surgery has been improved because of more refined technique, use of off-pump coronary artery bypass surgery, use of internal thoracic artery and radial artery as bypass graft. We should study the long-term follow up more for better operative results.

Clinical Analysis of Bronchogenic Cyst / 대한흉부외과학회지

BACKGROUND: Bronchogenic cyst is a rare and benign disease. Because of its complication or associated disease, Bronchogenic cyst requires surgical treatment. Recently, with the development of diagnostic methods, its incidence has increased. So we reviewed our results from the past 30 years. MATERIAL AND METHOD: We reviewed 27 cases surgically treated from March 1971 to March 2003. This investigation is designed to illustrate the peak age incidence, sex ratio, symptoms, anatomic location, radiologic imagings, associated diseases, operative methods, postoperative pathologic findings and postoperative complications. RESULT: The peak age incidence laid in the 1st to 3rd decade and the ratio of male and female was 1:1.5. The most common complaints were cough and dyspnea, but some had hemoptysis. There were 22 cases (81%) of Intrapulmonary bronchogenic cysts and 5 cases(19%) of mediastinal bronchogenic cysts. Thirteen cases (48.1%) showed cystic lesion in simple chest X-ray. Ten cases showed cystic lesion among 13 cases that had taken computed tomography. We found associated disease in 15cases (56%). The inflammatory diseases from infection were many in intrapulmonary bronchogenic cysts and especially, one case showed carcinosarcoma. Mitral regurgitation and Bronchial obstruction could be seen in mediastinal bronchogenic cysts. The 13 cases (48%) were managed by lobectomy, and cystectomy, pneumonectomy, and segemental resection were done in 7 cases (26%), 4 cases (15%), 3 cases (11%) respectively. Cystic contents were mucus in 9 cases, pus in 9 cases, blood in 2 cases, and carcinosarcoma in 1 case. Bronchotracheal communications were in 13 cases (48%). Five cases showed Postoperative complications, which were pneumothorax, empyema, bleeding. Postoperative death could not be found. CONCLUSION: Almost all patients had clinical symptoms. Severe complications could be associated with bronchogenic cysts. Recently, With the development of diagnostic methods, preoperatively accurate diagnosis is possible; therefore, invasive study has decreased. Bronchogenic cyst is a benign disease. However, because of its clinical symptoms, complications, and possibility of malignant change, immediate surgical treatment is needed.

The In-hospital Analysis of Outcome of Off-pump CABG and On-pump CABG / 대한흉부외과학회지

Background: With the developement of non-invasive surgical techeniques, coronary artery bypass graft without cardiopulmonary bypass has become popular. We compared the preoperative risk factors and in-hospital outcomes of patients having off-pump CABG with those having on-pump CABG. Material and Method: From January 2001 to June 2003, 87 patients underwent CABG. Thirty-six patients underwent on-pump CABG, fifty-one patinents underwent off-pump CABG. Preoperative risk factors, extent of coronary disease, operative time, postoperative endotracheal intubation time, duration of ICU stay & hospital stay, the amount of bleeding and postoperative levels of cardiac enzymes were compared in both groups. Result: There were no differences in their sex ratios, ages, preoperative risk factors, preoperative MI, Canadian classes, extent of coronary artery diseases and, echocardiographic ejection fraction between Off-pump CABG and On-pump CABG groups. Off-pump CABG group had significantly lower mean operative time (270+/-79.3 min vs 372+/-142.2 min, p<0.001), mean ventilation time (17.1+/-13.1 hr vs 24.3+/-17.8 hr) and CK-MB level (8.9+/-18.7 IU/L vs 25.7+/-8.4 IU/L) than on-pump CABG groups. On-pump CABG group had more distal grafts (2.2+/-0.5 vs 1.7+/-0.7) than Off-pump CABG groups did. There were no differences in their postoperative complications and outcomes including amount of postoperative bleeding for 24 hrs, reoperation for bleeding control, mean in-hospital days, postoperative infection, renal failure and neurologic complications between Off-pump CABG and On-pump CABG groups. Conclusion: This study showed that patients who underwent Off-pump CABG had less operation time & intubation time and lower CK-MB level; however, they also have less distal graft. Even though CABG without CPB provided satisfactory results, more clinical experience & longer follow-up is required.

Pulmonary Arteriovenous Fistula with Hemothorax: A case report / 대한흉부외과학회지

Pulmonary arteriovenous fistula is usually considered as a subset of congenital anomalies or acquired causes which can produce a variety of conditions such as dyspnea, cyanosis, and pulmonary vascular bruit. The diagnostic methods can be diverse such as arterial blood gas analysis (ABGA), chest X-ray, chest CT and pulmonary angiogram but the most accurate diagnostic modality is thought to be the pulmonary angiogram. The complications of this disease are a rupture that can cause hemothorax, brain abscess, and cardiovascular accident, and the treatment options are either segmental resection or therapeutic embolization. A twenty-six year old female developed sudden dyspnea and visited our emergency room. The patient was diagnosed as having pulmonary arteriovenous fistula (size; 4x4x3 cm) in the superior segment of the right lower lobe, evidenced by chest CT and pulmonary angiogram. Consequently, she underwent an emergency right lower lobectomy. We report this rare case of combined hemothorax that we have experienced, from diagnosis to treatment.

Early Clinical Experience in Valve Replacement Using On-X Prosthetic Heart Valve / 대한흉부외과학회지

Background: The On-X valve was recently introduced. It was the aim of this study to assess the safety and feasibility from the data derived from 28 patients who underwent aortic and/or mitral valve replacement with this prosthesis in National Medical Center. Material and Method: From May 1999 and May 2003, a series of 28 consecutive patients who had been implanted with 32 On-X prosthesis were reviewed. The operative procedure comprised of 12 MVR, 10 AVR and 6 DVR. The study followed the guidelines of AATS/STS. Mean follow-up was 27 months (total 64 patient-years). Result: Early (

The Extracardiac Fontan Operation in Adult: A case report / 대한흉부외과학회지

The Fontan operation is commonly practiced for the physiologic correction of univentricular heart diseases. However, for the patients who have risk factors against this operation, it is recommended to take the initial palliative operation rather than going to the Fontan operation at once. The proper timing to the Fontan operation after palliation is decided by assessing several factors such as patient's age and other risks of maintaining palliative state, etc. Usually, the Fontan operation is done relatively early after palliation stage. Here, we report a 36 years old-adult-female with univentricular heart disease who underwent the successful Fontan operation at 17 years after unidirectional Glenn procedure.

Surgical Treatment of Pulmonary Aspergillosis (III) / 대한흉부외과학회지

BACKGROUND: Pulmonary aspergillosis usually results from the colonization of the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life-threatening disease causing massive hemoptysis. Here we reviewed our results from the last 10 years. MATERIAL AND METHOD: We reviewed 31 cases surgically treated from Aug. 1992 to Jul. 2002. retrospectively. This investigation is designed to illustrate the peak age incidence, sex ratio, chief complaints, preoperative study, anatomic location of operative site, postoperative pathologic finding and postoperative complications. RESULT: The peak age incidence laid in the 3rd and 4th decade of 20 cases (64.5%). The most common complaint was hemoptysis in 27 cases (87.1%). The 31 cases had a history of treatment with anti- tuberculous drugs under impression of pulmonary tuberculosis. The 19 cases (61.3%) showed the so-called "Air- meniscus sign" on the preoperative chest X-ray. In the 31 cases (100%) on the chest computed tomography. as a preoperative diagnostic modality, positivity was shown in 37.9%, 83.3% was shown on the fungus culture of sputum for Aspergillus, serum immunodiffusion test for A. fumigatus, respectively. The anatomical location of aspergilloma was mainly in the upper lobe in 19 cases (61.3%) and the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 31 cases (100%) were combined with tuberculosis. The postoperative complications include empyema, prolonged air leakage, remained dead space, postoperative bleeding and these numbers of cases is 3 cases (9.7%), 2 cases (6.45%), 2 cases (6.45%), 1 case (3.23%), respectively. one case was died postoperatively due to massive beeding, and asphyxia. CONCLUSION: Compared with the previous study, there is no significant difference in results. Preoperative chest computed tomography and immunodiffusion test were more commonly available and showed high positivity. Operations often became technically difficult because of pleural space obliteration, indurated hilar structures, and poor expansion of the remaining lung, which were more prominent in the patients with complex aspergillosis. In such cases, medical treatments and interventional procedures like bronchial artery embolization are preferred. However, cavernostomy is also recommanded with few additional morbidity because of its relatively less invassiveness. Early surgical intervention is the recommended management for patients with simple aspergilloma considering the low surgical mortality and morbidity in recent days.

Esophageal stent insertion at the esophagogastrostomy site stenosis: Report of 3 cases / 대한흉부외과학회지

Although postanastomosis stenosis of esophageal reconstruction is rare but it is a very unwelcome complication. Previously, the problem was solved by balloon dilatation, reoperation, and feeding jejunostomy. However, balloon dilatation is not effective because of high recurrence rate, reoperation is difficult due to its operative approachableness and also jejunostomy is inconvenient for patients. Therefore, we inserted esophageal stent as a method of relieving postanastomosis stenosis. From Jan, 2001 to Dec, 2001, there were three patients with postanastomosis stenosis, who received esophageal stent insertion, one had case is benign esophageal stenosis, two had esophageal carcinoma. We followed up them over 12 months after inserting the stent, Dysphagia was improved, so we report that the clinical performance was satisfactory

Pulmonary Artery Intimal Sarcoma with Lung Metastasis / 대한흉부외과학회지

Primary pulmonary artery sarcoma is very rare disease. The diagnosis of pulmonary artery sarcoma is frequently confused with pulmonary embolism because its clinical symptom and radiologic findings are similar with pulmonary embolism. It was often diagnosed at autopsy as it progresses rapidly. So Pulmonary artery sarcoma must be suspected if the origin of thrombus is not known and anticoagulation therapy is not effective. In this case, a 57 years old man who has been diagnosed pulmonary embolism was transferred to our department because of ineffective anticoagulant therapy and its worsening lesion despite of 5 month-therapy. In operative findings, it was pulmonary artery sarcoma that invaded to pericardium. There was angiosarcoma in right pulmonary artery, which metastasized to lung parenchyme. Under cardiopulmonary bypass, we resected main pulmonary artery and right lung. The Gore-tex graft was interposed between main pulmonary artery and left pulmonary artery. He was discharged after chemotherapy.

The Long-term Clinical Result of St. Jude Mechanical Valve Replacement / 대한흉부외과학회지

BACKGROUND: The St. Jude Medical prosthesis is one of the popularly used artificial prosthesis, therefore the National Medical Center reports the long-term clinical results of patients who underwent prosthetic valve replacement with St. Jude medical valve for 18 years. MATERIAL AND METHOD: Between January, 1984 and June, 2002, a series of 163 consecutive patients who had implanted St. Jude prosthesis at the National Medical Center were reviewed. Mean age was 42.9+/-15.1 years and male to female ratio was 69:94. The operative procedure comprised of 87 MVR, 30 AVR, 45 DVR, and 1 TVR. The reoperative procedure comprised of 21 MVR, 2 AVR, and 14 DVR. Follow-up rate was 96.9%, and cumulative follow-up was 823.8 patient-years. RESULT: Early mortality rate was 7.9% (13 patients), late mortality rate was 8.7% (13 patients) and late mortality due to valve related complication was 4.7% (7 patients). Actual survival rate at 10 and 18 years were 91.7+/-2.1% and 91.0+/-1.9%. Linearized incidence was as follows: thromboembolism, 1.09%/ patient-year; anticoagulant related hemorrhage, 0.36%/patient-year; valve thrombosis, 0.24%/patient-year; paravalvular leakage, 0.12%/patient-year; and prosthetic bacterial endocarditis, 0.12%/patient-year. Linearized incidence of over all valve related complication was 1.94%/patient-year. Freedom from valve related complication at 10 and 18 years were 89.1+/-3.3% and 88.4+/-3.9%. Freedom from valve related death at 10 and 18 years were 95.1+/-1.2% and 95.1+/-1.0%. Valve related complication was related the age of patient, especially anticoagulant related hemorrhage was more common in patients over 60 years of age. Valve related complication, death were higher in DVR than AVR or MVR, and valve related death was higher in reoperation. There was no relationship between valve related complication or death and implant valve or size. CONCLUSION: The long-term clinical results of patients implanted with St. Jude Mechanical prosthesis was quite satisfactory with a low incidence of valve related complication and mortality.