Comparison of Repair and Replacement for Mitral / 대한흉부외과학회지

BACKGROUND: Mitral valve repair has been suggested to provide better postoperative outcome than valve replacement for mitral regurgita tion. MATERIAL AND METHOD: From Janu ary 1996 to May 2000, 87 patients had mitral valve repair(59 patients) or replac ement(28 patients) for mitral regurgitation. RESULT: The two groups were si milar in age, sex, and functional class. The cause of mitral regurgitation in th e repair group was degenerative in 45 patients, rheumatic in 12 patients, endoca rditis in 1, and ischemic in 1, and in the replacement group was degenerative in 12 patients, rheumatic in 11 patients, endocarditis in 4 and traumatic in 1 pat ient. A Carpentier ring was used in 51 patients and the most common size was 30 mm. The aortic cross-clamp time was 88.3+/-24.7 minutes in the repair group and 7 0.3+/-23.8 minutes in the replacement group(p<0.05), and total pump time was 13 9.6+/-30.5 minutes and 110.4+/-34.3 minutes(p<0.05) respectively. There was no hos pital death in both groups. Four-year actuarial survival was 97.9% for the repai r group and 100% for the replacement group(p = not significant). Postoperative c ardiothoracic ratio and ejection fraction decreased, and postoperative functiona l class improved in both groups(p = not significant). CONCLUSION: Mitral valve repai r for patients with mitral regurgitation can be performed with the satisfactory results as valve replacement.

Clinical Analysis for Thymic Carcinoma / 대한흉부외과학회지

BACKGROUND: Thymic carcinoma is a very rare disease and treatment modality is not standardized. So, we report our experience of management of thymic carcinoma. MATERIAL AND METHOD: Between 1984 and 1998, eight patients with thymic carcinoma were treated at Keimyung University Dongsan Medical center. RESULT: The median age was 46 years with a range of 23 to 67 years. Chief complaint was a anterior chest pain. Histologic subtypes included two lymphoepithelioma-like carcinoma, two squamous cell carcinoma, one basaloid carcinoma, and three mixed type. Clinical staging was classified to stage I in 2, stage II in 4, stage III in 1, and stage IVA in 1 according to the modified Masaoka staging system. Four patients underwent complete resection and three patients were found to have incomplete resection by histologic evaluation. One patient underwent only biopsy due to pericardial dissemination and invasion of adjacent organ. All patients had adjuvant chemotherapy, radiation therapy was administered to five patients for positive resection margin and above stage III. The median follow up period was 55.3+/-64.6 months, three patiants died and four patients are alive without recurrence. One patient in recurrence had two times re-operations and adjuvant chemoradiotherapy. He is still alive. CONCLUSION: We concluded that completely surgical resection and adequate adjuvant chemoradiotherapy after early diagnosis are useful to management of thymic carcinoma.

Primary Repair of Traumatic Aortic Transection with Clamp and Sew Technique: Report of 2 cases / 대한흉부외과학회지

Traumatic aortic transection after blunt chest injury is highly lethal and has high operative mortality. Recently, the diagnostic and therapeutic method of this injury is advanced, especially in spinal cord protection during aortic cross-clamping. We have experienced two cases of traumatic aortic transection with left hemothorax after blunt chest injury, which was diagnosed in operative field. The transected aorta was primarily repaired with clamp and sew method and postoperative paraplegia had not occured. The patients were dischraged without any significant complications. We report these cases with a review of literature.