From Feb. 1985 to Aug. 1996, 450 patients underwent open heart surgery with hypothermic cardiopulmonary bypass. In 450 cases of open heart surgery, 222 cases(49.3%) were congenital heart diseases and 228 cases(50.7%) were acquired heart diseases. In 222 cases of congenital heart diseases, there were 201 cases of acyanotic heart disease and 21 cases of cyanotic heart diseases. Among the 228 cases of acquired heart diseases, most cases were valvular heart diseases in which 206 valves were implanted. There were 32 cases of ischemic heart disease and the average graft anastomoses were 2.37 sites per operation. The operative mortality of congenital and acquired disease was 9.0% and 10.1% respectively and then overall mortality rate was 9.6%.
Cardiopulmonary Bypass ; Heart Diseases ; Heart Valve Diseases ; Heart* ; Humans ; Mortality ; Myocardial Ischemia ; Thoracic Surgery* ; Transplants

Pulmonary arterial hypertension is a significant complication of congenital heart disease, which carries a recognized risk of morbidity and mortality. There have been remarkable advances in the field of pulmonary arterial hypertension over the past several decades. At the third world symposium on pulmonary arterial hypertension held in Venice, Italy, 2003, congenital cardiac shunts were classified in the same group as idiopathic pulmonary hypertension. This article discusses the recent advances in understanding the pathology, pathobiology, diagnosis, and treatment of pulmonary arterial hypertension associated pediatric congenital heart disease.
Diagnosis ; Heart Defects, Congenital ; Heart Diseases* ; Heart* ; Hypertension* ; Hypertension, Pulmonary ; Italy ; Mortality ; Pathology ; Pediatrics

Pulmonary arterial hypertension is a significant complication of congenital heart disease, which carries a recognized risk of morbidity and mortality. There have been remarkable advances in the field of pulmonary arterial hypertension over the past several decades. At the third world symposium on pulmonary arterial hypertension held in Venice, Italy, 2003, congenital cardiac shunts were classified in the same group as idiopathic pulmonary hypertension. This article discusses the recent advances in understanding the pathology, pathobiology, diagnosis, and treatment of pulmonary arterial hypertension associated pediatric congenital heart disease.
Diagnosis ; Heart Defects, Congenital ; Heart Diseases* ; Heart* ; Hypertension* ; Hypertension, Pulmonary ; Italy ; Mortality ; Pathology ; Pediatrics

Atherosclerotic heart disease is a major source of cardiovascular morbidity and mortality in adult populations. To assess the prevalence of anatomical and functional abnormalities of the heart in such patients, we studied total 50 subjects with atherosclerotic heart disease by echocardiography and compared with 27 control subjects. We found significant change(p<0.05) of aortic root dimension, left ventricular mass, mitral valve E-F slope, E-point septal separation, and functional measurements show significant change in ejection fraction and fractional shortening of left ventricle. Characteristically, abnormal septal movement reveals in 70% of patients including paradoxical, flat & diminished, hyperactive motion, and among them paradoxical movement is the most frequent. Also left ventricular posterior wall movement is abnormal in 30% of the patient group. The prevalence of echocardiographic abnormalities is 80 percentile of total, which include 30 percentile subjects with only echocardiographic abnormalities without abnormality in 12-lead ECG, chest X-ray and laboratory findings. And these abnormalities can be detected well by echocardiography before they were otherwise apparent.
Adult ; Echocardiography* ; Electrocardiography ; Heart Diseases* ; Heart Ventricles ; Heart* ; Humans ; Mitral Valve ; Mortality ; Prevalence ; Thorax

During 1986, 111 cases of open heart surgery were performed at Yeungnam University Hospital consisting 88 cases of congenital heart disease and 23 cases of acquired heart disease. Among 88 congenital heart disease, 72 were acyanotic group and 16 were cyanotic. Common congenital heart diseases were ventricular septal defect (51%), atrial septal defect (18%) and Tetralogy of Fallot (16%). Among 23 acquired heart disease, 22 cases were valvular heart disease and one was dissecting aortic aneurysm. Three cases of the postoperative death were present resulting 2.7% of surgical mortality rate.
Aortic Aneurysm ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart Valve Diseases ; Heart* ; Mortality ; Tetralogy of Fallot ; Thoracic Surgery*

Heart rate variability (HRV) is a useful marker for predicting mortality and cardiovascular events in cardiac diseases. Various time- and frequency-domain parameters are used for assessing HRV. The time-domain measures include standard deviation of the NN intervals (SDNN), standard deviation of the average NN interval, root mean square of the successive differences SDNN index, NN50 count, and pNN50, while the power spectrum that is used the most widely in frequency-domain analyses is divided into low frequency (LF), high frequency (HF), LF norm, HF norm, and LF/HF. The HF band is modulated by the parasympathetic nervous system, while the LF band is modulated by both the sympathetic and parasympatheticnervous systems. Altered or reduced HRV parameters have been shown to be related to cardiovascular events in patients with various neurological disorders, such as parkinsonian syndromes, dementia, cerebrovascular disorder, and epilepsy. Furthermore, analyses of HRV have attempted to distinguish different diseases and evaluate the degree of disability. This article discusses the clinical use of HRV in the neurological field.
Cerebrovascular Disorders ; Dementia ; Epilepsy ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Mortality ; Nervous System Diseases* ; Parasympathetic Nervous System ; Parkinsonian Disorders

BACKGROUND: In spite of the improvement in the quality of artificial heart valves and surgical techniques, the incidence of the complications following valve replacement is still high. We reviewed the clinical results of the valve replacements performed in Korean University Anam Hospital during the last 26 years. MATERIAL AND METHOD: The data of 571 patients who received valve replacement between December 1976 and December 2003 were reviewed. RESULT: There were 304 cases of MVR which was the most common procedure performed. There were 122 cases of AVR, and 111 cases of AVR with MVR. Among the 47 patients who received redo operation 38 cases were redo cases including 31 cases of MVR. 32.5% of the patients who had tissue valve replacement had second valve replacement with 10.2+/-3.9 years interval. 24.3% (139/571) of the patients developed valve related complications and cerebral infarction was the highest in frequency. Atrial fibrillation was related with increased complication rates and the mechanical valve replaced group had higher hemorrhagic complication rate than tissue valve replaced group. The operative mortality was 3.68% and the most common cause of the failure was low output syndrome. The operative mortality was higher in the patient group who had valve replacement before the year 1990. The patient group who had mechanical valve replacement had higher operative mortality rate than the tissue valve group. The 5-year survival rate was 92.2% and 10 year survival rate was 85.7%. CONCLUSION: The operative mortality of valve replacement has been improved. The mechnical valve replaced patients had higher hemorrhagic complication rate than the tissue valve replaced patients and more tissue valve replaced patients received redo valve replacement.
Atrial Fibrillation ; Cerebral Infarction ; Heart Valve Diseases ; Heart Valves* ; Heart* ; Heart, Artificial ; Humans ; Incidence ; Mortality ; Survival Rate

BACKGROUNDAortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases. This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.

METHODSForty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012, and the mean interval time of re-intervention to aortic disease was 6 years ((6.0 ± 3.8) years). The secondary aortic surgery included aortic root replacement (14 cases), ascending aorta replacement (10 cases), aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases), and total thoracoabdominal aorta replacement (2 cases). All these patients have received outpatient re-exams or follow-up by phone calls.

RESULTSAfter the initial aortic valve replacement, patients suffered from aortic dissection (25 cases, 53%), ascending aortic aneurysm (12 cases, 26%) or aortic root aneurysm (10 cases, 21%). Diameter in ascending aorta increased (5.2 ± 7.1) mm per year and aortic sinus (3.3 ± 3.1) mm per year. The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P < 0.05). All 47 patients have received reoperation on aorta. One patient died in operating room because aortic dissection seriously involved right coronary artery. Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction. All patients were followed up, the mean survival time was (97.25 ± 17.63) months, 95% confidence interval was 55.24-73.33 months. Eight cases were died during follow-up and five-year survival rate was 83%.

CONCLUSIONTo reduce the aortic adverse events after first aortic valve surgery, it is necessary to actively treat and strictly follow-up patients with previous aortic operation especially patients with Marfan syndrome and rheumatic heart disease.

Adult ; Aortic Diseases ; mortality ; surgery ; Aortic Valve ; surgery ; Female ; Heart Defects, Congenital ; mortality ; surgery ; Heart Valve Diseases ; mortality ; surgery ; Humans ; Male ; Middle Aged

OBJECTIVETo define the determinants of perioperative death and complications after cardiac valve replacement in 702 patients.

METHODSClinical data of the patients after cardiac valve replacement were analyzed retrospectively.

RESULTSPerioperative mortality and morbidity correlated significantly with some of the perioperative variables, such as higher NYHA functional class (III or IV), large left ventricular end-diastolic diameter (>/= 70 mm), C/T >/= 0.70, prolonged aortic cross-clamping time and cardiopulmonary bypass time, unsatisfactory myocardial protection.

CONCLUSIONSPerioperative mortality and morbidity correlate significantly with some of perioperative variables, such as higher NYHA functional class, unsatisfactory myocardial protection, inappropriate surgical procedure, improper therapy of some complications after cardiac valve replacement. To avoid the occurrence of these independent predictors or to correct them timely might effectively decrease the perioperative mortality and morbidity after cardiac valve replacement.

Adolescent ; Adult ; Aged ; Cause of Death ; Child ; Female ; Heart Valve Diseases ; mortality ; surgery ; Heart Valve Prosthesis ; adverse effects ; Humans ; Intraoperative Complications ; mortality ; Male ; Middle Aged ; Mortality ; Postoperative Complications ; mortality

Right-sided heart failure is a major problem among patients with congenital heart diseases, due to the prevalence of congenital heart defects and the association of pulmonary hypertension. More attention is focused on the structure of the right heart particularly in association with congenital heart defects and chronic lung disease. The right ventricle (RV) may support the pulmonary circulation, and sometimes the systemic circulation (systemic RV) in congenital heart defects. Despite major progress being made, assessing the RV remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and cineangiography). Evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. While there is extensive literature on the pathophysiology and treatment of left heart failure, the data for right-sided heart failure is scarce. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. An understanding of RV physiology and hemodynamics will lead to a better understanding of current and future treatment strategies for right heart failure. This will review right-sided heart failure with the implications of volume and pressure loading of the RV in congenital heart diseases.
Heart Defects, Congenital ; Heart Diseases* ; Heart Failure* ; Heart Ventricles ; Heart* ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Lung Diseases ; Magnetic Resonance Imaging ; Mortality ; Physiology ; Prevalence ; Pulmonary Circulation