Two-dimensional Doppler echocardiographic velocity profiles of four cardiac valves in a group of 85 infants and children with left to right shunt lesions(VSD, ASD and PDA) are presented. Velocities were obtained before operation and 10 days afterward. The results were as follows ; 1) VSD(type 2) Peak velocities of mitral valve were significantly decreased when compared preop. with postop. echocardiogram(n=37, preop 132+/-24, postop 98+/-16 cm/sec, p<0.0005). Peak velocities of tricuspid valve were also significantly decreased(n=30, perop 60+/-21, postop 50+/-17cm/sec, p<0.01). Peak velocities of aortic valve were decreased(n=18, perop 120+/-20, postop 108+/-26cm/sec, 0.010.05). Peak velocities of pulmonic valve were significantly decreased(n=17, perop 168+/-46, postop 104+/-51cm/sec, p<0.0005). 3) PDA Peak velocities of mitral valve were significantly decreased when compared perop. with postop. echocardiogram(n=29, perop 138+/-28, postop 111+/-19cm/sec, p<0.0005). Tricuspid valve velocities showed no significant changes between preop. and postop. echocardiogram (n=15, perop 47+/-12, postop 44+/-10cm/sec, p>0.05). Aortic valve velocities showed no significant changes (n=10, perop 134+/-23, postop 121+/-25cm/sec, p>0.05). Peak velocities of pulmonic valve were significantly decreased(n=28, perop 138+/-37, postop 107+/-27cm/sec, p<0.005). This study demonstrates that Doppler echocardiographic assessment of velovity changes are correlated with known hemodynamic data and also will be a good index in the evaluation of operation.
Aortic Valve ; Child ; Echocardiography* ; Echocardiography, Doppler ; Heart Valves* ; Hemodynamics ; Humans ; Infant ; Mitral Valve ; Tricuspid Valve

Direction of blood flow and peak velocity measurement were made in the four cardiac valve and ascending aorta from 87 normal Korean adults (42 men and 45 women, age range 20-63 years) with CW Doppler echocardiography. Measurments of the peak velocities of mitral valve, tricuspid valve and aortic valve (ascending aorta) completed in the apical window using 2.0MHz Pedof transducer. The measurement of pulmonary flow completed in the parasternal view. Also aortic velocity data obtained from suprasternum (70/87), subcostal area (48/87) and right sternal border(41/87). Aortic flow velocity was highest (121+/-11.7 cm/xec), mitral flow velocity was 86.4+/-12.2 cm/sec, pulmonic flow was 85+/-13.3cm/sec, where as tricuspid was lowest (64.8+/-11.2cm/sec). The velocities of aorta obtained from apex (106.9+/-15cm/sec) and suprasternum (113.1+/-18.9cm/sec) were greater than other sites. These normal Doppler data provide a useful information for evaluating flow velocity pattern in patient with various heart disease.
Adult* ; Aorta* ; Aortic Valve ; Echocardiography, Doppler* ; Female ; Heart Diseases ; Heart Valves ; Humans ; Male ; Mitral Valve ; Transducers ; Tricuspid Valve

The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography.
Aortic Valve ; Echocardiography ; Echocardiography, Three-Dimensional ; Heart ; Heart Atria ; Heart Diseases ; Heart Valves ; Heart Ventricles ; Imidazoles ; Mitral Valve ; Nitro Compounds ; Tricuspid Valve

The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography.
Aortic Valve ; Echocardiography ; Echocardiography, Three-Dimensional ; Heart ; Heart Atria ; Heart Diseases ; Heart Valves ; Heart Ventricles ; Imidazoles ; Mitral Valve ; Nitro Compounds ; Tricuspid Valve

Although various animals have been used as models of cardiac valvular diseases in humans, the structural characteristics of cardiac valves in animals remain unclear. In this study, we investigated cardiac valves in representative animal models for the purpose of comparative anatomy. Adult hearts from three dogs, four goats, six rabbits, and six fowls were fixed with 10% neutral-buffered formalin and analyzed gross-anatomically. Cardiac appearance was spherical or oval in dogs, goats, and rabbits, whereas it had a long conical shape in fowls. Left atrioventricular (AV) valve was composed of membranous septal and parietal cusps connected to two papillary muscles in all animals. The right AV valve was composed of membranous septal, parietal, and angular cusps with three papillary muscles in dogs and goats, membranous septal and parietal cusps attached to four papillary muscles in rabbits, and a single muscular plate without any papillary muscles and chorda tendinae in fowls. Aortic valves with thin membranous right, left, and septal semilunar cusps in dogs, goats, and rabbits had a thick membrane with a bended free border in fowls. Pulmonary valve (PV) with membranous right, left, and intermediate semilunar cusps made a large central hole by being closely attached to the surrounding wall in dogs, goats, and rabbits, whereas it protruded into half of the lumen as a thick membrane in fowls. The membranous cusp of the PV was composed of several layers in dogs and goats but was a single layer in rabbits and fowls. These findings indicate that even if animals have two completely separated atria and ventricles each, cardiac valves have species-specific morphological characteristics, especially between mammals and fowls.
Adult ; Anatomy, Comparative ; Animals ; Aortic Valve ; Dogs ; Formaldehyde ; Goats ; Heart ; Heart Valves* ; Humans ; Mammals ; Membranes ; Models, Animal ; Papillary Muscles ; Pulmonary Valve ; Rabbits ; Rabeprazole

From January 1988 to December 1995, 27 patients, 11 men and 16 women, underwent surgical intervention at our institution for prosthetic valve dysfunctions. The mean age was 43.5+/-12.2 years. Seventeen (63.0%) patients had the mitral valve replacement, 8 (29.6%) the aortic valve, 1 (3.7%) the aortic composite graft, and 1 (3.7%) the tricuspid valve. Mean follow-up period was 49.5+/-30.9 months. In 12 bioprostheses, mean interval between the previous valve replacement and the reoperation was 104.9+/-34.9 months. The causes of redo surgery were structural deterioration of the prosthetic valve (12/12, 100%), paravalvular leak (2/12, 16.7%), and prosthetic valve endocarditis (1/12, 8.3%). In 15 mechanical prostheses, the mean interval was 55.2+/-43.7 months. The causes of redo surgery were pannus formation (8/15, 53.3%), paravalvular leak (4/15, 26.7%), and valve thrombosis (3/15, 20.0%). Posto-perative complications occurred in 7 patients (25.9%). There was no intraoperative death. But one patient, who received mechanical aortic valve replacement died on the 3rd postoperative day due to low cardiac output and multiorgan failure.
Aortic Valve ; Bioprosthesis ; Cardiac Output, Low ; Endocarditis ; Female ; Follow-Up Studies ; Heart Valve Prosthesis* ; Heart Valves* ; Humans ; Male ; Mitral Valve ; Prostheses and Implants ; Reoperation* ; Thrombosis ; Transplants ; Tricuspid Valve

BACKGROUND: The function of a bioprosthetic heart valve is determined largely by the material properties of the valve cusps. The uniaxial tensile test has been studied extensively. This type of testing, however, does not replicate the natural biaxial loading condition. The objective of the present study was to investigate the regional variability of the biaxial strain versus pressure relationship based on the types of fixation liquid models. MATERIAL AND METHOD: Porcine aortic valves and pulmonary valves were assigned to three groups: the untreated fresh group, the fixed with glutaraldehyde (GA) group, and the glutaraldehyde with solvent (e.g., ethanol) group. For each group we measured the radial and circumferential stretch characteristics of the valve as a function of pressure change. RESULT: Radial direction elasticity of porcine aortic and pulmonary valves were better than circumferential direction elasticity in fresh, GA fixed, and GA+solvent fixed groups (p=0.00). Radial and circumferential direction elasticity of pulmonary valves were better than aortic valves in GA fixed and GA+solvent fixed groups (p=0.00). Radial and circumferential direction elasticity of aortic valves were decreased after GA and GA+solvent fixation (p=0.00), except for circumferential elasticity of GA+solvent fixed valves (p=0.785). The radial (p=0.137) and circumferential (p=0.785) direction of elasticity of aortic valves were not significantly different between GA fixed and GA+solvent fixed groups. Radial (p=0.910) and circumferential (p=0.718) direction of elasticity of pulmonary valve also showed no significant difference between GA fixed and GA+solvent fixed groups. CONCLUSION: When fixing porcine valves with GA, adding a solvent does not cause a loss of mechanical properties, but, does not improve elasticity either. Radial direction elasticity of porcine aortic and pulmonary valves was better than circumferential direction elasticity.
Aortic Valve ; Elasticity ; Glutaral ; Heart Valves ; Pulmonary Valve ; Sprains and Strains ; Transplantation, Heterologous

BACKGROUND: As life expectancy has been increased, the cardiac valve disease has been increased. In past, mechanical valve for valve replacement surgery was used widely, but it has many weaknesses, such as hemorrhage, teratogenic effect caused by warfarin, acute mechanical failure, taking warfarin during life, etc. So, the tissue valve is used widely and researches for durability of tissue valve are in progress. Tissue valves being used are all imported in Korea, and there is a lack of information on its geometry and design. So, we studied the geometry of porcine aortic and pulmonary valve, and tried to suggest theoretical basis for making the aortic and pulmonary valve. MATERIAL AND METHOD: We harvested aortic and pulmonary valves of 25 pigs and measured the geometry of valve at fresh and glutaraldehyde (GA) fixed state. In each group, we measured the diameter of the base, diameter of commissure, valve height, commissural height, etc. Also, for making implantable porcine and bovine pericardial valve, we designed the valve stent form, thickness, height, and leaflet size, form, thickness by different size of valve. RESULT: The aortic and pulmonary valve geometry and ratio were measured in each group. The right coronary cusp of aortic valve and right facing cusp of pulmonary valve was bigger than other cusps and non coronary cusp was smaller than others (RCC:NCC:LCC=1:0.88:1). Valve height was correlated to the leaflet size. We designed the outer diameter of stented porcine aortic valve from 19 mm to 33 mm and designed stent height and width, using previous measured ratio of each structure, stent thickness, working thickness (for making valve). Also, we designed the size of stent and form for stented bovine pericardial valve, considering diameter of valve, leaflet length, height and leaflet minimum coaptation area. CONCLUSION: By measuring of 25 pig's aortic and pulmonary valve geometry and ratio, we can make theoretical basis for making implantable stented porcine valve and bovine pericardial valve in various size. After making implantable valve using these data, it is necessary to do in vivo and in vitro researches, furthermore.
Aortic Valve ; Glutaral ; Heart Valves ; Hemorrhage ; Korea ; Life Expectancy ; Pulmonary Valve ; Stents ; Swine ; Tissue Engineering ; Warfarin

BACKGROUND: The Duromedics valve has been used in Korea since 1982, however, but there were no long term clinical results that have been reported. This paper presents the long term clinical results of Duromedics valve implanted in Seoul National University Hospital. MATERIAL AND METHOD: Between 1987 and 1988, 23 patients underwent cardiac valve replacement with Duromedics mechanical valve. There were 8 mitral valve replacements, 5 aortic valve replacements, one tricuspid valve replacement, 6 aortic and mitral valve replacements, and one mitral and tricuspid valve replacement. There were 12 men and 11 women. The mean age was 35+/-10(15~52) years. We evaluated the clinical performance of Duromedics cardiac prosthesis. RESULT: The early operative mortality was 4.3%(1/23) and the late morlatity was 4.3%(1/23). Causes of death were low cardiac output syndrome and structural valvular failure. The mean follow-up duration was 133+/-43(8~157) months. There were 3 reoperations. The causes of reoperations were thrombosis and structural failure and nonstructural valvular failure. The actuarial survival rate at 10 years was 90.9%. CONCLUSION: Although the number of patients was not sufficient for effective clinical study, the long term clinical results of Duromedics valve was relatively good and there was no structural defect in this mechanical valve. However, more research is needed in the future.
Aortic Valve ; Cardiac Output, Low ; Cause of Death ; Female ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Valves ; Humans ; Korea ; Male ; Mitral Valve ; Mortality ; Prostheses and Implants ; Seoul ; Survival Rate ; Thrombosis ; Tricuspid Valve

Rheumatic valvulitis produces at least three distinct pathologic changes, the degree varying widely among the patients: fusion of the valve leaflets at the commissures; fusion and shortening of chordae tendinae: and fibrosis of the leaflets with subsequent stiffening, contraction and calcification. The most extensive changes usually are seen in patients with recurrent attacks of rheumatic fever. We studied on outcome of the surgical treatments of rheumatic valvular diseases that have been experienced for 12 years since 1982 at Pusan National University Hospital. The diagnoses were made by rheumatic fever history, echocardiographic findings, gross operative findings and microscopic findings. Total 502 patients were performed surgery for valvular heart diseases and 440 patients of rheumatic origin have bene analysed. There were more female than male patients as 1.3:1, and the mean age was 37.8 years old. 96.3% of them affected to the mitral valve, 19.8% to aortic valve, 16.3% affected to the tricuspid valve. Most of them underwent valve replacement, and valve repair was done in 3.9% of patients. There were 36 hospital deaths (8.2%) mainly from low cardiac output syndrome, and 15 late deaths equally due to embolism and hemorrhage. Follow up was 90.1% completed (2890 patient-year). Linealized rates of late complication events are follows : thromboembolism 1.3% per patient year; anticoagulant related hemorrhage 0.8% per patient year. Overall actuarial survival including hospital mortality was 92.7+/-2.9% in 1 year, 88.0+/-4.5% in 5 year, 82.3+/-7.7% in 10 year. We conclude that the rheumatic disease is still the most frequent and the most important cause of heart valve disease. So more intensive study is needed in spite of the abrupt decreasing rate of rheumatic fever in U.S.A. and other industrial country.
Aortic Valve ; Busan ; Cardiac Output, Low ; Diagnosis ; Echocardiography ; Embolism ; Female ; Fibrosis ; Follow-Up Studies ; Heart Valve Diseases ; Heart Valves* ; Hemorrhage ; Hospital Mortality ; Humans ; Male ; Mitral Valve ; Rheumatic Diseases ; Rheumatic Fever ; Thromboembolism ; Tricuspid Valve