Ninty-seven patients underwent prosthetic mitral valve replacement at Seoul National University hospital during the eight year period, from January 1, 1971, through September 20, 1978. Included in this group were patients who had concomitant aortic valve replacement (10 patients), tricuspid annuloplasty and valve replacement (12 patients), closure of atrial or ventricular septal defect (3 patients), and aortic valve replacement and tricuspid annuloplasty (1 patient). The ages of the patients at the time of operation ranged from 11 to 54 years, the mean being 32.0 years. Forty-eight patients were female and 49 male. Mitral valve replacement was carried out on 18 patients (18.6%) under 20 years of age. The operative findings of the mitral valve indicated rheumatic valvulitis in 94 patients, while in the remaining three the etiology was undetermined. Twenty-seven patients had predominant mitral stenosis, 29 predominant mitral regurgitation, and 27 mixed mitral lesions. Four patierts belonged to functional class II (NYHA), 45 to class III, and 34 to class IV. On physical and angiographic examinations, 13 patients had associated tricuspid regurgitation, 11 patients had aortic valvular disease, and 3 patients had atrial septal defect or ventricular septal defect. Forty-three patients had atrial fibrillation, 24 had normal sinus rhythm, and the remaining four had other supraventricular arrhythmia. Sixty-four patients were studied before operation by right heart catheterization. Severe pulmonary hypertension, indicated by a pulmonary arterial systolic pressure of 61 mmHg or greater, was present in 19 patients. In only one patients was the pulmonary arterial pressure normal. The average value for the systolic pressure in the 64 patients was 52 mmHg. One-hundred-five cardiac prosthetic valves were placed in 97 patients in the past 8 years. This series included 97 mitral, 11 aortic, and 7 tricuspid valve replacements. There were 18 perioperative deaths, an over-all mortality of 18.6 per cent. High perioperative mortality was seen in patients with associated aortic valvular diseases. Patients who were in class IV preoperatively had a higher motality (50 per cent) than those in class III (22 per cent). A dramatic decrease in the operative mortality from 100 per cent in 1971 to 5.7 per cent in this year was noted.
Aortic Valve ; Arrhythmias, Cardiac ; Arterial Pressure ; Atrial Fibrillation ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Female ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Seoul ; Tricuspid Valve ; Tricuspid Valve Insufficiency

No abstract available.
Cardiopulmonary Bypass* ; Child* ; Colloids* ; Humans ; Prospective Studies*

No abstract available.
Heart Arrest, Induced* ; Heart* ; Perfusion*

The protein C system is a natural anticoagulant and profibrinolytic system consisting of protein C and protein S and thrombomodulin. Because the increased fibrinolysis and the decreased activities of coagulation factor V and VIII are observed in patients undergoing cardiopulmonary bypass, which are known main effects of achivated protein C, we studied the protein C system in the plasma of patients undergoing operation with extracorporeal circulation(ECC group, 31 patients) and without ECC(control group, 10 patients). The nature of the enhanced blood fibrinolytic activity that evolved during extraacorporeal circulation was charaacterized by significantincrease or fibrin degradation product(FDP) in ECC group(P<0.01) but not in control group. The changes of protein C system also showed only in ECC group. The changes of protein C system were most pronounced in the early phase of cardiopulmonary bypass. The changes of FDP ane protein C system were observed in both bubble and membrane oxygenator-used group, but the pattern and degree of change were quite different (P<0.01), i,e., more severe in membrane oxygenator-used group. These results confirm the disturbance of protein C system by extracorporeal circulation, which is possibly activated by the contact activation between blood and synthetic surface. So measurement of changes of protein C system could be used as a good method in the development of new materials for extracorporeal circulation.
Cardiopulmonary Bypass ; Extracorporeal Circulation ; Factor V ; Fibrin ; Fibrinolysis ; Heart* ; Humans ; Membranes* ; Oxygen* ; Oxygenators* ; Plasma ; Protein C* ; Protein S ; Thoracic Surgery* ; Thrombomodulin

Two dimensional alignment of valves in the cardiac skeleton is studied using 49 fetal hearts. They are standardized with fixed length between the centers of mitral and tricuspid valves. The relations among the parameters and of wall thichness ratio are studied, especially by the change of gestational age, mitral aortic distance and pulmonary-aortic distance, the angles between the two lines and mitral-tricuspid line. Anterior shift of great vessels was seen in heart with gestational age less than 20 weeks. Long mitral-aortic distance showed anterior shift of the great arteries and left ventricle was relatively thicker than right ventricle. Narrow aortomitral-tricuspid angle denoted posterior shift of great vessels and thich right ventricle. Short pulmonary-aortic distance denoted antero-posterior alignment and posterior shift of the vessels and thick left ventricle. Left-right alignment of vessels was not associated with right-ward shift but only with pulmonic displacement to the left. By these observation abnormal alignment of valves in cardiac skeleton would be a basic defect in bulboventricular malformation and we could find basic difference of cardiac skeleton, between normal variation and abnormal heart.
Humans

No abstract available.

A total 139 patients with Tetralogy of Fallot underwent total correction in the Department of Thoracic Surgery, Seoul university Hospital during 5 year-period from January 1974 to December 1978, with overall mortality of 16.5 percent. Operative mortality varied according to severity of the lesion, age of the patients, nature of the previous surgical treatment and presence or absence of an outflow tract across the pulmonic valve ring. Twenty-two patients died in the early postoperative period, one in the postoperative 15 th day and 116 patients were discharged from the hospital alive. There were 90 male patients and 49 female patients with male preponderance. And the age of the patients varied from 2.8 years to 31 years with average of 11.1 years. A patch of the right ventricular outflow tract and pulmonic annulus was required to relieve pulmonic stenosis in 104 patients. There were 20 deaths in group(19.2%) as compared to 3 deaths in the group of 35 patients who were treated without a patch. The electrocardiogram showed right ventricular hypertrophy in 101 cyanotic patients. The interventricular conduction was normal in 112 patients preoperatively. It was normal postoperatively in 22 among 112 patients in these group who were survived. Complete RBBB appeared at operation in 70 patients and 20 patients developed incomplete RBBB. Major causes of death were complete A-V block, Congestive Heart Failure and Bleeding in order.
Cause of Death ; Electrocardiography ; Female ; Heart Failure ; Hemorrhage ; Humans ; Hypertrophy, Right Ventricular ; Male ; Mortality ; Postoperative Period ; Pulmonary Valve Stenosis ; Seoul ; Tetralogy of Fallot* ; Thoracic Surgery

A total 139 patients with Tetralogy of Fallot underwent total correction in the Department of Thoracic Surgery, Seoul university Hospital during 5 year-period from January 1974 to December 1978, with overall mortality of 16.5 percent. Operative mortality varied according to severity of the lesion, age of the patients, nature of the previous surgical treatment and presence or absence of an outflow tract across the pulmonic valve ring. Twenty-two patients died in the early postoperative period, one in the postoperative 15 th day and 116 patients were discharged from the hospital alive. There were 90 male patients and 49 female patients with male preponderance. And the age of the patients varied from 2.8 years to 31 years with average of 11.1 years. A patch of the right ventricular outflow tract and pulmonic annulus was required to relieve pulmonic stenosis in 104 patients. There were 20 deaths in group(19.2%) as compared to 3 deaths in the group of 35 patients who were treated without a patch. The electrocardiogram showed right ventricular hypertrophy in 101 cyanotic patients. The interventricular conduction was normal in 112 patients preoperatively. It was normal postoperatively in 22 among 112 patients in these group who were survived. Complete RBBB appeared at operation in 70 patients and 20 patients developed incomplete RBBB. Major causes of death were complete A-V block, Congestive Heart Failure and Bleeding in order.
Cause of Death ; Electrocardiography ; Female ; Heart Failure ; Hemorrhage ; Humans ; Hypertrophy, Right Ventricular ; Male ; Mortality ; Postoperative Period ; Pulmonary Valve Stenosis ; Seoul ; Tetralogy of Fallot* ; Thoracic Surgery

During the period from january, 1972, to march, 1979, Twenty-four patients underwent mitral valve replacement at the seoul national University Hospital. Their ages ranged from 8 years to 20 years, with 11 patients being 16 years of age or younger at the time of operation. There were 12 males and 12 females and their weight ranged from 25 to 53 Kilograms. Seventeen patients had advanced stages of heart disease as evidenced by the functional classification: 14 cases were in functional class III and 3 cases in functional class IV (New York heart Association). A history suggestive of rheumatic fever was elicited in 75 per cent of our patients. Radiographic evaluation demonstrated marked cardiomegaly in the majority of the patients. The cardiothoracic ratio was over 70 per cent in 5 patients and between 60 and 70 per cent in 17 patients. Cardiac catheterization was carried out in all patients before operation. There were 3 patients with evidence of severe pulmonary hypertension. In 2 patients the pulmonary artery pressures were normal. On physical and hemodynamic examinations, 3 patients had associated with aortic regurgitation, 2 patients had tricuspid regurgitation, 1 patient had tricuspid and aortic regurgitations and 3 patients had atrial septal defect or ventricular septal defect or transposition of great arteries. The pathologic findings of the mitral valve indicated rheumatic valvulitis in 16 patients, while in the remaining 7 the etiology was undetermined. In only one patient the cause was congenital cardiac anomaly. Seventeen patients had predominant mitral regurgitation and 7 patients predominant mitral stenosis. Twenty-nine cardiac prosthetic and bioprosthetic valves were replaced in 24 patients in the past 8 years. This series included 24 mitral, 4 aortic and 1 tricuspid valve replacement. Including in this group were patients who had concomitant aortic valve replacement(3 patients), tricuspid valve replacement(1 patient), tricuspide annuloplasty and closure of ventricular septal defect(1 patient), and closure of atrial septal defect and ventricular septal defec(3 patients). There were five deaths in the postoperative period, resulting in an operative mortality rate of 20.8 per cent. high postoperative mortality was seen in the patients with associated aortic valvular disease and congenital cardiac anomaly.
Adolescent* ; Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child* ; Classification ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Postoperative Period ; Pulmonary Artery ; Rheumatic Fever ; Seoul ; Transposition of Great Vessels ; Tricuspid Valve ; Tricuspid Valve Insufficiency

During the period from january, 1972, to march, 1979, Twenty-four patients underwent mitral valve replacement at the seoul national University Hospital. Their ages ranged from 8 years to 20 years, with 11 patients being 16 years of age or younger at the time of operation. There were 12 males and 12 females and their weight ranged from 25 to 53 Kilograms. Seventeen patients had advanced stages of heart disease as evidenced by the functional classification: 14 cases were in functional class III and 3 cases in functional class IV (New York heart Association). A history suggestive of rheumatic fever was elicited in 75 per cent of our patients. Radiographic evaluation demonstrated marked cardiomegaly in the majority of the patients. The cardiothoracic ratio was over 70 per cent in 5 patients and between 60 and 70 per cent in 17 patients. Cardiac catheterization was carried out in all patients before operation. There were 3 patients with evidence of severe pulmonary hypertension. In 2 patients the pulmonary artery pressures were normal. On physical and hemodynamic examinations, 3 patients had associated with aortic regurgitation, 2 patients had tricuspid regurgitation, 1 patient had tricuspid and aortic regurgitations and 3 patients had atrial septal defect or ventricular septal defect or transposition of great arteries. The pathologic findings of the mitral valve indicated rheumatic valvulitis in 16 patients, while in the remaining 7 the etiology was undetermined. In only one patient the cause was congenital cardiac anomaly. Seventeen patients had predominant mitral regurgitation and 7 patients predominant mitral stenosis. Twenty-nine cardiac prosthetic and bioprosthetic valves were replaced in 24 patients in the past 8 years. This series included 24 mitral, 4 aortic and 1 tricuspid valve replacement. Including in this group were patients who had concomitant aortic valve replacement(3 patients), tricuspid valve replacement(1 patient), tricuspide annuloplasty and closure of ventricular septal defect(1 patient), and closure of atrial septal defect and ventricular septal defec(3 patients). There were five deaths in the postoperative period, resulting in an operative mortality rate of 20.8 per cent. high postoperative mortality was seen in the patients with associated aortic valvular disease and congenital cardiac anomaly.
Adolescent* ; Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child* ; Classification ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Postoperative Period ; Pulmonary Artery ; Rheumatic Fever ; Seoul ; Transposition of Great Vessels ; Tricuspid Valve ; Tricuspid Valve Insufficiency