Since 1960s, when Ross and Barratt-Boyes introduced homograft replacement of the aortic valve, the valvular replacement using homografts or autografts has been gained increasing acceptance. Aortic or pulmonary valves (with or without associated vascular conduits) transplanted from one individual to another have exceptionally good hemodynamic profiles, a low incidence of thromboembolic complications without chronic anticoagulation, and a low re-infection rate following valve replacement for endocarditis. The homografts were primarily used for complex congenital reconstructions in infants, and children. However, more recently they have been increasingly used in adults requiring aortic valve replacement. Even though there are many advantages, the lack of available homografts, as well as concerns of long-term stenotic problems, may limit their use.
Adult ; Allografts* ; Aortic Valve ; Autografts* ; Child ; Endocarditis ; Hemodynamics ; Humans ; Incidence ; Infant ; Pulmonary Valve

Since 1960s, when Ross and Barratt-Boyes introduced homograft replacement of the aortic valve, the valvular replacement using homografts or autografts has been gained increasing acceptance. Aortic or pulmonary valves (with or without associated vascular conduits) transplanted from one individual to another have exceptionally good hemodynamic profiles, a low incidence of thromboembolic complications without chronic anticoagulation, and a low re-infection rate following valve replacement for endocarditis. The homografts were primarily used for complex congenital reconstructions in infants, and children. However, more recently they have been increasingly used in adults requiring aortic valve replacement. Even though there are many advantages, the lack of available homografts, as well as concerns of long-term stenotic problems, may limit their use.
Adult ; Allografts* ; Aortic Valve ; Autografts* ; Child ; Endocarditis ; Hemodynamics ; Humans ; Incidence ; Infant ; Pulmonary Valve

Surgical anterior ventricular endocardial restoration (SAVER) is a technique that improves hemodynamic status by excluding akinetic or dyskinetic portions of the left ventricle, restores the ventricle to normal elliptical shape and reduces ventricular wall tension to normal level in patients with acute anterior wall myocardial infarction that accompanies aneurysm. We performed redo-SAVER procedure in a 40-year old man with remodeled dilated ventricle who had already underwent LV aneurysmectomy 12 years earlier, and the results were satisfactory.
Adult ; Aneurysm* ; Anterior Wall Myocardial Infarction ; Heart Ventricles ; Hemodynamics ; Humans

BACKGROUND: We retrospectively evaluated the clinical results of surgically managing patients with Ebstein's anomaly. MATERIAL AND METHOD: Between Feb. 1984 and June 2006, 50 patients who underwent surgical treatment for Ebstein's anomaly at Yonsei Cardiovascular Center were retrospectively reviewed. The mean age of the patients was 26.9 years and 19 patients were male. Associated anomalies included atrial septal defect (33), patent ductus arteriosus (2), ventricular septal defect (1), and pulmonary stenosis (4), and 90% (45/50) of the patients had more than a moderate degree of tricuspid regurgitation. Carpentier type A was present in 6 patients, type B in 26, type C in 14 and type D in 4. Ten patients were associated with WPW syndrome. Conservative surgery was possible in 31 patients (tricuspid annuloplasty, plication of the atrialized RV), Fontan's operation was performed in 4 patients, tricuspid valve replacement was done in 12 and palliative surgery was done in 2 patients. Thirteen patients were associated with bi-directional cavopulmonary shunt (BCPS: one and a half ventricular repairs); 10 patients with WPW syndrome and 4 patients with atrial fibrillation underwent concomitant ablation. RESULT: The postoperative median NYHA functional class (3-->1) and the mean cardio-thoracic ratio (0.65-->0.59) were decreased significantly (p<0.001, p=0.014). The mean oxygen saturation (86.6-->94.1%), and median TR grade (4-->1) were also significantly improved (p=0.004, p<0.001). For comparison of BCPS and conservative surgery, the preoperative right ventricular pressure (33.0 vs. 41.3 mmHg), the ICU stay (2.86 vs. 1.89 days), the hospital say (10.6 vs. 16.8 days), and the left ventricular ejection fraction (64.3 vs. 72.8%) were statistically different. Postoperative mortality occurred in 3 patients (6%) due to biventricular failure in 2 patients and sepsis in the other patient. The mean follow up duration was 101.5 months, and one patient died of Fontan failure and 6 patients required reoperation (bioprosthetic degenerative change (2) and Fontan conversion (4)). The overall survival rate at 10 years was 90.2%; the freedom from reoperation rate and rate of cardiac related events were 78.9% and 49.2%, respectively. CONCLUSION: Surgical management of Ebstein's anomaly can be performed safely, and the associated BCPS may be helpful for high-risk patients. Adequate application of surgical management may increase the long-term survival with a reduced rate of reoperation.
Atrial Fibrillation ; Ductus Arteriosus, Patent ; Ebstein Anomaly* ; Follow-Up Studies ; Fontan Procedure ; Freedom ; Heart Bypass, Right ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Male ; Mortality ; Oxygen ; Palliative Care ; Pulmonary Valve Stenosis ; Reoperation ; Retrospective Studies ; Sepsis ; Stroke Volume ; Survival Rate ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ventricular Pressure ; Wolff-Parkinson-White Syndrome

This report describes the case of a 45-year-old Korean female who had suffered from Behcet's syndrome for two years with a huge, unruptured aneurysm originating from the left coronary sinus. The aneurysm had caused myocardial and aortic insufficiency by compressing the proximal left anterior descending coronary artery. The orifice of the aneurysm was at the left coronary sinus, about 5mm from the left main coronary ostium, and it was filled with organized thrombi. Surgical repair was performed by closing the entrance of the aneurysm with a Dacron patch and by implementing aortic valve repair and coronary artery bypass grafting. The patient's coronary flow was restored postoperatively, and all anginal symptoms disappeared.
Aortic Aneurysm/*complications/radiography/surgery ; Behcet Syndrome/*complications ; Coronary Artery Bypass ; Female ; Humans ; Middle Aged ; Myocardial Infarction/*etiology ; *Sinus of Valsalva/surgery ; Tomography, X-Ray Computed

PURPOSE: We compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery. MATERIALS AND METHODS: Fifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index > or =2 L/min/m2: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints. RESULTS: Patient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2+/-4.8 days vs. 10.8+/-4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652+/-519 mL vs. 11430+/-463 mL, p=0.004). CONCLUSION: NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization.
Aged ; Aged, 80 and over ; Cardiac Output/*physiology ; Cardiac Surgical Procedures/*methods ; Catheterization, Swan-Ganz ; Female ; Goals ; Heart Valves/*surgery ; Hemodynamics ; Humans ; Length of Stay/*statistics & numerical data ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Monitoring, Physiologic/methods ; Postoperative Complications/epidemiology/prevention & control ; Postoperative Period

BACKGROUND: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. METHODS: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was 18.1±8.6 months. RESULTS: The mean age of the patients was 77.1±5.8 years and their mean Society of Thoracic Surgeons score was 9.2±17.7. The mean cardiopulmonary bypass and aortic cross-clamp times were 94.5±37.3 minutes and 54.9±12.5 minutes, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, 13.9±8.6 mm Hg and peak, 27.2±15.0 mm Hg) at a mean of 9.9±4.2 months. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was 83.3%±10.8%. CONCLUSION Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

BACKGROUND: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. METHODS: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was 18.1±8.6 months. RESULTS: The mean age of the patients was 77.1±5.8 years and their mean Society of Thoracic Surgeons score was 9.2±17.7. The mean cardiopulmonary bypass and aortic cross-clamp times were 94.5±37.3 minutes and 54.9±12.5 minutes, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, 13.9±8.6 mm Hg and peak, 27.2±15.0 mm Hg) at a mean of 9.9±4.2 months. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was 83.3%±10.8%. CONCLUSION: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.
Aortic Valve Stenosis ; Aortic Valve ; Bioprosthesis ; Cardiopulmonary Bypass ; Echocardiography ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis Implantation ; Hemodynamics ; Humans ; Incidence ; Prostheses and Implants ; Surgeons ; Survival Rate ; Thrombosis

BACKGROUND: By improving the flow pattern in Fontan circuit, total cavopulmonary connection (TCPC) could result in a better outcome than atriopulmonary connection Fontan operation. For the patients with impaired hemodynamics after atriopulmonary Fontan connection, conversion to TCPC can be expected to bring hemodynamic and functional improvement. We studied the results of the revision of the previous Fontan connection to TCPC in patients with failed Fontan circulation. MATERIAL AND METHOD: From October 1979 to June 2002, eight patients who had failed Fontan circulation, underwent revision of previous Fontan operation to TCPC at Yonsei University Hospital. Intracardiac anomalies of the patients were tricuspid atresia (n=4) and other functional single ventricles (n=4). Mean age at TCPC conversion was 14.0+/-7.0 years (range, 4.6~26.2 years) and median interval between initial Fontan operation and TCPC was 7.5 years (range, 2.4~14.3 years). All patients had various degree of symptoms and signs of right heart failure. NYHA functional class was III or IV in six patients. Paroxysmal atrial fibrillation (n=1), cyanosis (n=2), intraatrial thrombi (n=2), and protein losing enteropathy (PLE) (n=3) were also combined. The previous Fontan operation was revised to extracardiac conduit placement (n=7) and intraatrial lateral tunnel (n=1). RESULT: There was no operative death. Major morbidities included deep sternal infection (n=1), prolonged pleural effusion over two weeks (n=1), and temporary junctional tachyarrhythmia (n=1). Postoperative central venous pressure was lower than the preoperative value (17.9+/-3.5 vs. 14.9+/-1.0, p=0.049). Follow-up was complete in all patients and extended to 50.1 months (mean, 30.3+/-12.8 months). There was no late death. All patients were in NYHA class I or II. Paroxysmal supraventricular tachycardia developed in a patient who underwent conversion to intraatrial lateral tunnel procedure. PLE was recurred in two patients among three patients who had had PLE before the convertsion. There was no newly developed PLE. CONCLUSION: Hemodynamic and functional improvement could be expected for the patients with Fontan circulatory failure after atriopulmonary connection by revision of their previous circulation to TCPC. The conversion could be performed with low risk of morbidity and mortality.
Anastomosis, Surgical ; Atrial Fibrillation ; Central Venous Pressure ; Cyanosis ; Follow-Up Studies ; Fontan Procedure ; Heart Failure ; Hemodynamics ; Humans ; Mortality ; Pleural Effusion ; Protein-Losing Enteropathies ; Shock* ; Tachycardia ; Tachycardia, Supraventricular ; Tricuspid Atresia

BACKGROUND: Intralobar and extralobar pulmonary sequestrations have been considered as congenital lesions that occur at different stages of embryonic life. However, most cases of intralobar pulmonary sequestration (IPS) seem to have an acquired origin, as they are absent in infants and associated anomalies are relatively uncommon among them. MATERIAL AND METHOD: The cases of 25 patients who were diagnosed as IPS after surgical resection from December, 1985 to July, 2002 were included in this study. The medical records were retrospectively reviewed and the clinical characteristics were age at operation; gender; symptoms at presentation; presence of congenital anomalies; combined diseases; preoperative studies and diagnosis; location of the lesion; method of surgical resection; origin, size and numbers of aberrant artery; histopathological findings; and postoperative complications. RESULT: There were 17 (68%) female patients and 8 (32%) male patients, their ages ranged from 1 to 57 and mean value was 23 years old. Though 14 patients (56%) complained of respiratory symptoms such as pneumonia and recurrent respiratory infections, a large number of patients (44%) were asymptomatic or had chest pain only when the lesion was discovered. Only 8 patients (32%) were diagnosed as pulmonary sequestration preoperatively and 8 (32%) were suspected as mediastinal or lung tumor, 5 (20%) were congenital or acquired cystic lung disease, and 4 (16%) were lung abscess or bronchiectasis, respectively. The majority of aberrant arteries (86.4%) confirmed during the operation were originated from thoracic aorta and 2 were thoracic and abdominal aorta, 1 was abdominal aorta, respectively. The younger patients (less than 10 years old) had more other congenital anomalies (30% vs 6.7%) but the proportion of congenital IPS was not signifi cantly different (10% vs 6.7%, p>0.05) compared with elder patients. Histopathologically, almost all lesions showed chronic inflammation, cystic changes and similar pleural adhesions regardless of age. CONCLUSION: The large portion of the patients with IPS (44%) was clinically asymptomatic or presented non-respiratory symptoms at diagnosis and likely to be diagnosed as mediastinal or lung tumor especially in elder patients. Though the younger patients had more other congenital anomalies, most cases of IPS proved to be acquired lesions in terms of the histopathlogical findings and the proportion of congenital evidences.
Aorta, Abdominal ; Aorta, Thoracic ; Arteries ; Bronchiectasis ; Bronchopulmonary Sequestration* ; Chest Pain ; Diagnosis ; Female ; Humans ; Infant ; Inflammation ; Lung ; Lung Abscess ; Lung Diseases ; Male ; Medical Records ; Pneumonia ; Postoperative Complications ; Respiratory Tract Infections ; Retrospective Studies ; Young Adult