The paravalvular leak after redo mitral prosthetic valve replacement is rare but serious complication when it does happen. This condition should be corrected surgically to increase life span and improve symptoms. But simple closure or patch closure of paravalvular leak are not effective in cases of weak annulus or broad defect. We report 3 cases of trido mitral valve replacement using mechanical valve with its sewing ring expanded by a collar of Dacron sheet. The prosthetic sewing ring is anchored on the weak mitral annulus with multiple interrupted sutures, while the Dacron collar is contineuously sutured to the left atrial wall for blood tight sealing. All of the three cases showed event free postoperative course.
Mitral Valve* ; Polyethylene Terephthalates* ; Reoperation ; Sutures

The paravalvular leak after redo mitral prosthetic valve replacement is rare but serious complication when it does happen. This condition should be corrected surgically to increase life span and improve symptoms. But simple closure or patch closure of paravalvular leak are not effective in cases of weak annulus or broad defect. We report 3 cases of trido mitral valve replacement using mechanical valve with its sewing ring expanded by a collar of Dacron sheet. The prosthetic sewing ring is anchored on the weak mitral annulus with multiple interrupted sutures, while the Dacron collar is contineuously sutured to the left atrial wall for blood tight sealing. All of the three cases showed event free postoperative course.
Mitral Valve* ; Polyethylene Terephthalates* ; Reoperation ; Sutures

Although postanastomosis stenosis of esophageal reconstruction is rare but it is a very unwelcome complication. Previously, the problem was solved by balloon dilatation, reoperation, and feeding jejunostomy. However, balloon dilatation is not effective because of high recurrence rate, reoperation is difficult due to its operative approachableness and also jejunostomy is inconvenient for patients. Therefore, we inserted esophageal stent as a method of relieving postanastomosis stenosis. From Jan, 2001 to Dec, 2001, there were three patients with postanastomosis stenosis, who received esophageal stent insertion, one had case is benign esophageal stenosis, two had esophageal carcinoma. We followed up them over 12 months after inserting the stent, Dysphagia was improved, so we report that the clinical performance was satisfactory
Constriction, Pathologic* ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis ; Humans ; Jejunostomy ; Recurrence ; Reoperation ; Stents*

BACKGROUND: The St. Jude Medical prosthesis is one of the popularly used artificial prosthesis, therefore the National Medical Center reports the long-term clinical results of patients who underwent prosthetic valve replacement with St. Jude medical valve for 18 years. MATERIAL AND METHOD: Between January, 1984 and June, 2002, a series of 163 consecutive patients who had implanted St. Jude prosthesis at the National Medical Center were reviewed. Mean age was 42.9+/-15.1 years and male to female ratio was 69:94. The operative procedure comprised of 87 MVR, 30 AVR, 45 DVR, and 1 TVR. The reoperative procedure comprised of 21 MVR, 2 AVR, and 14 DVR. Follow-up rate was 96.9%, and cumulative follow-up was 823.8 patient-years. RESULT: Early mortality rate was 7.9% (13 patients), late mortality rate was 8.7% (13 patients) and late mortality due to valve related complication was 4.7% (7 patients). Actual survival rate at 10 and 18 years were 91.7+/-2.1% and 91.0+/-1.9%. Linearized incidence was as follows: thromboembolism, 1.09%/ patient-year; anticoagulant related hemorrhage, 0.36%/patient-year; valve thrombosis, 0.24%/patient-year; paravalvular leakage, 0.12%/patient-year; and prosthetic bacterial endocarditis, 0.12%/patient-year. Linearized incidence of over all valve related complication was 1.94%/patient-year. Freedom from valve related complication at 10 and 18 years were 89.1+/-3.3% and 88.4+/-3.9%. Freedom from valve related death at 10 and 18 years were 95.1+/-1.2% and 95.1+/-1.0%. Valve related complication was related the age of patient, especially anticoagulant related hemorrhage was more common in patients over 60 years of age. Valve related complication, death were higher in DVR than AVR or MVR, and valve related death was higher in reoperation. There was no relationship between valve related complication or death and implant valve or size. CONCLUSION: The long-term clinical results of patients implanted with St. Jude Mechanical prosthesis was quite satisfactory with a low incidence of valve related complication and mortality.
Endocarditis, Bacterial ; Female ; Follow-Up Studies ; Freedom ; Heart Valve Prosthesis ; Hemorrhage ; Humans ; Incidence ; Male ; Mortality ; Prostheses and Implants ; Reoperation ; Surgical Procedures, Operative ; Survival Rate ; Thromboembolism ; Thrombosis

The Fontan operation is commonly practiced for the physiologic correction of univentricular heart diseases. However, for the patients who have risk factors against this operation, it is recommended to take the initial palliative operation rather than going to the Fontan operation at once. The proper timing to the Fontan operation after palliation is decided by assessing several factors such as patient's age and other risks of maintaining palliative state, etc. Usually, the Fontan operation is done relatively early after palliation stage. Here, we report a 36 years old-adult-female with univentricular heart disease who underwent the successful Fontan operation at 17 years after unidirectional Glenn procedure.
Adult* ; Fontan Procedure* ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Methods ; Risk Factors

BACKGROUND AND OBJECTIVES: Cardiac myxomas are uncommon. Early diagnosis and treatment are essential to reduce morbidity or mortality. Before 1970, preoperative diagnosis was difficult. With the development of echocardiography, a correct diagnosis is made before operation. We reviewed our clinical experience in diagnosis and management of 52 cases of myxomas seen over a 33-year period, 1966 to 1998. PATIENTS AND METHODS: There were 20 males (38%) and 32 females (62%);age range 7 - 80. All the patient's medical records were reviewed. In twenty-five patients in whom echocardiographic features could be reviewed, clinical fetures were compared according to two distinct echocardiographic features;Round and polypoid type. RESULTS: Eighty-four percents of the presenting symptoms were cardiac origin while systemic embolism (SE) accounted for 15%. Echocardiography was used most often for diagnosis. The myxomas were located in the left atrium in 50 (96%), right atrium in 2 (4%). One patient had multiple myxoma. The incidence of SE was significantly higher in polypoid type than in round type (58% vs 0%, p<0.05). Multivariate regression analysis revealed polypoid type was the only independent predictor of SE (p=0.0029). Follow-up duration was ranged from 1 to 266 months. There was no deaths associated with myxoma. One patient presented with a recurrence 3 years after resection, and reoperation was performed uneventfully. CONCLUSION: Due to the nonspecific presentation of myxoma, a high index of suspicion is needed. Surgical excision of myxoma can be considered curative with excellent long-term result. However, because of high possible occurrence of SE, a close attention should be given to those patients who have myxoma of polypoid type.
Diagnosis ; Early Diagnosis ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Incidence ; Male ; Medical Records ; Mortality ; Myxoma* ; Recurrence ; Reoperation

BACKGROUND: Pulmonary aspergillosis usually results from the colonization of the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life-threatening disease causing massive hemoptysis. Here we reviewed our results from the last 10 years. MATERIAL AND METHOD: We reviewed 31 cases surgically treated from Aug. 1992 to Jul. 2002. retrospectively. This investigation is designed to illustrate the peak age incidence, sex ratio, chief complaints, preoperative study, anatomic location of operative site, postoperative pathologic finding and postoperative complications. RESULT: The peak age incidence laid in the 3rd and 4th decade of 20 cases (64.5%). The most common complaint was hemoptysis in 27 cases (87.1%). The 31 cases had a history of treatment with anti- tuberculous drugs under impression of pulmonary tuberculosis. The 19 cases (61.3%) showed the so-called "Air- meniscus sign" on the preoperative chest X-ray. In the 31 cases (100%) on the chest computed tomography. as a preoperative diagnostic modality, positivity was shown in 37.9%, 83.3% was shown on the fungus culture of sputum for Aspergillus, serum immunodiffusion test for A. fumigatus, respectively. The anatomical location of aspergilloma was mainly in the upper lobe in 19 cases (61.3%) and the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 31 cases (100%) were combined with tuberculosis. The postoperative complications include empyema, prolonged air leakage, remained dead space, postoperative bleeding and these numbers of cases is 3 cases (9.7%), 2 cases (6.45%), 2 cases (6.45%), 1 case (3.23%), respectively. one case was died postoperatively due to massive beeding, and asphyxia. CONCLUSION: Compared with the previous study, there is no significant difference in results. Preoperative chest computed tomography and immunodiffusion test were more commonly available and showed high positivity. Operations often became technically difficult because of pleural space obliteration, indurated hilar structures, and poor expansion of the remaining lung, which were more prominent in the patients with complex aspergillosis. In such cases, medical treatments and interventional procedures like bronchial artery embolization are preferred. However, cavernostomy is also recommanded with few additional morbidity because of its relatively less invassiveness. Early surgical intervention is the recommended management for patients with simple aspergilloma considering the low surgical mortality and morbidity in recent days.
Aspergillosis ; Aspergillus ; Asphyxia ; Bronchial Arteries ; Colon ; Empyema ; Fungi ; Hemoptysis ; Hemorrhage ; Humans ; Immunodiffusion ; Incidence ; Lung ; Lung Diseases ; Mortality ; Postoperative Complications ; Pulmonary Aspergillosis* ; Retrospective Studies ; Sex Ratio ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

Primary pulmonary artery sarcoma is very rare disease. The diagnosis of pulmonary artery sarcoma is frequently confused with pulmonary embolism because its clinical symptom and radiologic findings are similar with pulmonary embolism. It was often diagnosed at autopsy as it progresses rapidly. So Pulmonary artery sarcoma must be suspected if the origin of thrombus is not known and anticoagulation therapy is not effective. In this case, a 57 years old man who has been diagnosed pulmonary embolism was transferred to our department because of ineffective anticoagulant therapy and its worsening lesion despite of 5 month-therapy. In operative findings, it was pulmonary artery sarcoma that invaded to pericardium. There was angiosarcoma in right pulmonary artery, which metastasized to lung parenchyme. Under cardiopulmonary bypass, we resected main pulmonary artery and right lung. The Gore-tex graft was interposed between main pulmonary artery and left pulmonary artery. He was discharged after chemotherapy.
Autopsy ; Cardiopulmonary Bypass ; Diagnosis ; Drug Therapy ; Hemangiosarcoma ; Humans ; Lung* ; Middle Aged ; Neoplasm Metastasis* ; Pericardium ; Polytetrafluoroethylene ; Pulmonary Artery* ; Pulmonary Embolism ; Rare Diseases ; Sarcoma* ; Thrombosis ; Transplants

Objective: To test the hypothesis that a longer duration of phase II cardiac rehabilitation is required to recover the exercise capacity of elderly patients compared to younger patients. Methods: We retrospectively reviewed and analyzed the medical records of patients who were referred to our cardiac rehabilitation (CR) center and underwent percutaneous coronary intervention for acute myocardial infarction (AMI). A total of 70 patients were enrolled who underwent an exercise tolerance test (ETT) 3 weeks after the occurrence of an AMI (T0), 6 weeks after the first ETT (T1), and 12 weeks after the first ETT (T2). Patients older than 65 years were assigned to the elderly group (n=24) and those aged 65 years and younger to the younger group (n=46). Both groups performed center-based or home-based CR for 12 weeks (3 times per week and 1 session per day). Exercise intensity for each individual was based on the target heart rate calculated by the Karvonen formula. The change in maximal metabolic equivalents (METmax) of the two groups was measured at each assessment point (T0, T1, and T2) to investigate the recovery of exercise capacity. Results: The younger group showed improvement in METmax between T0 and T1. However, METmax of the elderly group showed no significant improvement between T0 and T1. The exercise capacity, measured with METmax, of all groups showed improvement between T0 and T2. Conclusion Elderly patients with AMI need a longer duration of CR (>6 weeks) than younger patients with AMI.

BACKGROUND AND OBJECTIVES: We evaluated the two-year clinical outcomes in patients with angiographically intermediate lesions according to the plaque burden and treatment strategy. SUBJECTS AND METHODS: We prospectively enrolled patients with angiographically intermediate lesions (diameter stenosis 30-70%) with an intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm2 with 50-70% plaque burden of 16 Korean percutaneous coronary intervention centers. Patients were divided into medical therapy group (n=85) and zotarolimus-eluting stent group (ZES; Resolute) group (n=74). We evaluated the incidences of two-year major adverse cardiovascular events (MACE). RESULTS: A two-year clinical follow-up was completed in 143 patients and MACE occurred in 12 patients. There were no significant differences in the incidences of death (1.3% vs. 3.0%, p=0.471), target vessel-related non-fatal myocardial infarction (0.0% vs. 0.0%, p=1.000) and target vessel revascularizations (7.8% vs. 4.5%, p=0.425) between medical and ZES groups. Independent predictors of two-year MACE included acute myocardial infarction {odds ratio (OR)=2.87; 95% confidence interval (CI) 1.43-6.12, p=0.014}, diabetes mellitus (OR=2.46; 95% CI 1.24-5.56, p=0.028) and non-statin therapy (OR=2.32; 95% CI 1.18-5.24, p=0.034). CONCLUSION: Medical therapy shows comparable results with ZES, and myocardial infarction, diabetes mellitus and non-statin therapy were associated with the occurrence of two-year MACE in patients with intermediate lesion with IVUS MLA <4 mm2 with 50-70% of plaque burden.
Constriction, Pathologic ; Coronary Artery Disease ; Coronary Stenosis* ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Plaque, Atherosclerotic ; Prospective Studies ; Research Personnel* ; Stents ; Ultrasonography ; Ultrasonography, Interventional