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

Replacement of cardiac valves in the pediatric patients is infrequent compared with in adult for the treatment of diseased heart valve. Furthermore, uncertainties regarding the long term fate of prosthetic value and effects of a fixed-orifice walve in the growing children are the main concern in pedriatric patients. Between January 1974 and October 1979, in 10 children, 15years or younger, cardiac valves were replaced becasuse of congenital or acquired valvular heart diseases in the Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital. There were 8 mitral valves, one aortic valve and one mitral and aortic valve replaced. Indications for valve replacement were intractable congestive heart failure or apperently progressing cardiac symptoms and signs. Early postoperative death was noticed in one due to arrythmia, and late postoperative death in one due to cerebral thromboembolism after 9 months of double valve replacement. All Survlvors showed clinical improvement and good cardiac condition during postoperative and follow-up period till now.
Child ; Adult ; Male ; Female ; Humans

Forty three cases of the Tetralogy of Fallot for whom palliative surgical treatment was performed at the Department of Thoracic Surgery from January 1962 to October 1971 were reviewed in this study. 1. Sex ratio of the observed patients was 1.9:1, showing relating relatively high incidence on the male patients. 2. The age distribution in the series ranged from 2 to 24 years of age. and 31 patients were under 10 years of age. 3. On the electrocardiogram right ventricular hypertrophy pattern was observed in all of the patients and right axis deviation patern was observed in all except two cases which had dextrocardia and situs inversus visceralis. 4. The so-called "Pentalogy of Fallot" associated with atrial septal defect was observable in 7 cases and one of the pentalogy case had persistent left superior vena cava. Dextrocardia with situs inversus visceralis was observed in two cases. 5. Procedures employed in this series were as follows; Glenn operation in 13 cases, Bakulev operation in 1 cases, Blalock operation in 16 cases, Brock operation in 3 cases, Waterston's operation in 10 cases. 6. The operative mortality was 18.6% (8 cases).;i.e., 2 cases after Glenn operation, 2 cases after Brock operation, 1 case after Blalock operation, and 3 cases during or following Waterston's operation.
Age Distribution ; Axis, Cervical Vertebra ; Dextrocardia ; Electrocardiography ; Heart Septal Defects, Atrial ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Mortality ; Palliative Care* ; Sex Ratio ; Situs Inversus ; Tetralogy of Fallot* ; Thoracic Surgery ; Vena Cava, Superior

Over the past four decades after Korean War, a great deal of data and clinical experiences have been accumulated relating to the diagnosis and surgical treatment of cardiovascular diseases. Among many institutes, Seoul National University Hospital Including Children's Hospital has played a leading role up to date. Clinical data following the first open heart surgery on August 7,1959 up to December 1993 revealed that the total number of open heart surgery was cises in Seoul National University Hospital and overall mortality was 6.8%. Since 1977, the cases of open heart surgery has rapidly increased due to two main reasons : Accumulation of untreated cardiac patients and widening coverage by national medical insurance. The number of cases exceeded 100 in 1978, 400 in 1980, 600 in 1982 and 700 in 1986. In the second half of 1980's and 1990's the number of cases were over 700 per year. The ratio of congenital to acquired heat disease was 1.5:1 , and that of acyanotic to cyanotic congenital cardiac anomaly was 2.0: 1. The order of frequency of acyanotic group was Ventricular Septal Defect(56.4%), Atrial Septal Defect(28.6%), Endocardial Cushion Defect(4.6%), Pulmonary Stenosis(2.9%) and Patent Ductus Arteriosus(1.0%). Whereas the incidence of cyanotic group was Tetralogy of Fallot(57.5%), Transpotion of Great Arteries(9.5%),Double Outlet Right Ventricle(8.7%) and Pulmonary Atresia(5.7%). The overall mortality of acyanotic congenital heart disease was 2.9% and that of cyanotic congenital heart disease was 16.7%. Transposition of Great Arteries, Pulmonary Atresia and Truncus Arteriosus especially resulted in very high mortality,25-30%. The causes of high mortality in these group were inadequate patient selection for operation, inexperienced perioperative neonatal care and unskiled operative technique, but the figure was remarkebly improved since 1990, and now operative mortality reached under 10%. In 2019 cased of valvular heart disease, single mitral valve disease was most common (1139 cases) and double valvular disease was 534 cases and triple valvular disease was 41 cases. According to the order of frequency in redo valvular disease was 6,0%. The frequency of ischemic heart disease and aortic disease were not so frequency previously but these figures rapidly increase in recent days. The first CABG was performed at this hospital in 1981 and 240 cases have been performed by 1993.Overall mortality was 7.1%. The number of cases in 1993 was increased two times compared to 1992, but the mortality was decreased to 2.4%. Acute aortic dissection (57 cases) was most common among 127 cases of aortic disease which was operative mortality was 26.3% which was very high. Mortality gradually decreased recently down to zero because of appropriate brain protection technique including deep hypothemia, circulatory arrest and selective cerebral perfusion. In Korea, brain death is not accepted by law as well as traditional concept. However in 1993 and up to now, five cases of heart transplantation were performed by voluntary consent of familly of the donor and recipient.
Academies and Institutes ; Aortic Diseases ; Brain ; Brain Death ; Cardiovascular Diseases ; Diagnosis ; Endocardial Cushions ; Heart Defects, Congenital ; Heart Transplantation ; Heart Valve Diseases ; Heart* ; Hot Temperature ; Humans ; Incidence ; Insurance ; Jurisprudence ; Korea ; Korean War ; Mitral Valve ; Mortality ; Myocardial Ischemia ; Patient Selection ; Perfusion ; Pulmonary Atresia ; Seoul ; Thoracic Surgery* ; Tissue Donors ; Transposition of Great Vessels ; Truncus Arteriosus

Over the past four decades after Korean War, a great deal of data and clinical experiences have been accumulated relating to the diagnosis and surgical treatment of cardiovascular diseases. Among many institutes, Seoul National University Hospital Including Children's Hospital has played a leading role up to date. Clinical data following the first open heart surgery on August 7,1959 up to December 1993 revealed that the total number of open heart surgery was cises in Seoul National University Hospital and overall mortality was 6.8%. Since 1977, the cases of open heart surgery has rapidly increased due to two main reasons : Accumulation of untreated cardiac patients and widening coverage by national medical insurance. The number of cases exceeded 100 in 1978, 400 in 1980, 600 in 1982 and 700 in 1986. In the second half of 1980's and 1990's the number of cases were over 700 per year. The ratio of congenital to acquired heat disease was 1.5:1 , and that of acyanotic to cyanotic congenital cardiac anomaly was 2.0: 1. The order of frequency of acyanotic group was Ventricular Septal Defect(56.4%), Atrial Septal Defect(28.6%), Endocardial Cushion Defect(4.6%), Pulmonary Stenosis(2.9%) and Patent Ductus Arteriosus(1.0%). Whereas the incidence of cyanotic group was Tetralogy of Fallot(57.5%), Transpotion of Great Arteries(9.5%),Double Outlet Right Ventricle(8.7%) and Pulmonary Atresia(5.7%). The overall mortality of acyanotic congenital heart disease was 2.9% and that of cyanotic congenital heart disease was 16.7%. Transposition of Great Arteries, Pulmonary Atresia and Truncus Arteriosus especially resulted in very high mortality,25-30%. The causes of high mortality in these group were inadequate patient selection for operation, inexperienced perioperative neonatal care and unskiled operative technique, but the figure was remarkebly improved since 1990, and now operative mortality reached under 10%. In 2019 cased of valvular heart disease, single mitral valve disease was most common (1139 cases) and double valvular disease was 534 cases and triple valvular disease was 41 cases. According to the order of frequency in redo valvular disease was 6,0%. The frequency of ischemic heart disease and aortic disease were not so frequency previously but these figures rapidly increase in recent days. The first CABG was performed at this hospital in 1981 and 240 cases have been performed by 1993.Overall mortality was 7.1%. The number of cases in 1993 was increased two times compared to 1992, but the mortality was decreased to 2.4%. Acute aortic dissection (57 cases) was most common among 127 cases of aortic disease which was operative mortality was 26.3% which was very high. Mortality gradually decreased recently down to zero because of appropriate brain protection technique including deep hypothemia, circulatory arrest and selective cerebral perfusion. In Korea, brain death is not accepted by law as well as traditional concept. However in 1993 and up to now, five cases of heart transplantation were performed by voluntary consent of familly of the donor and recipient.
Academies and Institutes ; Aortic Diseases ; Brain ; Brain Death ; Cardiovascular Diseases ; Diagnosis ; Endocardial Cushions ; Heart Defects, Congenital ; Heart Transplantation ; Heart Valve Diseases ; Heart* ; Hot Temperature ; Humans ; Incidence ; Insurance ; Jurisprudence ; Korea ; Korean War ; Mitral Valve ; Mortality ; Myocardial Ischemia ; Patient Selection ; Perfusion ; Pulmonary Atresia ; Seoul ; Thoracic Surgery* ; Tissue Donors ; Transposition of Great Vessels ; Truncus Arteriosus

No abstract available.

A Clinical observation was made on five patients with ruptured aortic sinus of Valsalva who visited Seoul National university hospital during the period of May, 1975~Jan., 1980. 1. Age distribution was from 19 to 32 years and four patients were male and the rest one case was female. 2. Chief complaints on admission were dyspnea in 3 cases and chest pain in 2 cases. Onset of symptoms was abrupt in 4 cases. 3. Continuous murmur was heard at third and fourth intercostal space along left sternal border with thrill in all cases. 4. Cardiac catheterization and aortography showed regurgitant flow from aorta to right ventricle in all cases. 5. Operation was done successfully in 3 cases, of which aortic insufficiency was persistent in one case.
Age Distribution ; Aorta ; Aortography ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Female ; Heart Ventricles ; Humans ; Male ; Seoul ; Sinus of Valsalva*

Heart failure unresponsive to bed rest, low sodium diet, digitalis, diuretics, vasodilators and cardiac inotropic agents is a difficult therapeutic problem. Although remission was achieved with such treatment, its duration was short and easily recurred. We present a report of severe refractory congestive heart failure in three patients successfully treated with Continuous Ambulatory Peritoneal Dialysis (CAPD). These patients were admitted to the hospital many times and treated by conventional methods but cannon maintain their condition for a long time. In all three patients, edema, pulmonary congestion, electrolyte abnormalities, decreased ejection fraction and fractional shortening of myocardioum were eliminated or improved by CAPD. All three patients improved from Class IV congestive heart to Class II, as defined by the New York Heart Association, and experienced a define improvement in their sense of well being We conclude CAPD as an effective and the useful treatment for servere congestive heart failure refractory to conventional medical treatments.
Bed Rest ; Diet ; Digitalis ; Diuretics ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Pulmonary Edema ; Sodium ; Vasodilator Agents

No abstract available.
Diagnosis* ; Thrombosis*

STUDY DESIGN: A literature review. OBJECTIVES: To describe the causes and clinical characteristics of cauda equina syndrome. SUMMARY OF LITERATURE REVIEW: The cauda equina syndrome, complex symptoms and signs expressed as variable clinical manifestation, has rare incidence but needs attention since it can bring about serious complications and sequales if neglected. MATERIALS AND METHODS: The Author reviewed articles reporting the causes and clinical manifestation of cauda equina syndrome. RESULTS: There are marked inconsistencies in the current evidence base surrounding the definition due to various clinical presentation of cauda equina syndrome. CONCLUSION: As there is no symptom or sign which has an absolute diagnostic value in establishing the diagnosis of cauda equina syndrome, any patient in whom a clinical suspicion of cauda equina syndrome arises must undergo urgent magnetic resonance imaging for diagnosis.
Cauda Equina* ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Polyradiculopathy*