Recent Surgical Outcomes ofCongenital Heart Disease according toKorea Heart Foundation Data

Background and Objectives@#This study presents an update of the surgical outcomes ofcongenital heart disease (CHD) according to Korea Heart Foundation (KHF) data. @*Methods@#We investigated the data of the 7,305 patients who were economically supportedby KHF in 2000–2014. Of them, we analyzed surgical outcomes of the 6,599 patients whounderwent CHD surgery. @*Results@#The median patient age was 1.9 years (range, 0–71.5 years). Of the 6,599 patients,5,616 (85.1%) underwent biventricular repair and 983 (14.9%) underwent palliativeprocedures. The mean Basic Aristotle Score was 6.6±2.2. A complex procedure (definedas Basic Aristotle Score above 6) was performed in 3,368 patients (51.0%). The earlymortality rate was 3.8%, while the late mortality rate was 1.8%. Previous reports of the KHF(1984–1999) showed that the early surgical and late mortality rates were 8.6%, and 5.3%,respectively. There were 491 neonates (7.4%); among them, the early mortality rate was 12.2%and late mortality rate was 3.7%. There were 2,617 infants (40.0%); among them, the earlymortality rate was 6.0% and the late mortality rate was 2.3%. A total of 591 patients from 30countries were helped by the KHF. @*Conclusions@#More neonatal surgeries (491 vs. 74 patients) were performed than those inthe past (1984–1999). The surgical outcomes were much better than before. Our surgicaloutcomes revealed that the Republic of Korea has been transformed from a country receivinghelp to a country that helps other low socioeconomic status countries.

Passion in Cardiothoracic Surgery in Korea: Remembering Professor Pill Whoon Hong, M.D

No abstract available.

The Clinical Efficacy of Bidirectional Cavopulmonray Shunt in Young Infants / 대한흉부외과학회지

BACKGROUND: The bidirectional cavopulmonary shunt (BCPS) is one of the primary palliative procedures for complex congenital heart disease. It has many advantages, but it is known to have high risks in young infants. MATERIAL AND METHOD: From 1995 to 2003, 48 infants under the age of one year underwent BCPS. All the patients were Fontan candidates due to functional univentricular heart physiology. There were no significant differences in preoperative variables, except in mean age (67.58+/-3.78 vs. 212.91+/-13.44 days), and mean body weight (4.51+/-0.29 vs. 6.62+/-0.27 kg), between group A ( or=3 months, n=36). RESULT: In group A, the arterial oxygen saturations serially measured were significantly lower. Hospital mortality was 25%, and 19%, respectively. During follow up, there were 2 late mortalities in group A, and 5 in group B. CONCLUSION: This study showed that operative risk in young infants was comparable to that of older patients, and BCPS could be a good option as a primary palliative procedure, and may eliminate other repeated palliative procedures which could be the risk factors for Fontan candidates. However, in high-risk patients accompanying pulmonary hypertension, or heterotaxia syndrome, other palliative procedures should be considered.

Redo-Operation of the Aortic Valve Disease in Pediatric Population

No abstract available.

Surgical and Long Term Results for Double Outlet Right Ventricle by the Type of Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: The results of biventricular repair for double outlet right ventricle have been improved in recent series. We studied the surgical and long term results for total correction of double outlet right ventricle by the type of ventricular septal defect. MATERIAL AND METHOD: Between November 1979 and December 2003, 126 patients had biventricular repair for double outlet right ventricle. The mean age was 1.8 years (range 1~44) and 86 patients (68.3%) were male. We classified and studied this disease by the type of VSD. RESULT: The locations of VSD were subaortic in 79 (62.7%), subpulmonary in 17 (13.5%), doubly committed in 16 (12.7%) and noncommitted in 14 (11.1%). 28 patients had palliative operation before total correction and the mean interval to total correction was 41.0+/-45.1 months. The methods of total correction were intraventricular baffling in 37 (29.4%), intraventricular baffling with patch enlargement of right ventricular outflow tract in 49 (38.9%), intraventricular baffling with Rastelli procedure in 15 (11.9%), arterial switch operation in 8 (6.3%) and REV procedure in 4 (3.2%), etc. Hospital mortality rate was 10.3% (13 patients) and 25 reoperations were performed in 24 patients (19.0%). The risk factors for hospital mortality and reoperation were cardiopulmonary bypass time (p=0.020) and previous palliative operation (p=0.013), respectively. Follow up was possible in 98 patients and mean follow up period was 118.9+/-70.7 months. The percent survival and survival for freedom from reoperation at 15 years were 82.5% and 66.7%, respectively. The survival rate was significantly lower (p=0.003) in transposition of great artery type and remote type than in simple ventricular septal defect type and tetralogy of Fallot type, but there was no statistical differences in survival rate for freedom from reoperation. CONCLUSION: It is thought to be that acceptible surgical and long term results can be obtained with application of appropriate methods of repair for double outlet right ventricle.

Clinical Evaluation of Coronary Artery Fistula / 대한흉부외과학회지

BACKGROUND: Coronary artery fistula is rare congenital anomaly, which account for 0.27~0.40% of all congenital heart diseases. We report the clinical observations of 45 patients with coronary artery fistula. MATERIAL AND METHOD: We reviewed all patients presented with or without symptoms of coronary artery fistula between 1987 and 2004. Age ranged from 1 to 83 years. Twenty-six patients were female. The patients were divided into 2 groups according to the presenting symptoms. Twelve patients were in group A (asymptomatic) and 33 patients in group B (symptomatic). The most common clinical presentation in group B was angina (18) followed by dyspnea (7), atypical chest pain (5), syncope (1), fatigue (1), and palpitation (1). Twenty-five patients were associated with other cardiac diseases, which were atrial septal defect (4), coronary artery occlusive disease (6), hypertension (12), and valvular heart disease (2). RESULT: Patients were followed-up for a mean period of 64.8+/-62.7 months. There was no complication related to coronary artery fistula during the follow-up period in both group. There was no mortality related to coronary artery fistula. CONCLUSION: In symptomatic patients, early surgical treatment is recommended considering the low perioperative morbidity. In asymptomatic patients receiving medical treatment, close follow up may be necessary.

Noninvasive Evaluation of Coronary Artery Bypass Graft Patency by Electron Beam Tomography / 대한흉부외과학회지

Recently non-invasive diagnostic imaging replaced the invasive catheter angiography in the diagnosis of vascular disease. Catheter methods are now almost confined to the purpose of intervention. Coronary artery or coronary artery bypass graft still needs catheter technique because of small diameter and the cardiac motion. The last challenge for radiologists in this domain is to obtain a non-invasive imaging. Electron beam tomography(EBT) for high temporal resolution is able to obtain a coronary arteriogram or coronary artery bypass graft (CABG), of which CABG imaging is quite useful for the evaluation of patency. In our experience as well as others, the accuracy of EBT angiogram in evaluating CABG patency revealed that the accuracy of patency of saphenous vein grafts(SVG) is high due to relatively wide lumen, short and straight course and less influence from cardiac motion. The sensitivity and specificity of patency of SVGs were 92%, 97% respectively in the prospective evaluat on and 100% each in the retrospective evaluation. A false positive and a false negative case are rudimentary errors in the initial learing period. In contrast the analysis of left internal mammary artery(LIMA) graft was difficult due to the inherent small size and the adjacent surgical clips provoking beam-hardening artifact; therefore, the method of combining 3 dimensional reconstruction and flow mode study was important in improving the accuracy of LIMA patency. The sensitivity and specificity of LIMA patency were 100% and 80% in both prospective and retrospective evaluation. Therefore, EBT angiography is an accurate non-invasive diagnostic modality for evaluating the patency of CABG, particularly in SVGs. The accuracy can be improved with the improvement of the EBT and the development of the image reconstruction software.

In vitro pressure drop comparison between two mechanical valve prostheses

An hemodynamic evaluation of two mechanical heart valves is presented. A tilting disc valve and a bileaflet valve were incorporated in a mock circulatory system which consists of a closed flow loop with a pneumatically driven flexible diaphragm to simulate the physiologic pulsatile flow. Comparisons between the valves were made on the aortic pressure, ventricular pressure, as well as mean pressure gradient at a systolic duration of 45% and a heart rate of 90 beats per minute. The results showed that the tilting disc valve has higher ventricular pressure and mean pressure gradient than that of the bileaflet valve. This indicates that the tilting disc valve has higher transvalvular flow resistance and energy loss than that of the bileaflet valve. From this study it is demonstrated that the mock circulatory system can be a very useful device to evaluate the prosthetic heart valves in vitro.

Surgical Correction of Ruptured Aneurysm of Aortic Sinus of Valsalva

This is a report of 13 cases of surgically corrected ruptured aneurysm of the aortic sinus of Valsaha. The simultaneous trans-venous and trans-arterial catheterization and cineangiogram are the best diagnostic procedures. In 12 cases, the aneurysm originated from the right coronary sinus and only one from the noncoronary sinus. Eleven aneurysms ruptured into the right ventricle and 2 into the right atrium. Eight cases were associated with ventricular septa1 defect and 5 with aortic regurgitation. In three cases the Hancock porcine valve replacement was done. There was no surgical mortality.

The Issues in Surgical Treatment of Atrioventricular Septal Defect

No Abstract available.

Cardiac Surgery at Yonsei University Medical Center: A 30-year review

This is a 30-year review of 4,059 patients who underwent cardiac operations at Yonsei University Medical Center between September 1, 1956 and August 31, 1986. Of these, there were 1,191 patients with acquired and 2,868 with congenital cardiac lesions, constituting 29% and 71% of the group, respectively. Of 1,191 patients with acquired lesions, the number in each major category and the operative mortality were as follows: closed mitral commissurotomy, 210 and 0.95%; open mitral commissurotomy, 164 and 43%, mitral valve replacement, 370 and 3.5%, aortic valve replacement, 154 and 9.7%; double valve replacement 123 and 2.4%, and coronary artery bypass grafting 94 and 85%. Of 2,868 patients with congenital cardiac lesions, the number and operative major categories were as follows: repair of tetralogy of Fallot, 593 and 93% repair of ventricular septal defect 817 and 7.1%, closure of atrial septal defect 403 and 1.5%, and closure of patent ductus arteriosus, 550 and 1.3%.

Aortorenal Bypass with Saphenous Vein in the Patient of Left Renal Arterial Stenosis and Right Renal Hypoplasia / 대한비뇨기과학회지

Renal hypertension is found to be the cause in 5-15% of patients with hypertension, and may be vascular or renal parenchymal in nature. Recent advances in diagnostic technique and vascular reconstructive techniques now enable successful management in many patients with renal hypertension. We observed one case of renovascular hypertension due to right renal hypoplasia and left renal arterial stenosis, in 22 year-old female patient with complaints of headache and dizziness for 10 days. The treatment was done by right nephrectomy and left aortorenal bypass procedure with saphenous vin. Herein we reported a case of renovascular hypertension with a review of the literatures.

Post-exercise response of ventricular ejection fraction after total repair of congenital heart disease with left to right shunt

A radioisotope first pass study was done on patients over a period of 1 to 15 years (average 4.6 years) after repair for ventricular septal defect or arterial septal defect with a left to right shunt. The age of the patients ranged from 6 to 32 years (average 14.2 year) at the time of the study. The total work of exercise and the right and left ventricular ejection fraction(EF) were evaluated at rest and after exercise. The results were compared with the preoperative hemodynamic findings and with the age of patient at the time of the operation. 1) When the total work of exercise was divided with the maximal exercise capacity of the normal individual corresponding to the patients' height and body surface area (the percentage of total work), it were very low with the average of 40% of normal. There was no sexual difference, but the percentage of total work of exercise had significant correlation with the patients' age at the time of operation (r = -0.52,p<0.01) and post-exercise left ventricular ejection fraction (LVEF)(r = -0.39,p<0.05). 2) LVEF at rest had some correlation with the preoperative mean pulmonary arterial pressure (r = -0.29, p = 0.05), but showed no relationship with Qp/Qs or Rp/Rs ratios. The right ventricular ejection fraction (RVEF) at rest had no relations with the preoperative hemodynamic findings with maximal workload. 3) The post-exercise RVEF showed linear correlation with the preoperative Rp/Rs ratio (r = -0.49,p<0.005), and mean pulmonary arterial pressure (r = -0.37,p<0.05). The post-exercise LVEF had no significant correlation with any preoperative hemodynamic factors. 4) When greater than 5% increase in ventricular EF after exercise is considered normal, the group with the normal right and left ventricular responses (n = 11) showed normal preoperative Rp/Rs ratio (7.6 +/- 4.1). In the group with normal left, but abnormal right ventricular response (n = 9) and the group with abnormal biventricular response (n = 11), both demonstrated incremental increase in Rp/Rs ratio (20.1 +/- 11.3, 26.3 +/- 19.8 respectively). Normal right, but abnormal left ventricular reaction (n = 2) was noted in patients with residual aortic valvular insufficiency and residual ventricular septal defect. In conclusion, post-operative ventricular response was much more sensitive and informative than that of ventricular function at rest and to detect subclinical cardiac dysfunction. Post-exercise RVEF was closely correlated with preoperative pulmonary vascular hemodynamics, while post-exercise LVEF seemed to be a majo determinant of working capacity after repair.

Deep Hypothermia for Total Correction of Tetralogy of Fallot / 대한마취과학회지

Early correction of congenital cardiac defects has been facilitated by the use of deep hypothermia and cardiorespiratory arrest. Simple deep hypothermia has a number of advantages for infant open heart surgery, such as a quiet heart and bloodless operative field, reduced blood requirement, elimination of pulmonary and coagulation problems following cardiopulmonary bypass, elimination of cannulation, simple anesthetic technique, no neccessity of complicated facilities, and stable postoperative course. Deep ether anesthesia is the ideal agent for induction of deep hypothermia by surface cooling, especially when combined with ganglionic blocking agents in large quantities to elimiminate some of the undesirable effects of ether, thus improving and maintaining good peripheral perfusion. We have performed a total correction of TOF on March, 1979. Anesthesia was induced with intravenous thiopental and succinylcholine for intubation and maintained by a tight closed circuit system with ether. As soon as routine EKG, direct intra-arterial pressure, esophageal and rectal temperature monitoring devices were installed, slow intravenous administration of triflupromazine was followed by surface cooling. Surface cooling was done by the technique of covering the child with bags of crushed ice after placing the infant on an ice water blanket. After cooling, the intracardiac procedure was performed under circulatory occlusion and cardiac arrest, following cardioplegic infusion, for 45 minutes. After the intracardiac procedure, cardiac resuscitation and rewarming were accomplished by cardiopulmonary bypass technique. The patient recovered satisfactorily and was discharged on POD14 without any complication.

Anatomical Repair of Congenitally Physiologically Corrected Transposition with Dextrocardia, Situs Inversus and the Interruption of Right Pulmonary Artery / 대한흉부외과학회지

A 4-year and 11-month old child was diagnosed as having dextrocardia, pulmonary atresia, atrioventricular discordance, aorta from right ventricle, PDA, the interruption of right pulmonary artery and postoperative state of Blalock-Taussig shunt on right pulmonary artery. Anatomical repair so called "double switch operation" was performed; the Ratelli procedure on ventricular level and the Mustard procedure on atrial level. We report the successful anatomical repair of congenitally Physiologically Corrected Transposition even with Dextrocardia, Situs Inversus and the interruption of Right Pulmonary Artery.

Long - term Surgical Result for Complete Atrioventricular Septal Defects / 대한흉부외과학회지

Background :The purpose of this study was to evaluate the long-term surgical result and to analysis the risk factors associated postoperative death and residual left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect. MATERIAL AND METHOD: Case histories of the patients with atrioventricular septal defect presenting to our institution between July 1989 and June 2000 were reviewed. Seventy consecutive patients(M:36, F:34, age range, 1 month to 19 years, mean body weight 8.9+/-6.6 kg) underwent primary intracardiac repair of complete atrioventricular septal defect. Down syndrome was present in 39(55.7%). The 42 valves were postoperatively classified as Rastelli type A(60.0%), 6 type B(8.6%), and 20 type C(28.6%) and 2 valves were not clearly classified.Median follow-up time was 45.3 months. RESULT: Operative mortality was 12.9%(9 patients). Operative mortality, however, decreased over the period of the study from 20.0% before 1996 to 7.7% during the recent 5 years. Residual left atrioventricular valve regurgitation(over grade III/IV) was present in 10 patients(14.3%). Five-year and ten-year survival rate was 79.4% and five-year and ten-year freedom from reoperation was 91.4%. Multivariate logistic regression analysis identified only residual left atrioventricular valve regurgitation(over grade III/IV) as risk factor (odds ratio=38.5, p=0.001) for postoperative death and the commissure repair of left atrioventricular valve after cleft repair(odds ratio=6.72, p=0.02) as risk factor for residual left atrioventricular valve regurgitation(over grade III/IV). CONCLUSION: Repair of complete atrioventricular septal defect during the infancy and the early childhood has acceptable early mortality, long-term survival rate and a low incidence of reoperation. For postoperative good function of left trioventricular valve and improved survival rate, surgical method should be focused on the leakless repair of AV valve.

Posterior left ventricular wall rupture after mitral valve replacement / 대한흉부외과학회지

No abstract available.

Fontan Procedure for Functional Single Ventricle with Major Aortopulmonary Collateral Arteries / 대한흉부외과학회지

Not only morphology of pulmonary artery or pulmonary artery resistance, but major aortopulmonary collateral arteries are risk factors of Fontan procedure. We report a successful Fontan procedure after rehabilitation of pulmonary arteries by unifocalization and systemic to pulmonary shunt in a high risk Fontan candidate with functional single ventricle combined with hypoplastic pulmonary arteries and major aortopulmonary collateral arteries supplying most of the bilateral lung field.

External Compression of Bronchus by Aneurysm from Divided Major Aortopulmonary Collateral Artery after Unifocalization / 대한흉부외과학회지

Multistage unifocalization and complete repair have been performed for pulmonary atresia ventricular septal defect and major aortopulmonary collateral arteries. We reported a case that divided major aortopulmonary collateral artery was changed into an aneurysm that compressed the left main bronchus. A 1-year-8-month old boy was operated. The Rastelli operation with left pulmonary artery reconstructuion ligation of patent ductus arteriosus and take-down of right Blalock-Taussing shunt was performed on the patient who had pulmonary atreisia ventricular septal defect patent ductus arteriosus and MAPCA at 1 year and 8 months of his age. He previously underwent the unifocalization and right B-T shunt at 9 months of age,. He repeatedly had difficulty in weaning from the mechanical ventilator, After removing the aneurysm from the divided MAPCA that compressed the left main bronchus externally it was possible to wean him from the mechanical ventilator.

The effect of oxygenated crystalloid cardioplegia for myocardial protection / 대한흉부외과학회지

No abstract available.