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KMID : 0371319620040040213
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Journal of the Korean Surgical Society
1962 Volume.4 No. 4 p.213 ~ p.228
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Cardiac Surgery in Korea, 1956~1961
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Abstract
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All of the major cardiac procedures performed in Korea during the period from 1956 to 1961 are included in this report. There were 229 such procedures, mitral commissurotomy 169, obliteration of patent ductus arteriosus 17, decortication of chronic constrictive pericarditis 34, shunt operations for tetralogy of Fallot 8, and pulmonary valvulotomy 1. The case material was collected from the following institutions: National Medical Center, Seoul University Hospital and Severance Hospital, all in Seoul, Kyongbook University Hospital in Taegu and Presbyterian Medical Center in Chonjoo. Operations requiring the use of hypothermia and pump-oxygenator are not included in this report and will be reported separately.
I . Mitral Stenosis
One hundred and sixty nine mitral commissurotornies were carried out during this period. The male to female ratio was 3 to´ .2.. This. is in variance with that reported by Harken and others who stated that this was three times-more common in the female than in the male. Perhaps this can be explained by the social and economic factors in which men are in a far better position to receive surgical treatment than women.
Fifty one per cent of patients were in their twenties and 17% in their teens. The latter figure is significant because it is much higher than the figures reported by Bailey and others. That this relative youth did not seem to affect the outcome of the operation was attested by the fact that 88% of the patients in their teens were benefited by the operation whereas 85% of the patients in their. twenties and 76% of the patients in their thirties improved following surgery.
Only 18% of the patients gave a history suggestive of rheumatic fever, and 65% of the resected atrial appendage showed Aschoff bodies.
Finger fracture alone was used in 77% and combination of finger and valvulotome in 11%. There were 6 operative deaths or an --operative mortality of 4% in this series. Four of these 6 deaths resul= ted. from cerebral embolism.
Forty four percent of the entire series had an excellent result and 38% improved significantly following surgery. Thus, this operation was beneficial in 92% of the entire operated cases. 14% either did not benefit from surgery..or deteriorated postoperatively. Two factors seem to influence: the outcome_ of the operation significantly. First, the opening of both commissures was attended by improvement in 87% while the mobilization of the anterior commissure alone was accompanied by 75%;improvement. It was also. interesting, to note: in, this connection that severe postoperative regurgitation was less frequent when both commissures were opened ;; than when the -anterior commissure alone was, opened Second, while 88% of those patients in whom either there was no or only minimal regurgitation postoperatively showed improvement, the figure for the patients who developed severe regurgitation as the result of surgery was only 52% improvement. Thus, it was obvious that, even though mild postoperative regurgitation was relatively innocuous, severe regurgitation should be avoided with utmost care.
Despite its shortcomings, mitral commissurotomy is an effective procedure toward rehabilitating these patients. A more radical procedure such as correction of the valve deformity with the use of pump oxygenator will have to prove its value, both in its safety and effectiveness, before it can be accepted more widely.
II . Chronic Constrictive Pericarditis
A pericardiectomy was carried out in 34 patients with this disease. The youngest was 10 and the oldest 55 years of age. Forty-eight per cent of the patients were in their twenties. There were 21 males and 11 females. Forty six percent of the resected specimens showed microscopic changes compatible with tuberculosis.
In 15 patients, a bilateal thoracotomy was used with excellent exposure of the anterior and lateral aspects of the heart. A sternum splitting incision advocated by Holman was used in 12 patients. An effort was made to decorticate both ventricles, atria and the venae cavae, regardless of the amount of thickening of scar tissue covering these areas. Holman´s original concept of this disease being produced by constriction of the orifices of the venae cavae was considered no longer tenable, since preoperative catheterization in some of these patients failed to reveal a pressure gradient between the vena cava and the right atrium and also, in many cases, there was no evidence of venaa cava constriction at the time of surgery.
Twenty-five patients or 75.8% improved following operation and 8 patients or 24.4% died postoperatively. The cause of death was congestive failure in 3, bleeding in 2, reactivation of tuberculosis in and cardiac arrest in 1. The finding that the results in patients in whom tuberculosis was found in the resected specimen . were superior (81% improvement) than those with undetermined etiology was unexpected.
The physiological changes observed in constrictive pericarditis are solely the result of mechanical factors which have to be removed surgically. Although the operative mortality reported here and in the literature seems relatively high, surgery remains the only method available in these desperate patients. Even with the difficult nature of the pathological changes inherent in this disease, a better result may be anticipated with careful selection of the patient.
1. Patent Ductus Arteriosus,.
Seventeen patients with patent ductus arteriosus were operated upon. Their ages ranged from 3 to 28. There were 7 males and 10 females. Sixteen patients had ductus arteriosus alone and one patient had a ventricular septal defect in addition.
In 9 patients, the ductus was obliterated by suture-ligation technique and the remaining 8 by division and suture of the ductus.
There were three operative deaths in this group or a mortality rate of 17%. One died 30 hours after surgery from sudden cardiac arrest (her pulmonary artery pressure preoperatively was 81/54 (59)), one 2 days postoperatively from atelectasis and the other, a 28 year old female. with degenerative changes of the aotric wall, from rupture of the aorta, postoperative renal shut down and transfusion reaction. Surviving patients obtained an excellent result.
The mortality figure in this series is too high, some of which may have been preventable with better operative and postoperative care. It is hoped that increased experience will reduce some of the difficulties.
IV. Tetralogy of Fallot
A shunt procedure was carried out on 8 patients with this anomaly. They ranged from ages one and a half to 14. All of them had cyanosis, with other features characteristic of the disease such as .squatting and clubbing.
A Potts-Smith anastomosisi was carried out in 6 a Blalock Taussig procedure in 1 and superior vena cava-pulmonary anastomosis(Glenn operation) in 1.
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