17 results on '"Duk-Hyun Kang"'
Search Results
2. Long-term outcomes in distinct phenogroups of patients with primary mitral regurgitation undergoing valve surgery.
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Soongu Kwak, Seung-Ah Lee, Jaehyun Lim, Seokhun Yang, Hong-Mi Choi, In-Chang Hwang, Sahmin Lee, Yeonyee Elizabeth Yoon, Jun-Bean Park, Hyung-Kwan Kim, Yong-Jin Kim, Jong-Min Song, Goo-Yeong Cho, Kyung-Hwan Kim, Duk-Hyun Kang, Dae-Hee Kim, and Seung-Pyo Lee
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MITRAL valve insufficiency ,VENTRICULAR ejection fraction ,TRICUSPID valve surgery - Published
- 2023
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3. Transcatheter versus surgical closure of atrial septal defect in adult patients with tricuspid regurgitation.
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Mijin Kim, Pil Hyung Lee, Dae-Hee Kim, Sung-Ho Jung, Seung-Ah Lee, Sahmin Lee, Duk-Hyun Kang, Jae-Kwan Song, Jong-Min Song, Kim, Mijin, Lee, Pil Hyung, Kim, Dae-Hee, Jung, Sung-Ho, Lee, Seung-Ah, Lee, Sahmin, Kang, Duk-Hyun, Song, Jae-Kwan, and Song, Jong-Min
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TRICUSPID valve surgery ,HEART valve diseases ,RETROSPECTIVE studies ,TREATMENT effectiveness ,ATRIAL septal defects ,CARDIAC catheterization ,DISEASE complications - Abstract
Objectives: Transcatheter closure using a device has been established as an effective atrial septal defect (ASD) treatment, but its value in treating patients with concomitant functional tricuspid regurgitation (TR) is relatively unknown. We sought to evaluate outcomes of patients with ASD and significant TR after transcatheter ASD closure or surgical treatment.Methods: A total of 252 consecutive adult patients (53.8±13.8 years, 180 females) who had a significant functional TR before ASD closure were retrospectively analysed. The primary end point was a composite of all-cause death, stroke and heart failure. The secondary end point was significant residual TR early and at 1 year after ASD closure.Results: Transcatheter ASD closure alone and surgical ASD closure along with tricuspid annuloplasty (TAP) were performed in 68 and 184 patients, respectively. Significant TR remained in 32% (81/252) early after ASD closure and in 29% (52/182) after 1 year. The severity of TR was significantly decreased after transcatheter ASD closure (p<0.001). In multivariable analysis, TAP (OR 0.07; p<0.001) and ASD diameter (OR 0.90; p=0.040) were independent predictors of the significant residual TR early after treatment, while only TAP (OR 0.08; p<0.001) was a significant predictor at 1 year after treatment. After propensity score matching in patients with moderate or severe TR, there were no significant differences between the transcatheter ASD closure group and surgical ASD closure plus TAP group in terms of the event rates at 5 years (10.3% vs 5.5%, p=0.963).Conclusions: While TAP was effective for the treatment of significant TR, transcatheter ASD closure also significantly reduced TR as well. Transcatheter ASD closure may be considered an alternative treatment option in patients with moderate or severe TR. [ABSTRACT FROM AUTHOR]- Published
- 2022
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4. Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up.
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Ju Hyeon Kim, Jinoh Park, Yujin Yang, Sahmin Lee, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Seong-Wook Park, Seung-Jung Park, Jae-Kwan Song, Kim, Ju Hyeon, Park, Jinoh, Yang, Yujin, Lee, Sahmin, Kim, Dae-Hee, Song, Jong-Min, Kang, Duk-Hyun, Park, Seong-Wook, Park, Seung-Jung, and Song, Jae-Kwan
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Objective: Although recurring coronary artery spasm (CAS) may lead to the development of fixed atherosclerotic coronary stenosis (FS), the relationship between coronary atherosclerosis and CAS is still speculative. We evaluated the incidence of FS requiring percutaneous coronary intervention (PCI) in patients with documented CAS during long-term follow-up and analysed their clinical features.Methods: Clinical data of 3556 patients during a median follow-up of 9.4 years after non-invasive ergonovine spasm provocation testing with echocardiographic monitoring of left ventricular wall motion (erg echo) were analysed.Results: Erg echo documented CAS in 830 (23.3%) patients, who had higher frequencies of coronary risk factors than those without CAS. Patients with documented CAS on erg echo showed significantly lower 10-year overall (90.5% vs 94.2%, p<0.001) and PCI-free (97.4% vs 98.4%, p=0.002) survival rates than those without CAS. Documented CAS was an independent factor associated with later PCI after adjustment by either Cox regression model or Fine-Gray competing risk model. There was no significant difference in baseline clinical characteristics between patients who needed later PCI and those who did not. Among 28 patients who needed later PCI after documentation of CAS, the original CAS and later PCI territory were concordant in 25 (89.3%), while 3 (10.7%) showed discordance.Conclusions: CAS is a risk factor for the development of FS requiring PCI during long-term follow-up, and warrants physicians' vigilance and careful follow-up of patients with documented CAS and insignificant stenosis of major epicardial coronary arteries at the time of initial diagnosis. [ABSTRACT FROM AUTHOR]- Published
- 2022
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5. Early percutaneous mitral commissurotomy or conventional management for asymptomatic mitral stenosis: a randomised clinical trial.
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Duk-Hyun Kang, Sung-Ji Park, Seung-Ah Lee, Sahmin Lee, Dae-Hee Kim, Duk-Woo Park, Sung-Cheol Yun, Geu-Ru Hong, Jong-Min Song, Myeong-Ki Hong, Seung Woo Park, Seung-Jung Park, Kang, Duk-Hyun, Park, Sung-Ji, Lee, Seung-Ah, Lee, Sahmin, Kim, Dae-Hee, Park, Duk-Woo, Yun, Sung-Cheol, and Hong, Geu-Ru
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MITRAL valve surgery ,CARDIAC surgery ,CARDIAC catheterization ,CAUSES of death ,RESEARCH ,TIME ,RESEARCH methodology ,MEDICAL care ,PATIENTS ,MEDICAL cooperation ,EVALUATION research ,DOPPLER echocardiography ,COMPARATIVE studies ,RANDOMIZED controlled trials ,SYMPTOMS ,DISEASE management ,MITRAL stenosis ,LONGITUDINAL method ,MITRAL valve - Abstract
Objective: The decision to perform percutaneous mitral commissurotomy (PMC) on asymptomatic patients requires careful weighing of the potential benefits against the risks of PMC, and we conducted a multicentre, randomised trial to compare long-term outcomes of early PMC and conventional treatment in asymptomatic, severe mitral stenosis (MS).Methods: We randomly assigned asymptomatic patients with severe MS (defined as mitral valve area between 1.0 and 1.5 cm2) to early PMC (84 patients) or to conventional treatment (83 patients). The primary endpoint was a composite of major cardiovascular events, including PMC-related complications, cardiovascular mortality, cerebral infarction and systemic thromboembolic events. The secondary endpoints were death from any cause and mitral valve (MV) replacement during follow-up.Results: In the early PMC group, there were no PMC-related complications. During the median follow-up of 6.4 years, the composite primary endpoint occurred in seven patients in the early PMC group (8.3%) and in nine patients in the conventional treatment group (10.8%) (HR 0.77; 95% CI 0.29 to 2.07; p=0.61). Death from any cause occurred in four patients in the early PMC group (4.8%) and three patients in the conventional treatment group (3.6%) (HR 1.30; 95% CI 0.29 to 5.77). Ten patients (11.9%) in the early PMC group and 17 patients (20.5%) in the conventional treatment group underwent MV replacement (HR 0.59; 95% CI 0.27 to 1.29).Conclusions: Compared with conventional treatment, early PMC did not significantly reduce the incidence of cardiovascular events among asymptomatic patients with severe MS during the median follow-up of 6 years.Trial Registration Number: NCT01406353. [ABSTRACT FROM AUTHOR]- Published
- 2021
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6. Watchful observation versus early aortic valve replacement for symptomatic patients with normal flow, low-gradient severe aortic stenosis
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Sung-Cheol Yun, Dae-Hee Kim, Jeong Yoon Jang, Jae-Kwan Song, Jong-Min Song, Seung Woo Park, Jae Won Lee, Cheol-Hyun Chung, Sung-Ji Park, and Duk-Hyun Kang
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Severity of Illness Index ,Ventricular Function, Left ,Coronary artery disease ,Aortic valve replacement ,Risk Factors ,Internal medicine ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Registries ,Propensity Score ,Watchful Waiting ,Prospective cohort study ,Aged ,Proportional Hazards Models ,Heart Valve Prosthesis Implantation ,Ejection fraction ,business.industry ,Patient Selection ,Mortality rate ,Hemodynamics ,Stroke Volume ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Surgery ,Stenosis ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Watchful waiting - Abstract
Objectives The timing of aortic valve replacement (AVR) remains controversial in symptomatic patients with normal flow, low-gradient severe aortic stenosis (AS) and preserved LVEF. We sought to compare long-term mortality of early AVR versus a watchful observation strategy. Methods From 2000 to 2011, we prospectively evaluated 284 consecutive symptomatic patients (136 men, age 68±10 years) with normal flow, low-gradient severe AS and preserved LVEF who were potential candidates for early AVR. Normal flow, low-gradient severe AS was defined as indexed aortic valve area 2 /m 2 with mean gradient 2 . Early AVR was performed on 98 patients (early AVR group), while the watchful observation strategy was selected for 186 patients (watchful observation group). Patients in the watchful observation group were referred for AVR if mean gradient was ≥40 mm Hg during follow-up. Results There were no significant differences between the early AVR and the watchful observation groups for the risk of overall mortality (HR 0.94 for the early AVR; 95% CI 0.51 to 1.73) or for the estimated actuarial 8-year mortality rates (17±5% vs 27±5%, p=0.84) in the overall cohort. Society of Thoracic Surgeons score, comorbidity index, age, coronary artery disease, aetiology of AS and performance of AVR were associated with overall survival. For 83 propensity-score-matched pairs, the risk of overall death was not significantly different between the two groups (HR 1.13 for the early AVR, 95% CI 0.55 to 2.35, p=0.74). Conclusions Early AVR and watchful observation strategy show similar survival in symptomatic patients with normal flow, low-gradient severe AS and preserved LVEF. Watchful observation with timely performance of AVR should be considered a therapeutic option.
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- 2015
7. Determinants of clinical outcomes of surgery for isolated severe tricuspid regurgitation.
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Sung Jun Park, Jin Kyung Oh, Seon-Ok Kim, Seung-Ah Lee, Ho Jin Kim, Sahmin Lee, Sung Ho Jung, Jong-Min Song, Suk Jung Choo, Duk-Hyun Kang, Cheol Hyun Chung, Jae-Kwan Song, Jae Won Lee, Dae-Hee Kim, Joon Bum Kim, Park, Sung Jun, Oh, Jin Kyung, Kim, Seon-Ok, Lee, Seung-Ah, and Kim, Ho Jin
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TRICUSPID valve surgery ,TREATMENT effectiveness ,MARKOV chain Monte Carlo ,HEART valve diseases ,HEART transplantation ,BLOOD pressure ,HEMOGLOBINS ,AGE distribution ,RETROSPECTIVE studies ,PROGNOSIS ,SEVERITY of illness index ,HEART atrium ,PROSTHETIC heart valves ,LONGITUDINAL method ,BILIRUBIN - Abstract
Objectives: Although the incidence of patients with isolated tricuspid regurgitation (TR) is increasing, data regarding the clinical outcomes of isolated TR surgery are limited. This study sought to investigate the prognostic implications according to procedural types, and to identify preoperative predictors of clinical outcomes after isolated TR surgery.Methods: Among consecutive 2610 patients receiving tricuspid valve (TV) procedure, we analysed 238 patients (age, 59.6 years; 143 females) who underwent stand-alone TV surgery (repair, 132; replacement, 106) for severe TR. Primary outcome was the composite of all-cause mortality and heart transplantation. Clinical outcomes between the repair and the replacement groups were compared after adjusting with the inverse probability of treatment weighting (IPTW) method.Results: During follow-up (median, 4.1 years), 53 patients died and 4 received heart transplantation. Multivariable analysis revealed that age (p=0.001), haemoglobin level (p=0.003), total bilirubin (p=0.040), TR jet area (p=0.005) and right atrial (RA) pressure (p=0.022) were independent predictors of the primary outcome. After IPTW adjustment, there were no significant intergroup differences in the risk of primary outcome (HR 1.01; 95% CI 0.55 to 1.87). In the subgroup analysis, tricuspid annular diameter was identified as a significant effect modifier (p=0.012) in the comparison between repair versus replacement, showing a trend favouring replacement in patients with annular diameter >44 mm.Conclusions: The outcomes of stand-alone severe TR surgery were independently associated with the severity of TR and RA pressure. In selected patients with severe annular dilation >44 mm, replacement may become a feasible option. [ABSTRACT FROM AUTHOR]- Published
- 2021
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8. Dipeptidyl peptidase-4 inhibition to prevent progression of calcific aortic stenosis.
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Sahmin Lee, Seung-Ah Lee, Bongkun Choi, Ye-Jee Kim, Soo Jin Oh, Hong-Mi Choi, Eun Kyoung Kim, Dae-Hee Kim, Goo-Yeong Cho, Jong-Min Song, Seung Woo Park, Duk-Hyun Kang, Jae-Kwan Song, Lee, Sahmin, Lee, Seung-Ah, Choi, Bongkun, Kim, Ye-Jee, Oh, Soo Jin, Choi, Hong-Mi, and Kim, Eun Kyoung
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AORTIC stenosis ,MEDICAL sciences ,AORTIC valve diseases ,TYPE 2 diabetes ,HEART valve diseases ,ALDOSTERONE antagonists ,ECHOCARDIOGRAPHY ,DISEASE progression ,BIOLOGICAL models ,RESEARCH ,PROTEASE inhibitors ,ANIMAL experimentation ,RESEARCH methodology ,MEDICAL cooperation ,EVALUATION research ,TREATMENT effectiveness ,RATS ,SEVERITY of illness index ,COMPARATIVE studies ,CALCINOSIS ,DRUG monitoring ,AORTA ,HEMODYNAMICS ,AORTIC valve ,BLOOD flow measurement - Abstract
Objective: To evaluate whether the use of dipeptidyl peptidase-4 (DPP-4) inhibitors and their cardiac tissue distribution profile and anticalcification abilities are associated with risk of aortic stenosis (AS) progression.Methods: Out of the five different classes of DPP-4 inhibitors, two had relatively favourable heart to plasma concentration ratios and anticalcification ability in murine and in vitro experiments and were thus categorised as 'favourable'. We reviewed the medical records of 212 patients (72±8 years, 111 men) with diabetes and mild-to-moderate AS who underwent echocardiographic follow-up and classified them into those who received favourable DPP-4 inhibitors (n=28, 13%), unfavourable DPP-4 inhibitors (n=69, 33%) and those who did not receive DPP-4 inhibitors (n=115, 54%).Results: Maximal transaortic velocity (Vmax) increased from 2.9±0.3 to 3.5±0.7 m/s during follow-up (median, 3.7 years), and the changes were not different between DPP-4 users as a whole and non-users (p=0.143). However, the favourable group showed significantly lower Vmax increase than the unfavourable or non-user group (p=0.018). Severe AS progression was less frequent in the favourable group (7.1%) than in the unfavourable (29.0%; p=0.03) or the non-user (29.6%; p=0.01) group. In Cox regression analysis after adjusting for age, baseline renal function and AS severity, the favourable group showed a significantly lower risk of severe AS progression (HR 0.116, 95% CI 0.024 to 0.551, p=0.007).Conclusions: DPP-4 inhibitors with favourable pharmacokinetic and pharmacodynamic properties were associated with lower risk of AS progression. These results should be considered in the preparation of randomised clinical trials on the repositioning of DPP-4 inhibitors. [ABSTRACT FROM AUTHOR]- Published
- 2020
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9. Aortopathy and bicuspid aortic valve: haemodynamic burden is main contributor to aortic dilatation
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Yong-Giun Kim, Byung Joo Sun, Duk-Hyun Kang, Jae-Kwan Song, Gyung-Min Park, Jong-Min Song, Dae-Hee Kim, and Seungbong Han
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Adult ,Male ,Aortic valve ,medicine.medical_specialty ,Aortic Diseases ,Heart Valve Diseases ,Hemodynamics ,Aorta, Thoracic ,Regurgitation (circulation) ,Severity of Illness Index ,Aortic aneurysm ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Aortic valve replacement ,Risk Factors ,medicine.artery ,Internal medicine ,Aortic sinus ,Republic of Korea ,medicine ,Humans ,Retrospective Studies ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Surgery ,Cross-Sectional Studies ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Disease Progression ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
To evaluate factors associated with aortic enlargement in patients with a bicuspid aortic valve (BAV) and the impact of isolated aortic valve replacement (AVR).A retrospective analysis of clinical data in a tertiary referral hospital.We performed a cross-sectional analysis of 595 patients with BAV to assess variables determining maximal ascending aortic dimension. To measure annual dilatation rates, baseline and follow-up echocardiograms were analysed in 70 patients with BAV (BAV-AVR group) and 48 with a tricuspid aortic valve (TVA-AVR group) who underwent isolated AVR, and compared with 65 patients with BAV who did not undergo AVR (BAV-NAVR group).Aortic regurgitation (AR) severity was associated with aortic sinus diameter (p0.001), whereas aortic stenosis severity with the tubular diameter (p0.001). Multivariate analysis showed that age was an independent factor for both sinus and tubular diameter with AR severity being for aortic sinus diameter and moderate to severe aortic stenosis or AR being for aortic tubular diameter. Despite younger age and lower prevalence of moderate to severe valvular dysfunction at baseline, the annual dilatation rates at sinus and tubular part were significantly higher in the BAV-NAVR than in the BAV-AVR and TAV-AVR groups (p0.05 each), which did not differ in the BAV-AVR and TAV-AVR groups (p=0.402 for sinus and p=0.394 for tubular part).Age-dependent aortic enlargement associated with significant valvular dysfunction and the protective effects of isolated AVR in patients with BAV indicate that valvular dysfunction is a major determinant to the development of aortopathy.
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- 2012
10. Discrepancy between mitral valve areas measured by two-dimensional planimetry and three-dimensional transoesophageal echocardiography in patients with mitral stenosis
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Dae-Hee Kim, Duk-Hyun Kang, Yun-Jeong Kim, Jae-Kwan Song, Sun-Yang Min, Moo-Song Lee, Hong-Kyung Park, Jong-Min Song, and Mi-Ohk Seo
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Male ,medicine.medical_specialty ,Intraclass correlation ,Echocardiography, Three-Dimensional ,Diastole ,Transoesophageal echocardiography ,Severity of Illness Index ,Mitral valve ,Internal medicine ,medicine ,Humans ,Mitral Valve Stenosis ,In patient ,business.industry ,Reproducibility of Results ,Stroke Volume ,Stroke volume ,Middle Aged ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,ROC Curve ,Parasternal line ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
To compare mitral valve area (MVA) measurements obtained by 2D transthoracic planimetry and 3D transoesophageal echocardiography (TOE) in patients with mitral stenosis (MS), and to determine the causes of discrepancies between the two techniques.Reliability and agreement study.Tertiary referral centre.Eighty-seven patients with MS.MVA was determined by transthoracic 2D planimetry and 3D TOE. Clinical and echocardiographic variables were evaluated. The angle (Mα) between the lines of the true mitral valve (MV) tip and the echo beam-to-MV tip was measured at early diastole from the parasternal long-axis view obtained from 2D echocardiography.Although MVA measurements using 2D planimetry and 3D TOE showed good agreement (intraclass correlation coefficient, 0.853; p0.001), 2D planimetry overestimated MVA by 0.19±0.2 cm(2) compared with 3D TOE (p0.001). Left atrial (LA) dimension obtained from the parasternal long-axis view at end-systole (p=0.012), Mα (p0.001), and left ventricular ejection fraction (p=0.022) were independent determinants of the MVA difference (MVA by 2D-MVA by 3D TOE; MVA(2D-3D)) according to multiple linear regression analysis. The LA dimensions correlated with Mα (r=0.352, p=0.001). The best cut-off values for predicting significant overestimation by 2D planimetry (MVA(2D-3D)0.2 cm(2)) were LA dimension ≥49 mm (78% sensitivity, 72% specificity) and Mα≥9.5° (56% sensitivity, 89% specificity).Because 2D planimetry tends to overestimate MVA, 3D TOE should be considered for accurate MVA assessment, especially in patients with a large LA and large Mα.
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- 2012
11. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery
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Hyun Song, Jae-Kwan Song, Duk-Hyun Kang, Meong Gun Song, Cheol Hyun Chung, Jong-Min Song, Jae-Won Lee, Mi-Jeong Kim, and Suk Jung Choo
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Adult ,Male ,Aortic valve ,medicine.medical_specialty ,Heart Valve Diseases ,Postoperative Complications ,Sex Factors ,Internal medicine ,Mitral valve ,medicine ,Humans ,Postoperative Period ,Heart valve ,Aged ,Ultrasonography ,Tricuspid valve ,business.industry ,Hazard ratio ,valvular heart disease ,Age Factors ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Tricuspid Valve Insufficiency ,Surgery ,medicine.anatomical_structure ,Aortic Valve ,Heart failure ,Disease Progression ,Cardiology ,Mitral Valve ,Female ,Epidemiologic Methods ,Cardiology and Cardiovascular Medicine ,business - Abstract
Persistent significant tricuspid regurgitation (TR) after successful left-sided valve surgery is frequently reported.To evaluate the incidence, risk factors and clinical impact of development of late significant TR after successful left-sided valve surgery.638 patients (356 men, mean age 52 (SD 14) years) who had mild (or=grade 2/4) TR and underwent successful surgery without any procedure for TR were analysed. Development of significant TR was defined as a TR increase by more than one grade and final TR gradeor=3/4 at follow-up echocardiography. Clinical events were defined as cardiovascular death, repeated open-heart surgery, and congestive heart failure requiring hospital admission. The overall incidence of late significant TR was 7.7% (49/638). Age (hazard ratio (HR), 1.0, 95% CI, 1.0 to 1.1; p = 0.005), female gender (HR, 5.0; 95% CI 2.0 to 12.7; p = 0.001), rheumatic aetiology (HR, 3.8; 95% CI 1.4 to 10.3; p = 0.011), atrial fibrillation (Af) (HR, 2.6; 95% CI 1.1 to 6.4; p = 0.035) and peak pressure gradient of TR at follow-up (HR, 1.1; 95% CI 1.0 to 1.1; p0.001) were independent factors associated with development of late significant TR. During clinical follow-up of 101 (24) months, patients who developed late significant TR showed a significantly lower 8-year clinical event-free survival rate (76 (6) vs 91 (1)%, p0.001).Several clinical variables were independent risk factors for development of late significant TR. Early surgical intervention for TR in selected patients with these risk factors may be justified, even though they have only mild TR.
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- 2009
12. Three-dimensional characteristics of functional mitral regurgitation in patients with severe left ventricular dysfunction: a real-time three-dimensional colour Doppler echocardiography study
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Mi-Jeong Kim, Duk-Hyun Kang, Jong-Min Song, Yun-Jeong Kim, Sung-Hee Kang, Jae-Joong Kim, and Jae-Kwan Song
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Male ,medicine.medical_specialty ,Duplex ultrasonography ,Echocardiography, Three-Dimensional ,Severity of Illness Index ,Ventricular Dysfunction, Left ,symbols.namesake ,Internal medicine ,Mitral valve ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,In patient ,Functional mitral regurgitation ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,Middle Aged ,Echocardiography, Doppler, Color ,Treatment Outcome ,medicine.anatomical_structure ,Ventricle ,Circulatory system ,cardiovascular system ,symbols ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect ,Blood Flow Velocity - Abstract
We sought to evaluate the three-dimensional (3D) features of functional mitral regurgitation (FMR) and their geometric determinants by real-time 3D colour Doppler echocardiography.Real-time 3D colour Doppler echocardiography was performed in 52 patients with severe left ventricular dysfunction. With aliasing velocity set around 40 cm/s, proximal isovelocity surface area (PISA) radius was measured on medial, central and lateral antero-posterior planes at a mid-systole frame, and the largest (PISAmax) was determined. Geometric investigations of the left ventricle and mitral valve were performed.The distal length from the anterior leaflet angulation on the central plane was significantly longer in the 29 patients (56%) with eccentric PISA than in the 23 patients with central PISA (1.73 (0.44) vs 1.47 (0.33) cm, p0.05). The 18 patients (35%) with both-sides dominant PISA had a smaller anterior leaflet bending angle (141 degrees (8 degrees ) vs 147 degrees (8 degrees ), p0.05) and a longer distal length from the angulation on the central plane (1.80 (0.36) vs 1.51 (0.41) cm, p0.05) than the remaining 34 patients. The 14 patients (27%) with separate PISAs had smaller PISAmax (0.33 (0.13) vs 0.45 (0.16) cm, p0.05), and tenting height (0.91 (0.20) vs 1.06 (0.24) cm, p0.05) and tenting area (2.1 (0.6) vs 2.7 (0.8) cm(2), p0.05) on the central plane than in those with single PISA.3D features of FMR are quite diverse. The shape and site of anterior leaflet bending determine the shape of the regurgitant orifice, and small mitral valve tenting generates separate small regurgitant orifices of FMR in patients with severe left ventricular dysfunction.
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- 2008
13. Initial surgery versus conservative management of symptomatic severe mitral regurgitation in the elderly.
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Duk-Hyun Kang, Ran Heo, Sahmin Lee, Seunghee Baek, Dae-Hee Kim, Jong-Min Song, Jae-Kwan Song, Jae Won Lee, Kang, Duk-Hyun, Heo, Ran, Lee, Sahmin, Baek, Seunghee, Kim, Dae-Hee, Song, Jong-Min, Song, Jae-Kwan, and Lee, Jae Won
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MITRAL valve insufficiency ,MITRAL valve surgery ,HEALTH outcome assessment ,OLDER patients ,SYMPTOMS ,CARDIAC surgery ,MITRAL valve ,RISK assessment ,PATIENT selection ,DIAGNOSIS - Abstract
Objective: In elderly patients, the benefit of surgical correction of severe mitral regurgitation (MR) may not be greater than the operative risk. This study sought to compare the long-term clinical outcomes between initial surgery and conservative management in elderly patients (≥70 years of age) with severe MR.Methods: We prospectively evaluated 157 consecutive patients (75 men, 74±4 years of age) with severe degenerative MR and mild symptoms. Mitral valve surgery was performed on 79 (initial surgery group), whereas the conservative strategy was chosen for 78 patients (conservative management group). We compared the overall and cardiac mortality and cardiac event between strategies in the overall and propensity-matched cohort (46 pairs).Results: During the median follow-up of 5.4 years, overall death occurred less in the initial surgery group (16 vs 37 patients). This group showed reduced cardiac mortality (HR 0.31; 95% CI 0.13 to 0.73; p=0.007), overall mortality (HR 0.39; 95% CI 0.21 to 0.74; p=0.004) and cardiac event (HR 0.26; 95% CI 0.13 to 0.53; p<0.001). A significant reduction in cardiac mortality (HR 0.18; 95% CI 0.05 to 0.63; p=0.007), overall mortality (HR 0.36; 95% CI 0.15 to 0.86; p=0.022) and cardiac event (HR 0.20; 95% CI 0.07 to 0.52; p=0.001) in the initial surgery group was also observed in the propensity-matched cohort.Conclusions: In elderly patients with severe degenerative MR and mild symptoms, initial surgical strategy was associated with significant long-term reductions in cardiac and overall mortality compared with conservative management. [ABSTRACT FROM AUTHOR]- Published
- 2018
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14. Timing of surgery in infective endocarditis.
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Duk-Hyun Kang and Kang, Duk-Hyun
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INFECTIVE endocarditis , *OPERATIVE surgery , *HEART failure risk factors , *EMBOLISMS , *HEART valve diseases , *SURGERY , *THERAPEUTICS , *EMBOLISM prevention , *ENDOCARDITIS , *HEART failure , *PROSTHETIC heart valves , *INFECTION , *MEDICAL care , *NEUROLOGICAL disorders , *PATIENTS , *COMPLICATIONS of prosthesis , *RISK assessment - Abstract
Although early surgery is performed in approximately half of patients for the treatment of infective endocarditis (IE), the optimal timing of surgery remains unclear. Appropriate early surgery can avoid death and severe complications, but nearly one-quarter of patients with indications for surgery do not receive surgical intervention. Multidisciplinary collaborations among cardiologists, cardiac surgeons and infectious disease specialists are required for appropriate decisions about indication and timing of surgical intervention. Moreover, the potential benefits of early surgery should be weighed against its operative risks and long-term consequences. The main indications for early surgery in patients with IE are heart failure (HF), uncontrolled infection and prevention of embolism. Role of early surgery has been expanding and a recent randomised trial demonstrated that early surgery performed within 48 h after the diagnosis of IE effectively reduced systemic embolisms without increasing operative mortality or recurrence of IE. Urgent surgery is indicated in patients who have moderate to severe HF, uncontrolled infection and large vegetations associated with severe valvular disease. However, surgery should be delayed for 2-4 weeks in patients with large cerebral infarction and for at least 4 weeks in those with intracerebral haemorrhage if possible, because early surgery may pose significant risks of neurological deterioration and perioperative cerebral bleeding. The decision for surgical timing should be based on individual risk-benefit analysis, and early surgery is strongly indicated if its benefits exceed operative risks. [ABSTRACT FROM AUTHOR]
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- 2015
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15. Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia.
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Duk-Hyun Kang, Jeong Yoon Jang, Sung-Ji Park, Dae-Hee Kim, Sung-Cheol Yun, Jong-Min Song, Seung Woo Park, Cheol-Hyun Chung, Jae-Kwan Song, and Jae-Won Lee
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AORTIC stenosis treatment , *AORTIC valve transplantation , *SURVIVAL analysis (Biometry) , *FOLLOW-up studies (Medicine) , *ECHOCARDIOGRAPHY , *HEALTH outcome assessment - Abstract
Background: In Africa, screening for asymptomatic rheumatic heart disease (RHD) has been conducted in single communities using non-standardised echocardiographic criteria. The use of different diagnostic criteria has led to widely variable estimates of the prevalence of RHD in the same communities. Methods: Randomly selected school pupils, from 4 to 24 years of age in Bonteheuwel and Langa communities of Cape Town, South Africa, and Jimma, Ethiopia, respectively, were screened for RHD according to standardised evidence-based echocardiographic diagnostic criteria of the World Heart Federation (WHF). Results: We screened 4720 scholars. In South Africa (n=2720), 1604 (58.9%) were female and the mean age was 12.2±4.2 years. In Ethiopia (n=2000), 1012 (50.6%) were female and the mean age was 10.7 ±2.5 years. Echocardiographic screening revealed 55 cases of definite and borderline RHD by WHF criteria in South Africa and 61 cases in Ethiopia, corresponding to a prevalence of 20.2 cases per 1000 (95% CI 15.3 to 26.2) and 31 cases per 1000 (95% CI 23.4 to 39.0), respectively. The odds of detecting a scholar with RHD in Ethiopia were 1.5 times higher than in South Africa (OR 1.5; 95% CI 1.04 to 2.2, p=0.02). The prevalence of RHD was 27 cases per 1000 (95% CI 19.3 to 36.8) in Langa, and 12.5 cases per 1000 (95% CI 7.1 to 20.2) in Bonteheuwel. The odds of detecting a schoolchild with RHD in Langa compared with Bonteheuwel were 2.2 (OR 2.2; 95% CI 1.2 to 4.2, p=0.0071). Interpretation: There were significant differences in detecting asymptomatic RHD in school pupils of different countries and in different communities within a country in sub-Saharan Africa. The variation in the prevalence of RHD between countries and communities has important implications for the modelling of the global burden of RHD. [ABSTRACT FROM AUTHOR]
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- 2015
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16. Basal chordae sites on the mitral valve determine the severity of secondary mitral regurgitation.
- Author
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Jong-Min Song, Jae-Joong Kim, Tae-Yong Ha, Jae Won Lee, Sung-Ho Jung, Il-Seon Hwang, Inchul Lee, Byung Joo Sun, Dae-Hee Kim, Duk-Hyun Kang, and Jae-Kwan Song
- Subjects
MITRAL valve insufficiency ,MITRAL valve surgery ,HEART transplantation ,CARDIOMYOPATHIES ,ECHOCARDIOGRAPHY ,REGRESSION analysis - Abstract
Objectives To evaluate the variation between individuals in terms of basal chordae (BC) attachment sites on the mitral valve (MV) and the influence of this variation on secondary mitral regurgitation (MR) severity. Background BC-mediated MV tenting is the main cause of secondary MR. Methods In this prospective cross-sectional study, 38 consecutive patients with dilated or ischaemic cardiomyopathy who were due for cardiac transplantation underwent preoperative 3D full volume/ colour Doppler echocardiography in sinus rhythm, and MV apparatus geometry, LV volume and MR severity were assessed. The lengths and insertion sites of four BC in the explanted hearts were measured posttransplantation before fixation. Results Multiple linear regression analyses revealed that the anterior leaflet systolic tenting angle and bending angle associated with the distance between the medial and lateral BC insertion sites. By contrast, the posterior leaflet tenting angle associated largely with LV volume indices. The mean longitudinal distance of the four BC from the MV edge was the main determinant of the distal length of the anterior MV from the angulation point. Square root of effective regurgitant orifice area (√EROA) only associated significantly with the mean longitudinal distance of the outer two BC from the MV edge (r=0.509, p=0.001) among pathological parameters, and the central MV tenting area (r=0.524, p=0.001) among echocardiographical parameters. √EROA did not correlate with LV volume indices, LVEF or BC lengths. Conclusions BC insertion sites were associated with systolic anterior MV configuration and secondary MR severity in dilated LV and severe systolic dysfunction. [ABSTRACT FROM AUTHOR]
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- 2015
- Full Text
- View/download PDF
17. Impact of heart failure with normal ejection fraction on the occurrence of ischaemic stroke in patients with atrial fibrillation.
- Author
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Sun-Joo Jang, Min-Seok Kim, Hee-Jung Park, Seungbong Han, Duk-Hyun Kang, Jae-Kwan Song, Seong-Wook Park, Seung-Jung Park, and Jae-Joong Kim
- Subjects
ATRIAL fibrillation treatment ,HEART failure ,STROKE ,ISCHEMIA ,ECHOCARDIOGRAPHY ,ANTICOAGULANTS ,TREATMENT effectiveness - Abstract
Objectives The purpose of this study is to examine the risk of stroke in patients with heart failure with normal ejection fraction (HFNEF) and atrial fibrillation (AF). Design Clinical and echocardiographic data in patients with non-valvular AF who were not on anticoagulation were retrospectively investigated. A total of 304 patients had AF without heart failure, and 102 patients were diagnosed as AF with HFNEF. Main outcome measures We compared the rate of ischaemic stroke, death and composite of these in the two groups. Results Patients with AF and HFNEF were older than those with AF only (71.6 vs 64.0 years, p<0.001). Female sex, diabetes mellitus, hypertension, chronic kidney disease, angina, myocardial infarction, use of ß blocker or digoxin were more common in patients with AF and HFNEF. The rates of ischaemic stroke, death and composite of ischaemic stroke and death were higher in patients with AF and HFNEF than in those with AF only (20.6% vs 6.7%, p<0.001; 27.2% vs 2.0%, p<0.001; 41.2% vs 8.1%, p<0.001 at 3 years for AF with HFNEF vs AF only, respectively). After adjustment with propensity score method using the inverse probability of treatment weighting, the 3-year risks of for ischaemic stroke (HR 3.29; 95% CI 1.58 to 6.86; p=0.001), death (HR 5.52; 95% CI 2.24 to 13.63; p<0.001), and composite of ischaemic stroke and death (HR 4.08; 95% CI 2.30 to 7.26; p<0.001) were significantly higher in patients with AF and HFNEF. Conclusions HFNEF is associated with an increased risk of stroke and death in patients with AF. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
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