• Journal of Chest Surgery
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• v.31 no.4
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• pp.402-408
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• 1998

A 56-year old female underwent total aortic arch replacement March 1995, because of an expanding chronic Debakey type I aortic dissection. This aortic dissection had an intimal tear at the origin of the right carotid artery. Retrograde and antegrade propagation of dissection resulted in aortic arch blood flow separation and expanding pseudolumen to the abdominal aorta. Sudden anuria(ARF) developed 3 hours later postoperatively and renal doppler ultrasonography and aortography showed diminished blood flow of renal arteries. We performed balloon aortic dilatation but failed. She could be restored good renal flow after intimal flap fenestration resection and thrombectomy of the abdominal aorta. This patient could be discharged in a state of mild CRF after 2 months of ICU care for respiratory and renal failure.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.110-115
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• 2008

Malperfusion of a major organ with aortic dissection has various clinical features according branch. The morbidity and mortality rate can increase without suspicion especially postoperative period. Surgical outcomes and prognosis are influenced by early expeditious diagnostic and therapeutic measures are mandatory for successful treatment. The authors report four successful cases of acute aortic dissection with mal perfusion of various organs, such as the brain, kidney, and the lower extremities.

• Journal of Chest Surgery
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• v.40 no.8
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• pp.578-581
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• 2007

A 59-year old female patient was admitted due to massive hemoptysis. 6-months previously, we performed ascending aorta graft interposition for terating Debakey type 1 acute aortic dissection. Chest CT scan showed the fistula between the descending thoracic aorta and the left lower lobe. We performed descending thoracic aorta graft interposition under cardiopulmonary bypass. She recovered well without any postoperative problems. Distal aorto-bronchial fistula after a previous aortic operation is very rare. We report here the good results of treating aorto-bronchial fistula because we recognized this lesion early and performed an early operation.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.481-487
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• 1998

The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients(25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.733-744
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• 2007

Background: There is a controversy regarding the pathogenesis and management principle of an acute intramural hematoma (IMH) of the aorta, Recent studies have reported intimal defects in many patients diagnosed with IMH, and suggested that intimal defects play important roles in the pathogenesis, progression of the pathology, and prognosis. Material and Method: This study reviewed the preoperative and postoperative computed tomography (CT) scan images of 36 patients who underwent surgical treatment for Stanford type A acute IMH of the aorta. The surgical findings were also reviewed retrospectively from the medical records. Result: In 15 patients (41.7%), the findings suggestive of the intimal defects were found in the preoperative CT. During the operation, 20 patients (72.2%) were found to have small intimal defects in the ascending aorta or the arch, of which 13 patients (50.5%) did not have the CT findings suggestive of intimal defects. In 17 patients, the intimal defects were located in the aortic arch or distal ascending aorta, where a gross examination would have been impossible without total circulatory arrest. In all patients, the intimal defects identified were included in the resected aortic segment, or locally closed. Follow-up CT at 4 months or longer after surgery showed that the IMH in the descending aorta had disappeared or was markedly improved. Conclusion: Most patients undergoing surgical treatment for acute type A IMH had intimal defects. This suggests that a large proportion of IMH might have a similar pathogenic mechanism as classic dissection. Consequently, it is believed that those two entities of acute aortic syndrome should be treat-ed using the same principles.

• Journal of Chest Surgery
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• v.34 no.8
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• pp.604-610
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• 2001

Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 200, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. Material and method: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. Result: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperationc ases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.248-251
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• 2009

Nonocclusive mesenteric ischemia (NOMI) is a rare complication that occurs in about 0.05% of patients after openheart surgery, and NOMI refers to the mesenteric ischemia that's caused by splanchnic vasospasm without occlusion of the great intestinal vessels. In the presently reported case, NOMI developed to maintain the blood flow to the heart and brain after several minutes of a hypotensive status and the latter was caused by acute aortic dissection that complicated an aortic cannulation procedure. Unfortunately, the patient died even though the problems were diagnosed early and proper treatment was administered. Early diagnosis of NOMI by angiography and the selective infusion of vasodilators are thought to be the only way to improve survival for patients with clinically suspected NOMI.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.934-938
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• 2006

Organ malperfusion may mask the presence of aortic dissection and is one of major cause of death in patient with aortic dissection. Several key mechanism appear to contribute to the development of malperfusion, therefore optimal choosing of treatment is necessary to obtain better result. In cases of extremity malperfusion, open bypass procedures have been used for primary treatment, but noninvasive interventional procedures are also recommended as good alternatives in some cases. Here in, we report a case of successful aortic replacement followed by stent insertion in patient with extremity malperfusion caused by acute aortic dissection.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.30-34
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• 2003

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiographic with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, heompericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.557-558
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• 2001

We operated on a Marfan patient who had Stanford type A acute aortic dissection, aortic root aneurysm, and aortic regurgitation. The Yacoub-David aortic root remodeling procedure which preserves native aortic valve and replaces all three aortic sinuses and ascending aorta by a Dacron graft, was applied for this patient. A 24mm Hemashield graft was designed to three tongues at the aortic root end to meet the shape of the Valsalva sinuses. The patient recovered from the procedure uneventfully and there was no aortic regurgitation posto-peratively.