• Journal of Chest Surgery
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• 제38권5호
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• pp.385-388
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• 2005

Aortic intramural hematoma is a clinical condition that still has not been completely defined. And the treatment of intramural hematoma remains controversial. We present a patient with intramural hematoma combined with hemopericadium who was treated by an emergent surgical treatment.

• Journal of Chest Surgery
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• 제41권1호
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• pp.116-119
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• 2008

Transcatheter interventions are widely used for diagnosis and treatment of congenital heart disease. Complications associated with transcatheter interventions are uncommon. However, when they occur they are most often self-limited. Rarely, however, serious catheter related complications occur that may require emergent surgical intervention. In this case, the right common iliac artery was disrupted during transcatheter balloon valvuloplasty during the treatment of congenital aortic stenosis in a 2-week-old baby. After immediate surgical intervention with bleeding control using two balloon catheters the baby did well. Here we report this case and review the medical literature.

• Journal of Chest Surgery
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• 제36권4호
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• pp.261-266
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• 2003

Background: Surgery of abdominal aortic aneurysm revealed high operative mortality. We reviewed our 11-years' experiences of abdominal aortic aneurysm operation and wish to obtain information on the treatment. Material and Method: From Jan. 1990 to Dec. 2000, 48 patients were operated due to abdominal aortic aneurysm in Yonsei Cardiovascular Center Mean age was $62.8{\pm}12.7$ and there were 40 males and 8 females. Among 48 patients, nine patients had ruptured abdominal aortic aneurysm, and mean aneurysm diameter of non-ruptured cases was $8.8{\pm}2.4$cm. Result: There were 6 early deaths, and early mortality was 12.5%. Among 9 patients of preoperative aneurysm rupture, three patients died (33.3%), and among 39 patients of non-ruptured cases, 3 patients died (7.7%). Among preoperative variables, age (p<0.05), preoperative BUN level (p<0.05), and DM (p<0.05) were risk factors of early mortality. Among discharged 42 patients, 40 patients were followed up (f/u rate=95.2%) and mean follow up was $3.6{\pm}0.2$ years. During follow up periods, five patients died (late mortality=11.9%), and Kaplan-Meier survival analysis revealed $81.7{\pm}7.6$% survival rate at five and ten year. Linealized incidence of graft related event was 3.53% per patient-year. Conclusion: Surgical mortality of ruptured abdominal aortic aneurysm was higher than non-ruptured cases; therefore, early resection of the aneurysm can decrease the surgical mortality.

• Journal of Chest Surgery
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• 제42권1호
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• pp.34-40
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• 2009

Background: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. Material and Method: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. Result: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr ${\geq}$1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. Conclusion: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.

• Journal of Chest Surgery
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• 제37권7호
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• pp.578-584
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• 2004

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.

• Journal of Chest Surgery
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• 제32권7호
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• pp.665-667
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• 1999

We report a case of ruptured sinus of Valsalva aneurysm in 48-year-old male, presenting the symptom of congestive heart failure. Echocardiography showing a hairpin-like sac ex tended from the left coronary sinus to the left ventricle adjacent to the anterior mitral valve leaflet, suggested ruptured sinus of Valsalva aneurysm or aorto-left ventricular tunnel. Operative findings revealed that left sinus of Valsalva aneurysm had multiple openings faced left ventricle, 7 mm in diameter, 20 mm in length. The proximal opening was closed with bovine pericardium and distal openings were closed with spaghetti pledgeted reinforced sutures. The patient was discharged on the 14th postoperative day, and follow up for 8 months uneventfully. This case was reported for its rarity and to describe the techniques of surgical repair.

• Journal of Chest Surgery
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• 제42권1호
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• pp.111-114
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• 2009

Aorto-iliac artery aneurysms are very rare and the natural course of this disease is not well known. However, the risk of rupture is high and the mortality rate after rupture is extremely high. Preserving the pelvic circulation is important for the treatment of aorto-iliac artery aneurysms. We report here on a case of a patient suffering with aorto-iliac artery aneurysms, and these were treated by a hybrid endovascular operation that combined an open bypass of both iliac vessels with endovascular repair.

• Journal of Chest Surgery
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• 제39권11호
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• pp.868-871
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• 2006

Nuss operation as a method for correction of pectus excavatum is safe and satisfactory, but its complication presents pneumothorax, displaced bar, wound infection, pericarditis, pleural effusion, hemothorax, cardiac injury etc. We report a rare case of acute ascending aortic rupture after displaced and adhered Nuss bar removal. The patient was a 30-years old man who received Nuss operation 3 years ago. Nuss bar was removed without resistance but massively bled at both operation wound, so immediately femoro-femoral CPB and median sternotomy was done and repaired proximal aortic arch under deep hypothermic total circulatory arrest. The patient was discharged without complication at postoperative 13 day.

• Journal of Chest Surgery
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• 제36권5호
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• pp.363-366
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• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Journal of Chest Surgery
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• 제40권6호
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• pp.448-450
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• 2007

The mortality of left ventricular free wall rupture after acute myocardial infarction is high; however, subactue myocardial rupture can be diagnosed by echocardiogram and the use of the intraaortic balloon pump reduces the incidence of re-rupture. Bleeding from subacute myocardial rupture can be managed by employing fibrin glue and several patches. We report here on a case of successfully managed case of subactue left ventricular free wall rupture after acute myocardial infarction with using the sutureless technique and fibrin glue.