• Journal of Chest Surgery
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• v.36 no.6
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• pp.427-430
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• 2003

The surgical managements for the complicated aortic disease is still one of most challenging fields for the cardiac surgeons. The endovascular stent graft procedure has been tried recently to avoid serious complications caused by traditional graft replacement technique. However, indications for the procedures or management methods for the complications have not been clearly elucidated so far. We report a case of successful management for the newly-onset aneurysmal dilation of the distal aorta after an endovascular stent graft procedure in a patient with acute aortic dissection type IIIB.

• Journal of Veterinary Clinics
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• v.27 no.6
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• pp.740-745
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• 2010

Patent ductus arteiosus (PDA) is the persistent opening of ductus arterious located between pulmonary artery and descending aorta after birth. Although PDA can be occluded by surgical ligation, interventional closure of PDA using various devices is being rapidly replaced to surgical ligation, because of its non-invasive nature of treatment and minimal post-care after treatment. Main problem encountering in interventional treatment in toy breed dogs is vascular inaccessibility due to small size of artery. Although transvenous approach using jugular veins has been developed, this technique requires experienced skill to locate occlude devices into PDA and has high risk of accidental dislodgement of occluding devices (i.e. embolization coils or vascular plugs). Therefore, in this study, we developed a modified technique for coil embolization using mini-angiocatheter with trans-femoral approach in toy breed dogs (< 3.0 kg of body weight). With this modified method, we were successfully treated two toy breed (Maltese) dogs with the left to right shunted PDA.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.968-971
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• 2001

Pedicled omentoplasty is effective in thoracic surgery, but it is associated with several postoperative complications. A case of diaphragmatic hernia as a complication of pedicled omentoplasty in a 65-year-old male is reported. Because aortoesophageal fistula occurred three months after the patch aortoplasty for mycotic aneurysm of descending thoracic aorta, he underwent ascending thoracic aorta to abdominal aorta bypass surgery with resection of thoracic aortic aneurysm and esophagorrhaphy with wrapping of the esophageal suture line and the stumps of aorta with pedicled omental flap. Three years after the operation, herniation of the stomach developed. The pedicled omental flap was ligated and divided, and the diaphragm defect was repaired.

• 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 radiological science and technology
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• v.39 no.2
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• pp.149-156
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• 2016

Measurement of cardiac blood flow using the magnetic resonance imaging has been limited due to breathing and involuntary movements of the heart. The present study attempted to improve the accuracy of cardiac blood flow testing through phase contrast magnetic resonance imaging by presenting the adequate breathing method and imaging variables by comparing the measurement values of cardiac blood flow. Each was evaluated by comparing the breath hold retrospective 1NEX and non breath hold retrospective 1-3NEX in the ascending aorta and descending aorta. As a result, the average blood flow amount/velocity of the breath hold retrosepctive 1NEX method in the ascending aorta were $96.17{\pm}19.12ml/sec$, $17.04{\pm}4.12cm/sec$ respectively, which demonstrates a statistically significant difference(p<0.05) with the non-breath hold retrospective method 1NEX of $72.31{\pm}13.27ml$ and $12.32{\pm}3.85$. On the other hand, the average 2NEX blood flow and mean flow velocity is $101.90{\pm}24.09$, $16.84{\pm}4.32$, 3NEX $103.06{\pm}25.49$, $16.88{\pm}4.19$ did not show statistically significant differences(p>0.05).The average blood flow amount/ velocity of the breath hold retrospective 1NEX method in the descending aorta were $76.68{\pm}19.72ml/s$, and $22.23{\pm}4.8$, which did not demonstrate a significant difference in comparison to non-breath hold retrospective method 1-3 NEX. Therefore, the non breath hold retrospective method does not significantly differ in terms of cardiac blood flow in comparison with the breath hold retrospective method in accordance with the increase of NEX, so pediatric patients or patients who are not able to breathe well must have the diagnostic value of their cardiac blood flow tests improved.

• Journal of Chest Surgery
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• v.27 no.5
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• pp.394-398
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• 1994

Takayasu`s arteritis is one of chronic inflammatory disease characteristically involving the aorta and it`s major branches. We experienced two surgical cases of Takayasu`s arteritis associated with the stenosis of the descending thoracic aorta. One case was 15 year-old girl and she was admitted because of dyspnea on exertion for 12 months. Aortogram showed the stenosis of the descending thoracic aorta from just below left subclavian artery to the 9th thoracic vetebra. The other case was 10 year-old girl and she was admitted because of URI and hypertension. Aortogram showed narrowing of right innominate artery, but developed collateral circulation, and the stenosis of the descending thoracic aorta near the 9th thoracic vertebra. In each case, bypass graft from the ascending aorta to the abdominal aorta just above the inferior mesenteric artery was performed with satisfactory result.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.861-866
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• 1998

Background: Pulmonary atresia (PA) with ventricular septal defect has various morphology of pulmonary arteries and pulmonary blood flow sources, so pulmonary arterial hypoplasia and arborization abnormality make this anomaly difficult to manage surgically. In cases associated with juxtaductal stenosis, we evaluated the change of the pulmonary arterial and juxtaductal stenotic site after shunt operations, and would like to find useful information in surgical planning and methodology of these patients. Material and Method: Among 59 cases diagnosed as PA with ventricular septal defect associated with juxtaductal stenosis, 29 cases who had cardiac catheterization before and after shunt operation were selected from July, 1991 to July, 1996. In 10 cases of right shunt operation(Group I) and 19 cases of left shunt operation (Group II), the diameters of the descending aorta, both pulmonary arteries, and the juxtaductal stenosis site were measured before and after the shunt operation. Result: In both Group I and II, the pre- and postoperative ratio of diameters of the ipsilateral pulmonary artery to the descending aorta was from 0.78${\pm}$0.31 units to 1.01${\pm}$0.26 units and from 0.67${\pm}$0.18 units to 0.84${\pm}$0.27 units respectively, showing a signigicant increase. The contralateral pulmonary artery index was increased from 0.92${\pm}$0.28 units to 1.05${\pm}$0.15 units and from 0.94${\pm}$0.27 units to 1.08${\pm}$0.37 units respectively, but could not be confirmed statistically. In both groups, the change of juxtaductal stenosis showed an aggravating tendency but of no statistical significance from 0.43${\pm}$0.27 units to 0.39${\pm}$0.25 units and from 0.32${\pm}$0.10 units to 0.30${\pm}$0.16 units respectively, and we experienced 2 total obstruction in Group II. Because the increased pulmonary blood flow by shunt operation has a favorable effect to the pulmonary arterial growth, the shunt operation is a recommended treatment in patients with hypoplastic pulmonary arteries. But in PA with ventricular septal defects, the change of juxtaductal stenosis is very important. In conclusion, the growth of ipsilateral (shunt site) pulmonary artery was promoted by shunt operation, but there is a tendency for the juxtaductal stenosis to be aggravated. And we experienced 2 total obstruction in Group II. Conclusion: Thus, in cases operated with shunt method, much careful postoperative follow up study including angiographic evaluation is needed, and after the shunt operation on the side of pulmonary artery associated with juxtaductal stenosis, early precise planning for total correction is recommended.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.104-110
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• 1985

The anomalous systemic arterial supply to the lung without sequestration is an uncommon congenital anomaly characterized by the presence of a part of lung tissue which supplied by an aberrant artery from the aorta or its branch and normal communication with the normal bronchial tree, and it was reported by Huber in 1777 first. It differs from bronchopulmonary sequestration in having normal bronchial communication from the remainder lung and normal lung histology. We experienced a case of anomalous systemic arterial supply to the lung without sequestration, which was confirmed preoperatively. The patient was 16 year old male and came to us with complaints of mild fever and profuse sputum with coughing. Chest film showed a ring-like soft tissue shadow in Rt. middle lung field. Aortogram revealed an aberrant artery originated from abdominal aorta at 12th thoracic vertebral level and supplying a part of Rt. lower lobe of lung. At. the time of operation, an aberrant systemic artery which originated from the abdominal aorta supplying the Rt. lower lobe was noted, and the bronchial communications were normal. After division and ligation of the aberrant artery, Rt. lower lobectomy was performed The postoperative courses were uneventful and the patient was discharged with good condition.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.747-751
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• 1997

We developed a subcutaneously adjustable new pulmonary artery banding device which can be easily tightened or released in patients with unstable postoperative hemodynamics. The banding device consists of stainless spring which is enveloped with PTFE, nd polyvinyl catheter(5F). And the adjuster consists of another polyvinyl tube with forming cap. We mark transluscent polyvinyl tube 1mm each in length. 6 dogs weighing 15 to 25 kg underwent banding of descending thoracic aorta with the device. At postoperative 1 and 2 day, the device was effectively banded and released. Even 3 months later, we noted effective banding with some degree of vessel injury. The preliminary animal study suggests that this new device may be applicable in patient with excessive pulmonary blood flow.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.359-365
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• 2006

Background: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. Material and Method: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was $62.6{\pm}8.8$ years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%, There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. Result: The number of distal anastomoses was $3.1{\pm}0.91$ and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%, and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). Conclusion: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.