• Journal of Chest Surgery
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• v.43 no.3
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• pp.308-311
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• 2010

Coarctation of the aorta is frequently associated with intracardiac disease. It is very difficult to decide on the best method for surgically treating adult patients with these combined heart diseases. We performed single-stage repair via a modified Bentall operation and by creating an intrapericardial ascending-descending aortic bypass through a median sternotomy in a patient with coarctation of the aorta and annuloaortic ectasia, and the latter was associated with aortic valve regurgitation.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.510-513
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• 2003

Annuloaortic ectasia, aortic regurgitation(AR), and ventricular septal defect(VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hapoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.351-365
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• 1988

During one year[1987], 110 cases of open heart surgeries were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, Inje Medical College. And the results were summarized as follows. 1. Among the 110 cases, there were 77 cases of congenital heart diseases and 33 cases of acquired heart diseases. Age range of the congenital patients was 8 months to 30 years with the mean age of 8 years, and acquired patients was 16 to 56 years with the mean age was 32 years. 2. The heart lung machine used for cardiopulmonary bypass was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 50 of membrane type and 60 of bubble type. For all cases GIK[glucose-insulin-potassium] solution was used as cardioplegic solution for myocardial protection during operation. 3. Among the 77 congenital anomalies, there were 67 cases of acyanotic patients[ASD: 12, VSD: 50, PS: 1, AP window: 1, Gerbode defect: 1, ECD: 2] and 10 cases of cyanotic patients[TOF: 10], and to all of which the appropriate radical operations were applied. 4. Among the 33 acquired diseases, there were one case of left atrial myxoma, one of annuloaortic ectasia, 20 of mitral valve diseases[MS: 2, MSr: 8, MR: 2, MRs: 8], 9 of double valve diseases[MRs+AR: 1, MRs+ARs: 2, MRs+TR: 1, MSr+TR: 3, MSr+ASr: 1, MSr+ARs: 1], 2 of triple valve diseases[MSr+AR+TR: 1, MSr+ASr+TR: 1]. The left atrial myxoma was removed well with right atriotomy and atrial septal approach. And to the annuloaortic ectasia, Bentall operation was applied with good result. Mitral valve replacement[MVR] was applied to 20 cases of mitral valve diseases, double valve replacement[MVR+AVR] was applied to 6 cases of double valve diseases, MVR & tricuspid annuloplasty[TVA] was applied to 3 cases of mitral 5. The number of replaced valve were 39 in 31 cases. In MVR, 5 of mechanical valves[St. Jude Medical Valve] and 26 of tissue valves[Carpentier-Edward valve] were used. In AVR, 3 of mechanical valves and 5 of tissue valves were used. 6. Postoperative complications were occurred in 23 cases, and among them 21 cases were recovered with intensive cares, but 2 cases were expired[mortality: 1.8%].

• Journal of Chest Surgery
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• v.28 no.10
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• pp.906-911
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• 1995

From January 1991 to January 1995, 11 patients with aortic diseases underwent various surgical repairs. The age at operation ranged from 26 years to 63 years[ mean=50.9 years . The disease entities included 8 aortic dissections[ type I in 4, type II in 2 and type III in 2 cases , 2 Marfan`s syndrome with annuloaortic ectasia and 1 desecending thoracic aortic aneurysm The operative procedures we tried were 3 Bentall`s operation, 5 graft replacement of ascending aorta, and 3 graft interposition in descending thoracic aorta.Overall hospital mortality rate is 36.3%[4/11 . And causes of death are pump weaning failure in 2 cases and multiorgan failure in 2 cases. It was that 2 sternal dehiscence & mediastinitis, 1 acute renal failure, 2 hypoxic brain damages and 2 postoperative psychosis were complicated. Recently we tried surgical repair of aortic dissection five out of 6 cases using total circulatory arrest with deep hypothermia at 14$^{\circ}C$. Total circulatory arrest time ranged from 18 to 26 minutes[ mean 22.2 minutes , and mean aortic cross-clamping time was 48.2 minutes. One of 5 patient died on the 7th postoperative day due to multiorgan failure. Mortality of patients with TCA was 20%[1/5 , and it of remainders was 50%[3/6 . Our result for surgical repair using total circulatory arrest with deep hypothermia is satisfactory on the basis of our clinical data.

• Journal of Chest Surgery
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• v.25 no.8
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• pp.877-884
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• 1992

From October, 1986, to June, 1992 16 patients, 13 male and 3 female patients ranging in age 28 to 70 years, were operated on for thoracic aortic aneurysm, The etiology of these patients was atherosclerotic in 10, cystic medial necrosis in 4, and trauma in 2 cases, All patients were treated by use of CPB and circulatory arrest was applicated in one patient, Ten patients had aneurysms involving ascending aorta and six patients had descending aortic aneurysm, Among ten patients with ascending aortic aneurysm, annuloaortic ectasia with aortic regurgitation were seven and all underwent surgery with composite technique [Bentall operation], The other six patients with descending thoracic aneurysm were performed graft replacement. There was no early mortality but two late deaths occurred due to cerebral hemorrhage and renal problems at POD 3mo and 39mo respectively, We obtained satisfactory long-term results and overall survival rate at 5 year was 74.7%.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.158-163
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• 1988

12 Patients with thoracic aortic aneurysm were operated between May 1985 to Sept. 1987 at the our department, Hanyang University Hospital. We retrospectively evaluated the surgical results and considered diagnosis, surgical approach and perioperative problems of thoracic aortic aneurysm. There are 9 males and 3 females in the patients. The age ranged from 23 to 61 years with the mean age at 40.6 years. The cause of the aneurysm was atherosclerosis in 5, Marfan`s syndrome in 4, syphilis In 1, trauma in 1 and annuloaortic ectasia in 1 case. According to DeBakey`s classification, Type I was 1 case, Type II was 5 cases and Type III was 6 cases. Among 6 patients with ascending aortic aneurysm, Bentall`s operation in 4 cases and ascending aorta reconstruction using to Dacron Tube Graft in 2 cases were performed successfully. 6 cases with descending aortic aneurysm were managed by prosthetic graft replacement. Chylothorax was observed in 1 patient and postoperative hemorrhage necessitating reopening of the chest occurred in 4 of operative survivors. There were 2 hospital deaths; one patient was dead during the operation and one patient was dead during the post-operative course due to low cardiac output syndrome

• Journal of Chest Surgery
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• v.28 no.1
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• pp.65-68
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• 1995

Pectus excavatum occasionally occurs in patients who have underlying cardiac disease, especially Marfan syndrome. This report describes a patient with pectus excavatum who had ascending aortic aneurysm with aortic regurgitation and anterior leaflet prolapse of mitral valve. This patient underwent replacement of aortic valve and ascending aorta with 25 mm SJM valved conduit graft[Bentall operation with Cabrol shunt , and mitral valve replacement with SJM 31 mm, the pectus excavatum was corrected at the time of completion of the intracardiac operation with the modified sternal turnover. This procedure offered excellent operative exposure for the inracardiac operation with prevention of low cardiac output after operation due to depressed sternum and maintained chest wall stability resulting good cosmetic chest wall appearance. This patient recovered and discharged in good postoperative result with minimal temporary peroneal nerve palsy in his left leg.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.506-511
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• 1997

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

• Journal of Chest Surgery
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• v.24 no.4
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• pp.404-420
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• 1991

Surgical treatment of congenital and acquired heart disease preceded the development of accurate techniques for diagnosis, heart lung machine and cardiopulmonary bypass, intraoperative myocardial protection, operative techniques and cardiac anesthesia. For 5 years from Sep. 1985 to Sep. 1990, six hundred cases of open heart surgeries [OHS] were performed in the department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. The results were summarized as follows. 1. The annual number of OHS[cases per year] was above 100 since 1987, and the increasing rate of cases was 23.5% per year since 1986. 2. Among the total 600 cases, there were 470 cases of congenital heart diseases and 130 cases of acquired. Age range of the congenital patients was 8 months to 44 years with the mean age of 10 years, and acquired patients was 16 to 56 years with the mean age of 36 years. 3. Among the 470 congenital anomalies, there were 429 cases of acyanotic and 41 cyanotic patients. Totally, VSD was 286 cases[60.6%], ASD 103 cases[21.9%], TOF 35 cases [7.4%], PS 20 cases [4.1%], ECD 12 cases [2.0%], Ebstein`s anomaly 3 cases [0.6%], Valsalva sinus rupture 3 cases [0.6%] and others. The appropriate one stage radical operations were applied to the all congenital cases with the result of 2.6% immediate postoperative hospital mortality rate. 4. Among the 130 acquired cases, there were 122 cases of valvular heart diseases, 6 of heart tumors [5 myxoma, one malignant histiocytoma], one of LA thrombus and one of annuloaortic ectasia. Cardiac tumors and LA thrombus were removed through the atrial septal approach. Bentall procedure was adopted to the annuloaortic ectasia case. AVR, MVR and TVA [DeVega procedure] were applied to 120 valve diseases, and there were also one of OMC and one of MVA[Jerome-Kay procedure]. 5. Among the 120 valve replacement cases, there were 87 of single valve replacement cases [AVR: 8, MVR: 79], 11 of double valve replacement [AVR+MVR: 11], 12 of MVR+TVR and 10 of MVR+AVR+TVA. The total number of implanted prosthetic valves were 141. In MVR, 45 of St. Jude Medical valves, 63 of Carpentier-Edward valves and 4 of Ionescu-Shiley valves were used. In AVR, 18 of St. Jude Medical valves and 11 of Carpentier-Edward valves were used. in MVR, 29mm and 31mm sized valves were used mostly and In AVR, 23mm sized valves were used mostly. 6. Postoperatively many kinds of complications were occurred. Among them, wound problems [30 cases], low output syndrome [29 cases], arrhythmia [20 cases], pleural effusion and pneumothorax [13 cases] were occurred frequently. The postoperative immediate hospital mortality was 3.0% in total [congenital 2.6%, acquired 4.6%].

• Journal of Chest Surgery
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• v.24 no.9
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• pp.926-929
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• 1991

A 31 year-old male patient underwent surgical treatment of the pseudoaneurysm of the ascending aorta complicating after the Bentall operation, He had undergone the replacement of the ascending aorta using the composite valved graft with direct coronary reimplantation under the diagnosis of the annuloaortic ectasia of ascending aorta associated with Marfan syndrome. Eleven months after the operation, he started to feel dyspnea and anterior chest pain, and was diagnosed as pseudoaneurysm around the ascending aortic graft. The second operation consisted of the dacron patch closure of the defect of the aortic graft which was the hole for previous coronary reimplantation, and the anastomosis between the coronary orifice and the aortic graft with the intermediate graft of a 10mm woven dacron tube, and suture closure of the fistula opening from the aneurysm. His postoperative course was uneventful and discharged without complication. He is doing well 10 months postoperatively.