• Journal of Chest Surgery
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• v.46 no.1
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• pp.68-71
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• 2013

A 67-year-old female patient was treated with conventional total arch replacement and insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta for acute DeBakey type I aortic dissection at one time. She had been treated with right coronary artery stent insertion for acute myocardial infarct 4 days earlier, and at that time, she was diagnosed with acute DeBakey type I aortic dissection from the ascending aorta to the suprarenal artery based on trans-esophageal echocardiography and aorta computed tomography. Through a median sternotomy, we inserted the SET graft through the opened aorta to the descending aorta. We also performed anastomosis between the proximal stented graft and the distal aortic arch, and then performed total arch replacement. For acute DeBakey type I aortic dissection, we report total arch replacement with insertion of a SET graft as a combination of conventional surgery and the interventional technique.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.201-204
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• 1990

The double aortic arch is the commonest anomaly among the vascular rings are relatively rare congenital vascular anomalies. This anomaly is malformation of the aortic arch system may, by compression of the trachea and esophagus, cause respiratory distress and dysphagia. We experienced one case of double aortic arch with right sided descending aorta with predominant right anterior arch treated surgically at Kyung Hee University Medical Center. 1-year-old male patient with acute airway obstruction due to combination of double aortic arch and right descending aorta. The diagnosis was made by simple X-ray & confirmed by barium esophagogram & aortogram. The operative approach was through left thoracotomy & underwent division of the left aortic arch & division of ligamentum arteriosum & suspension of divided proximal end of anterior arch to anterior thoracic wall. The postoperative courses was uneventful and doing well on the 3 years.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.748-751
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• 2000

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root(Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.389-393
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• 2014

Retroesophageal aortic arch, in which the aortic arch crosses the midline behind the esophagus to the contralateral side, is a rare form of vascular anomaly. The complete form may cause symptoms by compressing the esophagus or the trachea and need a surgical intervention. We report a rare case of a hypoplastic left heart syndrome variant with the left retroesophageal circumflex aortic arch in which the left aortic arch, retroesophageal circumflex aorta, and the right descending aorta with the aberrant right subclavian artery encircle the esophagus completely, thus causing central bronchial compression. Bilateral pulmonary artery banding and subsequent modified Norwood procedure with extensive mobilization and creation of the neo-aorta were performed. As a result of the successful translocation of the aorta, the airway compression was relieved. The patient underwent the second-stage operation and is doing well currently.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.610-618
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• 1995

Three neonates with interrupted aortic arch with VSD underwent one stage repair using revised technique of cardiopulmonary bypass with short period of circulatory arrest. A left posterolateral thoracotomy was made to permit mobilization of the descending aorta and placement of polytetrafluoroethylene[PTFE graft for distal aortic perfusion. Then the patient was placed in the supine position and a median sternotomy was performed to permit the proximal dissection, VSD repair, and direct anastomosis between the ascending aorta and descending aorta. This technique has advantages to facilitate direct anastomosis between the ascending aorta and the descending aorta, to lessen circulatory arrest time, and to prevent dangerous laceration and post-operative narrowing of the thin small ascending aorta at cannulation site. There was no operative mortality but postoperative stenosis developed in one case which was relieved with balloon aortoplasty.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.509-512
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• 2021

Extensive thoracic aortic disease involving the ascending aorta, the aortic arch, and the descending thoracic aorta may require multiple surgical and interventional managements, which impose a burden in terms of cumulative surgical trauma and the risk of interval mortality. Herein, we describe a single-stage arch and descending thoracic aorta replacement via sternotomy in a patient with multiple comorbidities presenting with an extensive thoracic aortic aneurysm.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.297-302
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• 1996

From January 1989 to July 1995, 18 patients underwent aortic repair for type A dissections. The e were 9 male and 9 female patients aged 41 to 68 years(mean, 53.8). Thirteen patients underwent the procedure during the acute period, and 5 during the chronic period. During repair of acute dissection, procedures included graft replacement of the ascending aorta only (6 patients), ascending aorta plus partial aortic arch (3), ascending aorta plus total aortic arch (2), Bentall's operation (1), and Bentall's operation plus total aortic arch (1). During repair of chronic dissection, procedures included Bentall's operation (3 patients), ascending aorta only (1), and ascending aorta plus partial aortic arch (1). During repair of the arch, antegrade cerebral perfusion was applied in 4 patients and hypothermic circulatory arrest in 3 patients. There were 4 operative deaths(22.2%), 2 of hemorrhage. and 2 of left ventricular failure in the operating room. Follow-up has been 100% completed and ranged from 2 to 53 months (mean, 17 months). One late death resulted from sepsis following secon operation. Thirteen of the survivors are doing well.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.704-707
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• 2007

Penetrating atherosclerotic ulcer involving the aortic arch has rarely been reported on in the literature. Acute rupture of a penetrating atherosclerotic ulcer involving the distal arch and the proximal descending thoracic aorta was found in a 78-year-old male, and he originally presented with acute-onset shoulder pain and hoarseness. Patch repair of the perforated arch and the proximal descending thoracic aorta was successfully done under total circulatory arrest.

• Journal of Chest Surgery
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• v.4 no.2
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• pp.81-86
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• 1971

Aneurysm of the Aorta is a grave disease mostly producing disabling symptoms and ultimate death by rupture and hemorrhage without surgical intervention. Aneurysm of the thoracic aorta is more common in arteriosclerosis than syphilitic origin,since the incidence of cardiovascular syphilis has been reduced significantly in recent decades and the life span of population has increase. We have experienced a case of luetic aneurysm of aortic arch without pulse in tile left arm which was succesfully treated by surgical intervention.

• Journal of Chest Surgery
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• v.44 no.3
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• pp.215-219
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• 2011

Background: Selective antegrade perfusion via axillary artery cannulation along with circulatory arrest under deep hypothermia has became a recent trend for performing surgery on the ascending aorta and aortic arch and when direct aortic cannulation is not feasible. The authors of this study tried using moderate hypothermia with right brachial and femoral artery perfusion to complement the pitfalls of single axillary artery cannulation and deep hypothermia. Materials and Methods: A retrospective analysis was performed on 36 patients who received ascending aorta or aortic arch replacement between July 2005 and May 2010. The adverse outcomes included operative mortality, permanent neurologic dysfunction and temporary neurologic dysfunction. Results: Of these 36 patients, 32 (88%) were treated as emergencies. The mean age of the patients was 61.9 years (ranging from 29 to 79 years) and there were 19 males and 17 females. The principal diagnoses for the operation were acute type A aortic dissection (31, 86%) and aneurysmal disease without aortic dissection (5, 14%). The performed operations were ascending aorta replacement (9, 25%), ascending aorta and hemiarch replacement (13, 36%), ascending aorta and total arch replacement (13, 36%) and total arch replacement only (1, 3%). The mean cardiopulmonary bypass time was $209.4{\pm}85.1$ minutes, and the circulatory arrest with selective antegrade perfusion time was $36.1{\pm}24.2$ minutes. The lowest core temperature was $24{\pm}2.1^{\circ}C$. There were five deaths within 30 post-op days (mortality: 13.8%). Two patients (5.5%) had minor neurologic dysfunction and six patients, including three patients who had preoperative cerebral infarction or unconsciousness, had major neurologic dysfunction (16.6%). Conclusion: When direct aortic cannulation is not feasible for ascending aorta and aortic arch replacement, the right brachial and femoral artery can be used as arterial perfusion routes with the patient under moderate hypothermia. This technique resulted in acceptable outcomes.