• Journal of Chest Surgery
• /
• 제9권2호
• /
• pp.251-264
• /
• 1976

Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

• Journal of Chest Surgery
• /
• 제35권10호
• /
• pp.740-744
• /
• 2002

초저체온 하에 체외순환정지와 역행성 뇌관류는 대동맥궁 병변의 수술에서 뇌손상을 피하기 위해서 흔히 이용되는 수술과정이다. 좌측 개흉으로 원위 대동맥궁과 하행대동맥 병변을 수술할 때 역행성 뇌관류를 상대정맥으로 시행하기 어려울 경우 대퇴정맥에서 우심방으로 넣은 정맥 캐뉼라를 통해 전신정맥 관류를 시행하여 역행성 뇌관류(우심방-역행성 뇌관류)를 시행하는 것이 더 쉬운 방법일 수 있다 이러한 역행성 뇌관류 방법의 안전한 시간은 명확하지 않다. 저자들은 94분의 우심방-역행성 뇌관류 하에 대동맥궁 하행대동맥 병변을 수술하여 신경학적 이상 없이 환자를 회복시킬 수 있었다. 이 결과에서 초저체온의 순환정지 상태에서 90분 이상의 우심방-역행성 뇌관류로 뇌의 허혈을 극복할 수 있다고 생각된다.

• Journal of Chest Surgery
• /
• 제34권8호
• /
• pp.604-610
• /
• 2001

배경: Stanford 제A형(type A) 대동맥 박리증은 상행대동맥이나 대동맥궁의 인조혈관 치환 수술 후에도 남은 대동맥의 가강이 확장되거나 파열의 가능성이 있기 때문에 철저한 추적관리가 필요하다. 연세대학교 세브란스병원에서는 1984년 6월부터 2000년 3월까지 Stanford 제A형의 대동맥박리 수술이 124예 있었다. 수술 후 가강의 확장이나 파열로 재수술한 6예에서 Marfan 증후군과의 관련성 등 원인을 조사하고 재수술의 방법과 결과, 재수술의 위험을 줄일 수 있는 방법 등을 알아보고자 한다. 대상 및 방법: 처음 대동맥 박리로 수술시급성인 경우가 4예 만성이 2예였으며 이중 3예가 Marfan 증후군이였다. 1예를 제외한 모든 환자에서 상행대동맥내에 내막파열이 있어 대동맥판막의 폐쇄부전의 정도에 따라 상행대동맥 인조혈관 치한수술(2례) 또는 Bentall 수술을 시행하였으며(3례) 1예는 여러 개의 가강과의 연결부위가 있는 만성 박리 환자로 Bentall 수술과 더불어 대동맥궁까지 인조혈관으로 치환을 하였다. 재수술은 평균 67.6개월(4개월-14년4개월) 후에 시행하였는데 1예는 만성 하행대동맥 박리 및 동맥류로 1예는 염증성 가성동맥류로 나머지 4예는 급성대동맥 박리로 재수술을 시행하였다. 수술은 하행흉부대동맥만을 치환한 경우가 1예, Hemiarch로 시행한 경우가 1예 그리고 나머지 4예는 원위부 상행대동맥에서 대동맥궁을 포함하여 근위부 또는 중간부위의 하행 흉부대동맥까지 인조혈관으로 치환하였다. 결과: 전체 124예 중 Marfan 증후군이 동반된 경우는 18예였다.

• Journal of Chest Surgery
• /
• 제33권6호
• /
• pp.469-475
• /
• 2000

Background: Thoracic aortomyoplasty is one of the surgical treatment for heart failure and has advantages over artificial heart or intraaortic balloon pumps. It uses autogenous skeletal muscles and solves problems such as energy source. However its use in clinical settings has been limited. This preliminary study was designed to develop surgical technique and to determine the effect of acute descending thoracic aortomyoplsty. Material and Method: Thirteen adult Mongrel dogs were used. The left latissimus dorsi muscle was wrapped around the descending aorta under general anesthesis. Swan-Ganz and microtipped Millar catheter were used for the hemodynamics and endocaridial viability ratio. Data were collected with myostimulator on and off in normal hearts and the ischemic hearts. Result: In normal hearts, the mean aortic diastolic pressure increased from 72$\pm$15mmHg at baseline to 78$\pm$13mmHg with stimulator on. Coronary perfusion pressure increased from 61$\pm$11mmHg to 65$\pm$9mmHg. Diastolic time increased from 0.288$\pm$0.003 msec to 0.290$\pm$0.003msec. Systolic time decreased from 0.164$\pm$0.002msec to 0.160$\pm$0.002 msec. Endocardial viability ratio increased from 1.21$\pm$0.22 to 1.40$\pm$0.18. In ischemic hearts, mean aortic diastolic pressure incrased from 56$\pm$21mmHg at baseline to 61$\pm$15mmHg with stimulator on. Coronary perfusion pressure increased from 48$\pm$17mmHg to 52$\pm$15mmHg. Diastolic time increased from 0.290$\pm$0.003 msec to 0.313$\pm$0.004msec. Systolic time decreased from 0.180$\pm$0.002 msec to 0.177$\pm$0.003 msec. Endovascular viability ratio increased from 0.9$\pm$0.31 to 1.1$\pm$0.31. The limited number of cases ruled out the statistic significance. Conclusion: Descending thoracic aortomyoplasty is a simple operation designed to use patient's own skeletal muscles. It trends to increase diastolic augmentation and coronary perfusion pressure. Modification of surgical technique and stimulator protocol would maximize the effect to assist the heart.

• Journal of Chest Surgery
• /
• 제42권1호
• /
• pp.79-86
• /
• 2009

배경: 전산화 단층촬영은 흉부대동맥의 이상소견을 진단하는데 매우 중요한 수단이다. 그러나 재래의 전산화 단층좔영은 단면적인 영상만을 볼 수 있어 여러 부위의 대동맥 직경을 측정하기에는 한계가 있었다. 다중검출 전산화 단층촬영은 이러한 한계를 극복할 수 있는 진단기기로 이를 이용하여 곡선으로 된 흉부대동맥의 직경을 주행방향과 직각으로 측정하여 연령, 성별, 키와 몸무게, 체표면적과 체질량지수, 고혈압과의 관계를 알아보고자 하였다. 대상 및 방법: 다중검출 전산화 단층촬영 장비를 이용하여 대동맥 조영술을 시행한 환자 중 특별한 대동맥 질환이 없는 것으로 판독된 환자 331명을 대상으로 하였으며, 남자가 141명이고 여자가 190명이었다. 이들을 연령별로 20~39세, 40~59세, 60세 이상으로 분류하였다. 대동맥의 직경은 다면상으로 재구성한 단면에서 대동맥 주행방향과 직각이 되도록 측정하였으며 상행대동맥의 중간(level A), 원위부 상행대동맥(level B), 대동맥궁(level C), 대동맥 협부(level D), 하행대동맥의 중간(level E)의 다섯 군데에서 측정하였다. 결과: 대상환자의 평균연령은 남자가 49.5세이고 여자가 54.9세였다. 대동맥의 평균직경은 level A가 31.1 mm, level B가30.2 mm, level C가 26.5 mm, level D가 24.0 mm, level E가 22.6 mm였다. 대동맥의 직경은 나이에 비례해서 증가하는 양상을 보였으며 고혈압 환자가 정상인보다 대동맥의 직경이 크게 나타났다. 키와 체표면적에 따른 차이는 상행대동맥에서 유의하게 나타났고 대동맥궁과 하행대동맥은 유의한 차이가 없었다. 체중과 체질량지수는 모든 부위에서 통계적 유의성이 없었다. 결론: 흉부대동맥의 직경은 성별과 나이, 고혈압에 통계적으로 유의한 차이가 있었고 키와 체표면적은 상행대동맥에만 차이를 보였고 하행대동맥에는 차이가 없었다. 그리고 체중과 체질량지수는 모든 부위에서 통계적 유의성이 없었다. 본 연구에서는 고혈압이 없는 정상인에서 연령별 대동맥 직경의 표준값과 정상한계값을 측정하였고 이를 한국인의 흉부대동맥 직경의 참고자료로 제시하고자 한다.

• Journal of Chest Surgery
• /
• 제24권2호
• /
• pp.206-211
• /
• 1991

Interruption of the aortic arch may be defined as discontinuity of the aortic arch in which either an aortic vessel or a patent ductus arteriosus supplies the descending aorta. This anomaly is a rare congenital malformation that usually occurs with severe associated intracardiac congenital anomalies, such as ventricular septal defect, patent foramen ovale and abnormal arrangement of the brachiocephalic arteries. Rarely, transposition of the great vessel, truncus arteriosus are coexistent. We experienced a case of the interrupted aortic arch [Type A] associated with VSD, PDA and patent foramen ovale in a 16 years old female. One stage total correction was done under profound hypothermia with total circulatory arrest. Aortic continuity was established using patent ductus arteriosus with anterior wall of main pulmonary artery, which was anastomosed obliquely to anteromedial side of the ascending aorta. Ventricular septal defect was closed using Dacron patch and patent foramen ovale was closed directly. Postoperative course was uneventful, except mild hoarseness.

• Journal of Chest Surgery
• /
• 제26권12호
• /
• pp.955-958
• /
• 1993

Pseudocoarctation is extremely rare and is due to elongation and kinking of aortic arch which mimiks true coarctation but has no pressure gradient across it. This state is essentially benign entity and needs no surgical intervention, but it frequently tends to progress into the aortic aneurysm that results in compressive symptom due to mass effect and unawared rupture and death.We experienced a descending aortic aneurysm secondary to pseudocoarctation. The patient was 53 year-old female presented as easy f`atiguability and facial flushing. The aortogram revealed tortuous and enlarged aorta at the level of ligamentum arteriosum. The aneurysm was resected and was end-to-end anastomosed successfully under partial cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged on postoperative 10 day.

• Journal of Chest Surgery
• /
• 제15권4호
• /
• pp.409-413
• /
• 1982

The incidence of syphilitic aortic aneurysm was decreased now a day. The predilection site of cardiovascular syphilis is the thoracic aorta, especially ascending portion. The form of syphilitic aneurysm is characterized by saccular or fusiform. We have experienced 58 year old female complained of intermittent left chest pain for these 2 years. Saccular aneurysm of 7 cm in diameter at the descending thoracic aorta just distal to the left subclavian artery was confirmed with aortogram, and etiologic lesion was suspected as syphilis by her strong positive finding of serum VDRL test. Excision of the aneurysm was done under temporary bypass with heparinized 10mm silicone bypass cannula, and 23 mm Dacron aortic prosthetic graft in 10 cm segment was replaced, and excised aortic segment was confirmed as syphilitic aneurysm on light microscopic examination. Postoperative hospital course was uneventful, and discharged 3 weeks after operation in good normotensive condition. The patient died of CVA 3 months after discharge at home.

• Journal of Chest Surgery
• /
• 제24권7호
• /
• pp.725-731
• /
• 1991

Four patients with traumatic rupture of aorta underwent operative repair at Seoul national university hospital. All cases were confirmed by preoperative aortography. Rupture site was aortic isthmus or just distal to it. Operations were somewhat delayed due to the low degree of suspicion and difficulties in diagnosis: ranging from 5 hours to 8 days. Operation was performed as same manners in all cases: resection of the ruptured portion and tubular woven dacron graft interposition in conjunction with shunt or bypass procedures, TDMAC-Heparin shunt between ascending and descending aorta was used in 3 cases, and LA-femoral centrifugal pump was used in one case. There were no intraoperative or postoperative mortality. Hoarseness was developed in all patients but paraplegia or other significant complications were not found in any of patients. We concluded that 1] high degree of suspicion is essential in the early diagnosis and treatment of traumatic aortic rupture and 2] any kind of shunt or bypass procedure is necessary in operative repair of traumatic aortic rupture and use of centrifugal pump without systemic heparinization is easier and safer procedure than others for the maintenance of adequate distal flow.

• Journal of Chest Surgery
• /
• 제27권6호
• /
• pp.455-459
• /
• 1994

We experienced 20 cases of acquired aortic diseases during last 1 year [Sep. 1992-Aug. 1993] with newly developed surgical strategies. There were 13 cases[65%] of aortic dissections, 5 cases[25%] of aortic aneurysms and 2 cases of Takayasu arteritis with mean age of 56 + 16 years[range:5-78].In ten cases of patients requiring ascending aortic replacement, femoral artery and femoral vein &/or RA auricle were used as cannulation site. With deep hypothermic circulatory arrest and retrograde cerebral perfusion of cold oxygenated blood via SVC, we can replace the ascending aorta and part of arch if necessary. The mean duration of circulatory arrest was 30 minutes[17-45 min]. In 5 cases of patients who requiring descending and thoracoabdominal aorta replacement, we used simple aortic crossclamping under normothermia with no heparin. The mean duration of aortic crossclamping was 37 minutes[25-50 min].The results of operation were as follow:Operative mortality[2 cases, 10%], delayed cerebral infarct[1], low extremity weakness[1] and intraoperative myocardial infarct[1]. There are no delayed complication or mortality as yet.