• 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 Korean Neurosurgical Society
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• v.50 no.3
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• pp.252-255
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• 2011

Authors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed hemodynamic cerebral infarction and extensive cord ischemia, respectively. Computerized tomography angiography confirmed a dissecting aneurysm of the descending aorta. The cause of the brain infarction may not have been embolic, but hemodynamic one. Dissection-induced hypotension may have elicited cerebral perfusion insufficiency. The cause of cord ischemia may be embolic or hemodynamic. The dissected aorta was successfully replaced into an artificial patch graft. The arm monoparesis was improved, but the paraplegia was not improved. In rare cases of brain and/or spinal cord infarction caused by painless acute dissecting aneurysm of the aorta, accurate diagnosis is critical because careless thrombolytic therapy can result in life-threatening bleeding.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.591-594
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• 1993

To clarify the apparent hypoplasia of the descending aorta in infants with atrioventricular septal defect[AVSD] patients, we reviewed the catheterization data and angiograms of 34 consecutive patients with AVSD less than 1 year of age who underwent repair at our institution since 1985. We compared them to 10 patients with Atrial Septal Defect[ASD] and 10 patients with Ventricular Septal Defect[VSD] who were matched for age, size and Qp/Qs. The Descending Aorta Index [DAI] of the AVSD group was not different from the VSD or ASD groups, [147.9$\pm$ 34.8 mm2/m2 versus 158.6$\pm$ 31.5 mm2/m2 and 153.2$\pm$ 43.1 mm2/m2].However, the Pulmonary Artery Index [PAI] of the AVSD group was significantly larger than the other groups [684.3$\pm$ 170.7 mm2/m2 versus 454.1$\pm$ 109.1 mm2/m2 and 534.9$\pm$ 148.4 mm2/m2][p<0.05], as was the ratio of PAI/DAI in the AVSD group [4.99$\pm$ 1.77 versus 2.89$\pm$ 0.81 and 3.6$\pm$ 0.92][p<0.05]. Despite similar Qp/Qs ratios, both the mean PA pressure and the Rp/Rs in the AVSD group was higher than the VSD and ASD groups: 43.1$\pm$ 15.6 mmHg versus 29$\pm$ 11.6 mmHg and 24$\pm$ 18.1 mmHg [p<0.05], and 0.27$\pm$ 0.22 versus 0.14$\pm$ 0.03 and 0.11$\pm$ 0.05 [p<0.05] respectively. The apparent hypoplasia of the descending aorta in infants with AVSD is an illusion created by the abnormally large pulmonary arteries, which are significantly larger than in patients with ASDs or VSDs.

• Journal of Chest Surgery
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• v.11 no.1
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• pp.81-84
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• 1978

A 15 years Old girl was admitted with chief complaints of intermittent claudication of lower extremity, dizziness, and headache for 5 years. On admission, malignant hypertension was noted in the upper part of body [190-150/120-110] but femoral & dorsalis pedis pulse could not palpate. Once she had experienced C. V. A. due to hypertension of upper part, about years ago. On auscultation, systolic murmur was audible along the left sternal border. E.C.G. Showed left ventricular hypertrophy pattern, and others within normal limit. Retrograde aortography demonstrated diffuse narrowing of entire thoracic aorta with underdeveloped lower abdominal aorta [below the renal artery] & both common lilac artery, and rich collaterals, but normally visualized greater arteries in the aortic arch. On left posterolasteral thoracotomy, entire descending thoracic aorta revealed marked narrowing with mild perivascular adhesion, but no mediastinal pleura adhesion. These findings suggest as congenital type of atypical coarctation in the entire thoracic aorta with mild secondary change. But histopathology was showed the findings of chronic non-specific aortitis, later. Dacron by pass graft was performed with end to side anastomosis between graft and aortic wall. After operation, all her preoperative symptoms & signs were disappeared, and discharged with good general condition.

• Journal of Chest Surgery
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• v.27 no.4
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• pp.318-324
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• 1994

Cross-clamping of the descending thoracic aorta results in proximal hypertension,increase in left ventricular afterload,and impairment of distal organ perfusion. Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamping of the thoracic aorta. At Seoul National University Hospital, 7 patients were treated for the thoracic or thoracoabdominal aortic aneurysm using left atrium-femoral artery bypass with Bio-medicus centrifugal pump between October,1989, and January,1993. There were atherosclerotic thoracic aneurysm in 3 cases, thoracoabdominal aortic aneurysm due to chronic aortic dissection in 3 cases,aortic rupture due to trauma in 1 case. Total of 7 patients were operated by graft replacement with reimplantation of important branches. None of these cases developed severe complications and hospital death. We believe that the Bio-Medicus centrifugal pump is a simple and safe means of perfusing the lower body, kidneys, and spinal cord without necessitating heparinization.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.617-620
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• 1997

Traumatic aneurysm of both the thoracic aorta and the left ventricle are extremely rare in children because it is characterized by high mortality. We report a case which we experienced recently with sucessful outcome. A Five-year-old boy had a blunt trauma by bongo bus. He had pulmonary hemorrage and pericardial effusion complicated by multiorgan failure threatening his life. Aneurysm of LV and Descending aorta were showed by 2-D echocardiogram and MRI. The atient underwent successful corrective surgery 2 and half momths after trauma, the Postoperative status of this patient was uneventful, now he is being followed up the OPD.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.488-496
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• 1988

Thirty-seven patients of aortic aneurysm underwent operations during January 1984 December 1987 at our hospital. Twenty-six patients had aneurysms involving ascending aorta, three patients had aneurysms involving both ascending aorta and abdominal aorta. and eleven patients had aneurysms involving descending thoracic or abdominal aorta. Among the patients who had aneurysms involving ascending aorta, annuloaortic ectasia with aortic regurgitation were thirteen and all of these underwent ascending aorta graft replacement + AVR with composite graft. The patients who had aortic regurgitation due to ascending aortic dissection were three and all of these underwent intraluminal ringed graft insertion at ascending aorta + aortic valve resuspension. Intraluminal ringed graft insertion was safe, simple, and fast method in the operation for aortic aneurysm. Eleven patients were underwent this operation and the results were good. Major causes of death of the patients who underwent aortic aneurysm operation are underlying cardiovascular diseases or delayed rupture of the aneurysm or complications related newly appeared aneurysm. Among our patients, dissection progressions were appeared in two but neither severe nor complicated. And no patient died from delayed rupture of aneurysm or complications related newly appeared aneurysm. All patients were followed up via OPD and were controlled hypertension or heart failure if present. Operative mortality is 18.9\ulcornera in all, 23% in patients who had aneurysms involving ascending aorta and 7.6` who had aneurysms involving descending thoracic or abdominal aorta. Comparing with other reports, our operative mortality is still high but improved steadily. So we recommend aggressive surgical management of the aortic aneurysm.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.522-528
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• 1991

A successful repair of aortic dissection of descending thoracic aorta was performed in a 48 year old man. The patient was visited ER because of abruptly onset chest pain. On admission, Chest film showed mediastinal widening and undertaken chest CT, echocardiogram and angiogram There was evidence of dilation on descending aorta with internal separation of intimal calcification. Aneurysmal sac with dissection was noted from just below left subclavian artery to 2cm above of diaphragm. He underwent thoracotomy and the impending ruptured aneurysm of the aorta was replaced with a Woven Dacron graft[20Yo Albumin preclotted] using LA-femoral bypass. Postoperative course was uneventful.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.360-370
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• 1985

A case of complete interruption of aortic arch with aortopulmonary window, patent ductus arteriosus, and aberrantly originated right subclavian artery from proximal descending aorta, in a four year old boy is reported in detail. This is the only reported case in Korea, who has had a successful one-stage total anatomical correction of this combination of defects. Under deep hypothermia and total circulatory arrest, aortic continuity was established using patent ductus arteriosus and anterior wall of pulmonary artery, which was anastomosed obliquely to anteromedial side of ascending aorta. Aortopulmonary window was closed using Impra patch via pulmonary arteriotomy. Then pulmonary arteriotomy was reconstructed primarily except at the junction of right pulmonary artery and main pulmonary artery, where a small piece of pericardium was used to close the defect to prevent kinking and narrowing of right pulmonary artery. Postoperative cardiac catheterization demonstrated a good reconstruction.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.968-975
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• 1990

An aortobronchial fistula is a rare complication of aneurysm of the aorta. The fistula starting from a chronic traumatic aortic aneurysm is exceptionally rare. Our observation concerns a patient of 26 with previous chest trauma who had atelectasis of left lung following dyspnea and hemoptysis. Aortography and surgical intervention revealed that this was a chronic traumatic aortic aneurysm of descending thoracic aorta, which developed a fistula in the bronchus. She underwent left posterolateral thoracotomy and the surgical repair of the aneurysm was performed with a woven Dacron patch graft using a temporary external bypass between the ascending and the descending aorta. The fistula in the bronchus was closed with simple interrupted sutures. In the immediate postoperative period, double vision, headache, and hoarseness developed but returned normal.