• Journal of Chest Surgery
• /
• v.39 no.2 s.259
• /
• pp.150-153
• /
• 2006

Percutaneous transcatheter closure of atrial septal defects as a therapeutic alternative in appropriate patients provides superior cosmetic results, is less invasive, and allows for shorter hospital stays. Unfortunately, however, such percutaneous procedures can be associated with catastrophic procedure complications that may require immediate surgical intervention. We report a case of aorta-to-right atrial fistula two months after transcatheter occlusion of an atrial septal defect by an Amplatzer septal occluder. Revealed by dyspnea, palpitation and hemolysis, this complication needed an emergency surgical operation. The fistula between the noncoronary Valsalva sinus of the aorta and the right atrium was repaired. The atrial septal defect was closed by patch. The cause of this serious complication appears to be erosion into the aorta by the right atrial disk.

• Journal of Chest Surgery
• /
• v.47 no.1
• /
• pp.6-12
• /
• 2014

Background: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities. Methods: This study enrolled 41 patients (age, $55.2{\pm}11.9$ years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr). Results: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint. Conclusion: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

• Journal of Chest Surgery
• /
• v.17 no.3
• /
• pp.448-455
• /
• 1984

Coarctation of the Aorta is a congenital constriction of aorta of varying degree, usually located at or near the aortic ismuth with frequent associations of other cardiac anomalies. Various modes of surgical corrections, such as resection and end-to-end anastomosis, graft interposition, angioplasty using prosthetic patch or subclavian flap have been used according to the status of coarctation and age of the patient. We have experienced two cases of surgically treated coarctation of the aorta, one of which was preductal coarctation with hypoplastic aortic arch and ventricular septal defect in a 4 year old boy, and the other case was juxtaductal type with aortic regurgitation. Subclavian flap angioplasty with additional pulmonary artery banding procedure was done in the first case and wedge resection with end-to-end anastomosis and aortic valve replacement [St. Jude valve, 23mm] 20 days later of first operation in the other case. The first case developed massive tarry stool on 3rd POD, probably due to mesenteric arteritis with resultant bowl ecrosis, and expired the next day. Recovery was uneventful with the second case.

• Journal of Chest Surgery
• /
• v.17 no.4
• /
• pp.698-702
• /
• 1984

Anomalous origin of right pulmonary artery from ascending aorta is a rare congenital heart disease. We experienced a case of anomalous origin of right pulmonary artery from ascending aorta with associated patent ductus arteriosus and patent foramen ovale, which was diagnosed by angiocardiography and cardiac catheterization. The ductus was ligated just before bypass, and a Dacron-graft with a diameter of 16 mm was interpolated posteriorly to the aorta between the right pulmonary artery and the pulmonary trunk. The postoperative course was uneventful. The right heart catheterization and right ventriculography performed on postoperative twelfth day revealed widely patent anastomotic site between the right pulmonary artery and the pulmonary trunk without residual stenosis. She was discharged on postoperative fourteenth day.

• Journal of Chest Surgery
• /
• v.30 no.10
• /
• pp.1019-1023
• /
• 1997

The anomaly which the right pulmonary artery originates from the ascending aorta is a rare and usually fatal form of congenital heart disease. This lesion is often associated with a patent ductus arteriosus. Death frequently occurs in early infancy. Anomalous origin of the right pulmonary artery is much more common than anomalous origin of the left pulmonary artery. The anomalous right pulmonary artery usually arise from the posterior aspect of the ascending aorta close to the aortic valve. We report a 1 month-old infant with right pulmonary artery arising from the ascending aorta, which was corrected successfully by direct anastomosis to the main pul onary artery.

• Journal of Chest Surgery
• /
• v.33 no.1
• /
• pp.103-106
• /
• 2000

Advanced esophageal carcinoma which invades into adjacent organs are classified as T4 esophageal cancer,. Its complete resection without residual tumor would be difficult. Preoperative chemoradiotherapy and combined modality therapy are being tried to improve survival in patients with T4 esophageal carcinoma. In a 74-year-old man a 6cm squamous cell carcinoma of the esophagus with invasion of the thoracic aorta was detected (T4). After neoadjuvant chemoradiotherapy the patient was operated on using bio-pump with aorto-femoral cannulation. The invased segment of descending aorta was resected and reconstructed with a graft. The tumor was resected and EG anastomosis was done. The postoperative period was uneventful the patient was discharged after good condition and has been well to now.

• Journal of Chest Surgery
• /
• v.12 no.3
• /
• pp.183-190
• /
• 1979

A 23-year-old male patient complained dyspnea on exertion and orthopnea since December 1977. On examination, he was tall and slender. There was grade IV/VI to-and-fro murmur on the left sternal border especially on Erb`s point. The liver was descended 2 fingers breadth below right costal margin. There were no signs of Marfan`s syndrome. Echocardiography demonstrated partial closure of aortic valve and dilated aortic root with enlargement of ascending aorta. Left heart cardiac catheterization revealed moderately elevated pulmonary wedge pressure and right ventricular pressure. The left ventricular end diastolic pressure was markedly elevated to 26 mmHg. On aortography, the aortic regurgitation was severe and it was belonged to angiographically Grade IV. The aortic valve was replaced with Carpentier-Edwards valve without excision and replacement of ascending aorta, under the impression of rheumatic valvular heart disease. After closure of aortotomy, blood pressure was transiently elevated and bleeding from the site of inserting air vent needle of ascending aorta was developed. The bleeding was not controlled by any means. On postmortem microscopic study, the histologic changes were strikingly limited to the ascending aorta from the region of the aortic valve ring.

• Journal of Chest Surgery
• /
• v.19 no.4
• /
• pp.688-694
• /
• 1986

Takayasu`s disease is an arteritis of unknown etiology involving larger elastic arteries such as aorta and its branches, pulmonary arteries and rarely coronary arteries. Especially, aortic root involvement with the valvular leaflets has been reported in several cases of Takayasu`s arteritis. Recently we have experienced one case of Takayasu`s arteritis involving left subclavian artery, descending aorta, left renal artery and multiple valvular leaflets. The patient was 33 year-old female and admitted with complaints of cough, dyspnea and general weakness. Aortogram revealed extensive type of arteritis showing dilatation of ascending aorta, segmental narrowing of thoracic aorta and Riolan`s anastomosis. Double valve replacement [mitral and aortic valve] and tricuspid valve annuloplasty were performed. The patient made an excellent postoperative recovery and has shown striking improvement in cardiac status, NYHA functional class II eight months after operation.

• Journal of Chest Surgery
• /
• v.21 no.2
• /
• pp.334-339
• /
• 1988

We have experienced one case of ascending aorta aneurysm with aortic regurgitation due to atherosclerosis. The 45 year old man had been suffered from palpitation and precordial chest pain. 2-D echocardiogram and aortogram confirmed aneurysm of ascending aorta with aortic regurgitation. Atherosclerotic change was noted in the aortic wall and there was marked dilatation of the sinuses of Valsalva as well as the aortic annulus with upward displacement of coronary ostia in the operative field. The patient underwent complete replacement of the aneurysmal ascending aorta and the aortic valve with 27mm Bjork-Shiley aortic valve composite graft. We got preclotting with heparin free blood including thrombin and then autoclave at 132` for 3 minutes. The postoperative course was uneventful and the patient was discharged with good clinical result.

• Journal of Chest Surgery
• /
• v.27 no.12
• /
• pp.1042-1046
• /
• 1994

We experienced a case of traumatic aneurysm of descending thoracic aorta by an automobile accident. The patient was 23-year-old-male with a traumatic aortic aneurysm [6x12cm] on the descending thoracic aorta just distal to the origin of the left subclavian artery. Exposure was obtained through a left posterolateral thoracotomy incision in the fourth intercostal space and then partial femoro-femoral cardiopulmonary bypass was established.After aortic cross- clamping, the aneurysmal sac was opened and repaired with interposition of Dacron vascular graft and aortic cross-clamping period lasted for 100 minutes. Postoperative bleeding and vocal cord paralysis were complicated, but bleeding was controlled by reoperation and vocal cord paralysis was improved. Follow up was continued for 14months and postoperative course was uneventful.