• Journal of Chest Surgery
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• v.43 no.4
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• pp.428-432
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• 2010

A 67 years old male patient was admitted with back pain that had recurred from 6 months previously. Eleven years previously, he underwent stent grafting at the descending thoracic aorta for a chronic Stanford type B aortic dissection. The preoperative computed tomography showed aortic dissection from the origin of the left subclavian artery to the bifurcation of the abdominal aorta, and there was a type I endoleak at the proximal portion of the stent graft and aneurysmal dilatation of the descending aorta. A hybrid endovascular repair was successfully performed, and this involved debranching and rerouting the aortic arch vessels under extracorporeal cardiopulmonary bypass and then this was followed 13 days later by stenting in the ascending aorta, the aortic arch and the descending aorta. The postoperative computed tomography showed complete exclusion of the type I endoleak. After discharge, he has been followed up for 8 months without any problems.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.440-448
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• 2006

Background: Surgery of descending thoracic or thoracoabdominal aorta has the potential risk of causing neurological injury including spinal cord damage. This study was designed to find out the risk factors leading to spinal cord and brain damage after surgery of descending thoracic and thoracoabdominal aorta. Material and Method: Between October 1995 and July 2005, thirty three patients with descending thoracic or thoracoabdominal aortic disease underwent resection and graft replacement of the involved aortic segments. We reviewed these patients retrospectively. There were 23 descending thoracic aortic diseases and 10 thoracoabdominal aortic diseases. As an etiology, there were 23 aortic dissections and 10 aortic aneurysms. Preoperative and perioperative variables were analyzed univariately and multivariately to identify risk factors of neurological injury. Result: Paraplegia occurred in 2 (6.1%) patients and permanent in one. There were 7 brain damages (21%), among them, 4 were permanent damages. As risk factors of spinal cord damage, Crawford type II III(p=0.011) and intercostal artery anastomosis (p=0.040) were statistically significant. Cardiopulmonary bypass time more than 200 minutes (p=0.023), left atrial vent catheter insertion (p=0.005) were statistically significant as risk factors of brain damage. Left heart partial bypass (LHPB) was statistically significant as a protecting factor of brain (p=0.032). Conclusion: The incidence of brain damage was higher than that of spinal cord damage after surgery of descending thoracic and thoracoabdominal aorta. There was no brain damage in LHPB group. LHPB was advantageous in protecting brain from postoperative brain injury. Adjunctive procedures to protect spinal cord is needed and vigilant attention should be paid in patients with Crawford type II III and patients who have patent intercostal arteries.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.387-389
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• 2024

• Journal of Chest Surgery
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• v.49 no.4
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• pp.264-272
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• 2016

Background: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. Methods: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996-2015). Seventy percent of the cases were ascending aortic replacements, and 3 0% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of $6.6{\pm}4.6years$. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of $4.9{\pm}2.9years$. Results: There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in the ascending aortic replacement group, and 1 patient died of distal aortic rupture in the total arch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). Conclusion: The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.92-95
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• 2010

Endovascular stent grafting is regarded as a promising alternative approach to open surgical repair for treating various aortic diseases in high risk patients. We report here on a case of a 79-year-old female who underwent endovascular stent-graft insertion in the ascending aorta for treating a complicated ascending aortic rupture that occurred secondary to radiation necrosis during the treatment of recurrent breast cancer.

• 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.24 no.6
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• pp.625-630
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• 1991

From April 1990 through June 1990, three patients underwent subclavian flap aortoplasty for relief of the coarctation of the aorta. The age of the patients were 13 days, 7 months and 39 months and their weights were 3.3kg, 6.5kg, and 11kg, respectively. Two patients had persistence of the ductus arteriosus and all patients had associated intracardiac anomalies. We used the technique devised by Mendonca, namely, repair of the coarctation of the aorta using the subclavian artery as a flap and preservation of the arterial blood flow to the left arm. In one patient with long narrowing of isthmus, significant residual pressure gradient was remained by this technique and we added patch aortoplasty. There were no hospital deaths and follow-up over a one year period shows all patients in good condition.

• 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.36 no.9
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• pp.691-694
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• 2003

A 49-year-old woman had thoracic back pain for several years. Chest CT scan and MRI angiography revealed descending thoracic aortic aneurysm with a maximum diameter of 69 mm. Thoracic aortography showed not only the aortic aneurysm, but also coarctation of descending thoracic aorta at the level of aortic hiatus of the diaphragm. Intercostal artery arising Adamkiewicz artery was found in descending thoracic aortic aneurysm just above the coarctation, The aneurysm with coarctation of the aorta was successfully repaired with prosthetic graft replacement under left atrio-femoral bypass.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.865-869
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• 2001

Operations for extensive aortic aneurysm are generally performed as staged operations with or without elephant trunk technique. However, we must consider single stage replacement in cases that are unsuitable for elephant trunk technique. We report a case of successful sing1e stage replacement of the entire thoracic aorta from the aortic valve to the level of diaphragm. The patient was a 35-year-old male who had Marfanoid features and had previously undergone replacement of the ascending aorta for aortic dissection. He recovered without neurologic complication and was discharged on 29th day after the operation. .