• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.414-419
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• 2007

Background: Replacing the ascending aorta is a standard surgical option for treating acute type A aortic dissection. But replacing the aortic arch has recently been reported as an acceptable procedure for this disease. We compared the effects of aortic arch replacement for treating acute type A aortic dissection with the effects of ascending aortic replacement. Material and Method: From 2002 to 2006, 25 patients undewent surgical treatment for acute type A aortic dissection, 12 patients undewent ascending aortic replacement and 13 patients underwent aortic arch replacement. Among the aortic arch group, an additional distal stent-graft was inserted during the operation in 5 patients. 19 patients (11 arch replaced patients and 8 ascending aortic replaced patients) were followed up at the out patient clinic for an average of $756{\pm}373$ days. All the patients undewent CT scanning and we analyzed their distal aortic segments. Result: 4 patients who underwent ascending aortic replacement died, so the overall mortality rate was 16%. Among the 11 long term followed-up arch replacement patients, 2 patients (18.1 %) developed distal aortic dilatation and one of them underwent thoracoabdominal aortic replacement later on. However, among the 8 the ascending aortic replaced patients, 5 patients (62.5%) developed distal aortic dilatation. Conclusion: Aortic arch replacement is one of the safe options for treating acute type A aortic dissection. Aortic arch replacement for treating acute type A aortic dissection could contribute to a reduced distal aortic dilatation rate and fewer secondary aortic procedures.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.82-89
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• 1977

A rupture of a dissecting aneurysm of the aorta is life threatening disease and calls for emergency surgical treatment. The author recently experienced one case of ruptured dissecting aneurysm of the descending thoracic aorta complicated with left hemothorax who was recovered after emergency operation of Aug. 11, 1976. The patient was a 43 years old farmer with known hypertension [260/120] for 20 years but without any venereal disease and had experienced sudden throbbing chest pain. Chest film and aortogram revealed this case ruptured aneurysm of descending thoracic aorta complicated with left hemothorax. In this case, large dissecting aneurysm extend from proximal part of left subclavian artery below diaphragm and involved with 3.0 and 4.0cm sized elliptical rupture in proximal part of descending thoracic aorta. And so, neither fenestration procedure nor replacement of dacron artificial vessel was suitable for this case. Finally, only the rupture site of aneurysm was treated by covering with fibrous pleura and teflon patch. The post-operative management of this case was planned to control hypertension with antihypertensive drugs. The follow-up was possible up to date about 2months. The patient has been doing well with ordinary activities except mild chest discomfort.

• Journal of Chest Surgery
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• v.35 no.8
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• pp.584-589
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• 2002

Background : The thoracic and thoracoabdominal aortic surgery is a complicated procedure that has various method of approach and protection. The authors have performed several methods to treat these diseases. Therefore, we attempt to analyze their results and risks. Material and Method: From June of 1992 to August of 2001, we performed 26 cases of thoracic aortic surgery and 10 cases of thoracoabdominal aortic surgery. There were 17 aortic dissections, 17 aortic aneurysms, one coarctation of aorta and one traumatic aortic aneurysm. The thoracic aortic replacement was performed under a femorofemoral bypass, an LA to femoral bypass, or a deep hypothermic circulatory arrest. The thoracoabdominal aortic replacement was performed under a femorofemoral bypass or a pump assisted rapid infusion. Result: There were 7 renal failures, 11 hepatopathies, 7 cerebral vascular accidents, 2 heart failures, 5 respiratory insufficiencies, and 2 sepsis in postoperative period. There were 9 hospital mortalities which were from 2 bleedings, 2 heart failures, 2 renal failures, a sepsis, a respiratory failure, and a cerebral infarction. There were 3 late deaths which were from ruptured distal anastomosis, cerebral infarction, and pneumonia. Conclusion: Deep hypothermic circulatory arrest was not good supportive methods for thoracic aortic replacement. Total thoracoabdominal aortic replacement was a high risk operation.

• Journal of Chest Surgery
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• v.34 no.8
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• pp.604-610
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• 2001

Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 200, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. Material and method: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. Result: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperationc ases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.481-487
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• 1998

The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients(25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.

• Journal of Chest Surgery
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• v.45 no.1
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• pp.30-34
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• 2012

Background: The long-term results of homografts used in systemic circulation are controversial. We assessed the long-term results of using a cryopreserved homograft for an aortic root or aorta and its branch replacement. Materials and Methods: From June 1995 to January 2010, 23 patients (male:female=15:8, $45.4{\pm}15.6$ years) underwent a homograft replacement in the aortic position. The surgical techniques used were aortic root replacement in 15 patients and aortic graft interposition in 8 patients. Indications for the use of a homograft were systemic vasculitis (n=15) and complicated infection (n=8). The duration of clinical follow-up was $65{\pm}58$ months. Results: Early mortality occurred in 2 patients (8.7%). Perioperative complications included atrial arrhythmia (n=3), acute renal failure (n=3), and low cardiac output syndrome (n=2). Late mortality occurred in 6 patients (26.1%). The overall survival rates at 5 and 10 years were 66.3% and 59.6%, respectively. Six patients (28.6%) suffered from homograft-related complications. Conclusion: Early results of homograft replacement in aortic position were favorable. However, close long-term follow-up is required due to the high rate of homograft-related events.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.194-198
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• 2010

Intramural hematoma of the aorta (IMH) is the precursor or a variant of a classic aortic dissection where hemorrhage occurs within the aorta wall in the absence of an initial intimal tear. IMH has a high rate of mortality and morbidity. The optimal therapy for IMH is uncertain, yet the involvement of the ascending aorta is usually considered as an indication for surgery due to the associated risk of rupture or cardiac tamponade. We report here on a case of a 71-year-old man who presented with syncope. Because of misdiagnosis, he underwent computed tomography (CT) after 5 hrs from arriving to the ER. Computed tomography of the aorta revealed intramural hematoma of the ascending aorta with cardiac tamponade. He also had vascular complications such as acute renal failure and visceral ischemia. We performed emergency graft replacement of the total arch and ascending aorta. He was discharged without complication on postoperative day 14.

• Journal of Chest Surgery
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• v.9 no.1
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• pp.44-49
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• 1976

Aneurysm of the Aorta is a grave disease mostly producing disabling symptoms and ultimate death by rupture and hemorrhage without surgical intervention. The author recently experienced one case of surgical correction of descending thoracic aortic aneurysm treated with excision of the aneurysm and replacement of Dacron artificial vessel under temporary external by pass technique in November, 10th, 1975. 9mm internal diameter arterial cannula was inserted into upper and below the aneurysm. Bypass time was about 1 hour. The case was 35 years old women who had small egg sized saccular aneurysm in the upper third of the descending thoracic aorta involving the 1t. subclavian artery. Histopathological diagnosis was arteriosclerotic. Immediate postoperative course had been uneventful except low pressure and pulse of the left arm. The follow-up was possible up to date about 3 months. The patient has been doing well with ordinary activities except mild left chest discomfort.

• 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.35 no.9
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• pp.675-679
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• 2002

In patient with severe adhesion between lung and aorta, there is some limitation in approaching the distal arch or descending thoracic aorta through the usual left thoracotomy. We report a case of a successfully managed distal arch and descending thoracic aortic aneurysm through the median sternotomy without any manipulations of the lung in a 66 year old man who presented hemoptysis.