• Journal of Chest Surgery
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• 제49권5호
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• pp.397-400
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• 2016

Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an anomalous increase in platelet production. Many patients with ET are asymptomatic. Few studies have reported ET-associated thromboembolism in large vessels such as the aorta. We report a patient with ET who presented with peripheral embolism from an abdominal aortic thrombus and developed acute limb ischemia. The patient underwent aortic replacement successfully. The patient's platelet count was controlled with hydroxyurea, and no recurrence was noted over 2 years of follow-up.

• Journal of Chest Surgery
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• 제45권5호
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• pp.295-300
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• 2012

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.

• Journal of Chest Surgery
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• 제29권3호
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• pp.297-302
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• 1996

1989년 1월부터 1995년 7월까지 상행대동맥 박리환자 18례에 대한 교정수술을 시 행하였다. 남여비는 9 : 9였으며 연령분포는 41세부터 68세까지로 53.8세 였다. 급성박리가 13례, 만성박리가 5례 였다. 수술방법은 급성 13례에서 상행대동맥만 치환한 경우가 6례, 상행대동맥과 대동맥궁 일부를 치환 한 례가 3례, 상행대동맥과 대동맥궁 전부를 치환한 례가 1례, Bentall 술식이 1례, Bentall 술식 에 대동맥 궁 전부를 치환한 례가 1례 있었다. 만성 5례중 Bentall 술식을 시행한 경우가 3례, 상행대동맥을 치환한 경우가 1례, 상행대동맥 에 대동맥궁 일부를 치환한 례가 1례 있었다. 대동맥궁 교정수술을 시행한 환자 7례중 4례에서 선택적 뇌관류법을 시행하였고 3례에서 완전 순환차단법을 시행하였다. 18례중 급성에 서만 4례 사망하여 수술사망율은 22.2%였다. 사망원인은 출혈이 2례, 좌심실부전이 2례였다. 생존환자 14례를 술후 평균 17개월 외래추적하였으며 이중 1례에서 재수술후 2개월째 패혈증으로 사망하였고 나머지 환자는 양호한 편이다.

• Journal of Chest Surgery
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• 제45권3호
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• pp.148-154
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• 2012

Background: The adequate management of mild to moderate dilatation of the ascending aorta during cardiac operations remains controversial. In this study, we present the short-term outcomes of 90 patients undergoing ascending aortic wrapping with a Dacron graft during other cardiac operations. Materials and Methods: From March 2008 to January 2011, 90 consecutive patients underwent treatment for ascending aortic aneurysm using the external wrapping technique during the concomitant procedure. The study group consisted of 49 male and 41 female patients with a mean age of $58.7{\pm}13$years. The primary cardiac surgical procedures were coronary artery bypass grafting (CABG) in 3, aortic valve replacement in 2, and aortic valvuloplasty in 85 patients (isolated in 62 and combined with CABG or mitral valvuloplasty in 23). The ascending aorta diameter was measured using a computed tomography scan within 4 weeks after surgery, and was compared with the preoperative value. Results: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within a month after surgery from $46.4{\pm}4.3$ mm to $33.0{\pm}3.5$ mm (p<0.05). There was no early mortality or major surgical complication. During the mean follow-up period of $15.4{\pm}5.2$ months, there was only one late death caused by septic multiorgan failure. Conclusion: Dacron wrapping of the ascending aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of moderately dilated ascending aorta in selected patients.

• Journal of Chest Surgery
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• 제39권3호
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• pp.194-200
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• 2006

배경: 흉복부대동맥치환술은 흉강과 복강 및 횡격막의 절개가 필요한 광범위한 수술로 수술합병증과 사망률이 높은 질환으로 알려져 있다. 본 교실에서 2001년까지의 성적은 이미 보고한 바 있었으나 그 후 극저체온하 순환정지법을 사용하여 좋은 결과를 얻었기에 비교하여 보고하고자 한다. 대상 및 방법: 96년에서 2005년 8월까지 흉복부대동맥치환술을 20명의 환자에서 시행하였다. 원인질환은 동맥경화성흉복부대동맥류가 8예, 박리성흉복부대동맥류가 12예였다. 치환범위로는 Crawford분류법으로 I형이 2예, II형이 7예, III형이 1예, IV형이 7예, V형이 3예였다. 이들의 결과를 이미 보고한 시점인 2001년을 기준으로 구분하여 비교하였다. 걸과: 2001년 이전에 수술한 흉복부대동맥치환술 환자 9명중에 5명이 사망하였는데 type I, II의 3명은 모두 사망하였었다. 그 후에는 기존의 방법을 바꾸어 Crawford type I, II의 광범위 흉복부치환술 6명에서 극저체온하순환정지법을 사용하고, type III, IV, V의 국소 흉복부 치환술 5명에서 대퇴동정맥체외순환으로 적극적인 늑간동맥문합을 시행한 결과 11 명 모두에서 허혈성 합병증 없이 모두 치료되어 외래 경과 추적 중이다. 결론: 극저체온하 순환정지법은 광범위 흉복부대동맥을 안전하게 치환하게 하는 수기이다.

• Journal of Chest Surgery
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• 제28권4호
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• pp.409-411
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• 1995

One patient developing left main coronary stenosis following double valve replacement is reviewed. Angina pectoris developed 5 months postoperatively. Coronary perfusion with a balloon tip perfusion catheter was performed during previous operation and was considered technically satisfactory. Coronary angiography confirmed stenosis of the left main coronary artery. There was no further coronary arterial disease. An anterior approach between the aorta and pulmonary artery to expose the left main coronary artery was used and patch angioplasty was done. Repeat coronary angiography showed a widely patent left main coronary artery with excellent runoff. A careful search for coronary arterial injury should be made in all symptomatic patients following aortic valve replacement.

• Journal of Chest Surgery
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• 제24권9호
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• pp.926-929
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• 1991

A 31 year-old male patient underwent surgical treatment of the pseudoaneurysm of the ascending aorta complicating after the Bentall operation, He had undergone the replacement of the ascending aorta using the composite valved graft with direct coronary reimplantation under the diagnosis of the annuloaortic ectasia of ascending aorta associated with Marfan syndrome. Eleven months after the operation, he started to feel dyspnea and anterior chest pain, and was diagnosed as pseudoaneurysm around the ascending aortic graft. The second operation consisted of the dacron patch closure of the defect of the aortic graft which was the hole for previous coronary reimplantation, and the anastomosis between the coronary orifice and the aortic graft with the intermediate graft of a 10mm woven dacron tube, and suture closure of the fistula opening from the aneurysm. His postoperative course was uneventful and discharged without complication. He is doing well 10 months postoperatively.

• Journal of Chest Surgery
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• 제41권5호
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• pp.647-650
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• 2008

대동맥수술 후 대동맥질환의 재발은 주로 하부에 대동맥류의 형태로 나타나며 상부에 침투성 동맥경화성 궤양의 형태로 나타나는 것은 매우 드물다. 대동맥류 수술의 기왕력을 가진 환자에서 대동맥궁과 하행대동맥의 근위부에 걸쳐 발생한 침투성 동맥경화성 궤양의 파열을 완전순환정지 하에 인조혈관을 사용하여 패취봉합을 성공적으로 시행하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제51권4호
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• pp.286-289
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• 2018

We report a case of acute type I aortic dissection in which an emergency graft replacement of the ascending aorta and innominate artery was performed. We performed false lumen thrombosis through hybrid thoracic endovascular aortic repair to seal the primary entry tear, followed by false lumen obliteration at the level of the descending thoracic aorta, abdominal aorta, and right common iliac artery. Over a period of 4.5 years, we used Amplatzer vascular plugs and coils based on our computed tomography angiography follow-up protocol.

• Journal of Chest Surgery
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• 제46권1호
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• pp.33-40
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• 2013

Background: Total arch replacement (TAR) is being more widely performed due to recent advances in operative techniques and cerebral protective strategies. In this study, the authors reviewed the relationship between TAR and early- and mid-term changes of the false lumen after TAR in acute type A aortic dissection. Materials and Methods: Twenty-six patients (aged, $54.7{\pm}13.3$ years) who underwent TAR for acute type A dissection between June 2004 and February 2012 were reviewed. The relationship between the percentage change in the aortic diameter and the false lumen patency status was assessed by examining the early and late postoperative computed tomography imaging studies. Results: There were two in-hospital mortalities, one late death, and three follow-up loses. The mean follow-up duration for the final 21 patients studied was $54{\pm}19.0$ months (range, 20 to 82 months). The incidence of false lumen thrombosis within 2 weeks of surgery in the proximal, middle, and distal thoracic aorta, and the suprarenal and infrarenal abdominal aorta were 67%, 38%, 38%, 48%, and 33%, respectively, and 57%, 67%, 52%, 33%, and 33% for those examined at a mean of $49{\pm}18$ months after surgery, respectively. The false lumen regressed in 11 patients (42.3%). The aortic diameters were larger in the patients with a patent false lumen than those with a thrombosed false lumen at all levels of the descending aorta (p <0.05). Conclusion: TAR and a more complete primary tear-resection can be accomplished with a relatively low-risk of morbidity and mortality. Enlargement of the distal aorta significantly correlated with the false lumen patency status.