• Journal of Chest Surgery
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• v.37 no.6
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• pp.517-523
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• 2004

Background: The location of intimal tear can vary in type A acute aortic dissection. The aim of this study was to assess the operative result according to the intimal tear site. Material and Method: From January, 1995 to May, 2003, 18 patients underwent surgery for acute type A aortic dissection. The patients were classified according to the intimal tear site. In Group I (n=11), the intimal tear site was located within the ascending aorta, in Group II (n=7), the intimal tear site was located in the aortic arch, descending aorta, or intramural hematoma only. All clinical data were analyzed retrospectively. Result: In Group I, the operative time, cardiopulmonary bypass time, aorta cross clamp time and circulatory arrest time were 381.5$\pm$81.0 min, 223.5$\pm$42.5 min, 146.4$\pm$34.8 min and 36.5$\pm$17.4 min, respectively; and in group II, 461.7$\pm$54.0 min, 252.5$\pm$45.3 min, 162.5$\pm$45.3 min and 47.0$\pm$14.4 min respectively. All of those were greater in group II. The overall hospital mortality rate was 27.8% (5/18) and was significantly higher in Group II (57.1%)(p=0.003) compared to that in Group I (9.1%). The causes of death were hemorrhage (n=1) in group I and hemorrhage (n=2), multiple organ failure (n=1), and rupture of abdominal aorta (n=1) in group II. Conclusion: Surgical treatment of acute type A aortic dissection with intimal tear in the ascending aorta results in an acceptable mortality rate, but in patients with intimal tear in the aortic arch or descending aorta, the operative mortality still remains high when only ascending aorta replacement was performed. In these circumstances, in order to improve surgical results, efforts to include the intimal tear site in the operative procedure will be needed.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.298-302
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• 2008

We experienced a case of tuberculosis presented simultaneously with pseudoaneurysm of the aorta and ARDS. A 63-year-old man was admitted with complaints of fever and right upper quadrant abdominal pain for a week. Chest X-ray on admission showed a normal finding. Sub-diaphragmatic abscess on abdomen CT scan was suspected and serosanguinous fluid was aspirated from the abscess pocket. On day 2, he was getting more dyspneic and chest X-ray revealed extensive bilateral infiltration. Aspirated fluid revealed AFB. Later, follow-up abdomen CT scan revealed a leakage of dye from the aneurysmal sac of the descending aorta which was previously diagnosed as sub-diaphragmatic abscess. An aortic stent was placed, covering the opening into the aneurysm. The sputum also showed positive AFB. The patient was successfully weaned from the ventilator, and discharged with anti-tuberculous medication on day 42. Follow-up abdomen CT scan 6 months later showed that the aneurymal sac was completely disappeared.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.312-317
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• 1992

To evaluate the sensitivity and specificity of captopril renal scan for renovascular hypertension, we employed the captopril renal scan in conjunction with renal angiography in 81 patients, 159 kidneys, who were referred to evaluate the cause of hypertension. We defined the renovascular hypertension by the criteria of demonstration of renal artery stenosis by angiography, and improvement or cure of hypertension by revascularization. Visual and quantitative evaluation of $^{99m}Tc-DTPA$ renal scan was peformed pre and post captopril administration. The prevalence rate of renovascular hypertension was 40% in comparing with renal angiography, and 70% in confirmed cases. The causes of renovascular hypertension in 81 patients were Takayasu's arteritis, fibromuscular dysplasia, atherosclerosis, essential hypertension, chronic pyetonephritis etc. The sensitivity and specificity of captopril renal scan in comparing with renal angiography were 80%, 86.5%, respectively and also 84.2%, 72.6% in confirmed cases of renovascular hypertension, respectively. The causes of false negative cases were nonfunctioning kidney due to complete obstruction or long duration of disease in basal scan, segmental branch artery stenosis, unknown causes, and suspicious true negative cases without confirmation. The false positive cases were abdominal aortic stenosis or aneurysm, dehydration, unknown causes, and suspicious true positive cases. We conclude that captopril renal scintigraphy is highly sensitive, reasonably specific diagnostic method and comparable to other techniques very favorably.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.36-42
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• 2002

Background: To evaluate the efficiency of surgical treatment in patients with cardiac valvular and arterial involvement of Behcet's syndrome. Material and Method: 12 patients underwent surgical treatment due to the valvular heart diseases and the various arterial diseases associated with Behest's syndrome over 7 years; 6 with valvular heart disease, 1 with annuloaortic ectasia, 1 with ascending aortic aneurysm, 4 with pseudoaneurysms in abdominal aorta(n=2), carotid artery(n=1), and popliteal artery(n=1). All 12 patients had received valvular replacement(n=6) and the artificial(n=5) or autologous(n=1) graft interposition. We followed the results of these surgical treatments. Result: Operations were technically successful in all 12 patients and peri-operative complication was not demonstrated. However, 10 patients had recurrences; 6 with valvular dehiscence, 3 with pseudoaneurysm at anastostomosis site, and 1 with aorto-duodenal fistula. The duration of recurrence was 1 to 55 months(mean: 15.7$\pm$ 16.2 months). 7 patients underwent the second operation and among them, 4 patients showed repeated recurrences. Overall, 5 patients died 2 to 25 months after the operation(mean: 13.6 months), because of the bleeding at the anastomosis site Five patients did not present recurrence after the first(n=2) or the second operation(n=3) and their follow up duration was 5 to 60 months(mean: 45.8$\pm$41.7 months). Five patients received immune-suppressive therapy after the first(n=2) and second operation(n=3). Three did not shown recurrence for the 13, 29 and 33 months. Conclusion: Post-operative prognosis of arterial manifestation of Behcet's syndrome was not encouraging and if possible, other treatment strategy should be considered.