• Journal of Chest Surgery
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• 제33권8호
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• pp.676-680
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• 2000

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.

• Journal of Chest Surgery
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• 제27권11호
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• pp.907-913
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• 1994

From October 1990 to May 1993, 19 patients underwent replacement of the transverse aortic arch. [10 men, 9 women, mean age 52.5 years] Underlying diseases were acute aortic dissection [10 cases], chronic aortic dissection [4 cases],and aortic arch aneurysm [ 5 cases]. In 19 patients, 10 underwent partial replacement and 9 underwent total arch replacement. The cerebral protection was achieved by profound hypothermia [rectal temperature,16$^{\circ}$ to 2$0^{\circ}C$] associated with total circulatory arrest [mean 35.5 minutes]. In one patient, the aortic arch distal to the left common carotid artery was resected with the distal arch being cross-clamped and in another two patients, the selective cerebral perfusion was also applied during the period of total circulatory arrest via innominate artery and left common carotid artery because of longer total circulatory arrest time. Among 14 patients of aortic dissecton, 10 presented hypertension, 1 presented Marfan syndrome, 1 presented pregnancy-induced hypertension and 2 revealed no evidence of hypertension. All of the above 14 patients complained chest pain. Among 5 patients of aortic arch aneurysm, Be het disease was suspected in only one patient and atherosclerotic aneurysm was proved in another 4 patients. The overall hospital mortality was 32% [6/19]. In aortic dissection, the mortality was 43% [Acute aortic dissection 30%, chronic aortic dissection 75%] and in aortic arch aneurysm, the mortality was 0%. Follow-up was done in all survivors for from 7 months to 36 months[mean,17.3%].

• Journal of Chest Surgery
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• 제42권4호
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• pp.520-523
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• 2009

대동맥궁 대동맥류는 파열의 위험성으로 인해 적극적이며 응급에 준하는 치료가 필요하다. 그러나, 전통적인 방법의 대동맥궁 치환술은 나이가 많거나, 여러 질환이 동반된 경우 수술 후 생길 수 있는 위험 및 합병증이 높아 수술을 쉽게 시행하기 어렵다. 저자들은 대동맥궁 대동맥류를 가진 86세 남자환자에게 일반적인 수술이 아닌 Hybrid수술(심폐기를 사용하지 않은, 혈관 내 스텐트 그라프트 삽입술 및 탈분지 혈관 연결)을 시행하여 성공하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제43권3호
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• pp.292-295
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• 2010

대동맥궁에 발생한 동맥류에 대한 수술적 치료는 침습적인 수술이며 수술 후 높은 유병률과 사망률이 보고되고 있는 실정이다. 그러나 최근 많은 경우에서 이에 대한 치료로 스텐트-그라프트와 더불어 좌측 쇄골하동맥 등에 우회술을 동시에 시행하는 hybrid 방법이 사용되고 있으며 좋은 결과들이 보고되고 있다. 이에 저자들은 대동맥궁의 동맥류 환자에 대해서 스텐트-그라프트 삽입과 좌측 쇄골하동맥 우회술을 동시에 시행하였기에 저자들의 치험예를 문헌고찰과 함께 보고하는 바이다.

• 대한후두음성언어의학회지
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• 제8권2호
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• pp.232-234
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• 1997

After the first report of mitral stenosis as a cause of recurrent laryngeal nerve palsy by Ortner in 1897, many authors have described that some kinds of cardiovascular disease might contribute to the development of recurrent laryngeal nerve palsy. The estimated rate of aortic aneurysm related with recurrent laryngeal nerve palsy is about 5%. Aortic aneurysm is classified into 3 types according to the involving segment of aorta in which aneurysms develop, and the first class-aneurysm in ascending aorta and aortic arch-is known to be the only type related to recurrent laryngeal nerve palsy. Recently we experienced two cases of recurrent laryngeal nerve palsy each of which had aneurysm on aortic arch as a major contributing factor. We report these cases with brief review of the literature.

• Journal of Chest Surgery
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• 제54권6호
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• pp.509-512
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• 2021

Extensive thoracic aortic disease involving the ascending aorta, the aortic arch, and the descending thoracic aorta may require multiple surgical and interventional managements, which impose a burden in terms of cumulative surgical trauma and the risk of interval mortality. Herein, we describe a single-stage arch and descending thoracic aorta replacement via sternotomy in a patient with multiple comorbidities presenting with an extensive thoracic aortic aneurysm.

• Journal of Chest Surgery
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• 제43권5호
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• pp.529-533
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• 2010

대동맥궁 대동맥류에 대한 전통적인 수술 치료는 장시간의 심폐기 사용으로 인해 특히 고위험 환자군에서 술 후 합병증의 발생 및 사망률이 높다. 저자들은 원위부 대동맥궁 대동맥류가 있는 고위험 환자에서 Hybrid 술식을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제22권1호
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• pp.90-94
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• 1989

Ten patients underwent operation for aortic aneurysms from Jan. 1983 to April 1988 at the Department of Thoracic and Cardiovascular Surgery, Keimyung University Hospital. There were 7 males and 3 females in this series. The age ranged from 16 to 70 years with the mean age of 45 years. The cause of the aneurysm was atherosclerosis in 8 patients, mycosis in 1 patient and unknown in 1 patient. There were two patients with ascending aortic aneurysm treated by Dacron graft replacement, with no hospital death. One patient with aortic arch aneurysm was received Dacron graft replacement under cardiopulmonary bypass and died on the 21st postoperative day because of cerebral edema. There were three patients with descending aortic aneurysm. The aneurysm in two patients was successfully repaired by Dacron graft. One additional patient with ruptured aneurysm died at operation because of ventricular fibrillation. Four patients with abdominal aortic aneurysm were underwent Dacron graft replacement and the results were good.

• Journal of Chest Surgery
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• 제35권9호
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• pp.675-679
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• 2002

대동맥 궁 후방 또는 근위부 하행 흉부 대동맥에 병변이 있는 경우 일반적인 정중 흉골 절개술을 통한 접근 방법은 폐 질환으로 인한 유착이 심한 환자에 있어서 제한점이 있다. 본원에서는 객혈을 주소로 내원 한 근위부 하행 흉부 대동맥류 질환을 가진 66세 남자환자에서 정중 흉골 절제술을 통해 대동맥-폐간 유착 박리 등 폐조작을 가하지 않고 성공적으로 상행, 궁부, 하행 대동맥을 치환함으로써 이에 증례 보고하는 바이다.

• Journal of Chest Surgery
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• 제16권3호
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• pp.301-309
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• 1983

Twenty-three patients with aneurysm were operated between Jan. 1956 to July 1983 at the Department of Thoracic surgery, Seoul National University Hospital. There were 18 males and 5 females in this series. The age ranged from 14 to 68 years with the mean age of 41 years. The etiology of aortic aneurysms was atherosclerosis in 10, trauma in 2, annuloaortic ectasia in 4, syphilis in 1, and unknown etiology in six cases. Among the 4 patients with ascending aortic aneurysm, aortic valve replacement with aneurysmorrhaphy in three patients and Bentall operation in one patient were performed successfully. One patient with entire aortic arch aneurysm was received Dacron graft replacement with anastomosis of brachiocephalic arteries separately under cardiopulmonary bypass. There was no complication. Among 6 patients involving the descending thoracic aorta, three patients were managed by prosthetic bypass graft and aneurysm resection, and another three patients were also managed by prosthetic graft replacement. There were three hospital deaths. There were two thoracoabdominal aortic aneurysm. One patient in shock state due to preoperative rupture died from cardiac arrest during operative procedure. In another patient who had extensive involvement from the midportion of descending thoracic aorta to the terminal abdominal aorta, the aneurysm was successfully repaired with Dacron graft. In this instance celiac axis, superior and inferior mesenteric arteries and right renal artery were anastomosed separately. Eight of the 10 abdominal aortic aneurysms was replaced with prosthetic graft. One saccular aneurysm was treated by resection and primary closure. In another patient, cardiac arrest occurred during operation before definitive procedure. There was one another hospital death in the patient with preoperative rupture.