• Journal of Chest Surgery
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• 제12권3호
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• pp.170-173
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• 1979

Since John Davy reported the first well-documented case of occlusive disease involving the branches of the aortic arch in 1839, many similar cases have been reported in literature, especially from oriental countries. The prognosis and symptoms depend on the degree and extent of the occlusive lesions and also on the importance of the arteries affected. The course may progress slowly or rapidly with remissions and exacerbation, and death may result from acute CVA, cardiac failure or pulmonary edema, and renal failure. No medical therapy has been able to alter conclusively the course of the disease, so various surgical procedures have been applied to relieve the obstruction and to prolong the life. We present the case of an 18 year-old female with multiple stenosis of the aorta, and performed the long bypass graft from descending aorta to common lilac artery, and the result was excellent.

• Journal of Chest Surgery
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• 제45권1호
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• pp.24-29
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• 2012

Background: The conventional method of aortic cross-clamping is very difficult and increases the risk of cerebral infarct due to embolism of the calcified aorta in these patients. Accordingly, we analyzed our experience with 11 cases of ascending aorta and aortic valve replacement with hypothermic circulatory arrest. Materials and Methods: From January 2002 to December 2009, 11 patients had ascending aorta and aortic valve replacement with hypothermic arrest at our hospital. We performed a retrospective study. Results: There were 5 males and 6 females, with a mean age of 68 years (range, 44 to 82 years). Eight patients had aortic stenosis, and 3 patients had aortic regurgitation. An aortic cannula was inserted into the right axillary artery in 3 patients and ascending aorta in 6 patients. Two patients with aortic regurgitation had a remote access perfusion catheter inserted though the right femoral artery. The mean cardiopulmonary bypass time was 180 minutes (range, 110 to 306 minutes) and mean hypothermic circulatory arrest time was 30 minutes (range, 20 to 48 minutes). The mean rectal temperature during hypothermic circulatory arrest was $21^{\circ}C$ (range, $19^{\circ}C$ to $23^{\circ}C$). No patient had any new onset of cerebral infarct or cardiovascular accident after surgery. There was no hospital mortality. Early complications occurred in 1 patient who needed reoperation due to postoperative bleeding. Late complications occurred in 1 patient who underwent a Bentall operation due to prosthetic valve endocarditis. The mean follow-up duration was 32 months (range, 1 month to 8 years) and 1 patient died suddenly due to unknown causes after 5 years. Conclusion: Patients with a calcified aorta can be safely treated with a technique based on aorta and aortic valve replacement under hypothermic circulatory arrest.

• Journal of Chest Surgery
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• 제24권7호
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• pp.647-655
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• 1991

The efficacy of cold blood potassium cardioplegia during periods of ischemic arrest was assessed in 88 patients undergoing open heart surgical procedures at Chonnam National University Medical School from December, 1987 to January, 1989. The purpose of this study was to determine if the aortic cross clamping time[ACCT] over 120 minutes correlated with operative mortality, incidence of postoperative ventricular tachyarrhythmias, needs of postoperative inotropic support and serum enzyme levels. The patients were divided according to aortic cross clamping time[less than 120 minutes and 120 minutes or greater]. The results were as follows: 1. The operative mortality was 3.2% in ACCT<120min group and 7.7% in ACCT>120 min group. 2. The incidence of postoperative ventricular tachyarrhythmia was 1.6% in ACCT <120min group and 11.5% in ACCT>120min group[p<0.05]. 3. The incidence of postoperative inotropic support in congenital heart disease was 13.0Fo in ACCT<120min group and 45.0%o in ACCT>120min group[p<0.05]. The incidence in acquired heart disease was 26.0% in ACCT<120min group and 40.0% in ACCT> 120min group. 4. After cardiopulmonary bypass, serum GOT, LDH, CPK and CPK - MB were elevated prominently. Children showed higher value of the enzymes examined than adults did before and after cardiopulmonary bypass. In congenital heart diseases, postoperative serum GOT, LDH, CPK and CPK - MB levels of ACCT>120min group were significantly higher than those of ACCT<120min group. Postoperative serum GOT, LDH and CPK - MB levels of ACCT>=120min group were significantly higher than those of ACCT<120min group also in acquired heart diseases. The results suggest that the myocardial protective effect with cold blood potassium cardioplegic solutions was not sufficient when the aortic cross clamping time was over 120 minutes.

• Journal of Chest Surgery
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• 제42권6호
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• pp.774-776
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• 2009

57세 남자가, NYHA class III의 호흡곤란을 주소로 내원하여 시행한 심장초음파 검사상 Grade III에 해당하는 대동맥판막 역류증을 진단받았다. 그는 수술 전 시행한 심혈관조영술 검사상 단일관상동맥 기형을 가지고 있었으며, 기계판막을 이용한 대동맥판막 치환술을 시행받았다. 수술장 소견상 단일관상동맥이었으며 대동맥절개시술부위의 좌측절개부위와 우관상동맥의 주행이 인접한 해부학적 구조를 보였다. 판막치환술을 시행하고 절개된 대동맥을 봉합한 후 인공심폐기로부터 탈출하던 도중 좌측대동맥절개부위와 인접한 우관상동맥이 당겨지면서 심실세동이 발생하여 대동맥을 다시 절개하였으며, 우관상동맥을 박리하고 대동맥을 재봉합하여 문제 없이 수술이 종료되었다. 수술 직후 방실리듬이 관찰되어 심방조율하여 정상동방결절리듬으로 전환되었고, 술 후 8일 째 특이 문제없이 퇴원하였다.

• Journal of Chest Surgery
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• 제24권8호
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• pp.741-750
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• 1991

Between April, 1986 and July, 1991, 477 patients underwent open heart surgery with hypothermic cardiopulmonary bypass. There were 242 patients [50.7%] of acyanotic congenital anomalies, 34 patients [7.1%] of cyanotic congenital anomalies, and 187 patients [39.2%] of acquired heart diseases, 8 patients [1.7%] of coronary artery diseases, and 6 patients [1.3%] of mixed anomalies. Among the 276 congenital cardiac anomalies, 147 patients [53.3%] were male and 129 patients [46.7%] were female, ranged in age from 2 years to 58 years. Among the 187 acquired heart diseases, 72 patients [38.5%] were male and 115 patients [61.5%] were female, ranged in age from 10 years to 68 years. The common congenital defect were VSD and ASD in acyanotic cardiac patients, and TOF in cyanotic cardiac patients. Among the 187 acquired heart diseases, 180 patients underwent operation for cardiac valvular diseases, 4 patients were resected left atrial myxoma, and 3 patients underwent operation for aortic regurgitation with ascending aortic aneurysm. The operative mortality rate was 1.2% in acyanotic cardiac patients, 11.8% in cyanotic cardiac patients, and 6.9% in acquired cardiac patients, with overall mortality rate 4.2%.

• Journal of Chest Surgery
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• 제33권10호
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• pp.839-842
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• 2000

Aortoesophageal fistula is an uncommon and fatal complication after surgery of aortic aneurysm. A case of aortoesophageal fistula as a complication of synthetis patch aortoplasty for mycotic aneurysm of descending thoracic aorta is described. After 3 months since patch aortoplasty for mycotic aneurysm of descending thoracic aorta this patient visited the emergency room due to melena and hematemesis. After gastrofiberoscopy and computed tomography the patient was taken ot the operating room. The surgical intervention was performed in two steps. Median sternotomy and midline laparotomy were made. Hemashield's Dacron(16mm) bypass between ascending thoracic aorta and infra-renal abdominal aorta was established first. Through the posterolateral thoracotomy false aneurysm and previous Hemashield's Dacron patch of descending aorta were resected. The two ends of the aorta were sutured and esophageal fistula was repaired. The esophageal suture line and the stumps were covered with omental graft. Thirty months later the patient has had no difficulty referable to the aortic surgery.

• Journal of Chest Surgery
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• 제18권2호
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• pp.305-313
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• 1985

Surgical therapy for dissection of the aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. Recently, a new method of treatment with an intraluminal graft that requires no end-to-end anastomosis has been developed. Of the four patients with dissecting aneurysm of the aorta treated by inserting sutureless ringed intraluminal graft at the Department of Thoracic and Cardiovascular Surgery, S.N.U.H., three were DeBakey type I [one with associated aortic insufficiency] and the other was DeBakey type III. Suspected etiology of the dissection was Marfan`s syndrome in one and hypertension in the others. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta [type A] and simple aortic crossclamping was used for the patient with dissecting aneurysm of the descending aorta. The basic technique consists of inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in patient with aortic insufficiency associated with dissection of the ascending aorta. There were no hospital deaths and one patient with type III dissecting aneurysm developed postoperative paraparesis and renal insufficiency which was resolved. Follow-up has been from 1 month to 16 months with no evidence of prosthetic problems, such as erosion, migration, or thrombosis.

• Journal of Chest Surgery
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• 제27권7호
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• pp.581-586
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• 1994

From February 1985 to February 1993, 18 operations were performed in 17 patients for treatment of aneurysmal disease [n=12] and/or dissection of the ascending aorta [n=6]. The ages ranged from 26 to 69 years [mean 44.3 $\pm$ 11.0 years].The proposed operations include composite graft replacement of aortic valve and ascending aorta with coronary reimplantation in 11, graft replacement of ascending aorta alone in 5, aortic valve replacement and supracoronary graft replacement in 1 and ascending aorta to abdominal aorta bypass with thromboexclusion of descending aorta in one patient. Both Bentall [n=6] and Cabrol [n=5] technique were utilized for reimplantation of coronary arteries.Concomitant replacement of aortic arch and arch vessel reconstruction was necessary in two patients. Hypothermic circulatory arrest was utilized in 6 patients. Recently, four patients were managed on warm blood continuous cardioplegia via retrograde route. There were no operative deaths. No significant postoperative complications were noted. Postoperative follow up was complete in 15 patients from 1 month to 72 months. Redo operation was necessary in one patient who had suffered from distal recurrence of dissection 5 years after successful Bentall operation. The other patients are all in excellent clinical condition. From our early experience with those 17 cases, we assume that satisfactory operative result could be achieved with a variety of surgical technique including hypothermic circulatory arrest. In addition, continuous perfusion of warm blood cardioplegia via retrograde route is supposed to be beneficial in selected cases.

• Journal of Chest Surgery
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• 제22권4호
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• pp.609-619
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• 1989

During aortic valve surgery, cardioplegic solution is delivered through direct cannulation of both coronary ostia. Since this approach may cause an intimal injury leading to acute dissection or late ostial stenosis, this study was undertaken to evaluate myocardial protective effect of retrograde perfusion of cardioplegia [RCSP <% RRAP] in 18 clinical cases, which were compared with antegrade perfusion of cardioplegia in 27 clinical cases. This study were investigated 1] cease and return of electromechanical activity after cardioplegia infusion 2] the myocardial temperature during operation 3] the aortic cross clamping time and total bypass time 4] frequency of DC shock for defibrillation 5] need for inotropic drugs after operation 6] electrocardiographic evidence of myocardial infarction or ventricular arrhythmia after operation 7] the enzymes activity during preoperative and postoperative period as an evaluation of myocardial ischemic injury and 8] operative mortality rate The combination of retrograde cardioplegia and topical cooling with ice slush yielded promptly hypothermia of myocardium and shorter aortic cross-clamping time compared with antegrade cardioplegia [P < 0.05]. The temperature of the interventricular septum was maintained below 20oC by continuous perfusion or intermittent perfusion of cold blood cardioplegia and other results were no statistically significant difference between the two methods [P >0.05]. This technique provides clear operative field and avoids some serious complications which are caused by coronary ostial cannulation. These results suggested that the retrograde perfusion of cardioplegia is a simple, safe, and effective means of myocardial protection during open heart surgery.

• Journal of Chest Surgery
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• 제38권7호
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• pp.507-509
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• 2005

우측 개흉술을 통한 개심술은 심방중격 결손증, 승모판막 질환에서 이루어질 수 있다. 최근에 본원에서는 AESOP 3000을 이용하여 흉강경적 심방중격 봉합술, 승모판막 성형술, Maze 수술, 최소침습적 관상동맥 우회술 등을 시행하고 있다. 하지만, 흉강경을 이용한 대동맥 판막 치환술에 대해서는 현재 국내 보고가 없는 실정이다. 본원에서는 31세 여자 환자에게서 AESOP 3000을 이용한 흉강경적 대동맥 판막 치환술을 성공적으로 시행하였기에 문헌 고찰과 함께 보고하는 바이다.