• Journal of Chest Surgery
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• 제17권3호
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• pp.346-355
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• 1984

77 cases of Aortic Valve Replacement, which were composed of 64 rheumatic valvular heart disease and 13 combined congenital heart disease, were operated at Seoul National University Hospital for Aortic valvular disease during the period from June 1968 to December 1983. Among these 64 rheumatic aortic valvular heart disease cases, 8 patients were expired during and immediate after operation and overall mortality rate was 12.5%. For more precise remarks, these patients were divided into two periodic groups, 1st period [from 1968 to 1976] and 2nd [from 1977 to 1983] when annual open heart surgery were over 100 cases, and in 1st period three of four patients were died and in 2nd period five of sixty patients were died and its mortality rate was 8.3%. There were 12 cases of postoperative complication, which were 3 cases of remaining other valvular heart disease required MVR, 2 paravalvular leaks [one of them got Redo AVR], 4 thromboembolism or problem of anticoagulant therapy, 2 late death due to SBE with replaced valve failure and one functional AS with small sized valve. Operative death was affected by pump-time and aortic cross-clamping time, heart size, Ejection Fraction, LVEDP and symptom duration, and other many factors may influence the survival rate. Improved operative technique and myocardial protection and meticulous evaluation of the preoperative patient status will make the AVR safer.

• Journal of Chest Surgery
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• 제45권2호
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• pp.73-79
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• 2012

Background: Aortic cross clamping is associated with spinal cord ischemia. This study used a rat spinal cord ischemia model to investigate the effect of distal aortic pressure on spinal cord perfusion. Materials and Methods: Male Sprague-Dawley rats (n=12) were divided into three groups. In group A (n=4), the aorta was not occluded. In groups B (n=4) and C (n=4), the aorta was occluded. In group B the distal aortic pressures dropped to around 20 mmHg. In group C, the distal aortic pressure was decreased to near zero. The carotid artery and tail artery were cannulated to monitor the proximal aortic pressure and the distal aortic pressure. Fluorescent microspheres were used to measure the regional blood flow in the spinal cord. Results: After aortic occlusion, blood flow to the cervical spinal cord showed no significant difference among the three groups. In groups B and C, the thoracic and lumbar spinal cord and renal blood flow decreased. No microspheres were detected in the thoracic and lumbar spinal cord of group C. Conclusion: The spinal cord blood flow is dependent on the distal aortic pressure after thoracic aortic occlusion.

• Journal of Chest Surgery
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• 제49권3호
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• pp.165-170
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• 2016

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

• Journal of Chest Surgery
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• 제31권5호
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• pp.481-487
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• 1998

하행대동맥의 급성박리에 대한 외과적 치료에 대해서는 논란이 많다. 하행대동맥의 급성 박리병변이 수술적응이 될 경우 대동맥 차단시간은 30분 이상 소요될 수 있으므로 척수손상을 예방하기 위해 대동맥 차단부위 하방에 혈류를 유지하기 위한 여러 방법이 소개되었다. 저자들은 파열(혈흉) 및 쇼크의 합병증을 동반한 하행 대동맥의 급성 박리증 8예를 체외순환법을 이용하여 수술하고 그 방법에 대한 안전성과 효용성을 찾고자 하였다. 체외순환방법에 있어서는 대동맥병변의 상하에 2개의 동맥카뉼라를 넣어 대동맥 차단으로 수술 도중 상하체의 혈류공급을 동시에 이루어지도록 하였고, 산화기로 정맥혈의 환류를 위해 우심방이나 좌대퇴정맥에 정맥관을 삽입하였다. 비교적 장시간의 대동맥 차단에도 불구하고 수술후 8예 모두에서 척수손상은 없었다. 2예(25%)의 병원사망(각각 술후 31일과 41일)은 비교적 고령에서 지연성 합병증인 폐농양, 호흡부전증 등에 의해 발생했다. 주위조직의 부종 및 연약함 때문에 수술시간이 연장될 수 있는 급성 하행동맥 박리증에서 체외 순환방법하의 인공혈관 대치술은 대동맥 차단시간의 연장에 의한 척수 허혈손상을 피할 수 있는 안전하고 효과적인 외과적 치료방법이 될 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• 제46권1호
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• pp.27-32
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• 2013

Background: Minimal infusion of cardioplegic solution (CPS) during aortic surgery using total circulatory arrest (TCA) may reduce several potential side effects: clamping on a diseased aorta, insult of coronary ostia, and edema. Materials and Methods: From 2006 to 2009, 72 patients underwent aortic surgery without infusion of cardioplegic solution at the initiation of circulatory arrest. The diagnoses were acute aortic dissection (44), aneurysm (22), and intramural hematoma (6). Results: The duration of TCA, the lowest nasopharyngeal temperature, bypass time, and aortic clamp time was 45 minutes, $16.4^{\circ}C$, 162 minutes, and 100 minutes, respectively. The amount of CPS was 1,050 mL, and 15 patients underwent surgery without CPS. The average inotrope score was 113 points (range, 6.25 to 5,048.5 points) corresponding to the dopamine infusion of 5 mcg/kg/min for 1 day. Seven patients showed a level of creatine kinase-MB above 50 ng/mL, postoperatively, compared with the average of 12.75 ng/mL. The ischemic change was found on electrocardiogram in 5 patients, postoperatively. There was no cardiac morbidity requiring mechanical assist. The average of intensive care unit stay and postoperative hospital stay was 40 hours (range, 15 to 482 hours) and 11 days, respectively. Conclusion: Minimal infusion of only retrograde CPS during rewarming without initial infusion at TCA in aortic surgery is feasible and can be used with acceptable results.

• International Journal of Vascular Biomedical Engineering
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• 제1권2호
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• pp.13-19
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• 2003

Endothelial release of nitric oxide (NO) contributes to the regulation of vascular tone by inducing vascular relaxation. To estimate the blood flow-dependent nitric oxide level and half-life (T1/2) of nitric oxide in vivo state, we investigated the change of aortic NO currents during the change of aortic blood flow rate using NO-selective electrode system and electromagnetic flowmeter in the aorta of anesthetized rats. Resting mean aortic blood flow rate was $49.6{\pm}5.6ml/min$ in the anesthetized rats. NO currents in the aorta were increased by the elevation of blood pressure and/or blood flow rate. When the aortic blood flow was occluded by the clamping, aortic NO currents were decreased. The difference of NO concentration between resting state and occluded state was $1.34{\pm}0.26{\mu}M$ (n=7). This NO concentration was estimated as blood flow-dependent nitric oxide concentration in the rats. Also, while the aortic blood flow was occluded, NO currents were decreased with exponential pattern with $12.84{\pm}2.15$ seconds of time constant and $7.70{\pm}1.07$ seconds of half-life. To summarize, this study suggested that blood flow-dependent NO concentration and half-life of nitric oxide were about $1.3{\mu}M$ and 7.7 seconds, respectively, in the aorta of anesthetized rats. The nitric oxide-selective electrode system is useful for the direct and continuous measurement of NO in vivo state.

• Journal of Chest Surgery
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• 제22권5호
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• pp.816-822
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• 1989

Aneurysms of the descending thoracic aorta can be caused by various etiologies. So, its abrupt rupture leads life-threatening state, it must be operated as soon as possible. Surgical treatment of the descending thoracic aortic aneurysm requires temporary cross-clamping of major artery. The obligatory occlusion of the descending thoracic aorta during management causes proximal arterial hypertension and distal arterial hypotension. The former may leads to left ventricular failure, or cerebrovascular accident, whereas the latter may leads to spinal cord ischemia or renal injury. Some have recommended insertion of temporary shunt around the occluded descending aorta to prevent above problems. Still others would favor expeditious operation employing simple aortic occlusion during the repair of the descending aorta. Recently we had experienced two cases of dissecting aneurysms of descending thoracic aorta which performed aortoplasty with Gore-Tex conduit under simple aortic occlusion. The one was 34-year-old female patient with traumatic dissecting aortic aneurysm [5 em X 5 cm] on the descending thoracic aorta distal to the origin of the left subclavian artery and the other was 58-year-old female patient with atherosclerotic dissecting descending thoracic aortic aneurysm [6 cmX7 cm] and diffuse abdominal aortic aneurysms [3X5 cm]. Both patients performed standard left posterolateral thoracotomy. After the aneurysmal sac was mobilized, occluding vascular clamps were placed on the transverse aorta proximal to the origin of the left subclavian artery, and on the distal descending aorta without adjuvant bypass procedures for 31 and 32 minutes, respectively, and the aneurysmal sac was repaired with 18 mm ringed Gore-Tex conduit graft. Both patients postoperative courses were uneventful.

• Journal of Chest Surgery
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• 제13권1호
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• pp.72-76
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• 1980

A successful repair of transected descending thoracic aorta was performed in a 44-year-old man. The patient had once been hospitalized in a local clinic for 7 days after a steering wheel injury. Dealing with right Colle`s fracture, he was transferred to this hospital to rule out aortic injury. On admission, a chest PA film and concomitant aortogram revealed an aneurysm of the descending thoracic aorta just distal to the origin of the left subclavian artery measuring 6 cm in diameter and 8 cm in length. He underwent urgent thoracotomy and the injured part of the aorta was replaced with a woven Dacron graft utilizing a Gott`s heparinized aortic shunt. The postoperative course was very smooth except hoarseness and left phrenic nerve palsy due to a blind clamping of the proximal aorta during the operation.

• Journal of Chest Surgery
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• 제26권8호
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• pp.604-608
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• 1993

Coarctation of aorta is rather common congenital cardiovascular disease in the western contries, but it is known to be less than 2 % in Korea. From June 1986 to December 1992, seven patients of surgically treated coarctation of aorta who were less than 2 years old, were experienced at Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. The patients included six male and one female, with ages in the range of one month and 24 months. Four patients were preductal type and three juxtaductal. Associated cardiac anomalies were present in all patients and they were PDA[6 cases], ASD[3], VSD[2], bicuspid aortic valve[2], aortic stenosis[1], mitral regurgitation[1], and tricuspid regurgitation[1]. The operative procedures were four end to end anastomosis and three subclavian flap aortoplasty. Mean aortic cross clamping times were 37.3 minutes in patients with end to end anastomosis and 30.3 minutes in patients with subclavian flap aortoplasty. There were two operative deaths in patients who were treated with subclavian flap aortoplasty and pulmonary artery banding. One patient who had been treated with subclavian flap aortoplasty was complicated with postoperative mild paraplegia in lower limb. Pulmonary artery banding has been disappointing in our patients, and the data was suggestive that earlier total repair of complicated coarctation might improve survival.

• Journal of Chest Surgery
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• 제29권4호
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• pp.449-453
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• 1996

20개월 전에 신장이식을 시행한 환자에 있어서 해리성 흥복부 대동맥류를 성공적으로 절제하였다. 이 식된 신장은 정상 신장에 비하여 허혈에 보다 민감하므로 동맥혈 차단후 이식된 신장의 관류를 위하 여 대퇴 동-정맥으로 심페기를 연결하였다. 138분간의 대동맥 교차 차단중에 신장으로의 관류는 관류압이 (19-)1) 27 minHg이고 관류량은 0.53에서 0.83 Limin 였고, 32mm 크기의 헤마쉴드(길이 22cm)가 동맥류 부위 에 대용되 었다. 수술후 특별한 합병증은 없었으며 심폐기를 이용한 대퇴동-정맥 우회술은 이와같은 수술시 척수와 신 장을 보호하는 간단하고 효율적 인 방법으로 사료된다.