• Journal of Chest Surgery
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• 제49권5호
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• pp.387-391
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• 2016

The dehiscence of saphenous vein grafts (SVGs) is a rare, often fatal, complication of coronary artery bypass grafting (CABG). We present the case of a 57-year-old man who underwent hemiarch graft interposition and CABG for a Stanford type A aortic dissection. Five months after discharge, the patient developed streptococcal sepsis caused by a hemodialysis catheter. Complete rupture of the proximal anastomoses of the saphenous veins and containment by the obliterated pericardial cavity was observed 25 months after the initial operation. The patient was successfully treated surgically. This report describes a patient who developed potentially fatal dehiscence of SVGs secondary to infection and outlines preventive and management strategies for this complication.

• Journal of Chest Surgery
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• 제18권3호
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• pp.446-455
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• 1985

A total and consecutive 156 patients have undergone cardiac valve surgery including 13 closed mitral commissurotomy, 13 open mitral commissurotomy, one mitral annuloplasty, 75 mitral valve replacement, one aortic annuloplasty, 24 aortic valve replacement, 3 tricuspid valve replacement, 25 double valve replacement and one triple valve replacement. 155 prosthetic valves were replaced in a period between September 1976 and August 1985. There were 68 males and 88 females with age range from 8 to 69 yrs [mean 36.5 yr]. Out of replaced valves, 61 was tissue valve including 54 Carpentier-Edwards, and 4 was mechanical valves including 74 St. Jude Medical, and the position replaced was 101 valves for mitral, 46 for aortic and 8 for tricuspid. Single valve replacement in 102 cases, double valve replacement in 25 cases [17 for AVR+MVR, and 8 for MVR+TVR], and only one case was noted in the triple valve replacement. Early mortality within 30 days after operation was noted in 11 cases [7%]; 7 after MVR, 2 after DVR, and each one after open mitral commissurotomy and mitral annuloplasty. Cause of death was valve thrombus, cerebral air embolism, low output syndrome, uncontrollable arrhythmia, parapneumonic sepsis, acute cardiac tamponade and left atrial rupture. 7 late deaths were noted during the follow-up period from 1 to 104 months [average 48 month]; three due to valve and left atrial thrombus formation, two due to CVA from overdose of warfarin, and each one due to congestive heart failure and chronic constrictive pericarditis, Anticoagulants after prosthetic valve replacement were maintained with warfarin, dipyridamole and aspirin to the level of around 50% of normal prothrombin time in 79 cases, and Ticlopidine with aspirin in 47 cases to compare the result of each group. There were 11 major thromboembolic episodes including 3 deaths in the warfarin group. Two cases of CVA due to overdose of warfarin was noted in the warfarin group. In the ticlopidine group, there was only one left atrial thrombus confirmed at the time of autopsy. Among the survived 138 cases, nearly all cases[136 cases] were included in NYHA functional class I and II during the follow-up period. In conclusion, surgical treatment of the cardiac valve disease in 156 clinical cases revealed excellent result with acceptable operative risk and late mortality. Prevention of thrombus formation with anti-platelet aggregator Ticlopidine has better result than warfarin group presently with no specific side effect such as bleeding or gastrointestinal trouble.

• Journal of Chest Surgery
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• 제41권1호
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• pp.116-119
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• 2008

경피적 카테터를 이용한 시술은 선천성 심질환의 진단 및 치료에 폭넓게 이용되고 있다. 이러한 시술과 연관된 합병증은 흔하지 않으며 대부분 끈 문제가 없다. 그러나 드물게 응급 수술이 필요할 정도의 매우 심각한 합병증을 유발할 수 있다. 본 증례는 생후 2주된 선천성 대동맥 판막 협착증 환아에서 경피적 풍선 판막 성형술 중 발생한 우측 총장골 동맥의 파열을 적극적으로 조치하여 성공적으로 손상 혈관의 수술적 치료를 시행하여 좋은 결과를 보여 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제41권2호
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• pp.260-263
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• 2008

3예의 성인 대동맥축착증 환자에서 외해부학적(extraanatomical) 우회로조성술을 시행하였다. 축착 전 후의 광범위한 대동맥협착을 동반한 2예에서는 좌측 개흉술을 통해 좌쇄골하동맥에서 하행대동맥으로 우회술을 시행하였다. 대동맥판막폐쇄부전과 대동맥궁 발육부전이 동반된 대동맥축착 1예에서는 정중 흉골절개술을 통해 상행대동맥과 심장 뒤 하행대동맥간의 우회로술과 대동맥판막치환술을 동시에 시행하였다. 1예에서 술 후 4개월째 문합부 주위 동맥류의 파열이 있어 재수술을 시행하였으며 2예에서는 술 후 특별한 합병증이 없었다.

• Biomolecules & Therapeutics
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• 제28권1호
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• pp.98-103
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• 2020

Marfan syndrome (MFS), a connective tissue disorder caused by mutations in the fibrillin-1 (Fbn1) gene, has vascular manifestations including aortic aneurysm, dissection, and rupture. Its vascular pathogenesis is assumed to be attributed to increased transforming growth factor β (TGFβ) signaling and blockade of excessive TGFβ signaling has been thought to prevent dissection and aneurysm formation. Here, we investigated whether galunisertib, a potent small-molecule inhibitor of TGFβ receptor I (TβRI), attenuates aneurysmal disease in a murine model of MFS (Fbn1^C1039G/+) and compared the impact of galuninsertib on the MFS-related vascular pathogenesis with that of losartan, a prophylactic agent routinely used for patients with MFS. Fbn1^C1039G/+ mice were administered galunisertib or losartan for 8 weeks, and their ascending aortas were assessed for histopathological changes and phosphorylation of Smad2 and extracellular signal-regulated kinase 1/2 (Erk1/2). Mice treated with galunisertib or losartan barely exhibited phosphorylated Smad2, suggesting that both drugs effectively blocked overactivated canonical TGFβ signaling in Fbn1^C1039G/+ mice. However, galunisertib treatment did not attenuate disrupted medial wall architecture and only partially decreased Erk1/2 phosphorylation, whereas losartan significantly inhibited MFS-associated aortopathy and markedly decreased Erk1/2 phosphorylation in Fbn1^C1039G/+ mice. These data unexpectedly revealed that galunisertib, a TβRI inhibitor, showed no benefits in aneurysmal disease in MFS mice although it completely blocked Smad2 phosphorylation. The significant losartan-induced inhibition of both aortic vascular pathogenesis and Smad2 phosphorylation implied that canonical TGFβ signaling might not prominently drive aneurysmal diseases in MFS mice.

• Journal of Chest Surgery
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• 제35권2호
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• pp.102-112
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• 2002

배경: 본 연구는 대동맥근부를 침범한 상행대동맥류 환자에서 composite valve graft를 이용한 대동맥근부 치 환술 결과를 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2001년 6월가지 composite valve graft를 이용한 대동맥근부 치환술 환자 56명을 대상으로 후향적으로 조사하였다. 대동맥판막 폐쇄부전은 50명(89%), Mafan증후군이 18명(32%), 그리고 이엽성 대동맥판막이 7명(12.5%)에서 동반되었다. 진단은 대동맥판륜 확장증 30명(53.6%), 대동맥 박리증 13명(23.2%), 대동맥근부를 침범한 상행대동맥류 11명(17.6%), 그리고 대동맥염이 2명(3.6%)이였다. 대동맥 파열로 인한 심낭 압전 및 심인성 쇽은 2명에서 있었으며 과거에 심장이나 상행대동맥 수술을 받은 환자는 9명(16%)이었다. 근부치환술시 사용된 수술방법button술식 51명(91%), 변형 Cabrol 술식 4명, classic Bentall 술식을 1명에서 시행하였다. 동반수술은 대동맥궁 치환술 24명(43%), 관상동맥우회술 8명(14.3%), 승모판 성형술 2명 및 재치환술 1명, 기타 7명이었다. 평균 순환정지, 체외순환및 대동맥차단 시간은 각각 21$\pm$14분(6-60분), 186$\pm$68분과 132$\pm$42분이었다. 결과: 조기 사망은 1명(1.8%)에서 있었고 술후 합병증으로는 심기능 부전이 16명(28.6%), 출혈로 인한 재수술 7명(12.5%), 심낭삼출 2명, 그리고 기타가 6명이었다. 술후 생존자 55명중 53명(96.4%)에서 평균 23.2$\pm$18.7개월(1-75개월)을 추적하였다. 만기 사망은 외상성 뇌출혈로 사망한 1명을 포함해 2명(3.8%)이었으며 대동맥근부 치환술과 관련한 만기 사망률은 1.9%였다. 한편 술후 1년과 6년 survival rate는 각각 98.1$\pm$1.9%와 93.275.1%였다. 대동맥근부 치환술과 관련한 합병증으로 재수술이 2명에서 시행되었으며(3.8%), 1년과 6년 후 재수술로부터의 freedom rate는 각각 97.872.0%와 65.3$\pm$26.7%였다. 잔여 대동맥에 대한 수술은 술전에 동반된 흉복부대동맥류의 확장으로 2명에서 흥복부대동맥류 치환술을 시행하였다.

• Journal of Chest Surgery
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• 제36권5호
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• pp.335-342
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• 2003

배경: 급성대동맥 박리증의 수술 시 궁부에 내막 파열이 있는 경우 본원에서는 파열 원위부까지 대동맥 박리부를 치환하여 수술해 왔다. 이의 임상 경험을 분석하여 그 결과를 알아보고자 이 연구를 시행하였다. 대상 뜻 방법: 1996년 3월부터 2002년 7월까지 본원에 Stanford A형 급성 대동맥 박리증으로 수술받은 사람 중 대동맥궁 근처에 내막파열이 있었던 환자 31명을 대상으로 후향성 조사를 시행하였다. 환자의 성비는 남자 12명, 여자 19명이었고 나이는 59.6$\pm$9.4세이었다. 수술은 18명에서는 반궁치환술(Hemiarch replacement)을 시행하였고 13명에서는 궁분지치환술(Arch branch replacement)을 시행하였다. 3명은 Clamshell incision을 28명은 정중흉골절개술을 시행하였다. 모든 환자에서 극저체온 순환정지하에서 원위부 문합과 궁부 치환을 시행하였다. 동반 수술은 Bentall 수술이 2예, axillobifemoral bypass 1예, femorofemoral bypass 1예 carotid a bypass가 1예 등이었다. 결과: 술 후 합병증은 급성신부전이 8예, 중추신경합병증이 3예, 저심박출증이 2예, 말초 순환 부전이 2예, 창상 감염이 2예 발생하였다. 사망은 술 후 30일 이내 원내 사망이 4명으로 사인은 급성신부전 1예, 출혈 1예, 저심박출증 1예 및 말초순환장애 수술 후 재관류 손상 1예였다. 술 후 30일 이후 원내 사망은 3예로 사인은 신부전 1예와 다장기 부전증 2예로 총 수술사망률은 22.5%였다. 퇴원 후 만기 사망은 4예로 사인은 뇌출혈 2예와 원위부 파열이 2예였는데 이 중 반궁치환술을 한 경우가 3예였다. 결론: 반궁치환술은 궁분지치환술보다 상대적으로 수술시간이 짧고 수술사망이 적으나, 만기 사망이 많았다. 궁분지치환술은 수술시간이 길고 사망률이 높은 수술이나 대동맥궁 분지부에 길이 파열된 경우 필요한 수술이므로 향후 더 연구가 필요하리라 생각한다

• Journal of Chest Surgery
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• 제9권1호
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• pp.44-49
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• 1976

Aneurysm of the Aorta is a grave disease mostly producing disabling symptoms and ultimate death by rupture and hemorrhage without surgical intervention. The author recently experienced one case of surgical correction of descending thoracic aortic aneurysm treated with excision of the aneurysm and replacement of Dacron artificial vessel under temporary external by pass technique in November, 10th, 1975. 9mm internal diameter arterial cannula was inserted into upper and below the aneurysm. Bypass time was about 1 hour. The case was 35 years old women who had small egg sized saccular aneurysm in the upper third of the descending thoracic aorta involving the 1t. subclavian artery. Histopathological diagnosis was arteriosclerotic. Immediate postoperative course had been uneventful except low pressure and pulse of the left arm. The follow-up was possible up to date about 3 months. The patient has been doing well with ordinary activities except mild left chest discomfort.

• Journal of Chest Surgery
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• 제18권3호
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• pp.461-465
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• 1985

Rupture of the aorta following blunt trauma of the thorax may occur more frequently than has generally been recognized. Actual complete transection of the aorta usually results in immediate death but varying degrees of lesser disruption permit increased chance of survival. Chronic traumatic aneurysms are so designated following a period of 3 months from the traumatic incident. The exact time required for the acute process and hematoma to convert into an aneurysm is unknown. Because a thoracic surgeon encounters so few of these aneurysms, it is difficult for him to arrive at sound dicta of management from his personal experience. It is not surprising that controversy exists concerning the therapeutic approach to the aneurysm which is asymptomatic and is discovered months or years after the causative injury. In the hope of improving the surgical treatment of patients with this condition, we reported one case with chronic traumatic aneurysm of the descending thoracic aorta.

• Journal of Chest Surgery
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• 제24권2호
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• pp.171-181
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• 1991

Result of St. Jude Medical valve replacement are presented in 106 patients who underwent operation from January 1985 through July 1989. The patient were 52 males and 56 females. Total 136 of St. Jude Medical valves were implanted; 91 in mitral position, 45 in aortic position. The hospital mortality rate was 5.7%o[6 patients] and the late mortality rate was 2.0%[2 patients]. The causes of death were low cardiac output in 5, iatrogenic right ventricular rupture in 1, heart failure in 1, ventricular arrhythmia in l. And, the causes of valve related complication were anticoagulant related hemorrhage in 5 patients[0.03% /patient-year] and thromboembolism[0.01% /patient-year] in 2 patients. In conclusion, the performance of the St. Jude Medical valve compare most favorably with other artificial valves. But it remains still hazards of mechanical prosthesis such as thromboembolism and anticoagulant related hemorrhage.