• Journal of Chest Surgery
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• 제44권2호
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• pp.148-153
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• 2011

Background: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. Materials and Methods: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. Results: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. Conclusion: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.

• 한국콘텐츠학회논문지
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• 제9권6호
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• pp.266-274
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• 2009

복부대동맥류는 주로 65-75세의 중년이후 남성과 흡연자에서 주로 발생한다. 가장 중요한 증세는 대동맥 파열로서 생명에 치명적이며, 혈관벽이 헐고 약해지고 파열되어 많은 양의 혈액이 복강 내로 쏟아지는 것을 의미한다. 복부대동맥박리를 치료하기 위해서는 3차원 영상 정보가 필요하고, 수술시 임상의사에게 많은 도움이 된다. 3차원 정보는 MDCT로부터 계산되고 3차원 모델은 2차원 CT영상의 분할로 계산된 좌표로부터 재구성된다. 따라서 3차원 영상의 질은 2차원 영상의 분할알고리듬에 의존적이다. 본 연구에서는 목적장기만을 모델링하기 위해서 가변형 능동모델을 제안한다. 가변형 능동모델은 외부힘에 의해서 에너지가 최소화되는 수렴하는 모델이다. 외부힘은 GVF로 불리며, 그레이레벨 또는 영상으로 부터의 이 진경계지도의 구배가 확산되는 것을 계산한다. 실험결과 복부대동맥박리에 적용해서 3차원 표면재구성을 성공했으며, 분할알고리듬의 특성으로 시각적 및 정량적인 평가도 성공했다.

• Journal of Chest Surgery
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• 제53권6호
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• pp.353-360
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• 2020

Background: Most abdominal aortic aneurysms are degenerative atherosclerotic aneurysms. Inflammatory or infected abdominal aortic aneurysms, which show a slightly different clinical course, are rarely encountered in clinical settings. Therefore, we aimed to investigate the clinical course of these variants of abdominal aortic aneurysms. Methods: This retrospective study included 32 patients with atypical inflammatory or infected abdominal aortic aneurysms who underwent emergent graft replacement between November 1997 and December 2017. Patients were followed up at the outpatient clinic for a mean period of 4.9±6.9 years. We analyzed the patients' clinical course and compared it with that of patients with atherosclerotic abdominal aortic aneurysms. Results: There was 1 surgical mortality (3.0%) in a case complicated by aneurysmal free rupture. In 2 cases of infected abdominal aortic aneurysms, anastomotic complications developed immediately postoperatively. During the follow-up period, 10 patients (30%) developed graft complications, and 9 of them underwent reoperations; of these, 2 patients (22.2%) died of postoperative complications after the second operation, whereas 2 patients survived despite graft occlusion. Conclusion: Patients with inflammatory abdominal aneurysms frequently develop postoperative graft complications requiring secondary surgical treatment, so they require close mandatory postoperative follow-up.

• IMMUNE NETWORK
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• 제21권2호
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• pp.17.1-17.10
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• 2021

Abdominal aortic aneurysm (AAA) is a chronic dilation of the aorta with a tendency to enlarge and eventually rupture, which constitutes a major cause of cardiovascular mortality. Although T-cell infiltrates have been observed in AAA, the cellular, phenotypic, and functional characteristics of these tissue-infiltrating T cells are not fully understood. Here, we investigated the proportional changes of T-cell subsets-including CD4⁺ T cells, CD8⁺ T cells, and γδ T cells-and their effector functions in AAAs. We found that Vδ2⁺ T cells were presented at a higher frequency in aortic aneurysmal tissue compared to normal aortic tissue and PBMCs from patients with AAA. In contrast, no differences were observed in the frequencies of CD4⁺, CD8⁺, and Vδ1⁺ T cells. Moreover, we observed that the Vδ2⁺ T cells from AAA tissue displayed immunophenotypes indicative of CCR5⁺ non-exhausted effector memory cells, with a decreased proportion of CD16⁺ cells. Finally, we found that these Vδ2⁺ T cells were the main source of IL-17A in abdominal aortic aneurysmal tissue. In conclusion, our results suggest that increased Vδ2⁺ T cells that robustly produce IL-17A in aortic aneurysmal tissue may contribute to AAA pathogenesis and progression.

• Journal of Chest Surgery
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• 제43권1호
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• pp.92-95
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• 2010

고위험군의 대동맥 질환 환자에서 고전적인 수술에 대한 대안책으로서 혈관내 스텐트 그라프트를 고려할 수 있다. 본원에서는 유방암에 대한 항암 방사선 치료로 인한 전 흉부 괴사와 그에 따른 상행 대동맥 파열이 발생한 79세 여자 환자에 대해 혈관내 스텐트 그라프트를 이용하여 효과적으로 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제38권10호
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• pp.693-698
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• 2005

배경: 발살바동류(Sinus Valsalva Aneurysm, SVA)는 드문 질환으로, 심실중격결손증과 대동맥판막 궤쇄부전 등이 흔하게 동반되는 것으로 알려져 있다 이에 대한 치료로는 여러 가지 접근 방법을 통한 수술 기법이 시도되고 있지만 국내에서의 수술 치료 후 장기적인 결과는 보고된 바가 없다. 저자들은 지난 30년간 발살바동류 및 발살바동 파열로 수술 받은 환자들의 임상 기록을 고찰하여, 발살바동류 및 발살바동 파열의 수술 후 장기 성적을 살펴보았다. 대상 및 방법: 1974년 3월부터 2002년 2월까지 연세대학교 심장혈관병원에서 SVA 및 파열로 수술을 시행한 81명을 대상으로 후향적인 조사를 시행하였는데, 환자들의 평균 나이는 $29.2\pm1l.5$세였고 남자가 49명이었다. SVA에 동반된 심장 기형으로는 VSD가 50예, 동맥관 개존증과 Bechet's병이 각각 2예, 활로 4증후군, 우심실유출로 협착 그리고 대동맥륜 확장이 각각 1예에서 있었다. 77명$(95\%)$의 환자들에서 SVA의 파열이 있었으며, 14명의 환자들에서 아급성 세균성 심내막염이 동반되어 있었다. 대동맥판막 폐쇄부전은 grade I: 8명, II: 10명, III: 9명, IV: 4명에서 발견되었다. 발살바동류는 우관상동 부위에서 66예$(81\%)$로 가장 많이 발견되었으며, 발살바동류의 파열은 우심실과의 교통이 가장 많았다(53/77). 수술은 첨포를 사용한 경우가 37예, 직접 봉합을 한 경우가 38예, 기타의 방법이 1예 있었다. 결과: 수술 사망이 1명 있었다(수술 사망률=$1.2\%$). 환자들의 추적관찰은 2명을 제외한 78명에서 가능하였는데(추적률=$97.5\%$), 평균 추적기간은 $123.3\pm80.9 (3\~330)$개월이었다. 추적 기간 중에 3명의 환자가 사망하였으며(사망률=$3.8\%$), 1명의 환자는 심부전으로, 1명의 환자는 부정맥으로 사망하였으며, 1명의 환자는 원인을 알 수 없이 사망하였다. SVA수술 후 2명의 환자에서 추적 기간 중에 완전 방실차단이 발생하였으며, SVA수술과 관련하여 재발한 경우는 없었다. Kaplan-Meier 방법에 의한 생존율은 15년과 27년에 각각 $92.5\pm3.5\%$로 매우 양호한 결과를 나타내었다. 결론: 발상바동류 및 파열의 수술 결과는 매우 양호하였으며, 장기간의 생존율도 만족할 만하였다.

• 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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• 제33권5호
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• pp.391-397
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• 2000

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

• Journal of Chest Surgery
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• 제30권7호
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• pp.686-692
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• 1997

저자들은 1994년 2월부터 1995년 8월사이에 본 교실에서 흉부대동맥류로 외과적 치료를 받았던 15 례의 임상성적을 분석하여 수술수기 및 수술결과를 향상시키는 계기로 삼고저 한다. 남자가 9례, 여자 가 6례였으며 평균연령은 55.07$\pm$11.76세였다. 원인질환은 대동맥박리증이 9례, 죽상경화증이 4례, 외 상이 2례이었다. 9례에서 상행 대동맥 및 대동맥궁의 부분 및 완전 치환술을 시행하였으며 3례에서 하행 대동맥 및 흉복부 대동맥치 환술을 시행하였고, 1례에서는 전체 대동백치환술을 시행하였으며, 외 상성 대동맥류 2례에서는 단단문합하였는데 대동맥 박리증 환자에서는 Wheat씨 방법으로 봉합부위를 보강한 후 치환하였다. 9례에서는 정중흉골절개술을, 4례에서는 후외측 흉벽절개술을, 2례에서는 후외 측 흉부절개후 흉복부절개술을 시행하였다. 상행 대동맥 및 대동맥궁을 치환하였던 9례에서는 상대정맥을 통한 역행성 뇌관류를 평균 56.67$\pm$29.25분 동안 시행하였고 하행 대동맥 및 흉복부 대동맥을 치환하였던 3례에서도 고도의 저체온화를 시행하였는데 술후 항구적인 뇌나 척추 신경장애가 발생한 례는 없었다. 술후 외상성 복담즙에 의한 복막염, 다장기 기능부전, 악성고혈압에 의한 잔여 박리성 동 맥류파열로 3례(20%, 3/15)가 사망하였다. 술후 합병증으로는 출혈에 의한 재수술이 4례, 일시적인 의식장애 3례, 늑막삼출 등의 폐 합병증이 3례, 심낭압진 1례 있었다. 타의료기관에서 관찰중인 1례를 제외한 11례를 추적관찰중인데 사망하거나 만기 합병증을 보인 례는 없었다.

• Journal of Chest Surgery
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• 제12권4호
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• pp.365-370
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• 1979

The first Mitral Commissurotomy was performed for tight mitral stenosis on March 1957. The patient was at that time 22-year-old male, student. The longest follow 9p for 22 years and 8 months has been obtained. During the follow up period, late deterioration due to restenosis developed 4 years after initial good result and reoperation was succeeded by transventricular Mitral Valvotomy with Tubb`s ilator on April 1964. The possible cause of restenosis was attributed to recurrent rheumatic activity. After more than 13 years long-good life following 2nd operation, Endocarditis such as episode of high fever & chill intermittently followed by mild fever and night sweat, I t. tibial artery embolization and rupture of aortic cusp. At present, patient complained of no subjective symptom, enjoying ordinary life {NYHA II]. Blood pressure has been 110/50-60 mmHg, trivial diastolic murmur at apex and moderate degree of mechanical murmur on diastole at Erb`s rea. Neither signs of RVH for mitral stenosis nor sign of LVH. ST-T change for aortic regurgitation appeared yet during last 2 yrs. The patient`s are for prevention of Rheumatic activity and development of endocarditis is important for obtaining the better long-term result.