• Journal of Chest Surgery
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• v.34 no.9
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• pp.720-723
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• 2001

A case of Marfan’s syndrome with atresia of right coronary artery is reported. A 45-year-old woman, who was diagnosed as Marfan’s syndrome 1 year ago, came to the hospital complaining of acute chest pain. The patient showed arachynodactyly, pectus carinatum, and long and slender extremities. In echocardiography there were severe aortic regurgitation measured grade IV and aortic dilatation of ascending aorta maximally 5.9 cm in diameter. Mitral regurgitation was mild, but there were also moderate left ventricular dilation and moderately decreased ejection fraction of left ventricle. At operation, atresia of right coronary artery was found. We performed Bentall type operation with SJM 27mm valved conduit for left coronary artery, and Piehler’s modification for right coronary artery bypass using 6mm PTFE graft. The atretic portion of right coronary artery from the suspected right coronary ostium to distal coronary flow was about 4 cm in length. The combination of right coronary artery atresia and Marfan’s syndrome is very rare. The author describes the rare case, which is treated with combined technique of Bentall and Piehler modification for reconstruction of coronary circulation.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.225-227
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• 2007

The aortic inclusion technique is frequently used in the original Bentall's procedure for the control of excessive postoperative bleeding. Although this procedure has improved the outcome of patients with aortic root disease, there is a high incidence of both early and late complications, including coronary artery stenosis, kinking or pseudoaneurysm formation at the coronary suture lines. Pseudoaneurysm of the ascending aorta is a relatively rare, but fatal complication, which occurs after wrap-inclusion composite graft replacement. Herein, the case of a 45-year-old female, who developed a perigraft aortic pseudoaneurysm 10 years after a Bentall's procedure (wrap-inclusion technique), but was successfully managed using the Cabrol's method, is reported.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.153-156
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• 1994

Bentall`s operation for repair of annuloaortic ectasia has been associated with postoperative bleeding and with false aneurysm of the anastomotic site between the coronary orifice and composite graft.Among 5 cases, 2 cases have been operated direct anastomosis between coronary artery and vascular graft.Remained 3 cases have been operated with doughnutlike Teflon felt buttress.The technique of sandwiching the freed button of aortic wall bearing the coronary artery ostium between an outer Teflon felt doughnutlike buttress and the inner composite graft provides a leak-proof anastomosis.We experienced one case reoperation for bleeding at coronary anastomotic site above method.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.297-302
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• 1996

From January 1989 to July 1995, 18 patients underwent aortic repair for type A dissections. The e were 9 male and 9 female patients aged 41 to 68 years(mean, 53.8). Thirteen patients underwent the procedure during the acute period, and 5 during the chronic period. During repair of acute dissection, procedures included graft replacement of the ascending aorta only (6 patients), ascending aorta plus partial aortic arch (3), ascending aorta plus total aortic arch (2), Bentall's operation (1), and Bentall's operation plus total aortic arch (1). During repair of chronic dissection, procedures included Bentall's operation (3 patients), ascending aorta only (1), and ascending aorta plus partial aortic arch (1). During repair of the arch, antegrade cerebral perfusion was applied in 4 patients and hypothermic circulatory arrest in 3 patients. There were 4 operative deaths(22.2%), 2 of hemorrhage. and 2 of left ventricular failure in the operating room. Follow-up has been 100% completed and ranged from 2 to 53 months (mean, 17 months). One late death resulted from sepsis following secon operation. Thirteen of the survivors are doing well.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.156-160
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• 2010

The Bentall-DeBono operation is the technique of choice for aortic root replacement. When the patients have contraindications for lifelong anticoagulation, the biologic Bentall operation may be a good option. However, complex reoperation may be required when bioprosthetic degeneration occurs. For this reason, a new technique for simple reoperation after the Bentall operation has recently been performed by some surgeons. We performed a similar technique in two patients with aortic root dilation and for whom aortic valve sparing techniques could not be performed because of an unrepairable valve contour, we think this modification seems to be simple and reproducible for reoperation.

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.67-67
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• 1996

• Journal of Chest Surgery
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• v.20 no.4
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• pp.803-808
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• 1987

Two young male patients were operated on for the Marfan syndrome complicating ascending aortic aneurysm and a moderate degree of aortic regurgitation. We replaced the ascending aorta and aortic valve with Bjork-Shiley aortic valve composite graft and implanted the coronary ostia in the sides of the graft directly. Postoperatively, the atrial fibrillation occurred in one case and the other had uneventful course. They showed improvement in activity at follow-up.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.113-117
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• 1998

From October 1993 to April 1997, 37 patients(30 male and 7 female patients), ranging in age from 23 to 73 years, were operated for annuloaortic ectasia with or without aortic dissection. Four patients were in New York Heart Association Class I, 10 in Class II, 20 in Class III, and 3 in Class IV. In cases of annuloaortic ectasia with aortic dissection, the surgical treatment in all cases consisted of total replacement of the ascending aorta with composite graft and reimplantation of the coronary arteries to the tube graft. The postoperative complication, as postoperative bleeding or LV dysfunction, was 18%(7 cases) and late mortality for entire group was 2.7%(one death). The period of follow-up ranged from 1 month to 36 months(average 9.6 months). In conclusion, Bentall operation for annuloaortic ectasia with or without aortic dissection is reliable method with low mortality and excellent short-term results.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.573-579
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• 2008

Background: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. Material and Method: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was $43.7{\pm}14.1$ years old (range: $6{\sim}65$ years) and the male and female ratio was 21:4 (84% : 16%). The patients' follow-up was 100% complete, and the mean follow-up period was $60.7{\pm}50.4$ (range:$1{\sim}162$) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was $177.2{\pm}44.9$ minutes and the mean aortic cross clamping time was $123.4{\pm}34.1$ minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. Result: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. Conclusion: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.336-339
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• 1997

The surgical treatment of diseases of thoracic aorta has had much better success rate in recent years compaired to the past. Aortic aneurysms or dissections that extend along the entire thoracic aorta are usually approached in two or three stages. Recently we successfully perfofm d one-stage aortic replacement from the aortic root to the abdominal aorta in chronic DeBakey type I dissection. A 25 year-old man who had dyspnea on exertion (NYHA Fc II) and a Marfanoid feature was operated under the diagnosis of chronic type I dissection with severe aortic regurgitation. ' At operation, a huge ascending aorta with two intimal tearings was seen and the blood supply of intercostal arteries and right renal artery was done from the false lumen. Modified Bentall operation with total aortic replacement was done successfully, and the patient is being followed-up without major complications.