• Journal of Chest Surgery
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• v.32 no.6
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• pp.595-598
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• 1999

Some extensive thoracic aortic aneurysms are not amenable to staged repair, such as extremely large distal aortic aneurysms that are unsuitable for an elephant trunk anastomosis, or aneurysms that are accompanied by complications such as ruptured descending thoracic aneurysm. We report here a case of successful replacement of the aorta from the ascending to the descending aorta in one operation. The patient was 65-year-old man who had an aneurysm which involved the entire thoracic aorta and ruptured in the descending aorta. The operation was performed via transverse thoracosternotomy, and under the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The patient recovered uneventfully and was discharged without any neurologic complications.

• Journal of Chest Surgery
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• v.13 no.1
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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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• v.27 no.4
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• pp.318-324
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• 1994

Cross-clamping of the descending thoracic aorta results in proximal hypertension,increase in left ventricular afterload,and impairment of distal organ perfusion. Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamping of the thoracic aorta. At Seoul National University Hospital, 7 patients were treated for the thoracic or thoracoabdominal aortic aneurysm using left atrium-femoral artery bypass with Bio-medicus centrifugal pump between October,1989, and January,1993. There were atherosclerotic thoracic aneurysm in 3 cases, thoracoabdominal aortic aneurysm due to chronic aortic dissection in 3 cases,aortic rupture due to trauma in 1 case. Total of 7 patients were operated by graft replacement with reimplantation of important branches. None of these cases developed severe complications and hospital death. We believe that the Bio-Medicus centrifugal pump is a simple and safe means of perfusing the lower body, kidneys, and spinal cord without necessitating heparinization.

• Journal of Chest Surgery
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• v.46 no.1
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• pp.68-71
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• 2013

A 67-year-old female patient was treated with conventional total arch replacement and insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta for acute DeBakey type I aortic dissection at one time. She had been treated with right coronary artery stent insertion for acute myocardial infarct 4 days earlier, and at that time, she was diagnosed with acute DeBakey type I aortic dissection from the ascending aorta to the suprarenal artery based on trans-esophageal echocardiography and aorta computed tomography. Through a median sternotomy, we inserted the SET graft through the opened aorta to the descending aorta. We also performed anastomosis between the proximal stented graft and the distal aortic arch, and then performed total arch replacement. For acute DeBakey type I aortic dissection, we report total arch replacement with insertion of a SET graft as a combination of conventional surgery and the interventional technique.

• Journal of Chest Surgery
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• v.14 no.3
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• pp.291-296
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• 1981

Dissecting aortic aneurysm is a disease which is characterized by hemorrhagic intramural seperation of aortic wall and extension for varlng distances proximally, distally, or both from the site of the intimal tear. Most aortas show some type of medial degeneration most commonly described as cystic medial necrosis. DeBackey classified this disease according to involved aorta and site of intimal tear to 3 basic types, such as type I, II and III. Type III is defined that dissecting process arrises in the descending thoracic aorta just distal to origin of the left subclavian artery and extends distally for a varing distance. We expirienced a case of dissecting aneurysm, type III of DeBackey's classification which dissecting process is limited to the descending thoracic aorta in the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital. This patient was 40 year old woman and she had suffered from intermittent sharp back pain for 3 years .before admission. Excision of the aneurysm and Dacron graft were placed successfully under the left atrio-femoral bypass with artificial pump. The hospital course was uneventful.

• Journal of Chest Surgery
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• v.11 no.1
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• pp.81-84
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• 1978

A 15 years Old girl was admitted with chief complaints of intermittent claudication of lower extremity, dizziness, and headache for 5 years. On admission, malignant hypertension was noted in the upper part of body [190-150/120-110] but femoral & dorsalis pedis pulse could not palpate. Once she had experienced C. V. A. due to hypertension of upper part, about years ago. On auscultation, systolic murmur was audible along the left sternal border. E.C.G. Showed left ventricular hypertrophy pattern, and others within normal limit. Retrograde aortography demonstrated diffuse narrowing of entire thoracic aorta with underdeveloped lower abdominal aorta [below the renal artery] & both common lilac artery, and rich collaterals, but normally visualized greater arteries in the aortic arch. On left posterolasteral thoracotomy, entire descending thoracic aorta revealed marked narrowing with mild perivascular adhesion, but no mediastinal pleura adhesion. These findings suggest as congenital type of atypical coarctation in the entire thoracic aorta with mild secondary change. But histopathology was showed the findings of chronic non-specific aortitis, later. Dacron by pass graft was performed with end to side anastomosis between graft and aortic wall. After operation, all her preoperative symptoms & signs were disappeared, and discharged with good general condition.

• Journal of Chest Surgery
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• v.24 no.7
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• pp.685-692
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• 1991

Twelve patients underwent surgical interventions for aortic aneurysms consecutively from September 1986 to September 1990 in the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. They were all men ranging in age from 25 to 68 years with the mean age of 48 years. Five patients of them had aneurysms involving ascending aorta, one aneurysm involving both ascending and descending aorta, four aneurysms involving descending thoracic aorta, and the others had aneurysms involving abdominal aorta. According to morphological classification, six cases of them were in dissection and the others in fusiform aneurysms. All the cases were pathologically true aneurysms and four of them were in acute status. According to causal classification, seven patients of them had atherosclerosis, three cystic medial necrosis, and the others had syphilis and trauma respectively. Six patients with ascending aortic aneurysm had annuloaortic ectasia with aortic regurgitation and underwent ascending aortic graft and aortic valve replacement[Bentall`s operation]. The others with descending thoracic and abdominal aortic aneurysms underwent Dacron graft replacement. Both hemorrhage necessitating reopening of the chest and wound dehiscence were observed in three patients and hoarseness in one patient. Cerebrovascular accident occurred three and a quarter years postoperatively in one patient and he died two days later. The others were followed up via OPD and have been doing well postoperatively.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.328-331
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• 1995

A 42-year-old Marfan female had a chronic dissection of the descending aorta[Type B and the aneurysmal expansion of the descending aorta caused compression of the trachea resulting in respiratory distress which mimicked bronchial asthma. The patient has been successfully managed by resection and replacement of the aneurysm in the descending aorta. The operation could be done without the aid of the partial cardiopumonary bypass. As the patient had been prepared by unilateral axillo-bifemoral by-pass using prosthetic graft 8mm in diameter 10days prior to the main operation.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.748-751
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• 2000

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root(Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.704-707
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• 2007

Penetrating atherosclerotic ulcer involving the aortic arch has rarely been reported on in the literature. Acute rupture of a penetrating atherosclerotic ulcer involving the distal arch and the proximal descending thoracic aorta was found in a 78-year-old male, and he originally presented with acute-onset shoulder pain and hoarseness. Patch repair of the perforated arch and the proximal descending thoracic aorta was successfully done under total circulatory arrest.