• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.440-448
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• 2006

Background: Surgery of descending thoracic or thoracoabdominal aorta has the potential risk of causing neurological injury including spinal cord damage. This study was designed to find out the risk factors leading to spinal cord and brain damage after surgery of descending thoracic and thoracoabdominal aorta. Material and Method: Between October 1995 and July 2005, thirty three patients with descending thoracic or thoracoabdominal aortic disease underwent resection and graft replacement of the involved aortic segments. We reviewed these patients retrospectively. There were 23 descending thoracic aortic diseases and 10 thoracoabdominal aortic diseases. As an etiology, there were 23 aortic dissections and 10 aortic aneurysms. Preoperative and perioperative variables were analyzed univariately and multivariately to identify risk factors of neurological injury. Result: Paraplegia occurred in 2 (6.1%) patients and permanent in one. There were 7 brain damages (21%), among them, 4 were permanent damages. As risk factors of spinal cord damage, Crawford type II III(p=0.011) and intercostal artery anastomosis (p=0.040) were statistically significant. Cardiopulmonary bypass time more than 200 minutes (p=0.023), left atrial vent catheter insertion (p=0.005) were statistically significant as risk factors of brain damage. Left heart partial bypass (LHPB) was statistically significant as a protecting factor of brain (p=0.032). Conclusion: The incidence of brain damage was higher than that of spinal cord damage after surgery of descending thoracic and thoracoabdominal aorta. There was no brain damage in LHPB group. LHPB was advantageous in protecting brain from postoperative brain injury. Adjunctive procedures to protect spinal cord is needed and vigilant attention should be paid in patients with Crawford type II III and patients who have patent intercostal arteries.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.269-273
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• 1980

The rupture of the aorta commonly follows major blunt trauma to the thorax. It has markedly increased in recent years, paralleling the rising number of vehicular accidents. The most frequent site of rupture is the area of the isthmus, with the ascending aorta second. The diagnosis of the condition from clinical data is difficult, and aortography is used whenever aortic tear is suspected. We are presenting a case of patient who had intimal tearing of the thoracic aorta with multiple injuries. The patient underwent surgical repair 28 days after injury with left heart [LA-Femoral artery] bypass.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.524-527
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• 2009

A stent graft has been accepted as an alternative method for treating aortic diseases or to reduce the extent of surgery. We report here on a one-stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for the seperate aneurysmal lesions on the ascending and descending aorta.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.505-509
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• 1991

Rupture or laceration of the aorta is a more common result of nonpenetrating traumatic injury than is generally appreciated. If the lesion is promptly diagnosed, a appropriate surgical treatment may be life-saving. Diagnosis may be difficult and at times the rupture may remain clinically silent for variable period.< A 34 - year old male patient had sustained steering wheel injury to his chest during automobile accident 8 weeks prior to admission. The diagnosis of traumatic aneurysm of the aorta was delayed as he was asymptomatic. Surgical repair of false aneurysm of the descending aorta was successfully performed by partial cardiopulmonary bypass through the femoral artery and vein.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.594-600
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• 1989

Primary intracardiac repair of tetralogy of Fallot with low mortality and early good results, has been accomplished in recent years. But palliative procedures have been reserved for those hypoplastic pulmonary arteries, a hypoplastic left ventricle or anomalies of the coronary artery would make total correction difficult. And the Blalock-Taussig shunt operation is recognized as a standard and popular palliative procedure. I undertook a retrospective determination of the effect of the Blalock-Taussig shunt operation on the development of the main pulmonary artery and the right and left pulmonary arteries. Between January, 1980, and April, 1987, at the Severance Hospital, 16 patients were studied by cardiac catheterization and angiocardiography, before undergoing Blalock-Taussig shunting procedures for the palliation of severe symptoms of tetralogy of Fallot, and some time later, usually prior to a second procedure. The mean interval between catheterizations was 22.25 months. Patients with tetralogy of Fallot and pulmonary atresia or with an occluded shunt were not included. The primary and secondary angiograms of each patient were reviewed, and measurements of the diameter of the main pulmonary artery, the right and left pulmonary arteries, and the descending thoracic aorta were taken. The results are as follows; 1. The hematocrit decreased from 56.39% to 50.34%[p< 0.05], and the arterial oxygen saturation increased from 62.00 % to 81.31 %[p< 0.001] following shunt procedures 2. The ratio of the diameter of the right pulmonary artery plus the left pulmonary artery to the diameter of the descending thoracic aorta increased 1.30 k 0.28 times [p< 0.01]; but the ratio of the diameter of the main pulmonary artery to the diameter of the descending thoracic aorta increased 1.10 * 0.33 times, which was not. significant[p< 0.05]. 3. The interval between shunting and second catheterization was not related to the magnitude of change in the pulmonary arteries[r=0.141, p >0.05]. 4. The changes in the ratio of the diameter of the right pulmonary artery plus the diameter of the left pulmonary artery to the diameter of the descending thoracic aorta was inversely related to the initial ratio[r=0.757, p >0.001], but the change in the ratio of the diameter of the main pulmonary artery to the descending thoracic aorta was not related[r=0.059, p >0.05]. 5. There were no differences in enlargement of the pulmonary artery on the side of the shunt [ipsilateral] versus enlargement on the opposite side [p >0.05], nor according to the size of the shunt[p >0.05]. In conclusion, this study suggests that the Blalock-Taussig shunt is effective for the development of the right and left pulmonary arteries but not effective for the main pulmonary artery.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.617-620
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• 1997

Traumatic aneurysm of both the thoracic aorta and the left ventricle are extremely rare in children because it is characterized by high mortality. We report a case which we experienced recently with sucessful outcome. A Five-year-old boy had a blunt trauma by bongo bus. He had pulmonary hemorrage and pericardial effusion complicated by multiorgan failure threatening his life. Aneurysm of LV and Descending aorta were showed by 2-D echocardiogram and MRI. The atient underwent successful corrective surgery 2 and half momths after trauma, the Postoperative status of this patient was uneventful, now he is being followed up the OPD.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.213-218
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• 1997

Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four cases of thoracic aortic pseudoaneurysm who underwent surgical repair, The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.

• Journal of Chest Surgery
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• v.47 no.1
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• pp.6-12
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• 2014

Background: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities. Methods: This study enrolled 41 patients (age, $55.2{\pm}11.9$ years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr). Results: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint. Conclusion: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.522-528
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• 1991

A successful repair of aortic dissection of descending thoracic aorta was performed in a 48 year old man. The patient was visited ER because of abruptly onset chest pain. On admission, Chest film showed mediastinal widening and undertaken chest CT, echocardiogram and angiogram There was evidence of dilation on descending aorta with internal separation of intimal calcification. Aneurysmal sac with dissection was noted from just below left subclavian artery to 2cm above of diaphragm. He underwent thoracotomy and the impending ruptured aneurysm of the aorta was replaced with a Woven Dacron graft[20Yo Albumin preclotted] using LA-femoral bypass. Postoperative course was uneventful.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.968-975
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• 1990

An aortobronchial fistula is a rare complication of aneurysm of the aorta. The fistula starting from a chronic traumatic aortic aneurysm is exceptionally rare. Our observation concerns a patient of 26 with previous chest trauma who had atelectasis of left lung following dyspnea and hemoptysis. Aortography and surgical intervention revealed that this was a chronic traumatic aortic aneurysm of descending thoracic aorta, which developed a fistula in the bronchus. She underwent left posterolateral thoracotomy and the surgical repair of the aneurysm was performed with a woven Dacron patch graft using a temporary external bypass between the ascending and the descending aorta. The fistula in the bronchus was closed with simple interrupted sutures. In the immediate postoperative period, double vision, headache, and hoarseness developed but returned normal.