• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.178-187
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• 2020

Objective : The extensive vasa vasorum network functions as a conduit for the entry of inflammatory cells or factors that promote the progression of angiogenesis and plaque formation. Therefore, we investigated the correlation between the carotid vasa vasorum activities and carotid plaque vulnerability using indocyanine green video angiography (ICG-VA) during carotid endarterectomy (CEA). Methods : Sixty-nine patients who underwent CEA were enrolled prospectively from September 2015 to December 2017. During CEA, a bolus of ICG was injected intravenously before and after resecting the atheroma. Additionally, we performed immunohistochemistry using CD68 (a surface marker of macrophages), CD117 (a surface marker of mast cells), and CD4 and CD8 (surface markers of T-cells) antibodies to analyze the resected plaque specimens. Results : The density of active vasa vasorum was observed in all patients using ICG-VA. The vasa vasorum externa (VVE) and interna (VVI) were seen in 11 (16%) and 57 patients (82.6%), respectively. Macroscopically, the VVE-type patterns were strongly associated with preoperative angiographic instability (81.8%, p=0.005) and carotid plaque vulnerability (90.9%, p=0.017). In contrast, the VVI-type patterns were weakly associated with angiographic instability (31.6%) and plaque vulnerability (49.1%). CD68-stained macrophages and CD117-stained mast cells were observed more frequently in unstable plaques than in stable plaques (p<0.0001, p=0.002, respectively). Conclusion : The early appearance of VVE, along with the presence of many microvessel channels that provided nutrients to the developing and expanding atheroma during ICG-VA, was strongly associated with unstable carotid plaques. The degree of infiltration of macrophages and mast cells is possibly related to the formation of unstable plaques.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.261-269
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• 1987

From 1976 through 1986, authors have experienced 127 cases of peripheral vascular surgery which had been done in this department. There were 29 cases of atherosclerosis obliterances including 7 Leriche syndrome, 32 Buerger`s diseases, 25 arterial thromboembolisms, 21 vascular injuries, 2 peripheral arterial aneurysms, 2 renovascular hypertensions, 1 congenital A-V malformation, 13 varicose vein of lower extremities, and 2 Jugular venous ectasia. Cases with vena caval disease and aortic disease were excluded. The mean age of ASO and Buerger`s disease was 56.1 yrs, 33.8 yrs respectively. The male to female ratio showed marked male preponderance [27:2, and 30:2], and almost every male patient was smoker. The indication of operation was similar in both disease entities. The method of operation for ASO were bypass procedure [17], thromboendarterectomy [6], and lumbar sympathectomy [5], and for Buerger`s disease were mainly sympathectomy and few bypass procedures and amputations. Seventeen patients with ASO were followed from 3 to 75 month and overall patency rate for bypass or endarterectomy in one and two months and 2 1/2 yr were 93%, 87%, and 31% respectively. Post operatively patient`s symptoms was relieved or alleviated in almost ASO patients, and about 60% of Buerger`s disease. We concluded that in patient with ischemic limb, we must revascularized aggressively for symptomatic relief. And choice of graft for bypass procedure was to be evaluated further.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.173-175
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• 2004

Primary pulmonary arterial sarcomas, especially those originating from the pulmonary valve are extremely rare. A 35 year-old male patient was admitted for exertional dyspnea and fatigue. Large intraluminal mass in the main pulmonary artery and both pulmonary arteries was detected by chest computed tomogram, chest magnetic resonance imaging, echocardiogram, and pulmonary angiogram. We regarded the mass as a primary pulmonary arterial malignant tumor, and resected under cardiopulmonary bypass. The mass was appeared to originate from the posterior cusp of pulmonary valve, and extended from below pulmonary valve to main pulmonary artery and both pulmonary arteries. We resected the mass by pulmonary endarterectomy and replaced the pulmonary valve. The mass was diagnosed as a pulmonary arterial sarcoma in histopathologic examination.

• Journal of Chest Surgery
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• v.50 no.2
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• pp.114-118
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• 2017

Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries.

• Journal of Chest Surgery
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• v.51 no.3
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• pp.205-208
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• 2018

A 71-year-old female patient was admitted to the emergency department with sudden aggravation of chest pain and severe dyspnea. Computed tomography showed extensive pulmonary thromboembolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was instituted due to sudden bradycardia and hypotension. An emergency operation was performed. However, chronic pulmonary thromboembolism combined with an acute pulmonary embolism was detected in the operating room. Embolectomy and endarterectomy were performed. ECMO was then discontinued. The patient was discharged on postoperative day 13 with warfarin for anticoagulation. The patient was followed up for 46 months as an outpatient without further thromboembolic events.

• Journal of Korean Neurosurgical Society
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• v.44 no.3
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• pp.159-162
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• 2008

Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation, tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous, atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the atherosclerotic aorta.

• Journal of Chest Surgery
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• v.26 no.11
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• pp.833-837
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• 1993

In an effort to reduce the stroke rate of patients after coronary artery bypass, many authors have studied the prevalence of the extracranial carotid disease and its role in determining neurologic morbidity and mortality rates. From April 1992 to August 1993, Seventy-five patients undergoing coronary artery bypass were preoperatively evaluated for presence of carotid and femoral stenosis by Duplex sono. Among them, fourteen patients was positive by Duplex sono and overall prevalence of carotid or femoral stenosis was 18.7%. And significant carotid stenosis [ > 60% ] had proved to be in 3 patients [ 4.0% ].Prophylatic bilateral carotid endarterectomy was performed in one patient, at 5 months prior to and , 1 week prior to coronary artery bypass respectively. Their mean age was 57.6 years [ ranged from 40 to 70 years] and were composed of 10 males and 4 females. There was no postoperative morbidiry and mortality related to neurologic complications. Our data, although small, suggest that preoperative carotid screening is helpful to determine patients at high risk of stroke, and significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.359-361
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• 2023

Coronary ostium obstruction due to dislodgement of the prosthetic valve is a rare and life-threatening complication, and particular caution is required for sutureless aortic valve replacement (AVR) with concomitant valvular surgery. In general, coronary artery bypass surgery is performed when coronary ostium obstruction occurs after AVR, but other options may need to be considered in some cases. Herein, we present a case of coronary artery occlusion in an 82-year-old female patient who had undergone AVR and mitral valve replacement for aortic valve stenosis and mitral valve stenosis at the age of 77 years. A hybrid procedure involving redo AVR and percutaneous coronary intervention after left main coronary ostium endarterectomy was performed. To summarize, we present a case of hybrid AVR in a patient with coronary artery obstruction after AVR that was successfully managed using this method.

• Journal of Microbiology
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• v.42 no.4
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• pp.299-304
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• 2004

To investigate the presence of infectious agents in human atherosclerotic arterial tissues. Atherosclerotic plaques were removed from 128 patients undergoing carotid endarterectomy or other bypass proce­dures for occlusive disease, and from twenty normal arterial wall samples, obtained from transplant donors with no history of diabetes, hypertension, smoking, or hyperlipidemia. Using the polymerase chain reaction (PCR) or reverse transcription-PCR, these samples were analyzed for the presence of Chlamydia pneumoniae, cytomegalovirus, enterovirus, adenovirus, herpes simplex viruses types 1 and 2, and Epstein-Barr virus. The amplicons were then sequenced, and phylogenetic analyses were per­formed. Enteroviral RNA was found in 22 of 128 atherosclerotic vascular lesions $(17.2\%),$ and C. pneu­moniae and cytomegalovirus were each found in 2 samples $(1.6\%).$ In contrast, adenovirus, herpes simplex viruses, and Epstein-Barr virus were not identified in any of the atherosclerotic samples. Enterovirus was detected in 6/24 $(25.0\%)$ aortas, 7/33 $(21.2\%)$ carotid arteries, 6/40 $(15.0\%)$ femoral arteries, and 3/31 $(9.7\%)$ radial arteries of patients with chronic renal failure. There were no infectious agents detected in any of the control specimens. Using phylogenetic analysis, the enterovirus isolates were clustered into 3 groups, arranged as echovirus 9 and coxsackieviruses Bl and B3. Enteroviral RNA was detected in $17.2\%$ of atherosclerotic plaques, but was not observed in any of the control spec­imens. This suggests a connection between enteroviral infection and atherosclerosis. These findings dif­fer from those of other studies, which found more frequent incidence of C. pneumoniae and cytomegalovirus infection in atherosclerotic plaques.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.869-875
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• 2000

배경: 뇌혈관계 합병증은 관상동백우회술 후 발생하는 사망률 중 10% 이상을 차지하는 치명적인 질환이다. 최근들어 고령 환자, 고혈압, 당뇨병 등이 병발하고 고 위험군에 대한 수술이 증가하면서 뇌혈관계 합병증은 오히려 증가하고 있다. 본 연구는 관상동맥우회술을 받은 환자의 의무기록을 조사하여 관상동맥우회술 후 발생되는 뇌혈관계 질환의 위험 인자를 밝히고자 한다. 대상 및 방법: 1991년 3월부터 1999년 7월 사이에 관상동맥우회술을 받은 185명을 조사하여, 뇌혈관계 합병증의 위험 인자들을 통계적으로 검증하였다. 결과: 뇌혈관계 합병증의 유병율은 7.57%(14명)였으며 이중 5예는 사망하였다. 동 기간 중 전체 사망은 11예이므로 사망자의 45.5%가 뇌혈관계 합병증으로 사망한 것이다. 통계적의의가 있는 뇌혈관계 합병증 위험 인자로는 수술 후 부정맥(p=0.0064), 기왕의 뇌혈관계 병력(p=0.0090), 체외순환시간(p=0.0181), 대동맥의 동맥경화(p=0.03575) 및 당뇨병(p=0.0452) 등이었다. 경동맥협착이 동반되어 경동맥 혈관내막 절제술(carotid endarterectomy)을 동시에 시술한 경우는 2예였으나, 뇌혈관계 합병증은 발생하지 않았다. 75세 이상의 고령환자는 3명이었으며 모두 뇌혈관계 합병증은 발생하지 않았다. 결론: 관상동맥우회술 후 발생하는 뇌혈관계 질환과 통계적으로 유의한 위험요인은 수술 후 부정맥, 뇌혈관이상의 기왕력, 체외순환시간, 대동맥궁의 동맥경화, 당뇨 등이었다.