• Journal of Chest Surgery
• /
• v.36 no.1
• /
• pp.30-34
• /
• 2003

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiographic with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, heompericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

• Journal of Chest Surgery
• /
• v.30 no.2
• /
• pp.213-218
• /
• 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
• /
• v.19 no.3
• /
• pp.443-448
• /
• 1986

Aortic dissection is a serious disease that mortality does not approach to zero despite of medical and surgical improvement. Recently two cases of aortic dissection were treated with good results by the two other methods. Case 1 [57-Y-0-Male]; Chief complaint was chest pain radiating to the back. Preoperatively he was controlled by Minipress, dichlotride, & sodium nitroprusside. Aortography showed DeBakey Type III aortic dissection extending from just below the Lt. subclavian artery to the proximal portion of the origin of the renal artery. Through the midline long incision Flow reversal & Thrombo-exclusion method was used, and bypass course was proximal anastomosis at the ascending aorta - through the Rt. thoracic cavity - midportion of the diaphragm - posterior to the liver, stomach, & pancreas - distal anastomosis at the abdominal aorta proximal to its bifurcation. Bypass graft was preclotted 20 mm Dacron Woven Graft, and the aortic arch between the Lt. subclavian artery & Lt. common carotid artery was divided and meticulously sutured. Control aortogram which was done at 4th postoperative month revealed obstruction of the false lumen by thrombosis, and complications were not noticed. Case 2 [53-Y-0-Male]; Chief complaint was chest pain radiating to the abdomen. DeBakey Type III aortic dissection which was similar to the case 1 was detected by the aortography, and involvement of the Lt. subclavian & common carotid arteries was suspicious. Through the Lt. posterolateral thoracotomy the Ringed Intraluminal Sutureless Graft, No. 22 mm, was inserted from just below the Lt. common carotid artery to the midportion of the descending thoracic aorta under total circulation arrest using a F-F bypass, and the Lt. subclavian artery was ligated. Postoperatively hospital course was uneventful with antihypertensive drugs, and any specific complications were not noticed.

• Journal of Chest Surgery
• /
• v.30 no.5
• /
• pp.506-511
• /
• 1997

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

• Journal of Chest Surgery
• /
• v.28 no.1
• /
• pp.23-30
• /
• 1995

From January 1985 to December 1992, of 1257 patients who underwent a heart valve replacement 210 [16.8% underwent reoperation on prosthetic heart valves, and 6 of them had a second valve reoperation. The indications for reoperation were structural deterioration [176 cases, 81.5% , prosthetic valve endocarditis [25 cases, 11.6% , paravalvular leak [12 cases, 5.6% , valve thrombosis [2 cases, 0.9% and ascending aortic aneurysm [1 case, 0.4% . Prosthetic valve failure developed most frequently in mitral position [57.9% and prosthetic valve endocarditis and paravalvular leak developed significantly in the aortic valve [40%, 75% [P<0.02 . Mean intervals between the primary valve operation and reoperation were 105.3$\pm$28.4 months in the case of prosthetic valve failure, 61.5$\pm$38.5 months in prosthetic valve endocarditis, 26.8$\pm$31.2 months in paravalvualr leak, and 25.0$\pm$7.0 months in valve thrombosis. In bioprostheses, the intervals were in 102.0$\pm$23.9 months in the aortic valve, and 103.6$\pm$30.8 months in the mitral valve. The overall hospital mortality rate was 7.9% [17/26 : 15% in aortic valve reoperation [6/40 , 6.5% in reoperation on the mitral prostheses [9/135 and 5.7% in multiple valve replacement [2.35 . Low cardiac output syndrome was the most common cause of death [70.6% . Advanced New York Heart Association class [P=0.00298 , explant period [P=0.0031 , aortic cross-clamp time [P=0.0070 , prosthetic valve endocarditis [P=0.0101 , paravalvularr leak [P=0.0096 , and second reoperation [P=0.00036 were the independent risk factors, but age, sex, valve position and multiple valve replacement did not have any influence on operative mortality. Mean follow up period was 38.6$\pm$24.5 months and total patient follow up period was 633.3 patient year. Actuarial survival at 8 year was 97.3$\pm$3.0% and 5 year event-free survival was 80.0$\pm$13.7%. The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, so reoperation before severe hemodynamic impairment occurs is recommended.

• Journal of Chest Surgery
• /
• v.34 no.3
• /
• pp.252-255
• /
• 2001

본 30세 여환은 류마치스성 심장판막질환 진단하네 승모판막 및 대동맥판막 치환술 시행후 종격동염 발생하여 지속적 종격동 세척 및 3주간의 항생제 치료후 퇴원하였다. 외래 추적중 다시 감염 및 염증소견 보여 입원하여 혈액배양검사와 흉부전산화 단층촬영시행하였다. 검사상 종격동염의 이후 3주간의 항생제 치료에도 염증 소견이 지속되어 다시 시행한 흉부 전산화단층촬영상 상행대동맥에 거대 가성대동맥류소견보여 재개흉술을 시행하여 초저체온 완전 순환정지 하에 가성대동맥류를 절제한 후, 우심낭편을 이용하여 대동맥 성형술을 시행하였다. 수술후 환자는 순조롭게 회복하였으며 현재 외래에서 추적관리하고 있다.

• Journal of Chest Surgery
• /
• v.34 no.12
• /
• pp.968-971
• /
• 2001

Pedicled omentoplasty is effective in thoracic surgery, but it is associated with several postoperative complications. A case of diaphragmatic hernia as a complication of pedicled omentoplasty in a 65-year-old male is reported. Because aortoesophageal fistula occurred three months after the patch aortoplasty for mycotic aneurysm of descending thoracic aorta, he underwent ascending thoracic aorta to abdominal aorta bypass surgery with resection of thoracic aortic aneurysm and esophagorrhaphy with wrapping of the esophageal suture line and the stumps of aorta with pedicled omental flap. Three years after the operation, herniation of the stomach developed. The pedicled omental flap was ligated and divided, and the diaphragm defect was repaired.

• Journal of Chest Surgery
• /
• v.43 no.5
• /
• pp.490-498
• /
• 2010

Background: A hybrid procedure using an open surgical extra-anatomic bypass of aortic arch vessels and thoracic endovascular aortic repair (TEVAR) is less invasive than open surgery, and provides a suitable proximal landing zone. Here we report our experience with a hybrid TEVAR procedure at a single center. Material and Method: We retrospectively reviewed consecutive patients with thoracic aortic disease who received a hybrid TEVAR procedure between August 2008 and January 2010. Patients' data were prospectively collected and mean follow-up was $10.8{\pm}5.5$ months (range 3~20). Result: Nine patients (7 males and 2 females) with a mean age of $63.8{\pm}15.8$ years (range 38~84) underwent a hybrid procedure. Five patients had an arch or a proximal descending aortic aneurysm, two had a dissecting aneurysm of the descending aorta, and two had an aneurysm of the ascending arch and descending aorta. Mean expected mortality calculated by logistic EuroSCORE was 21%. Six patients underwent debranching and rerouting from ascending aorta to arch vessels, 2 had carotid-carotid bypass grafting, and 1 underwent carotid-axillary bypass grafting. Mean operation time was $221.4{\pm}84.0$ min (range 94~364). Deployment success of endovascular stent grafting was 100% with no endoleak on completion angiography. There was no mortality, and a small embolism in the branch of the right opthalmic artery in one patient. During follow-up, one intervention was required for the endoleak. Actuarial survival at 20 months was 100%. Conclusion: Early and mid-term results are encouraging and suggest that hybrid TEVAR procedures are less invasive and safer and represent an effective technique for treating thoracic aortic disease.

• Journal of Chest Surgery
• /
• v.37 no.6
• /
• pp.517-523
• /
• 2004

Background: The location of intimal tear can vary in type A acute aortic dissection. The aim of this study was to assess the operative result according to the intimal tear site. Material and Method: From January, 1995 to May, 2003, 18 patients underwent surgery for acute type A aortic dissection. The patients were classified according to the intimal tear site. In Group I (n=11), the intimal tear site was located within the ascending aorta, in Group II (n=7), the intimal tear site was located in the aortic arch, descending aorta, or intramural hematoma only. All clinical data were analyzed retrospectively. Result: In Group I, the operative time, cardiopulmonary bypass time, aorta cross clamp time and circulatory arrest time were 381.5$\pm$81.0 min, 223.5$\pm$42.5 min, 146.4$\pm$34.8 min and 36.5$\pm$17.4 min, respectively; and in group II, 461.7$\pm$54.0 min, 252.5$\pm$45.3 min, 162.5$\pm$45.3 min and 47.0$\pm$14.4 min respectively. All of those were greater in group II. The overall hospital mortality rate was 27.8% (5/18) and was significantly higher in Group II (57.1%)(p=0.003) compared to that in Group I (9.1%). The causes of death were hemorrhage (n=1) in group I and hemorrhage (n=2), multiple organ failure (n=1), and rupture of abdominal aorta (n=1) in group II. Conclusion: Surgical treatment of acute type A aortic dissection with intimal tear in the ascending aorta results in an acceptable mortality rate, but in patients with intimal tear in the aortic arch or descending aorta, the operative mortality still remains high when only ascending aorta replacement was performed. In these circumstances, in order to improve surgical results, efforts to include the intimal tear site in the operative procedure will be needed.

• Journal of Chest Surgery
• /
• v.35 no.5
• /
• pp.356-364
• /
• 2002

Background: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18 $\pm$ 9 minutes, 177 $\pm$ 42 minutes, and 127 $\pm$ 31 minutes, respectively. Result: There was 1 early death(1.9%). Mean follow-up was 24.6$\pm$ 19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0 $\pm$ 2.0% and 93.1 $\pm$ 5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site and a malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8 $\pm$ 2.0% and 65.3 $\pm$ 26.7% at 1 and 6 years, respectively.