• Journal of Chest Surgery
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• v.36 no.3
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• pp.194-201
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• 2003

Malperfusion of major organs which frequently accompanies acute aortic dissection is one of the major causes of death. Malperfusion does not only develop before surgery, but also during or after surgery in various manifestations according to the aortic branches involved. Expeditious diagnostic and therapeutic measures based on high degree of clinical suspicion are mandatory for successful treatment. The authors report four cases of acute aortic dissection accompanied by malperfusion of various organs that were successfully treated.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.865-867
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• 2004

Development of intraoperative aortic dissection during coronary artery bypass surgery is extremely rare with catastrophic outcomes resulting in high rates of morbidity and mortality. The prognosis is highly dependant upon prompt diagnosis and emergent treatment. We report our experience on a 72 year old female patient who successfully received ascending aortic graft replacement for acute intraoperative aortic dissection during coronary artery bypass procedure.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.173-177
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• 1998

A 28 years old pregnant woman(Gestational age 35 weeks) had been operated emergency Cesarian section for delivery and emergency graft replacement of ascending aorta and total arch for acute type A aortic dissection. 1 year and 6 months later, she underwent aortic graft replacement from descending thoracic aorta to both common iliac arteries because of further progression of aortic dissection. So far she has a complete artificial graft aorta.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.110-115
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• 2008

Malperfusion of a major organ with aortic dissection has various clinical features according branch. The morbidity and mortality rate can increase without suspicion especially postoperative period. Surgical outcomes and prognosis are influenced by early expeditious diagnostic and therapeutic measures are mandatory for successful treatment. The authors report four successful cases of acute aortic dissection with mal perfusion of various organs, such as the brain, kidney, and the lower extremities.

• Journal of Chest Surgery
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• v.40 no.8
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• pp.578-581
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• 2007

A 59-year old female patient was admitted due to massive hemoptysis. 6-months previously, we performed ascending aorta graft interposition for terating Debakey type 1 acute aortic dissection. Chest CT scan showed the fistula between the descending thoracic aorta and the left lower lobe. We performed descending thoracic aorta graft interposition under cardiopulmonary bypass. She recovered well without any postoperative problems. Distal aorto-bronchial fistula after a previous aortic operation is very rare. We report here the good results of treating aorto-bronchial fistula because we recognized this lesion early and performed an early operation.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.481-487
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• 1998

The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients(25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.125-132
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• 2001

배경 및 목적: Stand A형 급성대동맥박리증의 박리 시발점이 수술치환부위 내에 있는 경우와 그렇지 않은 경우의 임상적 차이점을 분석하여 치료에 도움을 주고자 하였다. 방법: 1991년 3월부터 1999년 7월까지 본원에서 급성상행대동맥박리증으로 진단되어 상행대동맥치환술을 받은 40명의 환자를 대상으로 병력기록을 근거로 수술 소견 상 찢어진 부위를 발견한 환자 27명을 1군, 발견 못한 나머지 13명을 2군으로 나누고 환자의 술 전 상태와 수술소견 및 술후 경과의 임상적 차이점을 분석하였다. 결과: 1군에서 술전에 저혈압, 대동맥판막부전, 심허혈, 신부전 등이 더 많이 발생되었다. 수술 소견 상 대동맥근부 이상은 1군에서 많았다. 가성 내강 내 혈종은 2군에서 더 많이 관찰되었지만 통계적으로 유의하지는 않았다. 술후에 2군에서는 신부전이 더 많이 발생하였고 술후 출혈로 인한 재수술은 1군에서 더 많았다. 조기 수술사망은 1군에 6명으로 사망률은 22.2%이었고 2군에는 사망 례는 없었다. 결론: 본 연구를 통하여 상행대동맥에서 내막 파열이 발견된 1군에서는 2군에 비해 술전 상태가 불량하였고 대동맥판막 병변으로 수술이 복잡해져 사망률이 높다고 생각된다. 반면 원위부 하행대동맥에서 박리가 진행되어 상행대동맥으로 이어진 2군에서는 1군에 비해 순환 장애로 인해 술후에 신부전이 더 많이 발생되었다. 결론적으로 상행대동맥내막에 파열점이 없었던 군에서 수술 예후는 상행대동맥내막에 파열점이 있는 군보다 더 좋았다.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.934-938
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• 2006

Organ malperfusion may mask the presence of aortic dissection and is one of major cause of death in patient with aortic dissection. Several key mechanism appear to contribute to the development of malperfusion, therefore optimal choosing of treatment is necessary to obtain better result. In cases of extremity malperfusion, open bypass procedures have been used for primary treatment, but noninvasive interventional procedures are also recommended as good alternatives in some cases. Here in, we report a case of successful aortic replacement followed by stent insertion in patient with extremity malperfusion caused by acute aortic dissection.

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

• Proceedings of the KTCVS Conference
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• 1998.10a
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• pp.61-61
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• 1998