• Journal of Chest Surgery
• /
• v.40 no.11
• /
• pp.733-744
• /
• 2007

Background: There is a controversy regarding the pathogenesis and management principle of an acute intramural hematoma (IMH) of the aorta, Recent studies have reported intimal defects in many patients diagnosed with IMH, and suggested that intimal defects play important roles in the pathogenesis, progression of the pathology, and prognosis. Material and Method: This study reviewed the preoperative and postoperative computed tomography (CT) scan images of 36 patients who underwent surgical treatment for Stanford type A acute IMH of the aorta. The surgical findings were also reviewed retrospectively from the medical records. Result: In 15 patients (41.7%), the findings suggestive of the intimal defects were found in the preoperative CT. During the operation, 20 patients (72.2%) were found to have small intimal defects in the ascending aorta or the arch, of which 13 patients (50.5%) did not have the CT findings suggestive of intimal defects. In 17 patients, the intimal defects were located in the aortic arch or distal ascending aorta, where a gross examination would have been impossible without total circulatory arrest. In all patients, the intimal defects identified were included in the resected aortic segment, or locally closed. Follow-up CT at 4 months or longer after surgery showed that the IMH in the descending aorta had disappeared or was markedly improved. Conclusion: Most patients undergoing surgical treatment for acute type A IMH had intimal defects. This suggests that a large proportion of IMH might have a similar pathogenic mechanism as classic dissection. Consequently, it is believed that those two entities of acute aortic syndrome should be treat-ed using the same principles.

• Journal of Chest Surgery
• /
• v.37 no.8
• /
• pp.652-659
• /
• 2004

Background: In this study, we retrospectively analyzed the outcomes of aortic valvuloplasty in pediatric age. Material and Method: Between January 1993 and March 2004, 35 patients underwent aortic valvuloplasty for aortic stenosis (AS) or aortic regurgitation (AR). The mean age was 81.1$\pm$61.5 (1∼223) months. The mean follow up was 50.8$\pm$30.2 (3∼121) months. Nine patients had AS, 21 had AR, and 6 had AS and AR. Valve morphology was tricuspid in 24 patients, bicuspid in 9, quadricuspid in 1, and unicuspid in 1. The mean peak pressure gradients of AS were 72.0$\pm$33.0 mmHg, and the mean grades of AR were 3.1$\pm$0.9. Result: There was one late mortality without early mortality. After operation, AS improved with mean peak pressure gradients of 23.5$\pm$21.0 mmHg (p < 0.05), and AR improved with mean grades of 1.9$\pm$0.8 (p < 0.05). At mean follow up of 35.0$\pm$23.0 months, AS maintained with mean peak pressure gradients of 31.5$\pm$24.0 mmHg, but AR progressed with mean grades of 2.8$\pm$1.3 (p < 0.05). Reoperation was required in 6 patients 38.3$\pm$21.8 months after the original operation. The actuarial figures for freedom from reoperation at 2, 5 and 8 years were 96.9$\pm$3.1%, 79.5$\pm$5.5%, and 56.8$\pm$11.4%, respectively. Age at operation, presence of AS, preoperative severity of AS or AR, and morphology of aortic valve were not significant risk factors for reoperation, and improvement of AS or AR. Conclusion: Aortic valvuloplasty showed good immediate postoperative valve function. Aortic valvuloplasty offers children many years with tolerable valve function and allows to postpone aortic valve replacement or Ross procedure in pediatric patients.

• Journal of Chest Surgery
• /
• v.42 no.6
• /
• pp.696-703
• /
• 2009

Background: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. Material and Method: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed, The mean patient age was 53 years (range: 14~84) The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the MR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. Result: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from $54.6{\pm}8.4$ mm to $38.3{\pm}3.8$ mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from $47.1{\pm}24.4$ mmHg to $15.1{\pm}11.7$ mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. Conclusion: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.

• Journal of The Korean Radiological Technologist Association
• /
• v.28 no.1
• /
• pp.337-337
• /
• 2002

• Journal of Chest Surgery
• /
• v.35 no.2
• /
• pp.102-112
• /
• 2002

This study was undertaken to analyze the outcome of composite valve graftreplacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7 The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21$\pm$14 minutes, 186$\pm$68 minutes, and 132$\pm$42 minutes, respectively. Result: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2 $\pm$ 18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1$\pm$1.9% and 93.2$\pm$5.1%, respectively. Two patients required reoperation for complication of CYGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8$\pm$2.0% and 65.3$\pm$26.7%, respectively.

• Journal of Chest Surgery
• /
• v.38 no.12 s.257
• /
• pp.856-859
• /
• 2005

A male neonate was referred to our hospital with facial cyanosis and tachypnea at 19 days of age. Two-dimensional echocardiography showed type B interrupted aortic arch, posterior malalignment ventricular septal defect and valvular aortic stenosis. A new surgical repair was done with biventricular repair and neo-aortic arch reconstruction. Left ventricular outflow track (LVOT) was consisted of aortic valve and pulmonic valve. Right ventricular outflow (RVOT) track was reconstructed with extracardiac conduit. Postoperative two-dimensional echocardiography showed no stenosis and turbulency flow on LVOT and RVOT.

• Journal of Chest Surgery
• /
• v.43 no.2
• /
• pp.199-203
• /
• 2010

Infected aortic aneurysms are rare, but the mortality of patients with infected aortic aneurysms remains high. Open surgical procedures are the standard of care for infected aneurysms of aorta, but the surgical results are often disappointing. The risk factors related to the high mortality include aneurysm rupture and a suprarenal aneurysm location. The classic method for treating infected aneurysms has been aneurysm resection, soft tissue debridement, remote arterial reconstruction out of the field of infection and antibiotics. Infected anuerysms located in the suprarenal aorta are highly lethal because of the need to reimplant the visceral or renal arteries and the graft related complications. We reported here on a case of suprarenal infected aortic aneurysm in a 55-years-old man. We also include a review of the relevant medical literature.

• Journal of the Korean association of regional geographers
• /
• v.20 no.3
• /
• pp.300-314
• /
• 2014

The study is to systematically review "DaedongYeojiJeondo", the mid-sized wood block map of Chosun to shed light on the cartographic characteristics not discovered by previous studies. First it was discovered that Kim Jung-ho is the developer of the map as the distance information from Seoul to towns is identical with the information on "Daedong Jiji" the manuscript map drawn by Kim Jung-ho himself (assumed to live from 1804~1866) that is still remaining unfinished. Second, the information Kim Jung-ho wanted to specify most precisely and specifically was distance from Seoul to towns and for this purpose he invented unique symbols for towns in tiny size on the map. Third, in selecting information to mark on the map including road network, street information, mountain routes and streams and location of islands, "DaedongYeojiJeondo" is not just a simple smaller copy of "DaedongYeojido" but an independent creative work as it is much different in many aspects of quality. Forth, but still "DaedongYeojiJeondo" and "DaedongYeojido" have something in common in the fact both of them tried to mark land and mountain routes and streams most precisely and specifically.

• Journal of Chest Surgery
• /
• v.42 no.6
• /
• pp.774-776
• /
• 2009

A 57-year-old man with dyspnea was transferred to our institution. Echocardiography demonstrated grade III aortic valve regurgitation with a bicuspid aortic valve. The preoperative coronary angiography showed a left single nary artery. Replacement of the aortic valve was performed. Ventricular fibrillation developed during weaning patient of cardiopulmonary bypass after aortotomy repair. An anomalous origin of the coronary arteries is an incidental finding. However, in patients who are undergoing aortic valve replacement, a can significantly complicate the procedure. If this is present, then it is imperative that the clearly identified and the required procedure should be modified to avoid injury to these.

• Journal of Chest Surgery
• /
• v.41 no.3
• /
• pp.373-376
• /
• 2008

Surgery is the general treatment modality for thoracic aortic pseudoaneurysm combined with traumatic aortic rupture. However, we should select other treatment modalities for patients who can't tolerate surgery due to severe multiple injuries. Herein we report on a case of successful stent-graft treatment for a traumatic descending thoracic aortic pseudoaneurysm combined with severe multiple trauma, and we include a review of the relevant literature.