• Journal of Chest Surgery
• /
• v.36 no.9
• /
• pp.691-694
• /
• 2003

A 49-year-old woman had thoracic back pain for several years. Chest CT scan and MRI angiography revealed descending thoracic aortic aneurysm with a maximum diameter of 69 mm. Thoracic aortography showed not only the aortic aneurysm, but also coarctation of descending thoracic aorta at the level of aortic hiatus of the diaphragm. Intercostal artery arising Adamkiewicz artery was found in descending thoracic aortic aneurysm just above the coarctation, The aneurysm with coarctation of the aorta was successfully repaired with prosthetic graft replacement under left atrio-femoral bypass.

• Journal of Chest Surgery
• /
• v.37 no.10
• /
• pp.865-867
• /
• 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
• /
• v.39 no.12 s.269
• /
• pp.939-942
• /
• 2006

Acute mesenteric ischemia after cardiac surgery is a serious complication associated with high mortality. Superior mesenteric artery is most commonly affected artery. Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. The keys to a successful outcome are early diagnosis and appropriate operative intervention. We successfully treated a patient with acute mesenteric ischemia after aortic valve replacement. Therefore, we report a case with a review of articles.

• Journal of Chest Surgery
• /
• v.35 no.3
• /
• pp.188-198
• /
• 2002

Background: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem. This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. Material and Method: Between May 1995 and April 2001, 30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively. The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months). Seven patients(23.3%) had two or more previous operations. The indications for reoperations were true aneurysm in 7 patients(23.3%), prosthetic valve endocarditis in 6(20%), false aneurysm in 5(16.7%), paravalvular leak associated with Behcet's disease in 4(13.3%), malfunction of prosthetic aortic valve in 4(13.3%), aortic dissection in 3(10%), and annuloaortic ectasia in 1(3.3%). The principal reoperations performed were aortic root replacement in 17 patients(56.7%), replacement of the ascending aorta in 8(26.7%), aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%), patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1 (3.3%). The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%). The mean time of circulatory arrest, total bypass, and aortic crossclamp were 20$\pm$ 12 minutes, 228$\pm$56 minutes, and 143$\pm$62 minutes, respectively Result: There were three early deaths(10%). The postoperative complications were reoperation for bleeding in 7 patients(23.3%), cardiac complications in 5(16.7%), transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%), and the others in 5. The mean follow-up was 22.8 $\pm$20.5 months. There were two late deaths(7.4%). The actuarial survival was 92.6$\pm$5.0% at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%). The 1- and 6-year actuarial freedom from reoperation was 100% and 83.3$\pm$15.2%, respectively. One patient with Behcet's disease are waiting for reoperation due to false aneurysm, which developed after aortic root replacement with homograft. There were no thromboembolisms or anticoagulant related complications. Conclusions: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity, and adequate surgical strategies according to the pathologi conditions are critical to the prevention of the reoperation.

• Journal of Chest Surgery
• /
• v.29 no.11
• /
• pp.1270-1275
• /
• 1996

Pulmonary artery aneurysms are extremely rare conditions usually associated with congenital cardiac defects that cause increased pulmonary blood flow and pulmonary hypertension. The prognosis of pulmonary artery aneurysms is fatal due to the potential for rupture of the aneurysm and the underlying severe pulmonary hypertension. A 40-year old woman was admitted to our hospital with headache following traffic accident. On admission a continuous murmur was heard over the 2nd to 3rd intercostal space along left sternal border and a calcified cystic mass at left hilar portion was incidentally discoverd on chest reontgenogram. Cardiac catherization was diagnostic of a left to right shunt at main pulmoanry artery level and pulmonary hypertension. Pulmonary angiogram demonstrated a large aneurysm of main pulmonary artery extending into proximal left pulmonary artery. The pulmonary artery aneurysm associated with patent ductus arteriosus was diagnosed definitively and the patient was underwent resection of pulmonary artery aneurysm, closure of PDA and Dacron prosthetic graft replacement under cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any problem.

• Journal of Chest Surgery
• /
• v.30 no.3
• /
• pp.340-343
• /
• 1997

We experienced a female patient with intramural hematoma of the aorta. This patient had a severe anterior chest pain radiating to interscapular area with choking sensation. CT revealed a intramural hematoma of the thoracic aorta and a part of the abdominal aorta but there was no evidence of intimal tearing. We did the eme gency operation under hypothermic circulatory arrest and retrograde cerebral perfusion. Ascending aorta was replaced and coronary artery bypass graft was done because of intimal tearing of the ostium of right coronary artery. She was discharged without any significant complication. We reported this case with consideration about necessity of emergency operation for intramural hematoma of the thoracic aorta.

• Journal of Chest Surgery
• /
• v.34 no.11
• /
• pp.865-869
• /
• 2001

Operations for extensive aortic aneurysm are generally performed as staged operations with or without elephant trunk technique. However, we must consider single stage replacement in cases that are unsuitable for elephant trunk technique. We report a case of successful sing1e stage replacement of the entire thoracic aorta from the aortic valve to the level of diaphragm. The patient was a 35-year-old male who had Marfanoid features and had previously undergone replacement of the ascending aorta for aortic dissection. He recovered without neurologic complication and was discharged on 29th day after the operation. .

• Journal of Chest Surgery
• /
• v.37 no.10
• /
• pp.868-871
• /
• 2004

A 42 year old male was operated with aortic root abscess and pseudoaneurysm. Aortic valve vegetations which measured $8\times5$ cm and root abscess were removed and debrided. We reconstructed root and noncoronary sinus with autopericardium. Antibiotics were administered for 4 weeks. In general, Aortic root abscess recurs frequently and mortality is high. It is usually requires early surgical eradication with antibiotics medication.

• Journal of Chest Surgery
• /
• v.35 no.6
• /
• pp.483-486
• /
• 2002

71 years old man was operated on due to abdominal aortic aneurysm associated with complete occlusion of left common iliac artery. The coexisting chronic deep vein thrombosis of the left femoral and iliac vein was not diagnosed preoperatively. Resection of aneurysm and Y-graft interposition was performed. Recurrent edema and pain occured to the left lower extremity immediately postoperatively, which aggrevated with the lapse of time, resulting in fatal extensive venous thrombosis. This report regards the surgical treatment and complication of the aortoiliac occlusive disease associated with chronic deep vein thrombosis.

• Journal of Chest Surgery
• /
• v.40 no.6 s.275
• /
• pp.445-447
• /
• 2007

Occlusion of a coronary artery ostium and especially occlusion of the right by an aortic cusp is a rare condition. We experienced an adult patient with occlusion of the right coronary ostium that was due to fusion of the right coronary cusp to the aortic wall along with underlying rheumatic aortic valve stenosis. During the operation, the adherent right coronary cusp was excised. After confirming that the right coronary ostium was patent, the other cusps were removed, and this followed by replacement of the aortic valve with a mechanical valve. The postoperative course was uneventful.