• Journal of Chest Surgery
• /
• v.27 no.11
• /
• pp.907-913
• /
• 1994

From October 1990 to May 1993, 19 patients underwent replacement of the transverse aortic arch. [10 men, 9 women, mean age 52.5 years] Underlying diseases were acute aortic dissection [10 cases], chronic aortic dissection [4 cases],and aortic arch aneurysm [ 5 cases]. In 19 patients, 10 underwent partial replacement and 9 underwent total arch replacement. The cerebral protection was achieved by profound hypothermia [rectal temperature,16$^{\circ}$ to 2$0^{\circ}C$] associated with total circulatory arrest [mean 35.5 minutes]. In one patient, the aortic arch distal to the left common carotid artery was resected with the distal arch being cross-clamped and in another two patients, the selective cerebral perfusion was also applied during the period of total circulatory arrest via innominate artery and left common carotid artery because of longer total circulatory arrest time. Among 14 patients of aortic dissecton, 10 presented hypertension, 1 presented Marfan syndrome, 1 presented pregnancy-induced hypertension and 2 revealed no evidence of hypertension. All of the above 14 patients complained chest pain. Among 5 patients of aortic arch aneurysm, Be het disease was suspected in only one patient and atherosclerotic aneurysm was proved in another 4 patients. The overall hospital mortality was 32% [6/19]. In aortic dissection, the mortality was 43% [Acute aortic dissection 30%, chronic aortic dissection 75%] and in aortic arch aneurysm, the mortality was 0%. Follow-up was done in all survivors for from 7 months to 36 months[mean,17.3%].

• Childhood Kidney Diseases
• /
• v.6 no.1
• /
• pp.114-119
• /
• 2002

Takayasu's arteritis(TA) is a chronic idiopathic vasculitis mainly involving the aorta and its main branches, such as brachiocephalic, carotid, subclavian, vertebral and renal arteries, as well as coronary and pulmonary arteries The clinical features usually reflect limb or organ ischemia resulting from gradual stenosis of involved arteries. We experienced a case of idiopathic Takayasu's arteritis with negative tuberculin test involving multiple main branch arteries at active stage without pulse. We treated this patient with combined therapy of steroid and azathioprine, with remission of disease activity. (J Korean Soc Pediatr Nephrol 2002 ;6 : 114-9)

• Journal of Chest Surgery
• /
• v.17 no.3
• /
• pp.371-380
• /
• 1984

Corrected transposition of the great arteries [C-TGA] is one of the rare congenital heart disease in which there is both a discordant atrioventricular relationship and transposition of the great vessels. With this arrangement, systemic venous blood passes through the right atrium into the morphologic left ventricle and out the pulmonary artery. Pulmonary venous blood returns to the left atrium, flows into the morphologic right ventricle and out the aorta. Thus, in the rare case when no additional cardiac anomaly is present, a hemodynamically normal heart exists. But more often they are symptomatic as a result of one or several of the commonly associated defects. This paper describes 13 patients who underwent repair of one or more cardiac anomalies associated with corrected transposition at SN UH, from June 1976 through June 1984. 1.8 were males and 5 females, with ages ranging from 3 years to 27 years. 2. Segmental anatomy was {S,L,L} in 12, or {I,D,D} in 1. 3.Associated anomalies were ventricular septal defect in 10, pulmonary outflow tract obstruction in 6, tricuspid insufficiency in. 4, atrial septal defect in 3, subaortic stenosis in 1, mitral insufficiency in 1, and patent ductus arteriosus in 1. 4.None had complete heart block preoperatively, and 3 developed complete heart block intraoperatively. But one of them recovered sinus rhythm on the postoperative 7th day spontaneously. 5.There were 3 cases of hospital morality. But there was no morality since Dec. 1980. 6.Patients with single ventricle, hypoplastic ventricle or those who had palliative surgery alone are not included in this review.

• Journal of Chest Surgery
• /
• v.21 no.3
• /
• pp.510-517
• /
• 1988

With the ligation of a patent ductus arteriosus by Gross in 1938, surgeons first entered the field of congenital heart disease, and treatment of the patent ductus is representative of the rapid advance made in thoracic surgery in the last 40 years. We have had clinical experiences about 36 cases of this in the department of Thoracic & Cardiovascular surgery, Pusan Paik Hospital, Inje medical college from March 1891 to June 1987. And the results were summarized as follows. 1. There were 11 males, 25 females. The age range of the patients were from 8 months to 36 years with the mean age of 7.9 years. 2. The chief complaints of the patients on admission were frequent URI[50%], dyspnea on exertion[29.8%], chest pain[11.1% k 1%], growth retardation[2%], cough[2.8%], anorexia[2.8%]. But there were 11 patients[30.6%] having no subjective symptoms. 3. In auscultation, the usual continuous machinery murmur was noticed in 30 patients[83.3%], only systolic murmur in 6[16.7%]. 4. In the preoperative chest P-A views, there were noticed cardiomegaly in 20 cases, enlarged pulmonary conus and / or pulmonary plethora in 22 patients[61.1%]. 5. In the preoperative EGG findings, there were noticed pattern of LVH in 8 patients[22.2`], RVH in 2[5.6%], BVH in 4[11.5%] and normal in 19[52.89o]. 6. The size of PDA[mean] was 9.5 mm[length] and 8.8 mm[width], the range of length was from 4 to 29 mm and the range of width was from 4 to 18 mm. 7. There were noticed 6 cases which were combined with other anomalies[VSD in 2 cases, Coarctation of aorta in 2, Mitral regurgitation in 1, and AP window in 1]. 8. On operation, simple ligation of the ductus was performed in 30 cases[83.3%], division and suture-ligation in 5[13.9%]. 9. Postoperative complications were noticed in 4 cases[pneumonia in one case, wound infection or disruption in 3], but there were no mortality.

• Journal of Chest Surgery
• /
• v.30 no.3
• /
• pp.247-252
• /
• 1997

Ten acute and chronic in vivo studies were utilized to develop a pneumatic ventricular assist device (VAD) as a bridge to heart transplantation or a circulatory assist device for patients with end-stage heart disease or poor myocardial funct on after cardiac surgery. Two sizes of blood pump of 70cc for adult patients and 34cc for pediatric patients were implanted in the animals. Ventricle of the blood pump was made from the polyurethaae to enhance antithrombogenecity. The VAD was implanted between the left atrium and the descending aorta. Average flow rate was 2.38 L/min for adult and 0.41 L/min for pediatric VAD at the rate of 60 bum. The duration of support ranged from 1 to 26 hours. The most frequent complication was bleeding. Main causes of death were heart failure and respiratory failure. The device function was good for short term use. Studies to date suggest that, with further refinement, a reliable long term VAD that will have clinical application can be developed.

• Journal of Chest Surgery
• /
• v.49 no.2
• /
• pp.107-111
• /
• 2016

Hypoplastic left heart complex (HLHC) consists of less severe underdevelopment of the left ventricle without intrinsic left valvular stenosis, i.e., a subset of hypoplastic left heart syndrome (HLHS). HLHC patients may be able to undergo biventricular repair, while HLHS requires single ventricle palliation (or transplant). However, there is no consensus regarding the likelihood of favorable outcomes in neonates with HLHC selected to undergo this surgical approach. This case report describes a neonate with HLHC, co-arctation of the aorta (CoA), and patent ductus arteriosus (PDA) who was initially palliated using bilateral pulmonary artery banding due to unstable ductus-dependent circulation. A postoperative echocardiogram showed newly appearing CoA and progressively narrowing PDA, which resulted in the need for biventricular repair 21 days following the palliation surgery. The patient was discharged on postoperative day 13 without complications and is doing clinically well seven months after surgery.

• Journal of Chest Surgery
• /
• v.41 no.4
• /
• pp.499-503
• /
• 2008

Berry syndrome (a distal aortopulmonary window and a right pulmonary artery originating from the ascending aorta, an intact ventricular septum, a patent ductus arteriosus and an interrupted aortic arch) is a rare complex congenital cardiac malformation. We describe a case of one stage repair with using an autologous arterial flap in a 19-day-old neonate who was suffering with this malformation, and we report on the development of postoperative right pulmonary artery stenosis and its successful management with performing multiple balloon angioplasties.

• Journal of Yeungnam Medical Science
• /
• v.34 no.2
• /
• pp.242-246
• /
• 2017

Acute limb ischemia (ALI) due to an embolism is associated with high mortality rate and poor prognosis, and early diagnosis with prompt revascularization is required to reduce the risk of limb amputation or even death. The etiologies of ALI are diverse, and it includes an embolism from the heart and thrombotic occlusion of the atherosclerotic native vessels, stents, or grafts. An uncommon cause of ALI is acute arterial thromboembolism, and atrial fibrillation (AF) is the single most important risk factors for systemic thromboembolism. It is important to correctly identify the source of ALI for secondary prevention, as it depends on the underlying cause. Percutaneous transluminal angioplasty (PTA) has been proven to be a safe and effective treatment for focal atherosclerotic and thrombotic occlusive diseases of the aorta and its major extremity branches. Herein, we report on a 77-year-old female patient with acute upper limb ischemia, treated by PTA using a catheter-guided thrombectomy. He was newly diagnosed with paroxysmal AF (PAF) while evaluation the cause of his acute arterial thromboembolism. We recommend that cardiologists always consider PAF as a possible diagnosis even in patients without any history of AF under ALI because it is possible to develop thromboembolism in clinical practice.

• Journal of Chest Surgery
• /
• v.16 no.2
• /
• pp.170-174
• /
• 1983

Aortic arch syndrome is an unusual disease entity characterized by the narrowing or obliteration of major branches of the arch of the aorta regardless of etiology. We have experienced 2 cases. One of them was 22 years old office girl with 3 months history of headache, intermittent syncope and weakness and claudication on left arm especially during her physical exercise. On physical examination, pulseless on left antecubital and radial artery and blood pressure on left arm was inable to check and coldness with weakness were noted on the same side. Aortic angiography reealed 34% narrowing of left subclavian artery as that of right. But both common carotid artery and both axillary arterial patency were relatively good. Through right supraclavicular and left axillary incision, bypass graft with Gore-tex prosthesis (I.D. 6mm, Length 25 cm) was implanted from right subclavian artery on 2cm distal to origin of right common carotid arery to left axillary artery distal to axillary fossa. End to side anastomosis with preservation of left subclavian artery was done. Postoperative state was stable with blood pressure of 110/70 mmHg on left arm and palpable antecubital and radial pulsation. Another one was 41 year old male patient with 8 months history of pain and numbness on right upper arm and shoulder. On admission, right arm blood pressure was 110/80 mmHg, left arm was 160/110 mmHg, but other physical findings had no abnormalities. Angiography revealed segmental narrowing of right axillary artery on the beginning with 2 cm in length. Operative treatment with right wupraclavicular and right axillary incision, bypass graft with great saphenous vein (Length; 15 cm) from right subclavian artery between scalenus anticus and medius to axillary artery at distal end of axillary fossa was done. The authors report two cases of Aortic arch syndrome treated with bypass graft using Autograft or Gore-tex with good result.

• Journal of Chest Surgery
• /
• v.13 no.1
• /
• pp.77-81
• /
• 1980

We present one case of 26-year-old male having saddle block combined with mitral valvular disease [NYHA Class IV] with auricular fibrillation. The most common cause of emboli is atrial fibrillation. The clinical manifestations of saddle emboli are relatively slow due to development of collateral circulation and large size of lumen of the aorta. The 5month duration of saddle emboli in this case led to severe atrophic changes, coldness, peripheral cyanosis on the both lower extremities, and flexion deformity on the knee and ankle joint of the left lower extremity. We planned staged operation for the saddle block and for mitral stenoinsufficiency and tricuspid insufficiency, because of poor general condition of the patient. The thromboembolectomy of aortic bifurcation was performed through the transabdominal approach without trial of Fogarthy catheter embolectomy, because of expectation of the secondary inflammatory changes of the vessel wall and thrombi which was 3 cm X 1 cm X 0.5 cm in size with irregular surfaced solid in consistency. 1 month later, after thromboembolectomy, mitral valve replacement and tricuspid annuloplasty were performed, with successful early operative result. During operation organized thrombi [1 cm X 0.5 cm] in the left auricle was removed. We wonder if simple management using Fogarthy catheter might be possible to remove the thromboemboli instead of thromboembolectomy by aortotomy in this case.