• Journal of Trauma and Injury
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• 제34권2호
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• pp.81-86
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• 2021

Purpose: This study investigated the clinical outcomes of trauma patients with blunt thoracic aortic injuries at a single institution. Methods: During the study period, 9,501 patients with traumatic aortic injuries presented to Trauma Center of Gil Medical Center. Among them, 1,594 patients had severe trauma, with an Injury Severity Score (ISS) of >15. Demographics, physiological data, injury mechanism, hemodynamic parameters associated with the thoracic injury according to chest computed tomography (CT) findings, the timing of the intervention, and clinical outcomes were reviewed. Results: Twenty-eight patients had blunt aortic injuries (75% male, mean age, 45.9±16.3 years). The majority (82.1%, n=23/28) of these patients were involved in traffic accidents. The median ISS was 35.0 (interquartile range 21.0-41.0). The injuries were found in the ascending aorta (n=1, 3.6%) aortic arch (n=8, 28.6%) aortic isthmus (n=18, 64.3%), and descending aorta (n=1, 3.6%). The severity of aortic injuries on chest CT was categorized as intramural hematoma (n=1, 3.6%), dissection (n=3, 10.7%), transection (n=9, 32.2%), pseudoaneurysm (n=12, 42.8%), and rupture (n=3, 10.7%). Endovascular repair was performed in 71.4% of patients (45% within 24 hours), and two patients received surgical management. The mortality rate was 25% (n=7). Conclusions: Traumatic thoracic aortic injuries are life-threatening. In our experience, however, if there is no rupture and extravasation from an aortic injury, resuscitation and stabilization of vital signs are more important than an intervention for an aortic injury in patients with multiple traumas. Further study is required to optimize the timing of the intervention and explore management strategies for blunt thoracic aortic injuries in severe trauma patients needing resuscitation.

• Journal of Chest Surgery
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• 제38권3호
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• pp.221-228
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• 2005

대동맥 축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 수술치료의 한 방법이라고 주장되어 왔다. 저자들은 대동맥판막치환술과 동반 시행한 상행대동맥의 변형 축소성형술에 대한 결과에 대해 알아보았다. 대상 및 방법: 2001년 7월부터 2002년 12월까지 상행대동맥벽의 절제 없이 봉합봉축법에 의한 변형 대동맥 축소성형술을 받은 14명의환자들을 대상으로 하였다. 평균 연령은 63.7$\pm$6.7세(50$\~$75세)였다. 10명의 환자에서 이엽성 대동맥판막이 동반되었다. 10명에서 심한 대동맥판막 협착을 보였으며 6명에서는 III-lV도의 대동맥판막폐쇄부전이 동반되었다. 상행대동맥의 직경은 수술 전과 후 그리고 6개월과 12개월 후에 심장초음파 및 컴퓨터 단층촬영으로 측정하였다. 술 후 평균 추적기간은 14.7$\pm$5.4개월(7$\~$24개월)이었으며 모든 7환자에서 추적이 가능하였다. 결과: 술 후 조기 사망이나 출혈과 같은 합병증은 없었다. 봉합봉축법에 의한 대동맥 축소성형술 후 상행대동맥의 직경은 술 전 49.4$\pm$3.5 mm에서 술 후 33.2$\pm$3.4 mm (P<0.001)로 감소하였다. 추적기간동안 만기 사망이나 상행대동맥의 재확장은 없었다. 결론: 대동맥벽의 절제없이 봉합봉축법에 의한 변형 대동맥축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 양호한 조기 및 중기성적을 보였다. 하지만 본 방법들 사용한 환자들에 대한 장기 추적결과에 추가적인 연구가 필요하리라 생각한다.

• Journal of Chest Surgery
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• 제50권4호
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• pp.291-294
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• 2017

A 74-year-old patient presented with recurrent aneurysms in the infrarenal abdominal aorta and right common iliac artery 6 years after endovascular aortic repair using endografts in the same location. The patient underwent an aorto-bi-iliac replacement with removal of the stent graft. Two holes measuring 2 mm each were found in the removed graft, and they appeared to have been caused by wear from continuous friction between the endograft and the aortic wall.

• Journal of Chest Surgery
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• 제53권6호
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• pp.414-416
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• 2020

Hemitruncus arteriosus is a rare cardiovascular malformation in which one of the pulmonary arteries anomalously originates from the aorta. Left hemitruncus arteriosus, defined as the origination of the left pulmonary artery from the aorta, is less common than right hemitruncus arteriosus. In this study, we report the case of a neonate diagnosed with left hemitruncus arteriosus, ventricular septal defect, and atrial septal defect who underwent successful surgical treatment.

• Journal of Chest Surgery
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• 제51권4호
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• pp.283-285
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• 2018

A 73-year-old woman who underwent combined bioprosthetic mitral valve replacement, tricuspid ring annuloplasty, and coronary artery bypass grafting 12 years previously visited our clinic due to aggravated dyspnea caused by structural valve deterioration of the mitral prosthesis. Because aortic or femoral artery cannulation and cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta and ilio-femoral vessels, and because there was a risk of redo sternotomy due to the patent bypass grafts, a comprehensive approach including axillary artery cannulation, a minimally invasive right thoracotomy approach, and a clampless hypothermic fibrillatory arrest technique was used during redo mitral valve replacement.

• Journal of Chest Surgery
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• 제44권2호
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• pp.183-185
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• 2011

Although outcomes of neonatal cardiac surgery have dramatically improved in the last two decades, low body weight still constitutes an important risk factor for morbidity and mortality. In particular, cardiac surgery in neonateswith very low birth weight (${\leq}$1.5 kg) is carried out with greater risk because most organ systems are immature. We report here on a successful case of early one-stage total repair of coarctation of the aorta and a ventricular septal defect in a 1,480 gram neonate.

• Journal of Chest Surgery
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• 제49권5호
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• pp.401-404
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• 2016

The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care.

• Journal of Chest Surgery
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• 제52권5호
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• pp.372-375
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• 2019

A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.

• Journal of Chest Surgery
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• 제21권3호
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• pp.567-573
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• 1988

Coarctation of the aorta is classically a congenital narrowing of the upper descending thorac aorta adjacent to the site of attachment of the ductus arteriosus which is sufficiently severe that there is a pressure gradient across the area. Recently we have experienced two cases of coarctation of the aorta and successfully performed resection of the sites of coarctation and end to end anastomosis of the aorta. The first case was a juxtaductal type of coarctation of the aorta with PDA and the pathology of the lesion was a diaphragm with central narrow opening. And the resection length was about 0.5cm and aortic clamping time was 20 minutes. The second case was also juxtaductal type coarctation of the aorta with mild tubular hypoplasia of aortic isthmus, left SVC and the pathology was also a diaphragm with central narrow opening. And the resection length was about 0.5cm and aortic clamping time was 29 minutes. Both postoperative course was uneventful and the patients were discharged two weeks after operation.

• Journal of Chest Surgery
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• 제19권1호
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• pp.134-139
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• 1986

Seventeen patients underwent operations for aneurysm of ascending aorta with aortic regurgitation from August 1979 to October 1985. 10 patients underwent complete replacement of the ascending aorta and the aortic valve with a composite graft and implantation of coronary ostia on the graft. Seven patients underwent supracoronary noncomposite graft replacement and aortic valve replacement. The patients ranged in age from 25 to 55 years [mean 37.6 years]. There were 11 male and 6 female patients. All patients had aortic incompetence and aneurysmal dilatation of the ascending aorta. Seven of the patients has concomitant aortic dissection in ascending aorta and one had dissection in abdominal aorta. Eight patients had signs of Marfan syndrome and the other 3 patients had cystic degeneration in the medial layer of the aorta. There was one hospital death[5.8%]. He died of sepsis on the 23rd postoperative day. All survivors showed improvement in NYHA functional classification in the 34.9 patient-year follow-up period.