• Journal of Chest Surgery
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• 제27권11호
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• pp.907-913
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• 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%].

• Journal of Chest Surgery
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• 제35권8호
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• pp.599-604
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• 2002

급성 혹은 만성 대동맥 해리증은 파열을 일으킬 수 있는데 이는 사망의 주요 원인이 된다. 상행대동맥의 해리성 동맥류(Stanford A형 대동맥 해리증)는 극히 드물게 상대정맥으로 파열되어 대동백-상대정맥루를 형성할 수 있는데 대동백-하대정맥루는 복부 대동맥류 환자에서 이따금씩 보고되어 왔다. 최근 상대정맥증후군의 증상을 가진 67세 남자환자에서 CT, MR angiography, 동맥촬영 등 방사선학적 검사결과 Stanford A형 대동맥 해리증 및 대동맥-상대정맥루가 진단되었다. 해리된 동맥류는 절제 후 인조혈관으로 치환되었고 대동맥-상대정맥루는 초저온 순환정지 상태에서 교정되었다. 이에 대해 상세하게 기술하는 바이다.

• Journal of Yeungnam Medical Science
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• 제6권1호
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• pp.179-184
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• 1989

본원에서는 Marfan씨증후군과 대동맥류, 대동맥판 역류로 진단받은 환자가 1년후 흉통을 주소로 내원하여 대동맥 박리로 이행한 것으로 밝혀져 응급수술을 성공적으로 치룬 1례를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제34권11호
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• pp.865-869
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• 2001

광범위한 대동맥류의 수술은 주로 elephant trunk 술식을 이용한 단계적인 수술로 이루어 지고 있다. 그러나 elephant trunk 술식을 적용하기 힘든 경우 동시 치환을 고려하여야 한다. 과거 급성 대동맥박리로 상행대동맥 수술을 받은 과거력이 있는, 마르팡 증후군이 의심되는 35세 환자에서 대동맥 근위부의 대동맥류 및 하행대동맥류 파열이 발생하여 대동맥 판막에서부터 횡격막에까지 전 흉부대동맥 동시치환술을 성공적으로 시행하였기에 문헌 고찰과 함께 보고한다.

• Journal of Chest Surgery
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• 제17권4호
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• pp.687-690
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• 1984

Aortic dissection, a condition characterized by hemorrhage into the media and variable extension along the length of the aorta, has long been recognized as a catastrophic Cardiovascular event. Recent developments in diagnostic and therapeutic skills have improved the prognosis considerably, but there is still controversy as to how cases should be managed. We experienced a case of dissecting aortic aneurysm [DeBakey Type III ], which were managed using intensive medical treatment. The period of follow up was about 11 years. At last, patient was died by progression of dissection into proximal aorta and resulted in aortic insufficiency and congestive heart failure.

• Journal of Chest Surgery
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• 제21권3호
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• pp.488-496
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• 1988

Thirty-seven patients of aortic aneurysm underwent operations during January 1984 December 1987 at our hospital. Twenty-six patients had aneurysms involving ascending aorta, three patients had aneurysms involving both ascending aorta and abdominal aorta. and eleven patients had aneurysms involving descending thoracic or abdominal aorta. Among the patients who had aneurysms involving ascending aorta, annuloaortic ectasia with aortic regurgitation were thirteen and all of these underwent ascending aorta graft replacement + AVR with composite graft. The patients who had aortic regurgitation due to ascending aortic dissection were three and all of these underwent intraluminal ringed graft insertion at ascending aorta + aortic valve resuspension. Intraluminal ringed graft insertion was safe, simple, and fast method in the operation for aortic aneurysm. Eleven patients were underwent this operation and the results were good. Major causes of death of the patients who underwent aortic aneurysm operation are underlying cardiovascular diseases or delayed rupture of the aneurysm or complications related newly appeared aneurysm. Among our patients, dissection progressions were appeared in two but neither severe nor complicated. And no patient died from delayed rupture of aneurysm or complications related newly appeared aneurysm. All patients were followed up via OPD and were controlled hypertension or heart failure if present. Operative mortality is 18.9\ulcornera in all, 23% in patients who had aneurysms involving ascending aorta and 7.6` who had aneurysms involving descending thoracic or abdominal aorta. Comparing with other reports, our operative mortality is still high but improved steadily. So we recommend aggressive surgical management of the aortic aneurysm.

• Journal of Chest Surgery
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• 제20권2호
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• pp.367-373
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• 1987

Dissecting aneurysm has long been recognized as an ominous and highly lethal form of aortic disease. Aortic dissection are characterized by longitudinal separation of aortic media and extension proximally, distally or both from the site of intimal tear. DeBakey and associates defined three types based on where the process originates and how far extends. In type I, intimal tear is located in the ascending aorta and extend beyond the descending aorta. We experienced a case of dissecting aneurysm, Type I of DeBakey`s classification which dissection extend to the left iliac artery. The patient was 61 years old woman and suffered from excruciating pain on admission. Excision of aneurysm and ascending aorta reconstruction using to Dacron Vascular Prosthesis were performed under extracorporeal circulation. The post-operative course was uneventful and follow up is continued.

• Journal of Chest Surgery
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• 제18권2호
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• pp.305-313
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• 1985

Surgical therapy for dissection of the aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. Recently, a new method of treatment with an intraluminal graft that requires no end-to-end anastomosis has been developed. Of the four patients with dissecting aneurysm of the aorta treated by inserting sutureless ringed intraluminal graft at the Department of Thoracic and Cardiovascular Surgery, S.N.U.H., three were DeBakey type I [one with associated aortic insufficiency] and the other was DeBakey type III. Suspected etiology of the dissection was Marfan`s syndrome in one and hypertension in the others. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta [type A] and simple aortic crossclamping was used for the patient with dissecting aneurysm of the descending aorta. The basic technique consists of inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in patient with aortic insufficiency associated with dissection of the ascending aorta. There were no hospital deaths and one patient with type III dissecting aneurysm developed postoperative paraparesis and renal insufficiency which was resolved. Follow-up has been from 1 month to 16 months with no evidence of prosthetic problems, such as erosion, migration, or thrombosis.

• Journal of Chest Surgery
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• 제24권4호
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• pp.352-356
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• 1991

From April, 1981, to April, 1990, 20 male and 7 female patients ranging in age from 17 to 63, were operated on for aortic insufficiency with an aneurysm of the ascending aorta. Ten patients were in New York Heart Association functional class II, 7 in class III, and ten in class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with composite graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft. In 15 patients an uncomplicated annulo-aortic ectasia existed, and in 12 an aortic dissection; three of the latter group were operated during the acute phase. 17 patients showed typical Marfan syndrome, and 3 patients showed severe ascending aortic aneurysm secondary to the aortic valve disease. The overall operative mortality was 7%[2 deaths]. Those 2 deaths occurred following emergency operation due to associated aortic dissection, but no death during elective operation. All survivors have been followed-up during a period ranging 1 to 108 month[average 34 months]. There was no late mortality. Among the survivors, clinical improvement is readily apparent[2,3 in class I, 2 in class II ]. In conclusion, the treatment of aortic insufficiency associated with an aneurysm of the ascending aorta by insertion of a composite graft and reimplantation of the coronary arteries through an intermediate Dacron tube is a reliable method with low mortality and excellent results.

• 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.