• Title/Summary/Keyword: Interposition graft

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Twenty-one Year Experience with Right Ventricle to Pulmonary Artery Conduit Interposition (우심실-폐동맥 간 도관 이식술의 21년간의 경험)

  • Kwak, Jae-Gun;Yoo, Jae-Suk;Kim, Yong-Jin;Kim, Woong-Han;Lee, Jeong-Ryul
    • Journal of Chest Surgery
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    • v.41 no.4
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    • pp.417-422
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    • 2008
  • Background: The aim of this study is to evaluate the long term results of creating various right ventricle to pulmonary artery conduits for treating complex congenital heart disease. Material and Method: Between June 1986 and July 2006, we retrospectively reviewed 245 patients who underwent reconstruction of the right ventricular outflow tract with various kinds of conduits. 410 operations were done in 245 patients, the mean age at operation was $3.2{\pm}4.9$ years (range: 7 days$\sim$45 years) and the mean body weight was $12.5{\pm}8.7\;kg$ (range: $2.4\sim76.3\;kg$). Result: We used the following conduits: Polystan conduit, Shelhigh conduit, Carpenter-Edward conduit, Dacron graft with an artificial valve, valveless Gore Tex vascular graft, homograft and hand-made bovine or autologous pericardial conduit. The mean follow up duration was $6.3{\pm}5.2$ years. Redo operation for RV-PA conduit dysfunction was performed in 131 patients, a second redo was done in 31 and a third redo was done in 3. The reoperation free rates were 67.3%, 48.5% and 39.4% for 5 years, 10 years and 15 years, respectively. The homograft showed the best durability, followed by the Dacron graft with artificial valve and the Carpentier-Edward conduit. The larger sized conduit showed better durability. Conclusion: The homograft showed lowest reoperation rate and a smaller size of conduit showed the highest reoperation rate. The reoperation rate for the RV-PA conduit was about 35% at 5 years, so it is mandatory to develop the more durable conduit for RV outflow.

Clinical Analysis of Coronary Artery Bypass Surgery for Ischemic Heart Disease (허혈성 심질환의 치료에서 관동맥우회술의 임상적 고찰)

  • Jung, Tae-Eun
    • Journal of Yeungnam Medical Science
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    • v.13 no.2
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    • pp.225-233
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    • 1996
  • From August 1992 to July 1996, 63 consecutive patients underwent coronary artery bypass surgery. The mean age of these patient was 57 years(range form 30 to 71years). There were 44 men and 19 women. Preoperative 12 patients had stable angina pectoris and 23 patients were unstable angina pectoris. 8 patients had previous myocardial infarctation history and emergency or urgent myocardial revascularization were performed in 9 cases. In the risk factors of coronary atherosclerosis, 25 patients(40%) were hypercholesterolemia, 38 patients(60%) have smoking history and 19 patients(30%) have hypertension history. In the patterns of disease, 9 patients were single vessel disease, 18 patients were two vessele disease and 33 patients were three vessel disease. We performed total 284 distal anastomosis(mean 3.5 anastomosis per patient) and performed one case of ascending aorta graft interposition, two cases of mitral valve replacement, one case of aortic valve replacement, one case of ventricular septal defect repair and one case of atrial septal defect repair and the mean aortic cross clamp time was 115.3 minutes. The common complications were arrhythmia(7cases), wound infection(5cases), perioperative myocardial infarction(4cases), reoperation for bleeding control(4cases) and stroke(4cases). There were six hospital deaths due to low cardiac output syndrome, ventricular arrhythmia and respiratory failure. In the evaluation of operative risk factors, preoperative intravenous nitroglycerin requirement and prolonged aortic cross clamp tirne(>2hours) were found to be predective factor of morbidity and old age(>65years) was found to be predective factor of mortality.

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Surgical Treatment of the Aortic Aneurysm (대동맥류의 외과적 치료)

  • 김학제;조원민;김태식;이송암;김욱진;손영상;최영호
    • Journal of Chest Surgery
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    • v.31 no.1
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    • pp.13-19
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    • 1998
  • Aortic aneurysm has poor prognosis and high mortality, but the incidence of aortic aneurysm is in increasing state. From July, 1986 to July, 1996, we operated on 25 patients with aortic aneurysm and analysed the clinical results and relations between the duration from symptoms onset to operation(Sx-Op), the duration from admission to operation(Adm-Op), preoperative blood pressure, preoperative heart rate and postoperative mortality, retrospectively. The patients were classified as dissecting aneurysm(10 cases), abdominal aortic aneurysm(9 cases), Marfan's syndrome(3 cases), descending thoracic aortic aneurysm(3 cases). The operative technique were graft interposition in 17 cases, Bentall's operation in 4 cases, aneurysm bypass in 2 cases, and wrapping of aorta in 2 cases. Seven patients died of several causes, bleeding in 5 cases, acute renal failure in 1 case and respiratory failure in another one case. Before 1992, the early stage of operation, 6 mortality among 14 operated patients occurred, and after then 1 mortality among 11 operated patients occurred. Eighteen survivors were followed up from 1 to 118 months(mean 50.6 months), and total follow up was 911 patient-months. During the follow up period one patient died of melena 30 months after operation. The other patients did not complain chest pain or dyspnea. The surgical mortality was improved in the late period, and the major cause of death was intraoperative or postoperative bleeding. The Sx-Op duration, the Adm-Op duration, preoperative blood pressure and preoperative heart rate were proven to have no statistical relations with postoperative mortality.

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Tuberculous Aortitis with Aorto-bronchial Fistula (대동맥-기관지루를 동반한 결핵성 대동맥염)

  • Wi, Jin-Hong;Han, Il-Yong;Yoon, Young-Chul;Lee, Yang-Haeng;Hwang, Youn-Ho;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.41 no.2
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    • pp.277-280
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    • 2008
  • Tuberculous aortitis is a very rare disease. Furthermore, it is all the more rare for it to be complicated by the development of an aortic aneurysm or the formation of aorto-bronchial fistula. If it is complicated by rupture of the aorta, mortality is very high. If the patient didn't contract tuberculosis, but was expectorating blood, we would have to carry out a chest CT promptly, in order to make a rapid and accurate diagnosis of this disease. A 46-year-old male patient was admitted due to the sudden onset of intermittent hemoptysis and chest discomfort. CT scans of the chest showed an aneurysmal change to the descending thoracic aorta, and the formation of an aorto-bronchial fistula, which originated from this aneurysm and communicated with its left lower lobe. We operated with an artificial vessel graft interposition of the descending thoracic aorta and a left lower lobectomy. Because the diagnosis was of tuberculosis, we started anti-Tbc medication and long term anti-Tbc medication was recommended.

Bilateral Popliteal Artery Entrapment Syndrome (양측성 슬와동맥 포착증후군)

  • Yoo, Dong-Gon;Kim, Chong-Wook;Park, Chong-Bin
    • Journal of Chest Surgery
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    • v.40 no.2 s.271
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    • pp.136-139
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    • 2007
  • Bilateral popliteal artery entrapment syndrome is a rare vascular disease, which leads to ischemic claudication as a result of disturbance to the blood flow from the abnormal relationship of the popliteal artery to the gastrocnemius muscle, a fibrous band or the popliteus muscle in the young male population. A 58-years-old male patient, complaining of ischemic claudication, coldness and 3rd toe gangrene of left leg of 1 month's duration was admitted to our institution. His left ankle-brachial index was decreased; therefore, a femoral artery angiography was peformed, which revealed a total occlusion below the distal superficial femoral artery of the left leg. An EKG revealed atrial fibrillation, suggestive of a thromboembolism of the popliteal artery due to atrial fibrillation; therefore, Urokinase thrombolysis was attempted. After the Urokinase thrombolysis, popliteal artery entrapment syndrome was diagnosed, with MRI then performed for an anatomical diagnosis. The popliteal artery entrapment was type 1, where the popliteal artery was displaced medial to the Gastrocnemius head. After complete removal of the popliteal artery aneurysm, interposition was performed with a contra lateral greater saphenous vein graft. A mild right popliteal artery aneurysm still remained, but surgery was not performed. Currently, the patent is surviving, without complications. Herein, the good results obtained for the surgical treatment of a severely affected leg, and the conservative treatment of a mildly affected leg, are reported.

Minimally Invasive Coronary Artery Bypass Grafting (소침습적 관상동맥우회술)

  • Na, Chan-Young;Lee, Young-Tak;Park. Joong-Won;Chung, Do-Hyun;Jung, Ill-Sang;Jung, Yoon-Seup;Kim, Ok-Sung;Bang, Jung-Hyun;Lee, Sub;Chung, Chul-Hyun;KIM, Woong-Han;Park, Young-Kwan;Kim, Chong-Whan;Hong, Sung-Nok;Han, Jae-Jin;Lee, Gun
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.118-124
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    • 1998
  • Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending(LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours(mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.

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Results of Surgical Management in Patients with Cardiac and Arterial Manifestations of Behcet's Syndrome (심장 및 동맥계를 침범한 베체트씨 증후군 환자의 수술 후 결과)

  • 원종윤;장병철;이도연;박상준
    • Journal of Chest Surgery
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    • v.35 no.1
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    • pp.36-42
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    • 2002
  • Background: To evaluate the efficiency of surgical treatment in patients with cardiac valvular and arterial involvement of Behcet's syndrome. Material and Method: 12 patients underwent surgical treatment due to the valvular heart diseases and the various arterial diseases associated with Behest's syndrome over 7 years; 6 with valvular heart disease, 1 with annuloaortic ectasia, 1 with ascending aortic aneurysm, 4 with pseudoaneurysms in abdominal aorta(n=2), carotid artery(n=1), and popliteal artery(n=1). All 12 patients had received valvular replacement(n=6) and the artificial(n=5) or autologous(n=1) graft interposition. We followed the results of these surgical treatments. Result: Operations were technically successful in all 12 patients and peri-operative complication was not demonstrated. However, 10 patients had recurrences; 6 with valvular dehiscence, 3 with pseudoaneurysm at anastostomosis site, and 1 with aorto-duodenal fistula. The duration of recurrence was 1 to 55 months(mean: 15.7$\pm$ 16.2 months). 7 patients underwent the second operation and among them, 4 patients showed repeated recurrences. Overall, 5 patients died 2 to 25 months after the operation(mean: 13.6 months), because of the bleeding at the anastomosis site Five patients did not present recurrence after the first(n=2) or the second operation(n=3) and their follow up duration was 5 to 60 months(mean: 45.8$\pm$41.7 months). Five patients received immune-suppressive therapy after the first(n=2) and second operation(n=3). Three did not shown recurrence for the 13, 29 and 33 months. Conclusion: Post-operative prognosis of arterial manifestation of Behcet's syndrome was not encouraging and if possible, other treatment strategy should be considered.