• Journal of Chest Surgery
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• 제22권5호
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• pp.816-822
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• 1989

Aneurysms of the descending thoracic aorta can be caused by various etiologies. So, its abrupt rupture leads life-threatening state, it must be operated as soon as possible. Surgical treatment of the descending thoracic aortic aneurysm requires temporary cross-clamping of major artery. The obligatory occlusion of the descending thoracic aorta during management causes proximal arterial hypertension and distal arterial hypotension. The former may leads to left ventricular failure, or cerebrovascular accident, whereas the latter may leads to spinal cord ischemia or renal injury. Some have recommended insertion of temporary shunt around the occluded descending aorta to prevent above problems. Still others would favor expeditious operation employing simple aortic occlusion during the repair of the descending aorta. Recently we had experienced two cases of dissecting aneurysms of descending thoracic aorta which performed aortoplasty with Gore-Tex conduit under simple aortic occlusion. The one was 34-year-old female patient with traumatic dissecting aortic aneurysm [5 em X 5 cm] on the descending thoracic aorta distal to the origin of the left subclavian artery and the other was 58-year-old female patient with atherosclerotic dissecting descending thoracic aortic aneurysm [6 cmX7 cm] and diffuse abdominal aortic aneurysms [3X5 cm]. Both patients performed standard left posterolateral thoracotomy. After the aneurysmal sac was mobilized, occluding vascular clamps were placed on the transverse aorta proximal to the origin of the left subclavian artery, and on the distal descending aorta without adjuvant bypass procedures for 31 and 32 minutes, respectively, and the aneurysmal sac was repaired with 18 mm ringed Gore-Tex conduit graft. Both patients postoperative courses were uneventful.

• Journal of Chest Surgery
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• 제10권1호
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• pp.82-89
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• 1977

A rupture of a dissecting aneurysm of the aorta is life threatening disease and calls for emergency surgical treatment. The author recently experienced one case of ruptured dissecting aneurysm of the descending thoracic aorta complicated with left hemothorax who was recovered after emergency operation of Aug. 11, 1976. The patient was a 43 years old farmer with known hypertension [260/120] for 20 years but without any venereal disease and had experienced sudden throbbing chest pain. Chest film and aortogram revealed this case ruptured aneurysm of descending thoracic aorta complicated with left hemothorax. In this case, large dissecting aneurysm extend from proximal part of left subclavian artery below diaphragm and involved with 3.0 and 4.0cm sized elliptical rupture in proximal part of descending thoracic aorta. And so, neither fenestration procedure nor replacement of dacron artificial vessel was suitable for this case. Finally, only the rupture site of aneurysm was treated by covering with fibrous pleura and teflon patch. The post-operative management of this case was planned to control hypertension with antihypertensive drugs. The follow-up was possible up to date about 2months. The patient has been doing well with ordinary activities except mild chest discomfort.

• Journal of Chest Surgery
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• 제45권6호
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• pp.408-411
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• 2012

A 51-year-old male with sustained fever was diagnosed with military tuberculosis and tuberculous aortitis complicated with pseudoaneurysm formation at the proximal descending aorta. A follow-up computed tomography evaluation showed an increased size of the pseudoaneurysm in this area, suggestive of a contained rupture. Consequently, the patient underwent emergency excision and replacement of the aorta using a left heart bypass. The patient was discharged without postoperative complications on post-operative day 12. During the one-year follow-up period, the patient was free of any complications or recurrence of tuberculosis. We report a case of pseudoaneurysm of the descending aorta that was successfully surgically repaired.

• Journal of Chest Surgery
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• 제33권9호
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• pp.748-751
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• 2000

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root(Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.

• Journal of Chest Surgery
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• 제48권4호
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• pp.238-245
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• 2015

Background: Some patients show favorable changes in the descending aortic false lumen after conventional repair of acute type A dissection, although the incidence of favorable changes has been reported to be low. We aimed to investigate the incidence of positive postoperative changes in the false lumen and the factors associated with positive outcomes. Methods: In 63 patients who underwent surgery for type A acute dissection as well as serial computed tomography (CT) scanning, morphological parameters were compared between the preoperative, early postoperative (mean interval, 5.4 days), and late CT scans (mean interval, 31.0 months) at three levels of the descending thoracic aorta. Results: In the early postoperative CT images, complete false lumen thrombosis and/or true lumen expansion at the proximal descending aorta was observed in 46% of the patients. In the late images, complete thrombosis or resolution of the proximal descending false lumen occurred in 42.9% of the patients. Multivariate analysis found that juxta-anastomotic false lumen thrombosis was predictive of favorable early changes, which were in turn predictive of continuing later improvement. Conclusion: Even after conventional repair without inserting a frozen elephant trunk, the proximal descending aortic false lumen showed positive remodeling in a substantial number of patients. We believe that the long-term prognosis of type A dissection can be improved by refining surgical technique, and particularly by avoiding large intimal tears at the anastomosis site during the initial repair.

• Journal of Chest Surgery
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• 제40권10호
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• pp.704-707
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• 2007

대동맥궁을 침범하는 침투성 동맥경화성 궤양은 드물게 보고되고 있다. 급성 어깨 통증과 쉰 목소리를 주소로 내원한 78세 남자 환자에서 원위부 대동맥궁부터 근위부 하행대동맥에 걸쳐있는 파열된 침투성 동맥경화성 궤양이 발견되었다. 완전순환정지하에서 인조혈관을 사용하여 원위부 대동맥궁과 근위부 하행대동맥에 대한 패치봉합을 성공적으로 시행하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제29권3호
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• pp.337-341
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• 1996

A 40-year-old male patient who had ascending aortic pseudoaneurysm Involving right coronary artery obstruction and thoracic descending aortic pseudoaneurysm was successfully managed by two-stage operation. Repair of intimal tear of ascending aortic pseudoaneurysm with a patch of woven dacron vascular graft and right coronary artery bypass graft with great saphenous vein were performed in first stage operation. On 28 days postoperatively, Repair of intimal tear of descending aortic pseudoaneurysm with a patch of woven dacron vascular graft was done under the femorofemoral partial cardiopulri!onary bypass in second stage operation. The patient was discharged at postoperative 13th days without any evident.

• Journal of Chest Surgery
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• 제13권1호
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• pp.72-76
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• 1980

A successful repair of transected descending thoracic aorta was performed in a 44-year-old man. The patient had once been hospitalized in a local clinic for 7 days after a steering wheel injury. Dealing with right Colle`s fracture, he was transferred to this hospital to rule out aortic injury. On admission, a chest PA film and concomitant aortogram revealed an aneurysm of the descending thoracic aorta just distal to the origin of the left subclavian artery measuring 6 cm in diameter and 8 cm in length. He underwent urgent thoracotomy and the injured part of the aorta was replaced with a woven Dacron graft utilizing a Gott`s heparinized aortic shunt. The postoperative course was very smooth except hoarseness and left phrenic nerve palsy due to a blind clamping of the proximal aorta during the operation.

• Journal of Chest Surgery
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• 제27권4호
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• pp.318-324
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• 1994

Cross-clamping of the descending thoracic aorta results in proximal hypertension,increase in left ventricular afterload,and impairment of distal organ perfusion. Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamping of the thoracic aorta. At Seoul National University Hospital, 7 patients were treated for the thoracic or thoracoabdominal aortic aneurysm using left atrium-femoral artery bypass with Bio-medicus centrifugal pump between October,1989, and January,1993. There were atherosclerotic thoracic aneurysm in 3 cases, thoracoabdominal aortic aneurysm due to chronic aortic dissection in 3 cases,aortic rupture due to trauma in 1 case. Total of 7 patients were operated by graft replacement with reimplantation of important branches. None of these cases developed severe complications and hospital death. We believe that the Bio-Medicus centrifugal pump is a simple and safe means of perfusing the lower body, kidneys, and spinal cord without necessitating heparinization.

• Journal of Chest Surgery
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• 제46권1호
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• pp.68-71
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• 2013

A 67-year-old female patient was treated with conventional total arch replacement and insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta for acute DeBakey type I aortic dissection at one time. She had been treated with right coronary artery stent insertion for acute myocardial infarct 4 days earlier, and at that time, she was diagnosed with acute DeBakey type I aortic dissection from the ascending aorta to the suprarenal artery based on trans-esophageal echocardiography and aorta computed tomography. Through a median sternotomy, we inserted the SET graft through the opened aorta to the descending aorta. We also performed anastomosis between the proximal stented graft and the distal aortic arch, and then performed total arch replacement. For acute DeBakey type I aortic dissection, we report total arch replacement with insertion of a SET graft as a combination of conventional surgery and the interventional technique.