• Journal of Chest Surgery
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• 제41권3호
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• pp.360-362
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• 2008

대혈관전위 환자에서 동맥치환술 시행 시 관상동맥의 위치는 수술의 성적 및 환자의 예후에 매우 중요한 요소이다. 본 증례는 과거 대혈관전위로 동맥치환술을 시행 받았던 환자에서 발생한 관상동맥 압박에 대한 보고이다. 14세 남자 환자로 운동 시 협심증을 주소로 내원하였고, 영상학적 검사 결과 좌관상동맥 기시부가 대동맥과 폐동맥 사이에 위치하여 눌리고 있는 양상이어서 수술적 치료를 결정하였다. 수술은 좌관상동맥 기시부를 대동맥에서 버튼 절제한 후 좌외측으로 재이식하여 폐동맥에 눌리지 않도록 하였다. 수술 후 관상동맥의 대혈관에 의한 압박 소견은 사라졌으며 환자는 현재까지 합병증이나 증상 재발 없이 추적 관찰 중이다.

• Journal of Chest Surgery
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• 제47권3호
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• pp.220-224
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• 2014

Background: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

• Journal of Chest Surgery
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• 제48권3호
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• pp.206-209
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• 2015

Ascending aortic aneurysms are usually treated with graft replacement under cardiopulmonary bypass. However, if a candidate for off-pump coronary artery bypass grafting has an enlarged ascending aorta, surgeons may consider wrapping it without cardiopulmonary bypass. Here, we report a 78-year-old female who underwent successful wrapping of the ascending aorta concomitant with off-pump coronary artery bypass grafting, using a new wrapping technique that involves multiple bootstraps.

• Journal of Chest Surgery
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• 제50권1호
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• pp.44-46
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• 2017

We report the case of a newborn with a rare anatomic variation: a right aortic arch with a retroesophageal left subclavian artery and an anomalous origin of the pulmonary artery from the aorta. This variation was diagnosed using echocardiography and computed tomography, and we treated the condition surgically.

• Journal of Chest Surgery
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• 제23권3호
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• pp.514-521
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• 1990

Patient with aortic valvular disease have increased left ventricular work and greater myocardial oxygen demand, which may aggravate the effect of concomitant coronary artery disease. Thus in patient who repair aortic valve replacement, concomitant aortocoronary bypass surgery is often performed when angiographically significant coronary artery disease is present. This approach is supported by reports that revascularization does not increase operative risk when associated coronary artery disease is present and significantly reduce the occurrence of late sudden death. Recently we have experienced one case of aortic valve replacement concomitant with aorta-coronary bypass surgery. The patient was 56 year-old male and admitted with complaint of anterior chest pain especially during his exercise. He was diagnosed as aortic valve stenosis and regurgitation [GIII] with proximal right main coronary artery occlusion We performed aortic valve replacement with aorta coronary bypass surgery by use of saphenous vein. Post operative course was uneventful and chest pain was relieved. Post operative coronary angiogram disclosed good patency of grafted vessel.

• Journal of Chest Surgery
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• 제11권1호
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• pp.81-84
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• 1978

A 15 years Old girl was admitted with chief complaints of intermittent claudication of lower extremity, dizziness, and headache for 5 years. On admission, malignant hypertension was noted in the upper part of body [190-150/120-110] but femoral & dorsalis pedis pulse could not palpate. Once she had experienced C. V. A. due to hypertension of upper part, about years ago. On auscultation, systolic murmur was audible along the left sternal border. E.C.G. Showed left ventricular hypertrophy pattern, and others within normal limit. Retrograde aortography demonstrated diffuse narrowing of entire thoracic aorta with underdeveloped lower abdominal aorta [below the renal artery] & both common lilac artery, and rich collaterals, but normally visualized greater arteries in the aortic arch. On left posterolasteral thoracotomy, entire descending thoracic aorta revealed marked narrowing with mild perivascular adhesion, but no mediastinal pleura adhesion. These findings suggest as congenital type of atypical coarctation in the entire thoracic aorta with mild secondary change. But histopathology was showed the findings of chronic non-specific aortitis, later. Dacron by pass graft was performed with end to side anastomosis between graft and aortic wall. After operation, all her preoperative symptoms & signs were disappeared, and discharged with good general condition.

• Journal of Chest Surgery
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• 제19권3호
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• pp.443-448
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• 1986

Aortic dissection is a serious disease that mortality does not approach to zero despite of medical and surgical improvement. Recently two cases of aortic dissection were treated with good results by the two other methods. Case 1 [57-Y-0-Male]; Chief complaint was chest pain radiating to the back. Preoperatively he was controlled by Minipress, dichlotride, & sodium nitroprusside. Aortography showed DeBakey Type III aortic dissection extending from just below the Lt. subclavian artery to the proximal portion of the origin of the renal artery. Through the midline long incision Flow reversal & Thrombo-exclusion method was used, and bypass course was proximal anastomosis at the ascending aorta - through the Rt. thoracic cavity - midportion of the diaphragm - posterior to the liver, stomach, & pancreas - distal anastomosis at the abdominal aorta proximal to its bifurcation. Bypass graft was preclotted 20 mm Dacron Woven Graft, and the aortic arch between the Lt. subclavian artery & Lt. common carotid artery was divided and meticulously sutured. Control aortogram which was done at 4th postoperative month revealed obstruction of the false lumen by thrombosis, and complications were not noticed. Case 2 [53-Y-0-Male]; Chief complaint was chest pain radiating to the abdomen. DeBakey Type III aortic dissection which was similar to the case 1 was detected by the aortography, and involvement of the Lt. subclavian & common carotid arteries was suspicious. Through the Lt. posterolateral thoracotomy the Ringed Intraluminal Sutureless Graft, No. 22 mm, was inserted from just below the Lt. common carotid artery to the midportion of the descending thoracic aorta under total circulation arrest using a F-F bypass, and the Lt. subclavian artery was ligated. Postoperatively hospital course was uneventful with antihypertensive drugs, and any specific complications were not noticed.

• Journal of Chest Surgery
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• 제54권2호
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Chest Surgery
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• 제24권6호
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• pp.625-630
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• 1991

From April 1990 through June 1990, three patients underwent subclavian flap aortoplasty for relief of the coarctation of the aorta. The age of the patients were 13 days, 7 months and 39 months and their weights were 3.3kg, 6.5kg, and 11kg, respectively. Two patients had persistence of the ductus arteriosus and all patients had associated intracardiac anomalies. We used the technique devised by Mendonca, namely, repair of the coarctation of the aorta using the subclavian artery as a flap and preservation of the arterial blood flow to the left arm. In one patient with long narrowing of isthmus, significant residual pressure gradient was remained by this technique and we added patch aortoplasty. There were no hospital deaths and follow-up over a one year period shows all patients in good condition.

• Journal of Chest Surgery
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• 제36권9호
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• pp.691-694
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• 2003

수년 전부터 있어 온 흉배부 통증을 주소로 내원한 49세 여자 환자로 전산화단층촬영과 자기공명 흉부혈관 촬영에서 만성 흉부 대동맥류를 가지고 있었으며, 흉부 대동맥 조영 촬영에서 대동맥류와 함께 하부 하행대동맥에 대동맥 축착증이 동반되었다. Adamkiewicz 동맥과 연결된 10번째 늑간 동맥이 대동맥 축착 직상부의 동맥류 내 대동맥에서 기시하고 있었다. 수술은 대동맥 축착증을 포함한 하행 흉부대동맥류를 인조혈관을 이용한 치환술을 시행하였기에 문헌고찰과 함께 보고하는 바이다.