• Journal of Chest Surgery
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• v.43 no.6
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• pp.769-773
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• 2010

Systemic hypotension has been traditionally used to facilitate deployment of thoracic stent grafts. Decreasing blood pressure with vasodilating agents further increases cardiac output and, consequently, the cardiac output-mediated windsock effect during deployment. Use of rapid ventricular pacing reduces the windsock effect during stent graft deployment and allows the graft to appose to the aortic wall under zero cardiac output, thus minimizing aortic wall shear stress. In this case we report the use of transvenous rapid ventricular pacing, a safe and reproducible technique to allow precise deployment of a Valiant Captivia stent graft in the distal thoracic arch for a saccular thoracic aneurysm.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.263-267
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• 1995

A total and consecutive 87 patients underwent aortic valve replacement[AVR with the St. Jude Medical prosthesis between 1984 and 1993. Age ranged from 14 to 66 years[mean:38.6$\pm$ 14.0 years .Twenty-one patients [24.1% had undergone previous valve replacement. There were 8 early deaths with an operative mortality rate of 9.2% [7.6% for primary AVR and 14.3 % for re-replacement AVR . Seventy-nine early survivors were,followed for a total of 309.1 patient-years[mean:3.9$\pm$ 2.5 years . A late mortality rate was 5.1% [4 patients or a linearized incidence of 1.294 %/patient-year. All were anticoagulated with coumadin to maintain the international normal ized ratio[INR between 1.5 and 2.5. One patient experienced thromboembolism[0.324%/patient-year , and none did bleeding. Endocarditis occurred in one[0.324%/patient-year . Paravalvular leak was the most frequent complication and was experienced by 8 patients[2.588%/patient-year , and 5 of them required re-replacement AVR[1.618 %/patient year of reoperation rate . There was no structural failure of the prosthesis. Actuarial survival including operative death was 83.9%$\pm$ 4.6% at 10 years.The actuarial estimates of freedom from thromboembolism and of freedom from late death and all complications were 95.1% $\pm$ 4.8 % and 81.4% $\pm$ 6.1%, respectively, at 10 years. These clinical results suggest that less intensive anticoagulation may be allowed for patients of AVR with the St. Jude Medical valve with low incidences of both thromboembolic and bleeding complications.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.213-218
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• 1997

Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four cases of thoracic aortic pseudoaneurysm who underwent surgical repair, The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.34-40
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• 2009

Background: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. Material and Method: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. Result: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr ${\geq}$1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. Conclusion: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.506-511
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• 1997

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.607-612
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• 1997

Between March 1963, and December 1994, fifty-three patients with a ruptured aneurysm of sinus of Vasalva(RSV) were operated. The RSV originated from the right coronary sinus in 43 patients(81%), from the non coronary sinus in 7 patients(13%), and from combined sinuses in 2 patients. The RSV from the right coronary sinus mainly drained to the right ventricle(81.4%), and the RSV from the non coronary sinus mainly drained to the right atrium(71.4%). Recently, we are using patch to repair the RSV through a double approach. During the operation, concomitant . procedures were performed; 32 Patch repairs of VSD, 14 aortic valvuloplasty, 10 aortic valve replacement, 2 tricuspid valvuloplasty, and one Bentall's procedure. During the follow up period between 1 and 31 years(mean 8 years, 94% follow up), there were 2 late deaths and 14 late complications. Actuarial 10-year survival rate .was 95%, and 10-year actuarial freedom from late event was 53 %. Factor analysis revealed that the combined SBE is a risk factor of late event. Actuarial freedom from failure of aortic valvuloplasty was 55% at 9 years. Although surgical repair of RSV achieved excellent long term survival, aortic regurgitation and endocarditis revealed significant risk factor in long-term results. Therefore, more attention should be required in patients of RSV associated with aortic regurgitation or endocarditis.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.133-139
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• 1977

Two cases of congenital aneurysm of sinus of Valsalva, ruptured into the right ventricle, and associated with ventricular septal defects, were undergone intracardiac repair with the aid of extracorporeal circulation using Bentley bubble oxygenator and moderate hypothermia. Case 1. A 20 year old male, with the chief complaints of palpitation and dyspnea, was admitted to Kyungpook National University Hospital on Dec. 16, 1976. Continuous machinery murmur was heard best at left 3rd. intercostal space along the sternal border. Retrograde aortography disclosed aneurysm of the right coronary cusp, which ruptured into the right ventricle. Utilizing cardiac bypass and moderate hypothermia, the right ventricle was opened and aneurysm was closed by direct sutures. Associated ventricuar septal defect was directly ,closed and suture line was reinforced by Dacron patch. Total bypass time was 112 minutes and total aortic cross clamping time was 37 minutes. Assist ventilation was carried out for 28 hours postoperatively. His postoperative course was smooth except removal o1 substernal hematoma and he was .discharged on 24th postoperative day. Case 2. A 28 year old man was admitted to our Hospital on June 9, 1976. two weeks prior to this admission, suddenly he had collapsed while he was walking on the street. Following `this episode, palpitation, dyspnea on exertion and frequent respiratory infection developed. Grade IV systolic murmur was heard best at 3rd intercostal space along the sternal border. Retrograde aortography confirmed the diagnosis of rupture of aneurysm of the sinus Valsalva ruptured into the right ventricle. Under the cardiopulmonary bypass the right ventricle was opened and ruptured aneurysm and infracristal ventricular septal defect were directly closed and reinforced with Dacron patch. Postoperative course was uneventful and he was discharged on 14th postoperative day. The pathogenesis of aneurysm of the sinus Valsalva and mode of diagnosis were discussed. Principle of surgical repair was presented.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.194-201
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• 2003

Malperfusion of major organs which frequently accompanies acute aortic dissection is one of the major causes of death. Malperfusion does not only develop before surgery, but also during or after surgery in various manifestations according to the aortic branches involved. Expeditious diagnostic and therapeutic measures based on high degree of clinical suspicion are mandatory for successful treatment. The authors report four cases of acute aortic dissection accompanied by malperfusion of various organs that were successfully treated.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.647-650
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• 2008

Aortic disease usually recurs after aortic surgery in the form a new aneurysm distal to the previous operation site, and finding a penetrating atherosclerotic ulcer proximal to the previous operation site has rarely been reported. We report here on a case of successful patch repair of a ruptured penetrating ulcer in the distal aortic arch, and this developed late after replacement of the descending thoracic aorta.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.581-586
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• 1994

From February 1985 to February 1993, 18 operations were performed in 17 patients for treatment of aneurysmal disease [n=12] and/or dissection of the ascending aorta [n=6]. The ages ranged from 26 to 69 years [mean 44.3 $\pm$ 11.0 years].The proposed operations include composite graft replacement of aortic valve and ascending aorta with coronary reimplantation in 11, graft replacement of ascending aorta alone in 5, aortic valve replacement and supracoronary graft replacement in 1 and ascending aorta to abdominal aorta bypass with thromboexclusion of descending aorta in one patient. Both Bentall [n=6] and Cabrol [n=5] technique were utilized for reimplantation of coronary arteries.Concomitant replacement of aortic arch and arch vessel reconstruction was necessary in two patients. Hypothermic circulatory arrest was utilized in 6 patients. Recently, four patients were managed on warm blood continuous cardioplegia via retrograde route. There were no operative deaths. No significant postoperative complications were noted. Postoperative follow up was complete in 15 patients from 1 month to 72 months. Redo operation was necessary in one patient who had suffered from distal recurrence of dissection 5 years after successful Bentall operation. The other patients are all in excellent clinical condition. From our early experience with those 17 cases, we assume that satisfactory operative result could be achieved with a variety of surgical technique including hypothermic circulatory arrest. In addition, continuous perfusion of warm blood cardioplegia via retrograde route is supposed to be beneficial in selected cases.